decontamination sciences intro Flashcards
defintion of ‘user’
the person designated by management to be responsible for the steriliser/washer disinfector
in the dental practice - may be the dental practitioner or dental nurse
decon legislation support
- SCEP (practice support manual)
- Health and Safety (general and infection control)
GDC standard for decon
- 1.5 You must treat pts in a hygienic and safe environment
o Health and safety
o Decontamination
o Medical devices
technical standards for decon
BSI Standards publications
how is decon in dental practices checked
NHS Scotland Dental Practice Inspections (Combined Practice Inspections CPI)
life cycle of re-usable surigical instruments
acquition (purchase, loan)
cleaning
inspection
disinfection possible disposal - scrap, return to lender
packaging
sterilisation
transport
storage
use
transport
4 principles for decon sciences in dental practices
- Facilities
o Compliance with current guidance (SHPN 13 part 2) - Equipment
o Use of AWD and sterilisers, testing and maintenance - Management
o Defines roles and responsibilities, training records…. - Process
*o In line with device manufacturers instructions *
6 steps in chain of infection
- The infectious agent.
- The reservoir
- The portal of exit
- The mode of transmission
- The portal of entry
- The susceptible host
facts about Pseudomonas Aeruginosa
- “false unit”, from the Greek
- The species name aeruginosa is a Latin word meaning verdigris (“copper rust”), as seen with the oxidized copper patina on the Statue of Liberty. This also describes the blue-green bacterial pigment seen in laboratory cultures of the species. This blue-green pigment is a combination of two metabolites of P. aeruginosa, pyocyanin (blue) and pyoverdine (green), which impart the blue-green characteristic color of cultures.
*Pyocyanin biosynthesis is regulated by quorum sensing, as in the biofilms associated with colonization of the lungs in cystic fibrosis patients
*The derivations of pyocyanin and pyoverdine are of the Greek, with pyo-, meaning “pus”, cyanin, meaning “blue”, and verdine, meaning “green”.
virulence factors for pseudomonas aeruginosa
Capsule production
* Polysaccharide like alginate
* protects from antibodies, complement, phagocytosis, antimicrobials and disinfectants
example case of severity of psedomonas aeruginosa infection
52yrM, no RMHx
Plan: Insertion of two implants, after right maxillary sinus augmentation.
Autologous bone source: Pt chin area using straight handpiece cooled with sterile saline solution
Case history
Implants and bone graft placed – (amoxicillin cover) – controversial, questionable evidence whether this cover is of benefit
Chx rinses
2/7 C/o severe pain & wound dehiscence mandible
3/7 Severe pain – R maxilla
Admitted to hosp for removal & debridement of implants & bone graft, systemic antibiotics
Culture & sensitivity of Pus sample
* Pseudomonas aeruginosa – treated with antibiotics for 12 months!
issue with tx pseudomonas aeruginosa or any infection
Number of carbapenemase-producing organism (CPO) isolates by enzyme type, 2003 to 2017
* exponential increase over years in AB resistance
Multi-drug resistant Pseudomonas
reservoir for pseudonmonas aeruginosa
Endogenous source
* Oral flora?
* Hands?
Exogenous source
* Water – dental unit water lines (large surface area for contamination)
* Suction system
* Aerosol turbines/Usonics
* Hands
* Inadequate decontamination
mode of transmission for pseudomonas aeruginosa
Inadequate decontamination?
Importance of wrapping prior to sterilisation and sterile at point of use?
Segregating clean from dirty?
Human error more likely than machine breakdown – need to make it clear clean from dirty
so type B steriliser best as wrapped prior to sterilisation and packaging changes in steriliser
portal of exit for pseudomonas aeruginosa
handpiece? spray bottle? (atomisers)
Post op dental infections – highlighted in case reports, cross infection (route and source not pinpointed, but shows potential)
