IMMUNIZATION AND TESTING

Dental personnel providing direct patient care, including civilian employees, volunteers, dental laboratory, and repair personnel who are directly exposed to blood and saliva, must receive an HBV vaccine. Also, all active duty healthcare personnel will receive HIV and tuberculosis testing and or screening on an annual basis during each calendar year.

Figure 9-1.\Heavy-duty utility gloves.

MEDICAL HISTORY REVIEW

A thorough review of each patient's current medical history is mandatory before initiating any dental examination or treatment procedure.

BARRIER TECHNIQUES AND PROTECTIVE ATTIRE

An effective approach to disease prevention is to reduce exposure to potentially dangerous micro-organisms that may contaminate the body. A method called the "barrier technique" provides a physical barrier between the body and source of contamination. Barrier techniques include the use of personnel protective equipment (PPE) and surface covers. PPE provides protection from contamination to the body with the use of a mask, eyeglasses, gloves, and clothing.

Barrier covers prevent contamination of areas that are exposed to aerosols, splatter, or contaminated fingers during patient treatment. If not covered, these same areas would require adequate disinfection after treatment; otherwise, they would be sources of cross-contamination for the next patient. To protect surfaces against contamination by blood or OPIM, use the following disposable materials:

Plastic wrap or bags

Aluminum foil

Impervious backed paper

These barrier covers (fig. 9-2) can also be used on areas in the dental treatment room (DTR) that are difficult to disinfect, such as light handles, dental control units, switches, headrests, bracket and instrument trays, three-way syringe bases and controls, or X-ray tube heads. Using surface covers as protective barriers has several advantages over disinfecting the surfaces.

Preparation and clean up of the DTR is accomplished with greater efficiency.

Figure 9-2.\Plastic barrier covers in a DTR.

Headrest covers, plastic wrap or bags, aluminum foil, or impervious backed paper can be placed and removed on the surfaces easier and faster than disinfecting.

A reduction in the amount of cleaners and disinfectants otherwise used.

Enhanced longevity of equipment because of reduced contact with corrosive, caustic, or staining compounds in disinfectants.

The disadvantages of using barrier covers are the increased cost of disposables and additional amount of solid waste.

Gloves

Wear gloves for all patient contact activity. Complete all treatment on each patient and wash and reglove before beginning treatment procedures on another patient. Gloves torn or punctured during patient treatment should be replaced immediately.

Since washing increases the porosity of gloves up to 60 percent, repeated use of a single pair of gloves is not permitted. Also petroleum-based hand lotions should not be used before donning gloves.

Many types of gloves are available for use in the dental clinic. The four most common are as follows:

Sterile surgical gloves\They are the highest quality, most expensive, and best fitting. They are used for surgical or invasive procedures (bloody) where maximum protection against infection must be provided for the patient and the provider.

Procedural gloves\They are manufactured the same as sterile surgical gloves; however, these gloves are nonsterile and are not individually wrapped in pairs. Procedural gloves offer the highest quality and best fit at a greatly reduced cost when sterile surgical gloves are not required.

Latex examination gloves\These are the least expensive type of nonsterile gloves that are commonly used in routine dental procedures. They are available in a variety of sizes and come with or without cornstarch for ease in putting them on and off. Some individuals may develop hypersensitive reactions either to the latex material or the cornstarch. If this occurs, latex powderless gloves should be worn. If a true latex allergy exists, it should be documented in the staff member's medical record.

Clinical Apparel

Wear reusable or disposable clinical apparel, such as smocks, scrubs, laboratory coats, or other personal protective attire when treating patients or working in areas where contaminated or potentially contaminated materials may be present. When surgical procedures are performed involving reasonable exposure to blood or OPIM, additional personnel protective equipment or apparel, such as long-sleeved gowns, is required. Forearms must be covered if one reasonably assumes that they will be splattered with saliva or blood. All dental personnel must take the following precautions regarding the use of clinical apparel:

Wear clinic apparel only in the DTF.

Change clinic apparel daily and when visibly soiled.

Turn in soiled linen at the end of the work period and place them in a soiled linen receptacle (fig. 9-3).

Do not leave dirty clinic attire in personal clothing lockers or spaces overnight.

Face Mask and Shield

Wear a face mask or a full-length face shield with a face mask during any patient treatment. Wear a mask in the DTR and central sterilization room (CSR) where aerosols are a problem, especially on the dirty side of the CSR. Personnel must change face masks in the following situations:

After each patient or when the mask is visibly soiled.

When involved in other activities such as prosthetic laboratory and equipment repair procedures where airborne particles or dusts are produced.

When sorting laundry.

During decontamination procedures.

When cleaning spills of infectious wastes.

Protective Eyewear

Wear protective eyewear when assisting or providing treatment or other procedures that may cause a splash, splatter, or airborne particles. Eyewear or goggles must have solid side shields to provide maximum protection. Patients must be provided approved protective eyewear. Disinfect patient eyewear after treatment.

Protective Headwear

Wear disposable protective headwear during surgical procedures such as periodontal, endodontic, and oral surgery. Headwear must fit the head to minimize exposure of the head and hair to potential splashing or spraying of blood or airborne particles.

Eating, Grooming, Drinking, and Smoking

Eating, grooming, drinking, and smoking are permitted only in designated areas separate from DTRs. Follow all BUMED and command instructions pertaining to this matter.