II. BEFORE PATIENT TREATMENT
medical history from patients will always be obtained and reviewed.
It should be updated at each subsequent visit. Specific questions
may be included concerning medications, current and recurrent
illness, unintentional weight loss, oral soft tissue lesions,
lymphadenopathy, other infections, history of hepatitis and
alcohol/drug abuse, coughing lasting more than 2 weeks (T13), etc.
B. Personal Protective
are used to interfere with the initial step in the infectious
disease process are called barrier techniques. These protective
barriers include gloves, masks, eyewear, and protective clothing.
considered the most important single procedure for the prevention of
cross-contamination. However, blood has been found under the
fingernails for periods up to five days. Therefore, gloves are a
necessity even with proper handwashing. Refer to Appendix A.
A surgical scrub
is recommended with rapid antimicrobial activity plus residual
action as the initial scrub of the day. Hands will be washed and
dried well after removing or changing gloves. A lotion may be
necessary 3 or 4 times a day to prevent chapped hands. Preferably a
lotion low in microbes, no petroleum base, and non-sticky after
applying. All jewelry should be removed and nails kept short in
order to prevent punctures in the glove material.
Gloves should fit
the hand snugly but allow the hand to move comfortably. Gloves will
be changed for every patient, when they become tacky or damaged, or
every hour, whichever comes first,- nor will gloves be removed and
re-donned for the same patient.
If breaking the
aseptic chain, such as acquiring supplies or exposing radiographs, a
pair of overgloves may be donned and removed before resuming
procedures. Gloves will be removed or covered with an overglove
before handling a patient's chart. Exam gloves should not be worn
out of the treatment area unless covered with overgloves.
concentration of microorganisms in dental aerosols are found 2 feet
in front of the patient. When aerosols or splatters are being
generated, it is necessary to wear a mask even if wearing a face
shield. The mask should be routinely changed every hour, or more
frequently in the presence of heavy aerosol contamination. The mask
will be put on while the hands are clean and before gloving for the
patient. It should fit over the ridge of the nose so that the
glasses will fit over the top edge of the mask to reduce fogging.
The mask should not be handled during dental procedures.
Face masks with
layers achieve the highest filtration. The mask should not fit flat
on the face but should fit close around the edges. Do not wear the
mask on the neck or forehead.
It should be
remembered that masks are also necessary during pre and
post-operative cleaning or when generating dust such as trimming
models. If lasers are used in the practice, higher filtration type
masks are needed.
toward the operator while performing dental procedures may contain
large concentrations of bacteria or can physically damage the eyes.
Protective eyewear with side shields is necessary for most dental
procedures. If prescription lenses are worn, side shields can be
added to the frames or goggles worn over the glasses.
Eyewear should be
able to tolerate cleaning. Eyewear that has both side shields and a
top shield offer the most protection. A face shield may be worn in
place of glasses but it does not replace a mask.
eyewear is also recommended for the patient. All eyewear should be
cleaned with soap and water and should not be handled during dental
Clothing worn by
dental personnel can become contaminated from aerosols and splatters
during dental procedures. Protective clothing is chosen according to
the anticipation of splash and spatter. In some cases, short sleeves
would be appropriate. The idea is that the skin will not come into
contact with body fluids. The protective clothing should I be
changed at the end of the day or when visibly soiled. Contaminated
clothing should not be worn out of the clinic.
At the end of the
day, the contaminated protective clothing will be placed in the
designated container in the sterilization area. This container (a
plastic bag is acceptable), will have a biohazard symbol on it.
clothing will be worn anytime there is a chance of contamination
from blood or potentially infectious fluid (which includes dental
Hair is another
concern for potential contamination. Surgical caps or hoods may be
worn to prevent contamination by potentially infectious material
such as occurs from Cavitrons or high speed drills.
C. Preparing the Operatory
The hands will be
At the beginning of the day, following
the recommended "initial handwashing" procedures. (Otherwise using
"between nonsurgical patient" procedures.)
Immediately after gloves are removed
Refer to Appendix
while wearing utility gloves, masks, and protective eyewear, will
disinfect all surfaces except electrical switches, with the
spray-wipe-spray method (Refer to Appendix B). Barriers are
recommended, reducing the amount of surface disinfectant. The water
lines will be flushed in the air/water syringe and the handpiece
hoses for 1-2 minutes at the beginning of the day (and any other
water equipment such as the Cavitron). This is done before the
handpiece or air/water tip is added. Between patients, flush hoses
10-15 seconds and a minute after long breaks. Wash and remove
utility gloves; then wash hands. Cover light handles, air/water
syringe, and switches on chairs, units and x-ray machines with
plastic or foil. These will be replaced after every patient. It is
not necessary to disinfect those areas covered with barriers except
at the end of the day.
The bracket table
or tray should be covered with plastic wrap or plastic cleaner's
bags, which covers the entire surface including the holders. Paper
tray covers or surgical wraps are placed on top. Under no conditions
should there be more than one tray cover on the bracket table or
tray at a time. A disposable tray is another alternative. -
Tray "setups" or
individual instruments that have been sterilized are placed on the
bracket table along with needed supplies and covered with a clean
patient napkin. Instruments should be opened in the patient's
presence. If tray setups are used, the individual tray should also
be covered with plastic.
that can possibly be sterilized, will be. (Refer to Appendix C).
There are several methods that can accomplish sterilization, i.e.,
steam, dry heat, chemical heat and ethylene oxide.
The CDC and ADA
has suggested weekly monitoring of dental sterilizers for
verification of sterilization. Color indicators such as autoclave
tape are useful but they only tell that a certain temperature was
reached. It does not tell if the temperature was held long enough to
kill spores. Chemical indicator strips will be placed inside each
instruments should be wrapped and stored in clean boxes or drawers
until ready to be used. Drawers should also be cleaned routinely.
Most wraps are capable of maintaining sterility up to 2 months. Do
not get wraps wet. It is not acceptable to remove sterilized
instruments from a package and place them in a drawer for later use.
There should be no loose instruments in drawers.
sterilized or disposable tip on the air/water syringe. Place a
sterilized handpiece on the unit. All handpieces and prophy angles
will be sterilized or disposable. Slow speed motors and other not
sterilized handpieces will be covered with plastic sleeves.
rubber cups or brushes on prophy angles. Brushes tend to cause more
splatter and should not be used unless absolutely necessary.