Infection control breaches can result in the transmission of infectious agents, particularly bloodborne pathogens. These breaches are situations when established procedures are not followed, thus potentially placing patients and healthcare workers at risk.
A few common infection control breaches found in healthcare facilities, including dental healthcare facilities, are:
Unsafe injection practices include reusing syringes or needles on more than one patient. It also includes using a syringe to access a medication vial that is then used on multiple patients. Cases like these have resulted in documented transmission of bloodborne pathogens.
Two common myths with unsafe injection practices are that changing the needle makes a syringe safe for reuse and that leftover medication in a single use vial is safe to reuse on additional patients. Once a needle and syringe are used, they are considered contaminated and must be discarded. A new needle and syringe must be used for each entry into a medication vial and for each injection. Single use vials of medication are just that – single use! They do not contain antimicrobial preservatives and therefore can only be used once.
Sadly, the reuse of single use devices, also called disposable devices, is common. Reusing items that are labeled single use increases the risk of transmitting infections. Single use devices must be used for only one patient during a single procedure. Items that are single use are intended to be discarded after use and NOT reprocessed. Any item that does not have instructions for reprocessing are single use. Examples of single use items in healthcare are syringes, needles, gloves, masks, bandages, wraps, catheters, surgical blades, and certain retractors. Examples in dentistry are irrigating syringes, certain burs, needles, masks, gloves, saliva ejectors, and high-volume suctions. Single use items are made from materials not designed for heat sterilization nor can they be cleaned properly thus making them single use.
Failure to monitor sterilization equipment is another significant infection control breach. Autoclaves must be monitored utilizing physical, chemical, and biological indicators. Physical indicators include observing and documenting the time, temperature, and pressure of the autoclave. This ensures that the parameters for sterilization have been met. Chemical indicators are indicators that will result in a change to one or more of the conditions within the sterilizing chamber. These are used to detect sterilizer malfunction or failures resulting from human error, deficiencies of the sterilizing agent, or malfunction of the machine. The chemical indicator will undergo a change of color when the parameters for sterilization are present. Chemical indicators do not validate sterilization; they are a way to detect potential sterilization failure. Biological indicators, commonly referred to as spore test, are the only way to verify sterilization. Spore testing must be done at least weekly and with each implantable device. These tests are available in vials or strips. You can use a mail-in system or in-house incubators.
Hand hygiene and proper use of PPE are critical to reduce the spread of infection. Hand hygiene is the single most critical measure to reduce the spread of organisms to your patients and to each other. In hospitals, improper or not performing hand hygiene has resulted in outbreaks of infections. Studies have shown a low adherence to hand hygiene, with an adherence rate of less than 40%. Some of the most frequent reasons given for the lack of hand hygiene among healthcare personnel are:
Remember, clean hands are an important defense against spreading infections.
Inconsistent use of PPE is another common infection control breach. PPE is used to protect the clothing and skin of healthcare workers. The selection of PPE must be made based on the potential exposure risk during each procedure. Healthcare workers, including dental healthcare workers, must ensure proper use of PPE for each exposure risk and each procedure performed. Improper use of PPE can facilitate the spread of infection between patients and workers.
Infection control breaches must be identified immediately and action taken to correct the breach. In some cases, consultations with infection preventionist and health authorities must take place. Notification and testing of patients may be a result of these breaches. Following standard precautions and your facilities standard operating procedures will ensure a safe, healthy environment for patients and healthcare professionals.
