Prevention of Disease Transmission in Oral Health Care
Preventing disease transmission in dental hygiene practice requires an understanding of the control of microbial contamination, infection, and disease in the oral health care environment. Implementing and practicing protective measures from the perspective of standard precautions is essential.
Modified from Miller CH, Palenik CJ: Infection control and management of hazardous materials for the dental team, ed 4, St Louis, 2010, Mosby.
d. Personal protective equipment (PPE)—items designed to protect oral health care workers (OHCWs) from exposure to bloodborne and other pathogens (e.g., gloves, masks, safety glasses, face shields, and barrier gowns)
e. Standard precautions—treating all blood and bodily fluids (including secretions and excretions, except sweat), nonintact skin, and mucous membranes as potentially infectious in all clients; in the oral health care setting, saliva is an important source of contamination, as it is invisible but capable of containing infectious agents that can survive on surfaces for a long period
Data from US Department of Labor, Occupational Safety and Health Administration: Controlling occupational exposure to bloodborne pathogens, Washington, D.C., 1996, 2001, OSHA 3127 (revised).
2. Address specific questions related to present health status, physician care, hospitalizations, surgery, diseases, medications, allergies, current or chronic illness, review of major organ systems, and recent overseas travel
3. Be aware that obtaining health histories will not identify all infectious clients; clients may suppress information purposely or unknowingly (many persons with hepatitis B virus [HBV], hepatitis C virus [HCV], and human immunodeficiency virus [HIV] are asymptomatic)
c. Prophylactic antibiotic premedication to reduce the incidence of autogenous infections, that is, conditions caused by introducing the microflora of clients into injured tissues (e.g., bacteremia, abscess)
5. The Centers for Disease Control and Prevention (CDC) recommends conducting a tuberculosis risk assessment for an oral health care setting and then formulating a prevention program appropriate for its designated risk category; most dental settings will be low or very low risk
3. Immunizations are recommended for the following diseases, unless evidence of past infection and immunity: hepatitis B, varicella zoster, influenza, measles, mumps, polio, rubella, tetanus, influenza A (H1N1); consult with a primary care physician before vaccination, as some vaccines are contraindicated for immunocompromised and pregnant persons
(4) Seroconversion rates are 95% to 97% in healthy younger adults; lower rates (approximately 70%) in persons over 40 years old, smokers, overweight persons, and those receiving injections in the buttocks
(2) Transient flora contaminate hands when hands touch contaminated surfaces. This type colonizes the outer layers of skin, only survive for a limited time, and can be easily removed by routine handwashing
6. Hands must be washed after removal of gloves because defects, tears, and punctures may occur in gloves, permitting microorganisms to be transferred to hands; this also helps remove glove powder, which contains latex protein and other glove chemicals that can elicit irritant contact dermatitis or an allergic reaction in sensitized individuals
8. Nails must be kept short and clean and the cuticles well maintained; artificial nails and nail jewelry are not recommended, since current research has implicated them in disease transmission in hospitals
10. OHCWs who have open or weeping lesions or dermatitis on hands should not provide client care until the condition resolves, since dermatitis reduces the effectiveness of handwashing and nonintact skin provides a portal of entry for microorganisms
(1) Prevents direct contact with microorganisms in the client’s mouth and on contaminated surfaces (bare hands often will have areas of nonintact skin providing portals of entry for pathogenic microorganisms)
(2) If it is necessary to leave the chairside during client care, remove gloves, and after hand hygiene, don a new pair on returning (prevents contamination of additional surfaces one may touch and also prevents contamination of the client with microorganisms that already may be present on those surfaces)
(1) Nonsterile, ambidextrous gloves in sizes extra-small, small, medium, and large are adequate for most procedures; proper glove fit is important to ensure efficient instrumentation and to prevent hand fatigue and possibly carpal tunnel syndrome
(c) Symptoms: skin (hives, swelling, burning, tightness, itching, redness, tingling), lungs (asthma, wheezing, constriction, coughing, sneezing, rhinitis, angioedema), and other (nausea, vomiting, diarrhea, cramps, hypertension, tachycardia, shock)
(e) High-risk individuals for latex allergy include: persons who have had multiple surgeries and persons with spina bifida, urogenital anomalies, spinal cord injuries, and allergies to bananas, kiwis, chestnuts, or avocados
(f) Reductions in exposure to latex proteins are known to decrease sensitivity (important for OHC team to reduce their daily exposure to airborne latex proteins by wearing powder-free, reduced-protein latex or latex-free gloves)
(3) May protect client from microorganisms on street clothing or may provide protection against disease transmission when soiled protective clothing is changed between clients (fomites—clothing and paper that can absorb and transmit infectious agents)
1. Critical—instruments that penetrate oral soft tissue or bone, enter the bloodstream, or enter other sterile tissues of the mouth (e.g., curet); must be heat sterilized or be single-use (disposable) devices (SUDs)
2. Semi-critical—items that come in contact with mucous membranes (used in the mouth) but will not penetrate soft tissue, contact bone, enter the bloodstream, or enter other sterile tissues of the mouth (e.g., radiographic film holders)
‡The Centers for Disease Control and Prevention (CDC) indicates that low-level disinfectants can be used on clinical contact surfaces if the product has a label claim of killing human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in addition to being an EPA-registered hospital disinfectant.
Modified from Centers for Disease Control and Prevention: Guidelines for infection control in dental health-care settings, Morbidity and Mortality Weekly Report 52(RR-17):1–66, 2003.