Standard Precautions in Prevention of Cross-infection: Policies in Placed
May 24, 2015
Standard Precautions in Prevention of Cross-infection:
Policies in Placed
INTRODUCTION GENERAL POLICY STATEMENT PREVENTION OF JAPANESE ENCEPHALITIS PREVENTION OF TUBERCULOSIS PREVENTION OF HIV PREVENTION OF SARS PREVENTION OF H1N1
OUTLINE
The invasion, adhesion, and multiplication of a microorganism in the host.
Infection of a host can occur exogenously (from outside) or endogenously (from inside)
Infection
the transmission of infectious agents between
patients and staff within a clinical environment
either directly or indirectly via instruments,
appliances and surfaces
Cross Infection
Cross infection..
Next patientpatient
TECHNICIAN
Operator
There is always the potential for contamination and
transmission in dentistry.
Saliva is a potentially infectious fluid and has
transmitted Hepatitis B, Herpes and many other infections.
The most serious infections in dentistry are transmitted by
blood to blood contact through accidental sharps injuries.
Risk of Cross infection in Dentistry?
Dentistry always has the potential to transmit
infection and hence
Standard Precautions
must always be observed.
1. Direct contact eg. blood or body fluids
2. Indirect contact eg. with a contaminated instrument or
surface
3. Contact of mucosa of the eyes, nose, or mouth with
droplets or spatter
4. Inhalation of airborne microorganisms
Mode of transmission
Chain of InfectionPathog
en
Source
ModeEntry
Susceptible host
General policy statement
Infection control is the concept of standard precautions
to reduce the risk of bloodborne pathogen transmission
The primary principle - medical history and examination
cannot reliably identify all patients infected with blood-
borne pathogens.
All patients, therefore, must be regarded as potentially
infectious.
Policy Statement on Bloodborne Pathogens,Infection Control and the Practice of Dentistry(1999:977, 983; 2004:300; 2008:453)-ADA (1998)
Based on the concept that all blood and body fluids,
secretions and excretions should be treated as infectious
when it comes into contact with non intact skin/mucous
membranes: universal precautions concept expanded by
CDC, USA:1996
Apply to all patients
Standard precaution
Hand Hygiene and Skin Care
Protective Clothing
Safe Handling of Sharps
(including Sharps Injury Management)
Spillage Management.
All blood and body fluids are potentially
infectious and precautions are necessary to
prevent exposure to them.
Everyone involved in providing care in dental
practice should know and apply the standard
principles of hand decontamination
STANDARD PRINCIPLE OF INFECTION CONTROL
Transmission
JE virus is transmitted by the bite of an infected mosquito,
mainly Culex tritaeniorhynchus and C. vishnui complex,
night-time biters that breed in stagnant water such as rice
paddy fields.(1;3)
Humans can also become infected coincidentally through
proximity to JE virus-infected animals and birds.
Japanese Encephalitis
JE virus, rarely, may also be transmitted person-to-person through blood transfusion, organ ,transplantation, intrauterine transmission and possibly breast milk.
(Alberta Health and Wellness Public Health Disease
Under Surveillance Management Guidelines
Japanese Encephalitis,March 2011 )
Single Case/Household Cluster
Determine history of recent living in, immigration from or travel to Asia
and northern Australia including:
geographic location,
season,
duration of exposure, and
occupational and recreational activities (while travelling).
Determine history of mosquito bites.
Determine immunization history (i.e., recent receipt of JE vaccine).
Key Investigation
Temperature:
Destroyed by heating for 30 minutes above 56
;Termal Inactivation Point(TIP) is 40 .℃ ℃
pH:
Inactivated in acid environment of pH 1-3(stable in
alkaline environment ofpH7-9)
Resistance to physical and chemical action
Chemicals/Disinfectants:
Inactivated by organic and lipid solvents,common
detergents,iodine,phenol iodophor 70%thanol,glutaraldehyde
3-8%,formaldegyde 1%,sodium hypochlorite.
Survival:
Sensitive to uv light ad gamma radiation.
PREVENTION AND CONTROL
Sanitary prophylaxis
Housing animals in-doors in screened stabling can provide protection
from mosquitoes
Especially during active JE outbreaks and during peak vector activity
(usually dawn to dusk)
Insecticides, repellents and fans also provide protection
Vector control reduces transmission
Immunisation of swine as they are JE virus amplifier
If practical, swine should not be raised near horses
Medical prophylaxis
Vaccine is available for both horses and swine; also for humans
Two types of vaccine:
modified live (produced in hamster or swine kidney tissue
culture or hamster lung (HmLu) cell line) or
inactivated (prepared in mouse brain, chick embryo
or cell lines, e.g. Vero cells)
(Chapter 2.1.7 Japanese encephalitis in the latest
edition of the OIE Manual of Diagnostic
Tests and
Vaccines for Terrestrial Animals)
TB Infection TB Disease (also called Active TB)
It’s important to recognize the difference!
There are two forms of Tuberculosis..
People with a positive TB skin test have been exposed to the TB germ.
They…◦ Have a TB Infection◦ Do not look or feel sick◦ Cannot infect others◦ May or may not develop TB Disease (Active TB)◦ May take medication to prevent TB Disease from
developing
TB Infection
May have these symptoms… A cough for more than two weeks Coughing up blood Night sweats Fever Loss of appetite Weight loss
TB Disease (Active TB)
Most important to remember:A person with
TB Disease (Active TB)can infect others!
Ask history of TB disease and symptoms suggestive of TB
Promptly referred to a physician Positive history and symptoms of active TB Evaluation for possible infectiousness
Elective dental treatment should be postponed until a physician confirms, using recognized diagnostic
evaluations, that the patient does not have active tuberculosis.
Policy for Treatment of Dental Patients with Active or Suspected Infection with Tuberculosis-CDC:1994
In urgent dental care TB isolation practices Treatment limited to relieve the patient's immediate pain.
DHCWs with persistent cough and other symptoms suggestive of active TB evaluated promptly for TB should not return to work until a diagnosis of TB has been
excluded or on therapy and determination has been made that the worker is not infectious.
Cont..
Blood, saliva, and gingival fluid from all dental patients should be considered infective.
All dental workers should wear surgical masks and protective eyewear or chin-length plastic face shields during dental procedures
Minimize generation of droplets and spatterRubber dams, high-speed evacuation and proper patient
positioning
Universal Precautions for Prevention of Transmission of HIV and other Bloodborne Infections-CDC:1996
Handpieces, ultrasonic scalers should be sterilized after use with each patient.
Cont..
Blood and saliva should be thoroughly and carefully cleaned from material that has been used in the mouth
Contaminated materials, impressions, and intra-oral devices should be cleaned and disinfected
Dental equipment and surfaces that are difficult to disinfect (e.g., light handles or X-ray-unit heads)should be wrapped with impervious-backed paper,
aluminum foil, or clear plastic wrap
Cont..
1. Transmission of H1N1 influenza: droplet exposure of mucosal surfaces indirect contact –by hands and respiratory
secretions from infectious patient/contaminated surface
inhalation of small particle aerosols
Prevention of H1N1 Influenza Transmission in Dental Health Care Settings-CDC:2009
1) Elimination of potential exposures e.g. deferral of ill patients
2) Engineering controls reduce or eliminate exposure at the source without placing
primary responsibility of implementation on individual employees.
3) Administrative controls sick-leave policies and vaccination
4) Personal protective equipment (PPE) exposures that cannot otherwise be eliminated or controlled.
Hierarchy of control measures of H1N1
Should avoid treatment of individuals who have symptoms consistent with SARSwhen these symptoms have started within 10 days of
departing from a SARS affected area. Dentists should ensure that the symptomatic
individuals consult their GP for medical assessment. Dentists should avoid treating probable or confirmed
cases of SARS and contacts of SARS cases whileThey are symptomatic During the period following symptoms when the case is
advised to limit their contact with others
Prevention of SARS –Health Protection Agency (DEC:2003)
ADA Guidelines for infection control 2nd Edition, 2012 Infection Control, Standard Precautions & Tuberculosis.
Washington County Health Sysytem (Effective Date: May 1, 2006)
References
Thank you