Infection Control in Dental Radiography

Hi everybody, this is Ms. O'Brien again. In this presentation, we're going to go over chapter 16 of your Dental Radiography Principles and Techniques textbook, and this is the chapter on infection prevention and the dental radiographer, and that's you. Okay, so let's talk about our objectives for this lesson. We're going to define the key terms associated with infection control. We're going to describe the rationale for infection prevention. We're going to describe the three possible routes of disease transmission. We're going to describe the conditions that must be present for the disease transmission to occur. We're going to discuss PPE, that's personal protection equipment, hand hygiene, sterilization and disinfection of instruments, and the cleaning and disinfection of the dental unit and environmental surfaces. We're going to describe infection prevention procedures that are necessary before, during, and after the x-ray exposure. We're going to describe infection prevention procedures that are necessary for digital imaging and film processing. We're going to discuss film handling in the darkroom with and without barrier envelopes. And we're going to discuss film handling without barrier envelopes using the daylight loader. of an automatic processor. So that's a lot of stuff that we have to go over. So let's go ahead and get started. Okay, so the basics of infection control for the dental radiographer, that's what we're concentrating on here. So you guys have probably heard a lot about PPE and infection control, especially in the wake of COVID. You know, when COVID came along, infection control, even for lay people. took on a whole new level of importance because, you know, the highly contagious nature of that virus. So infectious diseases, these are a significant hazard in the dental environment. And what do we mean by infectious diseases? This is basically any infection that can be passed along. So that could be a viral infection like COVID or the flu or even the common cold. It could be some sort of a bacterial infection like tuberculosis, for example. So there's a lot of infectious diseases out there. And we want to protect ourselves because we are working very, very closely with these patients, very intimately. You know, we're in the area of their mouth where a lot of the, you know, germs escape, basically. So, you know, so we want to be very careful. So infectious diseases, again, they're a significant hazard in the dental environment. And dental professionals are at an increased risk, but we can minimize this risk. You know, I feel like I'm more safer in a dental office than I am out at the grocery store because I have the knowledge and the equipment that I need to keep myself safe. And then infection control protocols. These help minimize disease transmission. So it's really, really important that dental health care professionals were aware of these. So the purpose of this chapter is to prevent the rationale for infection control. So. We're going to review guidelines from the CDC, which are continuously updating. So it's always smart to keep an eye on those, be informed. And then we're going to describe in detail step-by-step infection control procedures in dental imaging. So again, this is radiology class. So we're focusing on what we do when we're taking dental images. OK, so if you look at this picture, that's pretty gross, right? That picture frightens me. It really does. So when somebody sneezes, like on a microscopic level, excuse me, that's what's happening. Look at all those germs. Can you imagine if you were sitting next to this person and they didn't cover their mouth? You know, so it's really, really important that we're careful about this stuff. And, you know, we cover our mouths when we sneeze or we sneeze into the crook of our elbow or, you know, use a tissue when we cough. So, you know, you want to be aware of this stuff inside the dental office and outside the dental office because you can get sick anywhere. So the primary purpose of infection control is to prevent transmission of infectious diseases from the patient to the dental professional, from the dental professional to the patient, and from the patient to the patient. So the patient to the dental professional, you know, imagine you are working on a patient and they do this, they sneeze at you and you're not wearing goggles, you're not wearing a mask, you're not wearing anything. then you would be exposed to whatever they might have. You know, it might be a cold, it might be COVID, it might be the flu. So, you know, so the patient can transmit diseases to the dental professional. Another way is say you were injecting the patient or the dentist was injecting the patient with the local anesthesia. When they're handing the needle back to you, you know, maybe you guys weren't being super careful and you get jabbed with the needle. Well, guess what? that needle was exposed to the patient's blood and now you've gotten jabbed with it. So again, you're exposed to whatever bloodborne disease that patient has. So, you know, so those are some ways that infectious diseases can be spread from the patient to the dental professional. The same thing can occur in the reverse order, right? If you go into work and you have COVID and, you know, either you didn't know or you ignored the symptoms or whatever, you could put your patients at risk. So, you know, especially if you're not wearing proper PPE or following infection control protocols, you know, the patient could catch your COVID or, you know, if there was some sort of a puncture exposure, you know, the patient could be exposed to whatever bloodborne pathogen you have. So, you know, it goes in two directions. Then also patient to patient. So, you know, during COVID, they started closing down waiting rooms. You know, they tell the patients, wait in your car and we'll text message you and then you can come in. That's because the waiting room can be, you know, it can be a big petri dish. Patients can come in with a cold or a flu or whatever, and that could be, you know, given to another patient. In a lot of pediatric medical practices, they'll have a sick waiting room and a well waiting room because they don't want the sick kids infecting the well kids. You know, the kids that come in because they have the flu, they don't want the kid that just comes in to get, you know, their yearly, you know, checkup to be exposed to that. And not just in the waiting room. Patients can expose other patients to infections through dirty instruments, for instance. So if you're... dental office doesn't, you know, sterilize their instruments properly, and there's pathogens on an instrument from a patient, if that instrument is used on another patient without being sterilized, that pathogen can be transmitted to the other patient. And this has happened before, you know, there's been practices that have been unscrupulous and unethical, and they don't sterilize their instruments. And then, you know, a patient that has HIV you know, they could have gotten it from another patient through an unsterilized instrument. So, you know, so these routes of transmission, they're real, you know, and they've been documented again and again and again. So these things do happen. So, you know, so you have to be very careful. So disease transmission involves pathogens, and these are microorganisms that are capable of causing disease. So it's that, you know, HIV virus or the COVID virus or the flu virus, you know, that's considered a pathogen. And pathogens may be present in the oral or respiratory secretions. So if you think about the common cold, you know, that's a lot of that takes place in your chest. And when you sneeze, you know, these pathogens are going to be in, you know, what comes out. So being exposed to the oral cavity, you know, we're going to be exposed to these oral and respiratory secretions. So, again, we have to be very careful. And then the general routes of disease transmission include direct contact. direct contact with pathogens. This can be in saliva, blood, respiratory secretions, or lesions. So that means you, you know, the pathogen comes in direct contact with you. Say this person sneezes and you just happen to walk in front of them right afterwards and this is still in the air and you breathe it in. That's direct contact, right? Indirect contact with contaminated objects. So like I said, if you use instruments on one patient and they're not sterilized properly, and that patient has a bloodborne disease, and you use that instrument on another patient, then that patient could potentially get that bloodborne virus or pathogen. So that's considered indirect contact. You know, you don't come in direct contact, but there's some sort of object that's contaminated that's involved. And then direct contact with airborne contaminants. So again, this is, you know, when somebody sneezes and maybe you walk through that and you're exposed to that aerosol, that's a direct contact with an airborne contaminant. And that takes me back, the direct contact with pathogens, that does, you know, one part of that is direct contact with airborne contaminants, but you could have direct contact with other pathogens, you know, like if saliva from the patient's mouth splashes in your eye, for instance. that would be considered a direct contact with pathogens. Okay, so quick learning check. This is kind of what I was referring to. March 29, 2013, so not that long ago, an Oklahoma dentist accused of exposing thousands of patients to HIV, hepatitis B, and hepatitis C may face criminal charges for his actions. Susan Rogers, president of Oklahoma Board of Dentistry, told ABCnews.com. A dentist in Oklahoma lost his license in 2013 for not sterilizing or not properly sterilizing dental instruments used for oral surgery. This resulted in many patients contracting hepatitis C and HIV from contaminated instruments. This would be an example of which route of disease transmission. Would this be direct contact with pathogens and body fluids? Would this be indirect contact with contaminated objects? Or would this be direct contact with airborne contaminants? What do you guys think? Okay, if you said indirect contact with airborne contaminants, then you would be right, because that I mean, I'm sorry, indirect contact with contaminated objects. The instruments are contaminated. You know, they were used on one patient, they became contaminated with bloodborne pathogens, and then they were used on another patient. So that's considered indirect contact with contaminated objects. Okay, so pathogens dental personnel may be exposed to. So we might be exposed to cold and flu viruses and bacteria. coronavirus or COVID-19. There's something called cytomegalovirus, which is in oral and respiratory secretions. There's hepatitis B virus, which is a bloodborne pathogen. Hepatitis C virus, again, bloodborne pathogen. Herpes simplex virus, we can be exposed to two different strains of that. And if you have ever experienced a cold sore, then you know what herpes simplex virus is. You know, if somebody has a cold sore on their lip, that's a manifestation of the herpes virus, and that's very, very contagious. And, you know, a cold sore, you don't really think of it as a big deal. But if you were to get that virus, like in your eye, for instance, it could cause blindness. So it can be very, very serious. So you have to be careful how you handle patients that do have some sort of a herpetic outbreak, like a cold sore, for instance. You don't treat them until it's resolved. you know, they usually resolve within about 10 days. HIV, I'm sure you guys have heard of HIV and AIDS. That's a bloodborne pathogen or bloodborne virus. And then mycobacterium tuberculosis. So I'm sure you've heard of tuberculosis or TB. That's a bacterial infection. And again, that's something that dental personnel may be exposed to. Okay, so there are certain conditions needed for infection to occur. First of all, you need a susceptible host. So the host, you know, has to be susceptible. And if the host has a very weak immune system, like, for instance, patients that have HIV or AIDS, their immune system becomes very, very diminished as the virus progresses. So they would be more susceptible than somebody with a healthy immune system. But even somebody with a healthy immune system can be susceptible. So you do need a susceptible host. You need a pathogen with sufficient infectivity and numbers to cause infection. So the pathogen, it doesn't merely need to be present. It needs to be present in enough force that it can cause an infection. portal for pathogen to enter the host. So what is the portal? If you had a needle stick, for instance, the portal would be the puncture in the skin. If you were talking about some sort of airborne respiratory virus like COVID, the portal would be the, you know, the respiratory system of the host. So you have to have all three of those for infection to occur, the susceptible host, the pathogen, and the portal for entry. So effective infection control is intended to alter one of these three conditions. So, and hopefully all three, you know, the more conditions you can alter, you have a better chance of not being infected. So there's a chain of transmission, they call it. And you have the, you know, the pathogenic agent that might be a virus or a bacterial infection. The reservoir, which is in the person that has the infection. And. The portal of exit, maybe that's from their oral cavity. And then transmission to, you know, a susceptible host and then a portal of entry that could be, you know, through the respiratory system, it could be a puncture in the skin, and then the host susceptibility. So that's basically your chain of transmission. Okay, so let's talk real quick about some terminology. There is a lot of terminology associated with infection control. And you may be familiar with some of these or maybe even all of them. So a lot of times you'll hear these referred to in the news, especially with COVID in the news so much. A lot of these things became. more part of our, you know, daily verbiage. So antiseptic, this is a substance that inhibits the growth of bacteria. So it inhibits it or slows it down. Then we have asepsis. This is the absence of pathogens or disease-causing microorganisms. So asepsis is a really, really high level of infection control because you don't just have an inhibition. of the growth of bacteria or pathogens, you have an absence of pathogens. So asepsis is really a high level of infection control. Bloodborne pathogens. These are pathogens present in the blood that can cause disease in humans. So usually when we talk about bloodborne pathogens, the big ones are HIV and hepatitis. These are both viruses that are present in the blood, and a lot of times they can be transmitted. through needle sticks in medical and dental settings. Like if you accidentally poked yourself with a needle that was used on somebody, you know, that could happen. It's a possibility. Disinfect. This means you use a chemical or physical procedure to inhibit or destroy pathogens. This does not include highly resistant bacteria and mycotic or fungal spores. So disinfection can, you know, can kill a lot of pathogens. but it doesn't necessarily mean that you kill all of them. Exposure incident. Excuse me. Exposure incident, this is contact with blood or other potentially infectious materials. So when you do have an incident in a clinical setting where, let's say, an operator, a dental health professional was poked by a needle that has been used on a patient, that's considered a quote-unquote exposure incident. Then we have infectious waste. So as you can imagine, you know, in the medical and dental fields, you know, after a lot of procedures, you have gauze that's soaked with blood or blood products, you have contaminated needles and instruments, you know, things that have been used on the patient that have been exposed to their blood and other types of products. So this is considered infectious waste. And infectious waste is highly regulated. You can't just take a used needle and throw it in the trash. That's no, that's, you can't do that. because somebody else could get poked with it and be exposed to you know a disease so so you have to put it like in a sharps container and then a special waste disposal company has to come and take it away so this is all very very highly regulated occupational exposure this is contact with blood or other infectious materials that involve the skin the eye the mucous membranes or and it results from the procedure performed by the dental professional. So this is something that happens on the job during your, you know, while you're performing your occupation. And then parenteral exposure. This is exposure to blood or other infectious materials that results from puncturing the skin. So if there's some sort of puncture from a needle or a sharp instrument or something like that, that's considered a quote-unquote parenteral exposure. Then personal protective equipment. PPE. You hear it abbreviated a lot of times. So this includes all your protective attire. This is your gown, your gloves, your mask, your eyewear, everything that's put in place to protect you from contracting some sort of infection or disease from the patient you're working on. That's all considered personal protective equipment. And then sharps. You know, we have sharps containers in all dental offices and medical offices too. And any object that can penetrate the skin, like needles or scalpels, for example, those need to be disposed of in the sharps container. And then again, that doesn't just go in the trash. That's taken away by a special biohazard, you know, disposal company. And then standard precautions. So standard precautions, these are measures that include a standard of care designed to protect healthcare personnel and patients from pathogens that can be spread by blood or any other body fluid excretion or secretion. So standard precautions, we'll talk a lot more about that. But the standard precautions is you want to treat every patient that comes in like they have a disease. I mean, you know, not, not, you know, you don't want to be rude or cruel or anything, but, you know, patients, even if they have a medical history and they check no for everything, they could have an infection and not even know about it, right? So you don't just, you know, a patient that does check the box that they have hepatitis, you use the same precautions with them that you use with the patient that checked no for hepatitis or HIV or whatever. You want to treat every patient like they do have a blood-borne pathogen. And that's just, you know, again, that's not being... you know, rude to the patient or anything, that's just making sure that you always are as careful as you can be with every patient. You wear all of your PPE. You're very careful handling sharp instruments. You dispose of needles correctly. You know, so that's basically the, you know, what standard precautions means. And then sterilize. This is to physically or chemically destroy all pathogens, right? And this includes highly resistant bacteria and mycotic spores. Oops, mycotic means fungal. So, you know, so we sterilize instruments. After we use instruments on a patient, we always sterilize them because you don't want that indirect contact to take place. You know, you don't want another patient to be exposed to a pathogen that a previous patient had. So we always sterilize, you know, all of our instruments. Okay. So infection control practices in dental healthcare settings. There's a lot of them because it's really important that we keep ourselves safe. So vaccination of dental professionals. So when you guys got into the program, you were told that you need certain vaccines in order to be part of the program. And that's really important because, for instance, there's a hepatitis B vaccine. If you get that vaccine and you do have some sort of exposure incident where the patient had hepatitis B, you're protected. right? So the hepatitis B vaccine is really important. Flu vaccines even, they're not 100%, but, you know, kind of gives you a little bit of extra protection during flu season. Use a protective attire and barrier techniques. So again, we talked about PPE. Hand hygiene, you know, washing your hands is really, really important. Hand hygiene is important because, you know, germs or bacteria, viruses, whatever, can get on your hands. And if you, you know, work on a patient with those hands without washing them properly, you could, again, expose the patient to, you know, to a virus or some sort of pathogen. Or yourself, you know, if you touch a door handle that, you know, somebody just sneezed on their hand and then they open the door. And then you come along a few minutes later and you touch the door handle and then, you know, maybe rub your nose, then. you know, you could have gotten a respiratory infection from that. So, you know, so it's always important to wash our hands in both the clinical and non-clinical settings. Proper use and care of sharp instruments and needles. Again, we talked about sharps containers. Sterilization or disinfection of instruments. Again, that's very important. Cleaning and disinfection of the dental unit and environmental surfaces. So when you get into a career in dentistry, part of your job is cleaning. I mean, that's just the way it is. So, and, you know, and it's fast and it's not hard, but it's important, you know, so after every patient, you're going to have to wipe down everything in the room. Because again, we want to break this chain of transmission. Disinfection of the dental laboratory. So again, when you're working on like study models or things like that, that might have any pathogens on them, you have to be really, really careful and you have to wipe everything down. with something that will kill those germs, you know, and keep the environment safe. Use and care of hand pieces, anti-retraction valves, and other intraoral dental devices attached to air and water lines of dental units. Again, we're going to go over a lot of this later in the semester in chairside assisting. Yeah, you'll learn a lot about infection control because it is so important and it's such a foundation of, you know, dental health care. Single-use disposable instruments can be used. You know, a lot of things we throw away after one use in the dental office because they can't be sterilized and you don't want to expose your patient. So these are things like, you know, suction or the little plastic air water syringes. So you'll see we do have a lot of disposables in dentistry. On proper handling of biopsy specimens, you know, obviously a biopsy, they cut a portion of the tissue from the patient and this is usually, you know. contaminate it. You know, it has blood and everything, so you have to be very careful handling those. And you have to be very careful handling extracted teeth in dental education settings. Sometimes we use real extracted teeth when teaching students, so we have to sterilize those before using them. Proper disposal of waste materials. Again, we talked about that. And implementation of recommendations. So we really need to stay up to date with everything the CDC is recommending, especially when you're, you know, we're not in the midst of a pandemic currently, but, you know, a lot of things change very, very quickly when there is something like COVID that occurs. Okay. So guidelines for infection control in the dental health care settings. This was from 2003, but it was updated in 2016. So, you know, a lot of these infection control practices are kind of timeless, you know, so 2003 seems like a long time ago, but they make, you know, updates and a supplement to address, you know, more, you know, emerging infection issues. And then we've got OSHA's occupational exposure to bloodborne pathogen. So OSHA is the Occupational Safety and Health Administration. And they're really there. They're a government agency and they're there for the protection of the worker. So OSHA is your ally. You know, if you ever have a problem at work with, you know, you think they're being unsafe, you know, or you feel like the workers are being exposed to something they shouldn't be. that would be an issue that you could report to OSHA, for instance. Okay, so OSHA guidelines for infection control include using personal protective equipment. So you can see, you know, the eyewear that this professional has on, the mask, the gloves. She should have some sort of jacket, lab jacket on. Implementing hand hygiene and hand care. respiratory hygiene and cough etiquette. Again, you don't just cough into the open air. You either cough into a Kleenex or into the crook of your arm. You don't want to expose everyone to that. Sterilizing and disinfecting. All instruments need to be properly sterilized and or disinfected. So usually the manufacturer of those instruments will give you instructions for that. And then cleaning and disinfecting. Again, after every single patient, we're going to clean and disinfect the dental unit. all the environmental surfaces, and that's before and after procedures. So you want to clean that place like your mom is coming in or your child is coming in. You know, that's, you want to treat everybody with high regard as far as, you know, infection control. Okay, so what is personal protective equipment? Okay. So personal protective equipment, this includes a gown, lab coat, or, you know, part of your uniform. So usually in dental, we wear scrubs with a lab coat over top. And then this prevents skin and mucous membrane exposure with blood or body fluids, because you can be exposed to a lot of fluids when you're working in dentistry. There's just a lot of saliva, blood, you know, sometimes you wipe your face mask off and you see splatter and you're just like, oh. I'm really glad I had that face mask on. So these things need to be changed daily or visibly soiled. You know, you're not going to wear your lab jacket the entire week. You want to take it home and launder it or launder it at the office after each day. Remove before leaving the dental office. You know, you shouldn't be walking out in all your PPE. You should be removing that lab jacket and, you know, not taking those pathogens home with you. And then launder per manufacturer's directions. So usually we want to wash these things in hot water to kill any pathogens. So personal protective equipment prevents skin contact with blood, saliva, or mucous membranes. So, you know, it's just a barrier between our skin and, you know, our respiratory system, our oral cavities, between that and the patient. So we want to wear new gloves for each patient, obviously. If you happen to tear your glove during treatment, you know, obviously take that glove off, you wash your hands, you put a new glove on. You want to wear gloves when touching contaminated objects. There's non-sterile gloves that are used for exams and then sterile gloves for surgical procedures. So usually we wear the non-sterile gloves in the regular dental office. If you're working in an oral surgery office, then, you know, you might have the option for sterile gloves. But for most... For most procedures in the dental office, you'll be wearing the non-sterile exam gloves. And then hand hygiene. So anytime. So before you put gloves on, you need to wash your hands. After you take gloves off, you need to wash your hands. So always wash your hands before putting on the gloves and after taking gloves off. Whenever spatter or aerosol sprays of blood and saliva are likely, you need to be wearing, you know, your PPE. And that's during any procedure, really, even during taking x-rays. Sometimes I'll see people take x-rays and they're not wearing a mask or eyewear. you know, or whatever. And that's not, that's not acceptable. You know, it doesn't seem like you'd be exposed to a lot while taking x-rays, but what if that patient sneezed at you? Or what if some of their saliva splattered? Because some people do, they drool a lot. So, so you really need to have your PPE on during every procedure in the dental office. Your mask should be changed between patients or if it gets wet or moist during the procedure. Sometimes you're going to be doing two-hour procedures and your mask might... become wet, you know, so you need to change that out during the procedure. At least change it between every single patient. And then eyewear, this should be worn whenever you're doing any kind of procedure, and it should be cleaned between patients. So usually eyewear is just cleaned with soap and water. Some of the stronger types of like Biorex and things like that can can scratch it or make it foggy looking. So, you know, soap and water is fine. And then N95s. So once COVID came along, a lot of people started wearing N95s because this filters 95% of airborne particles. You know, N95s, they're, you know, not all offices are wearing them any longer. But when COVID was so prevalent, most people were wearing N95s to see all their patients. Okay, so protective clothing, gloves, mask, and protective eyewear. That's your PPE. Okay, so hand hygiene. We want to perform hand hygiene before and after each patient. So anytime, or even during the patient, anytime you have to remove your gloves, you need to wash your hands. Anytime you're putting on new gloves, you need to wash your hands. So always, you know, hand hygiene before putting your gloves on and after you're taking your gloves off. Obviously, when hands are visibly soiled or contaminated, you need to wash them. After bare hands, contact objects likely to be contaminated. You need to wash your hands when you remove, discard gloves and wash hands or use antiseptic hand rub before exiting the treatment area. So, you know, if you've been in the treatment area, even if you removed your gloves and you washed your hands, if you stuck around and did more things in that area, you still need to wash your hands or use. hand sanitizer before exiting the area. Gloves, they should never be washed before use and never disinfect it for reuse. You know, one pair of gloves is used on one person only. You don't save gloves for, you know, you don't say, oh, I only used them a little bit. I'll just wash them and use them on the next patient. No, no, no, no, no, never, right? First of all, that you just can't do that. And, you know. Washing your gloves, it's not like washing your hands. It doesn't remove pathogens and it breaks down the material of the gloves. So even if you're tempted to wash your gloves, even if you're using them on the same patient, don't do it. Just get a new pair of gloves. Always get a new pair of gloves for each patient. And you might need to use several pair of gloves on one patient if it's a longer procedure. Remove gloves if they're punctured or torn. then you want to wash or use hand sanitizer before re-gloving. So if you do notice that your glove is torn or punctured, you know, right away stop the procedure, wash your hands very, very well, and then put on a new set of gloves. Okay, so routine hand washing, antiseptic hand wash, antiseptic hand rub technique. So you can use, you know, hand washing is really best. but it is acceptable to use antiseptic hand rubs like hand sanitizer. Okay, so the five moments for hand hygiene. So you want to do hand hygiene, either washing your hands fully or using hand sanitizer before touching a patient. So really, you should be washing your hands with soap and water at the beginning of the day, at the end of the day, and between each patient. The hand sanitizer is more for like quick glove changes. So before touching the patient, perform hand hygiene. Before clean aseptic procedures, so clean your hands immediately before performing any type of aseptic procedure. You know, you want to also wash your hands after any sort of body fluid exposure rinse. For instance, if your glove was torn and you might have been exposed to the body fluid, then, you know, perform hand hygiene then. after touching a patient. So even if you're just performing an extro-oral exam where maybe you're palpating the patient's lymph nodes, you still need to wash your hands before and after touching that patient and after touching patient surroundings. So anything in the treatment room, if you touch it, make sure you wash your hands afterwards because it could be contaminated. Okay, so hand hygiene methods. So we've got routine hand wash. This is water. in plain soap for 40 to 60 seconds. So 40 to 60 seconds is a long time. You know, keep an eye on the clock so you know you're doing it for that long because some people will, you know, kind of cut it short. Antiseptic hand wash. So antiseptic hand wash, you know, if you're using an antimicrobial soap, you can wash the hands not quite as long, you know, 15 seconds is good for that. And then antiseptic hand rubs. So always, if you're using an alcohol-based rub or hand sanitizer, you know, rub it in until the hands are dry. Don't, you know, rub it in and then it's still wet and get a paper towel. No, you want to keep rubbing until the alcohol kind of evaporates on its own. Okay, and then it's really important that we take good care of our hands because any sort of cut on our hands, even if we're wearing gloves, that's still a portal of entry for that pathogen, right? So you want to, you know, kind of take really, really good care of your hands. So we want to take precautions to avoid hand injuries during dental procedures or even outside of the clinic. Dental professionals with exudative or weeping lesions, you know, if the lesion is kind of wet and it's got maybe pus on it or something, you know, if you have that, you have to refrain from patient contact and from handling patient care equipment. because that could be, you know, again, even with the gloves on, that's something that could potentially be contagious. So you have to be very careful. Okay, and then this just shows you how to hand wash. So it's really, really important that you, you know, wet the hands with the water, you apply enough soap, you rub the hands together, you get in between the fingers, the fingernails, all that stuff. So I'll let you guys read over that. But remember, you have to, you know, this is not a quick procedure. It's, you know, if you're just using water and plain soap, it's going to be almost a minute for you to wash your hands. So, you know, just wash them really, really well. And then another thing, when you do turn off the faucet, remember the handle of the faucet could be dirty, so use a paper towel when you turn it off. And we want to wash our hands with soap and water when they're visibly soiled. You know, I would recommend washing your hands with soap and water between each and every patient. Save this hand sanitizer just for when you're treating a patient and maybe you need to change your gloves during that patient's procedure. But between patients, wash your hands really well and always let the patient see you washing your hands because that's more, that's comforting for them to know that you have clean hands, you know. Okay, a little bit of animation there. Okay, and then hand rub. So the hand rub technique, oops, let's go back there. The duration of the entire procedure for hand rub, which is the sanitizer, is about 20-30 seconds. So you want to put the sanitizer in your hand. And again, you want to, you know, get it between the fingers, you want to get it under the fingernails, the palms of the hand, everything. So again, you keep rubbing your hands together until, you know, everything becomes dry. You don't want to get a paper towel in there and take off the hand sanitizer. That won't do. Okay. And then respiratory hygiene and cough etiquette. So you want to cover your cough or sneeze with a tissue. You know, you don't want to just let it fly into the air for everyone to walk through. Then you want to toss the tissue in the trash and then wash your hands, of course. So this was added to the standard precautions of the CDC in 2007 because cough etiquette is very, very important. is designed to limit disease spread by respiratory pathogens via droplet or airborne route. And this includes signage to the patient. So putting up signs, you know, around the office, signage to patient with respiratory conditions to cover their mouths and noses when sneezing, proper disposal of tissues and hand washing after contacting respiratory secretions. So, you know, usually people are pretty good about covering their nose and mouth, but you know, a lot of times little kids are not so great. So sometimes you have to give them a reminder. No-touch receptacles for disposal of tissues should be available in hand-washing stations. So when they say no-touch receptacles, that might be like a foot pedal to open a trash can or something like that. So you don't have to touch things with your hands. And then masks should be offered to coughing patients and space to be seated away from other patients. So if you do have a patient that has a nasty cough. You know, if they might have some sort of infection, you kind of want them away from the other patients to limit any sort of spread of infection. Okay, and sterilization and disinfection of instruments. So we've got three categories of instruments. We've got critical instruments, semi-critical instruments, and non-critical instruments. So we'll talk about those. So critical instruments, so these aren't used when you're doing radiographs, you know, or x-rays, obviously. Critical instruments penetrate bone and or soft tissue. So this is more like scalers or scalpels, you know, when you're doing a oral surgery or scaling and root planing, things like that. So these have to be sterilized after each use because they're exposed to blood and, you know, any blood-borne pathogens could be transmitted from one patient to another if the instruments aren't sterilized. So those are critical instruments. Then we have semi-critical instruments. These contact but do not penetrate bone and or soft tissue. Still, we want to sterilize these after each use. Or use high-level disinfection. So with semi-critical instruments, sometimes they can be damaged by heat, and sterilization is done with heat and steam. So if it's an instrument that'll melt, for instance, if it's a semi-critical instrument, you can use some sort of high-level disinfection. Sometimes we call it, you know, cold bath or cold disinfection. So that's a possibility for semi-critical instruments. And then non-critical instruments, these have no contact with mucus membranes, and these can be intermediate or low-level disinfection can be used. So this is like the radiology machine, the position indicating device, the tube head, the control panel, the lead apron, the keyboard, the mouse, these all need to be disinfected, but you use like basically a liquid spray kind of thing, and you spray it on there and then you wipe everything down. Now, the radiology tools, the beam alignment devices, you know, the patient bites on these, so they go inside the mouth. So these are considered semi-critical, and ordinarily these go through the autoclave. They don't melt or anything. Okay, and then acceptable methods of sterilization. So most offices use an autoclave, and this is steam under pressure. It's kind of like a big pressure cooker. You can also use dry heat, chemical vapor, but you need to... to verify that your autoclave or whatever machine you're using is actually killing the germs that it's supposed to kill, right? So what we do with that, we use these biological indicator strips, bacterial spore test strips. So what you do is you run one of these test strips through the autoclave, and then it's read to see if it killed this bacteria that's on it. And if it killed the bacteria on it, that means that your autoclave is working fine. If it didn't, you've got a problem. Your autoclave needs to be serviced or, you know, there's something wrong. So, you know, so these test strips that should be done at least every week, those are run to make sure that the autoclave is working as it should be working. Now, I've never seen any sort of an issue in the places that I've worked, but you never know, which is why you want to do the spore testing. And that'll be part of your... responsibilities when you guys get into private practice. Okay, so high-level disinfectants. The EPA classifies these things, and they classified certain chemicals as sterilence disinfectants. So this is just a high-level disinfectant, and this is used to disinfect heat-sensitive, semi-critical dental instruments. So the metrocyte, this is glutaraldehyde. And we'll talk about these things in dental materials. But this, you know, this is something that can be used as an alternative to the autoclave for these semi-critical dental instruments that might, you know, melt in the presence of heat, for example. And then cleaning and disinfecting of dental unit and environmental surfaces. So, Birex is kind of the, you know, the disinfectant of choice for this. That's what we use down in the clinic. So you're going to be going through a lot of Biorex. You know, after each patient, you're going to be cleaning the room with Biorex. You're going to be spraying everything down and wiping it and all that stuff. So you want to use Biorex at the beginning of every day and after each patient has been treated. So you have to clean the surfaces and countertops. You can either use the spray, you know, Biorex or they have these wipes that you can use. So, surfaces. must then be disinfected with EPA-listed hospital disinfectants and tuberculosis classified as intermediate-level disinfectants. In other words, intermediate-level disinfectants are recommended, not low-level. So, Biorex is your intermediate level that you can use for disinfecting. We use Biorex, you know, in our clinic, and it's made by a company called Biotrol. It contains phenols, iodophores, and chlorine. or I'm sorry, it contains phenols and autophores, but chlorine containing products are also acceptable. But Biorex is usually what you'll see. So you need to clean surfaces like the door, faucet, handle cabinets, patient chair, dental equipment, all the hoses, you know, all that stuff you need to wipe down with Biorex and you actually get pretty fast at it. So that's good. Okay. So quick learning check. Instruments that penetrate bone and or soft tissue are classified as semi-critical instruments. What do you guys think? Is that true or false? Semi-critical instruments may be cleaned with intermediate or low-level disinfection. Is that true or false? What do you guys think? Okay, they're both false, right? Instruments that penetrate bone and or soft tissue, those are actually classified as critical instruments, right? So, so semi-critical instruments, they can be cleaned with, with a high level disinfection, but, but not, you know, intermediate or low level disinfection. That is not acceptable for a semi-critical instrument. So both of those statements are false. Okay. Infection control during dental imaging. So in dentistry, you know, standard precautions are required when treating all patients. It doesn't matter if this patient has disease or not, you treat all the patients the same. Standard precautions are the minimum infection prevention practices that apply to all patient care. So minimum infection prevention practices. And these are designed to protect the healthcare professional and patients from pathogens that can be spread by blood or any other body fluid excretion or secretion. So all of those. So standard precautions, they include hand hygiene, which we talked about, use of PPE, like gloves, masks, eyewear. respiratory hygiene and cough etiquette, sharp safety, which we talked about, safe injection practices, and we'll talk more about that in other classes, and then sterile instruments and devices, and clean and disinfected environmental surfaces. So all these are important for infection control. Okay, so infection control, it protects the healthcare personnel and patients from pathogens. We use the same infection control procedures for each and every single patient. You don't cut corners on anybody. There's no exceptions. No extra precautions should be used on any patient. So if you're using these standard precautions, that should be used on every single patient. No exceptions. You don't treat somebody differently because they have HIV, for instance. You don't double glove. No, you just use your regular precautions because that's enough. Radiographic areas are capable of transmitting infectious diseases because people, you know, you are working inside the mouth. So it is possible that infectious diseases can be spread. Specific infection control procedures apply to dental imaging and must be used before, during, and after radiographic exposure, as well as during film processing. So if you're, you know, using a dark room to process films, which doesn't really occur that much anymore, you still have to use your PPE because those films can be covered with saliva, which can contain pathogens. Okay, so before exposing radiographs, the treatment area must be prepared using aseptic techniques. Surfaces must be cleaned and disinfected using an intermediate level disinfectant. We use Birex. Next, surfaces should be covered with disposable barriers. So, we're going to be using a lot of disposable barriers when we're taking um you know, working on patients and taking x-rays, for instance. So this can include like plastic wrap. You put plastic wrap over the keyboard, for instance. Sometimes people use aluminum foil. Not so much. That's kind of the exception. Adhesive plastic tape from a dental supply company. You use a lot of tape. You put that on any surfaces that you're going to touch with your hands. The textbook states use of disposable barriers eliminates the need for surface cleaning and disinfection between patients. No, that is wrong, okay? Just because you have a disposable barrier on does not mean that you don't wipe the surface. I don't know why your textbook says that. That is so wrong. So anyway, even whether you put barriers on a surface or not, you still disinfect that surface between patients, period. Okay. Textbook also states if disposable barriers are not used after radiographic procedures are completed, all contaminated surfaces must be cleaned and disinfected with intermediate level disinfectants. Okay, that's true. You know, but whether there's a barrier or not, you have to disinfect all surfaces, period. Okay, that's, that's, you know, that's just silly. Clean and disinfect all surfaces, apply disposable barriers, expose radiographs, then remove barriers, perform surface cleaning and disinfecting, then reapply new surface barriers. So here at NOVA, you know, where you guys are going to be learning, we're going to, you know, we go into the room, we clean and disinfect all surfaces. So we spray the Biorex, we wipe it all down. Then we put barriers onto, you know, anything that we're going to touch, the exposure button, the, you know, the tube head. Then we'll remove, we'll expose the radiographs. Then once we're finished, we'll remove the barriers and we'll clean and disinfect all the surfaces. Again, we will go over that in lab so you guys will know exactly what you're doing. Surfaces that have to be disinfected and are covered. That would be the x-ray machine, the tube head, the PID, the control panel, the exposure button, all that stuff. The dental chair, the headrest and chair adjustment controls. The general work area, the countertops, like the, you know, tray cover or paper towel must be placed on top of the counter where the film and sensor will be placed. So if you're sitting something down on the counter, even though you wiped it down, you still have to sit, put like a paper towel or a patient napkin on that surface because you don't want to take that stuff that's gone in the mouth and sit it right on the surface of the cabinet. You want something disposable under that. And then the patients wear lead aprons during the exposure, right? You put the lead apron on before you take the x-ray. So this has to be wiped and disinfected between patients because, again, you could, you know, have some sort of pathogen on there. Okay, and then preparation of supplies and equipments. Radiographers should have all anticipated supplies and equipment out and ready to use prior to radiographic exposure. So you really need to think ahead and be prepared. You know, what am I going to need? I'm going to need my sensor. I'm going to need a cover. I'm going to need the aiming rings. I'm going to need the holder. You know, you don't want to get everything set up and have your gloves on and ready to go. And oops, I forgot something, you know, and then you're taking out the gloves. You have to sanitize. You have to throw the gloves away. You're wasting materials, you know. So the more prepared you are, the better. Make sure you have everything in there before you bring the patient back. OK, so we're going to be using digital sensors only in our clinic. But, you know, you might get to an office where you use film. I would be very surprised because it's very rare, but you never know. Then there's something else called PSPs. These are phosphor plates. They're kind of like film and digital sensors mixed, but they handle a little bit more like film. So if you have conventional dental film or these phosphor plates, they come from a central supply area. So basically you'll keep them all in one spot. And then you have to put barrier envelopes over top of the film to protect them from saliva. So, again, we won't be using those in our lab. And I would be very surprised if you ever use them in your career, but you never know. Pretty much we all use digital sensors now. So you can see a picture of the digital sensor over here and you have a covering on it. So this digital sensor cannot be heat sterilized, right? So you have to cover it and then you have to disinfect it afterwards. But you have to be very, very careful because it's delicate. It's electronic. You can't get it overly wet. You can't put it in heat. So, you know, so we use a plastic disposable barrier sheet. That's this plastic. bag right here, and we cover the sensor and the sensor wire. So it doesn't just cover the sensor because part of the wire is going to go in the patient's mouth, so it's a little bit long. And then after exposure of radiographs, the sensor and the sensor wire must be cleaned and disinfected with EPA-registered intermediate-level disinfectant after removing the plastic barrier and before using the sensor on another patient. So basically, we want to get rid of this plastic barrier after we're all done. Then we want to take a paper towel and wet it with Birex. That's our intermediate level disinfectant. And then we very, very carefully wipe down the sensor and the wire. Okay, you wipe that whole thing down. And again, we'll show you how to do that in lab. So here's the plastic barrier. So the film, it goes in like a little plastic sheath. And then the sensor, again, you put that in a plastic sheath. You would never want to put this in a patient's mouth without that plastic over top of it. Thank you. Okay, and then beam alignment devices. These are your XCPs. These go in sterilization bags, and then they get sterilized in the autoclave. So, you know, these go in the patient's mouth, they're exposed to saliva, so we autoclave them. And believe it or not, that plastic does not melt in that high heat. So, again, we'll show you how to accomplish that in lab. And then miscellaneous items. Sometimes you might be using like cotton rolls. you know, or other disposable items. This can help stabilize the receptor placement. You just throw those away. Paper towels, you might give the patient a paper towel to hold, like if they have excess saliva, they drool a little bit, you know, that again can get thrown away. Disposable container labeled with patient's name may be used to collect exposed films or phosphor plate sensors. So, you know, if you are using films, you would put all the exposed films in a cup. to carry those back to the dark room. And then all items should be dispensed from a central supply area. So usually they have one area where they have films and they have the covers and they have the sensors and everything like that. So again that varies from office to office and we will show you that in lab. Okay preparation of the patient. Prior to the radiographer completing hand hygiene and donning gloves, putting on gloves, the following patient preparation steps must be completed. The patient has to be seated upright. You know, they have to be sitting up straight to do these x-rays. The patient's headrest must be supported or must be adjusted to support the patient's head because you don't want the patient's head moving around while you're taking these radiographs, right? That could lead to an image not being diagnostic. Lead apron and thyroid collar must be placed on the patient and secured. So you always want to have the lead apron and the thyroid collar. Objects that may interfere with radiographs should be removed by the patient at this time. So patients should take off their glasses. They should get rid of any chewing gums, take out dentures, take out earrings, because those can interfere with the x-ray image. And then a pretreatment rinse may be used to disinfect the patient's mouth. So pretreatment rinse, that's like Listerine or something stronger, and it's usually antibacterial. So if you have the patient rinse. It kills some of the pathogens inside their mouth, and then it just makes it safer for the practitioner. Okay, and then preparation of the dental radiographer. This is what you should look like, basically. You know, gloves, gown, mask, you know, some sort of face shield, you know, eye protection. So after patient preparation and before the radiographic procedure, The radiographer must complete infection control procedures. So they should do hand hygiene in front of the patient. So that should be either washing your hands with soap and water or alcohol hand sanitizer. After hand hygiene, the radiographer must don gloves. So the gloves must be worn. You know, you have to wear gloves when you're doing this because your hands are going to be in and out of the patient's mouth. Now your textbook, once again. they they mess up a little bit um they say that the mask and protective eyewear is optional that is so not true what if somebody sneezed in your face when you're like got your you know you have to get very close in there to make sure you're placing the the sensor in the right spot so your face is going to be right in that person's mouth right and if you don't wear a mask and protective eyewear that's insane so you're just asking to get sick um so so always wear all of your PPE. We require it at NOVA, but even after you leave, wear it all. So, okay, so the correct order to put everything on, you want to put your eyewear on first, your glasses on first, your mask second, and your gloves last. If you put your gloves on first, and then you start putting your mask on, and you're, you know, you're touching your hair, and then you're getting your glasses, that's gross, right? So make sure you put the gloves on last. Once you have the gloves on, then you want to remove the sterilized beam alignment devices, the XCPs, from sterilized packages with gloved hands in front of the patient. So, you know, you want the patient to see that those instruments are clean that you're going to be using. Okay, so once the gloves are donned and the exposures begin, the radiographer should touch only covered surfaces with those. you know, with those hands. So only touch where tape is covering. Again, we will show you this. Touch as few surfaces as possible. You know, you don't want to be digging in a drawer for a cotton roll after everything's begun. If you're doing that, you need to take those gloves off and then rewash your hands and everything. While working with beam alignment devices, contaminated instruments should never be placed on an uncovered countertop. So have a paper towel down that you can sit that XCP and that sensor on. Right? You don't want to sit in on a bare countertop. Okay, interruptions during radiographic exposures. This happens quite a bit. If the radiographer is interrupted and must leave the room, what's the protocol? So first of all, we want to remove contaminated gloves and dispose of those in the trash can. Then we want to wash our hands before we leave the area. Then we want to do whatever we need to outside the room. Then once we come back in, we have to wash our hands again and then don a new pair of gloves. Okay, and then infection control procedures used after the radiographic procedure. Immediately after completing exposures, all contaminated disposable items must be discarded while still wearing gloves, right? You want to keep your gloves on because the stuff you're disposing of could potentially have saliva on it. Uncovered surface areas must be disinfected. So like countertops and things like that, you're going to, parts of the x-ray machine, you're going to wipe down with Biorex. And contaminated items must be handled consistent with recommended infection control guidelines. Okay, and then if you're using phosphor plate sensors or conventional film, you know, you can go ahead and read about that in Chapter 16 for more details. We don't have phosphor plates or conventional films in our clinic. So, you know, it's basically the same procedure as with the sensors, except you have to take into account that you're going into the dark room. So you guys can read over that on your own. Okay. And then contaminated items, they must be discarded while the radiographer is still wearing gloves, right? You don't want to use bare hands to remove barriers that might have saliva on them. The radiographer must carefully unwrap all covered surfaces, dispose of contaminated items in front of the patient, and all contaminated items must be disposed of following local state environmental regulations. So usually this stuff can be disposed of in a regular trash can because it's not covered with blood. If it's got saliva on it, that's okay. That can be, you know, disposed of in regular trash. So while wearing gloves, remove BNM alignment devices from the treatment area, placing them in sterilization bags and sterilization area, and then we're going to label the sterilization sterilization bags properly with our name and the date. After removing and disposing of contaminated items, the radiographer removes gloves and washes hands or uses antiseptic hand rub gel. And after completion of hand hygiene, we want to remove the lead apron from the patient. And the lead apron should be handled by clean hands only. So, you know, it's really difficult to disinfect the lead aprons. So only handle them with clean hands. But then you do want to take a sanitizer or a disinfectant and wipe them off, you know, after the patient's dismissed. Then dismiss the patient from the radiography area. Remaining uncovered surfaces must be cleaned and disinfected using intermediate level disinfectant and utility gloves. So these purple gloves are your utility gloves. So make sure you bring those each time we have radiography lab. Okay, so the sensors. The same wired sensors used for each and every patient. You know, most offices have maybe one or two sensors. They're very expensive, so you don't have multiple, you know, multiple sensors usually. Sensors cannot be placed in the autoclave. They'll melt and they'll be ruined. Sensors cannot be submerged in a disinfecting solution because, again, they, you know, the liquid can get inside the sensor and the electronics will be ruined. Sensors must be properly disinfected between each patient, and they must be covered in plastic sheaths prior to usage. So just remember, these wired sensors are delicate and expensive, and they have to be handled very, very carefully. So after the radiographic exposure, we remove the plastic sheath from the wired sensor. Then we wipe the sensor with disinfectant approved by the manufacturer. So this is usually the Biorex. So you don't... soak it. You soak a paper towel and then you wipe it, you know, wipe the sensor down with the wet paper towel. And then we want to return the disinfectant sensor to the proper storage location afterwards. Okay, so quick learning check. After completing a set of patient radiographs, the radiographer should remove the lead apron from the patient using the surgical gloves worn while taking radiographs, a fresh pair of surgical gloves, clean hands only. or utility gloves. Do you guys remember? All right. The answer to that is clean hands only. So only handle the apron with clean hands. Okay. Don't use dirty gloves to take the apron off. You're going to take the apron off, let the patient go. Then when you're wiping down the room with gloves, you're going to wipe down the apron, but don't put it on and off with your exam gloves that have saliva on them. Okay, and that's it for this chapter. I know it's a long chapter, but it's so important that you protect yourselves. So yeah, so we'll talk more about this at school and in lab. And thank you so much for listening. I hope it was a good lesson for you. Bye bye.

We're going to describe the rationale for infection prevention. We're going to describe the three possible routes of disease transmission. We're going to describe the conditions that must be present for the disease transmission to occur.

We're going to discuss PPE, that's personal protection equipment, hand hygiene, sterilization and disinfection of instruments, and the cleaning and disinfection of the dental unit and environmental surfaces. We're going to describe infection prevention procedures that are necessary before, during, and after the x-ray exposure. We're going to describe infection prevention procedures that are necessary for digital imaging and film processing. We're going to discuss film handling in the darkroom with and without barrier envelopes.

And we're going to discuss film handling without barrier envelopes using the daylight loader. of an automatic processor. So that's a lot of stuff that we have to go over.

So let's go ahead and get started. Okay, so the basics of infection control for the dental radiographer, that's what we're concentrating on here. So you guys have probably heard a lot about PPE and infection control, especially in the wake of COVID.

You know, when COVID came along, infection control, even for lay people. took on a whole new level of importance because, you know, the highly contagious nature of that virus. So infectious diseases, these are a significant hazard in the dental environment.

And what do we mean by infectious diseases? This is basically any infection that can be passed along. So that could be a viral infection like COVID or the flu or even the common cold. It could be some sort of a bacterial infection like tuberculosis, for example.

So there's a lot of infectious diseases out there. And we want to protect ourselves because we are working very, very closely with these patients, very intimately. You know, we're in the area of their mouth where a lot of the, you know, germs escape, basically. So, you know, so we want to be very careful. So infectious diseases, again, they're a significant hazard in the dental environment.

And dental professionals are at an increased risk, but we can minimize this risk. You know, I feel like I'm more safer in a dental office than I am out at the grocery store because I have the knowledge and the equipment that I need to keep myself safe. And then infection control protocols.

These help minimize disease transmission. So it's really, really important that dental health care professionals were aware of these. So the purpose of this chapter is to prevent the rationale for infection control. So.

We're going to review guidelines from the CDC, which are continuously updating. So it's always smart to keep an eye on those, be informed. And then we're going to describe in detail step-by-step infection control procedures in dental imaging.

So again, this is radiology class. So we're focusing on what we do when we're taking dental images. OK, so if you look at this picture, that's pretty gross, right? That picture frightens me.

It really does. So when somebody sneezes, like on a microscopic level, excuse me, that's what's happening. Look at all those germs. Can you imagine if you were sitting next to this person and they didn't cover their mouth? You know, so it's really, really important that we're careful about this stuff.

And, you know, we cover our mouths when we sneeze or we sneeze into the crook of our elbow or, you know, use a tissue when we cough. So, you know, you want to be aware of this stuff inside the dental office and outside the dental office because you can get sick anywhere. So the primary purpose of infection control is to prevent transmission of infectious diseases from the patient to the dental professional, from the dental professional to the patient, and from the patient to the patient. So the patient to the dental professional, you know, imagine you are working on a patient and they do this, they sneeze at you and you're not wearing goggles, you're not wearing a mask, you're not wearing anything. then you would be exposed to whatever they might have.

You know, it might be a cold, it might be COVID, it might be the flu. So, you know, so the patient can transmit diseases to the dental professional. Another way is say you were injecting the patient or the dentist was injecting the patient with the local anesthesia. When they're handing the needle back to you, you know, maybe you guys weren't being super careful and you get jabbed with the needle.

Well, guess what? that needle was exposed to the patient's blood and now you've gotten jabbed with it. So again, you're exposed to whatever bloodborne disease that patient has. So, you know, so those are some ways that infectious diseases can be spread from the patient to the dental professional. The same thing can occur in the reverse order, right?

If you go into work and you have COVID and, you know, either you didn't know or you ignored the symptoms or whatever, you could put your patients at risk. So, you know, especially if you're not wearing proper PPE or following infection control protocols, you know, the patient could catch your COVID or, you know, if there was some sort of a puncture exposure, you know, the patient could be exposed to whatever bloodborne pathogen you have. So, you know, it goes in two directions.

Then also patient to patient. So, you know, during COVID, they started closing down waiting rooms. You know, they tell the patients, wait in your car and we'll text message you and then you can come in. That's because the waiting room can be, you know, it can be a big petri dish. Patients can come in with a cold or a flu or whatever, and that could be, you know, given to another patient.

In a lot of pediatric medical practices, they'll have a sick waiting room and a well waiting room because they don't want the sick kids infecting the well kids. You know, the kids that come in because they have the flu, they don't want the kid that just comes in to get, you know, their yearly, you know, checkup to be exposed to that. And not just in the waiting room.

Patients can expose other patients to infections through dirty instruments, for instance. So if you're... dental office doesn't, you know, sterilize their instruments properly, and there's pathogens on an instrument from a patient, if that instrument is used on another patient without being sterilized, that pathogen can be transmitted to the other patient. And this has happened before, you know, there's been practices that have been unscrupulous and unethical, and they don't sterilize their instruments.

And then, you know, a patient that has HIV you know, they could have gotten it from another patient through an unsterilized instrument. So, you know, so these routes of transmission, they're real, you know, and they've been documented again and again and again. So these things do happen.

So, you know, so you have to be very careful. So disease transmission involves pathogens, and these are microorganisms that are capable of causing disease. So it's that, you know, HIV virus or the COVID virus or the flu virus, you know, that's considered a pathogen.

And pathogens may be present in the oral or respiratory secretions. So if you think about the common cold, you know, that's a lot of that takes place in your chest. And when you sneeze, you know, these pathogens are going to be in, you know, what comes out. So being exposed to the oral cavity, you know, we're going to be exposed to these oral and respiratory secretions.

So, again, we have to be very careful. And then the general routes of disease transmission include direct contact. direct contact with pathogens. This can be in saliva, blood, respiratory secretions, or lesions.

So that means you, you know, the pathogen comes in direct contact with you. Say this person sneezes and you just happen to walk in front of them right afterwards and this is still in the air and you breathe it in. That's direct contact, right?

Indirect contact with contaminated objects. So like I said, if you use instruments on one patient and they're not sterilized properly, and that patient has a bloodborne disease, and you use that instrument on another patient, then that patient could potentially get that bloodborne virus or pathogen. So that's considered indirect contact. You know, you don't come in direct contact, but there's some sort of object that's contaminated that's involved.

And then direct contact with airborne contaminants. So again, this is, you know, when somebody sneezes and maybe you walk through that and you're exposed to that aerosol, that's a direct contact with an airborne contaminant. And that takes me back, the direct contact with pathogens, that does, you know, one part of that is direct contact with airborne contaminants, but you could have direct contact with other pathogens, you know, like if saliva from the patient's mouth splashes in your eye, for instance.

that would be considered a direct contact with pathogens. Okay, so quick learning check. This is kind of what I was referring to. March 29, 2013, so not that long ago, an Oklahoma dentist accused of exposing thousands of patients to HIV, hepatitis B, and hepatitis C may face criminal charges for his actions. Susan Rogers, president of Oklahoma Board of Dentistry, told ABCnews.com.

A dentist in Oklahoma lost his license in 2013 for not sterilizing or not properly sterilizing dental instruments used for oral surgery. This resulted in many patients contracting hepatitis C and HIV from contaminated instruments. This would be an example of which route of disease transmission. Would this be direct contact with pathogens and body fluids? Would this be indirect contact with contaminated objects?

Or would this be direct contact with airborne contaminants? What do you guys think? Okay, if you said indirect contact with airborne contaminants, then you would be right, because that I mean, I'm sorry, indirect contact with contaminated objects. The instruments are contaminated. You know, they were used on one patient, they became contaminated with bloodborne pathogens, and then they were used on another patient.

So that's considered indirect contact with contaminated objects. Okay, so pathogens dental personnel may be exposed to. So we might be exposed to cold and flu viruses and bacteria. coronavirus or COVID-19. There's something called cytomegalovirus, which is in oral and respiratory secretions.

There's hepatitis B virus, which is a bloodborne pathogen. Hepatitis C virus, again, bloodborne pathogen. Herpes simplex virus, we can be exposed to two different strains of that. And if you have ever experienced a cold sore, then you know what herpes simplex virus is. You know, if somebody has a cold sore on their lip, that's a manifestation of the herpes virus, and that's very, very contagious.

And, you know, a cold sore, you don't really think of it as a big deal. But if you were to get that virus, like in your eye, for instance, it could cause blindness. So it can be very, very serious.

So you have to be careful how you handle patients that do have some sort of a herpetic outbreak, like a cold sore, for instance. You don't treat them until it's resolved. you know, they usually resolve within about 10 days. HIV, I'm sure you guys have heard of HIV and AIDS. That's a bloodborne pathogen or bloodborne virus.

And then mycobacterium tuberculosis. So I'm sure you've heard of tuberculosis or TB. That's a bacterial infection.

And again, that's something that dental personnel may be exposed to. Okay, so there are certain conditions needed for infection to occur. First of all, you need a susceptible host. So the host, you know, has to be susceptible.

And if the host has a very weak immune system, like, for instance, patients that have HIV or AIDS, their immune system becomes very, very diminished as the virus progresses. So they would be more susceptible than somebody with a healthy immune system. But even somebody with a healthy immune system can be susceptible.

So you do need a susceptible host. You need a pathogen with sufficient infectivity and numbers to cause infection. So the pathogen, it doesn't merely need to be present.

It needs to be present in enough force that it can cause an infection. portal for pathogen to enter the host. So what is the portal? If you had a needle stick, for instance, the portal would be the puncture in the skin. If you were talking about some sort of airborne respiratory virus like COVID, the portal would be the, you know, the respiratory system of the host.

So you have to have all three of those for infection to occur, the susceptible host, the pathogen, and the portal for entry. So effective infection control is intended to alter one of these three conditions. So, and hopefully all three, you know, the more conditions you can alter, you have a better chance of not being infected. So there's a chain of transmission, they call it.

And you have the, you know, the pathogenic agent that might be a virus or a bacterial infection. The reservoir, which is in the person that has the infection. And. The portal of exit, maybe that's from their oral cavity.

And then transmission to, you know, a susceptible host and then a portal of entry that could be, you know, through the respiratory system, it could be a puncture in the skin, and then the host susceptibility. So that's basically your chain of transmission. Okay, so let's talk real quick about some terminology.

There is a lot of terminology associated with infection control. And you may be familiar with some of these or maybe even all of them. So a lot of times you'll hear these referred to in the news, especially with COVID in the news so much. A lot of these things became.

more part of our, you know, daily verbiage. So antiseptic, this is a substance that inhibits the growth of bacteria. So it inhibits it or slows it down.

Then we have asepsis. This is the absence of pathogens or disease-causing microorganisms. So asepsis is a really, really high level of infection control because you don't just have an inhibition. of the growth of bacteria or pathogens, you have an absence of pathogens.

So asepsis is really a high level of infection control. Bloodborne pathogens. These are pathogens present in the blood that can cause disease in humans.

So usually when we talk about bloodborne pathogens, the big ones are HIV and hepatitis. These are both viruses that are present in the blood, and a lot of times they can be transmitted. through needle sticks in medical and dental settings. Like if you accidentally poked yourself with a needle that was used on somebody, you know, that could happen.

It's a possibility. Disinfect. This means you use a chemical or physical procedure to inhibit or destroy pathogens. This does not include highly resistant bacteria and mycotic or fungal spores. So disinfection can, you know, can kill a lot of pathogens.

but it doesn't necessarily mean that you kill all of them. Exposure incident. Excuse me.

Exposure incident, this is contact with blood or other potentially infectious materials. So when you do have an incident in a clinical setting where, let's say, an operator, a dental health professional was poked by a needle that has been used on a patient, that's considered a quote-unquote exposure incident. Then we have infectious waste.

So as you can imagine, you know, in the medical and dental fields, you know, after a lot of procedures, you have gauze that's soaked with blood or blood products, you have contaminated needles and instruments, you know, things that have been used on the patient that have been exposed to their blood and other types of products. So this is considered infectious waste. And infectious waste is highly regulated.

You can't just take a used needle and throw it in the trash. That's no, that's, you can't do that. because somebody else could get poked with it and be exposed to you know a disease so so you have to put it like in a sharps container and then a special waste disposal company has to come and take it away so this is all very very highly regulated occupational exposure this is contact with blood or other infectious materials that involve the skin the eye the mucous membranes or and it results from the procedure performed by the dental professional.

So this is something that happens on the job during your, you know, while you're performing your occupation. And then parenteral exposure. This is exposure to blood or other infectious materials that results from puncturing the skin. So if there's some sort of puncture from a needle or a sharp instrument or something like that, that's considered a quote-unquote parenteral exposure. Then personal protective equipment.

PPE. You hear it abbreviated a lot of times. So this includes all your protective attire.

This is your gown, your gloves, your mask, your eyewear, everything that's put in place to protect you from contracting some sort of infection or disease from the patient you're working on. That's all considered personal protective equipment. And then sharps. You know, we have sharps containers in all dental offices and medical offices too. And any object that can penetrate the skin, like needles or scalpels, for example, those need to be disposed of in the sharps container.

And then again, that doesn't just go in the trash. That's taken away by a special biohazard, you know, disposal company. And then standard precautions. So standard precautions, these are measures that include a standard of care designed to protect healthcare personnel and patients from pathogens that can be spread by blood or any other body fluid excretion or secretion.

So standard precautions, we'll talk a lot more about that. But the standard precautions is you want to treat every patient that comes in like they have a disease. I mean, you know, not, not, you know, you don't want to be rude or cruel or anything, but, you know, patients, even if they have a medical history and they check no for everything, they could have an infection and not even know about it, right? So you don't just, you know, a patient that does check the box that they have hepatitis, you use the same precautions with them that you use with the patient that checked no for hepatitis or HIV or whatever.

You want to treat every patient like they do have a blood-borne pathogen. And that's just, you know, again, that's not being... you know, rude to the patient or anything, that's just making sure that you always are as careful as you can be with every patient.

You wear all of your PPE. You're very careful handling sharp instruments. You dispose of needles correctly.

You know, so that's basically the, you know, what standard precautions means. And then sterilize. This is to physically or chemically destroy all pathogens, right? And this includes highly resistant bacteria and mycotic spores. Oops, mycotic means fungal.

So, you know, so we sterilize instruments. After we use instruments on a patient, we always sterilize them because you don't want that indirect contact to take place. You know, you don't want another patient to be exposed to a pathogen that a previous patient had.

So we always sterilize, you know, all of our instruments. Okay. So infection control practices in dental healthcare settings.

There's a lot of them because it's really important that we keep ourselves safe. So vaccination of dental professionals. So when you guys got into the program, you were told that you need certain vaccines in order to be part of the program.

And that's really important because, for instance, there's a hepatitis B vaccine. If you get that vaccine and you do have some sort of exposure incident where the patient had hepatitis B, you're protected. right? So the hepatitis B vaccine is really important. Flu vaccines even, they're not 100%, but, you know, kind of gives you a little bit of extra protection during flu season.

Use a protective attire and barrier techniques. So again, we talked about PPE. Hand hygiene, you know, washing your hands is really, really important. Hand hygiene is important because, you know, germs or bacteria, viruses, whatever, can get on your hands.

And if you, you know, work on a patient with those hands without washing them properly, you could, again, expose the patient to, you know, to a virus or some sort of pathogen. Or yourself, you know, if you touch a door handle that, you know, somebody just sneezed on their hand and then they open the door. And then you come along a few minutes later and you touch the door handle and then, you know, maybe rub your nose, then.

you know, you could have gotten a respiratory infection from that. So, you know, so it's always important to wash our hands in both the clinical and non-clinical settings. Proper use and care of sharp instruments and needles.

Again, we talked about sharps containers. Sterilization or disinfection of instruments. Again, that's very important. Cleaning and disinfection of the dental unit and environmental surfaces. So when you get into a career in dentistry, part of your job is cleaning.

I mean, that's just the way it is. So, and, you know, and it's fast and it's not hard, but it's important, you know, so after every patient, you're going to have to wipe down everything in the room. Because again, we want to break this chain of transmission. Disinfection of the dental laboratory. So again, when you're working on like study models or things like that, that might have any pathogens on them, you have to be really, really careful and you have to wipe everything down.

with something that will kill those germs, you know, and keep the environment safe. Use and care of hand pieces, anti-retraction valves, and other intraoral dental devices attached to air and water lines of dental units. Again, we're going to go over a lot of this later in the semester in chairside assisting. Yeah, you'll learn a lot about infection control because it is so important and it's such a foundation of, you know, dental health care. Single-use disposable instruments can be used.

You know, a lot of things we throw away after one use in the dental office because they can't be sterilized and you don't want to expose your patient. So these are things like, you know, suction or the little plastic air water syringes. So you'll see we do have a lot of disposables in dentistry.

On proper handling of biopsy specimens, you know, obviously a biopsy, they cut a portion of the tissue from the patient and this is usually, you know. contaminate it. You know, it has blood and everything, so you have to be very careful handling those.

And you have to be very careful handling extracted teeth in dental education settings. Sometimes we use real extracted teeth when teaching students, so we have to sterilize those before using them. Proper disposal of waste materials. Again, we talked about that.

And implementation of recommendations. So we really need to stay up to date with everything the CDC is recommending, especially when you're, you know, we're not in the midst of a pandemic currently, but, you know, a lot of things change very, very quickly when there is something like COVID that occurs. Okay. So guidelines for infection control in the dental health care settings. This was from 2003, but it was updated in 2016. So, you know, a lot of these infection control practices are kind of timeless, you know, so 2003 seems like a long time ago, but they make, you know, updates and a supplement to address, you know, more, you know, emerging infection issues.

And then we've got OSHA's occupational exposure to bloodborne pathogen. So OSHA is the Occupational Safety and Health Administration. And they're really there.

They're a government agency and they're there for the protection of the worker. So OSHA is your ally. You know, if you ever have a problem at work with, you know, you think they're being unsafe, you know, or you feel like the workers are being exposed to something they shouldn't be. that would be an issue that you could report to OSHA, for instance. Okay, so OSHA guidelines for infection control include using personal protective equipment.

So you can see, you know, the eyewear that this professional has on, the mask, the gloves. She should have some sort of jacket, lab jacket on. Implementing hand hygiene and hand care. respiratory hygiene and cough etiquette.

Again, you don't just cough into the open air. You either cough into a Kleenex or into the crook of your arm. You don't want to expose everyone to that. Sterilizing and disinfecting.

All instruments need to be properly sterilized and or disinfected. So usually the manufacturer of those instruments will give you instructions for that. And then cleaning and disinfecting.

Again, after every single patient, we're going to clean and disinfect the dental unit. all the environmental surfaces, and that's before and after procedures. So you want to clean that place like your mom is coming in or your child is coming in. You know, that's, you want to treat everybody with high regard as far as, you know, infection control.

Okay, so what is personal protective equipment? Okay. So personal protective equipment, this includes a gown, lab coat, or, you know, part of your uniform.

So usually in dental, we wear scrubs with a lab coat over top. And then this prevents skin and mucous membrane exposure with blood or body fluids, because you can be exposed to a lot of fluids when you're working in dentistry. There's just a lot of saliva, blood, you know, sometimes you wipe your face mask off and you see splatter and you're just like, oh.

I'm really glad I had that face mask on. So these things need to be changed daily or visibly soiled. You know, you're not going to wear your lab jacket the entire week. You want to take it home and launder it or launder it at the office after each day.

Remove before leaving the dental office. You know, you shouldn't be walking out in all your PPE. You should be removing that lab jacket and, you know, not taking those pathogens home with you. And then launder per manufacturer's directions.

So usually we want to wash these things in hot water to kill any pathogens. So personal protective equipment prevents skin contact with blood, saliva, or mucous membranes. So, you know, it's just a barrier between our skin and, you know, our respiratory system, our oral cavities, between that and the patient. So we want to wear new gloves for each patient, obviously. If you happen to tear your glove during treatment, you know, obviously take that glove off, you wash your hands, you put a new glove on.

You want to wear gloves when touching contaminated objects. There's non-sterile gloves that are used for exams and then sterile gloves for surgical procedures. So usually we wear the non-sterile gloves in the regular dental office. If you're working in an oral surgery office, then, you know, you might have the option for sterile gloves. But for most...

For most procedures in the dental office, you'll be wearing the non-sterile exam gloves. And then hand hygiene. So anytime.

So before you put gloves on, you need to wash your hands. After you take gloves off, you need to wash your hands. So always wash your hands before putting on the gloves and after taking gloves off. Whenever spatter or aerosol sprays of blood and saliva are likely, you need to be wearing, you know, your PPE.

And that's during any procedure, really, even during taking x-rays. Sometimes I'll see people take x-rays and they're not wearing a mask or eyewear. you know, or whatever.

And that's not, that's not acceptable. You know, it doesn't seem like you'd be exposed to a lot while taking x-rays, but what if that patient sneezed at you? Or what if some of their saliva splattered?

Because some people do, they drool a lot. So, so you really need to have your PPE on during every procedure in the dental office. Your mask should be changed between patients or if it gets wet or moist during the procedure. Sometimes you're going to be doing two-hour procedures and your mask might...

become wet, you know, so you need to change that out during the procedure. At least change it between every single patient. And then eyewear, this should be worn whenever you're doing any kind of procedure, and it should be cleaned between patients.

So usually eyewear is just cleaned with soap and water. Some of the stronger types of like Biorex and things like that can can scratch it or make it foggy looking. So, you know, soap and water is fine. And then N95s. So once COVID came along, a lot of people started wearing N95s because this filters 95% of airborne particles.

You know, N95s, they're, you know, not all offices are wearing them any longer. But when COVID was so prevalent, most people were wearing N95s to see all their patients. Okay, so protective clothing, gloves, mask, and protective eyewear. That's your PPE.

Okay, so hand hygiene. We want to perform hand hygiene before and after each patient. So anytime, or even during the patient, anytime you have to remove your gloves, you need to wash your hands.

Anytime you're putting on new gloves, you need to wash your hands. So always, you know, hand hygiene before putting your gloves on and after you're taking your gloves off. Obviously, when hands are visibly soiled or contaminated, you need to wash them.

After bare hands, contact objects likely to be contaminated. You need to wash your hands when you remove, discard gloves and wash hands or use antiseptic hand rub before exiting the treatment area. So, you know, if you've been in the treatment area, even if you removed your gloves and you washed your hands, if you stuck around and did more things in that area, you still need to wash your hands or use.

hand sanitizer before exiting the area. Gloves, they should never be washed before use and never disinfect it for reuse. You know, one pair of gloves is used on one person only. You don't save gloves for, you know, you don't say, oh, I only used them a little bit.

I'll just wash them and use them on the next patient. No, no, no, no, no, never, right? First of all, that you just can't do that.

And, you know. Washing your gloves, it's not like washing your hands. It doesn't remove pathogens and it breaks down the material of the gloves. So even if you're tempted to wash your gloves, even if you're using them on the same patient, don't do it.

Just get a new pair of gloves. Always get a new pair of gloves for each patient. And you might need to use several pair of gloves on one patient if it's a longer procedure.

Remove gloves if they're punctured or torn. then you want to wash or use hand sanitizer before re-gloving. So if you do notice that your glove is torn or punctured, you know, right away stop the procedure, wash your hands very, very well, and then put on a new set of gloves.

Okay, so routine hand washing, antiseptic hand wash, antiseptic hand rub technique. So you can use, you know, hand washing is really best. but it is acceptable to use antiseptic hand rubs like hand sanitizer.

Okay, so the five moments for hand hygiene. So you want to do hand hygiene, either washing your hands fully or using hand sanitizer before touching a patient. So really, you should be washing your hands with soap and water at the beginning of the day, at the end of the day, and between each patient.

The hand sanitizer is more for like quick glove changes. So before touching the patient, perform hand hygiene. Before clean aseptic procedures, so clean your hands immediately before performing any type of aseptic procedure. You know, you want to also wash your hands after any sort of body fluid exposure rinse.

For instance, if your glove was torn and you might have been exposed to the body fluid, then, you know, perform hand hygiene then. after touching a patient. So even if you're just performing an extro-oral exam where maybe you're palpating the patient's lymph nodes, you still need to wash your hands before and after touching that patient and after touching patient surroundings.

So anything in the treatment room, if you touch it, make sure you wash your hands afterwards because it could be contaminated. Okay, so hand hygiene methods. So we've got routine hand wash. This is water. in plain soap for 40 to 60 seconds.

So 40 to 60 seconds is a long time. You know, keep an eye on the clock so you know you're doing it for that long because some people will, you know, kind of cut it short. Antiseptic hand wash.

So antiseptic hand wash, you know, if you're using an antimicrobial soap, you can wash the hands not quite as long, you know, 15 seconds is good for that. And then antiseptic hand rubs. So always, if you're using an alcohol-based rub or hand sanitizer, you know, rub it in until the hands are dry. Don't, you know, rub it in and then it's still wet and get a paper towel. No, you want to keep rubbing until the alcohol kind of evaporates on its own.

Okay, and then it's really important that we take good care of our hands because any sort of cut on our hands, even if we're wearing gloves, that's still a portal of entry for that pathogen, right? So you want to, you know, kind of take really, really good care of your hands. So we want to take precautions to avoid hand injuries during dental procedures or even outside of the clinic. Dental professionals with exudative or weeping lesions, you know, if the lesion is kind of wet and it's got maybe pus on it or something, you know, if you have that, you have to refrain from patient contact and from handling patient care equipment. because that could be, you know, again, even with the gloves on, that's something that could potentially be contagious.

So you have to be very careful. Okay, and then this just shows you how to hand wash. So it's really, really important that you, you know, wet the hands with the water, you apply enough soap, you rub the hands together, you get in between the fingers, the fingernails, all that stuff.

So I'll let you guys read over that. But remember, you have to, you know, this is not a quick procedure. It's, you know, if you're just using water and plain soap, it's going to be almost a minute for you to wash your hands. So, you know, just wash them really, really well.

And then another thing, when you do turn off the faucet, remember the handle of the faucet could be dirty, so use a paper towel when you turn it off. And we want to wash our hands with soap and water when they're visibly soiled. You know, I would recommend washing your hands with soap and water between each and every patient.

Save this hand sanitizer just for when you're treating a patient and maybe you need to change your gloves during that patient's procedure. But between patients, wash your hands really well and always let the patient see you washing your hands because that's more, that's comforting for them to know that you have clean hands, you know. Okay, a little bit of animation there. Okay, and then hand rub.

So the hand rub technique, oops, let's go back there. The duration of the entire procedure for hand rub, which is the sanitizer, is about 20-30 seconds. So you want to put the sanitizer in your hand. And again, you want to, you know, get it between the fingers, you want to get it under the fingernails, the palms of the hand, everything. So again, you keep rubbing your hands together until, you know, everything becomes dry.

You don't want to get a paper towel in there and take off the hand sanitizer. That won't do. Okay. And then respiratory hygiene and cough etiquette. So you want to cover your cough or sneeze with a tissue.

You know, you don't want to just let it fly into the air for everyone to walk through. Then you want to toss the tissue in the trash and then wash your hands, of course. So this was added to the standard precautions of the CDC in 2007 because cough etiquette is very, very important.

is designed to limit disease spread by respiratory pathogens via droplet or airborne route. And this includes signage to the patient. So putting up signs, you know, around the office, signage to patient with respiratory conditions to cover their mouths and noses when sneezing, proper disposal of tissues and hand washing after contacting respiratory secretions. So, you know, usually people are pretty good about covering their nose and mouth, but you know, a lot of times little kids are not so great.

So sometimes you have to give them a reminder. No-touch receptacles for disposal of tissues should be available in hand-washing stations. So when they say no-touch receptacles, that might be like a foot pedal to open a trash can or something like that. So you don't have to touch things with your hands. And then masks should be offered to coughing patients and space to be seated away from other patients.

So if you do have a patient that has a nasty cough. You know, if they might have some sort of infection, you kind of want them away from the other patients to limit any sort of spread of infection. Okay, and sterilization and disinfection of instruments. So we've got three categories of instruments.

We've got critical instruments, semi-critical instruments, and non-critical instruments. So we'll talk about those. So critical instruments, so these aren't used when you're doing radiographs, you know, or x-rays, obviously.

Critical instruments penetrate bone and or soft tissue. So this is more like scalers or scalpels, you know, when you're doing a oral surgery or scaling and root planing, things like that. So these have to be sterilized after each use because they're exposed to blood and, you know, any blood-borne pathogens could be transmitted from one patient to another if the instruments aren't sterilized. So those are critical instruments. Then we have semi-critical instruments.

These contact but do not penetrate bone and or soft tissue. Still, we want to sterilize these after each use. Or use high-level disinfection.

So with semi-critical instruments, sometimes they can be damaged by heat, and sterilization is done with heat and steam. So if it's an instrument that'll melt, for instance, if it's a semi-critical instrument, you can use some sort of high-level disinfection. Sometimes we call it, you know, cold bath or cold disinfection.

So that's a possibility for semi-critical instruments. And then non-critical instruments, these have no contact with mucus membranes, and these can be intermediate or low-level disinfection can be used. So this is like the radiology machine, the position indicating device, the tube head, the control panel, the lead apron, the keyboard, the mouse, these all need to be disinfected, but you use like basically a liquid spray kind of thing, and you spray it on there and then you wipe everything down.

Now, the radiology tools, the beam alignment devices, you know, the patient bites on these, so they go inside the mouth. So these are considered semi-critical, and ordinarily these go through the autoclave. They don't melt or anything. Okay, and then acceptable methods of sterilization. So most offices use an autoclave, and this is steam under pressure.

It's kind of like a big pressure cooker. You can also use dry heat, chemical vapor, but you need to... to verify that your autoclave or whatever machine you're using is actually killing the germs that it's supposed to kill, right?

So what we do with that, we use these biological indicator strips, bacterial spore test strips. So what you do is you run one of these test strips through the autoclave, and then it's read to see if it killed this bacteria that's on it. And if it killed the bacteria on it, that means that your autoclave is working fine. If it didn't, you've got a problem. Your autoclave needs to be serviced or, you know, there's something wrong.

So, you know, so these test strips that should be done at least every week, those are run to make sure that the autoclave is working as it should be working. Now, I've never seen any sort of an issue in the places that I've worked, but you never know, which is why you want to do the spore testing. And that'll be part of your...

responsibilities when you guys get into private practice. Okay, so high-level disinfectants. The EPA classifies these things, and they classified certain chemicals as sterilence disinfectants.

So this is just a high-level disinfectant, and this is used to disinfect heat-sensitive, semi-critical dental instruments. So the metrocyte, this is glutaraldehyde. And we'll talk about these things in dental materials.

But this, you know, this is something that can be used as an alternative to the autoclave for these semi-critical dental instruments that might, you know, melt in the presence of heat, for example. And then cleaning and disinfecting of dental unit and environmental surfaces. So, Birex is kind of the, you know, the disinfectant of choice for this.

That's what we use down in the clinic. So you're going to be going through a lot of Biorex. You know, after each patient, you're going to be cleaning the room with Biorex. You're going to be spraying everything down and wiping it and all that stuff.

So you want to use Biorex at the beginning of every day and after each patient has been treated. So you have to clean the surfaces and countertops. You can either use the spray, you know, Biorex or they have these wipes that you can use. So, surfaces.

must then be disinfected with EPA-listed hospital disinfectants and tuberculosis classified as intermediate-level disinfectants. In other words, intermediate-level disinfectants are recommended, not low-level. So, Biorex is your intermediate level that you can use for disinfecting. We use Biorex, you know, in our clinic, and it's made by a company called Biotrol. It contains phenols, iodophores, and chlorine.

or I'm sorry, it contains phenols and autophores, but chlorine containing products are also acceptable. But Biorex is usually what you'll see. So you need to clean surfaces like the door, faucet, handle cabinets, patient chair, dental equipment, all the hoses, you know, all that stuff you need to wipe down with Biorex and you actually get pretty fast at it.

So that's good. Okay. So quick learning check. Instruments that penetrate bone and or soft tissue are classified as semi-critical instruments. What do you guys think?

Is that true or false? Semi-critical instruments may be cleaned with intermediate or low-level disinfection. Is that true or false? What do you guys think?

Okay, they're both false, right? Instruments that penetrate bone and or soft tissue, those are actually classified as critical instruments, right? So, so semi-critical instruments, they can be cleaned with, with a high level disinfection, but, but not, you know, intermediate or low level disinfection. That is not acceptable for a semi-critical instrument. So both of those statements are false.

Okay. Infection control during dental imaging. So in dentistry, you know, standard precautions are required when treating all patients.

It doesn't matter if this patient has disease or not, you treat all the patients the same. Standard precautions are the minimum infection prevention practices that apply to all patient care. So minimum infection prevention practices.

And these are designed to protect the healthcare professional and patients from pathogens that can be spread by blood or any other body fluid excretion or secretion. So all of those. So standard precautions, they include hand hygiene, which we talked about, use of PPE, like gloves, masks, eyewear. respiratory hygiene and cough etiquette, sharp safety, which we talked about, safe injection practices, and we'll talk more about that in other classes, and then sterile instruments and devices, and clean and disinfected environmental surfaces.

So all these are important for infection control. Okay, so infection control, it protects the healthcare personnel and patients from pathogens. We use the same infection control procedures for each and every single patient.

You don't cut corners on anybody. There's no exceptions. No extra precautions should be used on any patient.

So if you're using these standard precautions, that should be used on every single patient. No exceptions. You don't treat somebody differently because they have HIV, for instance. You don't double glove.

No, you just use your regular precautions because that's enough. Radiographic areas are capable of transmitting infectious diseases because people, you know, you are working inside the mouth. So it is possible that infectious diseases can be spread.

Specific infection control procedures apply to dental imaging and must be used before, during, and after radiographic exposure, as well as during film processing. So if you're, you know, using a dark room to process films, which doesn't really occur that much anymore, you still have to use your PPE because those films can be covered with saliva, which can contain pathogens. Okay, so before exposing radiographs, the treatment area must be prepared using aseptic techniques. Surfaces must be cleaned and disinfected using an intermediate level disinfectant.

We use Birex. Next, surfaces should be covered with disposable barriers. So, we're going to be using a lot of disposable barriers when we're taking um you know, working on patients and taking x-rays, for instance. So this can include like plastic wrap. You put plastic wrap over the keyboard, for instance.

Sometimes people use aluminum foil. Not so much. That's kind of the exception. Adhesive plastic tape from a dental supply company. You use a lot of tape.

You put that on any surfaces that you're going to touch with your hands. The textbook states use of disposable barriers eliminates the need for surface cleaning and disinfection between patients. No, that is wrong, okay?

Just because you have a disposable barrier on does not mean that you don't wipe the surface. I don't know why your textbook says that. That is so wrong. So anyway, even whether you put barriers on a surface or not, you still disinfect that surface between patients, period.

Okay. Textbook also states if disposable barriers are not used after radiographic procedures are completed, all contaminated surfaces must be cleaned and disinfected with intermediate level disinfectants. Okay, that's true.

You know, but whether there's a barrier or not, you have to disinfect all surfaces, period. Okay, that's, that's, you know, that's just silly. Clean and disinfect all surfaces, apply disposable barriers, expose radiographs, then remove barriers, perform surface cleaning and disinfecting, then reapply new surface barriers.

So here at NOVA, you know, where you guys are going to be learning, we're going to, you know, we go into the room, we clean and disinfect all surfaces. So we spray the Biorex, we wipe it all down. Then we put barriers onto, you know, anything that we're going to touch, the exposure button, the, you know, the tube head.

Then we'll remove, we'll expose the radiographs. Then once we're finished, we'll remove the barriers and we'll clean and disinfect all the surfaces. Again, we will go over that in lab so you guys will know exactly what you're doing. Surfaces that have to be disinfected and are covered.

That would be the x-ray machine, the tube head, the PID, the control panel, the exposure button, all that stuff. The dental chair, the headrest and chair adjustment controls. The general work area, the countertops, like the, you know, tray cover or paper towel must be placed on top of the counter where the film and sensor will be placed.

So if you're sitting something down on the counter, even though you wiped it down, you still have to sit, put like a paper towel or a patient napkin on that surface because you don't want to take that stuff that's gone in the mouth and sit it right on the surface of the cabinet. You want something disposable under that. And then the patients wear lead aprons during the exposure, right?

You put the lead apron on before you take the x-ray. So this has to be wiped and disinfected between patients because, again, you could, you know, have some sort of pathogen on there. Okay, and then preparation of supplies and equipments.

Radiographers should have all anticipated supplies and equipment out and ready to use prior to radiographic exposure. So you really need to think ahead and be prepared. You know, what am I going to need?

I'm going to need my sensor. I'm going to need a cover. I'm going to need the aiming rings. I'm going to need the holder. You know, you don't want to get everything set up and have your gloves on and ready to go.

And oops, I forgot something, you know, and then you're taking out the gloves. You have to sanitize. You have to throw the gloves away.

You're wasting materials, you know. So the more prepared you are, the better. Make sure you have everything in there before you bring the patient back.

OK, so we're going to be using digital sensors only in our clinic. But, you know, you might get to an office where you use film. I would be very surprised because it's very rare, but you never know. Then there's something else called PSPs.

These are phosphor plates. They're kind of like film and digital sensors mixed, but they handle a little bit more like film. So if you have conventional dental film or these phosphor plates, they come from a central supply area. So basically you'll keep them all in one spot.

And then you have to put barrier envelopes over top of the film to protect them from saliva. So, again, we won't be using those in our lab. And I would be very surprised if you ever use them in your career, but you never know.

Pretty much we all use digital sensors now. So you can see a picture of the digital sensor over here and you have a covering on it. So this digital sensor cannot be heat sterilized, right? So you have to cover it and then you have to disinfect it afterwards. But you have to be very, very careful because it's delicate.

It's electronic. You can't get it overly wet. You can't put it in heat.

So, you know, so we use a plastic disposable barrier sheet. That's this plastic. bag right here, and we cover the sensor and the sensor wire.

So it doesn't just cover the sensor because part of the wire is going to go in the patient's mouth, so it's a little bit long. And then after exposure of radiographs, the sensor and the sensor wire must be cleaned and disinfected with EPA-registered intermediate-level disinfectant after removing the plastic barrier and before using the sensor on another patient. So basically, we want to get rid of this plastic barrier after we're all done. Then we want to take a paper towel and wet it with Birex.

That's our intermediate level disinfectant. And then we very, very carefully wipe down the sensor and the wire. Okay, you wipe that whole thing down. And again, we'll show you how to do that in lab. So here's the plastic barrier.

So the film, it goes in like a little plastic sheath. And then the sensor, again, you put that in a plastic sheath. You would never want to put this in a patient's mouth without that plastic over top of it.

Thank you. Okay, and then beam alignment devices. These are your XCPs.

These go in sterilization bags, and then they get sterilized in the autoclave. So, you know, these go in the patient's mouth, they're exposed to saliva, so we autoclave them. And believe it or not, that plastic does not melt in that high heat. So, again, we'll show you how to accomplish that in lab.

And then miscellaneous items. Sometimes you might be using like cotton rolls. you know, or other disposable items.

This can help stabilize the receptor placement. You just throw those away. Paper towels, you might give the patient a paper towel to hold, like if they have excess saliva, they drool a little bit, you know, that again can get thrown away.

Disposable container labeled with patient's name may be used to collect exposed films or phosphor plate sensors. So, you know, if you are using films, you would put all the exposed films in a cup. to carry those back to the dark room. And then all items should be dispensed from a central supply area.

So usually they have one area where they have films and they have the covers and they have the sensors and everything like that. So again that varies from office to office and we will show you that in lab. Okay preparation of the patient. Prior to the radiographer completing hand hygiene and donning gloves, putting on gloves, the following patient preparation steps must be completed. The patient has to be seated upright.

You know, they have to be sitting up straight to do these x-rays. The patient's headrest must be supported or must be adjusted to support the patient's head because you don't want the patient's head moving around while you're taking these radiographs, right? That could lead to an image not being diagnostic. Lead apron and thyroid collar must be placed on the patient and secured. So you always want to have the lead apron and the thyroid collar.

Objects that may interfere with radiographs should be removed by the patient at this time. So patients should take off their glasses. They should get rid of any chewing gums, take out dentures, take out earrings, because those can interfere with the x-ray image.

And then a pretreatment rinse may be used to disinfect the patient's mouth. So pretreatment rinse, that's like Listerine or something stronger, and it's usually antibacterial. So if you have the patient rinse.

It kills some of the pathogens inside their mouth, and then it just makes it safer for the practitioner. Okay, and then preparation of the dental radiographer. This is what you should look like, basically. You know, gloves, gown, mask, you know, some sort of face shield, you know, eye protection. So after patient preparation and before the radiographic procedure, The radiographer must complete infection control procedures.

So they should do hand hygiene in front of the patient. So that should be either washing your hands with soap and water or alcohol hand sanitizer. After hand hygiene, the radiographer must don gloves. So the gloves must be worn.

You know, you have to wear gloves when you're doing this because your hands are going to be in and out of the patient's mouth. Now your textbook, once again. they they mess up a little bit um they say that the mask and protective eyewear is optional that is so not true what if somebody sneezed in your face when you're like got your you know you have to get very close in there to make sure you're placing the the sensor in the right spot so your face is going to be right in that person's mouth right and if you don't wear a mask and protective eyewear that's insane so you're just asking to get sick um so so always wear all of your PPE.

We require it at NOVA, but even after you leave, wear it all. So, okay, so the correct order to put everything on, you want to put your eyewear on first, your glasses on first, your mask second, and your gloves last. If you put your gloves on first, and then you start putting your mask on, and you're, you know, you're touching your hair, and then you're getting your glasses, that's gross, right?

So make sure you put the gloves on last. Once you have the gloves on, then you want to remove the sterilized beam alignment devices, the XCPs, from sterilized packages with gloved hands in front of the patient. So, you know, you want the patient to see that those instruments are clean that you're going to be using.

Okay, so once the gloves are donned and the exposures begin, the radiographer should touch only covered surfaces with those. you know, with those hands. So only touch where tape is covering. Again, we will show you this. Touch as few surfaces as possible.

You know, you don't want to be digging in a drawer for a cotton roll after everything's begun. If you're doing that, you need to take those gloves off and then rewash your hands and everything. While working with beam alignment devices, contaminated instruments should never be placed on an uncovered countertop. So have a paper towel down that you can sit that XCP and that sensor on. Right?

You don't want to sit in on a bare countertop. Okay, interruptions during radiographic exposures. This happens quite a bit.

If the radiographer is interrupted and must leave the room, what's the protocol? So first of all, we want to remove contaminated gloves and dispose of those in the trash can. Then we want to wash our hands before we leave the area. Then we want to do whatever we need to outside the room.

Then once we come back in, we have to wash our hands again and then don a new pair of gloves. Okay, and then infection control procedures used after the radiographic procedure. Immediately after completing exposures, all contaminated disposable items must be discarded while still wearing gloves, right?

You want to keep your gloves on because the stuff you're disposing of could potentially have saliva on it. Uncovered surface areas must be disinfected. So like countertops and things like that, you're going to, parts of the x-ray machine, you're going to wipe down with Biorex.

And contaminated items must be handled consistent with recommended infection control guidelines. Okay, and then if you're using phosphor plate sensors or conventional film, you know, you can go ahead and read about that in Chapter 16 for more details. We don't have phosphor plates or conventional films in our clinic.

So, you know, it's basically the same procedure as with the sensors, except you have to take into account that you're going into the dark room. So you guys can read over that on your own. Okay.

And then contaminated items, they must be discarded while the radiographer is still wearing gloves, right? You don't want to use bare hands to remove barriers that might have saliva on them. The radiographer must carefully unwrap all covered surfaces, dispose of contaminated items in front of the patient, and all contaminated items must be disposed of following local state environmental regulations. So usually this stuff can be disposed of in a regular trash can because it's not covered with blood. If it's got saliva on it, that's okay.

That can be, you know, disposed of in regular trash. So while wearing gloves, remove BNM alignment devices from the treatment area, placing them in sterilization bags and sterilization area, and then we're going to label the sterilization sterilization bags properly with our name and the date. After removing and disposing of contaminated items, the radiographer removes gloves and washes hands or uses antiseptic hand rub gel.

And after completion of hand hygiene, we want to remove the lead apron from the patient. And the lead apron should be handled by clean hands only. So, you know, it's really difficult to disinfect the lead aprons.

So only handle them with clean hands. But then you do want to take a sanitizer or a disinfectant and wipe them off, you know, after the patient's dismissed. Then dismiss the patient from the radiography area. Remaining uncovered surfaces must be cleaned and disinfected using intermediate level disinfectant and utility gloves.

So these purple gloves are your utility gloves. So make sure you bring those each time we have radiography lab. Okay, so the sensors. The same wired sensors used for each and every patient. You know, most offices have maybe one or two sensors.

They're very expensive, so you don't have multiple, you know, multiple sensors usually. Sensors cannot be placed in the autoclave. They'll melt and they'll be ruined. Sensors cannot be submerged in a disinfecting solution because, again, they, you know, the liquid can get inside the sensor and the electronics will be ruined.

Sensors must be properly disinfected between each patient, and they must be covered in plastic sheaths prior to usage. So just remember, these wired sensors are delicate and expensive, and they have to be handled very, very carefully. So after the radiographic exposure, we remove the plastic sheath from the wired sensor.

Then we wipe the sensor with disinfectant approved by the manufacturer. So this is usually the Biorex. So you don't...

soak it. You soak a paper towel and then you wipe it, you know, wipe the sensor down with the wet paper towel. And then we want to return the disinfectant sensor to the proper storage location afterwards.

Okay, so quick learning check. After completing a set of patient radiographs, the radiographer should remove the lead apron from the patient using the surgical gloves worn while taking radiographs, a fresh pair of surgical gloves, clean hands only. or utility gloves.

Do you guys remember? All right. The answer to that is clean hands only.

So only handle the apron with clean hands. Okay. Don't use dirty gloves to take the apron off. You're going to take the apron off, let the patient go.

Then when you're wiping down the room with gloves, you're going to wipe down the apron, but don't put it on and off with your exam gloves that have saliva on them. Okay, and that's it for this chapter. I know it's a long chapter, but it's so important that you protect yourselves. So yeah, so we'll talk more about this at school and in lab. And thank you so much for listening.

I hope it was a good lesson for you. Bye bye.

Transcript for:Infection Control in Dental Radiography

Transcript for:
Infection Control in Dental Radiography