axillofaciall idelines
ogy infe radiogr
These infection control guidelines are recommendations approved by the American Academy Maxillofacial Radiology. Infection risk as low as reasonably achievable (ALARA) is advocated current paucity of scientific information on this matter as it applies to dental radiology. (ORAL SLRG ORAL MED ORAL PATHOI. 1992;73:248-9)
T
he probability of transmitting a viral, bacteria!, or fungal infection during an oral radiographic procedure is poorly understood. Current fears regarding virus-borne disease have prompted changes in dentistry’s approach to infection control. Still, overconcern, as well as underconcern, can be a problem if patients forego necessary treatment as a result of undue fear. Risk-benefit analysis is as appropriate to infection control as it is to radiation use. When risks are real, however small, they should be addressed, but the concrete benefits associated with diagnostic and therapeutic procedures must not be lost. An “infection risk as low as reasonably achievable” (ALARA) position is appropriate in light of our current knowledge. Many potentially infectious patients cannot be identified by history and examination. As a result, an infection control policy should not distinguish between patients, whether they are known to be infectious or not. Guidelines should lead to practices that protect sufficiently; yet they should be practical enough to permit one standard of care to be used with all patients. ADMINISTRATION
1. Each dental practice and educational facility shah develop a written infection control policy. Infec*These guidelines were developed by the following committee: J. Brand: DDS, MS-Committee Chairman (Oklahoma Universiry), B. Benson, DDS, MS (Baylor University), B. Ciola, DDS, MSD (VAMC, Connecticut), 5. Glass, DDS, MS (University of Texas at San Antonio), .I. Katz, DMD, MS (University of Missouri), L. Otis, MS: DDS (University of Southern California). E. Parks, DMD (Western Kentucky University), J. Pettigrew, DMD (University of Florida, Gainesville). 7/I&/33356 248
of Orai and in view of the
tion control measures during oral radiographic procedures should be consistent with this policy and local regulations. 2. All patients shall be treated as potentially infectious. The infection control policy regarding oral radiographic procedures should have as its goal the prevention of disease transmission from patient to operator, operator to patient, and patient to subsequent patient. 3. A dentist in the practice or a member of the faculty shall be given full and complete authority and responsibility to establish, implement, and monitor guidelines and policies on infection control. In a dental education facility, the radiology faculty shall participate in the development of those guidelines associated with radiographic procedures. 4. A dentist or faculty member shall provide for the education of all personnel regarding potential hazards associated with the spread of infection that could occur in the workplace and methods to minimize these hazards. PHYSICAL
FACILITIES
AND EQUIPMENT
1. Operators shall be instructed to avoid touching walls and other environmental surfaces with contaminated gloves. Operatories shall be cleaned on a regular basis as circumstances dictate. When a contamination is known to have occurred, disinfection procedures shall be accomplished. 2. Materials and instruments used during the appointment shall be kept on work surfaces that are covered or disinfected with an ADA-approved surface disinfectant. 3. Nondisposible instruments including intraoral film holders, beam-aligning devices, and panoramic
Infect,ion control guidelines for dental radiographic
Volume ‘73 Number 2
bite-blocks shall be sterilized with heat or gas, Cold sterilization requires hours of immersion and is considered unacceptable. 4. Ear rods, chin rests, and head positioners that cannot be removed for cleaning and sterilization shall be disinfected with an ADA-approved surface disinfectant 5. All materials used during the appointment shall be disposable or sterilized before reuse. Supplies shall be dispensed in the amounts appropriate for each patient procedure. 6. Disposal of all contaminated supplies shall be accomplished in a manner that minimizes risk to patients, employees, and the community in compliance with existing regulations. Disposables shall be placed in sealed plastic bags. OPERATIVE
PROCEDURES
1. During the appointment, charts shall be kept well away from all sources of contamination. 2. All operators shall wash their hands before and after wearing gloves. Appropriate disinfection procedures shall be used for faucets, handles, and soap dispensers. Foot co’ntrols and other methods to avoid hand contact should be considered when new equipment is purchased. 3. Gloves shall be worn during all radiographic procedures and while handling contaminated film packets, supplies, and instruments. Gloves shall be worn during clean-up procedures. 4. Since all disinfecting solutions have drawbacks, their use can be Iminimized by covering all work surfaces. A. Surfaces likely to be contaminated shall be covered to eliminate the need for disinfection between patients. B. Those surfaces that are not covered shall be cleaned and disinfected with an ADA-approved surface disinfectant. Immersion disinfectants are not appropriate for this purpose. C. The exposure switch and thle cone shall be covered or disinfected since lheir manipulation with the gloved hand is unavoidable. D. Chair adjustments can be set in advance. A single standard head position for maxillary and mandibular periapical radiographs shall be used. Chair controls shall be covered.
procedures
249
E. Film packets and supplies can be obtained prior to seating the patient to avoid contact with a film dispenser or storage area. If additional materials are needed, they shall be obtained from a coworker, or operators shall remove their gloves before obtaining the necessary supplies. Placing a pair of examination gloves over the contaminated gloves is an alternative method. 5. As a service to patients, serologic screening for hepatitis virus and HIV can be offered. Referrals for medical and social services are within the scope of dentistry. DARKROOM
PROCEDURES
1. .A11 surfaces that are contaminated by film packets shall be disinfected regularly. 2. Contaminated film packets shall be wiped dry and carried to the darkroom in a disposable container, such as a paper cup, or wrapped in a towel. Access to the darkroom shall not involve contamination of doors or other environmental surfaces. 3. Gloves shall be worn while handling contaminated film packets. Films can be removed from the packets and packets removed from barrier bags by dropping them onto a clean, covered surface, and then processed with ungloved hands. 4. Gloves shall not be worn while receiving and mounting radiographs or while handling paperwork. 5. Daylight loaders should be discouraged since contamination is difficult to avoid. If films are not removed from barrier bags before the daylight loader is used, then the following protocol shall be used A. Remove gloves and wash hands before using the loader. B. Gloves and the contaminated film packets are placed inside the loader through the removable cover. C. Put the hands into the loader and put on the gloves before handling the film packets. D. Remove gloves before the hands are withdrawn. Repvint requests: John W. Brand Director of Oral Radiology College of Dentistry University of Oklahoma PO Box 26901 Oklahoma City, OK 73190
ogy infe radiogr
These infection control guidelines are recommendations approved by the American Academy Maxillofacial Radiology. Infection risk as low as reasonably achievable (ALARA) is advocated current paucity of scientific information on this matter as it applies to dental radiology. (ORAL SLRG ORAL MED ORAL PATHOI. 1992;73:248-9)
T
he probability of transmitting a viral, bacteria!, or fungal infection during an oral radiographic procedure is poorly understood. Current fears regarding virus-borne disease have prompted changes in dentistry’s approach to infection control. Still, overconcern, as well as underconcern, can be a problem if patients forego necessary treatment as a result of undue fear. Risk-benefit analysis is as appropriate to infection control as it is to radiation use. When risks are real, however small, they should be addressed, but the concrete benefits associated with diagnostic and therapeutic procedures must not be lost. An “infection risk as low as reasonably achievable” (ALARA) position is appropriate in light of our current knowledge. Many potentially infectious patients cannot be identified by history and examination. As a result, an infection control policy should not distinguish between patients, whether they are known to be infectious or not. Guidelines should lead to practices that protect sufficiently; yet they should be practical enough to permit one standard of care to be used with all patients. ADMINISTRATION
1. Each dental practice and educational facility shah develop a written infection control policy. Infec*These guidelines were developed by the following committee: J. Brand: DDS, MS-Committee Chairman (Oklahoma Universiry), B. Benson, DDS, MS (Baylor University), B. Ciola, DDS, MSD (VAMC, Connecticut), 5. Glass, DDS, MS (University of Texas at San Antonio), .I. Katz, DMD, MS (University of Missouri), L. Otis, MS: DDS (University of Southern California). E. Parks, DMD (Western Kentucky University), J. Pettigrew, DMD (University of Florida, Gainesville). 7/I&/33356 248
of Orai and in view of the
tion control measures during oral radiographic procedures should be consistent with this policy and local regulations. 2. All patients shall be treated as potentially infectious. The infection control policy regarding oral radiographic procedures should have as its goal the prevention of disease transmission from patient to operator, operator to patient, and patient to subsequent patient. 3. A dentist in the practice or a member of the faculty shall be given full and complete authority and responsibility to establish, implement, and monitor guidelines and policies on infection control. In a dental education facility, the radiology faculty shall participate in the development of those guidelines associated with radiographic procedures. 4. A dentist or faculty member shall provide for the education of all personnel regarding potential hazards associated with the spread of infection that could occur in the workplace and methods to minimize these hazards. PHYSICAL
FACILITIES
AND EQUIPMENT
1. Operators shall be instructed to avoid touching walls and other environmental surfaces with contaminated gloves. Operatories shall be cleaned on a regular basis as circumstances dictate. When a contamination is known to have occurred, disinfection procedures shall be accomplished. 2. Materials and instruments used during the appointment shall be kept on work surfaces that are covered or disinfected with an ADA-approved surface disinfectant. 3. Nondisposible instruments including intraoral film holders, beam-aligning devices, and panoramic
Infect,ion control guidelines for dental radiographic
Volume ‘73 Number 2
bite-blocks shall be sterilized with heat or gas, Cold sterilization requires hours of immersion and is considered unacceptable. 4. Ear rods, chin rests, and head positioners that cannot be removed for cleaning and sterilization shall be disinfected with an ADA-approved surface disinfectant 5. All materials used during the appointment shall be disposable or sterilized before reuse. Supplies shall be dispensed in the amounts appropriate for each patient procedure. 6. Disposal of all contaminated supplies shall be accomplished in a manner that minimizes risk to patients, employees, and the community in compliance with existing regulations. Disposables shall be placed in sealed plastic bags. OPERATIVE
PROCEDURES
1. During the appointment, charts shall be kept well away from all sources of contamination. 2. All operators shall wash their hands before and after wearing gloves. Appropriate disinfection procedures shall be used for faucets, handles, and soap dispensers. Foot co’ntrols and other methods to avoid hand contact should be considered when new equipment is purchased. 3. Gloves shall be worn during all radiographic procedures and while handling contaminated film packets, supplies, and instruments. Gloves shall be worn during clean-up procedures. 4. Since all disinfecting solutions have drawbacks, their use can be Iminimized by covering all work surfaces. A. Surfaces likely to be contaminated shall be covered to eliminate the need for disinfection between patients. B. Those surfaces that are not covered shall be cleaned and disinfected with an ADA-approved surface disinfectant. Immersion disinfectants are not appropriate for this purpose. C. The exposure switch and thle cone shall be covered or disinfected since lheir manipulation with the gloved hand is unavoidable. D. Chair adjustments can be set in advance. A single standard head position for maxillary and mandibular periapical radiographs shall be used. Chair controls shall be covered.
procedures
249
E. Film packets and supplies can be obtained prior to seating the patient to avoid contact with a film dispenser or storage area. If additional materials are needed, they shall be obtained from a coworker, or operators shall remove their gloves before obtaining the necessary supplies. Placing a pair of examination gloves over the contaminated gloves is an alternative method. 5. As a service to patients, serologic screening for hepatitis virus and HIV can be offered. Referrals for medical and social services are within the scope of dentistry. DARKROOM
PROCEDURES
1. .A11 surfaces that are contaminated by film packets shall be disinfected regularly. 2. Contaminated film packets shall be wiped dry and carried to the darkroom in a disposable container, such as a paper cup, or wrapped in a towel. Access to the darkroom shall not involve contamination of doors or other environmental surfaces. 3. Gloves shall be worn while handling contaminated film packets. Films can be removed from the packets and packets removed from barrier bags by dropping them onto a clean, covered surface, and then processed with ungloved hands. 4. Gloves shall not be worn while receiving and mounting radiographs or while handling paperwork. 5. Daylight loaders should be discouraged since contamination is difficult to avoid. If films are not removed from barrier bags before the daylight loader is used, then the following protocol shall be used A. Remove gloves and wash hands before using the loader. B. Gloves and the contaminated film packets are placed inside the loader through the removable cover. C. Put the hands into the loader and put on the gloves before handling the film packets. D. Remove gloves before the hands are withdrawn. Repvint requests: John W. Brand Director of Oral Radiology College of Dentistry University of Oklahoma PO Box 26901 Oklahoma City, OK 73190
