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Recommended infection-control practices for dentistry, 1993. Centers for Disease Control and Prevention.

This document updates previously published CDC recommendations for infection-control practices in dentistry to reflect new data, materials, technology, and equipment. When implemented, these recommendations should reduce the risk of disease transmission in the dental environment, from patient to dental health-care worker (DHCW), from DHCW to patient, and from patient to patient. Based on principles of infection control, the document delineates specific recommendations related to vaccination of DHCWs; protective attire and barrier techniques; handwashing and care of hands; the use and care of sharp instruments and needles; sterilization or disinfection of instruments; cleaning and disinfection of the dental unit and environmental surfaces; disinfection and the dental laboratory; use and care of handpieces, antiretraction valves, and other intraoral dental devices attached to air and water lines of dental units; single-use disposable instruments; the handling of biopsy specimens; use of extracted teeth in dental educational settings; disposal of waste materials; and implementation of recommendations.

Dental Instruments↗

Concerns regarding infection control recommendations for dental practice.

It goes without saying that the members of any professional group are more likely to modify their behavior if they are provided with logical, rational reasons to enact the suggested change. In the mid 1980s, health care providers, including dental personnel, were advised to adopt universal precautions and to alter their infection control habits with minimal justification, apart from the general unease and paranoia surrounding AIDS. Therefore, it is understandable that some practitioners would react with scepticism to the idea that their traditional infection control techniques were less than adequate, while others would overwhelmingly embrace the new recommendations in the misguided belief that personal, patient, staff and family safety would be enhanced. This predictable confusion is epitomized by the dentist who "sterilizes" extraction forceps by immersing them in alcohol for 10 minutes, versus the dentist who wears gloves, mask and disposable gown to conduct a recall examination. And if dentists are perplexed, it is clear that their staffs are equally, if not more confused, since they are exposed to the exaggerated claims and counter claims of sales agents. The microbes encountered in dental practise, apart from the hepatitis B virus, pose no significant risk to dental personnel or their patients, and the danger of hepatitis B transmission is reduced most effectively by vaccination. In reality, the genesis of dentistry's current emphasis on infection control resides entirely with HIV disease. But there is no credible clinical evidence to suggest that HIV infection is transmitted via dental treatment. Indeed, it may be theorized that for such a transmission to occur, the blood stream of the susceptible recipient would have to be invaded directly by a pathogenic inoculum of the virus--an unlikely event in the normal practise of dentistry. Under such circumstances, infection control practises should ignore the danger of HIV transmission, but concentrate on: Sterilization of all surgical and invasive instruments to protect patients from potential cross-infection. All dental staff receiving hepatitis B vaccinations. Dental staff wearing gloves, especially while performing intraoral procedures with blood release, and handling used instruments, to protect them from direct contact with potential pathogens. Working in a clean environment, in which blood spills and splatters are removed mainly for esthetic reasons. Such measures reflect the actual potential for disease transmission, as it exists in dentistry. They are justified and economical, and will be implemented by concerned but knowledgeable dental staff.

Acquired Immunodeficiency Syndrome↗

Survey of infection control precautions: a comparison to recommended guidelines.

The emergence of acquired immune deficiency syndrome as a new and devastating communicable disease has led to concern among health care workers as to their risk of acquiring human immunodeficiency virus (HIV) in the workplace. Centres for Disease Control, and Health and Welfare Canada guidelines seek to prevent HIV transmission through modification of work practices. A study was performed in the authors' institution to quantitate health care worker compliance with such practice modifications as outlined in the researchers' institutional infection control procedures and to evaluate administrative and engineering controls related to this policy. An infection control program to educate health care workers and modify practices was being implemented prior to commencement of this study. Three areas were studied: emergency room, dental clinic and plastic surgery clinic. Adherence to established procedures was judged as compliant, noncompliant and interpretive compliant. Of 806 observations made on 24 health care workers in the three areas, 31.3% were compliant, 28% were noncompliant and 40.7% were interpretive complaint. The most serious non-compliance was noted in handling and disposal of needles. Use of gloves, eyewear, gowns or masks varied among the three sites. Administrative and engineering controls were lacking for eyewear, gowns, puncture-resistant containers and a written policy in some sites. The lack of compliance with institutional infection control procedures needs to be confirmed in other institutions. If there is generalized compliance failure, then a re-evaluation of the present strategies to reduce risk of HIV infection in health care workers is essential.

Clinical Protocols↗

A body-system approach to infection control and discharge planning.

Discharge planning is a complex process that must address all patient needs, including safety and infection control. A tremendous amount of collaboration and consideration of all factors that impact on utilization, quality assurance, and discharge planning are necessary from the infection control nurse and discharge planning nurse. The Joint Commission on Accreditation of Healthcare Organizations has adopted standards to address timely and smooth transitions of patients to appropriate posthospital care. Infection control policies must address these standards.

Aged↗

A national task analysis of infection control practitioners, 1982. Part Three: The relationship between hospital size and tasks performed.

One aspect of the Certification Board of Infection Control's (CBIC) task analysis survey was to determine those tasks done most frequently and considered most important by ICPs. A randomized stratified sample of ICPs was taken from U.S. hospitals of various bed-size categories. There were 473 responses (78.8%) from a targeted sample of 600 ICPs. Statistical analyses were done to find if a relationship existed between hospital size and the tasks performed. The frequency of performance and importance of the majority of infection control tasks studied were found to vary in relation to hospital size. Some tasks were found to be both important and frequently performed by the majority of ICPs in all hospital bed-size categories. These included performing and reporting epidemiologic surveillance, educating personnel, developing infection control policies and procedures, and consulting with hospital personnel. Other tasks were found to be relatively less important and infrequently performed by the majority of ICPs in all hospital bed-size categories. These included performing bedside patient care procedures, recommending specific antimicrobial therapy, and using statistical methods. The greatest differences in the performance of tasks were found in the subsample of the ICPs from hospitals with less than or equal to 100 beds.

Communicable Disease Control↗

A comparison of infection control practices of different groups of oral specialists and general dental practitioners.

OBJECTIVE: The purpose of this study was to compare the infection control practices of general dentists and dental specialty groups. METHODS: A survey was mailed to 5997 dentists in 1994; the response rate was 70%. The data were analyzed with multiple logistic regression (reference group: general dentists). RESULTS: When sociodemographic influences were taken into consideration, significant predictors of routine infection control practices included all of the following characteristics (odds ratios are in parentheses): 1. Gloves: being younger than 40 years of age (4.5) and being female (5.9). 2. Using gloves and changing gloves after each patient: being younger than 40 years of age (4.0), being female (3.0), being an oral surgeon (3.6), and being an orthodontist (0.2). 3. Using gloves, masks, and protective eyewear: being younger than 40 years of age (2.5), being female (2.3), and being an orthodontist, oral physician, or oral pathologist (0.2). 4. Hepatitis B vaccination for the practitioner: being younger than 40 years of age (5.1). 5. Hepatitis B vaccination for all clinical staff members: being younger than 40 years of age (1.2), being an oral surgeon (1.7), and being an orthodontist (0.6). 6. Heat sterilization of handpieces: being younger than 40 years of age (1.5), being an oral surgeon (5.4), and being an orthodontist (0.2). 7. Taking no additional precautions for patients with HIV: being younger than 40 years of age (1.7), being a periodontist (2.6), being a pedodontist (2.3), and being an oral physician/oral pathologist (4.3). CONCLUSION: Improved compliance with recommended infection control procedures is required for all groups and is particularly necessary for orthodontists.

Adult↗

Novel uses of the aromagram in infection control and epidemiology.

BACKGROUND: To facilitate the interpretation of data used in infection control and epidemiology, a novel data presentation format (the aromagram) has been developed and modified. METHODS: Aromagrams were developed with a personal computer-based graphics application. Aromagrams were based on antimicrobial susceptibility data from all specimen submitted to the University of California San Diego Medical Center's clinical microbiology laboratory between July 1992 and December 1994. RESULTS: The aromagrams created displayed both bacterial species-specific and antimicrobial agent-specific susceptibilities. Additional modified aromagrams incorporated costs of antimicrobial agents and temporal trends in susceptibility of individual species to selected antibiotics. CONCLUSIONS: The aromagram is a unique format for data presentation that can be used to illustrate antimicrobial susceptibilities (specific to both organisms and antimicrobial agents), temporal trends in susceptibility data, and antimicrobial costs. Aromagrams may be used to display data useful to infection control and epidemiology professionals and to clinicians.

California↗

The AHCPR pressure ulcer infection control recommendations revisited.

The 1994 AHCPR Pressure Ulcer Treatment Guideline had five recommendations on infection control topics. A review of the literature since mid-1993 when the evidence to support these recommendations was undertaken is reported on here. The author suggests that the recommendations be revisited in light of two recent quasi-experimental studies, but since no randomized controlled trials were found, the strength-of-evidence ratings should remain at C for all five recommendations. Infection control for chronic wound care is a complex issue and is clearly in need of further research. In the meantime, common-sense, reasonably prudent, do-no-harm interventions should be considered best practice.

Bandages↗

Ethical issues in infection control in home care.

The history of infection control is ancient and inextricably bound to the histories of disease, medicine, and nursing. This history reveals the beliefs about the cause of infectious disease through time and the remedies enacted in response. Implicit in this history is an ethical history reflecting the relationship of the infected individual to the group and the power of the state to institute protective measures. In the Middle Ages, for example, a requiem mass or mass for the dead was held for lepers in which the church was draped in black and dirt thrown on the lepers' head. Afterward, they were lead to the leprosaria and given a rattle they were required to use to warn others of their approach.

Attitude of Health Personnel↗

Prevention of infections associated with permanent cardiac antiarrhythmic devices by implementation of a comprehensive infection control program.

OBJECTIVE: To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs). DESIGN: Prospective before-after trial with 2 years of follow-up. SETTING: A tertiary-care, university-affiliated medical center. PATIENTS: A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002. INTERVENTION: An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates. RESULTS: Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005). CONCLUSIONS: We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.

Adult↗

[Joint effort to improve quality in a Brazilian pediatric public hospital through cross-infection control]

OBJECTIVES: To examine the role of the laboratory in nosocomial infection control from January 1993 to December 1996 in Centro Geral de Pediatria of Hospital Foundation of Minas Gerais state. METHODS: Follow -up of 101,139 patient-days (11,147 discharges + deaths + transfers) in the wards and intensive care unit by using the National Nosocomial Infection Surveillance (NNIS) system proposed by the Centers for Disease Control and Prevention (CDC- Atlanta). Prospective surveillance of nosocomial infections at all sites was performed according to the hospital - wide (since 1992) and intensive care unit (since 1996) NNIS components. The CDC definitions since 1988 and Brazilian Ministry of Health regulation number 930 since 1992 were used to diagnose the nosocomial infections. RESULTS: The five most frequent nosocomial pathogens (from a total of 139 isolates) were Klebsiella sp = 24.5%; S. aureus = 18%; P. aeruginosa = 13.7%; E. coli = 12.9%; S. epidermidis = 12.2%. The percentage of identification of pathogens isolated from nosocomial infection sites has increased from 6.2% in 1993 to 13.3% in 1995 and 28.2% in 1996 (p< 0.001) and so has the attempt to isolate the pathogens: 7.5% in 1993, 16.1% in 1995, 33.8% in 1996 (p< 0.001). The time interval taken for lab results (from specimen collected to microbiology result) has decreased from the average of ten days in 1993 to six days in 1996 (p = 0.001). CONCLUSIONS: The continuing education and improved communication among infection control personnel, pediatricians, surgeons and members of the laboratory have proven to play a key role in the epidemiology of nosocomial infections by defining their etiologies in the Centro Geral de Pediatria. A task force to determine the microbiology has been achieved by the understanding of all clinicians that it is important to treat their patients specifically. The NNIS method applied to Brazilian hospitals has shown its impact on the microbiology lab role in nosocomial infection control as well.

Journal Article↗

Infection control and outpatient parenteral antibiotic therapy.

Outpatient procedures have become more complex, requiring outpatient providers to offer technical procedures in the home, office, and clinic. This shift in health care has brought about the need for staff members to become proficient in a variety of technical procedures that were once done only in the hospital setting. Outpatient i.v. therapy has caused home health care agencies, physicians' offices, and clinics to seek education and training regarding i.v. therapy and to develop basic infection-control guidelines and guidelines related to the insertion and maintenance of i.v. devices. The goals of the outpatient provider are to prevent i.v.-related complications and to provide quality patient care. These can be accomplished by strict adherence to sound infection-control guidelines and routine monitoring of procedure techniques and complications of care. Outpatient providers may wish to seek expertise and guidance from hospital infection-control personnel, infectious diseases specialists, or other infection-control consultants to meet the demands of the complexity of outpatient care.

Anti-Bacterial Agents↗

Perceptions of physicians on infection control activities in Turkish hospitals: a cross-sectional survey.

BACKGROUND: Most countries practice some form of infection control (IC) to minimize hospital-acquired infections. There is still considerable diversity in IC activities in Turkey. Little is known about practical issues and perceptions of physicians regarding IC in Turkey. METHODS: The authors developed an 11-item questionnaire addressing questions on IC activities. Physicians attending a national infection control meeting (n = 285) were asked to participate. RESULTS: The response rate was 86%. Respondents from nonuniversity teaching hospitals stated a higher involvement in IC. Physicians from university hospitals were in greater need of IC training. CONCLUSIONS: Academic hospitals are particularly concerned with IC. Domains such as surveillance of endemic hospital infections, specific preventive protocols, antibiotics policy, and staff education should be addressed by IC committees. IC is well established in Turkey, but there is still a long way to go to reach the standards found in developed countries.

Attitude of Health Personnel↗

Infection control.

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Cross Infection↗

Infection control among dentists in private practice in Durban.

The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.

Adult↗

Infection control and its application to the administration of intravenous medications during gastrointestinal endoscopy.

Several infection control practices and procedures crucial to the prevention of disease transmission in the health care setting are reviewed and discussed. Emphasis is placed on the importance of infection control to gastrointestinal endoscopy. Recommendations that minimize the risk of nosocomial infection during the preparation, handling, and administration of intravenous medications, particularly propofol, are provided. These recommendations include the labeling of predrawn syringes; use of sterile single-use syringes, needles, and administration sets for each patient; and, whenever feasible, administration of intravenous medications promptly after opening their prefilled syringes or after opening their ampoules or vials and filling the sterile syringes.

Cross Infection↗