10 - Health and Safety/Infection Control

Amalgam waste generated in the clinics is to be disposed of in a container labeled “amalgam waste”. All unused, scrap, and empty amalgam capsules are to be placed in a properly labeled container provided in the amalgam procedure tub. Specifically:

1. Extracted teeth with amalgam are to be placed in a container labeled amalgam waste for hazardous waste disposal.
2. Using the HVE to suction waste amalgam from equipment, floors or counters is prohibited.
3. Amalgam waste generated during pre-clinical laboratory exercises must be disposed of in provided containers labeled “amalgam waste”.
4. All hazardous waste is logged, labeled, and packaged by the Director of Compliance. The OUHSC EHSO hazardous materials staff is responsible for the disposal of the hazardous material following federal and state laws.

OUHSC Plumbing will inspect the boxes when they do their PM in the equipment room every 6 months.

1. The plumbing shop will notify the Facilities Coordinator as to how many boxes are full and need to be changed out.  

2. Call Rebec at 1-800-569-1088, and ask for Christi Gochanour. Inform Christi of how many boxes need to be replaced. 

3. Rebec will send empty boxes. KEEP THE CARDBOARD BOXES THEY COME IN!  

4. Put in SUR to have the new boxes switched out with the full ones. 

   • Every time you need the boxes changed out, you must put in a new SUR. 

5. The plumbing shop will put the full ones in the cardboard boxes used to ship the new ones. Then tape up the boxes and secure them to empty pallets with clear plastic wrap.  

6. Call Rebec again and set up a pick-up by UPS freight. 

7. UPS will pick up the pallet. 

Safety Data Sheets (SDS) can readily be obtained online 24 hours a day from any computer at the following web site:

Safety Data Sheets (ouhsc.edu)

Hard copies of SDS sheets are maintained in the Shipping and Receiving office at the College of Dentistry, however it is recommended using the Internet, as the information is more easily accessible.

Workforce members are to look at labels for warnings such as flammable and toxic. The label contains information on proper PPE to be worn during handling as well as proper procedures for spill clean-up and emergency measures.

If a substance is transferred from the original manufacturer’s container and placed in a secondary container, the container must be labeled with contents and hazard warnings. Small quantities transferred to a secondary container and not labeled must be used immediately.

The College of Dentistry follows the Centers for Disease Control and Prevention (CDC), Organization for Safety and Asepsis Procedures (OSAP), Occupational Safety and Health Administration (OSHA), and the University of Oklahoma Health Science Center (OUHSC) Infectious Disease Policy (https://compliance.ouhsc.edu/ehso/Home/Forms-Resources/Links) recommendations and guidelines for infection control to ensure patient and workforce member safety. 

The infection control guidelines are intended to foster an awareness of concepts and methods when performing required patient care procedures. For your safety and the safety of others, the general principles of cleanliness in the workplace, the use of protective attire, the separation of uncontaminated and contaminated items and work areas, and constant consideration of the potential for cross-contamination should be observed. 

For all dental procedures, students will be observed and graded accordingly for compliance with infection control and patient safety. 

The Office of Compliance performs routine monitoring of infection control compliance to ensure adherence to the guidelines and recommendations. 

Gross negligence in infection control standards may result in the generation of a Professionalism Concerns Report and up to a two-week suspension from the clinic.

Each clinic’s tabletop (Prevacuum) sterilizer (Statum) undergoes a weekly spore test inoculated with Geobacillus using the following procedure:

1. The spore tests are brought to CS for processing.
2. The results are kept on each sterilizer in a logbook maintained by the CS staff.
3. If results are positive, repeat the spore test and examine the procedure to ensure the sterilizer is loaded correctly (not overfilled), the pack is not too large, and the manufacturer’s instructions have been followed.
4. If the results are positive again, do not use the sterilizer until it has been inspected or repaired. Using another sterilizer, reprocess any items sterilized since the last negative spore test.

The College of Dentistry uses ADEC®¹ closed water system dental unit.

1. Each day before use, flush the dental unit water lines for 30 seconds.
2. Flush the ultrasonic scaler unit water line for 30 seconds prior to placing the insert.
3. Refill water bottles with deionized water treated with ICX® tablets to prevent biofilm in the lines. Treated water can be found in each clinic in 20 L bottles labeled “ ICX® Treated Water”.
4. When refilling water bottles on the units, do not touch the inner tubing with your hands or gloves.

UNIT SETUP

PRECLEAN

1. Wash hands for 40 - 60 seconds and gather PPE (surgical mask, eyewear, face shield (optional), head covering (optional), and over-gown) and the pitcher to flush the evacuation system.

2. Put on surgical mask and eyewear. Perform thorough hand hygiene for 40 – 60 seconds. Don new gloves

3. Position patient, operator and assistant chairs, bracket table, light (position light pole to opposite side of operator), assistant’s cart, swivel arm & rheostat.

4. Fill the water bottle with properly treated water (DO NOT touch the tubing when reattaching the water bottle to the unit).

5. Flush the evacuation system for 2 minutes.

6. Flush the water lines for 30 seconds and place the pitcher back in the cabinet. The unit is ready for patient care.

DISINFECT

1. Clean dental chair, operator's and assistant's stools utilizing soap* and water. *If blood is present, use a disinfectant towelette.

Use disinfectant towelettes (using “Wipe Discard Wipe Technique”) on:

2. Operator’s and assistant’s levers and assistant’s cart

3. Dental light switch, handles, and arm

4. Bracket table, bracket table accessories (A/W syringe, connectors, holders, and hoses), bracket table arm, and water bottle

5. Swivel arm and accessories (A/W syringe, connectors, holders, and hoses)

6. Paper towel dispenser, soap dispenser, faucet handle, all objects on countertop, countertops, cabinet facings, cabinet handles, & sink rim

7. Rheostat and rheostat cord

8. Remove gloves, dispose of into trash, and perform hand hygiene. Don new gloves.

9. Cover chair back and place barrier film on switches, controls/levers, and arm rests—includes the hydraulic lever.

10. Cover bracket table and assistant’s cart with dental bibs; place instrument cassette on bracket table.

11. Insert saliva ejector, HVE, and A/W syringe tip; cover with plastic sleeves

12. Hang white bag from unit; throw all items used during treatment into white bag then place into trash

13. Barrier keyboard/mouse (Rule of thumb: keyboard cover on – gloves on; keyboard cover off – gloves off

UNIT BREAKDOWN

DISINFECT

1. While wearing PPE used during treatment, disinfect the unit.

2. Remove contaminated gloves used for treatment, perform hand hygiene, dismiss patient, and don new gloves.

3. Safely and securely place instruments in the cassette before transporting to designated bin.

4. Place contaminated disposables in the white bag and place the bag into the trash. Remove contaminated gloves and dispose of into trash. Perform hand hygiene and don new gloves.

5. Repeat steps 1-7 for unit disinfection above. Afterwards, remove contaminated gloves, dispose of into trash, perform hand hygiene, and don new gloves.

6. Flush water and evacuation lines for 30 seconds.

7. Return equipment to its original position. Place the rheostat on the dental chair on a paper towel.

8. Remove over gown and contaminated gloves, dispose of into trash, perform hand hygiene, and don new gloves.

9. Remove face shield and protective eyewear (operator and patient)and disinfect using soap and water. Remove contaminated gloves, dispose of into trash, perform hand hygiene, and don new gloves.

10. Remove surgical mask and disposable head cover (if used) to dispose of into trash. Remove contaminated gloves, dispose of into trash, perform hand hygiene, and don new gloves.

11. Retrieve mop from dispensary and mop with floor cleaner around treatment area.

12. Remove contaminated gloves, dispose of into trash, and perform hand hygiene.

The following includes the policy document containing expected infection control practices and procedures for the Labs. These policies are to be followed at all times. Student failure to do so will result in a grade reduction in the Professionalism category, see course syllabus,  and students will be subject to the relevant warnings.

Student/Resident/Faculty Hygiene Policies Prior to Lab Use:

• Users are required to perform the appropriate hand hygiene procedures upon entering the Wet Labs and prior to utilizing any lab equipment
  • If the user has not been actively engaged in patient care immediately prior to entry, they may opt to utilize hand sanitizer only
  • If the user has been actively engaged in patient care immediately prior to entry, they must wash their hands  
• Users are required to obtain and use the appropriate PPE upon entering the Wet Labs and prior to utilizing any lab equipment
  • At a minimum the correct PPE for use in the wet lab should include:
    • Gloves
    • Safety Goggles
    • Mask
    • Gown (optional)

Disinfection and/or Sterilization of Items Transported Into the Lab:

• Any impressions brought into lab must undergo the following procedure prior to entry:
  • Impressions must first be washed with water (and gently cleaned if necessary) to remove any blood, saliva, or bioburden that would impede decontamination
  • Next, impressions should be sprayed thoroughly with Clorox for Healthcare and allowed to sit for the necessary 3 minute contact time
  • Finally, any remaining or pooled disinfectant or cleaning agents should be rinsed and the impression should be dried to prevent any deleterious effects on materials cast in the impression
• Any dental prostheses or indirect restorations brought into the Lab must undergo the following procedure prior to entry:
  • Provisional and permanent indirect restorations:
    • Restorations brought from a laboratory setting directly to the Lab do not require any additional disinfection
    • Restorations brought directly from patient care must first be washed with water and cleaned to remove any blood, saliva, plaque, calculus, or any other bioburden that would impede decontamination
    • Next, restorations should be sprayed thoroughly with Clorox for Heathcare and allowed to sit for the necessary 3 minute contact time
    • Finally, the restoration should be rinsed of any remaining disinfectant and dried
• • Removeable prostheses
    • Prostheses brought from a laboratory setting directly to the Lab do not require any additional disinfection
    • Prostheses brought directly from patient care must first be washed with water and cleaned to remove any blood, saliva, plaque, calculus, or any other bioburden that would impede decontamination
      • If bioburden persists and attempts to remove are unsuccessful, place the prosthesis in a sealable bag, put your name and chair number on the bag. Ask the clinic Inventory Assoicate to have access to the ultrasonic inside the dispensary. Pour enough tarter and stain remover to cover the appliance; initiate the ultrasonic cycle for 15 minutes and re-examine prosthesis to ensure bioburden has been completely removed. Repeat cycle as needed.
    • Next, prostheses should be sprayed thoroughly with Clorox for Healthcare and allowed to sit for the necessary 3 minute contact time
    • Finally, the prostheses should be rinsed of any remaining disinfectant and dried

Materials/Equipment

• Stone Use: After any and all impressions brought into the wet lab are appropriately disinfected and labelled, various stone substances may be mixed (according to manufacturer prescribed water/stone mixture ratio).
  • Available stone:
    • Found in the drawers under the stone grinders
    • Die Stone–
    • Mounting Stone –
      • Pink
      • Green
    • White Stone –
  • After pouring the appropriate stone mixture into any impression, the cast may be allowed to rest on Styrofoam trays with your name and date or in holders or on the counter surface of the Stone casts are allowed to remain in this area no more than 24 hours
    • Any impressions left without being appropriately labelled will be thrown out.
    • Any stone casts left in the designated cast setting area for more than 24 hours will be thrown out
  • Any stone spilled on the floor must be swept up and thrown away to prevent a fall risk in the t Labs (a dustpan and hand-broom are available in the clinic)
• Mixing Bowls/Spatulas
  • Prior to disinfecting, clean any bioburden from mixing bowl and spatula
  • Disinfect with PDI disinfecting wipes, using wipe discard wipe technique or sprayed thoroughly with Clorox for Healthcare using spray wipe spray technique.
  • Allow to sit for the necessary 3 minute contact time
  • It is recommended that you remove the stone from any bowls or spatulas prior to allowing stone to set by rinsing with cold water
  • If stone is allowed to set, it will be required to remove any and all set stone from the bowl and/or spatula by any means necessary
• Table Vibrators
  • Prior to use for pouring stone into any impression, must ensure that the table and motor box are clean and free from stone (to the best of your ability). Then utilize the clear cover-bags (provided in the drawer near the vibrator) to cover the table.
  • If, during the course of use for the day, the clear cover-bag becomes excessively dirty or torn, you must replace the cover-bag
  • The last person of the day to use the, after use for pouring stone into any impression, must remove and discard the clear cover-bag and ensure the table and motor box are clean and free from stone (to the best of your ability).
• Combination Unit
  • When using the Whip Mix Vacuum Stone Mixer, inspect the device first to make sure the vacuum hose is intact and unobstructed
  • After using the unit, you must ensure there is no stone left on the unit to set up, and you must clear or clean any remaining stone from the appliance
  • Clean mixing bowl and tubing immediately after use
• Designated Stone Setting Areas
  • After pouring the appropriate stone mixture into any impression, the cast may placed to set in the stand holders provided or on Styrofoam trays on the counter surface in the wet lab
  • How they are to be placed:
    • Ensure the stone cast has your name and date on the tray
    • At the end of each day, any setting casts and impression trays that are not appropriately labeled will be disposed of in the appropriate manner. In addition, any setting casts or impression trays that are labeled with the previous date will also be disposed of.
  • After you reclaim any set stone casts and trays, ensure the area is completely free of stone and the counter is clean

Ultrasonic Cleaning Bath

• • Setting up the Ultrasonic Bath for use:
    • The clinic Inventory Associate is responsible for the maintanence and cleaning of the ultrasonic baths
  • Cleaning Intraoral Prostheses:
    • Obtain a sealable plastic bag from the cart next to the dispensary and place your prostheses in the bag
    • Put your name and chair number on the outside of the bag with a Sharpie
    • Ask the clinic Inventory Assoicate to have access to the ultrasonic inside the dispensary.
    • Pour enough tarter and stain remover to cover the appliance; Place plastic bag into a beaker filled with water
    • Place beaker into ultrasonic and initiate the ultrasonic cycle for 15 minutes. Re-examine prosthesis to ensure bioburden has been completely removed. Repeat cycle as needed.
    • After the prostheses is cleaned, remove it from the Tartar and Stain solution and thoroughly rinse to ensure no solution is transferred back to the patient
    • Empty the beaker of any remaining solution and rinse it thoroughly with water from the sink. Leave next to ultrasonic

• Wet Model Trimmer
  • You must wear safety glasses to use model trimmer.
  • When using the wet model trimmer, ensure there is adequate water flow to the internal grinding wheel; immediately after using the appliance, and prior to turning it off, use the attached water-sprayer to clean the wheel (while in motion), as well as the trimming table and the recess underneath the trimming table
  • After trimming your model, check the sink for any large, set pieces of stone and throw them into the trash to prevent clogging the sink. If the sink appears backed up or the trap under the sink appears to be mostly full of stone, please notify the Inventory Assoicate.
  • After Using the Trimmer and turning it off, inspect the Clear Plastic Safety Shield once again and clean as needed
• Polishing Lathe/Buffer
  • Inspect the Lathe to ensure the appliance is undamaged.
  • Remove any residual pumice/residue, wipe thoroughly with PDI, and allow to sit for the necessary 3 minute contact time.
  •  Place clean Styrofoam tray in the tray area. Do not reuse tray or lathe attachments that are left on from the previous person.
  • Place IN USE magnet on the lathe you are using
  • Prior to using the Lathe for polishing, obtain new pumice (located next to the Sand blaster); the pumice should be damp, but not runny). Utilize this pumice paste to polish your prostheses
  • After Polishing and prior to Buffing any prostheses, Obtain a new Styrofoam tray, rag wheel, and buffing compound block (all separate from the equipment utilized in polishing). Secure the rag wheel to the Lathe and apply the Buffing compound directly to the dry rag wheel (while the wheel is moving; no solution is necessary)
  • Once finished with the Polishing Lathe, remove the catch tray and discard, Remove the rag wheel and place into “dirty rag wheel tub” located behind the lathe. Finally, wipe the Lathe down with a damp paper towel to ensure no pumice paste residue is left on the appliance
• Abrasive Blaster
  • The Abrasive Blaster does not require any additional sterilization methods if the prosthesis being cleaned has been adequately disinfected (see above).

1. Prior to Using a Lab Station, ensure the station and associated Electric Handpiece are clean and free from obstruction. If using the Electric Handpiece, ensure the table vacuum motor is turned on (operating switch is located on the front of the motor box), and that the intake is unobstructed, while also ensuring the plastic safety shield is fastened in place (in front of the vacuum intake).
2. If using/working with flame and wax, please place white butcher paper over the entirety of the workspace table to prevent wax from melting/adhering to/damaging the table surface. Butcher paper is on a roll mounted on the wall.
3. Upon completion of using the Lab Station, remove and dispose of any paper, clean off any stone residue, disinfect the surface with PDI wipes and allow to sit for the necessary 3 minute contact time, and ensure the table vacuum motor is turned off. If any tools/burs are left unsupervised, they will be disposed of (or may be confiscated and sterilized for use by the dispensary).

• Pressure Pot for Curing
  • NOTE: The Great Lakes Pressure Pot has the potential to be the most dangerous piece of equipment in the Wet Lab, as improper use and failure can result in EXPLOSION! Please ensure you are using the pot correctly for your safety as well as the safety of any other lab occupiers
  • The pressure pot should be cleaned daily to prevent residue buildup. If you are the first person to use the pot, use a wet paper towel to wipe the inside clean, followed by a dry paper towel to dry the internal surfaces. If the pot has large amounts of residue on the inside, or the water appears excessively dirty, contact clinic Inventory Assoicate. After this, add approximately ½ inch of water.
  • When using the Pressure Pot, place your prosthesis inside the pot on the tray and secure the lid by ensuring both handles align and the lock switch is moved into the locked position.
  • To pressurize the pot, flip the toggle lever on the right side until the pressure reaches between 15-20 PSI. If the pressure exceeds 20 PSI, depressurize the pot, discontinue use, and immediately conatact the clinic Inventory Associate to inform them that the appliance is over pressurizing and needs to be repaired.
  • To release pressure and open the Pressure Pot, first, ensure the pressure line is closed by moving the toggle switch to the closed position. Then, press the pressure release button above the lock switch on the handle (pressure release will make a loud hissing sound). Finally, move the switch to the unlocked position, rotate the upper handle and open.

After use of any lab equipment for the fabrication of dental casts or any dental prosthesis, it is necessary to disinfect the item prior to removing it from the lab (for transport to chairside or non-chairside location) to prevent any unforeseen cross-contamination

• First, casts/prostheses/restorations should be sprayed thoroughly with Cavicide and allowed to sit for the necessary 3 minute contact time
• Finally, the item should be rinsed of any remaining disinfectant and dried

Any sharp tool or instrument used in the Wet Labs must utilize the same policy implemented throughout the entirety of the COD

• Sharps must be disposed of in a sharps container located at every dental unit
• Any Sharp or Lab Equipment related injuries must be reported

During business hours:

• If the injury results in minor trauma and requires little to know first-aid with no serious risk to life or limb, first focus on the appropriate first aid treatment of the injury. Once the injury is treated, immediately (so as to not forget any relevant information) report it to the COD Office of Compliance
• If the injury results in moderate trauma, requiring more attention than basic first aid (ex. sutures), but posing no serious risk to life or limb, stabilize the wound, then immediately report to the supervising faculty and the COD Office of Compliance (Rm. 232).
• If the injury results in major trauma that poses serious risk to life or limb, STOP, perform immediate first aid and contact 911, requesting Emergency Medical Services(EMS) to your location. Immediately after that, contact COD Office of Compliance (13083 or 405-473-6064) to inform them of your situation so they can direct EMS to your location.

After business hours:

• If the injury results in minor trauma and requires little to know first-aid with no serious risk to life or limb, first focus on the appropriate first aid treatment of the injury. Notify COD Office of Compliance about injury.
• If the injury results in moderate trauma, requiring more attention than basic first aid (ex. sutures), but posing no serious risk to life or limb, stabilize the wound, then transport yourself to the nearest Emergency Room for treatment.
• If the injury results in major trauma that poses serious risk to life or limb, STOP, perform immediate first aid and contact 911, requesting Emergency Medical Services to your immediate location.

Adherence to the above polices is considered Mandatory, and any observed deviation from the above written protocol should be immediately corrected by any on looking observers. If the offending party fails to correct their mistake, it should be documented and reported to the Director of Compliance and the Assistant Dean for Clinical Affairs.

All alginate, polyvinyl siloxane, and polysulfide impression material should be handled in the following manner after removal from the mouth: 

1. Rinse the impression by filling it with water and dumping the water.
2. Spray liberally with the disinfectant solution presently in use (Clorox for Healthcare) and place in a sealed baggie for recommended contact time (3 minutes).
3. Rinse the impression again.
4. Alginate should be gently dried, and the casts poured as soon as possible. 
5. Polyvinyl siloxane and polysulfide impressions should be gently dried, and the casts poured according to the manufacturer’s directions. 

1. Wear proper PPE when performing laboratory procedures. Eyewear is a MUST when using any rotating equipment.
2. Hair and loose clothing need to be secured to minimize the potential for cross-contamination and injury.
3. Always use fresh pumice, a clean disposable tray, and a sterile rag wheel when using the polishing lathe.

All reusable critical and semi-critical items that are heat tolerant undergo heat sterilization.   Semi-critical items that are not heat tolerant will undergo high-level disinfection or are disposed of.  If a high-level disinfectant is used, it will be tested for efficacy prior to placing items. Currently, we use a hydrogen peroxide high-level disinfectant (Resert XL® by Steris).  It is a solution of a concentration of hydrogen peroxide (2.0%) and a blend of inert ingredients that help achieve rapid microbial efficacy (8-minute contact time).  Prior to use, the solution must be checked with monitoring strips for efficacy.

Single-use items will never be re-used.

All cassettes that are not prepackaged or water-resistant go through the washers prior to sterilization. Each washer is tested daily for chemical effectiveness. The test strips are kept in a logbook maintained by CS staff.

Methods of Heat Sterilization:

Central Sterilization uses pre-vacuum sterilization. Each sterilizer undergoes a weekly spore test inoculated with Geobacillus.

1. The results are kept for each sterilizer in a logbook maintained by the Central Sterilization staff. 
2. If results are positive, repeat the spore test and examine the procedure to ensure that the sterilizer is loaded properly (not overfilled), the pack is not too large, and the manufacturer’s instructions have been followed.
3. If the results are positive again, do not use the sterilizer until it has been inspected or repaired. Using another sterilizer, reprocess any items sterilized since the last negative spore test.
4. A challenge pack is placed in every load before sterilization.
5. The load cannot be released for use until the challenge pack has been verified for all parameters of sterilization have been met.
6. The challenge packs are kept in a logbook for reference.
7. Class V indicators are placed inside sterilization bags that have been packaged in CS.

Extracted teeth used for the education of Dental Health Care Workers (DHCW) should be considered infective and classified as clinical specimens because they contain blood. All persons who collect, transport, or manipulate extracted teeth should handle them with the same precautions as for biopsy specimens.

1. Ask your local dentists or oral surgeons if you can have their extracted teeth.
2. Standard precautions should be adhered to whenever handling extracted teeth.
3. Since pre-clinical educational exercises simulate clinical experiences, students should adhere to standard precautions in both settings.
4. All persons who handle extracted teeth in educational settings should receive the Hepatitis B vaccine. 

Before extracted teeth are manipulated, the teeth first should be cleaned of adherent material by scrubbing with detergent and water or by using an ultrasonic cleaner.

If possible, separate the collected teeth into two separate containers.

• One for teeth without any silver (amalgam) fillings.
• One for teeth with silver (amalgam) fillings.
• If you are unsure if they contain silver or are unable to separate, place them all into one container. 

1. Cover teeth with water to keep them moist.
2. Acceptable containers are plastic or glass wide-mouth jars with a lid that will close securely (mayonnaise jar).
3. Do not use plastic water bottles.
4. Print your full name and graduation year on your container; for example, Joe Student 2027.
5. You may now begin to turn your teeth into Central Sterilization on the first floor. 
6. Sterilization times may vary.
7. Teeth without amalgam will be heat sterilized using a liquid autoclave cycle for 40 minutes. 
8. Teeth with amalgam will be immersed in a 10% formalin solution for 14 days.