AADMRT GUIDELINES FOR INFECTION CONTROL PROCEDURES
It is the A.A.D.M.R.T.'s position that an effective infection control program is essential to maintenance of patient care at the level which we all wish
to provide to the public. The intent of this document is to propose a set of recommended infection control procedures for the Dental X-Ray Laboratory setting.
These guidelines are not intended as a detailed set of instructions, but rather as a set of baseline recommendations. It is strongly suggested that
the ongoing development of our infection control practices be made a top priority in our laboratories.
1. Barrier Technique
a.) Personnel: It is recommended that single-use disposable gloves be worn for all patients when contact with blood, saliva, or mucous membrane is a
norm or a possibility. Latex "double dip" or "straight dip" gloves are preferable to vinyl due to superior tactile characteristics and strength of material.
Masks and protective eyewear should be worn during any procedure with potential for spatter or aerosols of blood and/or saliva.
b.) Surface: Environmental work surfaces and equipment that can become
contaminated during procedures should be covered with single-use
impervious-backed paper, aluminum foil, or clear plastic wrap to prevent
contamination. X-Ray tube heads, exposure switches, control knobs, darkroom
countertops and camera equipment are examples of surfaces that can become
contaminated in the laboratory setting. The contaminated barrier material
should be carefully removed while still gloved, discarded, and then replaced
(after ungloving) with clean material.
2. Instrument Pre-soak and Pre-clean: Organic debris is more difficult to
remove once dried; therefore, it is recommended that contaminated instruments
go directly into a pre- soak or holding solution. Glutaraldehydes and iodophors
prepared according to manufacturer instructions are two examples of chemical
agents suitable for this purpose. The contaminated instruments should then
be pre-cleaned prior to sterilization. This is best accomplished by either
ultrasonic cleaner or handscrubbing using utility gloves to protect the hands.
The degree to which instruments must next be dried is dependent upon the
method of sterilization to be used.
3. Instrument Sterilization: Effective methods that have shown to work well
in the laboratory setting are: Autoclave, Chemical Vapor Sterilizer, and
Glutaraldehydes (when used as sterilants, typically full strength with 6.75
to 10 hours immersion). There are other effective methods but at this time
none seem practical for use in the laboratory setting for a variety of reasons.
The individual laboratory operator must choose the method or methods that
best suit his or her facility. Due to the prevalence of heat sensitive
instruments in the laboratory setting, it is expected that the use of a
glutaraldehyde will at least be a part of the sterilization regimen. Care
must be taken to assure that the produce is EPA registered, and ADA accepted
to ensure that the product is suitable for use in these applications. It
is also critical that the product be stored, mixed, used and reused according
to the manufacturer's instructions. It is also recommended that all instruments
that contact the oral cavity be sterilized. The use of a glutaraldehyde (or
other chemical agent) as a disinfectant (typically full strength or in dilution
with 10 to 90 minute immersion) is a compromise and should only be used for
instruments that cannot be sterilized.
4. Sterilization Monitoring: It is recommended that process indicators be
used with each load sterilized with an autoclave or chemical vapor sterilizer
to eliminate the possibility of reusing contaminated instruments. It is
recommended that a biological monitor be used once a week to check operator
and unit function.
5. Surface Disinfection: Environmental work surfaces, equipment and control
switches that become contaminated during procedures should be covered with
single-use impervious- backed paper, aluminum foil, or clear plastic wrap
to prevent contamination. If the surface is not protected with barrier material
it is recommended that it be decontaminated with an appropriate chemical
agent. Care must be taken to assure that the product is EPA registered and
ADA accepted to ensure that the product is suitable for use in these
applications. It is also critical that the product be stored, mixed, and
used according to the manufacturer's instructions. Iodophors and chlorine
compounds are two examples of chemical agents suitable for this purpose.
Generally speaking, the process consists of two steps. The first step is
the cleaning of the surface with an initial application, with the second
application being applied and allowed to remain for the manufacturer's specified
amount of time.
6. Disposables: The utilization of single-use disposable instruments such
as intra-oral x-ray bite blocks and mouth props whenever possible is recommended.
7. Handwashing: Hands should be washed before and after gloving for each
patient, after touching contaminated surfaces, and before leaving the x-ray
area. An antimicrobial soap (such as a 4% chlorhexidine gluconate product)
is recommended. The soap should have completed the FDA registration process.
A National Drug Commission (NDA) number is then issued and will be displayed
on the product's labeling. It is also recommended that the product be accepted
by the ADA Acceptance Program, indicating it is acceptable for use in the
8. Waste Disposal: Generally speaking, waste contaminated with blood and/or
body fluids must be placed in a sturdy impervious bag to prevent leakage,
sealed and disposed of at least daily according to local and state regulations.
Additional procedures may apply depending upon the particular type of waste
and variances between different state and local agencies involved. It is
recommended that you familiarize yourself with the appropriate regulations
in your area and institute measures to assure compliance.
9. Hepatitis b Vaccination: The CDC publication "Preventing the Transmission
of Hepatitis B, AIDS, and Herpes in Dentistry" states, "Hepatitis B infection
is the most critical infectious occupational hazard for the dental professional."
It goes on to say, "DHCW's have a five- to ten-fold greater chance of acquiring
the infection than the general population." The CDC, OSHA, ADA, and other
major dental organizations either recommend or suggest that dental health
care workers receive vaccination against hepatitis B. Vaccination may not
be appropriate for everyone and should be the individual's decision made
in consultation with their physician. It is recommended that you consider
hepatitis B vaccination.
10. Assumption of Infectious Status: It is recommended that infection control
procedures be implemented for all patients and for all procedures where contact
with mucous membrane, blood, or body fluids is either expected or an inherent
possibility. Each patient's blood and saliva must be considered to be capable
of disease transmission and treated accordingly.
11. Patient History: It is recommended that specific questions about past
and current illnesses be included on patient questionnaires. The purpose
is to allow the operator the option of initiating additional precautions
for the known infectious patient. These precautions may include the use of
additional disposable barriers and disposable instruments to ease the process
of surface disinfection and eliminate the process of instrument sterilization
12. Standard Operating Procedures: It is recommended that written, detailed
Standard Operating Procedures (SOP's) be developed for each laboratory task
where exposure to mucous membrane, blood, or body fluids is a norm or a
possibility. These SOP's should detail the appropriate methods for performing
these tasks and the protective materials to be used.
13. Employee Training: It is recommended that all employees who perform these
laboratory tasks receive detailed training on the modes of transmission of
HBV and HIV and on the proper implementation of the SOP's prior to any patient
contact. There are additional OSHA standards that apply to health care employee
training and maintenance of a facility that is free from recognized hazards.
It is recommended that you familiarize yourself with federal OSHA standards
and/or state standards and take all steps necessary to assure
Ethics can simply be viewed as doing the "right" thing. Society has established
an accepted standard of "right" and "wrong," with many of these distinctions
going beyond the law. Professional ethics include items of a legal nature
as well as a personal judgment nature. By law, dental radiologic technologists
must follow certain guidelines regarding radiation protection and infection
control. By law, they are required to operate with a current license and
in a facility that is safe for both the operator and the patient. However,
many items which may be legal according to the law may be inappropriate or
unethical according to the standards of society. It is imperative that all
professionals and auxiliaries be familiar with accepted standards of care
and action and abide by these standards as much as possible. One of the freedoms
given to many professionals is the right of self-government. By staying involved
in self-governing organizations, and by adhering to the established rules
and regulations, professionals help insure their continued right to be
self-governing. Following established rules of ethics and hygiene will also
ensure that patients will continue to receive caring and fair treatment and
that their needs will be properly met. Continuing in education will also
help keep professionals abreast of changes in both the legal and the ethical
obligations to society.
For Additional Information
» Link to U.S. Department of Labor OSHA Bloodborne Pathogens
» ADA Policy Statement On Bloodborne Pathogens, Infection Control and The Practice Of Dentistry