ce 3rs 4-19-2015 inf control (6)

Recommendations: Infection Control

Today’s Topics• Personal Protective Equipment (PPE)• Hand Hygiene• Surface Disinfection• Instrument Cleaning and Sterilization• Cleaning Evacuation System• Dental Unit Water Lines


What is the goal of Infection Control?

The goal of Infection Control is to minimize the potential risk from exposure to known pathogens for patients and dental staff.

My goal for this session is to share:• Basic infection control ideas• Common mistakes I have observed• Practical solutions


Major Infectious Diseases

• Mycobacterium Tuberculosis (TB)• 1/3 of the world's population is infected • In 2013, 9 million developed symptoms and 1.5 million died. • 1,222 cases in Texas 2012

• Hepatitis B • Around 400 million people are infected worldwide.• 3.2 million Hep C USA• 1.2 million Hep B USA

• HIV• 35 million people are infected with HIV worldwide.• Over 75,000 Texans have HIV • Est. 13,000 have it but are not diagnosed

How many are your patients?

Infection Control

How long do these organisms live on surfaces?• HIV: • Rhinovirus: • Staph: • HBV: • TB:

Infection Control

• HIV: Hours• Rhinovirus: 14 Hours• Staph: 5 Days• HBV: 7 Days• TB: 6-8 Months

Infection Control

Don’t be Like TULSA

Who is responsible in your practice?

“All dental health care workers shall comply with the universal precautions, as recommended for dentistry by the Centers for Disease Control”

Section 108.25, page 54,TSBDE

Standard Precautions

Assume _____Who ?_____ is Sick and Infectious.


Assume EVERY PATIENT is Sick and Infectious.


4 Categories of PPE

1. _______________ 2. _______________3. _______________4. _______________

Personal Protective Equipment

4 Categories of PPE

1. Gloves2. Face Mask3. Safety Glasses4. Lab Jackets /Gowns


Use ALL PPE when treating patients.• Yes, lab jackets are required!• Must be changed when VISIBLY soiled.• May not be taken home and washed.• May be washed on-site.• May be sent to professional cleaners.• I recommend Disposables.

• Less expensive than sending to Cleaners.


Use ALL PPE when treating patients.• Change face masks between each patient • Sooner if it becomes wet and compromised during treatment.• Wear a new pair of gloves for every patient change gloves

immediately if they become torn or punctured during a procedure.

• DO NOT re-use gloves to save money!• DO NOT answer the phone!• Wash and disinfect eye protection between patients if soiled.


Use ALL PPE when Disinfecting Operatories.• Do not wear mask around your neck and “save” to use again.• Must cover nose!

Safety• SDS leading Surface Disinfectant. Inhalation: Move to fresh air if effects

occur and seek medical attention if effects persist.

• SDS leading Surface Disinfectant. Eye Contact: Hold eye open and rinse slowly and gently with water for 15-20 minutes. Remove contact lenses, if present, after the first 5 minutes, then continue rinsing. Call a poison control center or doctor for treatment advice.


Use ALL PPE when Processing Instruments.

• Wedding Dress?• Most sharps injuries.• Utility Gloves.

• Recommendations• Face mask.• Safety glasses.


“There is no use trying to fool ourselves—infection control is a product-dependent discipline. Good techniques and procedures cannot overcome the consequences of facemasks and operating gloves that leak profusely, or disinfectants and antiseptics that have weak kill of bacteria and no kill of viruses.”

Rella P. Christensen, PhD

Infection Control Products and Equipment

“Just because “someone” told you how to do something doesn’t mean they know what they are talking about. Please read directions!”

Rick Simmons

• Hands are a very common mode of pathogen transmission.• BEST METHOD: Wash your hands….With Soap? Yes, with soap!!!• Happy Birthday Song 2X• Prior to donning gloves for treatment and after removing gloves.• If hands are not visibly soiled, a hand sanitizer may be used. • CDC Standard: minimum 60% Alcohol• Ethyl Alcohol performs better than Isopropyl Alcohol.• DO NOT use lotions with Mineral Oil. Why?• Rings and Artificial Nails Should NOT be worn.

Hand Hygiene

Hand Hygiene

How Do You Choose a Surface Disinfectant?• Details

• Is it an EPA registered product?• What is the TOTAL Kill Time?• Is it a One-Step or Two-Step product?

• Safety• Read the MSDS. “Avoid breathing vapors. Wash thoroughly after handling.”

• Real Cost• Is it Effective?• Is it Efficient?

Surface Disinfection

What is an Intermediate Level Surface Disinfectant?

• To be labeled as an EPA hospital disinfectant, the product must pass Association of Official Analytical Chemists (AOAC) effectiveness tests against:

• Salmonella choleraesuis • Staphylococcus aureus• Pseudomonas aeruginosa

• EPA-registered Intermediate-Level Hospital Disinfectant.• Mycobacterium tuberculosis TB



Difficulty of Kill on Surfaces

FDA Approved: High Level Sterilant

EPA Approved Intermediate Level Surface Disinfectant.

Prions

Spores(C. Difficile, Bacillus)

Mycobacterium (TB)

Virus-Non-Enveloped (Canine Parvovirus, Polio, Adeno virus, HPC A Rhino

virus, Rotavirus)

Fungi (Trichphyton Metagrophytes, Candida Albicans)

Bacteria Gram Negative (Pseudomonas aeruginosa, salmonella, E-Coli Bodetella)

Bacteria Gram Positive(Staphylococcus Aureaus, VRE, MRSA, VRSA, S Mutans, Legionella)

Virus-Envelope (HBV, HIV, HCV, Influenza virus A, Herpes Simplex Type 1&2)

SERIOUS PROBLEM• 30 seconds in surface disinfection time.• Problem: Some products 10 minutes are required.

Question: Are you disinfecting or just cleaning?



What is the total time for these products to kill all 4 microorganisms required by the EPA?


1 Min. 1 Min. 5 Min. TB 10 Min. All 4 All 4 10 Min. Fungicidal All 4

PLEASE…. Read Directions!• SPRAY~WIPE~SPRAY• “Blood and other bodily fluids must be thoroughly cleaned from

surfaces and objects before disinfection with Cavicide.”• “For Tuberculocidal activity, surface must remain visibly wet for

a full 3 minutes at room temperature.”


Equipment Care• Fill at least 2/3 with water.• Use basket• Do not overload.• Drain daily.• Clean.• Disinfect Unit.• Bi-Annual Foil Test.

Instrument Cleaning

Instrument Cleaning

Cleaning Protocol• Read Directions.• 3-10 minutes.• Use proper amount of solution.• Rinse• Dry• Pouch / Wrap!!• For efficiency and safety…Use Cassettes

Safety First• NO hand scrubbing.• NO hand scrubbing!• Keep The Lid on at All Times!• Wear your PPE!!• Utility gloves• Mask• Safety Glasses• Jacket

Instrument Cleaning

Equipment Care• Daily

• Disinfect external surfaces.• Remove and clean gasket.

• Weekly• Drain, clean and refill.

• Monthly• Clean chamber and plumbing.• Clean fill vent and air filter…• Yes, there are filters

Instrument Sterilization

Sterilization Protocol• “Cold Sterile”• Use rack and trays provided by Mfg.• Space to breath.• Paper side up.• Open hinges.• That’s too tight.• DO NOT store wet packs.• Open in front of patient.


When should you perform a spore test?• Whenever a new type of packaging material or cassette is

used.• After training new sterilization personnel.• After a sterilizer has been repaired.• After any change in the sterilizer loading procedures.• Implantable device.• CDC Minimum: 1X per week.• Send to lab • Keep records


Does your Vacuum System Suck?• Do you use a system to clean your Vacuum Lines?• How often do you run a cleaner?• What is the pH of your cleaner?• Is it corrosive? • Does It Foam?

Cleaning Evacuation System

Cleaning Evacuation SystemThese are NOT Vacuum Line Cleaner Dispensers


That’s Better…

Product Base Foaming? pH Level Cost per Use

Purevac Chemical Some Very Acidic $0.95

Monarch Chemical Very little Neutral $0.55CleanstreamAirTechniques

BioPure* Bacteria None. Neutral $0.50Sable Industries


Would you drink water from your A/W syringe? • Biofilm is like plaque.• Legionella• Pseudomonas aeruginosa • Non-TB mycobacteria• Small round worms !!• Measured in Cfu/mL. • 1,000,000 cfu/mL !!!• Why does it grow?• Stagnant water…yuck!!

• ADA goal: <200 cfu/mL

Dental Unit Water Lines

4 Step Process1. Self-Container Bottle System.2. Clean “Shock” water lines.3. Maintain lines.

Tap vs Distilled?4. Test Water. Minimum annually.5. Wash hands before.Additional Steps• Flush lines after each patient.• Purge lines dry every night.


Maintenance Products

Hu-Friedy* ProEdge Adec CrosstexTeamVista Blu-Tab ICX DentaPure


Water Tests

ProEdge* Baylor HPTC


Resources• The Organization for Safety and Asepsis Procedures:

Founded in 1984 specifically for dentistry. osap.org• Center for Disease Control: cdc.gov• OSHA: osha.gov• World Health Organization: who.int

Contact Info.Laura Stinson RDH 817.291.6972

[email protected] Garrett Johnson 512.378.3206

[email protected] Simmons 214.674.6545

[email protected]

mailto:[email protected]



ce 3rs 4-19-2015 inf control (6)

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