Quality Resource Guide

Infection Control and OSHA Update Part Two 4th Ed.

www.metdental.com

Unfortunately, there are numerous equipment

malfunctions and human factors that can adversely

affect a sterilizer’s performance. Earlier studies

tested over 400 sterilizers in dental practices

investigating possible reasons for sterilization cycle

failures,

and the findings indicated that 85-87%

0f the failures were due to human error and not

equipment malfunction. It is therefore imperative

that sterilizer effectiveness be routinely monitored

and verified using mechanical, chemical, and

biological

indicators.

Mechanical

monitoring

of each sterilization cycle involves observing

gauges, displays, or computer printouts for correct

temperature, pressure, and exposure time. Heat-

sensitive chemical indicator and integrators such as

those that change color after exposure to heat are

useful in detecting major unit malfunctions or human

errors during sterilization procedures, yet they do not

ensure adequacy of the sterilization cycle. In recent

years, more effective

chemical monitors (

i.e.

Class 5

integrators) have become available which are able

react with the three sterilization parameters (

i.e.

temperature, pressure, and time). It is important

to remember that testing with these chemical

sterilization monitors is not a substitute for spore

testing, which remains the “gold standard” for heat

sterilization. However, a positive result with is type

of monitor can serve as an immediate indication

that the sterilization cycle was successful. These

chemical process monitors can be used with each

load of processed instruments to detect problems

in between BI test intervals.

It is recommended to place a chemical indicator

on the inside of each package to evaluate whether

the instruments were exposed to the sterilization

conditions.

The instrument recirculation system should be logical

and organized in such a manner as to:

1. most efficiently accomplish reprocessing and

sterilization;

2. minimize procedures which can place the HCW

at risk for percutaneous, sharps exposures or

other hazards, such as hand scrubbing of dirty

instruments;

3. conduct instrument reprocessing in an area

outside of the treatment operatory; and

4. assure separation of the area for contaminated

items from the clean/ sterile area.

In addition, no food or drink is to be present in the

operatory, sterilization, or dental material storage

areas, such as refrigerators. The 2003 CDC dental

infection control guidelines further recommend

avoiding the use of carpeting and cloth-upholstered

furnishings in dental operatories, laboratories, and

instrument processing areas.

Many choices for

implementation are available for practitioners, each

of which can be effective when used appropriately.

Personal Protective Barriers

The routine use of personal and environmental

barriers is important in reducing the tissue contact

with potentially infectious pathogens and materials,

ultimately reducing cross-contamination and cross-

infection between the HCW and their patient. The

HCW must wear protective attire such as disposable

gloves, eyewear and protective clothing when

performing treatment procedures capable of causing

splash, spatter, contact with body fluids or mucous

membranes, or touching items or surfaces that may

be contaminated with body fluids (

Table 4

Gloves

Properly fitting gloves protect the HCW from direct

exposure through visually undetected cuts and

abrasions on the hands. Gloves used during the

provision of patient care are single-use items and

must not be used when providing care for another

patient or be washed for reuse. The American

Dental Association (ADA) initially approached

the issue of practitioners wearing disposable

gloves in an important 1976 publication

aimed

at protecting dental clinicians from occupational

HBV

infection.

This

recommendation

was

re-enforced and expanded in later ADA and CDC

publications,

5-8,10-14

and in today’s health care

environment the routine use of disposable gloves

constitutes the single most important aspect of

personal protective protection.

Traditionally, the most common type of glove worn

during patient treatment has been comprised of

latex. This material can be manufactured in a number

of sizes and specifications (ambidextrous, right or left

hand, low powder, powder-free, low protein), affords

Table 4 - Personal Protective Barriers

Face Mask

Protective Clothing

Protective Eyewear

1. It must ﬁt the face well to minimize open

spaces on the side of the face.

2. It should be able to prevent penetration of

aerosolized particles generated during the

procedure for which the mask is worn.

3. It should not rest against the mouth, as the

wearer’s breath can condense and wet the

fabric.

1. The outer occupational garment should be ﬂuid resistant,

not ﬂuid proof.

Appropriate garment material should not permit blood

or other potentially infectious ﬂuids to pass through or

reach the health-care worker’s clothes or epithelial/

mucosal tissues.

3. For routine dental procedures, cotton or cotton/

polyester laboratory coats or clinic jackets with cuffs are

satisfactory.

Protective garments must be changed at least when

visibly soiled.

Protective garments must be removed before

leaving the workplace.

1. It should have solid sideshields to afford

peripheral protection.

2. It must meet the American National Standards

Institute Occupational and Educational Eye

and Face Protection Standard for impact

resistance.

3. It should be able to withstand cleaning and

disinfection between patient procedures.

4. It should not distort the operator’s vision.

5. A faceshield worn with a mask can be worn

when greater protection is desired.