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Monday, March 23rd, 2020 | by ADS Transitions

Infection Protection in The Practice


“No time like the present” has never been more appropriate than right now when it comes to protecting your practice from any form of an infection. And, while patient well-being is always first and foremost, there’s a secondary concern about an infection incident that can impact a practice – image and value.

Anything that adversely affects your practice can jeopardize the value of your practice if you are thinking about selling it. That is why ensuring standard precautions are followed to prevent and minimize infection are so important.

The Center for Disease Control and Prevention has in-depth guidelines for preventing and minimizing infection in dental health care settings. The full document can be found here.

Hand sanitizer and masks

Standard precautions should include:

1. Hand hygiene
2. Use of personal protective equipment
3. Respiratory hygiene/cough etiquette
4. Sharps safety
5. Safe injection practices
6. Sterile instruments and devices
7. Clean and disinfected environmental surfaces

Hand Hygiene – Performed:

– When hands are visibly dirty.
– After touching any instrument, device, or any other object that may have come in contact with blood, saliva, etc.
– Prior to and following patient treatment
– Immediately following removal of gloves

Use of personal protective equipment:

1. Provide sufficient and appropriate Personal Protective Equipment (PPE) and ensure it is accessible
2. Educate all DHCP on proper selection and use of PPE
3. Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
4. Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM is anticipated.
5. Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6. Remove PPE before leaving the work area.

Respiratory hygiene/cough etiquette:

1. Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit.
a. Post signs at entrances with instructions to patients with symptoms of respiratory infection
b. Provide tissues and no-touch receptacles for disposal of tissues.
c. Provide resources for performing hand hygiene in or near waiting areas.
d. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting.
e. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care.
2. Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

Sharps safety:

1. Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries.
2. Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body.
3. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (e.g., between multiple injections and before removing from a non-disposable aspirating syringe).
4. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as possible to the area where the items are used.

Safe injection practices:

1. Prepare injections using aseptic technique2 in a clean area.
2. Disinfect the rubber septum on a medication vial with alcohol before piercing.
3. Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
4. Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient.
5. Use single-dose vials for parenteral medications when possible.
6. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
7. Do not combine the leftover contents of single-use vials for later use.
8. The following apply if multidose vials are used
a. Dedicate multidose vials to a single patient whenever possible.
b. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.
c. If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use.
d. Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial.
9. Do not use fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient.

Sterile instruments and devices:

1. Clean and reprocess (disinfect or sterilize) reusable dental equipment appropriately before use on another patient.
2. Clean and reprocess reusable dental equipment according to manufacturer instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.
a. Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.
3. Assign responsibilities for reprocessing of dental equipment to DHCP with appropriate training.
4. Wear appropriate PPE when handling and reprocessing contaminated patient equipment.
5. Use mechanical, chemical, and biological monitors according to manufacturer instructions to ensure the effectiveness of the sterilization process. Maintain sterilization records in accordance with state and local regulations.

Clean and disinfected environmental surfaces:

1. Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in dental health care settings.
a. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs, computer equipment) and change surface barriers between patients.
b. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient. Use an intermediate-level disinfectant (i.e., tuberculocidal claim) if visibly contaminated with blood.
2. Select EPA-registered disinfectants or detergents/disinfectants with label claims for use in health care settings.
3. Follow manufacturer instructions for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, disposal).

Infection prevention is key in protecting the health and well-being of both your patients and your practice. For additional information and current updates, please visit www.cdc.gov today.

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