Personal Protection

Module 3

Nancy Goodwin, CDA, RDH, MEd.

All rights reserved

Some things to think about.

What do you do everyday at work to

protect yourself from potential pathogens?

Do you always have on the personal
protective equipment that you should?
What things that you know of are
considered personal protective
equipment?
Are there other things you can to limit
your risk of exposure?

Objectives
Following the completion of the instruction in this Module, the participant will
be able to:
Discuss the vaccinations and medical testing that are recommended for
dental personnel.
Discuss the different types of immunity.
Discuss how to break the chain of infection
Identify the categories of employees as defined by OSHA.
Define an occupational exposure (incident).
Discuss and demonstrate recommended hand hygiene procedures
including the use of alcohol-based hand rubs and antimicrobial soap.
Describe the types of PPE that are recommended for dental personnel and
rationales.
List examples of engineering controls and work practice controls that
prevent exposure in the dental setting.
Discuss the rationale for preprocedural mouthrinses for patients.
Access materials that are available online from the CDC and OSAP.
Demonstrate proper sequence for donning and removing PPE.
Explain how the use of PPE, vaccinations, work practice and engineering
controls are related to the pathogens discussed in Modules 1 and 2.

Current recommendations
Immunizations
Handwashing protocols
Personal Protective Equipment
Work practice controls
Engineering controls
Patient preprocedural mouthrinses

Who should comply with these

recommendations?
To guide professionals in this decision, the
OSHA Bloodborne Pathogens Standard
requires employers to categorize
employees based on their risk of
occupational exposure to potential
pathogens.

 An occupational exposure can occur

through a percutaneous (through the skin)
injury, a permucosal (contact with mucous
membranes like the eyes or mouth).

The Bloodborne Pathogens Standard

requires the employer to provide training
in infection control and safety to all
employees who have a risk of occupational
exposure at no cost to the employee.

Occupational Exposure Risk

Categories
Category 1: Routinely exposed to blood,
saliva, or both (dental clinical personnel)
Category 2: May be exposed to blood or
saliva or both occasionally (other office
employees)
Category 3: Never exposed to blood or
saliva (no chance that they will be in the
clinical treatment area)

All hygienists and assistants are classified by

OSHA as Category 1 employees.

 Since all practicing dentists, dental

hygienists, and dental assistants are
Category 1 employees, all methods for
personal protection that have been
recommended by the CDC are essential for
us.
We will discuss each recommendation in
detail.

Immunizations
Immunizations provide artificially

acquired immunity through an

injection or series of injections, or
vaccines.
Vaccines are made from genetically
engineered or weakened disease-causing
organisms that result in the bodys
production of antibodies through the
immune response.

 Naturally acquired immunity has occurred

when a person has had a disease and has
recovered, thereby developing antibodies to the
disease.

This type of immunity is considered active,

because the body was actively involved in the
process.

Passive immunity occurs during pregnancy

when the fetus receives antibodies from the
mother, or after birth from breast milk.

Immunizations recommended for

dental personnel
Hepatitis B (recombiant or
immunoglobulin)
Influenza (flu)
Measles, Mumps, Rubella (MMR)
Varicella Zoster (live vaccine or immune
globulin)
(Bacille Calmete Guerin- only in rare
instances)

Immunizations recommended for

dental personnel
Hepatitis B
Pre-exposure regimen is the HBV
recombinant vaccine which is administered in
3 doses: two doses IM 4 weeks apart, and a
third dose 5 months after the second dose.
Employer must offer to employee within 10
days of assignment to Category 1 or 2 job.
Blood tests to check the serologic response
should be performed 1-2 months after
completion of the series.

 Hepatitis B immune globulin

For persons who have not had the HBV
vaccine (and are not immune) in the case of
exposure to blood or body fluids containing
HBV (surface antigen).
Should be administered as soon as possible
after exposure (but no later than 7 days);
second dose should be administered 1 month
later if HBV vaccine series has not been
started.

Influenza Vaccine
Annual single dose vaccination
Intramuscular (IM)
Especially important for dental workers
who:
work in chronic care facilities
have contact with patients at high risk for
influenza
have high-risk medical conditions
who are over the age of 50

Measles, Mumps, Rubella (MMR)

One dose subcutaneously (SQ) for mumps
and rubella component; for measles, first
dose (SQ) and second dose 1 month later.
For persons born after 1957 without
documentation (blood test) of immunity
NOT for pregnant women, severely
immunocompromised persons, or for
individuals who have had a severe allergic
reaction to neomycin.

Varicella Zoster
Live virus vaccine
Two doses (SQ) 4 to 8

weeks apart
For persons without a
reliable history or lab
evidence of varicella
(chicken pox)
Not in pregnancy or for
immunocompromised
individuals

Immune globulin
Dosage depends on

weight
For persons who have
close and prolonged
exposure to an
infected individual, or
for those likely to be
susceptible or at high
risk for complications
(like pregnancy)

Bacille Calmette-Guerin
Vaccination
For tuberculosis
One percutaneous dose
ONLY for dental healthcare workers where
multiple drug resistant TB is prevalent or
there has been a failure of infection
control measures to prevent transmission
to other healthcare workers.

 An employee does have the right to decline

a recommended vaccination.
In this case, they must sign an informed
refusal which is kept on file in the dental
office.
The employee may change their mind and
receive the vaccination at a later time.

Handwashing Protocols

 Handwashing is considered to be the

most important preventive procedure
for health care workers.

The practice of regular and thorough

handwashing protects dental
healthcare workers and patients.

 The hands contain both resident flora

(microorganisms which are always present) and

transient flora (which can come and go and
contain any pathogen which is contacted by the
hands).

Resident flora cannot be

completely removed,
even with a surgical scrub.

Resident flora are not

http://www.fotosearch.com/DGV045/73091270

the major concern in cross-contamination.

 Transient skin flora do not survive on the

hands for long.

They can be removed or greatly decreased

by routine and careful handwashing since
they reside on the outermost surface of the
skin.

There is no agent that sterilizes the

hands.

Handwashing Procedures
All components of handwashing are important;

the vigorous washing with plain or antimicrobial

soap suspends the microorganisms away from the
skin surface so that they may be rinsed away with
water.
Since non-intact skin can be a portal of entry,
choose approved products that also protect the
skins integrity.
Alcohol based rubs may be used if there is not
bioburden (patient blood or other potentially
infectious material) on the hands.

 Handwashing is recommended and is

critical before donning gloves and after

glove removal following patient treatment.

A significant percentage of dental

hygienists and assistants surveyed and

observed during a recent research project
did not wash their hands before, after, or
sometimes before or after patient care.

The wearing of gloves should not ever take

the place of handwashing.

Procedure for handwashing

as
recommended by OSAP, 2004, p. 24

Procedure for using Alcohol hand

rub technique

as recommended by OSAP, 2004, p. 25

Gloves

 Gloves protect the dental healthcare

worker from direct contact with
microorganisms in the patients mouth
and on surfaces; they also protect the
patient from potential pathogens on the
hands of the clinicians.

Since so many pathogens are transmitted

through this type of contact, gloves are an
important personal protective measure.

Types of Gloves
1.
2.
3.

Latex, vinyl, nitrile (for patient care)

Sterile gloves (for surgical procedures)
Heavy duty utility (for disinfection procedures
and handling of contaminated instruments)
4. Overgloves (similar to food handler gloves; can
be used over contaminated gloves for writing
or retrieving supplies during patient care)
5. Heat resistant gloves (for handling instruments
still hot from sterilization procedures)

Utility gloves

Latex gloves
Overgloves

Gloves for use during patient

care may be latex, latex-free,
powdered or powder free, or
any number of specialty types.
Choose gloves that are well-fitted,
comfortable, and non-irritating.

 Latex, nitrile, or vinyl- for use during all patient

care where there is any risk for exposure to
potentially infectious patient materials (blood,
saliva, etc.)
Must be changed for every patient.
Should not be washed or disinfected for reuse as
this alters the integrity of the material and
diminishes their effectiveness.
Should not be used for disinfection procedures
because many of these chemicals compromise
glove integrity.

 Remember: Once gloves have

entered a patients mouth, they
are contaminated.
Consequently, you should not
touch any clinical surface with
these gloves which will not be
cleaned and disinfected.

Helpful hints for glove use

Choose size and style most appropriate
and comfortable for you. (latex allergy?)
Keep fingernails short to avoid tearing
Do not wear jewelry
Do not wear fingernail polish or acrylic
nails. They have been linked to higher
incidence of bacterial growth even after
handwashing.
Kelsch, (2007);Scaramucci & Pacak,
(2006)

Masks

 Masks are intended to protect the worker from

the spray/splatter/aerosols that are produced
during most dental procedures.
(permucosal exposure)

They should be worn when any possibility exists

for spray or splatter to occur during patient
treatment.( the nose and mouth are portals of
entry)

Considering the pathogens which are

characterized by airborne or droplet

transmission, the mask is an essential part of
personal protective equipment.

Helpful hints for mask use

The outside surface is considered highly

contaminated and should not be touched with

ungloved hands.
Masks should be changed with every patient or if
they become wet.

 They should cover the

nose and mouth.

They should have a
BFE (bacterial
filtration efficiency) of
95%
Should be worn along
with face shields

http://www.smartpractice.com

Link
Risk of aerosols:
http://
www.cdc.gov/OralHealth/infectioncontrol/faq
/aerosols.htm

From this link, try to discover the difference

between splatter and aerosols. Why is it
important to understand the distinction?

Protective Eyewear

 Should be worn when any possibility exists

for spray or splatter to occur during all
patient treatment. (the eyes are a portal of
entry/permucosal exposure).

Should be worn for lab procedures

Should be worn during disinfection or

cleaning procedures when sprays are being

used or where splashing of a chemical is a
possibility.

 Eyewear should provide

protection to the front
and side of eyes (side
shields).

Face shields should be

chin length, have top

protection, and curved to
the side. As noted earlier,
they should be worn with
a mask.

Eye damage can occur

from pathogens or objects

that are propelled into the
eyes during patient
treatment or lab
procedures.

 Remember: Many patients who

have a transmissible disease are
unaware of their status; Standard
precautions state that we should
consider all body fluids, including
secretions and excretions, as
potentially infectious in all
patients.
Miller & Palenik, 2005

Protective Clothing

 Protective clothing is recommended because of

the ability for splash and splatter to land on
clothing and exposed skin.

Consequently, protective clothing is

recommended anytime that possibility exists
during patient care.

OSHA does not permit dental personnel to take

home this contaminated clothing for laundering;
employer must provide this.

 Protective clothing worn for patient care

should come to the neck and to the wrist.

Protective clothing should be changed

daily, or if it becomes visibly soiled.

It should not be worn out of the office at

any time (out to lunch, for instance). This

would be an example of contamination
that could occur from the dental office to
the community.

PPE for
patient
care

Preprocedural Mouthrinses
To lower the overall count of
microorganisms, it is recommended that
all patients rinse with an antimicrobial
mouthrinse prior to treatment.
A non-alcohol rinse should be chosen in
the case of a patient who has known or
suspected alcohol addiction, or who uses
tobacco.

Link
OSAP Check-Up: 2003 CDC Guidelines
Is your infection control program up to date?:

http://www.osap.org/associations/4930/files
/OSAP%20CheckUp%202003%20CDC%20Guidelines.
df
Check out the OSAP checklist for PPE on page 4 of
this link to see how you are doing.
Print this newsletter for an excellent reference for
your office.

Sequence for putting on PPE

1.
2.
3.
4.

Put on protective clothing

Place mask
Place protective eyewear
Wash hands, take care not to touch
surfaces.
5. Dry hands with disposable towels
6. Carefully put gloves on, one at a time.

Sequence for removal of PPE

1.
2.

3.
4.
5.

**Key is to prevent contamination**

Remove disposable gown by pulling it
over gloves and turning it inside-out.
Remove gloves by their cuffs
Remove eyewear by the ear area and
disinfect between patients.
Remove mask by its ties or elastic strap.
Wash hands

Work Practice
Engineering
Controls
Controls
Methods that alter the Devices that are
way a task is
designed to reduce
performed, reducing
the possibility of an
the likelihood of an
exposure.
exposure.
Examples are the
For example, always
ultrasonic instrument
using a one handed
washer, sharps
scoop method for
containers, and selfrecapping needles.
capping needles.

Clinical Application
What are some work
practice controls that you
already have in place at
your office?

Can you think of other

procedures that you could
implement to reduce the
likelihood of an exposure
in your office?

What engineering
controls do you already
use in practice?

Are there any devices

available to you that you
could start using to
protect yourself?

References
Kelsch, N. (2007, September). Infection control right at
your fingertips. RDH, 27(9), 80-82,154.
Miller & Palenik, (2005). Infection control and
management of hazardous materials for the dental
team (3rd Ed.). St. Louis, MO: Elsevier/Mosby.
OSAP (2004). From Policy to Practice: OSAPs Guide to
the Guidelines. Annapolis, MD: OSAP.
Scaramucci, M. K., & Pacak, D. K. (2006, January). The
foundation of infection control. Dimensions of Dental
Hygiene, , 18-20.