Quality Resource Guide l Infection Control and OSHA Update Part Two 5th Ed. 4 www.metdental.com over a period of days to weeks and are localized to the areas of exposure. Most of these adverse manifestations stop at the boundary of the glove cuff with skin. In addition to frequent washing and use of harsh chemicals, dermal reaction can result from: 1) not completely rinsing antiseptics off skin after washing; 2) irritation from cornstarch powder in gloves; 3) excessive perspiration while wearing gloves; 4) improper washing techniques; 5) using hot water for handwashing; and 6) failure to dry hands completely. (Figure 1) The degree of skin irritation varies considerably, and can be reduced substantially by choosing hand hygiene products with emollients and using appropriate hand lotions that reduce dryness. Antimicrobials in products, such as chlorhexidine gluconate, parachorometaxylenol (PCMX), or iodophors, can also promote treat nonspecific irritation dermatitis. Even alcohols, which are among the safest antiseptics, can cause drying and skin irritation. Preventing hand dermatitis requires compliance with recommended hand hygiene procedures and routine care of hands. Washing with a handwash agent or waterless product that is the least irritating can help prevent initial drying of skin. Soap should be rinsed off completely after washing and hands should be dried thoroughly. A HCW with exudative lesions or weeping dermatitis should refrain from direct patient contact until the condition is resolved. Individuals should also take steps to allow re-establishment of epithelial integrity in areas of damaged skin by ceasing to use antiseptics that remove skin oils, and replacing them with a non-antiseptic, mechanical cleansing agent, such as liquid soap and water. Lotions are also often recommended to ease the dryness resulting from frequent hand washing and more recently to prevent dermatitis resulting from glove use. Unfortunately, petroleum- based lotion formulations used by many people outside of health care settings can weaken latex and other glove types, which can cause increased permeability. For that reason, lotions that contain petroleum or other oil emollients should not be used. Instead, multiple water-based lotions are available to resolve hand dermatitis problems and prevent dermatitis recurrences. Instrument Reprocessing A basic principle for effective infection control is: Do not disinfect when you can sterilize. Sterilization of contaminated instruments is a fundamental quality control component of any asepsis program. An initial distinction must made here between the required antimicrobial outcomes of sterilization and disinfection. Sterilization is defined as the destruction of all forms of life, with particular reference to microbial forms. The limiting requirement and basic criterion for accomplishment of sterilization is the destruction of high numbers of bacterial and mycotic spores, the most heat resistant microbial forms. In contrast, disinfection refers to the inhibition or destruction of pathogens. Spores are not killed during disinfection procedures. The use of heat has long been recognized as the most efficient, reliable method of sterilization. The historical practice of using liquid chemical disinfectants in dentistry (“cold sterilization”), including agents such as glutaraldehyde or chlorine dioxide, is no longer necessary or appropriate, since most reusable instruments devices used in dentistry can withstand heat sterilization. If certain devices cannot be sterilized, single-use disposable replacements should be considered. Several methods of heat sterilization are available and effective in dental health-care settings. These include steam under pressure (autoclave), dry heat, or unsaturated chemical vapor ( Table 3). Steam sterilization remains the most efficient, widely used modality for wrapped and unwrapped items that are not sensitive to heat and moisture. The evolution of steam sterilization has continued with development of a number of technological advances. The most recent major innovations are classified as pre- and post-vacuum sterilizers, also called “Class B” sterilizers. In this type of unit, a pump housed within the sterilizer creates a vacuum at the beginning of the cycle to prevent the mixing of air and steam. This ensures more rapid and efficient penetration of steam to instrument surfaces. The post-vacuum component at the end of the sterilization interval facilitates more thorough and effective drying, thereby reducing metal corrosion. The CDC has continued to update earlier dental infection control recommendations first published in 1986, 5-13 calling for proper functioning of sterilization cycles to be verified by the periodic use (at least weekly) of biologic indicators (spore tests). Biologic indicators containing heat-resistant spores provide the best challenge for sterilization cycles. Two species are used, Geobacillus stearothermophilus and Bacillus atrophaeus (formerly Bacillus stearothermophilus and Bacillus subtilis). A fundamental feature to note is that a spore vehicle designed for one sterilization method is not necessarily the proper Figure 1