EXPOSURE INCIDENT

Dental personnel who sustain percutaneous inoculation of serum or saliva by accidental puncture, or splashing while handling contaminated instruments, equipment, or supplies must receive immediate medical evaluation to comply with local military treatment facility (MTF) guidelines. Refer to the Nosocomial Infection Control Manual for Ambulatory Care Facilities, NEHC-TM89-2, and

report the incident as a mishap to the command safety officer using OPNAVINST 5102.1.

SECURING THE DTR

To secure the DTR at the end of the day, follow all steps as mentioned under the "Disinfecting the DTR Between Patients" heading.

Flush the high-volume evacuator (HVE) system with at least one quart of water. Clean the system with an HVE system cleaner at least once each week. Use the system cleaner more often if indicated by problems.

Spray-wipe-spray the countertops, dental unit, chair, and dental light. Flush each unit waterline and hose for 30 seconds.

If unit has a self-contained water delivery system, follow manufacturer's instructions for flushing and air purging the lines.

HOUSEKEEPING

Although micro-organisms are normal contaminants of walls and floors, these surfaces are rarely associated with transmitting infection to staff and patients; however, all facilities must remain clean. Any infection control instruction will determine and implement a written schedule for cleaning and a method of disinfection based upon location within the facility, type of surface, type of contaminant present, and tasks or procedures performed in a given area.

The OSHA and NAVOSH requirements for housekeeping include sections on equipment, laundry, and infectious waste disposal.

Equipment

OSHA and the Navy require that all DTFs ensure a clean and sanitary workplace. Work surfaces, equipment, and other reusable items must be decontaminated with an EPA-registered disinfectant upon completion of procedures when contamination occurs through splashes, spills, or other contact with blood and OPIM. Observe and perform the following procedures:

Clean uncarpeted floor and other horizontal surfaces regularly and when spills occur. Use mops with a detergent and an EPA-registered disinfectant or a detergent with sodium hypochlorite (1:100 dilution). Mops must not be used for more than 1 day without cleaning.

Clean walls and blinds only if they are visibly soiled.

Inspect, clean, and disinfect on a regular basis, all bins, pails, cans, and similar receptacles intended for reuse and having the potential for contamination with blood or OPIM. Clean and disinfect these containers immediately or as soon as possible upon visible contamination.

Noninfectious waste refuse containers are not considered infection control hazards. Line them with plastic bags, leave them uncovered, and do not allow them to overflow. Remove hinged doors on cabinet refuse containers and hinged lids on freestanding containers since they present an increased potential for cross-contamination.

Do not pick up broken glassware directly with your hands. Instead, use mechanical means such as a brush and dust pan, vacuum cleaner, tongs, cotton swabs, or forceps.

Laundry

Bed linens, towels, smocks, trousers, and other protective attire are considered ordinary laundry unless they are visibly soiled by blood or OPIM. Ordinary laundry should be sorted wearing gloves and processed following your command's laundry policy.

Contaminated laundry is any laundry soiled with blood or OPIM, including saliva and will be packed in a red biohazard container or bag, or in a leakproof plastic bag with a biohazard label, before shipment to the laundry. When sorting laundry, you should wear gloves and other appropriate personnel protective attire. Bag contaminated laundry at the location of use.

Do not sort or reuse soiled laundry in patient care areas. If your command has on-site laundry service, follow instructions contained in BUMEDINST 6600.10, Dental Infection Control Program.

Regulated Waste Disposal

Infectious waste, now termed "regulated waste" in the DTR is defined as any disposable material with blood or saliva on which, if handled, would release or express blood or saliva. If there is doubt as to the infectiousness of the material in question, contact the ICO or supervisor.

HANDLING.\Regulated waste must be placed in closable, leakproof containers or bags that are labeled as a biohazard (fig. 9-4). The container may be in the DTR or in a central area in the clinic. If a centralized area is used as the regulated waste depository for the clinic, the regulated waste from each DTR must be transported to this central area. If headrest covers from the DTR are used to transport the regulated waste to the depository, they must be closable and identified with a biohazard label.

The ICO should ensure that all DTRs within a clinic and all clinics within a command handle regulated waste in a uniform manner.

RECORDKEEPING. \The ICO should implement a practical system to monitor disposal of infectious waste. This system includes date, type of waste, amount (weight, volume, or number of containers), and disposition.

Further guidance for infectious waste can be found in BUMEDINST 6600.10, Dental Infection Control Program, and BUMEDINST 6280.1, Management of Infectious Waste.

HANDWASHING

Handwashing is one of the most important procedures in preventing the transfer of microorganisms from one person to another. The purpose of handwashing is to remove these micro-organisms from the folds and grooves of the skin by lifting and rinsing them from the skin surface. Good handwashing techniques and use of gloves are essential before anticipated exposure to patients' blood or body fluids.

The skin harbors two types of flora, resident and transient. Resident organisms have these characteristics:

Can survive and multiply on the skin.

Can be cultured repeatedly from the skin.

Are usually of low virulence and are not easily removed.

Conversely, transient bacteria have these characteristics:

Do not survive and multiply on the skin.

Are not firmly attached to the skin.

Are effectively removed by rubbing of the hands together and rinsing them under running water.