INFECTION CONTROL IN THE DTR

Infection control in the DTR is your responsibility. There are many precautions and procedures involved with infection control practices. The implementation of aseptic techniques is required when preparing for patient treatment, during

Figure 9-3.\Soiled linen receptacle.

treatment, and after the patient is dismissed. There can be no short cuts or deviation from your command's written procedures and guidelines on infection control. They must be done correctly. You must be able to accomplish the following infection control procedures:

Prepare the DTR for treatment.

Assist the dental officer during treatment.

Disinfect the DTR between patients.

Secure the DTR at the end of the day.

Perform housekeeping duties.

Sort laundry.

Dispose of infectious waste.

PREPARATION OF THE DTR

In accordance with BUMEDINST 6600.10, the Dental Infection Control Program, the following procedures should be used. As a dental assistant, it is your responsibility to ensure that your DTR is properly prepared to treat dental patients. All dental personnel must strictly adhere to the procedures explained next.

Unit Water Supply System

At the beginning of each workday, flush each of the unit water lines and hoses for at least 1 minute, beginning with the cup filler and cuspidor even if their use is not anticipated. Potable water supplies may contain up to 100 bacterial colony forming units per millimeter (cfu/ml), and water in dental units, at times, can contain in excess of 1,000,000 cfu/ml. This microbial contamination comes from the retraction of contaminated water and saliva through the dental handpiece and the growth of bacteria in the unit water lines. Although most incoming water is chlorinated, chlorine loses its potency as the water lies stagnant in the unit tubing. Under the right circumstances, these bacteria will multiply and may become pathogenic.

Working Surfaces

Open instrument trays, packs, or cassettes and leave wrapping material underneath as a barrier for the work surface. To protect surfaces against contamination by blood, you should cover and use barriers for areas that are difficult to disinfect.

Infection Control During Dental Treatment

Aerosols in the work environment present a potential health hazard for both the dental staff and patient. The long term effect is cumulative and may be harmful. The use of high-volume evacuators (HVEs) and rubber dams during all dental procedures generating aerosols will reduce the volume of aerosols and decrease the level of micro-organisms. Aerosol levels can also be lowered and minimize the potential risk by employing the following procedures:

Clean cavity preparations with water, air, or an air and water combination.

Cover ultrasonic tanks when in use.

The dental officer may direct you to have patients brush their teeth or rinse with a mouthwash before treatment. This will reduce the microbial concentration of their oral flora (saliva). Three 10-second rinses will temporarily reduce a patient's microbial count by up to 97 percent. Many dentists are now using a 0.12 percent chlorhexidine gluconate preoperative rinse that also significantly decreases the amount of microbial count of an aerosol.

The following procedures should be used with all dental patients for infection control:

Be sure to wash your hands before donning and after removal of gloves.

Wear sterile gloves for all invasive surgical procedures.

Use nonsterile gloves for examination and other nonsurgical dental procedures.

Use a rubber dam whenever possible. Swab isolated teeth with an antimicrobial mouthwash to reduce aerosolization of oral bacteria.

Use disposable suction, saliva ejector, and irrigation tips.

Autoclave all instruments that can withstand heat sterilization.

Sterilize rotary cutting instruments such as burs and diamonds before using.

Use the unit dose concept when dispensing supplies for each treatment setup. This is mandatory.

Use sterilizable cassettes, tray sets, or packs for instruments.

Place the proper amount of supplies in each setup before sterilizing.

Store opened packages of supplies in closed drawers or cabinets in the DTR (in a covered container if practical).

Use clean forceps to dispense only enough supplies for immediate use.

Never use your hands to dispense items from bulk storage containers.

Use of bottled irrigation solution for surgical and nonsurgical procedures is considered sterile only for that patient if aseptic techniques are maintained.

Record expiration dates on all opened containers.

Before leaving the DTR, all personnel will remove and discard gloves and masks worn during patient treatment, except when transporting contaminated items to the CSR or to the prosthetic laboratory if authorized by your Command Infection Control Officer.

To prevent transfer of secretion to and contamination of a patient's chart, remove gloves and wash hands (unless cover gloves are worn) before writing in dental records, viewing radiographs, or taking photographs.