What are the links in the chain of infection?
- infectious agent
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- susceptible host
What is the Spaulding Classification?
They classify medical instruments based on their associated risks.
What is critical Spaulding level?
- high risk
- require heat sterilisation if not single use
- items in contact with normally sterile body sites, ie pierce skin or mucosa - ie forceps / periodontal scaler / burs / probe
What is semi-critical Spaulding level?
- medium risk
- require high level disinfection
- items in contact with intact mucous membranes / skin
- ie dental handpiece / mirror / 3in1 / amalgam compactor
What is non-critical Spaulding level?
- low risk
- only intact skin
- 2 classifications
- clinical contact areas are touched by a contaminated glove - ie dental light / light cure / drawer handles
- housekeeping areas - ie walls / floors / lights / dental chair
How can the reservoir be reduced?
- surface design (ie no seams)
- surface material
- easily cleanable / non absorbent - cleaning and disinfection
- surgery shouldn’t be cluttered and nothing should be left on surfaces
What is the definition of a detergent?
- synthetic organic water soluble agents that have a wetting agent, and can emulsify and hold soil
What is high level disinfection?
- takes hours
- kills all microbes except bacterial spores
What is low level disinfection?
- takes less than 10 minutes
- kills most microbes
How is aerosol controlled?
- high volume aspiration
- rubber dam
What are the five moments for hand hygiene?
- before touching a patient
- before a clean/aseptic procedure
- after a bodily fluid exposure risk
- after touching a patient
- after touching a patient’s surroundings
Give an example for breaking each of the links in the chain of infection.
- infectious agent = none
- reservoir = cleaning / design of surfaces
- portal of exit = aerosol control
- mode of transmission = hand hygiene
- portal of entry = PPE
- susceptible host = vaccinations
What is the black waste stream?
- trivial risk
- domestic waste
What is the orange waste stream?
- low risk
- items likely contaminated with blood / bodily fluids
- PPE
What is the yellow waste stream?
- high risk
- sharps / medical devices / anatomical tissues
What is a sharp?
- item used in healthcare that could injury either the patient or the operator
- bur / probe / endo file / forceps / scalpel
Who is responsible for sharps disposal?
- operator
- even if the task is delegated (eg to a nurse) the operator remains responsible
What are the different types of sharps container?
- orange lid = no pharmaceutical drugs eg scalpels / burs
- blue lid = contains pharmaceutical drugs eg LA cartridge and needle
How are sharps containers made safe for use?
- temporary closure should remain in place when not in use
- lid should be firmly closed
- do not fill above the line, once the line is reached the permanent closure mechanism should be used
- details of when / who / where the container was assembled and closed should be recorded on it
What is the procedure if a sharps injury occurs?
- stop
- inform patient
- remove gloves and check for injury
- report to the senior clinician
- risk assessment carried out by senior clinician
- blood tests done off site
- datix completed
How do you treat a sharps injury?
AWARE
- apply pressure
- wash don’t scrub
- assess type of injury
- risk of source blood?
- establish contact
What is the chance of contracting a BBV?
- 1 in 3 for HBV
- 1 in 30 for HCV
- 1 in 300 for HIV
What is the course of action for HBV exposure?
- baseline bloods
- PEP
- no need for PEP if positive response to the vaccine
What is the course of treatment of HIV exposure?
- baseline bloods
- antiretroviral medication for 28 days (very toxic)
- follow up 12 weeks post-exposure
