Final Revision Flashcards
How can infections be transmitted in dental practice?
through immediate contact with blood, saliva and other secretions or through contaminated or inadequately disinfected or sterilized instruments
What are the basic measures that need to be taken to be protected?
single use gloves mask protective gloves appropriate medical clothing surface covering single-use instruments instrument sterilization surface and flooring sterilization hand washing injury prevention vaccination immunization of dental personnel
Hand Washing =
cornerstone of patient - doctor and staff protection circle against cross-contamination
- before and after in contact with the patient/instruments used
- independently of wearing gloves or not, during the operation
- after removing gloves, hands must be carefully washed since pores are present in latex allowing contaminated material to penetrate
Solution to dry skin and dermatitis:
skin moisturizing lotions/creams
- used at the end of the day as they affect the material of the gloves creating micro holes
- as consequence, the gloves provide no protection whatsoever
During dental work for hands you should use:
water and soap, followed by antimicrobial solution (with prolonged action)
-if injury you should wait until wound is healed. if this not possible use a double pair of suitable and tolerable gloves
Use of antimicrobial solution with prolonged action:
- protects hands against development of microorganisms on the hand surface below the gloves
- it is ineffective if you don’t wash your hands prior to it
Use of alcohol antiseptic solutions or gels:
destroy the germs on the hand surface, provided that adequate cleaning has been preceded
When does a solution have a prolonged antiseptic action?
only if it contains an antiseptic agent
ex: chlorhexidine, quaternary ammonium compounds, octenidine, or triclosan
When should dispensers be filled?
- when the container should be completely empty
- dispensers must be washed and dried prior to filling
- on hand cleaning and antiseptic products, microorganisms may occur when remaining in dispensers for a long time
The gloves of medical and auxiliary staff should:
- be sterilized only if an operation is going to take place, particularly on HIV patients
- be used at any dental work for a single patient only and then they should be removed and discarded
- DO NOT wash the gloves or use them on another patient !!
- sterilizing examination gloves is not allowed as their integrity preservation is not guaranteed and any disinfection fluid, essential oil etc it may distort the cohesion of the glove material
- use DOUBLE GLOVES (DGT) with HIV patients for the protection of the surgeon -> difficult for them to get ripped
Latex gloves can cause:
What is the solution to it?
- can cause anaphylactic rxn
- solution: use of hypoallergic gloves or vinyl/nitrile gloves
In case of an injury, scratch or exudative injury the use of:
double pair gloves is recommended for extra protection
Masks:
- to avoid splashes of blood or other biological fluids
- they must be able to withhold at least 95% of the microorganisms
- in case patient suffers from airborne disease (tuberculosis) the mask must be enhanced and fully adaptable to the wearer’s face
- must be able to withhold particles and microorganisms with a diameter up to 1μm at a percentage of 95% (aspirator N95, FFP3)
- if a mask gets wet it must be discarded and replaced
In case goggles/ eye protectors are contaminated in b/w patients we must:
rinse with abundant water and disinfect them
Suitable medical clothing:
- changed on daily basis and definitely as soon as they get stained
- cover a great part of the dentist’s body and arms
- if the operative procedure is expected to involve large amount of bleeding or pt is SEROPOSITIVE (person living with HBV/HCV/HIV), you should wear a specially designed single use clothing
- they must be washed in a machine washer at an appropriate Tm using a detergent and always separately from domestic and non-medical clothing
- these clothes should not be used outside dental practice
Any surface/device/handles etc should:
- be covered with special rollers and plasticized paper sheets, cellulose film, aluminium foil, self-adhesive films, nylon cases, latex and vinyl cases etc
- be replaced after every contact and every patient
Cleaning and sterilization of dental instruments:
- immediately after the completion of a dental work
- must be discarded in a special plastic container filled with appropriate disinfectant sol or enzyme sol with a proteolytic action
- they remain in sol for as long as the manufacturer recommends
- then they are transferred to machine washers where they undergo thorough mechanical cleaning using the appropriate detergents
How should the instruments be cleaned if they have dental materials fixed to them? (process)
- with ultrasonic devices and appropriate solutions
- NOT with manual cleaning as injuries are highly to be caused
- then they are packaged in special bags or perforated cassettes and they are taken to the autoclaves to be sterilized
Autoclaves:
- operate according to
1. the packaging of the instruments
2. to the default specifications set by the manufacturer - completion of cycle and sterilization process is confirmed through electronic instrument indications and changes in the color or shape of the indicators
- aforementioned times DO NOT INCLUDE preheating of the autoclave or air removal
- it will inform you if i needs a change
fresh: transparent, aging: dull - once you take our the instrument box from autoclave, the indicator will change color to let us know that sterilization has been completed
- steam sterilization
- removes microorganisms with high Tms and pressures
- ex: for surgical materials
Single use instruments types:
obligatory single use and optionally single use instruments
obligatory single use Vs optionally single use instruments
obligatory single use:
- used once and then are discarded
- ex: surgical suctions, needles, rubber cups, scalpes, fluoride trays etc
optionally single use:
-ex: napkin holders, impression trays, burrs, speed handpieces, stump formation in seropositive patients etc
Sterilization of handpieces:
- before use
- after dental work completion, the external surfaces of the handpiece have come in contact with fluids and debris and residues of dental materials
- their internal tubes might got infected due to various hydrodynamic phenomena taking place when cavity forms subgingivally
- moist heat using saturated water vapours (autoclave)
When can handpieces get infected by pathogens?
- opening up a coronal cavity during endo therapy
- forming stumps
- polishing gingival restorations
- polishing cervical areas of teeth after perio treatment
Asepsis control:
- protection from any contact with the fluids existent in oral env
- chemical disinfection
- thermal sterilization
- disinfection using microwaves
- disinfection via irrigation
- single use handpieces
- moist heat using saturated water vapours (autoclave)
Sterilization of handpieces process:
- after dental work, operate them for a few sec over wash basin (container) while ejecting water and air
- then detached them from the tubes, connect them with the unit to be washed and brushed under water and dried with an absorbent paper
- after external cleaning the handpiece is reconnected to the tubes and operates for a few sec only with air so that water residues are removed from the interior of the tubes and the impellers
- then is lubricated and operated again only with air so that lubricant is properly distributed throughout the sensitive areas of the head
- then it is enclosed in a special pouch air tightly sealed with a self-adhesive tape or a thermosealer
- placed in autoclave
- the pouch should include: handpiece and sterilization indicator (special tape / vial with carbon grains) -> not necessary is the pouch includes the length of stay and vapor Tm w/in autoclave
- sterilized
- lubrication again sometimes with a different from previous time
Tm of autoclave operates at:
121 degrees for 20’
127 degrees for 13’
134 degrees for 3’
Sterilization of burrs process:
- meticulous cleaning or using paste-like mixture with saliva
- don’t use rubber, goldsmith’s brushes or old toothbrushes
- use ultrasonic devices (baths) with suitable fluids and addition of enzymes with proteolytic action
- after they are removed from bath, they are dried with absorbent paper and hot air
- then they are placed in appropriate device for sterilization depending on the material they are made of
Which burrs should not be placed in autoclave and why?
carbon steel b/c it will undergo oxidation
Problem with the sterilization of burrs device:
-dry heat ovens for sterilization; if their usage is prolonged it may damage the cutting edge of the burrs
-aldehydes and phenols may damage the integrity of rotating cutting instruments
-no technique can fully remove debris, thus result in successful sterilization
SO single use burrs are discarded after each patient
Use and care of sharp instruments and needles:
- shouldn’t be recapped either with both hands or using any other technique when the point of the needle is directed towards the body
- techniques: 1 hand to recap OR mechanic device designed to hold the needle cap
Packaging and disposal of waste:
- non-hazardous domestic waste
- only these are allowed to be packaged in a conventional way - potentially hazardous waste
- hazardous waste
- sharp and instruments
- from 2 to 4 are both packaged and disposed in plastic or metal containers lined with a high quality, thick, plastic bag of visible color
- single use or household gloves should be worn
- do not press on the waste bag
- on waste bag should bear an indication that it contains hazardous waste (even on the new bag)
- the fluids (ex: disinfectants) must be discarded in the drainage through a special funnel, not in the sinks or toilets and then the funnel is disinfected with an appropriate solution afterwards
Storing sharp instruments:
- special storage boxes
- special freezer
Preparing impressions for the lab:
- after removing trays from the mouth, they must be cleaned and sterilized in an appropriate way with suitable solutions
- then tray is transferred to the wash basin and use of water is used to remove blood, saliva etc
- afterwards, spray/immerse the tray with disinfectant depending on the impression material used
- impressions must be packaged in a suitable plastic box so they can be safety transported to lab
Protection measures prior to beginning dental work:
- vaccination against hepatitis B (for free)
- take detailed medical history
- independently of the info you have collected from pt, you must consider their potentially contaminated and take the precautions advised for all pts
- instruments should be sterilized
- protect working surfaces
- disinfectant fluids and waste containers ready
- sterilize in autoclave or dry heat instruments in contact with tissues
SOS
When to wash hands:
Before food preparation or consumption After touching raw food After using the toilet After cleaning/refilling personal hygiene items Before and after patient care After coughing, sneezing, rheum After contact with animals and their faeces After packing any kind of waste Before and after contact with trauma
SOS
When to wash hands in dental office:
Before starting daily activity Before putting on gloves !! After removing the gloves !! Immediately after an injury (or suspicion) !! After secretarial work After cleaning work !! After disinfection / sterilization work !! After completing daily activity
SOS
How to wash hands in dental office:
Wet your hands with lightly warm water
Apply a dose of hand cleanser
Rub your palms, wrists, opisthenar, fingers and between the fingers for 15-20 sec
Clean the areas around and under nails
Rinse the detergent thoroughly
Dry your hands !!! (critical for your safety)
-not necessary to wash with a strong antiseptic, even a normal soap is fine
Places on hands where is most crucial to wash: below nails opisthenars finger tips b/w fingers palms above hands
SOS
Methods of hand drying:
- Paper:
- More superior than electric air dryers
- Most effective
- Should be used by hospitals and clinics
- Safe technique
- Financially difficult
- Not environmentally friendly - Air
- electric hand driers pose health risk
- jet air dryer: thousand virus particles, warm air dryer: hundred virus particles, paper towel: ten virus particles - Rolling towel
- Towel
- not scrubbing them, but tapping them b/c it can cause irritation in a few weeks
Are electric air dryers the right solution?
- a warm air dryer and electric hand dryer increase the average numbers of bacteria on the hands after use, whereas paper towel reduces them
- jet air dryerhas potential tospread contaminationto users and washroom environment thanwarm air dryers
- energy consuming
- there’s a conical inside that helps trap moisture and doesn’t spread
Warm/Hot air dryers Vs Cloth roller towels:
Warm/Hot air dryers:
- not recommended for use
- slow and noisy
- their hygiene performance is questionable
Cloth roller towels:
- not recommended
- they can become common-use towels at the end of the roll
- can be a source of pathogen transfer to clean hands
SOS
The transmission of bacteria is more likely to occur through _ skin surfaces:
wet
Single use paper towels is the optimal choice b/c:
Offer protection against disease Preferred among washroom users Endorsed by experts Sustainable, economic and energy efficient Cause less contamination to the washroom environment Dry hands effectively Easy to install and maintain Remove bacteria effectively They are superior to electric air dryers THE BEST but, expensive
