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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.

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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.

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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.

    9

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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.

    11

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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 location where it will not

    become contaminated .

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    Cleaning and disinfection of dental

    unit and environmental surfaces

    Dental unit surfaces should be cleaned withdisposable toweling, using an appropriatecleaning agent and water as necessary.

    Surfaces then should be disinfected using asuitable germicide.

    A chemical germicide registered with EPA as ahospital disinfectant and labeled fortuberculocidal activity is recommended for

    disinfecting surfaces that has been soiled withpatient material.(eg iodophors, phenoliccompounds)

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 23

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    A fresh solution of sodium hypochlorite prepared

    daily is an inexpensive and effective intermediate

    level germicide.

    Concentrations ranging from 500 to 800 ppm ofchlorine are effective on environmental surfaces

    that have been cleaned of visible contamination.

    Intermediate or low level disinfectants are notrecommended for reprocessing critical or semi

    critical dental instruments.

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    Dental Unit Waterlines, Bio film, and

    Water Quality

    Water that meets EPA regulatory standards for drinkingwater (i.e.,

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    Disinfection and dental laboratory

    Lab materials and other items that have been

    used in mouth should be cleaned and

    disinfected before and after being

    manipulated in laboratory.

    A chemical germicide having at least an

    intermediate level of activity is appropriate for

    such disinfection.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 26

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    Receiving area

    It should be separate from production area. The worksurface should be cleaned and then disinfected dailywith appropriate surface disinfectant.

    Incoming cases

    All cases should be disinfected as they are received.

    Containers should be sterilized or disinfected after each

    use. Packing materials should be discarded to avoid cross

    contamination.

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    Production area Person working in production area should wear a clean

    lab coat, face mask, protective eyewear, disposablegloves.

    Work surfaces should be kept free of debris anddisinfected daily.

    Brushes and other equipments should be disinfecteddaily.

    Outgoing cases Each case should be disinfected before it is returned to

    dental office.

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    Use and care of hand pieces, anti retraction valves, and

    other intraoral dental devices attached to air and water

    lines of dental use

    According to manufacturers, virtually all highspeed and low speed hand pieces in productiontoday are heat tolerant.

    Manufacturers instruction for cleaning,lubrication and sterilization procedure should befollowed closely.

    Internal surfaces of hand pieces may become

    infected during treatment. Surface disinfection bywiping or soaking in liquid chemical germicides isnot an acceptable method.

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS --- 20032003 / 52(RR17);1-61WILLIAM G. KOHN ET AL

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    Retraction valves may cause the aspiration of patient

    material back into hand pieces and water lines.

    Hence, antiretraction valves must be installed.

    Water lines should be allowed to run and to

    discharge water for several minutes at the beginning

    of each day. Studies have shown that there is

    reduction in microbial accumulation in water lines.

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    All other reusable instruments which are

    attached to but removable from dental unit air

    or water lines should be cleaned and

    sterilized.

    Flushing at the beginning of each clinic day

    also is recommended.

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    Disposal of health care waste material

    Waste produced in the course of health care

    activities carries a higher potential for

    infection and injury than any other type of

    waste.

    Whenever it is generated, safe and reliable

    methods for its handling are therefore

    essential.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 32

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    Categories of health care waste

    Infectious waste lab cultures, equipments in contactwith infected patients

    Pathological waste human tissues, fluids

    Sharps needles, blades

    Pharmacutical waste drugs

    Genotoxic waste contains genotoxic substanceswhich has carcinogenic properties eg: cytotoxic drugs

    Chemical waste lab reagents, solventWaste with high content of heavy metal

    Radioactive waste

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    Handling storage and transportation of

    health care wastes Health care waste should be segregated and waste material

    should be sorted in different color coded plastic bags.

    The other practices recommended are:

    Sharps should be collected together regardless of whether

    they are contaminated or not. Containers should bepuncture proof and tamper proof.

    Where plastic or metal containers are unavailable, densecardboard containers with a plastic lining recommended.

    Bags and containers for infectious wastes should be marked

    with the international infectious substance symbol. Highly infectious waste should preferably be packed in red

    bags and sterilized immediately by autoclaving.

    TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY SOBEN PETER 34

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    Expired pharmaceutical should be returned to thepharmacy for disposal.

    The identity of waste should be clearly marked oncontainer.

    Waste with a high level of heavy metals like cadmium andmercury should be collected separately.

    Aerosols containers if empty may be collected with generalhealth care wastes. They should not be incinerated.

    Low level radioactive wastes may be collected in yellow

    bags if destined for incineration. Non hazardous waste should be handled in same manner

    as domestic refuse and collected in black bags

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    Collection

    The waste bags are tightly closed or sealed when theyare about three quarters full.

    Waste should not be allowed to accumulate at point ofproduction.

    Waste should be collected daily and transported tostorage site.

    No bags should be removed until they are labeled.

    The bags and containers should be replacedimmediately with new ones of same type.

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    Storage

    The waste should be stored in an appropriate area depending

    upon quantity of waste produced and frequency of collection.

    The storage area should have an impermeable hard standingfloor with good drainage. It should be easy to clean and

    disinfect.

    There should be water supply for cleaning purposes..

    The storage area should allow easy access to staff.

    Easy access for waste collection vehicle is essential.

    There should be protection from sun.

    It should be inaccessible for birds, insects.

    It should have good lighting and ventilation.

    It should not be located close to food sources.

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    Transportation

    Should be transported in wheeled trolleys or

    carts not used for any other purpose.

    Vehicle should be cleaned and disinfected

    daily.

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    Treatment and disposal technology for

    health care waste

    The treatment and disposal options are

    incineration

    chemical disinfection

    wet thermal treatment

    microwave irradiation

    encapsulation

    safe burying

    inertization

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    Handling of biopsy specimens

    Biopsy instruments should be put in a

    container with a secure lid to prevent

    leakage.

    Care should be taken when collecting

    specimens to avoid contamination of the

    specimen outside of the container.

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    Precautions For Handling Extracted

    Teeth

    All persons who collect, transport or manipulateextracted teeth should handle them with sameprecaution as a specimen for biopsy.

    Universal precautions should be adhered to

    whenever extracted teeth are handled. All persons who handle extracted teeth in dental

    educational settings should receive Hepatitis Bvaccines.

    Teeth should first be cleaned of adherent patientmaterial by scrubbing with detergent and wateror by using ultrasonic cleaner.

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    Person handling extracted teeth should wear

    gloves.

    Gloves should be disposed properly and hands

    washed after completion of work activities.

    Work surfaces and equipments should be

    cleaned and decontaminated with an

    appropriate liquid germicide after completionof work activities.

    Disinfection Methods of Extracted human teeth Nikita V Lolayekar, Vidya Bhat S, Sham S Bhat 42

    IN SOME STUDIES 10%

    Formalin, 5.25% Sodium

    Hypochlorite and autoclaving

    were able to sterilize all the

    teeth,but each method does

    have its drawbacks.

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    PREVENTION OF PSYCHOLOGICAL

    HAZARD: STRESS

    Stress is the most common psychological

    condition that occurs in the dental profession.

    Some studies indicate that dentists perceive

    their profession as more stressful than other

    occupations .

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    PREVENTION

    THE CAUSE OF STRESS SHOULD BE IDENTIFIEDAND EFFECTIVE MEASURES SHOULD BE TAKENTO ELIMINATE THE CAUSE.

    SOME EFFECTIVE WAYS TO BREAK STRESS GOOD EXERCISE

    INTAKE OF HEALTHY AND NUTRITIOUS DIET

    GOOD INTERACTION WITH FAMILY AND COLLEAGUE

    HEALTHY COWORKER RELATIONSHIP

    DEVELOP A PATTERN OF HEALTHY LIVING CULTIVATE JOB SATISFACTION.

    STRESS, BURNOUT, ANXIETY AND DEPRESSION AMONG DENTISTS

    ROBERT E. R ET AL (2004) J AM DENT ASSOC, VOL 135, NO 6, 788-794. 44

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    PREVENTION OF HAZARDS TO BODY

    PARTS

    Injury to eye may occur during operative procedures

    which can be prevented by use of protective eye wear

    or face shield

    Noise has tendency to damage inner receptor cells ofcochlea. Noise of 120 db or more can damage hearingwithin a very short time. This can be prevented by use

    of modern and well equipped low frequencyinstruments.

    Infection prevention in dental practice

    Dutch Working Party on Infection Prevention October 2007 45

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    Regular oiling of handpieces recommended.

    If noise produced by any other source whichhas tendency to damage the ear, the cause

    should be identified and eliminated.Treatment rooms should be made acoustically

    satisfactory.

    Personal protection by using ear plugs andmuffs which reduce high intensity sounds by30 to 35 db should be used.

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    Skin complaints make up about half of the

    total number of occupational illness in health

    care workers. Occupational skin disease

    affects about 6 in 1000 workers.

    This can be prevented by use of barrier cream

    and gloves.

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    The respiratory system can become a site of

    infection or can be damaged by various dusts

    or other materials.

    Can be prevented by use of face mask and

    regulation of aerosol production.

    Infection prevention in dental practiceDutch Working Party on Infection Prevention October 2007 48

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    PREVENTION OF PHYSICAL HAZARDS:

    These include chemical dependency and

    musculoskeletal problems that have a direct

    relation to practising dentistry, such as

    postural practices that may increase the risk oftwisting and contorting the body, varicose

    veins,etc.

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    PREVENTION OF

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    PREVENTION OF

    MUSCULOSKELETAL DEFORMITIES

    Reduction of physical stress to the body by

    adopting a correct posture is important in

    everyday practice.

    Low seated, closely supported dentistry with

    certain physiotherapeutic exercises provide a

    new ray of hope.

    PREVENTING MUSCULOSKELETAL DISORDERS IN CLINICAL DENTISTRY AM DENT ASSOC, VOL 134, NO 12, 1604-1612. 2003 BETHANY VALACHI 50

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    Prevention of Neck, Shoulder and Back DisordersErgonomic recommendations for minimizing therisks of back injuries focus on improving workingposture and equipment design. These include:

    1) Change Posture - Alternate between sitting andstanding to reduce postural fatigue and maximize

    postural variety, which helps to reduce staticmuscle fatigue.

    PREVENTING MUSCULOSKELETAL DISORDERS IN CLINICAL DENTISTRY AM DENT ASSOC, VOL 134, NO 12, 1604-1612. 2003 BETHANY VALACHI 51

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    2) Use Support - When sitting or standing, dont leanforwards or stoop in an unsupported posture forprolonged periods. If you are sitting, sit up straight orrecline slightly in a chair with good back support, anduse a good footrest if necessary. If you are standing forprolonged periods try to find something to help youlean against.

    3) Safe reaching - Avoid having to reach awkwardly toequipment and work close to the patient. Keep the

    items used most frequently within a distance of about20 inches (50 cm). Use assistants to help moveequipment into this zone.

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    4) Normal arm posture - Keep elbows and upperarms close to the body and dont raise and tensethe shoulders when working. Also, ensure thathand postures are not deviated because this

    could lead to wrist problems.5) Use Comfortable Equipment - Use equipment

    that isnt too heavy, that can be used withoutawkward upper body posture, and that feels

    comfortable to use. Ergonomically designedequipment helps to minimize stresses on theupper extremities and the back.

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    6) Manage Time - Avoid long appointments

    where possible, or intersperse these with

    frequent short rest breaks in which you

    change posture and relax the upperextremities.

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    PREVENTION OF PERCUTANEOUS

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    PREVENTION OF PERCUTANEOUS

    EXPOSURE

    Reducing Inoculation Injuries:

    The majority of inoculation injuries sustained in thedental environment are avoidable.

    For example:For re-sheathing local anestheticneedles manually

    The barrel of the syringe is held in one hand and theneedle cap is scooped up from a flat, hard surface.

    Only when the needle is covered by the cap shouldthe second hand be used to complete the re-sheathing and secure the needle cap.

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    Cover existing wounds, skin lesions and all breaks inexposed skin with waterproof dressings

    Remember that gloves cannot be relied upon to form

    an intact barrier.

    The longer that gloves are worn, the more likely that:

    The number and size of holes in gloves will

    increase as a consequence of physical trauma. Latex gloves become porous due to hydration of

    latex.

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    Avoid sharps usage where possible.

    When sharps have to be used, exercise particularcare in handling and disposal.

    Each member of the team should understand inadvance what tasks they are to perform.

    Use approved sharps containers that conform tostandards for off-site disposal.

    The book of hospital waste management

    Dr.D.B Acharya and Dr Meeta Singh 57

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    Out of the reach of children.

    As close as is practical to the point of use.

    Place all disposable sharps in sharpscontainers immediately after use.

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    Discard disposable items as a single unitwhere possible, rather than dismantling theminto their components.

    Do not overfill sharps containers.

    Secure the lids of sharps containers prior to

    transfer to a licensed authority for subsequentincineration.

    The book of hospital waste management

    Dr.D.B Acharya and Dr Meeta Singh 59

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    Avoid wearing open footwear in situationswhere blood may be spilt or where sharpinstruments or needles are handled.

    Clear up spillage of blood promptly anddisinfect surfaces.

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    Wear gloves:

    Where contact with blood or other body fluids (e.g. saliva) isanticipated.

    To clean equipment prior to sterilization or disinfection.

    When handling disinfection fluid

    When cleaning up spillages.

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

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    PREVENTION OF CHEMICAL HAZARDS

    Mercury health hazard:

    It is known that high exposure to mercury

    vapour can cause biological and neurological

    damage . The use of sealed amalgam capsuleswith reduced mercury level, water irrigation

    and high suction, good ventilation and proper

    collection and discarding of amalgam havegreatly reduced the mercury hazard .

    62

    Prevention

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    Prevention

    Use of precapsulated alloys

    Good ventilation

    Excess and spilled mercury should be collected infixer containing break resistant bottles.

    Do not touch mercury with bare hands becausemercury gets absorbed quickly through the skin.

    63

    STANDARD OPERATIVE PROCEDURES TO

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    STANDARD OPERATIVE PROCEDURES TO

    PREVENT MERCURY HAZARDS

    Clean the area around spill Wear heavy duty latex gloves or two layers of latex gloves.

    A regular syringe can be used to suck the mercury. Smallspills can be managed by using stiff paper to scoop andgather the mercury . Large droplets of mercury may besucked up by a syringe.

    The collected mercury should be poured into a plasticcontainer with 5 to 10 ml of water.

    Seal the container that contains mercury by using scotch

    tape Put the used syringe in a separate plastic container for

    further use.

    Dispose off the used gloves carefully after disinfection

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

    64

    Anaesthetic gases in the dental office:

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    Anaesthetic gases in the dental office:

    This is a specific hazard for those who use

    nitrous oxide gas regularly over an extended

    period of time .

    Adequate ventilation and proper

    handling by a trained dental staff

    helps to overcome this hazard.

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    PREVENTION OF RADIATION HAZARDS

    Ionizing radiation: The use of X-ray machinesin the dental office exposes dentists toionizing radiation

    Non-ionizing radiation: introduction ofcomposites and other resins, in addition tothe introduction of lasers in dentistry, exposes

    dentists to non ionizing radiations.

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    Radiation Protection and Prevention

    The goal is to minimize the radiation exposure

    of office personnel and patients during

    radiographic examination.

    TEXTBOOK OF RADIOLOGY:WHITE AND PHAROAH 67

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    Following are the recommendations for safety ofthe practitioner:

    Buying of standard radiographic equipment,which rigidly follows the National Council onRadiation Protection and Measurements (NCRP)and ISI recommendations.

    Well-collimated and filtered beam of at least 1.5mm of aluminium filtration should be available.

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    Special conch shell designs are recommendedfor the X-ray departments.

    During construction use a special bariumplaster, which absorbs the scattered radiation.

    Lead aprons should be routinely used for allpatients, and for all children special thyroidshield should be used.

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    Use of fast films, i.e. Ekta (E) speed to lower

    exposure times.

    Dental surgeons must use a film badge service

    provided by the Bhabha Atomic Research

    Centre (BARC), Mumbai for personnelmonitoring.

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    Wear gloves when exposing radiographs and

    handling contaminated film packets.

    Use heat-tolerant or disposable intraoral deviceswhenever possible (e.g., film-holding andpositioning devices).

    Transport and handle exposed radiographs in an

    aseptic manner to prevent contamination ofdeveloping equipment

    TEXT BOOK OF ORAL MED -ANIL GOVINDRAO GHOM(1ST EDITION) 71

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    PREVENTION OF INFECTIOUS HAZARDS

    Various types of infections like HIV, Hepatitis,

    Tuberculosis etc are potential threat for

    dentists.

    They may be spread from one patient to otherif adequate sterilization protocols not

    followed.

    Every care should be taken to prevent thisfrom happening.

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    The risk of nosocomial transmission of HIV, HBV,and other blood borne pathogens can beminimized if health-care workers use the followinggeneral guidelines:**

    Take care to prevent injuries when using needles, scalpels,

    and other sharp instruments or devices; when handlingsharp instruments after procedures; when cleaning usedinstruments; and when disposing of used needles.

    Do not recap used needles by hand; do not remove usedneedles from disposable syringes by hand; and do not

    bend, break, or otherwise manipulate used needles byhand.

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS --- 2003

    2003 / 52(RR17);1-61WILLIAM G. KOHN ET AL 73

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    Place used disposable syringes and needles,

    scalpel blades, and other sharp items in

    puncture-resistant containers for disposal.

    Locate the puncture-resistant containers as

    close to the use area as is practical.

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    Use protective barriers to prevent exposure to

    blood, body fluids containing visible blood,

    and other fluids to which universal

    precautions apply. The type of protective barrier(s) should be

    appropriate for the procedure being

    performed and the type of exposureanticipated.

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    Immediately and thoroughly wash hands andother skin surfaces that are contaminated withblood, body fluids containing visible blood, orother body fluids to which universal precautions

    apply.

    USE OF GLOVES: Gloves should always beavailable to health-care workers who wish to use

    them.

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    The Center for Devices and Radiological Health, FDA,has responsibility for regulating the medical gloveindustry.

    The following general guidelines are recommended:

    Use sterile gloves for procedures involving contact withnormally sterile areas of the body.

    Use examination gloves for procedures involvingcontact with mucous membranes, unless otherwiseindicated, and for other patient care or diagnostic

    procedures that do not require the use of sterilegloves.

    Change gloves between patient contacts.

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS --- 2003

    2003 / 52(RR17);1-61WILLIAM G. KOHN ET AL 77

    PREVENTION OF TB

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    General Recommendations

    A)Educate all DHCP regarding the recognition of signs,

    symptoms, and transmission of TB .

    B) Conduct a baseline TST, preferably by using a two-steptest, for all DHCP who might have contact with persons with

    suspected or confirmed active TB, regardless of the risk

    classification of the setting.

    C) Assess each patient for a history of TB as well as symptoms

    indicative of TB and document on the medical history form .

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS --- 20032003 52 RR17 1-61WILLIAM G. KOHN ET AL

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    E)Evaluate the patient away from other patients and

    DHCP. When not being evaluated, the patient shouldwear a surgical mask or be instructed to cover mouthand nose when coughing or sneezing .

    F) Defer elective dental treatment until the patient isnon infectious .

    G) Refer patients requiring urgent dental treatment toa previously identified facility with TB engineeringcontrols and a respiratory protection program .

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    Immunization Against Blood-Borne Viruses and

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    Immunization Against Blood Borne Viruses and

    Prevention of Hepatitis B

    All health care workers (HCWs) who have directcontact with patient's blood or other potentiallyinfectious body fluids or tissues, should be

    immunized against Hepatitis B.

    Successful immunization also provides protection

    against Hepatitis D (delta agent) which can only

    replicate in the presence of Hepatitis B infection.

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS --- 2003

    2003 / 52(RR17);1-61WILLIAM G. KOHN ET AL 80

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    Immunization does not diminish the need tofollow rigorous cross-infection procedures.

    To date, no effective vaccines have been

    produced that prevent

    HIV infection

    Hepatitis C infection

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    PREVENTION OF MEDICOLEGAL HAZARDS

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    Medico legal hazards are of a quite different

    nature from the risks already discussed.

    Complications of dental practice

    Professional negligence

    Professional misconduct

    Problems with employees or partnerships

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    PREVENTION

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    PREVENTION

    The dental surgeon can minimize medicolegal risks in hispractice by

    Maintaining correct dental records.

    Obtaining informed consent from patient/parents in

    case of children.

    By attending conferences, workshops and continuingdental education programs to keep updated with thelatest technologies and knowledge.

    Lastly the dental surgeon can cover himself usingProfessional Indemnity Insurance in event of amalpractice suit.

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    CONCLUSION

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    CONCLUSION

    Occupational health risks are present in every

    profession.

    With advent of advanced technology, no matter howbeneficial it is, can exert a negative impact also on

    some members of the population.

    Dentists are one such professional group. In spite of

    these hazards we cannot refrain from providing care

    and serving community.

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    Once identified and recognized as risk, newguidelines, precautions and protocols shouldbe rapidly instituted to reduce or eveneliminate the hazards.

    Proper care and proper handling ofinstruments would play a significant role inelimination of hazards which exists in this

    profession and would provide a betteropportunity to serve the people.

    86

    REFERENCES

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    REFERENCES

    TEXTBOOK OF PREVENTIVE AND COMMUNITYDENTISTRY SOBEN PETER (1ST EDN)

    PREVENTIVE DENTISTRY DR.SATISH

    CHANDRA,DR.SHALEEN CHANDRA.

    THE BOOK OF HOSPITAL WASTE MANAGEMENTDR.D.B ACHARYA AND DR MEETA SINGH

    TEXT BOOK OF ORAL MED -ANIL GOVINDRAO

    GHOM(1ST EDITION)

    TEXT BOOK OF PREVENTIVE AND COMMUNITYDENTISTRYSS HIREMATH(1ST EDITION)

    87

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    STRESS, BURNOUT, ANXIETY AND DEPRESSION AMONG DENTISTS

    ROBERT E. R ET AL (2004) J AM DENT ASSOC, VOL 135, NO 6, 788-794.

    INFECTION PREVENTION IN DENTAL PRACTICE DUTCH WORKING

    PARTY ON INFECTION PREVENTION OCTOBER 2007

    PREVENTING MUSCULOSKELETAL DISORDERS IN CLINICAL

    DENTISTRY AM DENT ASSOC, VOL 134, NO 12, 1604-1612. 2003BETHANY VALACHI

    GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE

    SETTINGS --- 2003

    2003 / 52(RR17);1-61WILLIAM G. KOHN ET AL DISINFECTION

    METHODS OF EXTRACTED HUMAN TEETH NIKITA V LOLAYEKAR,

    VIDYA BHAT S, SHAM S BHAT

    88

    Th k

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    Thank you


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