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Chapter 16: Aseptic Techniques
1.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Aseptic Techniques Chapter 16 1
2.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Learning Objectives Lesson 16.1: Aseptic Techniques 1. Describe how to limit the spread of disease agents from the hands to environmental surfaces and from dental aerosols and spatter. 2. Describe the importance of the high-volume evacuator in infection control and how to change a high-volume evacuator trap safely. 3. Describe the proper use of the saliva ejector and rubber dam. 2
3.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. 4. Describe the use of preprocedure mouth rinses. 5. Describe the proper use of disposable items. 6. Describe proper housekeeping and cleaning considerations, as well as other aseptic techniques. 3 Learning Objectives Lesson 16.1: Aseptic Techniques (Cont.)
4.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Limited Touching of Surfaces Gloves used for patient care are contaminated Touch as few surfaces as possible with saliva- or blood-coated fingers 4
5.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Limited Touching of Surfaces Surfaces that may be touched should be protected with surface covers or precleaned and disinfected. Dispense all items needed at chairside before patient care begins. This task reduces the need for leaving chairside with contaminated gloves, mask, and protective clothing, which may spread contamination to other parts of the office. 5
6.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Limited Touching of Surfaces Removal of contaminated gloves or use of an overglove before leaving chairside during patient care is the best practice. Put on gloves or carefully remove and discard overgloves when returning to chairside. Another alternative is to have an uninvolved person retrieve items needed unexpectedly during patient care, which is particularly important during some types of surgery (e.g., implant surgery). 6
7.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Minimizing Dental Aerosols and Spatter Dental aerosols and spatter are generated during use of high- and low-speed handpieces, ultrasonic scalers, and the air/water syringe 7
8.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Minimizing Dental Aerosols and Spatter What are dental aerosols? Dental aerosols and spatter are small, invisible particles of saliva that may contain a few microorganisms and may be inhaled or remain airborne for extended periods. Aerosol particles are less than 50 µm in diameter, and the smallest ones of 5 µm in diameter can be inhaled to the depths of the lungs (air sacs or alveoli). 8
9.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Minimizing Dental Aerosols and Spatter Spatter consists of particles larger than 50 µm. When these particles are propelled from the patient’s mouth, they settle rapidly or land on nearby operatory surfaces or the face, neck, chest, and arms of the dental team member providing care to the patient. Minimizing the generation of dental aerosols and spatter by use of high-volume evacuation and the rubber dam and by proper positioning of the patient’s head reduces the spread of microbes from the patient’s mouth. 9
10.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. High-Volume Evacuation When rotary equipment and the air/water syringe are used, HVE greatly reduces the escape of salivary aerosols and spatter from the patient’s mouth 10
11.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. High-Volume Evacuation The HVE system should be cleaned at the end of the day by evacuating a detergent or water-based detergent-disinfectant through the system, but not bleach (sodium hypochlorite) because this chemical can destroy metal parts in the system. After flushing, remove and clean the trap in the system periodically. A safer approach, however, is to use a disposable trap. These traps may contain scrap amalgam that should be disposed of properly. 11
12.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. High-Volume Evacuation The dental team member must wear gloves, masks, protective eyewear, and protective clothing when cleaning or replacing these traps to avoid contact with patient materials in the lines from splashing and direct contact. 12
13.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Proper Use of Saliva Ejector Previously suctioned fluids might be retracted into the patient’s mouth when a seal around the saliva ejector is created Do not tell patients to close their lips around the ejector and “spit” into the tip Never position the vacuum line above the patient’s head for this could allow flow of materials in the line toward the tip 13
14.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. The seal can cause a type of “suck back” or reverse flow in the vacuum line that might allow the contents of the line to reach the patient’s mouth. Although disease spread, if this occurs, has not been demonstrated, reverse flow should not be allowed to happen. Thus one should not tell patients to close their lips around the ejector and “spit” into the tip. Alternatively, some disposable saliva ejector tips now have a small hole in the side that relieves the pressure when the tip is closed off, preventing reverse flow. Others have a closable valve that prevents backflow. 14
15.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Use of the Rubber Dam Reduction in microorganisms escaping a patient’s mouth in aerosols or spatter can approach 100% with proper use of the rubber dam 15
16.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. What is a rubber dam? A thin square of latex rubber Simultaneous use of HVE and the rubber dam provides the best approach to minimize dental aerosols and spatter. A sealant is also available for placement at the rubber dam–tooth interface to reduce further the leakage of saliva into the operative site. Because the rubber dam reduces the amount of - saliva present at the operative site, less saliva is available for retraction into water spray handpieces or air/water syringes if antiretraction valves in the dental unit fail. 16
17.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Preprocedure Mouth Rinses The application of antiseptics to skin or mucous membranes before surgery or injections has been practiced for many years The use of an antimicrobial mouth rinse is based on a similar principle: It reduces the number of oral microorganisms 17
18.
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Elsevier Inc. All Rights Reserved. This reduction also lowers the number of microorganisms that may escape a patient’s mouth during dental care through aerosols, spatter, or direct contact. Although studies have not yet shown that the aseptic technique of preprocedure mouth rinsing actually prevents diseases in dental team members, studies have shown that a mouth rinse with a long- lasting antimicrobial agent can reduce the level of oral microorganisms for up to 5 hours. Use of nonantimicrobial mouth rinses allows the oral microorganisms to return to their original levels before most dental procedures are completed, thus having little infection control value. 18
19.
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Elsevier Inc. All Rights Reserved. Use of Disposables A disposable item is manufactured for a single use or for use on only one patient Not heat tolerant Not to be cleaned 19
20.
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Elsevier Inc. All Rights Reserved. Use of Disposables These items are manufactured from plastics or less expensive metals. Thus, an item that is labeled as disposable must be disposed of properly after use, and should not be precleaned and sterilized or disinfected for reuse on another patient. 20
21.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Use of Disposables A single-use device (SUD) is a device originally cleared by the Food and Drug Administration (FDA) for a single use on one patient. If one wishes to reprocess an SUD, the FDA now requires one to meet the same good manufacturing standards used by the original manufacturer. Determination of cost-effectiveness of disposables or reusables must include the cost of the items and also the labor dollars required to decontaminate the reusable items. 21
22.
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Elsevier Inc. All Rights Reserved. Disposable Items 22
23.
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Elsevier Inc. All Rights Reserved. Disposable Items (Cont.) 23
24.
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Elsevier Inc. All Rights Reserved. Disposable Items (Cont.) 24
25.
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Elsevier Inc. All Rights Reserved. Housekeeping and Cleaning Dusting of surfaces or sweeping of floors in patient-care areas can distribute microorganism-laden dust particles to other surfaces unless performed with a wet cloth or wet mop 25
26.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Housekeeping and Cleaning Properly clean mops and cloths after use and allow them to dry before reuse, or use single- use, disposable mop heads or cloths. Mop water should contain a low-level disinfectant to keep microorganisms from building up in the water and being painted onto the floor. The filters in air vents and furnaces require frequent changing to avoid dust buildup. 26
27.
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Elsevier Inc. All Rights Reserved. Housekeeping and Cleaning A smooth-surface floor rather than carpeting is more appropriate for patient-care areas because of its cleanability and lesser likelihood of accumulating dust and dirt. Avoid using carpeting and cloth-upholstered furnishings in the dental operatory, laboratory, or instrument-processing areas. 27
28.
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Elsevier Inc. All Rights Reserved. Other Aseptic Techniques There are many other things to consider in dentistry concerning aseptic techniques Aseptic techniques with regard to instrument processing Unit dosing and sterile retrieval system 28
29.
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Elsevier Inc. All Rights Reserved. Other Aseptic Techniques High-speed handpiece processing involves the spraying of cleaner/lubricant into the drive air line and flushing excess lubricant out by connecting the dental unit air system on an air line installed in the sterilizing room. Flush the air system so that the aerosol is not released into the air environment by flushing directly into the vacuum system or into a sink with water or a container with absorbent material that will catch the spray. 29
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