Infection Control for Dental Hygiene Students
Please read the material in this booklet carefully. When finished answer the
post test questions. Print out the answer page, record your answers, and bring
the competed answer sheet to the Health Sciences Orientation.
Midlands Technical College
Prepared by
Cathy Milejczak, CDA, RDH, MSPH
Infection Control for
DHG and EDDA Student’s
Health care workers have a professional responsibility to patients, peers and
themselves to practice appropriate infection prevention techniques. As a
condition of employment health professionals must display knowledge of and the
ability to practice appropriate infection control techniques. Lack of knowledge
and application to practice demonstrates unprofessional conduct. This course is
designed to introduce all Midlands Technical College Dental Hygiene students to
a basic understanding of blood borne pathogens, hazard communication and
infection control as they enter their program of study. This course must be
completed before entry into all clinical sites.
The course is designed to enhance the student's ability to comply with
scientifically accepted principles and practices of infection control and to
monitor compliance with OSHA's and CDC's recommendations concerning disease
transmission in health care settings.
Upon completion of the course the student will be able to:
1. Demonstrate a basic knowledge of principles and practices of infection
control.
2. Demonstrate an accurate perception of occupational risks and protective
measures.
3. Create and maintain a safe environment for patient care.
DISEASE TRANSMISSION
The goal of Infection Control is to prevent the transmission of disease by
implementing procedures to break the chain of infection.
Microorganisms such as bacteria, viruses, fungi, and parasites cause disease.
Infection is the growth of an organism in a host (person) and there may or may
not be any signs of illness. There are two types of diseases usually discussed,
infectious disease and communicable diseases. Infectious diseases are the result
of the microorganism invading the body. The term infectious means caused by a
pathogen. Communicable diseases are ones that can be spread from one person to
another. A disease can be infectious but not communicable.
METHODS OF TRANSMISSION
For a disease to be transmitted, the following four conditions must be met:
1. A microorganism (pathogen) is present.
2. There is enough of the microorganism to cause disease.
3. A person is susceptible to the pathogen.
4. The microorganism passes through the correct entry site.
HOW DISEASE ENTERS THE BODY
1. Direct contact- spread by direct contact with infected blood or body fluids
from one person to another
2. Indirect contact- touching blood soaked gauze or contaminated equipment.
3. Airborne- a person coughs or sneezes
4. Vector borne- animal bites
5. Vehicle- from food or water.
HOW MICROORGINISMS ENTER THE BODY
1. Through mucous membranes- mouth nose, eyes, ears and genitals.
2. From needle sticks, broken glass.
3. Through non-intact skin- skin cuts, scratches, scrapes, burns, rashes,
blisters, acne.
UNIVERSAL PRECAUTION
The safest way to handle exposure to blood in the work environment is to take
universal precaution. Universal precaution means to treat all blood and body
fluids/ materials as if it is infectious. OSHA states that universal precaution
should always be followed. Following universal precaution means to wear proper
protection equipment and to follow infection control protocols. These
precautions must be practiced if you are exposed to blood on a regular basis, or
rare situations such as an injury to a co-worker.
INFECTIONS MATERIALS
Blood, vaginal secretions, semen, cerebrospinal fluid (around the brain) pleural
fluid (around the lungs), synovial fluid (around the joints), saliva from dental
procedures, any fluid with visible blood, and any unidentifiable fluid.
NON-INFECTIOUS MATERIALS
Tears, sweat sputum, urine, feces, vomitus, and nasal secretions.
MOST HARMFUL DISEASES TO HEALTHCARE WORKERS
Both bloodborne and airborne organisms can cause disease in health care
settings, but bloodborne infectious organisms, like hepatitis B and HIV, pose
the greatest threat.
Hepatitis
Hepatitis is an inflammation of the liver. The most common forms of hepatitis
are caused by alcohol abuse, drugs, or other chemicals and cannot be
transmitted. Viruses can also cause hepatitis. There are at least six hepatitis
viruses that cause clinically similar diseases: hepatitis A, B, C, D, E, AND G.
The two most common types are A and B. Hepatitis A and E are mainly transmitted
through contaminated food and water; hepatitis B, C, D, And G are bloodborne
diseases usually transmitted by direct contact with infected body fluids.
Hepatitis also may be caused by excessive alcohol consumption, exposure to some
hazardous chemicals, and as a complication of other viral infections. Hepatitis
is known to live at least 7 days in dried blood. OSHA considers Hepatitis a
major health hazard. There is no known cure for hepatitis.
SYMPTOMS OF HEPATITIS
Initial symptoms:
• General fatigue
• Joint and muscle pain
• Loss of appetite
More severe symptoms
• Fever
• Nausea, vomiting
• Diarrhea or constipation
• Jaundice
• Cirrhosis of the liver
SOME FACTS ABOUT THE TYPES OF HEPATITIS
HEPATITIS A
Hepatitis is also known as infectious hepatitis. It is common in older children
and young adults. It is primarily transmitted by Fecal- oral, person-to-person
contact, and by uncooked shellfish, fruits, vegetables, and contaminated water.
Pre-exposure prophylaxis includes either immungolobulin (IG) or Hepatitis A
series of injections give before exposure. This is recommended for travelers to
certain international countries. Travelers to developing countries should avoid
drinking the water and avoid uncooked shellfish, fruits, and vegetables.
HEPATITIS B
Hepatitis B is also known as serum hepatitis. Hepatitis B is transmitted via
blood or body fluids at birth or during early childhood, through sexual contact
and by contaminated needles. Healthcare workers would be at risk for this
disease when in direct contact with blood or sustaining a contaminated
needlestick injury or by a cut with a blood covered sharp object. A needlestick
injury presents the greatest risk for infection with hepatitis B it the source
blood is infected with the virus. (6 to 30%) About 50 to 60% of infected persons
do not know that they are infected with this virus, thus reporting this virus is
very important. Hepatitis B presents the greatest risk for occupational illness.
Taking a hepatitis B vaccine can prevent this disease. There are two vaccines
available to prevent this disease, Recombivax and Engerix HB. Both have approved
safety and efficacy.
HEPATITIS C
Hepatitis C is also known as non-A, non-B hepatitis. Hepatitis C is transmitted
in the same manner as hepatitis B. It is considered to be as serious as
Hepatitis B. People at risk of acquiring Hepatitis C include transfusion
receiptients, IV drug users, and dialysis patients. Hepatitis C accounts for 20
to 40 percent of acute viral hepatitis in the United States.
HEPATITIS D
Hepatitis D is also known as the Delta – agent hepatitis. This type of hepatitis
may cause infection only in the presence of active HBV (hepatitis B) infection.
Hepatitis D virus is a defective virus that needs a part of the HBV to complete
its life cycle. The Hepatitis D virus is transmitted by routes similar to those
of hepatitis B. There have been reported cases of Hepatitis D in the United
States. Individuals who are susceptible to hepatitis B infection are also
susceptible to hepatitis D. Successful vaccination against hepatitis B should
also prevent hepatitis D.
HEPATITIS E
Hepatitis E was first identified through waterborne epidemics in developing
countries. Sporadic cases of hepatitis E have been reported in the United
States. Hepatitis E is a problem in the Middle East. Hepatitis is a mild disease
except in women in the third trimester of pregnancy in which the mortality rate
is high. Neither a carrier state nor a chronic live disease has been reported
with this disease.
HEPATITIS G
Hepatitis G is the most recently described viral hepatitis. It was first
recognized in 1995. To date, very little information in available about this
virus or disease. It is thought that the route of transmission is through
bloodborne spread.
HEPATITIS VACCINATION
If you are exposed to blood or other infectious material on a regular basis, the
hepatitis B vaccination is available. All students entering into the health
sciences programs are required to have this vaccine. The vaccination is given in
three intervals (initial dose, second dose one month following the first, and
third dose six months following the first) and has proven to be ninety percent
effective in preventing disease. Since 1992, OSHA has required all employers to
offer the hepatitis B vaccine to all employees who are likely to have direct or
indirect contact with blood and/or saliva. The vaccine is to be offered at no
charge.
There are two recombinant hepatitis B vaccines, Recombivax HB and Engerix-B that
are FDA approved. The vaccine is done in a series of three injections.
Injections given in the deltoid muscle have produced seroconversions rates over
95% to 97% in immunocompetent, seronegative adults. Complete protection against
HBV includes post-screening for antibody levels (a HBV titer). This procedure
should be conducted one to two months after the final injection. All Dental
Hygiene students will have a titer done at the completion of their hepatitis B
series of injections. If a vaccine recipient fails to seroconvert, a second
series of injections or a booster, as prescribed by a physician, should be
given. After completion of the second series, another titer will be needed.
Continued failure to respond should be investigated.
HIV/AIDS
Aids (Acquire immune deficiency syndrome) is cause by HIV (Human
Immunodeficiency Virus) and is a result of a weakened immune system. HIV attacks
white blood cells and destroys the body’s ability to fight infection. The
infections that strike people whose immune systems are weakened by HIV or other
conditions include severe pneumonia and fungal infections of the mouth and
esophagus. HIV infected people may also develop unusual cancers. Persons
infected with HIV are considered to be communicable from the time of infection.
HIV cannot be spread through casual contact. HIV infection is transmitted
primarily by sexual contact- male-to-male, male to female, and in few cases
female to male. HIV is known to be transmitted only through exposure to infected
blood, semen, vaginal secretions, or breast milk. Being exposed to blood through
use of soiled equipment or supplies or blood splashed on mucous membranes or
broken skin can transmit HIV. It can be transmitted through sharing of IV drug
needles and syringes and in smaller numbers by occupational exposure (needle
stick injury) or through blood transfusion.
Symptoms of AIDS
Less severe symptoms
• Weakness
• Fever
• Shortness of breath
• Swollen lymph nodes
• Sore throat
• Headaches
• Chronic diarrhea
• Severe fatigue
• Night sweats
• Unexplained weight loss
• Discolored areas of the skin
Severe symptoms
• Mental disorientation- dementia
• Muscle wasting/ weakness- myelopathy
• Peripheral nerve numbness- neuropathy
• Persistent diarrhea
• Weight loss of more than ten percent of body weight
EXPOSURE CONTROL PLANS
An Exposure Control Plan is and important step in removing or reducing employee
exposure to blood and other possibly infectious materials. The exposure control
plan is a written plan of a company’s policies and procedures for handling blood
and body fluids. The plan must be made available to employees at all times.
Midlands Technical College’s Exposure Control Plan can be found at the following
locations:
• Chair of Health Sciences
• Student Affairs
• Personnel
• Allied Health & Nursing
• Operations
The Exposure Control Plan must contain:
• Identification of whom is covered.
• Rules of the engineering controls used.
• The work practice controls that are in use.
• Personal protection devices.
• A housekeeping schedule.
• Procedures for maintaining medical and training records.
• A list of tasks that can result in exposure and a list of the staff according
to exposure category.
• A schedule and method of compliance for each part of the plan.
• The procedure for evaluating exposure incidents.
Exposure Determination
Each employer shall list tasks and procedures that have the potential to cause
occupational exposure. The list is divided into groups or categories as follows:
• Category I
Includes those tasks in which employees performing the tasks
have occupational exposure. These employees can expect
contact with blood, body fluids, or tissues.
• Category II
Includes those tasks in which employees performing the tasks occasionally have
occupational exposure. These employees normally have no contact with blood, body
fluids, or tissues. However, these employees sometimes perform Category I tasks
• Category III
Includes those tasks in which employees do not have occupational exposure. These
employees have no exposure to
blood, body fluids, or tissues.
ENGINEERING CONTROLS
Engineering controls are devices that isolate or remove the hazard from the
workplace. They are the procedures that you use to do your job. Engineering
controls include puncture-resistant containers for sharp equipment and
mechanical needle recapping device. To ensure that they work well, engineering
controls should be examined and maintained or replaced on a regular basis.
SOME REQUIRED ENGINEERING CONTROLS ARE:
• Hand washing facilities that are readily accessible to employees.
• When hand-washing facilities are not feasible the employer must provide
appropriate antiseptic hand cleaner and clean cloth or paper towels.
• Provide puncture resistant sharps containers for glass.
WORK PRACTICE CONTROLS
Work practice control reduces the likelihood of exposure by changing the way a
task is carried out. The protection provided by work practice controls is based
on the way an employer and employee behave rather than on a physical device.
Your personal hygiene habits, such as frequent handwashing, are as important in
preventing infection as any equipment you might use. Some of required work
practice controls are:
• Wash hands or other skin with soap and water as soon as feasible.
• Flush mucous membranes with water as soon as possible.
• Do not bend or recap needles.
• Eating, drinking, smoking, applying cosmetics or lip balm and handling contact
lenses are prohibited in work areas.
• Do not store food and drinks with blood and body fluids. (hospital and labs)
• Decontaminate equipment that has become contaminated as necessary.
• Remove contaminated clothing as soon as possible.
• Do not wear contaminated clothing home.
GENERAL PERSONAL HYGIENE
Infection control begins with personal hygiene. The general rules for personal
hygiene in health care settings are:
• Never touch anything that you don’t need to touch in performing your task. If
your job requires you to treat patients and handle contaminated objects,
touching other surfaces and materials causes contamination of these objects.
• Keep your hands off your body. Don’t rub your eyes, scratch your nose, or put
your fingers in your mouth.
• Don’t eat, drink, smoke, apply cosmetics or lip balms, or handle contact
lenses in the work areas.
• Do not wear jewelry. Rings can tear gloves. Earring can become contaminated if
not covered and necklaces get in the way.
• Do not store food in areas where lab specimens are kept.
• Keep hair away from your face. Use disposable head covers during surgical
procedures or anytime you think your hair could enter the operating field or
become splattered with blood.
• Keep your fingernails clean and short.
• If you have open or weeping sores, refrain from all direct patient contact
until the lesions heal.
• Male healthcare workers- scrub your face thoroughly before shaving. Keep your
beards and mustaches covered with a suitable mask.
• When working with blood or other potentially infectious materials, minimize
splashing, spraying, splattering, and aerosols. Never pipette any material by
mouth.
• Wash your hands. Infection control begins with hand washing. Wash your hands a
minimum of 15 seconds at the beginning and end of each day. The soap must be in
contact with your skin for this long if it is to be effective. Iodophors and
liquid hand cleaners containing PCMX, chlorhexidine gluconate, and triclosan are
excellent for washing your hands.
PERSONAL PROTECTION EQUIPMENT
Personal protective equipment includes all equipment and supplies that keep you
from direct with infected materials. These items act as a barrier between
infectious substances and potential routes of entry. Protective equipment
includes disposable gloves, gowns, masks and shields, eyewear and resuscitation
devises.
The following guidelines should be followed when using protective equipment:
GLOVES
• Should be worn in any situation in which there is potential hand contact with
blood. Disposable gloves are most commonly used.
• Check the gloves for holes, tears, or punctures before wearing.
• When removing potentially contaminated gloves, rollup the end of the glove
inside out. This gives you a clean surface to remove the second glove with an
unprotected hand.
• Wash hands immediately after removing gloves.
• Never wash or decontaminate disposable gloves for reuse.
• Hypoallergenic gloves are available if you are allergic to the gloves normally
provided.
• Use heavy-duty (nitrile/vinyl) utility gloves to clean and disinfect the
operatory and to scrub dirty instruments prior to sterilization.
PERSONAL APPAREL
• Gowns, aprons, and lab coats protect infectious materials from reaching your
clothing. In extreme situations these gowns must be leak proof.
• Garments that become penetrated by blood or other potentially infectious
materials must be removed immediately or as soon as possible and placed in an
appropriately designated area or container for storage, washing, decontamination
or disposal.
• Each day newly laundered garments must be worn.
• Jewelry, including rings, bracelets, earrings, and necklaces, should not be
worn in clinic areas.
PROTECTIVE EYE WEAR
• Protective eyewear is required for procedures that produce splashes, spray,
spatter, droplets of blood, or aerosols.
• Protective eye wear (goggles or glasses with side shields) must be worn
whenever contamination of the face can be reasonable anticipated.
• Chin-length face shields may be worn instead of goggles as long as the shield
completely covers prescription glasses and wraps around far enough to protect
the sides of the face and eyes from foreign material.
• A face shield is no substitute for a mask.
FACE MASKS
• OSHA prohibits working without a mask, even when wearing a shield. Aerosols
can be sucked beneath and around the shield and into a worker’s respiratory
system.
• Masks must cover the nose and mouth and block the inhalation of 95% of
particles 3 to 5 microns in size.
• Masks must fit properly.
• Discard the mask between patients or whenever they become damp.
• Never wear a mask around your neck or on top of your forehead.
RESUSCITATION BAGS
• Use resuscitation masks or airway devices whenever you are performing
artificial respiration.
• Resuscitation bags or pocket respirators with one way valves are recommended
for emergency responders to protect against fluids that may be protected
In a resuscitation emergency.
HOUSEKEEPING
The standard requires a written plan for cleaning, identifying the method of
decontamination bases on the location within the facility, type of surface to be
cleaned, type of soil and present procedures being performed in the area. A
written schedule must ensure that work sites and equipment are clean and
sanitary. The plan should also include a list of employees responsible for
containment and disposition of the spill.
Some general rules to follow when cleaning are:
• Always wear gloves when cleaning.
• Clean up spills immediately or as soon as possible.
• If the spill is mixed with sharp objects, (such as glass) use a broom and
dustpan to clean it up.
• Dispose of all contaminated items in a biohazard bag.
• Flood the area with disinfected solution of 1 part chlorox to 10 parts water,
and allow it to stand for at least 20 minutes.
SHARPS
The greatest threat of exposure to bloodborne pathogens in the work place comes
from a puncture to the skin from contaminated sharp objects.
When handling sharps, follow these guidelines:
• Use mechanical means such as broom and dustpan or tongs for picking up
potentially contaminated sharp objects from the floor.
• Sharp containers must be used for the disposal of potentially contaminated
sharp objects.
• Sharps containers are color coded with the Bio-safety red-orange and are
puncture resistant and leak proof.
• When recapping needles use a needle- recapping divide or the one-handed scoop
technique.
• Gloves do not offer complete protection from being punctured by a sharp
object. Janitorial or housekeeping personnel should use caution when handling
linen or trash because or possible improper disposal of sharps.
SPILLS
Spills of blood or other potentially infectious material must be cleaned up
immediately to prevent further contamination of the area. Follow these
guidelines:
• Only the designated personnel should handle spills.
• Proper personal protective equipment should be worn.
• All materials used in the cleanup must be properly decontaminated and disposed
of.
• A 1 – 10 ration of sodium hypochlorite (bleach) to water effectively kills any
virus contained in blood.
• All absorbent material and disposable protective equipment used in the cleanup
must be properly disposed of in bio-safety bags.
POST EXPOSURE EVALUATION AND FOLLOW UP
Despite being careful, accidents with potentially infectious materials can
occur. An exposure incident is a specific eye, mouth, or other mucus membrane,
non-intact skin or contact with blood or other potentially infectious blood. It
is important to know what to do in case of emergency. If you suspect that you
have be exposed to an infectious disease, the first step that should be taken
are:
• Wash any areas of contact with soap and water as quickly as possible.
• Contain material using absorbent barriers.
• Dispose of contaminated materials in approved waste containers.
• Notify your supervisor and safety/ Health department.
• Complete an incident report.
A number of steps will be taken for you if you are involved in an
exposure incident:
• Your employer will provide a written description of the incident, routes of
exposure and identity of the source individual to the health care professional.
• Your blood will be tested for infection
• An appointment will be arranged with a health care professional to discuss the
results of your blood test and recommend any appropriate treatment.
• The June 14, 1994 State law 44-29-230 states that the source individual can be
tested against their will if there is an occupational exposure.
• The health care profession will provide your employer with an evaluation of
the results of your test and their treatment for you.
• All information from your medical evaluation will remain confidential.
TRAINING
As soon as employees are assigned to Category I or category II (see exposure
determination), they must take part in a training program, provided at no cost
during working hours. The program must train employees to assess, prevent, and
control infectious and communicable diseases. The program must be repeated
annually, and additional training
must be offered when a change in procedures affects occupational exposure.
RECORDKEEPING REQUIREMENTS FOR TRAINING
Documentation of training should include:
• The dates of the training session
• The contents and summary of the session
• The names and qualifications of the persons conducting the training.
• Names and job titles of all persons attending.
• The training records must be kept for 3 years from the date on which the
training occurred.
RECORD KEEPING
The standard requires employers to establish and maintain records for all
employees.
TRAINING RECORDS
Annual training must be provided to all employees who are covered by the
regulation. Employees must receive this training before they are assigned to
tasks where occupational exposure can occur. Documentation of training
should include:
• The dates of the training session
• The contents and summary of the session
• The names and qualifications of the persons conducting the training.
• Names and job titles of all persons attending.
• The training records must be kept for 3 years from the date on which the
training occurred.
MEDICAL RECORDS
Medical records must be kept on every employee with occupational exposure. The
records must include the name and social security number of the employee, a copy
of the employee’s hepatitis B vaccination statue, a copy of any exposure and
follow up forms. The medical records are to be kept confidential. They are not
to be disclosed without the employees written consent.
For credit in completing the orientation you must complete the following test.
Use a scantron answer sheet and return your test and CD to the infection control
Coordinator. Thank you.
The Post Test:
1.The goal of infection control is _____________to by breaking the chain of
infection.
a. protect health workers
b. protect patients
c. sterilize all operating rooms
d. prevent disease transmission
2. The biggest threat of disease in health facilities comes from
a. blood borne pathogens
b. air borne pathogens
c. water borne pathogens
d. all of the above
3. OSHA requires that all health workers be offered the ________ vaccination at
no cost to the worker.
a. rubella
b. hepatitis B
c. influenza
d. all of the above
4. Soap must contact your hands for___________ if hand washing is to be
effective.
a. 15 seconds
b. 30 seconds
c. 1 minute
d. 2 minutes
5.Should your skin or mucous membranes contact a patient’s blood,______.
a. call 911
b. wash immediately
c. continue procedures as if nothing occurred
d. all the above
6.Protective garments that become penetrated by blood must be _______.
a. changed immediately
b. incinerated
c. reported to OSHA
d. washed at home
7.Eye wear is required for procedures that produce ________.
a. droplets and aerosols
b. droplets of blood
c. splashes, spray and spatter
d. all the above
8. Gloves must be worn if it can be reasonably expected that you will
a. contact blood
b. contact mucous membranes
c. handle contaminated items
d. all the above
9. Universal precautions are required because _________.
a. some infectious diseases have window phases
b. some patients do not know they have diseases
c. some patients do not disclose infectious diseases on their history forms
d. all the above
10. To recap needles safely, use _______.
a. a recapping device
b. the one handed scoop technique
c. both are acceptable
d. it is never acceptable to recap needles.
11. Potentially infectious materials covered under universal precautions
include _________.
a. blood, saliva, body tissues
b. tears, urine, vomitus
c. objects that touch infectious patients
d. all the above
12. The greatest threat to exposure to bloodborne pathogens in the work place
comes from _________.
a. Bacterial aerosols.
b. assisting in surgery.
c. wearing inappropriate personal protective equipment.
d. puncture to the skin from a contaminated sharp object.
13. The goal of infection control is to______ by carrying out procedures to
break the chain of infection.
a. protect healthcare workers
b. protect patients
c. sterilize all operating rooms
d. prevent disease transmission
14. The biggest threat of disease in health facilities comes from ______.
a. bloodborne pathogens
b. airborne pathogens
c. waterborne pathogens
d. vector borne pathogens
15. Items that penetrate tissue must be properly _________after each use.
a. disposed of
b. sterilized
c. stored so that they remain sterile
d. all of the above
16. Personal hygiene requires that you ___________.
a. keep fingernails short and clean
b. refrain from direct patient care if you have open sores.
c. cover mustaches with a mask
d. all of the above
17. Recommended hand soaps contain __________.
a. triclosan
b. PCMX
c. Chlorhexidine gluconate
d. All the above
18. Required protective equipment provided to employees includes ________.
a. gloves
b. eye protection
c. gowns
d. all the above
19. Disposable gowns are preferred for procedures likely to involve large
amounts of blood or for _____________.
a. procedures that produce aerosols
b. patients with fever of unknown origin
c. procedures that contact mucous membranes
d. patients whose medical history is incomplete
20. OSHA’s Bloodborne Pathogen Standard applies to all ________exposures to
blood or other potentially infectious materials.
a. occupational
b. parenteral
c. mucosal
d. parenteral and mucosal
Print this page and bring it with you to the Health Sciences Orientation.
Name:_______________
Date: _______________
Infection Control for Dental Hygiene Students
Answer Sheet
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