Defines the approach to be taken for all patient care. Most HIV and HBV patients will go unidentified since about 80% show no symptoms and are unaware of their infectious disease state. Therefore, universal precautions will be used with all patients by assuming that all body fluids, contaminated instruments and materials are infectious.
All DHCWs, including laboratory personnel, who may be occupationally exposed to blood and saliva must receive the HBV vaccine or otherwise possess immunity due to prior exposure.
Review of each patient's current medical history will be done before the initiation of any dental exam or treatment.
A. Gloves
Sterile gloves shall be worn in connection with surgical procedures involving soft tissue and bone.
Medical exam gloves are to be worn whenever there is a potential for contact with blood, blood-contaminated saliva or mucous membranes. Wash hands prior to donning and after removing gloves. Gloves are to be changed for every new patient, and removed or covered if leaving the Dental Treatment Room (DTR). Medical gloves shall not be washed before or after use.
Heavy duty gloves shall be worn to process instruments before sterilization or high level disinfection.
B. Clinical Apparel
C. Masks/Face Protection: For all patient care, surgical masks & protective eyewear or chin length plastic face shields in conjunction with a mask are to be worn. After each patient and during patient treatment if applicable, masks shall be changed if moist or contaminated.
D. Eyewear: Protective eyewear is to be worn during all patient exams and treatment and in the decontamination room. Prescription eyewear may be worn with the addition of side shields. Patients should wear eye protection during dental treatment. The patient may wear their own glasses or alternative eye protection, e.g., safety goggles. All eyewear are to be cleaned & disinfected between patients.
E. Headwear: In surgical procedures or in the presence of significant aerosols, disposable protective headwear should be worn.
F. Eating or drinking in areas where aerosols are produced is prohibited, i.e., all DTR's. There will be no food or drink brought into or eaten in the CSR or treatment areas. This is specifically prohibited by OSHA regulations.
G. Ventilation and resuscitation devices should be in easy access to areas where the need for resuscitation is predictable. This minimizes the need for unprotected mouth-to-mouth resuscitation.
H. Sterilized packs, instruments, and decontaminated supplies and equipment are to be the only items stored and dispensed from CSR's.
A. Difficult to disinfect surfaces, and items such as, but not limited to light handles, bracket tables or X-Ray tubes are to be covered with impervious backed paper, plastic, aluminum foil, or clear plastic wrap. Patient chairs may be covered with a large plastic bag that is placed over the entire chair, armrest, and controls. Between patients, the covers must be removed, discarded, and replaced with a clean covering.
B. Whenever possible, supplies and equipment should be dispensed in unit dose packages, e.g., cassettes, individual instruments, burs, gauze, and cotton rolls can all be distributed in unit doses for a given patient procedure.
C. Handpieces are to be sterilized for each patient treatment appointment. If no self-purging capabilities are on the dental unit, lines are purged with air or flushed with water for at least 2 minutes at beginning and end of the day; also for 30 seconds between patients. This is done before sterile handpieces, scalers & other devices are attached. End-of-day protocol includes air purging all water lines for 30-60 seconds.
D. Anti-retraction valves (one-way flow valves) in dental unit water lines shall be installed and maintained.
A. To decrease the infectivity of an aerosol, have patients brush their teeth, rinse with mouthwash or chlorhexidine gluconate 0.12% (Peridex) for 30 seconds before dental treatment. This reduces the microbial concentration of their oral flora.
B. Sterile coolant/irrigants shall be used for surgical procedures involving soft tissue or bone. Sterile coolant/irrigants are deemed sterile when delivered using a device or process that has a Food and Drug Administration (FDA) marketing clearance for delivery or sterile/coolant irrigants to the patient. Delivery of sterile coolant/irrigants shall be in accordance with the manufacturer's directions.
C. Use dental dam and high velocity evacuation whenever possible.
D. Organize all necessary items prior to seating patient.
E. The unit dose concept is mandatory when dispensing cotton and gauze supplies. No open cotton and gauze supplies are to be kept in the DTR.
F. Use single-handed re-capping techniques or needle capping devices for safe management of needles.
G. No gloves are to be worn (unless over-gloves are utilized) while viewing and handling radiographs, making notation of dental records or taking photographs.
A. Utility gloves are always worn while handling contaminated materials or cleaning contaminated surfaces, equipment, or instruments.
B. All non-sharp, contaminated disposable materials will be placed in proper waste containers.
C. All used disposable sharps will be placed in sharps containers located in the DTR. Disposable sharps are defined as needles, scalpel blades, suture needles, matrix bands, and anesthetic carpules. Never bend, break or re-cap needles by hand; use the single-handed scoop technique or needle capping device.
D. All needles are to remain capped when not in use.
E. No preloaded syringes will be left stored and open in the anesthesia tray for a future patient.
F. Sharps containers are to be replaced when they are three-quarters full and disposed of according to waste management guidelines. (Chapter Nine).
G. Close instrument cassettes after re-assembling all used instruments in proper order. Remove handpieces from couplings. Transport to CSR for processing and sterilization.
H. Invert large plastic bag covering chair and place all disposable items used on the patient into the inverted bag. Tie off the bag at the top.
I. All biohazardous and infectious waste will be placed into separate red infectious waste bags and containers. These are disposed of according to waste management guidelines.
J. All unprotected high-touch areas are to be disinfected with an intermediate level EPA registered ADA approved disinfectant using the spray, wipe, spray method. The initial spray-wipe is to remove all debris before disinfection for the appropriate time specified by the manufacturer after the final spray.
K. Pre-clean & surface disinfect bottles, jars, plastic boxes, etc. before replacing in storage.
L. Disinfect all eyewear protection.
M. Remove gloves and wash hands and any possibly exposed skin surfaces.
N. Remove face mask, handling it only by the cloth tie or by the elastic strings never touching the mask itself.
A. Follow steps VII A-N above.
B. Flush evacuation system by suctioning each hose with hot water for several minutes.
C. Spray, wipe, spray the countertops, dental unit, chair and light.
Inspect, clean, and disinfect on a regular basis all trays, bins, drawers, pails, cans or receptacles that have the potential for contamination with blood or other potentially infectious materials. Disinfect and clean these containers immediately or as soon as possible upon visible contamination.
PERIODONTICS INFORMATION CENTER