CHAPTER 9 INFECTION CONTROL

Infection control involves taking steps to prevent the spread of infectious agents. Your command will develop standard infection control policies and written protocols following BUMEDINST 6600.10. COs and OICs must appoint in writing an infection control officer (ICO) to assist in implementing the infection control program. Material in this chapter and in chapter 10 are taken from BUMEDINST 6600.10, Dental Infection Control Program. Some of the information may be different from what your command policies and procedures are for infection control. COs and OICs may adapt the policies and procedures from BUMEDINST 6600.10 to meet their local conditions and criteria. Compliance with BUMEDINST 6600.10 is mandatory. If your command has significant variations from BUMEDINST 6600.10, the ICO must document in the infection control manual the reasons for those changes.

All dental personnel must be aware of sources and methods of transmission of pathogenic micro-organisms and infectious diseases. The emergence of the human immunodeficiency virus (HIV) epidemic, along with recent reports about health care workers who have acquired an HIV infection through occupational exposure, has generated much fear and worry within all the health professions, including dentistry. Healthcare personnel are caught in a conflict between concern for their patient's needs on the one hand and fear of acquiring HIV infection on the other.

Adding to this dilemma is the problem of the hepatitis virus (HBV) infection, a major infectious occupational health hazard in all the healthcare professions. Each year, several thousand healthcare workers become infected with the HBV. The Center for Disease Control (CDC) estimates that HBV infection in healthcare personnel actually results in some 600 hospitalizations and 200 deaths annually. These concerns have led to a renewed interest in the problem of infection control in the dental health care environment.

CLASSIFICATIONS OF MICRO-ORGANISMS

Microbiology is the study of microscopic life forms referred to as micro-organisms. They are so small that they can only be seen with the aid of a microscope. Micro-organisms are always present in our environment; most live in warm, dark surroundings where adequate food supply exists. The oral cavity is one such area where enormous numbers of micro-organisms commonly exist and multiply. A pathogen is an organism capable of causing disease. Disease producing organisms are said to be pathogenic. Other micro-organisms that are not considered pathogenic can produce infections under favorable conditions. Micro-organisms are classified as bacteria, bacterial spores, viruses, protozoa, and fungi.

BACTERIA

Bacteria are one-celled plants that lack chlorophyll (the chemical that provides the green coloring to plants). A single drop of water may contain as many as two billion medium-sized bacteria. Some diseases caused by bacteria are dental decay, periodontal disease, and tuberculosis.

The three main types and shapes of bacteria are as follows:

1. Cocci - spherical and shaped like small beads

2. Bacilli - rod-shaped

3. Spirochetes - spiral-shaped

Gram Positive and Gram Negative Bacteria

Certain antibiotics treat different types of bacterial infections. A liquid dye called gram stain is used on the bacteria to determine if they are gram negative or gram positive.

Bacteria that are stained by the dye and turn a dark purple color under microscopic study are called gram-positive bacteria. If no color exists after staining and viewing, the bacteria is called gram negative. A dental officer may submit a bacterial culture to the medical laboratory to determine if it is gram positive or negative before prescribing an antibiotic to treat an infection.