Читать книгу Fundamentals of Fixed Prosthodontics - James C. Kessler - Страница 26

Protecting against cross-contamination of patients and preventing exposure of the office staff to infectious diseases have become major concerns in dentistry in recent years. In particular, patients should be queried about a past history of hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV. Although AIDS has received greater publicity and generated near hysteria in the recent past, hepatitis is the major infectious occupational hazard to health care professionals.⁴⁴ HCV is the most common chronic, blood-borne infection in the United States⁴⁵ and is transmitted primarily through contact with blood from an infected individual.45 It has been estimated that 3.2 million Americans have been infected with HCV.⁴⁶

Fig 1-15 Rubber gloves, a surgical mask, and eye protection are important for safeguarding dental office personnel.

There is no evidence that these diseases are contracted through casual contact with an infected person. However, the nature of dental procedures does produce the risk of contact with blood and tissues. A safe, effective vaccine against HBV is available and is recommended by the Centers for Disease Control^47–49 and the ADA Council on Dental Therapeutics⁵⁰ for all dental personnel who have contact with patients. There is no vaccine against HCV.

While special precautions should be taken when treating patients with a history of either disease, every patient should be treated as being potentially infectious. Rubber gloves, a surgical mask or full-length plastic face shield, protective eyeglasses (if a shield is not used), and a protective uniform are recommended for the dentist and all other office personnel who will be in contact with the patient during actual treatment (Fig 1-15).

Concern for these matters does not end at the door to the operatory. Any item contaminated with blood or saliva in the operatory, such as an impression, is just as contaminated when it is touched outside the operatory. The specifics of decontaminating impressions are covered in chapter 17.

In addition, steps must be taken in a receiving area of the laboratory to isolate and decontaminate items coming from the dental operatory.⁵⁰ An infection-control program should be established to protect laboratory personnel from infectious diseases, as well as to prevent cross-contamination that could affect a patient when an appliance returns from the laboratory to the operatory for insertion in the patient’s mouth.⁵¹ There is more to dental laboratory work than manipulating inert gypsum, wax, resins, metal, and ceramics.