Infection control dental

Infection control dental

Infection control dental water unit

“Practice A used tap water for pulpotomies without water quality monitoring or bleaching of waterlines at the end of each day, as recommended in the manufacturer guidelines.* All water samples from the seven dental stations had bacterial counts above the American Dental Association recommended ≤500 colony-forming units (CFU)/mL (average = 91,333 CFU/mL); M. abscessus was isolated from all water samples. All water and patient isolates were indistinguishable by PFGE, indicating a common source.” Seems odd all would have the same bacterial signature.

Source

OSAP has very good guidelines from 2018 that are more in depth than the CDC from 2016.

Infection Prevention from the CDC

The CDC short version of the extensive 2016 guidelines. I have read there is an app that helps staff but unable to find.

Surface cleaning products

Dental Advisor Caviwipes

Hinged instrument sterilization

The CDC does recommend that hinged instruments be open for sterilization (1, 2) but there is no evidence this matters and I think the reason they ask that the instruments be open is to “allow the cleaning solutions to reach the serrations, ratchets and joints.” 1 However, this is for cleaning and not the sterilization process. It does not make sense to me that the sterilization would not work as the cleaning agent is heat and pressure not a liquid. Furthermore evidence of this is found in recommendations that recommend opening and closing the hinged instruments while cleaning them.1 I believe it is a cleaning issue not a sterilization issue but the two got interchanged by someone along the way possibly due to things like cold sterilization where the agent of sterilization is liquid.

Backflow of low evacuation

The CDC knows this occurs but since no evidence of harm they do not seem to be too concerned.

Backflow occurs when previously suctioned fluids present in the suction tubing flow back into the patient’s mouth. Backflow can occur when:

  • There is pressure in a patient’s mouth (a result of closing their lips and forming a seal around the tip of the ejector) that is less than in the saliva ejector (similar to how liquid flows back into a cup after drinking through a straw).
  • The suction tubing attached to the ejector is positioned above the patient’s mouth.
  • A saliva ejector is used at the same time as other evacuation (high-volume) equipment.

Although no adverse health effects associated with the saliva ejector have been reported, dental health care personnel (DHCP) should be aware that backflow could occur when they use a saliva ejector. DHCP should not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids. DHCP should contact the manufacturer of the dental unit to review proper use and maintenance procedures, including appropriate cleaning and disinfection methods.

References

Barbeau J, ten Bokum L, Gauthier C, Prevost AP. Cross-contamination potential of saliva ejectors used in dentistry. J Hosp Infect 1998;40:303–311.

CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. Available at: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf[PDF-1.2M]. Accessed March 18, 2016.

Mann GLB, Campbell TL, Crawford JJ. Backflow in low volume suction: The impact of pressure changes. J Am Dent Assn 1996;127:611–615.

Watson CM, Whitehouse RLS. Possibility of cross-contamination between dental patients by means of the saliva ejector. J Am Dent Assn 1993;124:77–80. Saliva backflow between dental patients

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