Safety Standards and Infection Control for Dental Hygienists

by Dietz-Bourguignon,Ellen

• ISBN13: 9780766826601
• ISBN10: 0766826600
• Format: Paperback
• Copyright: 2001-12-21
• Publisher: Cengage Learning

Summary

Dental Hygienists preparing for certification boards now have the ideal reference for reviewing the Infection Control Procedures. Safety Standards and Infection Control for Dental Hygienists presents thorough coverage of the safety standards and infectious disease prevention in five key areas: Microbiology and Disease Prevention Specific to Dentistry, National Guidelines, Recommendations, and RegulationsAffecting Dental Practice, Infection Control Techniques in the Dental Office, Environmental Health and Safety in the Dental Office, and Office Communications Regarding Infection Control. The detailed content is augmented by Skill Mastery Assessment questions at the end of each chapter to assess comprehension and retention of the material. Numerous hands-on procedures are included in the chapters, which hygienists can put into practice immediately. In addition, many useful charts and forms have been included that may be reproduced for training other members of the dental team. This is a must-have text for dental hygienists to ensure that they are up to speed with the latest procedures to ensure their and their patients' safety.

Table of Contents

Foreword	xv
Preface	xvii
About the Authors	xix
Acknowledgments	xxi
SECTION I Microbiology and Disease Prevention Specific to Dentistry	1	(74)
Introduction to Microbiology	3	(22)
The Importance of Infection Control in the Dental Office	4	(1)
Maintaining Aseptic Technique	4	(1)
Members of the Dental Team Responsible for Infection Control	4	(1)
The Six Components in the Chain of Infection Control	4	(10)
Infectious Agents	6	(6)
Reservoir	12	(1)
Portal of Exit	13	(1)
Means of Transmission	13	(1)
Portal of Entry	13	(1)
Susceptible Host	14	(1)
Types of Infections	14	(1)
Endogenous	14	(1)
Exogenous	15	(1)
Nosocomial	15	(1)
Opportunistic	15	(1)
The Five Stages of Infectious Disease	15	(1)
Incubation Stage	15	(1)
Prodromal Stage	16	(1)
Acute Stage	16	(1)
Declining Stage	16	(1)
Convalescent Stage	16	(1)
The Immune System	16	(1)
Immunization	17	(1)
Diseases of Concern to the Dental Hygienist	17	(1)
Hepatitis	17	(3)
Tuberculosis	20	(1)
Herpesvirus	20	(1)
HIV Disease	21	(1)
AIDS	22	(3)
Disease Prevention in the Dental Office	25	(16)
Infection Control in Dentistry: Goals for Reducing Cross-Contamination	26	(1)
Ten Basic Principles of Infection Control	27	(4)
Patient Screening	27	(1)
Universal Precautions	28	(1)
Training of Employees	28	(1)
Aseptic Technique	28	(1)
Personal Protection: Hepatitis B Vaccine, Barriers, and Personal Protective Equipment (PPE)	28	(1)
Instrument and Handpiece Sterilization	29	(1)
Disinfection Procedures	30	(1)
Equipment Asepsis	30	(1)
Dental Laboratory Asepsis	30	(1)
Waste Management	31	(1)
Handwashing: The First Line of Defense in Disease Prevention	31	(2)
OSHA's Handwashing Requirements	32	(1)
Procedure Into Practice: Handwashing	33	(2)
General Handwashing Guidelines	35	(1)
Risk Reduction at Chairside	35	(6)
Preprocedural Antiseptic Mouthrinses	36	(1)
Disposables	36	(1)
Dental Dam	37	(1)
High-Volume Evacuation	37	(4)
Patient Assessment	41	(12)
Function and Importance of a Medical/Dental History	42	(2)
Updating the Medical History	42	(2)
Filing Lab Test Results	44	(1)
Latex Sensitivity	44	(1)
Methods to Combat Allergic Responses to Latex	44	(1)
Screening Patients for Latex Allergy	45	(1)
Completing Medical/Dental History Forms	45	(3)
Interacting with the Patient	45	(2)
Managing Difficult Patients	47	(1)
Managing Sensitive Topics	47	(1)
Related Forms	48	(5)
Clinical Records	49	(1)
Financial Responsibility and Insurance	49	(2)
Informed Consent	51	(2)
Legal and Ethical Considerations of Infection Control	53	(22)
Legal and Ethical Responsibilities	54	(1)
Dental Jurisprudence	54	(1)
Dental Ethics	54	(1)
Professional Standards of the Dental Hygienist	54	(4)
Malpractice Insurance	55	(1)
Vicarious Liability	55	(1)
Dental Hygiene Code of Ethics	55	(3)
Maintaining Confidentiality of Patients' Records	58	(3)
Patient Confidentiality and the Fax Machine	58	(1)
Informed Consent	58	(1)
Privileged Communications	59	(2)
Treating High-Risk Patients	61	(1)
Office Policy Statement on Treating Patients with HIV/AIDS	61	(1)
Observe Applicable Laws	61	(1)
The Americans with Disabilities Act	61	(4)
Implications for the Dental Office	62	(1)
Necessary Office Renovations	63	(2)
Risk Management and Quality Assurance Strategies to Prevent Malpractice	65	(10)
Negligence	65	(1)
Standard of Care	66	(1)
Abandonment	66	(1)
Burden of Proof	66	(1)
Elements of Malpractice	67	(1)
Causes of Malpractice Suits	67	(1)
Steps to Prevent Malpractice	68	(1)
When an Accident Happens or a Patient Complains	69	(1)
When a Patient Declines or Discontinues Treatment	69	(6)
SECTION II National Guidelines, Recommendations, and Regulations Affecting Dental Practice	75	(20)
Regulatory Government Agencies and Professional Associations	77	(8)
The Role of Government Agencies	78	(1)
Complying with Local, State, and Federal Regulations	78	(1)
Differences and Distinctions	78	(1)
Centers for Disease Control and Prevention	78	(1)
Occupational Safety and Health Administration	79	(1)
Environmental Protection Agency	79	(1)
Food and Drug Administration	80	(1)
Organization for Safety and Asepsis Procedures	80	(1)
American Dental Association	80	(1)
American Dental Hygienists' Association	81	(4)
The Dental Office Safety Supervisor	85	(10)
Role of the Office Safety Trainer	86	(1)
Training Organization	86	(1)
Record Keeping of Training Sessions	87	(1)
Twelve Tasks of the Office Safety Supervisor	87	(8)
Train Newly Hired Personnel	87	(1)
Retrain All Personnel at Least Annually	87	(1)
Schedule Review Meetings	88	(1)
Train Janitorial Service Personnel	88	(1)
Maintain Records Files	89	(1)
Perform Hands-on Daily Functions	89	(1)
Perform Inventory Control	89	(1)
Supervise Staff Quality Control	89	(1)
Supervisor Handling and Treatment of Contaminated Laundry	90	(1)
Conduct Monthly Compliance Inspections	90	(1)
Monitor Infection Control Publications	90	(1)
Prepare Patient Communications	90	(5)
SECTION III Infection Control Techniques in the Dental Office	95	(94)
Personal Safety and Barrier Protection	97	(24)
Hepatitis B and Other Recommended Vaccinations	98	(1)
Identifying Employees at Risk: Exposure Determination by Categories	98	(2)
Task Categorization	98	(1)
Category I	98	(2)
Category II	100	(1)
Category III	100	(1)
Universal Precautions: Gloves, Masks, Eyewear, and Outer Protective Clothing	100	(1)
Types of Gloves Used in Dentistry	100	(5)
Disposable (Nonsterile) Examination Gloves	101	(1)
Overgloves	101	(1)
Sterile Gloves	102	(1)
Nitrile Utility Gloves	103	(1)
Nonallergenic Gloves	103	(1)
Proper Use of Gloves	103	(1)
Gloving Procedure	104	(1)
Glove Storage	104	(1)
Latex Warnings	104	(1)
Masks	105	(1)
Eyewear	105	(1)
Scrubs or Protective Outer Garments	106	(1)
Laundering of Reusable PPE	107	(1)
Guidelines for Putting On and Removing PPE	108	(1)
Procedure Into Practice: Donning PPE	108	(1)
Procedure Into Practice: Removing PPE	109	(2)
Eyewash Stations	111	(1)
Sharps Management and Disposal	111	(1)
Procedure Into Practice: Emergency Eyewash Procedure	112	(2)
Recapping Contaminated Needles	113	(1)
Procedure Into Practice: Minimizing Personal Injury from Contaminated Sharps	114	(1)
Updated Safety Needle Management Regulations	114	(1)
Handling an Accidental Exposure	115	(2)
Procedure Into Practice: What the Dental Hygienist Must Do in the Event of an Accidental Exposure	117	(1)
Procedure Into Practice: What the Dentist/Employer Must Do in the Event of an Accidental Exposure	117	(4)
Instrument Recirculation	121	(28)
Introduction to Instrument Recirculation	122	(1)
Critical, Semicritical, and Noncritical Classifications	122	(1)
Critical Items	122	(1)
Semicritical Items	123	(1)
Noncritical Items	123	(1)
Processing Contaminated Instruments	123	(1)
After Completion of a Chairside Procedure	123	(1)
Procedure Into Practice: Processing Contaminated Instruments	124	(1)
Instrument Precleaning/Soaking	125	(1)
Instrument Scrubbing	125	(1)
Manual Instrument Scrubbing	126	(1)
Procedure Into Practice: Manual Instrument Scrubbing	126	(2)
Ultrasonic Tips and Air Abrasive Tips	127	(1)
Ultrasonic Instrument Cleaning	127	(1)
Procedure Into Practice: Ultrasonically Scrubbing Instruments	128	(1)
Monitoring the Ultrasonic Instrument Cleaner	129	(1)
Disinfection versus Sterilization	129	(1)
Chemical Disinfection of Instruments	129	(1)
Procedure Into Practice: Chemical Disinfection of Instruments That Cannot Be Heat Sterilized	130	(1)
Sterilization	131	(1)
Accepted Methods of Sterilization	131	(5)
Liquid Chemical Sterilants	131	(1)
Ethylene Oxide Sterilization	131	(2)
Dry Heat Sterilization	133	(1)
Steam under Pressure (Autoclaving)	134	(2)
Procedure Into Practice: Instructions for Operating the Autoclave	136	(2)
Flash ``Priority'' Sterilization	137	(1)
Chemical Vapor Sterilization	137	(1)
Processing High-Speed Dental Handpieces	138	(1)
Procedure Into Practice: Handpiece Sterilization Steps	139	(2)
Processing Fiber-Optic Handpieces	140	(1)
Procedure Into Practice: Packaging Instruments and Loading the Sterilizer	141	(1)
Sterilizer Monitoring	142	(1)
Biological Monitors	142	(1)
Procedure Into Practice: Maintaining a Sterilization Monitoring Log	142	(2)
Process Indicators	143	(1)
Storage of Sterilized Instruments	144	(1)
Most Common Reasons for Instrument Sterilization Failure	145	(4)
Autoclave Sterilization Errors	145	(1)
Unsaturated Chemical Vapor Sterilization Errors	145	(1)
Dry Heat Sterilization Errors	145	(4)
Environmental Surface and Equipment Asepsis	149	(12)
The Need for Surface Disinfection	150	(1)
Classification of Environmental Surfaces	150	(1)
Decontamination of Environmental Surfaces	150	(1)
Chemical Disinfectants	151	(2)
Chlorine Dioxide Compounds	151	(1)
Glutaraldehydes	151	(1)
Iodophors	152	(1)
Sodium Hypochlorite	152	(1)
Phenolics	152	(1)
Isopropyl Alcohol	152	(1)
Spray-Wipe-Spray Technique	153	(1)
Procedure Into Practice: Guidelines for Mixing, Handling, and Discarding Chemical Sterilants and Disinfectants	154	(1)
Placement of Protective Barriers	154	(1)
Procedure Into Practice: Guidelines for the Spray-Wipe-Spray Technique	155	(2)
Custom Barriers	157	(1)
Front Office Barriers	157	(1)
Procedure Into Practice: Guidelines for Placing and Removing Environmental Surface Barriers	157	(4)
Dental Laboratory Asepsis	161	(14)
The Importance of Infection Control Procedures in the Dental Office Laboratory	162	(4)
Communication with the Commercial Dental Lab	162	(1)
Logging and Tracking Lab Cases	162	(1)
Management of Outgoing Lab Cases	163	(1)
Management of Incoming Lab Cases	163	(2)
Asepsis in the Shipping/Receiving Areas of the Office	165	(1)
Appropriate PPE in the Lab	165	(1)
Disinfection of Lab Counters and Work Surfaces	165	(1)
Disinfection of Removable Prosthetics and Orthodontic Appliances	166	(1)
Procedure Into Practice: Disinfection of a Dental Prosthesis or Orthodontic Appliance	166	(1)
Disinfection of Dental Impressions	167	(2)
Elastomeric Impressions	168	(1)
Alginate (Irreversible Hydrocolloid) Impressions	168	(1)
Hydrocolloid (Reversible) Impressions	168	(1)
Disinfection of Related Dental Laboratory Items	169	(2)
Wax Rims and Wax Bites	169	(1)
Bite Registrations	170	(1)
Custom Acrylic Impression Trays, Bleaching Trays, and Mouth Protectors	170	(1)
Dental Casts	170	(1)
Miscellaneous Chairside Lab Items	170	(1)
Rubber Bowls and Mixing Spatulas	170	(1)
Stock Impression Trays	171	(1)
Asepsis in the Dental Office Lab	171	(1)
Pumice	171	(1)
Brush Wheels and Rag Wheels	171	(1)
Disposal of Laboratory Waste Materials	172	(3)
Infection Control in Dental Radiography	175	(14)
Infection Control Awareness in Dental Radiography	176	(1)
Prior to Exposing Radiographs	176	(1)
Protective Barriers in the Radiographic Area	176	(1)
ADA Infection Control Recommendations for X-Ray Equipment and Films	177	(1)
Procedure Into Practice: Placing and Removing Protective Surface Barriers in the Radiographic Operatory	177	(1)
Procedure Into Practice: Infection Control Procedures for the Radiography Operatory	178	(1)
Handling the X-ray Film Packet	179	(2)
Handling Technique	179	(1)
Barrier Protection Technique	179	(1)
Two-Wipe Technique	179	(2)
Procedure Into Practice: Infection Control Procedures for the Darkroom: Handling Technique	181	(1)
Procedure Into Practice: Barrier Protection Technique	181	(1)
Procedure Into Practice: Surface Disinfection Two-Wipe Technique	181	(1)
Procedure Into Practice: Infection Control Procedures While Using a Daylight Loader	182	(1)
Disinfection of Intraoral Film Packets	183	(1)
Advantages and Disadvantages of Various Infection Control Methods for Exposing Dental Radiographs	183	(3)
Waste Management of Radiographic Chemistry	186	(3)
SECTION IV Environmental Health and Safety (Hazard Communication) in the Dental Office	189	(78)
Hazard Communication	191	(26)
Hazard Communication Program	192	(1)
Physical and Chemical Hazards in the Dental Office	193	(1)
Product Warning Labels and Stickers	193	(7)
Material Safety Data Sheets (MSDS)	195	(1)
Staff Training	195	(2)
Training Record Keeping	197	(1)
Reducing Hazards in the Dental Office	198	(1)
Handling Hazardous Materials	199	(1)
Biological Hazards in the Dental Office	200	(1)
Hepatitis B Vaccination	200	(1)
Bloodborne Pathogens Standard	201	(6)
Exposure-Control Plan	201	(1)
Engineering and Work Practice Controls	202	(1)
Universal Precautions	203	(1)
Personal Protective Equipment	203	(1)
Housekeeping Schedule	203	(1)
Waste Management	203	(4)
Exposure Incidents	207	(1)
Employee Medical Records	207	(1)
New OSHA Compliance Directive	207	(10)
Exposure-Control Plan (Update)	208	(1)
Engineering and Work Practice Controls (Update)	209	(1)
FDA Device Approval (Update)	209	(1)
Multiemployer Work Sites (Update)	209	(1)
CDC Guidelines on Vaccination and Postexposure Management (Update)	210	(1)
Training and Education (Update)	210	(1)
Replaced and Updated Appendices (Update)	211	(6)
Waterline Biofilms	217	(14)
What Are Biofilms?	218	(1)
Conditions That Facilitate Biofilm Formation in Waterlines	218	(2)
Stages of Biofilm Formation in Waterlines	220	(1)
Initial Attachment	220	(1)
Accumulation	220	(1)
Release	220	(1)
What Is the Quality of Drinking Water?	221	(1)
Recommendations for Dental Unit Waterline Biofilm Reduction	221	(1)
Procedure Into Practice: Reduction of Waterline Biofilms	221	(1)
Solutions to Reduce Waterline Biofilms	222	(1)
Improve the Quality of the Incoming Water	222	(1)
Control Biofilms in the Tubing	223	(1)
Control Water Quality As It Leaves the Tubing	223	(1)
Equipment Manufacturers Make Modifications	223	(1)
Procedure Into Practice: Steps for Weekly Waterline Asepsis	224	(1)
Nonsterile Water Delivery Systems	225	(1)
Sterile Water Delivery Systems	225	(1)
Methods of Sterilizing Water for Reservoirs	225	(1)
Independent Water Reservoirs versus Filters	225	(1)
Boil-Water Advisory Procedures	226	(5)
While a Boil-Water Advisory Is in Effect	226	(1)
When the Boil-Water Advisory Is Canceled	226	(5)
Occupational Environmental Hazards	231	(24)
Health Hazards of Concern to the Dental Hygienist	232	(1)
Mercury	232	(1)
Radiation	232	(1)
Procedure Into Practice: Guidelines for Handling Mercury	233	(1)
Procedure Into Practice: Recommended Guidelines for Cleaning Up a Mercury Spill	234	(2)
Protection of the Operator	234	(1)
Protection of the Patient	235	(1)
Policy for Protecting Pregnant Patients	236	(1)
Caustic Agents and Other Hazardous Chemicals	236	(1)
Disinfectants and Cleaning Solutions	236	(1)
Glutaraldehyde	236	(1)
Procedure Into Practice: Guidelines for Protection When Working with Glutaraldehyde	237	(1)
Gases: Nitrous Oxide, Oxygen, and Ethylene Oxide	238	(1)
Adverse Effects of Nitrous Oxide	238	(1)
Procedure Into Practice: Guidelines to Reduce Exposure During Conscious Sedation Administration of Nitrous Oxide	239	(2)
Methods of Reducing Health Hazards Associated with Nitrous Oxide	239	(1)
General Guidelines for Safe Use of Oxygen	240	(1)
Instructions for Oxygen Tank Operation	240	(1)
Precautions for Ethylene Oxide Use	240	(1)
Procedure Into Practice: Safety Precautions for Oxygen Use	241	(1)
Bioaerosols	241	(1)
Procedure Into Practice: Reducing Bioaerosols in the Dental Office	242	(1)
Latex Allergies	242	(3)
Types of Allergic Reactions to Latex	243	(1)
Type I (Immediate Hypersensitivity)	243	(1)
Type IV (Delayed Hypersensitivity)	244	(1)
Irritant Dermatitis (ID)	244	(1)
Treatment for Latex-Sensitive Individuals	245	(1)
White Visible Light and Dental Lasers	245	(1)
Procedure Into Practice: Guidelines to Combat Allergic Response to NRL	245	(2)
Bonding Materials and Acrylics	247	(1)
Hazardous Noise Levels	247	(1)
Procedure Into Practice: Guidelines for Preventing Injury Caused by Acid Etch Materials	247	(1)
Repetitive Motion Injury and Carpal Tunnel Syndrome	248	(1)
Procedure Into Practice: Precautions for Preventing Occupational NIHL	248	(7)
A Simple Self-Test for CTS	249	(1)
Methods to Prevent Hand Injuries and CTS	249	(6)
Office Emergency Procedures	255	(12)
General Office Safety	256	(1)
Fire Safety and Emergency Evacuation	256	(2)
How a Fire Starts	257	(1)
The ABCs of Fire Extinguishers	257	(1)
Natural Disaster Preparedness	258	(1)
Tornado Safety	258	(1)
Procedure Into Practice: How to Use a Fire Extinguisher	259	(1)
Hurricane Emergencies	260	(1)
Earthquakes	260	(1)
Bomb Threats and Violence in the Workplace	260	(1)
Preventing Violence in the Workplace	260	(1)
Concealed Handguns and Other Weapons	261	(1)
Signage Requirements	261	(1)
First-Aid and Emergency Kits	261	(2)
Emergency Oxygen	263	(1)
Procedure Into Practice: Emergency Administration of Oxygen	263	(4)
SECTION V Office Communications Regarding Infection Control	267	(14)
Marketing Infection Control	269	(12)
The Need to Market Infection Control	270	(1)
Role of the Dental Hygienist in Marketing Infection Control	270	(1)
Front Office Marketing	271	(3)
The Need to Explain Infection Control Procedures to Patients	271	(1)
Infection Control Brochures	271	(1)
Signs, Plaques, and Posters	271	(1)
Statement Stuffers	272	(1)
Letters and Newsletters	272	(1)
Web Sites	272	(1)
Office Tours of Instrument Recirculation Area	273	(1)
Educating Patients about Infectious Diseases	274	(2)
Ten Facts Used to Educate Patients about HIV/AIDS	274	(2)
The Importance of an AIDS Treatment Policy	276	(1)
Chairside Marketing	276	(5)
Rationale for Protecting Patients	277	(1)
Rationale for Personal Protective Equipment	277	(1)
Rationale for Opening Sterile Instrument Packs in Front of the Patient	277	(4)
Bibliography	281	(6)
Appendix A	287	(8)
Appendix B	295	(6)
Glossary	301