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Dental Infection Control & Occupational Safety for Oral Health

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Dental Infection Control & Occupational Safety for Oral Health Dental Council of India DentalDental InfectionInfection ControlControl && OccupationalOccupational SafetySafety ForFor OralOral HealthHealth ProfessionalsProfessionals anil kohli & raghunath puttaiah COORDINATORS: Padma Bhushan Awardee Honorary Brigadier Dr. Anil Kohli MDS, FDS RCS (Eng), DNBE (USA) FACD, D. Litt (Hon) Consultant to the Indian Armed Forces President –Dental Council of India, New Delhi, India Dr. Raghunath Puttaiah, BDS, MPH Associate Professor – Diagnostic Science, Director – Infection Control, Baylor College of Dentistry, Texas A&M University Health Science Center, 3302 Gaston Ave, Dallas, Texas, United States of America Phone: 001-214-828-8245; Fax: 214-828-8306; email: [email protected] ADDITIONAL CONTRIBUTORS Dr. Raman Bedi, BDS, DDS, FDS RCS (Edin, Eng) Dr. Ajoy Roychowdhury, BDS, MPH Professor& Director Associate Professor – Oral Surgery King’s College London, London, United Kingdom All India Institute of Medical Sciences, New Delhi, India Dr. K. Sadashiva Shetty, BDS, MDS Dr. Vimal Arora, BDS, MDS Principal & HOD Orthodontics Professor – Prosthodontics Bapuji Dental College, Davangere, India Brigadier and Command Dental Advisor – Southern Command Dr. Malika Kohli BDS, MS Command Dental Center, Pune, India Department of Periodontology Goldman Dental School, Boston University, Boston, USA Dr. Dennis Youngblood, DDS Oral & Maxillofacial Surgeon, North Texas Dental Dr. B. Sureshchandra, BDS, MDS Consultants Professor and Head of Department, Conservative Dallas, USA Dentistry and Endodontics A.J. Institute of Dental Sciences, Mangalore, India Dr. Robert Cederberg, DDS Associate Dean, Clinical Affairs Dr. Jay Shulman, DMD, MSPH ATSU Dental School, Mesa, Arizona, USA Professor – Public Health Sciences Baylor College of Dentistry, TAMUS HSC, Dallas, USA Dr. Hui Liang, DDS, PHD Associate Professor, Radiology Dr. Usha Mohan Das, BDS, MDS Baylor College of Dentistry, TAMUS HSC, Dallas, USA Principal Professor and Head, Department of Pedodontics and Mr. Shih-Ming Lin, BS Preventive Dentistry Graduate Student, Biomedical Sciences & Research V.S. Dental College, Bangalore, India Assistant – Diagnostic Science Baylor College of Dentistry, TAMUS HSC, Dallas, USA Dr. Vishal Gupta, MDS (Gold Medalist), MOrth RCS (Edin) Consultant Orthodontics i ii iii iv v Table of Contents 1. INTRODUCTION 1 2. THE RATIONALE FOR DENTAL INFECTION CONTROL AND OCCUPATIONAL SAFETY 2 3. COMMON INFECTIOUS DISEASES ENCOUNTERED IN DENTISTRY 9 4. INFECTIOUS DISEASE IN INDIA – Epidemiology, Impact and Perceptions 13 5. THE STATUS OF DENTAL INFECTION CONTROL & SAFETY IN INDIA – A STUDY 17 6. MEDICAL HISTORY AND DENTAL SAFETY 22 7. IMMUNIZATION OF PERSONNEL INVOLVED IN DENTAL CARE 25 8. HANDWASHING AND HANDCARE 27 9. PERSONAL PROTECTIVE EQUIPMENT 30 10. SURFACE BARRIERS VERSUS DISINFECTION 34 11. SINGLE-USE-DISPOSABLES 37 12. CHEMICAL GERMICIDE USE 40 13. INSTRUMENT REPROCESSING AND STERILIZATION MONITORING 46 14. DENTAL UNIT WATER SYSTEM CONTAMINATION CONTROL 52 15. INFECTION CONTROL IN DENTAL RADIOLOGY 58 16. CONSIDERATIONS FOR DENTAL LABORATORIES 63 17. SPECIAL TOPICS 65 -Extracted teeth, biopsy specimens and tissues 65 -Oral and Maxillofacial Surgery and LASER/Electrosurgery plumes 65 -CJD & Prion Related Diseases 66 18. CLASSIFICATION & MANAGEMENT OF DENTAL WASTES AND SHARPS 67 19. MANAGEMENT OF EXPOSURE TO BLOOD AND BODY FLUIDS 68 20. ASEPTIC AND CLINICAL REQUIREMENTS DURING PATIENT CARE 69 21. OCCUPATIONAL SAFETY DIRECTIVES FOR DENTISTRY 70 -Bloodborne Pathogens 70 -Chemical Hazard Control 75 -Facility and equipment safety 77 22. SELECTED DEFINITIONS 80 23. SOURCES OF INFORMATION, LIST OF READINGS INCLUDING INTERNET RESOURCES 84 vi INTRODUCTION Kohli & Puttaiah Scope of these recommendations This “first” document addresses the Dental Infection Control & Occupational Safety for practices in India. These recommendations are applicable to all levels and fields of dental practice and all persons involved in providing dental care directly or indirectly including dentists, dental assistants, dental nurses, dental technicians, students, trainees and volunteers. This document is applicable to dental care provided within dental clinics, hospitals, dental colleges, dental auxiliary institutions, mobile dental units, dental laboratories, clinical laboratories and dental camps or outreach services providing dental care. This document will be updated regularly based on new risks and possible control measures for the risks. Objectives of these recommendations The objectives of this document when implemented, is to control patient-to-patient infectious disease transmission, and occupational exposure of dental health care personnel (DHCP) to infectious, chemical and other hazards present/encountered during the practice of dentistry. This document provides a framework for developing a concise yet practical curriculum in dental safety to be implemented in the didactic and clinical curriculum of undergraduate dentistry, post-graduate dentistry, and dental auxiliary programs as an integral part of educational requirements. This document provides the framework in initial and regular periodic continuing dental education requirements and documentation of training for all active dental practitioners, including dental auxiliaries involved in patient care, as well as supervisory and educational duties as in clinical faculty. Sources of information The sources of information for crafting this document is from published papers, reports, white-paper documents and governmental publications of recommendations and standards that are being followed in countries that have achieved success. While evidence-based information is used in developing this document, a pragmatic and common sense approach is used in the absence of evidence-based information. A majority of this document has been adapted from “Dental Infection Control & Safety Manual, © of Dental Innovative Devices & Educational Solution LLC, Dallas, TX, USA” and is being used as an in-office safety manual in conjunction with an Audio-Visual CD/DVD by dental practitioners in the United States. 1 CHAPTER 1 THE RATIONALE FOR DENTAL INFECTION CONTROL AND OCCUPATIONAL SAFETY Puttaiah, Bedi, Youngblood, Shulman & Kohli Introduction Many countries currently follow acceptable standards in Dental Infection Control & Safety dictated by a higher level of practice standards. These standards are formulated by regulatory agencies in their respective countries or regions to improve the level of patient safety and personnel safety. Many patients were infected with Hepatitis-B virus by dentists and dental surgeons in the United States in the nineteen sixties and seventies, still, infection control did not gain importance, possibly due to the advent of vaccines to combat the Hepatitis-B virus. Although concepts in dental infection control were developed in the 1960s (due to Hepatitis-B viral infections), this field only gained priority and was implemented after Human Immunodeficiency Viral (HIV) infections reached epidemic proportions. Infection control gained further momentum in the United States of America after patients treated by a Human Immunodeficiency Virus dentist later tested positive for the HIV virus, and also after health care workers became infected while involved in patient care activities. While this disease has been ravaging the African subcontinent since the late eighties, and today Asia and South-Asia in particular, it is now being controlled in the United States of America and Western Europe, where dentists have improved their practice of infection control either voluntarily or involuntarily. The number of individuals infected with HIV and developing severe disease (i.e. AIDS) continues to rise worldwide. There is an annual increase world-wide, each with high morbidity levels within the populations, but with dramatic regional variations. While the caseload in the Americas and Europe is increasing, it is not as much as in Asia, with India having about 5.7 million cases, and China about 650,000 cases of HIV infections. Apart from HIV and AIDS there is a plethora of bloodborne and other common diseases encountered in the dental clinic that may pose a risk. Based on the evidence, information, and rules, local to either the country or region, high standards of Dental Infection Control & Occupational Safety must be followed by the dental team for the safety of the patients and Dental Healthcare Workers. Disease transfer to the dentist and dental staff during dental care is considered an “occupational exposure” to a given pathogen, while disease transfer from one patient to another in the dental clinics is considered “cross-infection”. Therefore, the dental health care provider must be knowledgeable about the diseases commonly encountered during dental care and must responsibly provide care to patients without getting infected, or without infecting patients. Rationale The rationale for infection control is to “control” iatrogenic, nosocomial infections among patients, and potential occupational exposure of care providers to disease causing microbes during provision of care. The term “disease control or infection control” does not mean total prevention of iatrogenic, nosocomial infections or occupational exposures to blood and other potentially infectious material (BOPIM), it only means reducing the risks of disease transmission. Although the goals are oriented towards disease prevention, reduction in potential risks of disease spread is only practical. Routes of Disease Transmission Routes of disease transmission
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