Biosafety in dentistry

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* Principles of Biosafety

* Definition of Terms

* Practical recommendations for activities related to patient care

* Cleaning and disinfection of materials and equipment

* Criteria for disinfection, decontamination, cleaning, disinfection

* Procedures for decontamination, cleaning, disinfection and sterilization

* Recommendations for care at the dental center

* Minimum biosecurity standards in dentistry

* Bibliography

INTRODUCTION

Biosafety regulations are intended to reduce the risk of transmission of microorganisms from recognized or unrecognized sources of infection in health services related to accidents by exposure to blood and body fluids.

The objectives of these recommendations are to establish:

* The accident prevention measures of health that are exposed to blood and other body fluids.

* The action to take against an accident with exposure to these elements.

It should be noted that due to scientific and technological development should anticipate periodic reviews of these standards for the purpose of ensuring the updating of the same.

Both the Surgeon Dentists and Health staff are those most at risk of contracting infectious diseases such as AIDS, hepatitis B, tuberculosis, and herpes hominis virus infections. The dental office is one of the environments in which the patient and the practitioner can get these diseases if not taken into account the fundamentals of Biosafety.

At the beginning of the 80’s comes first in isolation and then as HIV pandemic. Since then this has aroused great interest in all health professionals especially in the field of dentistry “because of its increasing prevalence and its mode of transmission.

From the point of view of possibility of infection by an infectious agent, the disease that more should concern the dental profession is infection by the hepatitis B virus is estimated that worldwide there are over 200 million asymptomatic carriers with this virus , there are several reports of dentists and laboratory technicians who have been infected after exposure to contaminated materials.

Thus, it is proven that several cases of infections in health personnel has occurred by accidental contact with blood, the virus-contaminated material.

The emergence of these infections among others has had an impact on dental practice and public health. Also represents challenge to the profession, and has compelling retrain and reassess the knowledge and methods of care the main goal of these changes is an appropriate education leading to the dentists know the manifestations of these infections and rules to prevent contagion for dental care.

One of the changes that have occurred in the profession, has been the adoption of new rules of infection control to ensure that the risk of transmission of these for dental care is minimal.

The Authors

BIOSECURITY

CONCEPT:

The set of preventive measures that are intended to protect the health and personal safety of health professionals and patients against the risks caused by various biological, physical, chemical and mechanical.

These rules indicate how to make fewer mistakes and suffer fewer accidents and, if they occur, how we minimize its consequences.

Biosecurity should be understood as a doctrine aimed at achieving behavioral attitudes and behaviors that reduce the risk of health worker for infection in the workplace. Also committed to all those others who are in the care environment, this environment should be designed as part of a risk mitigation strategy.

To prevent the spread of disease or infect must interrupt the transmission process of the same.

So protective measures must be taken to protect both coma to protect people who are in our care. During the work is essential to consider the basic principles of biosecurity.

Biosecurity principles

A) Universality: Involves consider that any person can be infected. Also, consider all potentially contaminating body fluid. The measures should involve all patients in all services, whether or not know their serostatus. All staff should routinely follow standard precautions to prevent exposure of the skin and mucous membranes, in all situations that may lead to accidents, whether or not foreseen with blood or other body fluids of the patient. These precautions should be applied to all people without exception or distinction, whether present or not pathologies.

B) Use of barriers: Understands the concept of avoiding direct exposure to blood and other potentially polluting fluids, using suitable materials that stand to touch them.

The use of barriers (eg gloves) do not prevent accidents of exposure to these fluids, but decrease the consequences of the accident.

C) Means of disposal of contaminated material: Includes all devices and procedures through which the materials used in patient care, are deposited and removed without risk of infection due to mishandling of these.

DEFINITION OF TERMS

TRANSMISSION. – Contagion by direct and indirect means.

ASEPSIS. – Absence of infection.

HEALTH. – State biopsychosocial optimal according to the capabilities of a person.

NORMA BIOSAFETY. – Set of rules to preserve the health and safety of staff and community patient against the risks of infection.

Antisepsis. – Inhibition of pathogenic microorganisms to prevent infection.

BARRERA. – Obstacle to prevent transmission of infection.

Infection. – Act of acquiring an infectious disease

Sterilization. – A generic term that means the elimination of all forms of living material including bacteria, viruses, spores and fungi. Systems usually include heat or radiation. Is the procedure to follow with invasive instruments (surgical instruments and material to be introduced into the patient’s body.

Disinfection. – Generic term which implies that most pathogens are often eliminated but remains non resistant pathogens or forms thereof. Usually includes chemicals. Is the procedure to follow in articles that do not necessarily require a sterilization process such as work surfaces of the dental unit.

Levels of Disinfection This process is divided into three levels:

* Low Level Disinfection: It eliminates the bacterial spores and Mycobacterium tuberculosis.

* Intermediate Level Disinfection: Kill the Mycobacterium but not bacterial spores.

* High-level disinfection (HLD): Removes the Mycobacterium tuberculosis virus, fungi and some spores.

The noninvasive instrumental level of disinfection required Alto – through intermediate, while the environmental material requires a level of disinfection Under – Intermediate.

Antiseptic. – Inhibiting agent but not necessarily destroy microorganisms. Acts on living tissue.

Decontamination. – Is a necessary pretreatment for protection when handling potentially contaminated materials

Practical recommendations to develop activities related to patient care

Material Handling sharps like needle, scalpel, sharp instruments, sheets, etc. To prevent accidents, it is mandatory discard materials in descartadores sharps after use.

we recommend:

* No recapping of needles.

* Do not bend.

* Do not break them.

* No separate handling of the needle to the syringe.

* If possible use tongs to handle sharp instruments.

* Descartadores containers must be as close as possible to the work area.

Needles and syringes

You should use disposable materials. The syringes and needles should be placed in containers descartadores. The needles should not be bent, nor are they place the protective cap and it must be discarded at the same time withdrawing the needle sterile.

Descartadores

Descartadores the recipient is considered where they are deposited, bound for disposal by incineration, all sharps materials. These descartadores should not under any circumstances be reused.

The descartador must be made of material resistant to punctures and support the process of incineration without environmental condition.

It is recommended that have descartadores carrying handle and manipulate that it allows far descartador opening.

The opening should be ampl to so that when you insert the discarded material, the operator’s hand suffers no risk of accident.

The lid should descartador that when filled to three-quarters of the volume thereof can securely seal it.

The descartadores should be yellow and have the infectious material symbol and an inscription warning that is handled with care. And such registration must be symbol of dimensions not smaller than one third of the minimum height and capacity of the container with two impressions, so as to easily visualize from any position.

Material cures (gauze, swabs)

After use should be placed in a plastic bag (yellow) that will close properly before shipping direct incineration as waste or hospital.

Housekeeper

All care must be sanitized environment with water and neutral detergent, using cleaning tools that facilitate the task time protect the worker.

In case of blood and body fluids, local treatment is indicated prior to use of chlorinated compounds.

Service personnel should wear proper uniform with gloves and other cleaning utensils (personal protective equipment

CLEANING AND DISINFECTION OF MATERIALS AND EQUIPMENT

Material Classification

* CRITICAL materials or instruments exposed to sterile areas of the body must be sterilized. Eg surgical instruments and / or healing.

* SEMI CRITICAL materials or instruments that come into contact with mucous membranes can be sterilized or disinfected with high level disinfectants (glutaraldehyde). Ex ventilatory therapy equipment, endoscopes, endotracheal cannulas, vaginal specula metal.

* NO CRITICAL materials or instruments that come into contact with intact skin should be cleaned with soap and water and disinfected with a disinfectant intermediate or low level.

Ex sphygmomanometers, Dishes, flat and violins, furniture, clothes.

Articles critical and noncritical semicritical be cleaned by mechanical action using water and a mild detergent or enzymatic.

All materials to be used should then be placed in immersion or in a neutral detergent enzyme for at least 5 minutes, then brushed and rinsed in running water to remove the effects of any residual organic material. Dried and then according to the categorization of the material must be sterilized or disinfected.

Critics should be sterilized, the semicritical can be processed with high-level disinfectants (eg 2% glutaraldehyde in a minimum of 20 minutes) and by disinfecting noncritical intermediate or low level.

CRITERIA FOR DISINFECTION DECONTAMINATION, cleaning, disinfection

Decontamination. – Is a necessary pretreatment for protection when handling potentially contaminated materials. You must use enzymatic detergents and disinfectants then.

May use chlorine 0.5%, 5% phenol, hydrogen peroxide 6% glutaraldehyde, formaldehyde, etc. Glutaraldehyde is recommended for metal instrumental.

Cleaning. – Is the physical removal of blood, body fluids or any other visible foreign matter (dust or dirt) in the skin or inanimate objects

Must be cleaned thoroughly with water and detergent, hard toothbrushes are suitable to remove the organic material of the equipment and instruments.

This step will eliminate most microorganisms (up to 80%)

Chemical disinfection. – For a DAN (High Level Disinfection) soaking items in a high-level chemical disinfectant for 20 minutes and then rinsed thoroughly with sterile water or boiled.

Chemical Disinfectants:

– Chloride solutions. – Inactivate all bacteria, viruses, parasites and some spores. They are inexpensive, readily available and act quickly. They are very

effective against Hepatitis B virus and HIV (AIDS virus)

You can decontaminate large areas as examination tables

Procedure:

* Use chlorine solution 0.1% in drinking water

* The surfaces (tables, beds, dental chairs, etc..), Wipe thoroughly with a cloth soaked in the solution, let stand about 10 minutes and then re-cleaned

* Replace the solution daily or more often, it loses its potency over time and sun exposure.

8% formaldehyde. – Can be used in liquid or gaseous forms, both as to chemical sterilization DAN

It is readily inactivated by organic materials

A 24 hour soak in formaldehyde kills all microorganisms, including bacterial endospores

You can use up to 14 days. Replace sooner if cloudy

Glutaraldehyde. – Found as alkaline, neutral or acidic. The neutral or alkaline have greater power of annihilation and anticorrosive properties that acids

Most commonly used, 2% glutaraldehyde, to be used at temperatures of 25 C (77 F)

For an effective DAN, soaking instruments and other items for 20 minutes

Their preparation should follow the manufacturer’s instructions

Formaldehyde and glutaraldehyde are toxic formaldehyde being of greater toxicity.

Should handle them with care.

Its vapors are irritating to the skin, eyes and respiratory tract

Wear them in a ventilated area, wear gloves and limit exposure time

All equipment or instruments must rinse thoroughly soaked then boiled or sterile

Never mix chlorine formaldehyde when combined they form a toxic gas (ether bisclorometlico)

Disinfectants commonly used

CRITERIA FOR STERILIZATION

Sterilization by Physical Means: This can be achieved by heat or radiation (UV lamps commonly have proved not to be effective against HIV). The election system in Stomatology heat sterilization is wet or dry

Moist:

Employs saturated steam sterilization in an autoclave under pressure. It is the most effective and less costly to sterilize most objects or materials, if done correctly. Requires a temperature of 121 C at 1.5 atmospheres (15 psi) for 15 minutes

Dry Heat:

Is achieved by heat conduction, from the external surface of the article towards the inner layers. Microorganisms die slow burn proteins.

Takes longer than steam sterilization, is slower warming without humidity

Using this method only for articles which can withstand a temperature greater than 160 C in a time not less than 60 ‘.

The needles and instruments with sharp edges such as endodontic files, suture needles, should be sterilized at temperatures no higher than 160 C. Higher temperatures decrease the sharpness of the cutting edges.

Counting time is recommended only from the moment that the desired temperature is reached. We recommend the following relationships temperature / time:

After cooling, remove loose instruments with sterile tweezers or tongs and stored in covered containers, also sterile.

Sterilization methods (simplified table)

METHODS AVERAGE OPTIONS

Physical moist heat-saturated steam autoclave

Dry Heat – furnace

liquid – immersion in 2% glutaraldehyde

– Immersion peracetic acid

Chemical Gas-ethylene oxide gas (EtO)

– Formaldehyde gas

– Hydrogen peroxide vapor

Plasma – Plasma hydrogen peroxide

– Peracetic acid plasma

Note: Autoclaving is a cheap and effective. They may be available as options, the pupinel (oven), glutaraldehyde and formaldehyde. All others are expensive

PROCEDURES Decontamination, cleaning, disinfection and sterilization

*

* Clean the instruments manually by experienced personnel using thick rubber gloves. Prior to sterilization restregarn in hot water with detergent and remove all traces of blood and saliva.

* Be sterilized mirrors, explorers, clamps, portaclamp, cutters, polishers, metal dies, die sets, cartridge syringes, scalpel handles, tweezers, metal impression tray, punch dam, arch Young, curettes, carbide burs and diamond , forceps, elevators and the like surgical instruments and operative.

* The orthodontic tweezers should be sterilized by heat or disinfected with chlorhexidine or transparent phenolic agents in alcohol.

* Must be disposable plastic cups or paper, syringe needles, cartridges or empty anesthesia surplus materials, impression tray or plastic media used, saliva ejectors, sutures and needles.

* Autoclave gauze, cotton wool, and linen paper points

* The spatulas and mixing glass plates washed with hot water and detergent and then stylize them by heat.

* The story of the operating room and general work surfaces with detergent and dry wash daily.

* Lamps daily cleaning to remove dust

* Cleaning equipment (buckets, mops, clothes, etc) should be rinsed and stored dry.

The handpiece clean with water and detergent using soft brush and dry with absorbent material before being immersed in disinfectant solution for 10 minutes (can be used 70% alcohol and other recommended solution). For sterilization is necessary to check the manufacturer’s specifications, some brands may not be sterilized (in these cases, follow the disinfection procedure indicated by the manufacturer).

Biosafety recommendations in dentistry:

The dentist is a college graduate with a solid scientific and humanist whose scope should be able to:

* Provide high quality dental care and referral, promptly and correctly, patients who require specialized dental care. In addition, you must run Health promotion and, in particular dental, participate in disease prevention, recovery and rehabilitation of them.

It shall adopt rules and regulations in force dental standards regarding health and environment, conducting themselves as ethical and humanistic principles, which the care of the biological integrity, physical and psychological patients.

When performing routine dental procedures, can cause minor bleeding during maneuvers or even not rare to observe spontaneous bleeding.

Considering also that the oral cavity carries a variety of microbial agents, we can conclude that the dentist can be contaminated or accidentally contaminate.

For this reason, we believe that the dentist should know in detail biosafety standards and incorporate them into their daily practice

Then apply for such systematic care practice all previously developed and for that reason will not reiterate in this chapter. We believe the focus should on the following topics, not depleting their treatment, but in light of the practical problems useful special consideration:

Mechanisms of infection:

The infection in dental practice may occur by the following mechanisms:

* Direct contact with infected substance (injury, blood, saliva)

* Direct contact with contaminated objects

* Splashes of blood or saliva, nasopharyngeal secretions on the skin or mucosa or abraded healthy

* Contamination by infected aerosols

PRECAUTIONS patient consultations:

Consider the following aspects of patient assessment:

* In clinical history: References on weight loss, infections by bacteria, viruses, fungi (with special emphasis on infections by mycobacterium tuberculosis, Hepatitis B, C, herpes simplex and AIDS).

* In the clinical examination: lesions in skin or mucosa; lymphadenopathy

RECOMMENDATIONS FOR THE TREATMENT OF PATIENTS

1. – Hand washing:

Its purpose is to eliminate transient bacterial flora, reduce and prevent the transport resident.

It is therefore imperative washing hands before and after placement of the gloves. The measure has as its foundation the possible existence of injuries and abrasions that can not be noticed at first glance, the presence of blood under the nails hit the professional and the possibility of no visible holes on the surface of the gloves.

You must also include the cleaning of the subungual bed. To make it effective should always be removed from hands any jewelry, including the clock.

It is recommended soap solutions containing 4% chlorhexidine gluconate as active ingredient due to their residual action. The bar soaps can become sources of cross-infection

Rinsing must be done with cold water to close the pores, drying must be done with napkins or paper towels. Terry towels can become sources of cross-infection.

Wash hands immediately after contacting blood, saliva or surgical instruments.

HAND WASHING TECHNIQUE

The hand washing technique has the following sequence:

* Roll up your sleeves to the elbow

* Remove jewelry and watch

* Wet hands with running water

* Apply 3-5 ml of liquid soap

* Rubbing surfaces of the palm of the hand and fist for 10 or 15 seconds

* Rinse in running water trawl

* Dry with paper towel

* Off the faucet with the towel.

2. – GLOVES

It is recommended for clinical examination nonsterile disposable gloves. For surgical procedures recommended sterile disposables. Reusable gloves should be thick and are employed only for washing instruments.

Gloves contaminated with blood or other fluids must be discarded

The gloves washing with antiseptic agents alters the nature of the latex and ensures no dragging of microorganisms on its surface.

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Avoid actions unrelated to patient care while wearing gloves. If treatment is surgical and should be interrupted momentarily and then continue with the same procedure (take a bottle, opening a door, answer the phone, make a note, etc..) Are very useful mittens or disposable polyethylene sachets superimposed the latex glove.

Remove gloves:

* After use.

* Before touching uncontaminated areas or environmental surfaces.

* Before going to another patient.

Hands should be washed immediately after gloves removed to eliminate contamination of the same happens even with gloves.

3. – MASKS

The mask protects mainly the nasal mucosa and prevents aerosol pollution caused by the practice of rotary instruments. Although the mask protects the nasal and oral, the latter is less dangerous because it is more difficult to transmit the pathogens.

Among disposable masks, the material of choice is a glass fiber or the mixture of synthetic fibers microbes filter better than paper.

It should fit comfortably and properly on the bridge of the nose to prevent fogging of eyewear

In surgical procedures the surface of the mask should be considered contaminated material and should be avoided contact even with gloved hands.

4. – EYE PROTECTION

They avoid eye injury from flying particles to the face of the operator, while protecting against infections whereas many germs normal oral flora are opportunistic pathogens.

Due to the difficulty for sterilization should be washed between patients with water, germicidal soap or antiseptic solutions. After being rinsed should be dried with towels or paper napkins. The procedure should not damage the surface of the protector.

5. – PROFESSIONAL DRESS

Includes apron, bib and hat. It aims to prevent the introduction of microorganisms in the work area. It also prevents contamination of street clothes during care at the office.

The aprons should have long sleeves, high neck and closed.

6. – OFFICE ESTERILIZACINACIN and disinfection, materials and equipment:

The local welfare should have walls and floors easy washing, avoiding unnecessary fixtures or rough or porous materials that impede hygiene practice.

The salivera must be sanitized after each patient and eliminate all types of waste that may accumulate and must use chemical disinfectants. The work table should be kept in good hygienic conditions throughout the workday. To achieve this it is recommended to be placed on the disposable paper, which will be changed after each patient care.

In this work table should only be the necessary equipment for the care of each patient. It should specifically avoid the waste carrier is in said work table.

Focus relative to the handle must cover the same with a nylon bag that must be changed after every patient.

The instruments should be sterilized or disinfected in closed boxes or wrapped in paper correctly, identifying in each case the date the procedure was performed.

Strawberries should be sterilized or disinfected as the rest of the material and stored in metal boxes. They should not be put to use in a strawberry. After being used for a patient, proceed according to the rest of the dirty instruments. Do not use the windows to expose the material out of the aforementioned conditions.

The turbine cleaning pads can be made using glutaraldehyde or alcohol embedded with the recommended concentrations, being necessary to carry such hygiene procedure after use with each patient. Sterilization and disinfection of reusable materials directly related to patient care should follow the following sequence:

* The first dirty material must be dipped in a solution of sodium hypochlorite or 0.5% 2% glutaraldehyde for 20 minutes.

* Then proceed to brushing with detergent or enzyme to remove organic matter.

* Rinse with water and drying wind current.

Finally sterilized or disinfected (see “Methods of sterilization and disinfection”).

Rubber cups, spatulas and nonmetallic buckets disinfected with 2% glutaraldehyde for 20 minutes or sodium hypochlorite 0.5% 20 minutes or using alcohol 70 C by mechanical friction.

It should be remembered that the disinfectant chemicals must comply with the recommendations of the manufacturers, both in terms of time of exposure of the materials to ensure disinfection, as to its validity after being prepared.

7. DISPOSAL OF MATERIAL DISPOSABLE:

Dirty or disposable materials should be disposed of safely. For this purpose sharps objects or materials shall be deposited in appropriate descartadores as it was stated in these rules.

It is recommended that the containers are rigid walls, wide mouth large capacity and material compatible with the incineration and environmental condition. For the purposes of its disposal, reached after three-quarters of its capacity, it should be sealed mouth and proceed to its elimination.

Gauze and cotton as well as dirty teeth removed from the mouth, should be placed in thick plastic bags closed properly.

The final treatment descartadores and bags of soiled material should be regarded as the provisions regarding hospital waste incineration is directly or after collection.

PRECAUTIONS IN SPECIFIC AREA OF WORK stomatological

* Avoid accidental injuries with contaminated sharps and sharp or contact mucous membranes or open skin lesions with material from patients.

* Use disposable syringes and needles and then place them, along with scalpel blades and other sharp materials, in a cut-resistant container located in the same place where the procedures are performed.

* In procedures involving contact with blood or potentially infectious body fluids wear gowns, masks and goggles. If your hands are stained with blood, wash it off carefully, then apply disinfectant solutions for safety.

* Clearly label with a special warning, samples of blood and other secretions. Disinfect the outside of the container with a chlorine solution.

* The objects soiled with blood, put them in a bag labeled (“Warning: contains blood”), before sending them to their clearance and destruction.

PRECAUTIONS WHEN PRESENTED ACCIDENTAL INJURIES:

* In case of accidental injury suffered potentially infected sharps immediately conduct a thorough washing with soap and water.

* Previously press the edges of the wound to promote the outflow of blood from the same. If necessary insert a dressing. Do not rub the brush area due to the risk of causing microlesions.

* In the case of eye exposure, flush immediately with water and then irrigate with sterile saline

* Also if stained with blood, secretions or fluids, wash the area neatly with soap and water

* If it is decided that the injury is significant (as a result of accidents tab), follow patient assessment and, after counseling, they should test for HIV and hepatitis B, both the patient and report to you responsible for the accident to Biosecurity’s office or clinic.

* If the patient outcome is positive for hepatitis B, you should receive immediate treatment with immunoglobulin and the first dose of hepatitis B vaccine

* It is recommended that all workers who are at risk of exposure to blood or other fluids, this vaccinated against hepatitis B.

RECOMMENDATIONS DURING DENTAL CARE CENTER

* In addition to the general precautions should bear in mind the following recommendations:

* Wear apron or jacket with long sleeves, gloves, masks and eye protection when performing surgical procedures.

* Dental instruments used in each patient, must properly sterilized before reuse.

* We recommend that has a set of basic instruments, including drill set for each patient. At the end of the work shift properly sterilize

* Disinfection of strawberries, impression trays nonsurgical steel material or aluminum is recommended that the right with 70% alcohol for 30 minutes, the rapidly corroded hypochlorite

* The heat sensitive instruments (spatula resin and others) can be subjected to DAN and then rinse.

* Do not use anesthesia cartridges remaining solution in another patient.

* Thread the needle on your guard carpule by a hand technique to avoid accidental injury.

* Handle with care the material used for each patient (x-rays, impressions, bite registrations, etc.)

* Try to avoid hand injuries

* It is better to use soft sponge for scrubbing hands. The brushes can cause microdamage.

* During the surgical procedure, use a plastic shield on his jacket and put another on the patient to avoid contact with contaminated blood and fluids

* Cite the patient with suspected or confirmed diagnosis infection for the last hour consultation.

* The plastic cups used for mouthwash should be disposable

* Use rubber dams, high-speed ejector and place the patient in the most comfortable position to avoid splashing.

* Wrap with plastic equipment and disinfect hard surfaces (lamps, heads of units of X-ray equipment, etc..). Remove these protectors to conclude during surgery.

* It is desirable to sterilize handpieces between patients. If not possible, wash well and immersed in a disinfectant solution for 20 minutes (4% chlorhexidine in 60% dilution is suitable for the rotor not corrode, alcohol iodinated if corrosive).

* The inclusion of the image plate in the patient’s mouth for decision must be made with instruments, not your hand. After the shot, take the plate with pliers jet rinse and let stand a few minutes in disinfectant solution before revealed.

* Reveal plates with clamps to prevent acid dermal injury

* Decontaminate triple syringe soaking in disinfectant solution for 30 minutes.

* To avoid the spray of infected material from the handpiece, run and discharge water for 1 minute piece before starting a day care and after care of each patient.

Dental equipment surfaces must be perfectly smooth and almost seamless. They should also have a finish to allow cleaning and disinfection

ENVIRONMENTAL CONTROL

Disposable Covers:

* Reduce time spent on cleaning, disinfecting surfaces that can not be easily decontaminated between attentions as the dental chair trays, desks, among others. They can be: aluminum foil, polyethylene bags, pads of lined paper plastic etc.

* The person who removes contaminated disposable covers must have thick rubber gloves, mask and eye protection.

Disposal:

Wastes are of three types: common or not contaminated, contaminated and infectious or special.

* Common wastes contaminated or not: no risk of infection for people who handle them, such as paper, boxes, unused sample bottles, plastic containers, etc..

* Infectious waste or contaminated: Are wastes large amounts of microorganisms and if not disposed of properly, are potentially risky. Many of them are contaminated with blood, pus and other body fluids.

* Special Waste: The elements are radioactive and toxic liquids, such as Rx revealed substances, insecticides.

Remember that proper management of waste items minimizes the spread of infection to health workers and the local community, protects from accidental injury to handlers and provides a friendly atmosphere.

Disposal of sharps:

Clamp Place all items in a sharps container and label indicating that it contains. These containers can be made from readily available items such as a can with a lid or a plastic bottle deposit.

Sharps waste Soak in a solution of sodium hypochlorite in order to disinfect the material and damage to prevent re-use.

OCCUPATIONAL HEALTH

Staff must maintain adequate health, immunization against hepatitis B. The immunization consists of three doses (the second after 1 month and the third at 6 months) and protects for a period of 10 years after which reinforcement is required.

According to the IDF students and professionals related to dentistry that perform invasive procedures and whose HIV status is unknown but by factors beyond their professional duties are at risk of being HIV-seropositive must have regular examinations to establish the appropriate level HIV risk.

Minimum Standards Biosafety Dentistry

We know what the virus to which we are exposed, such as Hepatitis (ABCD), HIV, tuberculosis, herpes, fungal infections and diseases by new unconventional infectious agents.

Dentistry of late twentieth century has found new and unexpected challenges to interpret and solve.

When starting the treatment the patient:

* Disinfect with sodium hypochlorite 2%, 2.5% povidone-iodine or dental furniture surfaces, turbines, micro motor, triple syringe and especially the spittoon. These maneuvers are repeated for each patient.

* Proceed similarly with the prosthesis or appliance that is received from the laboratory, or sent.

* Draw up a patient’s medical history in a concise and timely (no more than ten questions), independent dental tab; trying to learn the latest history of infectious diseases, if any, and medicine intake.

* The patient was placed in the chair, only then will place the bib, the glass and the ejector (disposable).

* The water will run the turbine and the water and air syringe for approximately 30 seconds.

During treatment:

* Both you and your support staff use disposable gloves, masks (not cloth), if not Wear protective eye wear glasses with side panels, as these provide full protection. Use both and put the gown on both when performing practices.

* As for your hands, protect washing with antiseptic soap may be of povidone-iodine or chlorhexidine 2% before putting on gloves and remove them. Do not dry with cloth towels, wipe with disposable paper towels. If during patient care, these gloves are punctured or torn, should be discarded immediately placing a new pair. Change gloves with each patient, not reuse, remember that latex loses consistency and becomes more porous, allowing the passage of very small organisms such as viruses. A new glove reduces by 50% the risk of infection Should a crash, (prick with needles and other contaminated). In case of high risk patients, use two pairs of gloves.

* Carefully handle sharp and piercing instruments (scalpels, sindesmtonos, elevators and special needles). Remember that for the spread of hepatitis B, only requires a “shot” with 0.004 ml of infected blood.

* By anesthetizing his patient, do it with a sterile syringe, disposable needle and fresh anesthetic solution, containing anestubos avoiding excess use of other anesthetics. “No needles encapuche unless do with protecting.”

Try to minimize the formation of dental aerosols. It has been found that the dispersion and therefore the microorganisms, can reach two meters away. Work with absolute isolation of the operative field when the operation allows. This prevents the formation and dispersion of aerosols.

* The RX periapical and occlusal wipes clean with phenolic compounds or povidone-iodine solution 2.5% before and after use.

At the end of treatment:

All these tasks, whether you make them, as their support staff, should be performed with gloved hands:

* The disposable items, such as needles, scalpel blades or other sharp or pointed items should be decontaminated with sodium hypochlorite 2% for 20 minutes. This method is much cheaper and here no matter the corrosive action of sodium hypochlorite, as this material is discarded. After this step, should be discarded in rigid containers for disposal or incineration.

* The gauze, cotton and other items contaminated with blood or saliva that are disposable, not pointed or sharp, you should decontaminate them for 30 minutes in sodium hypochlorite 2% prior to disposal in labeled polythene bags.

* With all instruments or objects that are not disposable, shall be decontaminated either with chemicals like sodium hypochlorite 2% povidone-iodine solution 2.5%, enzymatic detergent solution 8 ml per liter for 10 minutes autoclaving or 130 , 1/2 and 1 atmosphere pressure for 20 minutes.

* After this decontamination step, proceed to wash the instruments with water, dry it with a paper towel and it conditioned for subsequent sterilization.

* As suggested sterilization method:

* Pressure autoclave at 134 , 1/2 and 1 atmosphere for 20 minutes.

* Dry heat stove, we suggest using it for 2 hours minimum, 200 (this is the recommended time, because no burning instruments and gauze).

* It is essential to control the operation of ovens and autoclaves once every three months through sterilization biological controls.

*

  • For the heads of the turbines, micromotors and syringes phenolic or triple use wipes hypochlorite solution.

    * Clean the platen, side table, rolling and spittoon module with absorbent towels, disposable soaked in sodium hypochlorite, povidone-iodine, phenolic wipes.

    * Finally clean surfaces that have been contaminated during patient care:

    REFERENCES

    * Operative Dentistry MOONEY BARRANCOS Third Edition Mosby / Doyna Books 1995 pp: 185-192

    * CD Dictionary Mosby Medicine, Nursing and Health Sciences 5th. Harcourt Publishing Edition – Spain.

    * Reference Library Microsoft Encarta Encyclopedia 2004

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