In addition to previous formal instruction in a university or college dental program, it is important that all OHCWs receive office-specific training in infection prevention and control as part of their orientation and whenever new tasks, procedures or equipment are introduced. This training should be supplemented whenever necessary and reviewed at least annually by means of staff meetings, attendance at continuing education courses and through self-learning programs.
All OHCWs should receive training that includes information about their exposure risks, infection prevention and control strategies specific to their occupational tasks, and the management of significant exposures to blood or blood contaminated saliva and/or blood splatter.
It is also recommended that the College’s Guidelines, as well as key reference materials identified in it, form part of an in-office infection prevention and control manual.
All OHCWs should be adequately immunized against hepatitis B, measles, mumps, rubella, varicella, influenza, diphtheria, pertussis, tetanus and polio. It is important that all OHCWs know their immunization status and ensure that it is up-to-date. OHCWs should consult with their family physicians about the need for immunization, as well as baseline and annual tuberculosis skin testing.
Yes. Hepatitis B is the most important vaccine-preventable infectious disease for all workers engaged in health care. Immunization against HBV is strongly recommended for all OHCWs who may be exposed to blood, body fluids or injury involving sharps.
The OHCW should complete a second vaccination series, followed by retesting for anti-HBs. OHCWs who fail to respond to the second vaccination series should be tested for HBsAg.
Non-responders to vaccination who are HBsAg-negative should be counselled regarding precautions to prevent HBV infection and the need to obtain immunoglobulin prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood.
Safe recapping of a needle is preferred to prolonged exposure to an unprotected needle. Therefore, following use, needles should be recapped as soon as possible by using a one-handed scoop technique or a commercial recapping device.
Blood-borne pathogens, such as HBV, HCV and HIV, can be transmitted to OHCWs through occupational exposures to blood, saliva and other body fluids. Significant exposures include percutaneous injuries with contaminated needles, burs or other sharp instruments, as well as accidents in which blood, saliva or other body fluids are splashed onto non-intact skin or the mucosa of the eyes, nose or mouth. However, percutaneous injuries pose the greatest risk of transmission of blood-borne pathogens to OHCWs.
In the event of a significant exposure, immediate first-aid measures should be instituted:
For percutaneous injuries, allow the wound to bleed briefly and freely. Then, gently wash the wound with soap and water, and bandage as needed.
For exposures involving the eyes, nose or mouth, flush the area with copious amounts of water.
For exposures involving non-intact skin, wash the site with soap and water.
The dentist should then assess the source patient’s status and risk for blood-borne illnesses by reviewing the patient’s medical history and, if necessary, asking them additional questions.
Reasonable efforts should be made to obtain the patient’s informed consent to be tested for HBV, HCV and HIV. This can be accomplished by referring the patient to her/his family physician for consultation, assessment of risk factors and any blood tests that are considered necessary.
At the same time, the injured OHCW should be referred to their family physician, and infectious disease specialist or hospital emergency department for counselling, baseline blood test and, if deemed necessary, post-exposure prophylaxis and/or administration of immunoglobulins.
If necessary, post-exposure prophylaxis should be administered as soon as possible. For example, in the event of a high-risk exposure to HIV infection, anti-retroviral drugs should be administered within hours.
Critical and semi-critical instruments should be processed in a manner that will maintain sterility during storage. Suitable packaging materials include wrapped, perforated instrument cassettes; peel pouches of plastic or paper; and woven and nonwoven sterilization wraps.
Biological indicators (or spore tests) are the most accepted means for monitoring of sterilization, because they directly assess the procedure’s effectiveness in killing the most resistant micro-organisms. According to the College’s IPAC Guidelines, a biological indicator should be included each day a sterilizer is used.
Mechanical indicators are the gauges or displays on the sterilizer for cycle time, temperature and pressure. Some tabletop sterilizers have recording devices that print out these parameters, which is preferred. Mechanical indicators should be checked and recorded for each load.
Chemical indicators (i.e. internal and external) use sensitive chemicals to assess physical conditions during the sterilization process. For example, heat-sensitive tape, applied to the outside of a package, changes colour rapidly when a given temperature is reached. This signifies that the package has undergone a sterilization cycle, although it does not ensure that sterilization has been achieved.
Each package must have external and internal chemical indicators.
The daily operation of every sterilizer must be reviewed and documented. A logbook should be kept for this purpose. Any malfunction must be noted and appropriate action taken.
All critical and semi-critical instruments used in dentistry, including handpieces, are available in heat-tolerant and/or single-use (disposable) forms. All heat-tolerant critical and semi-critical instruments must be heat-sterilized between uses. All single-use items must be disposed following use.
Hands should be washed with plain or antimicrobial soap and running water:
When hands are visibly soiled (including with powder from gloves) or contaminated with body fluids;
Following personal body functions.
If hands are NOT visibly soiled (i.e. the majority of instances), the use of a 70-90% alcohol-based hand rub is the preferred method of hand hygiene. This includes:
Before and after direct contact with individual patients.
After contact with environmental surfaces, instruments or other equipment in the dental operatory.
After contact with dental laboratory materials or equipment.
Before eating or drinking.
Use professional judgement for either procedure. If you think your hands have accidentally become contaminated with body fluids, wash with soap and water to remove organic matter. However, there is sufficient evidence that alcohol-based hand rubs are superior to washing with soap and water, except in cases where the hands are visibly soiled or contaminated with body fluids.