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Occupational Hazard Part 2

Apr 14, 2018

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    PART 2

    Preventive aspects

    DR SANDEEP KUMAR

    PG STUDENT

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    INTRODUCTION

    Dental environment is associated with a significant risk forexposure to various microorganisms.

    Dental patient and dental health care workers may beexposed to variety of microorganisms via blood or oral or

    respiratory secretions. For an infection to occur all three factors should be

    present host, agent, environment

    Effective infection control strategies are intended to breakone or more of these links in the chain thereby preventing

    infections. A set of infection control strategies are needed to reduce the

    risk of transmission of infectious diseases caused by bloodborn pathogens such as HBV and HIV.

    2

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    CATEGORIES OF TASK IN RELATION TO

    RISK

    CATEGORY 1

    Task that involve exposure to blood, body

    fluid, or tissues. Most tasks performed by the

    dentist, dental hygienist, dental assistant and

    lab technician falls in this category.

    3

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    CATEGORY 2

    Tasks that does not involve routine exposure

    to blood, body fluid or tissues.

    Clerical or non professional workers who may

    help clean up the office ,handle instruments

    or impression materials or send dental

    materials to the lab fits into this category.

    4

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    CATEGORY 3

    Tasks that involve no exposure to blood, body

    fluid or tissues. A front office receptionist ,book keeper or

    insurance clerk who does not handle dental

    instruments or materials belongs to a category

    3 worker.

    5

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    OSHA REGULATIONS

    (occupational safety and health act)

    The American dental association and

    occupational safety and health act

    (OSHA)guidelines advice that all dental office

    staff in category 1 and 2 and dentist be trained

    in infection control to protect themselves and

    their patients.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 6

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    SUMMARY OF OSHA REGULATIONS

    Provide Hepatitis B immunization toemployees without charge within 10 days ofemployment.

    Require that universal precaution be observedto prevent contact with blood and otherpotentially infectious material .

    Implement engineering control to reduceproduction of contaminated spatter, mists andaerosols.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 7

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    Implement work practice control precautions

    to minimize splashing, spatter or contact of

    bare hands with contaminated surfaces.

    Provide facilities and instructions for washing

    hands after removing gloves and for washing

    skin immediately or as soon as possible after

    contact with blood or other potentiallyinfectious material.

    8

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    Prescribe safe handling of needles and other sharpitems.

    Prescribe disposable or single use needles, wires,carpules, and sharps as close to the place of use as

    possible, as soon as feasible, in leak proof containersthat are closable. Containers must be red or bear abiohazard label. Teeth must be discarded into sharpscontainers.

    Contaminated reusable sharp instruments must not be

    stored or processed in a manner that requiresemployees to reach hands into containers to retrievethem.

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    Prohibit eating, drinking, handling contact

    lenses etc in contaminated environments. Ban

    storage of foods and drinks in refrigeration or

    other spaces where blood or infectious

    materials are stored.

    Place blood and contaminated specimen to be

    shipped, transported or stored into suitableclose containers that prevent leakage.

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    At no cost to employees, provide them with personal

    protective protective instruments and clear directions

    for use of appropriate universal barrier protection in

    treating all patients.(PPE includes gloves, gowns)

    Ensure that employees correctly use and discard PPEor properly prepare it for reuse.

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    As soon as possible after treatment attend to

    housekeeping requirements including floor

    ,sinks etc that are subject to contamination.

    Provide a written schedule for cleaning.

    Contaminated sharps are regulated waste:

    Discard in hard walled containers

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    Contaminated equipment that requires servicemust first be decontaminated or a biohazard labelmust be used to indicate contaminated parts.

    Place reusable contaminated sharp instrumentsinto a basket in a hard walled container fortransportation to clean up area. Personnel mustnot reach hands into containers of contaminated

    sharpsProvide laundering of protective garments used

    for universal precautions at no cost to employees

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    VACCINES FOR DENTAL HEALTH CARE

    WORKERS The OSHA blood borne pathogens final rule requires that

    employers make hepatitis B vaccinations available withoutcost to their employees who may be exposed to blood orother infectious materials.

    In addition CDC recommends that all workers includingDHCW who might be exposed to blood or bloodcontaminated substances in an occupational setting bevaccinated for HBV

    DHCW also are at risk for exposure to and possibletransmission other vaccine preventable disease.Accordingly, vaccination against influenza, measles,mumps, rubella and tetanus may be appropriate forDHCWS.

    The book of hospital waste management Dr.D.B Acharya and Dr Meeta Singh 14

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    PROTECTIVE ATTIRE AND BARRIER

    TECHNIQUES

    Gloves should always be worn by DHCW whenthere is potential for contacting blood, bloodcontaminated saliva, or mucous membranes.

    Sterile gloves should be used: non sterile glovesare inappropriate for surgical procedures.

    Before treatment of each patient DHCW shouldwash their hand and put on new gloves .

    After treatment of each patient or before leavingthe dental operatory, DHCW should remove anddiscard gloves :and then wash hands.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 15

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    DHCW should always wash hands and re-glovebetween patients

    Surgical or examination gloves should not be

    washed before use nor should they be washed,sterilized or disinfected for reuse.

    Washing of gloves may cause wicking(penetrationof liquid through small holes) and is not

    recommended. Disinfecting agents, oils, oil based solutions

    ,autoclaving cause detoriation of gloves.

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    Surgical mask and protective eyewear should

    be worn while performing dental procedures.

    When a mask is used it should be changed

    between patients or during patient treatment

    if it becomes wet or moist.

    Face shields or protective eyewear should be

    washed with an appropriate cleaning agent.

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    Reusable protective coating should be washedusing normal laundry cycle, according to theinstruction of the detergent and machine

    manufacturers. Protective coating should be changed daily or as

    soon as it becomes visibly soiled.

    Protective garments and devices should be

    removed before personnel exit areas of thedental office used for laboratory or patient careactivities.

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    Aluminium foil or plastic covers should be used toprotect items and surfaces that may becomecontaminated by blood or saliva during use.

    Between patients, the coverings should beremoved ,discarded and replaced with cleanmaterial.

    Appropriate use of rubber dam ,high velocity airevacuation and proper patient positioning should

    minimize the formation of droplets and aerosolsduring patient treatment.

    Splash shield must be used in dental lab.

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    HANDWASHING AND CARE OF HANDS

    DHCW should wash their hands before and after treatingeach patient and after barehanded touching of inanimateobjects likely to be contaminated with saliva or blood.

    Hands should be washed after removal of gloves becausegloves may become perforated during use and maycontaminate the hands of DHCW.

    nonsurgical procedures soap

    surgical antimicrobial hand scrub

    When gloves punctured or torn replace immediately

    Dhcw who have exudative lesions or weeping dermatitisshould refrain from all direct patient care and handling theinstruments

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 20

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    For procedure involving multiple injections

    with a single needle, the unsheathed needle

    should be placed in a

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