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Infection Control
 

Infection Control

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  • Today,the infection control update will include a short OSHA update Statistical information about injuries I.C. monitoring results for the year
  • During the provision of dental treatment, both patients and dental health care personnel (DHCP) can be exposed to pathogens through contact with blood, oral and respiratory secretions, and contaminated equipment. Following recommended infection control procedures can prevent transmission of infectious organisms among patients and dental health care personnel.
  • Theoretically, transmission of bloodborne pathogens may occur from patient to DHCP, from DHCP to patient, and from patient to patient. Because DHCP frequently are exposed to blood and blood-contaminated saliva during dental procedures, they are at greater risk of infection by a bloodborne pathogen than are patients.
  • Infection through any of these routes requires that all of the following conditions be present: An adequate number of pathogens, or disease-causing organisms, to cause disease. A reservoir or source that allows the pathogen to survive and multiply (e.g., blood). A mode of transmission from the source to the host. An entrance through which the pathogen may enter the host. A susceptible host (i.e., one who is not immune). The occurrence of all these events is considered the “chain” of infection . Effective infection control strategies prevent disease transmission by interrupting one or more links in the chain of infection. Eg. Portal Wear Universal Barriers = PPE Personal Protective Equipment. MRSA Study verified & established protective standards for restorative dental Tx of MRSA Carriers in NHs. Eg. Pre-rinses especially With CHX as demonstrated by my study. Ok to Tx MRAS active skin but not pulmonary or Septic blood bourne except extreme urgent emergencies.
  • Compliance is built around the “Standard Precautions” The guiding principle is that “ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS!”
  • Universal precautions is the guiding principle that all blood and body fluids are considered to be infectious Work practice controls -
  • Compliance is built around the “Standard Precautions” The guiding principle is that “ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS!”
  • Compliance is built around the “Standard Precautions” The guiding principle is that “ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS!”
  • OShA regulations require that each health care facility have an Infection Control Plan . Here at the Dental Branch that is the infection control manual. This is a written plan to eliminate exposure to blood and body fluids. It includes: Exposure determination which identifies who should be protected The plan must be accessible for every health care worker The plan defines how compliance to the regulations is established in the work site
  • This slide shows some examples of clinical contact surfaces, including a light handle, countertop, bracket tray, dental chair, and door handle (shown by arrows). Photo credit: Lt. Col. Jennifer Harte, U.S.A.F. Dental Investigation Service, Great Lakes, IL.
  • Because clinical contact surfaces come into direct contact with contaminated gloves, instruments, spray or spatter, their risk of transmitting infection is greater than for housekeeping surfaces. These surfaces can subsequently contaminate other instruments, devices, hands, or gloves. Surface barriers can be used to protect clinical contact surfaces and changed between patients. Surface barriers are particularly useful for surfaces that are hard to clean, such as switches on dental chairs. This practice will also reduce exposure to harmful chemical disinfectants. If surface barriers cannot be used, clean and then disinfect the surface with an EPA-registered hospital disinfectant effective against HIV and HBV (low-level disinfectant). If the surface is visibly contaminated with blood or other patient material, clean and then disinfect the surface with an EPA-registered hospital disinfectant with a tuberculocidal claim (intermediate-level disinfectant).
  • Studies have shown that colonies of microorganisms, or biofilms, can form on the inside of the small-bore plastic tubing that transports water within the dental unit to handpieces and air-water syringes. Once formed, a biofilm serves as a reservoir that may dramatically increase the number of free-floating microorganisms in water used for dental treatment. Most organisms isolated from dental water systems originate from the public water supply and do not pose a high risk of disease for healthy persons. Although a few pathogenic organisms, such as Legionella spp . and Pseudomonas sp . , have been found, adverse public health threats have not been documented. Photo credit, top: CDC Image library. This Scanning Electron Micrograph depicts an E. coli (ATCC 11775) biofilm grown on PC (polycarbonate) coupons using a CDC biofilm reactor. Photo credit, bottom: Illustration from the Center for Biofilm Engineering, Bozeman MT.
  • Despite a lack of documented adverse health effects, using water of uncertain microbiological quality is inconsistent with infection control principles. Levels of contamination in water from untreated systems can exceed 1 million colony forming units per milliliter (mL) of water. Untreated dental units cannot reliably produce water that meets drinking water standards (fewer than 500 CFU/mL of heterotrophic water bacteria) . Even using source water containing ≤500 CFU/mL of bacteria (e.g., tap, distilled, or sterile water) in a self-contained system will not eliminate bacterial contamination in treatment water if biofilms in the water system are not controlled. Removal or inactivation of dental waterline biofilms requires use of chemical germicides.
  • For this reason, CDC recommends that water used for routine dental treatment meet regulatory standards for drinking water (fewer than 500 CFU/mL of heterotrophic water bacteria).
  • Odor complaints- diesal from big trucks outside road bwt Anderson Natural Gas – open gas line somewhere—tubing problems last year Hazardous waste – expired medications, clinic waste, haz chemicals, RAM, X-ray film waste Animals
  • Odor complaints- diesal from big trucks outside road bwt Anderson Natural Gas – open gas line somewhere—tubing problems last year Hazardous waste – expired medications, clinic waste, haz chemicals, RAM, X-ray film waste Animals
  • OShA regulations require that each health care facility have an Infection Control Plan . Here at the Dental Branch that is the infection control manual. This is a written plan to eliminate exposure to blood and body fluids. It includes: Exposure determination which identifies who should be protected The plan must be accessible for every health care worker The plan defines how compliance to the regulations is established in the work site
  • OShA regulations require that each health care facility have an Infection Control Plan . Here at the Dental Branch that is the infection control manual. This is a written plan to eliminate exposure to blood and body fluids. It includes: Exposure determination which identifies who should be protected The plan must be accessible for every health care worker The plan defines how compliance to the regulations is established in the work site

Infection Control Infection Control Presentation Transcript

  • Dental Branch 2008 Annual Clinic Update Presented by: Environmental Health & Safety Bloodborne Pathogens & Infection Control
  • Objectives
    • Bloodborne Pathogens
    • Preventive Measures
    • Spill, Injury/Potential Exposure
    • TB, MRSA, Flu
    • Water Lines & Quality
    • General Safety (drills, physical, x-ray, laser)
  • Regulations & Guidelines
    • Occupational Safety & Health Administration (OSHA)
    • Centers for Disease Control & Prevention (CDC)
    • American Dental Association (ADA)
    • Texas Department of State Health Services (DHSH)
    • Texas Commission on Environmental Quality (TCEQ)
  • Training Requirements
    • All health care workers with potential for exposure to blood or other body fluids must receive training:
        • At time of initial assignment
        • Annually
  • Bloodborne Pathogens OSHA 1910.1030
    • Definition:
      • Any pathogenic microorganism that is present in human blood or other potentially infectious materials (OPIM), and can infect and cause disease in humans.
  • Bloodborne Pathogens (BBP)
    • Examples:
      • HIV
      • HBV
      • HCV
      • T. pallidum
      • Herpes Virus
      • M. tuberculosis (typically an aerosol hazard)
      • Human T-Lymphotropic Virus Type I (HTLV-I)
  • Bloodborne Pathogens (BBP)
    • Body fluids that can harbor BBP:
      • Blood
      • Semen and vaginal secretions
      • Saliva involved in dental procedures
      • Synovial fluid
      • Cerebrospinal fluid
      • Human tissue and cell cultures
      • All body fluids containing blood
  • Occupational Exposure *
    • Mucous membrane contact
      • Splash to the eyes, nose or mouth
    • Percutaneous inoculation
      • Misuse of sharps (broken glass, needles, scalpels, dental bur, knife)
    • Exposure to broken/damaged skin
      • Risk increases if contact involves a large area of broken/damaged skin or if contact is prolonged
    • * Risk increases with high titer levels in the source
  • Why Is Infection Control Important in Dentistry?
    • Both patients & dental health care personnel (DHCP) can be exposed to pathogens
    • Contact with blood, oral & respiratory secretions, & contaminated equipment occurs
    • Proper procedures can prevent transmission of infections among patients and DHCP
  • Potential Routes of Transmission Patient DHCP DHCP Patient Patient Patient
  • Break the Chain of Infection Pathogen Source Mode Entry Susceptible Host
  • Preventive Measures
    • Risk of exposure can be minimized or eliminated by using the following controls:
      • Engineering controls
      • Personal protective equipment (PPE)
      • Administrative controls
      • Work place practices
  • Engineering Controls
    • Leakproof containers
        • Use for storage & transportation of ALL bloodborne pathogen material
    • Sharps containers
        • Fill no greater than ¾ full
    • Needleless devices
        • Use retractable syringes, self-sheathing needles (if possible)
  • Personal Protective Equipment (PPE)
    • Consider that all patients are infectious
    • Wear personal protective equipment
      • Gowns
      • Gloves
      • Masks
      • Protective Eyewear
  • Clinic Gown
    • The official protective gown for use in all Dental Branch clinics is the Clinic Gown:
      • White for faculty
      • Blue for students
  • Laboratory Gown
    • Working in a clinical dental laboratory:
      • Yellow gown should be used
  • Nonsurgical Gloves Vinyl, nitrile, or latex examination gloves must be worn when treating nonsurgical patients
  • Surgical Gloves Sterile disposable gloves must be worn during all surgical procedures
  • Utility Gloves
    • Each student must have a pair of heavy-duty utility gloves for break down after patient treatment
      • Must be washed with antimicrobial soap, rinsed & dried
      • Stored in plastic bag in locker
  • Masks
    • Masks must be worn to protect:
      • Face
      • Oral & nasal mucosa
  • Masks
    • Masks must be changed if they become damp
    • The mask must be changed for each new patient, except for short exams!
    • If a face shield is worn it must be worn at the same time as a surgical mask
  • Special Masks A laser plume face mask must be worn during a laser or electrosurgery procedure!
  • Protective Eyewear
    • Must be worn to protect from aerosol & spatter
    • Regular eyewear must have side shields
    • Side shields must be securely attached to the eyewear frame, abutting the lenses & free of vents or openings
    • Special protective eyewear for laser procedures
  • Administrative Controls
      • Medical surveillance
          • TB skin (PPD) or Quantiferon test, baseline serum
      • Immunizations
          • Hepatitis B series
      • Training
          • BBP, infection control, hazard communication
      • Management of staff
          • SOP compliance
      • Background checks
  • Hepatitis B Vaccination
    • Available at no cost to employees
    • All health care workers must have vaccination
    • Employees can decline vaccination, but must sign a declination statement
  • Good Work Place Practices
    • Universal/Standard precautions
    • A standard of care designed to protect health care providers & patients from pathogens that can spread by blood & other body fluids
    • Treat all human blood & body fluids as if known to be infectious for HIV, HBV or other BBP
    • ALL BLOOD AND BODY FLUIDS ARE CONSIDERED TO BE INFECTIOUS !
  • Good Work Place Practices (cont.)
    • Follow SOPs
    • NEVER recap needles with two hands!
    • Establish & maintain clean & dirty zones
    • Decontaminate work surfaces
      • At start & end of procedures
      • Immediately after spill
      • Before removal of equipment
    • Survey work area
      • Note locations of all necessary equipment, waste containers, disinfectants, soaps
  • Good Work Place Practices (cont.)
    • Wash hands frequently, always between patients & always before leaving work area!
    • DO NOT eat, drink, or apply cosmetics in the work area
    • Practice proper personal hygiene for the dental clinic setting
    • Label containers - hazard communication
      • Chemical & biological working stocks
    • Dispose of waste properly
  • Exposure Control Plan
    • Written plan to eliminate exposure to blood & body fluids
      • Exposure determination
      • Plan must be accessible
      • Compliance
    • UTHSC-H Dental School Clinic Manual
      • www.db.uth.tmc.edu/clinicpat/Documents/Clinic_Manual.pdf
    • UTHSC-H Biological Safety Manual
      • www.uth.tmc.edu/safety
  • Injury Prevention
    • Remove burs from handpiece immediately after completion of dental procedure
    • Recap anesthetic needles using proper technique
    • Restrict use of fingers in tissue retraction or palpation during suturing or administration of anesthesia
    • Avoid uncontrolled movements of dental instruments. THINK BEFORE MOVING AN INSTRUMENT!
  • Injury Prevention (cont.)
    • Burs
    • Must be removed from handpiece immediately upon completion of patient treatment
  • Recapping Anesthetic Needles
    • Use the needle recapper to recap anesthetic needles
    • NEVER use two hands!
  • Recapping Anesthetic Needles
    • Use the “ one-handed scoop ” technique to recap if a recapper is not available
    • NEVER use two hands!
  • Sharps
    • Handle carefully
    • Do not recap with two hands
    • Discard in sharps container
    • Do not bend or break needles
    • Report all injuries
  • Sharps
    • Discard in sharps containers
      • Used needles
      • Blades, scalpels
      • Burs
      • Anesthetic cartridges
      • Broken glass
  • Sharps – Red Handled Lab Knife
    • USE OF SHARP INSTRUMENTS
      • To prevent accidental exposure injuries related to trimming wax with a red handled lab knife at chair-side, DISINFECT when possible and…
      • BE EXTREMELY CAREFUL WHEN USING THE RED HANDLED LAB KNIFE!
      • Policy 2.39
  • Maintain the Clinical Worksite
      • Worksite must be maintained in a clean & sanitary condition
      • Equipment & work surfaces must be cleaned & disinfected before & after procedures, & after any contact with blood or OPIM
      • Protective covering must be used to cover equipment and work surfaces
      • Biological waste & contaminated materials must be disposed of in appropriate biological waste containers
  • Contact Surfaces
  • Clinical Contact Surfaces
    • Risk of transmitting infections greater for clinical contact surfaces than for general housekeeping surfaces
    • Clean & disinfect surfaces
    • Apply barriers
  • Routine Surface Decontamination
    • Sani-Cloth Plus Disinfectant
    • EPA registered
    • Meets OSHA & CDC guidelines
    • Double ammonium chloride & alcohol
    • Tuberculocidal, bactericidal & virucidal
    • Use on surfaces in dental operatories
  • Sani-Cloth Plus Disinfectant
    • Effective against:
      • Methicillin Resistant Staphylococcus aureus (MRSA)
      • Vancomycin Resistant Enterococci (VRE)
      • Mycobacterium tuberculosis
      • Flu Viruses
      • RSV (Respiratory Syncytial Virus)
      • Pseudomonas sp.
      • Hepatitis B & C Viruses (HBV, HCV)
      • Herpes Simplex Virus (HSV)
      • Human Immunodeficiency Virus (HIV)
      • Others
  • Routine Surface Decontamination
    • Sani-Cloth Plus Disinfectant
    • The disinfecting process is a two-step process:
      • Wipe to clean the surface & remove bioburden
      • Wipe a second time to disinfect
    • All disinfectants must be used correctly to be effective!
  • Surface Covers Handles, handpieces & similar surfaces that may be contaminated by blood, saliva or OPIM must be wrapped with clear plastic wrap
  • Rubber Dam
    • Provides protection from aerosols and spatters
  • Clinical Computer Equipment
    • Procedures should be followed to avoid contamination of electronic equipment when possible
    • If it will be necessary to enter data while a patient is in the operatory, barrier protection for equipment must be utilized & high touch areas must be disinfected
    • Follow established guidelines
  • Electronic Equipment Barriers
    • Apply two lengths of plastic wrap to cover entire keyboard & tuck in on all sides
    • Use Sani-Cloth Plus Disinfectant
    • Disinfect daily, or if contaminated or visibly soiled
    • Touch monitor screen with cotton tipped applicator only (no Sani-Cloth Plus on the monitor screen)
  • Hand Hygiene Source: Hand Hygiene Resource Center http://www.handhygiene.org/
    • On average only 40% of health care workers regularly wash their hands
    • Hospital acquired infections result in transmission of:
      • MRSA – Methicillin resistant S. aureus
      • VRE – Vancomycin resistant Enterococci
    • Methods for contamination
      • Moving patients
      • Taking blood pressure
      • Touching bedrails
  • Hand Hygiene (cont.)
    • Proper hand washing is VITAL to infection prevention!
    • You may not realize you have germs on your hands!
    • Wash your hands, even if gloves have been worn…
    • Before patient contact, including between different patients
    • After contact with anything contaminated
    • During patient care:
      • Before & after invasive procedure
      • Before & after contact with wound
      • Between procedures on different parts of same patient
      • Between glove changes
      • Immediately if skin is contaminated or an injury occurs
  • Proper Hand Washing
    • Wet hands with warm (not hot) water
    • Apply soap on hands
      • Liquid soap is better (germs can live on wet soap bars)
    • Rub hands together for at least 15 seconds
      • Wash longer if there is visible dirt on hands
      • Cover all surfaces of hands & fingers - including between fingers, backs of hands, thumbs, under fingernails
    • Rinse hands thoroughly with warm water
    • Dry hands thoroughly
      • If using air dryer, push button with elbow
      • If available, use towel to turn off water
    • What song is about 15 seconds long….
    • Source: Hand Hygiene Resource Center http://www.handhygiene.org/
  • Where do we miss?
  • Hand Hygiene (cont.)
    • Alcohol sanitizers
      • 62% ethyl alcohol
      • Accepted as effective under certain conditions
      • Should not be used when there is visible dirt or grime!
  • Good Work Place Practices (cont.)
    • Eating & drinking prohibited in all clinical areas
    • Do not wear jewelry in clinic areas
  • Hair
    • Hair should be short & well-managed
    • Long hair should be pulled back or completely covered with a surgical cap to minimize the possibility of contamination
    • Beards, mustaches, or other facial hair must be neatly trimmed to fit under the mask
  • Fingernails
    • Fingernails must be short to help prevent collections of microbes & tears in gloves
    • C o l o r e d nail polish is prohibited
      • May obscure soil under the nails
    • False fingernails are prohibited
  • Blood (or OPIM) Spill Clean up
    • Wear appropriate PPE & clean up all blood (or OPIM) spills with a 10% bleach solution or another EPA-approved disinfectant
    • Apply disinfectant to perimeter of spill
      • Slowly proceed inwards
    • Allow at least 15 minutes of disinfectant contact time
    • Be careful of sharps! Remove any sharps from the spill (after disinfectant contact time) using forceps & discard in sharps container
    • Slowly wipe up spill, working from the perimeter of the spill inwards; clean area with disinfectant again
    • Materials used to clean up the spill (e.g., towels) should be disposed in biohazard container
  • Biological Waste Disposal
    • Blood, saliva or OPIM saturated items must be discarded in biohazard bags at chairside
    • Biohazard bags must be maintained in hard-walled, leakproof, secondary containment
    • Small biohazard bags must be discarded in larger biohazard bags (at the dispensary)
  • Biological Waste Disposal
    • Place sharps in appropriate hard-walled, leakproof sharps container
      • Do not overfill (no more than ¾ full), see “fill line”
      • Call for pickup – UTHSC-H Waste Line 713-500-5837
  • Regulated Medical Waste
    • Contaminated waste disposal
    • Sharps disposal
    • In compliance with OSHA, DSHS & TCEQ
  • Injury/Potential Exposure
    • Stop procedure
    • Apply routine first aid immediately
      • Clean site of injury with soap or antiseptic & flush with warm water for at least 15 minutes
      • Flush mucous membranes with water or saline for at least 15 minutes
    • DO NOT dismiss patient
    • Report incident to nearest dispensary
      • Notify supervisor
      • Complete “Supervisor’s First Report of Injury” form
      • Seek medical attention
  • Injury/Potential Exposure
    • REMEMBER!
    • If you have received a puncture or laceration injury from a contaminated needle or instrument…
    • REMOVE THE ANESTHETIC SYRINGE OR INSTRUMENT FROM CASSETTE – DO NOT REUSE INSTRUMENT !
  • Injury/Potential Exposure “ Please wait here for a few minutes” DO NOT DISMISS THE PATIENT!
  • Medical Surveillance
    • Baseline Labs
      • HIV antibody (with consent)
      • RPR (Syphilis)
      • Hepatitis B surface antibody
      • HCV antibody
        • If source is known to be Hepatitis C + , also obtain a liver function & HCV RNA tests
      • CBC with differential & platelets, chemistry profile, urine pregnancy test if source is known HIV + and if exposed personnel chooses to utilize post-exposure prophylaxis
    • Hepatitis B Vaccination
    • Tuberculin skin test, Quantiferon test
  • Rights
    • In the event of a potential exposure to BBP, the person is entitled to:
      • Confidential medical evaluation & follow-up
        • UT Student or Employee Health Services Clinic
      • Documentation of routes of exposure
      • Identification, documentation, testing & results of the source individual
        • Source blood draw for testing
      • Counseling
      • Evaluation of reported illness
  • Record Keeping
    • Medical records related to exposure incidents must be retained for duration of employment plus 30 years
    • Training records must be maintained for three years
  • Tuberculosis
    • Caused by Mycobacterium tuberculosis
    • Spread by airborne droplets – coughing, sneezing, speaking
    • Also considered to be bloodborne
  • Patient Assessment for Risk of Tuberculosis
    • Routinely ask all patients:
      • Do you have a history of TB disease?
      • Do you have symptoms suggestive of TB?
  • TB Presentation & Isolation
    • Cough
    • Chest Pain
    • Coughing up blood
    • Weakness
    • Fever or night sweats
    • Weight loss
  • Patients with History or Symptoms of Undiagnosed TB
    • Should be referred promptly for medical evaluation of possible infection
    • Should not remain in the dental facility any longer than required to arrange a referral
    • Should wear surgical mask while in the dental facility
    • Should have urgent dental care provided in areas that can provide TB isolation
  • Patients with History or Symptoms of Undiagnosed TB (cont.)
    • Should have elective dental treatment deferred until a physician confirms that the patient does not have infectious TB
    • If diagnosed as having active TB, elective dental treatment should be deferred until no longer infectious
  • Methicillin Resistant Staphylococcus aureus (MRSA)
    • Responsible for “difficult-to-treat infections”
    • Multiple- or multidrug-resistant (MRSA), or oxacillin-resistant (ORSA) bacteria
    • Resistant to beta-lactam antibiotics:
      • Methicillin
      • Dicloxacilliln
      • Nafcillin
      • Oxacillin
  • Methicillin Resistant Staphylococcus aureus (MRSA)
    • According to CDC, each year:
      • Over 94,000 people develop a serious MRSA infection
      • Nearly 19,000 die from serious MRSA infections
  • Staphylococcus (Staph.) Bacteria
    • Most common cause of skin infections
        • Most are minor (pimples, boils)
        • Some can be serious (surgical wound infections, blood stream infections, & pneumonia)
    • Nose colonization in 25 - 30% of population
    • MRSA colonization in ~ 1% of population
  • Staph. Skin Infection Wounds
  • What Does “Colonized with MRSA” Mean?
    • MRSA is present in or on the body, but is not causing infection
    • Colonized individuals are the main source of infection for susceptible individuals
  • Transmission
    • Most common source
      • Individuals who have MRSA but do not have symptoms (i.e., colonized with MRSA)
    • Main mode of transmission
      • Through human hands (especially health care workers hands)
  • Who Gets Serious MRSA Infections?
    • Individuals with compromised immune systems are susceptible to serious MRSA infections
    • Colonized individuals can be the source of MRSA for immunocompromised patients in the dental office
  • MRSA in Dentistry - What is Our Responsibility?
    • Prevent transmission of MRSA in dental settings
    • Frequent handwashing
    • Sterilization of instrumentation
    • Appropriate use of disinfectants & barriers
    • Prescribe responsibly
  • Seasonal or Pandemic Flu
    • Person to person transmission by:
      • Coughing, sneezing, spitting
      • Droplets from infected person on
        • Hands
        • Environmental surfaces
          • Table tops, door knobs, handrails, phones
      • Droplets reach uninfected person
        • Directly from coughing, sneezing, spitting
        • Hand shakes
        • Touching contaminated environmental surfaces
  • Help Prevent Flu Transmission
    • Cover your mouth & nose with a tissue when you cough or sneeze
    • Cover your mouth & nose with your upper sleeve (not your hands), if you do not have a tissue & need to cough or sneeze
    • Wash your hands as soon as possible after coughing, sneezing, or blowing your nose
    • Practice social distancing during flu season or a flu pandemic
  • Help Prevent Flu Transmission (cont.)
    • Keep surfaces touched by more than one person clean & disinfected (door knobs, handrails)
    • Remember to clean first & then disinfect
    • Wash your hands frequently & always before eating
    • Carry alcohol-based (60 – 95%), sanitizing hand wipes or gel with you to disinfect your hands
    • Teach your children to practice good hand hygiene
      • Flu is often transmitted at school
  • Pandemic Preparedness
    • UTHSC-H has an appointed Task Force that includes input from:
      • Harris County Health Dept.
      • City of Houston Health Dept.
      • TMC
      • Memorial Hermann Hospital
  • Pandemic Preparedness: How to protect yourself
    • Get vaccinated for seasonal flu
    • Wash hands frequently
    • Practice & teach cough etiquette
    • Practice social distancing
      • Avoid close contact with sick people
      • Avoid close contact if sick
      • Stay home if sick!
  • Dental Unit Waterlines & Biofilm
    • Microbial biofilms form in small bore tubing of dental units
    • Biofilms serve as a microbial reservoir
    • Primary source of microorganisms is municipal water supply
  • Dental Unit Water Quality
    • Using water of uncertain quality is inconsistent with infection control principles
    • Microbial counts in water from untreated systems can exceed 1,000,000 CFU/mL ( CFU = colony forming unit)
    • Untreated dental units cannot reliably produce water that meets drinking water standards
  • Dental Unit Water Quality (cont.)
    • For routine dental treatment, meet regulatory standards for drinking water:
        • < 500 CFU/mL of heterotrophic water bacteria
    • ADA standards:
    • < 200 CFU/mL of heterotrophic bacteria
  • Dental Unit Water Quality (cont.)
    • ICX Tablets
    • Available on gray cabinets at the back of the bays
    • Instructions posted in each cubicle
  • Dental Unit Water Quality (cont.)
    • ICX Tablets
    • Rinse empty water bottle with tap water
    • Prior to rinsing, make sure the water from tap has run for at least 30 seconds or until clear
    • Add one tablet of ICX to empty water bottle – avoid touching the tablet
    • Fill bottle with tap water
    • Wait 60 seconds for tablet to fully dissolve
  • Fire Alarm Design
      • Stop patient procedure
      • Send one person to emergency exit to listen to announcement, & ask that person to tell you if there is a need to evacuate
      • Alarm sounds on involved floor, & floor immediately above & below
      • If fire discovered, alarm will sound in entire building
      • If you see smoke or fire, evacuate immediately using the nearest stairwell exit
    1 2 3 4 5 6 7 8 9
  • Safe Handling & Ergonomics
    • Squat down, bending at the hips & knees only.
    • Press your chest straight forward. This helps keep your upper back straight while maintaining a slight arch in your lower back.
    • Slowly lift by straightening your hip & knee joints (not your back).
    • Hold the load as close to your body as possible, at naval level of your navel.
    • Set down your load carefully, squatting with the knees & hips only.
    • Do not attempt to lift or set down by bending forward at the waist.
    • Avoid turning or twisting your body while holding a heavy object.
    • Work with objects at a surface near waist high, rather than bending to the items on the floor.
  • X-Ray & Laser Safety
    • Special training is available for personnel that will use X-Rays & Lasers
    • Programs are available for individuals who are pregnant
  • Contact Information
    • General safety concerns, emergency response (including after hours)
      • Ext. 5832
    • Hazardous waste
      • Ext. 5837
    • Environmental Health & Safety
      • Ext. 8100 (Main number)
  • Resources
    • UTHSC-H Dental School Clinic Manual
      • www.db.uth.tmc.edu/clinicpat/Documents/Clinic_Manual.pdf
    • UTHSC-H Biological Safety Manual
      • www.uth.tmc.edu/safety
    • OSHA
      • www.osha.gov
    • CDC
      • www.cdc.gov
  • Resources (cont.)
    • ADA
      • www.ada.org
    • DSHS
      • www.dshs.state.tx.us
    • TCEQ
      • www.tceq.state.tx.us
  • Questions??