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Infection Control for Dental Assisting Exam Study Guide (page 2)

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Updated on Jun 23, 2011

Occupational Safety and Health Administration (OSHA)/Centers for Disease Control and Prevention (CDC)

Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) are federal agencies that are primarily responsible for infection control measures utilized in the United States. OSHA is a regulatory agency responsible for ensuring the safety and health of employees in the United States. OSHA has developed a set of standards to provide a safe workplace in the dental office. OSHA’s main concern is the welfare of the employee, not the patient. The agency also conducts training and educational programs regarding OSHA implementation and regulations.

The CDC is an advisory agency tasked with the research and study of diseases of consequence to the American population. They make recommendations, or suggestions, regarding infection control after conducting intensive research on the topic. The CDC’s main concern is the health and protection of the overall population through preventive measures and proper treatment.

Blood-Borne Pathogens Standard

OSHA developed the Blood-Borne Pathogens (BBP) Standard, which has become the most important law governing infection control in dentistry today. The BBP Standard discusses how the dental office deals with, and its plan for, exposure to blood-borne pathogens. There are several parts to this standard that are discussed in detail in OSHA’s BBP Standard.

Universal Precautions

Universal precautions is a protocol followed by each dental office that mandates that all patients be treated as if they have a deadly disease, regardless of their health history.

Standard Precautions

Standard precautions is an expansion of universal precautions. Standard precautions outlines how the dental office will handle its infection control protocol for each patient. This means that the infection control protocol for each patient will be the same, no matter what.

Categories of Employees

OSHA has designed categories for each employee in the dental office based on his or her exposure risk to blood, saliva, or bodily fluids. Category I is the highest risk category, involving direct contact with blood, saliva, and other potentially infectious materials (OPIM). These dental healthcare members include the dentist, chairside dental assistants, and the hygienist.

Post-Exposure Protocol

Each dental office is required by OSHA to develop a written protocol outlining steps or measures to be taken after an exposure incident occurs. An example of an exposure incident is being stuck with a contaminated needle, being punctured by an instrument, or being cut with a bur.

Hepatitis B Immunization

OSHA requires that every dentist offer and pay for the Hepatitis B vaccination to all categories of employees who want to be immunized. The Hepatitis B vaccine is given in three doses over a specified period of time.

Management of Sharps Waste

Sharps, such as needles, scalpels, broken glass from an anesthetic carpule, old burs, broken instruments, etc., must be disposed of in a biohazard, non-permeable, red plastic container. Each operatory or treatment room must have its own sharps container. The office contacts a hazardous material company to dispose of the sharps waste properly, following the laws of the state.

Personal Protective Equipment (PPE)

Personal protective equipment (PPE) is required by OSHA as a means of protection for the dental healthcare worker. The dentist must supply the proper PPE for the employee. PPE consists of scrubs (overcoat, jacket, and disposable protective gown), leather shoes, lab coat, mask, safety glasses/face shield, and gloves. PPE should be donned/performed in the following manner: lab coat, mask, safety glasses/face shield, wash hands, and gloves. PPE should be removed/performed in the following manner: gloves, wash hands, safety glasses, mask, lab coat, and second hand washing.

Classifications of Waste

There are many types of waste in a dental office. OSHA classifies waste as general waste, contaminated waste, hazardous waste, infectious waste, and biohazardous waste. Each must be disposed of properly.

Waste Management for the Dental Office

OSHA requires that all dental offices have a waste management plan. This is designed to protect the environment, follow state and federal laws, and ensure the safety of those who may come in contact with the materials in the garbage. Accurate disposal records must be kept.

Disinfection

Disinfection is the process of killing some microorganisms, but not all. Some bacteria will form into spore colonies to protect themselves from being destroyed. Disinfection does not kill spores.

Disinfection in the Dental Office

In the dental office, most hard surface areas are disinfected with disinfectant wipes or spray. Any area that may have been contaminated during a procedure will be disinfected. Some examples of areas that would need to be disinfected following treatment include the mobile cart, lines, counter tops, dental chair, light, and any other contaminated surfaces.

Use of Surface Barriers

Surface barriers are materials used to cover equipment and surfaces to prevent cross-contamination. Any surface that may be contaminated during treatment should be covered with a disposable plastic barrier. Some examples of surface barriers include light handle covers, syringe sleeves, and chair covers.

Single-Use

Disposable Items Today, many dental supplies used for patient treatment are single-use disposable items. Some examples include cotton rolls, gloves, prophy angles, 2 x 2 gauze, HVE tips, and so on.

Types of Gloves for Protection

There are four main types of gloves that a dental assistant may use for protection. These are examination gloves, utility gloves, overgloves, and sterile gloves.

Examination Gloves

Examination gloves are latex, vinyl, or nitrile materials that are most often worn by members of the dental team. Examination or procedure gloves are inexpensive and disposable. They come in a variety of sizes and colors, and can be scented or flavored.

Utility Gloves

Utility gloves are similar to old-fashioned dishwashing gloves. They are used to break down a contaminated treatment room and to handle contaminated instruments. They would never be used when treating a patient. These gloves can be disinfected and/or sterilized in the autoclave.

Overgloves

Overgloves are used when an assistant must leave the treatment room, open a drawer during the procedure to retrieve a supply the dentist needs, or to make notes. These gloves are similar to food-handling gloves.

Sterile Gloves

Sterile gloves are utilized during surgical procedures involving the bone or periodontium. These gloves are supplied in a protective pouch. When the protective pouch is opened, the gloves can clearly be seen labeled for the right or left hand.

Disinfectants

Disinfectants are used to kill some of the microorganisms prior to sterilization. Dental assistants use disinfectants to wipe down treatment rooms or other contaminated surfaces following a procedure. The two most popular disinfectants utilized in the dental office are iodophors and gluteraldehydes.

Iodophors

Iodophors are used in the dental treatment rooms to disinfect the hard surface areas and equipment, but they have a tendency to stain. They are supplied in either a spray or a wipe.

Gluteraldehydes

Gluteraldehydes are interesting due to their ability to be both a sterilant and a disinfectant. In the dental office, gluteraldehydes are used as the holding bath or “cold sterile.” Some instruments cannot withstand heat sterilization and must be sterilized in the cold sterile. For this to occur, the instrument must be immersed in the solution for ten hours. Anything less than that time, and the instrument is considered to be disinfected, but not sterilized.

Procedural Steps in Disinfection

All contaminated items are removed from the treatment room and properly disposed of or taken to the sterilization area in a closed, covered container. Begin disinfection using the desired method selected by the dental office. The wipes method of disinfection is most popular. Wipe the entire operatory thoroughly while wearing proper PPE. After the room is disinfected, wash hands, and place new barriers.

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