Exposure Control:Exposure Control:Barriers for Barriers for

Patient and ClinicianPatient and Clinician

Immunizations and Immunizations and Periodic TestingPeriodic Testing

Basic Immunizations:Basic Immunizations: Hepatitis A, BHepatitis A, B DiphtheriaDiphtheria TetanusTetanus PertussisPertussis Influenza type BInfluenza type B Measles, mumps, Measles, mumps,

rubella (MMR)rubella (MMR) VaricellaVaricella MeningococcalMeningococcal

Boosters:Boosters: May occur upon May occur upon

exposureexposure

Adult Recommendations: Tetanus and Tetanus and

diphtheria diphtheria =every 10 years=every 10 years

Annual influenzaAnnual influenza Annual TB skin Annual TB skin

testtest

ReviewReview

Which of the following should be done annually?Which of the following should be done annually?A) Tuberculin skin test (Mantoux)A) Tuberculin skin test (Mantoux)B) Influenza vaccineB) Influenza vaccineC) HBV vaccine boosterC) HBV vaccine boosterD) Tuberculin skin test and influenza vaccineD) Tuberculin skin test and influenza vaccineE) HBV booster, tuberculin skin test, and influenza E) HBV booster, tuberculin skin test, and influenza

vaccinevaccine

AnswerAnswer

D) Tuberculin skin test and D) Tuberculin skin test and influenza vaccineinfluenza vaccine

The tuberculosis skin test needs to The tuberculosis skin test needs to be done annually as well as the be done annually as well as the influenza (flu) vaccine. The HBV influenza (flu) vaccine. The HBV vaccine does not have a vaccine does not have a specified booster schedule.specified booster schedule.

Personal Protective Personal Protective Equipment(PPE)Equipment(PPE)

1.Clinical attire: Gown1.Clinical attire: Gown Hair: Pulled back from field of vision Hair: Pulled back from field of vision 2.Face mask: pulled over nose and chin2.Face mask: pulled over nose and chin 3.Protective eyewear with side-shields3.Protective eyewear with side-shields 4.Gloves: changed often 4.Gloves: changed often OSHA Recommendations: Occupational OSHA Recommendations: Occupational

Safety and Health AdministrationSafety and Health Administration Protects the worker from physical, chemical or Protects the worker from physical, chemical or

infectious hazards in the workplace.infectious hazards in the workplace.

PPE’sPPE’s When is it appropriate to wear When is it appropriate to wear

personal protective gear?personal protective gear? A. When in contact with aerosols, A. When in contact with aerosols,

spatter, or body fluidsspatter, or body fluids B. When taking radiographsB. When taking radiographs C. Handling denturesC. Handling dentures D. All of the aboveD. All of the above

AnswerAnswer D. All of the aboveD. All of the above

What is OSHA?What is OSHA? Occupational Safety and Health Occupational Safety and Health

Administration Administration A government agency in the A government agency in the

Department of Labor to maintain Department of Labor to maintain a safe and healthy work a safe and healthy work environmentenvironment

Safety Data SheetSafety Data Sheet SDS: SDS: OSHA requires chemical OSHA requires chemical

products in the clinic and products in the clinic and company information be made company information be made available to all individuals in the available to all individuals in the work placework place

Contains: Contains: hazard chemical hazard chemical inventory of each product, exact inventory of each product, exact name, product number and name, product number and supplier’s name and addresssupplier’s name and address

Test your KnowledgeTest your Knowledge What does SDS mean?What does SDS mean? Where is it located?Where is it located?

AnswerAnswer Safety Data SheetSafety Data Sheet Dental clinic/front desk areaDental clinic/front desk area

Facial and Facial and Respiratory ProtectionRespiratory Protection

Use of a face maskUse of a face mask Mask efficiencyMask efficiency

Filtration: Filtration: 95% of particles as small as 95% of particles as small as 3 u3 u

Fit : Fit : cover entire nose and chin areacover entire nose and chin area Moisture absorption: Moisture absorption: change after change after

each patient and wore no longer than each patient and wore no longer than 1 hour1 hour

Comfort: supports complianceComfort: supports compliance Mask removal: graspMask removal: grasp side string side string

ReviewReview

When should the face mask be changed?When should the face mask be changed?A) Every hourA) Every hourB) When it becomes wetB) When it becomes wetC) For each patientC) For each patientD) For each patient, when it becomes D) For each patient, when it becomes

wet, and at least every hourwet, and at least every hour

AnswerAnswer

D) For each patient, when it becomes D) For each patient, when it becomes wet, and at least every hourwet, and at least every hour

A new face mask should be used with A new face mask should be used with each patient to prevent cross-each patient to prevent cross-contamination. The effectiveness of the contamination. The effectiveness of the face mask is compromised when wet face mask is compromised when wet and after use for an hour and should be and after use for an hour and should be changed accordingly.changed accordingly.

Protective EyewearProtective Eyewear Clinician protection: Clinician protection: prevent injury prevent injury

and infectionand infection Patient protection: Patient protection: prevent injury, prevent injury,

contact lens protectioncontact lens protection Features: Features: wide lens, side shieldswide lens, side shields Types of eyewear: Types of eyewear: goggles or goggles or

glasses (magnification loupes)glasses (magnification loupes) Eyewash station: Eyewash station: located in located in

disinfection area and dental disinfection area and dental materials labmaterials lab

Face ShieldFace Shield Worn over mask and safety Worn over mask and safety

glassesglasses Used during polishing and Used during polishing and

ultrasonic scalerultrasonic scaler

Required EyewearRequired Eyewear

Hand Care Hand Care Hands: means of transmission, Hands: means of transmission,

reservoir, port of entryreservoir, port of entry Hand care: Hand care: avoid breaks in cuticlesavoid breaks in cuticles Fingernails: Fingernails: Short, trimmedShort, trimmed Jewelry wear: Jewelry wear: traps bacteriatraps bacteria CDC 2012 guidelinesCDC 2012 guidelines

http://www.cdc.gov/handhygiene/

Handwashing PrinciplesHandwashing Principles Rationale: Rationale: prevent organisms prevent organisms

acquired from patient acquired from patient Purposes: Purposes: Reduce bacteria floraReduce bacteria flora Facilities: Facilities: foot control to avoid foot control to avoid

cross-contaminationcross-contamination Agents: Agents: antimicrobial soap or antimicrobial soap or

alcohol rub alcohol rub

““Handwashing is considered the most Handwashing is considered the most important single procedure for prevention important single procedure for prevention

of cross-contamination.”of cross-contamination.”

Dr. Esther M. WilkinsDr. Esther M. Wilkins

Indications for HandwashIndications for Handwash Before gloves placedBefore gloves placed After gloves removedAfter gloves removed Torn, punctured glovesTorn, punctured gloves After bare hands touch inanimate objectAfter bare hands touch inanimate object When visibly soiledWhen visibly soiled Entering and leaving operatoryEntering and leaving operatory

Types of HandwashTypes of Handwash

Routine HandwashRoutine HandwashWater and non-antibacterial soapWater and non-antibacterial soap

Antiseptic HandwashAntiseptic HandwashWater and antibacterial soapWater and antibacterial soap

Antiseptic Hand RubAntiseptic Hand RubAlcohol based rubAlcohol based rub

Gloving TechniqueGloving Technique Mask and eyewear placement: Mask and eyewear placement: prior to prior to

handwashing and glovinghandwashing and gloving

Preglove handwash:Preglove handwash:

Glove placement:Glove placement: Glove removal: Glove removal: wash promptly after wash promptly after

removalremoval

Factors Affecting Factors Affecting Glove IntegrityGlove Integrity

Torn, cut, or punctured gloves: Torn, cut, or punctured gloves: replacereplace

Length of time worn: Length of time worn: each new patient, no more than each new patient, no more than 1 hour, when they become sticky1 hour, when they become sticky

Size of glove: Size of glove: proper fit important for tactile sensitivityproper fit important for tactile sensitivity

Agents used in care provision: Agents used in care provision: vaseline, antiseptic vaseline, antiseptic handwash, and alcohol breakdown glove integrityhandwash, and alcohol breakdown glove integrity

Hazards from hands, jewelry: Hazards from hands, jewelry: long nails and ringslong nails and rings

Latex SensitivityLatex Sensitivity Clinical manifestations: dermatitis to anaphylaxisClinical manifestations: dermatitis to anaphylaxis

Individuals at riskIndividuals at risk: health care workers, multiple : health care workers, multiple surgeries, food allergiessurgeries, food allergies

Clinical management: patient may ask about our Clinical management: patient may ask about our clinic…latex free clinic…latex free

ReviewReview

Which of the following are at high risk of Which of the following are at high risk of developing a latex allergy?developing a latex allergy?

A) A person with spina bifidaA) A person with spina bifidaB) Healthcare workersB) Healthcare workersC) A person allergic to bananasC) A person allergic to bananasD) A person allergic to bananas, a person with D) A person allergic to bananas, a person with

spina bifida, and healthcare workersspina bifida, and healthcare workers

AnswerAnswer

D) A person allergic to bananas, a person with D) A person allergic to bananas, a person with spina bifida, and healthcare workersspina bifida, and healthcare workers

Individuals at high risk for latex sensitivity have Individuals at high risk for latex sensitivity have had frequent exposure to latex products; this had frequent exposure to latex products; this would include healthcare workers and would include healthcare workers and persons who have had multiple surgeries. persons who have had multiple surgeries. Also, persons with certain food allergies such Also, persons with certain food allergies such as avocado, banana, kiwi fruit, chestnuts, and as avocado, banana, kiwi fruit, chestnuts, and papaya are at higher risk for latex allergies.papaya are at higher risk for latex allergies.

Factors to Teach Factors to Teach the Patientthe Patient

Importance of medical history for Importance of medical history for patient and clinicianpatient and clinician

Necessity for personal protective Necessity for personal protective equipmentequipment

Importance of eye protection Importance of eye protection during clinical procedures during clinical procedures