Guide for Safety and Infection Control For Oral Healthcare Missions. An education and training tool for humanitarian dental care workers

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Guide for Safety and Infection Control For Oral Healthcare Missions An education and training tool for humanitarian dental care workers Guide for Safety and Infection Control for Oral Healthcare Missions
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Guide for Safety and Infection Control For Oral Healthcare Missions An education and training tool for humanitarian dental care workers Guide for Safety and Infection Control for Oral Healthcare Missions An education and training tool for humanitarian dental care workers An education and training resource prepared by OSAP the Organization for Safety and Asepsis Procedures Guide for Safety and Infection Control for Oral Healthcare Missions is an education and training tool produced by the Organization for Safety and Asepsis Procedures (OSAP). The development of this guide was supported by Cooperative Agreement No. U58/CCU from the U.S. Centers for Disease Control and Prevention. Its contents are solely the responsibility of OSAP and do not necessarily represent the official views of the Centers for Disease Control and Prevention. Production and distribution of the guide was generously underwritten through donations from past and current OSAP Association and Foundation Boards. Published by OSAP, Annapolis, MD Copyright 2004 by OSAP. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of OSAP. Printed in the United States of America OSAP P.O. Box 6297 Annapolis, MD IMPORTANT DISCLAIMER: Although OSAP believes that the information contained herein is accurate, inadvertent errors may occur. Accordingly, OSAP makes no representations of any kind that its interpretations are always correct, complete, or up-to-date and expressly disclaims any representation that this guide satisfies any applicable standard of care. OSAP shall not be liable for any direct, indirect, incidental, special, or consequential damages resulting from the user s reliance upon the material contained herein. Guide for Safety and Infection Control for Oral Healthcare Missions Section I Introduction 1 Using this Guide 1 Section II Advance Preparation 3 Local Resources 3 Accommodations 3 Food Hygiene 3 Local Advance Arrangements 4 Population Needs 4 Creating a Patient Chart 4 Transportation Requirements 5 Safe Packing 5 Supplies and Medications 5 Section III Team Health and Safety 7 Routine Immunizations 7 Special Considerations 7 Worker Health Information 7 Prepare for Emergencies 8 Advance Training 9 Local Safety Concerns 9 Section IV Infection Control 11 Planning for Infection Control 12 Precautions During Delivery of Care 14 Exposure Prevention 15 Exposure Response 16 Sterilization and Disinfection 18 Storing Instruments 20 Section V Waste Management and Disposal 21 Appendices A. Main Checklist 23 B. Instrument Calculation Tool 27 C. Site Evaluation Checklist 29 D. Patient Medical Review Form 31 E. Worker Health Information Form 33 F. Emergency Medical Release Form 35 G. Treatment for Exposures 37 H. Exposure Follow-Up: Returning Home 39 I. Sterilization and High-Level Disinfection: Available Methods and Chemical Agents 41 J. Oral Care Humanitarian Mission Briefing 43 K. After-Action Mission Report 45 L. Selected Resources 49 See enclosed CD for electronic forms Acknowledgments 51 OSAP is the Organization for Safety and Asepsis Procedures. Founded in 1984, the non-profit association is dentistry s premier resource for infection control and safety information. Through its publications, courses, website, and worldwide collaborations, OSAP and the taxexempt OSAP Foundation support education, research, service, and policy development to promote safety and the control of infectious diseases in dental healthcare settings worldwide. For more information on OSAP activities, call OSAP ( ), or visit the organization s website at Section I Introduction to this Guide Welcome to OSAP s Guide for Safety and Infection Control for Oral Healthcare Missions. Before beginning, you must understand the scope of the material presented in the coming sections. Each mission, each area of the globe, presents its own challenges for visiting healthcare workers. An understanding of both the benefits and limits of this guide is necessary to help you and your fellow travelers best prepare for your missions. This guide is a practical guide to providing safe dental care in nontraditional settings.... a resource for healthcare providers who participate in humanitarian missions that provide dental care to individuals in nontraditional settings. These settings often lack the necessary resources or modern amenities that are found in dental practices in the United States.... a compilation of suggestions provided by persons who have actually experienced and participated in humanitarian missions.... a useful, sequential presentation of information that should be tailored to the specific mission at hand. This guide is not:... a comprehensive planning document for all missions and all aspects of a mission. Rather, it provides guidance for ensuring the health and safety of mission participants, their dental patients, and the community at large.... an exhaustive list of Dos and Don ts. You ll find plenty more on your own.... a be-all, tell-all book of best practices. Discovered a tip we omitted? Found a way to smooth out a particularly rocky part of trip preparation? Please let us know. By working together and sharing successful strategies, we help ourselves, our colleagues, and our patients. Using this Guide OSAP s Guide for Safety and Infection Control for Oral Healthcare Missions includes detailed information on everything from trip and mission planning to writing a postmission report. Checklists ensure that all aspects of the mission are considered during the development stage. Use the sample forms in the appendices for recording important health information about workers and patients. Forms also can be completed and printed from the CD supplied with this guide. Sample forms include: a Site Evaluation Checklist, a comprehensive Main Checklist, an Instrument Calculation Tool, a Worker Health Information Form, an Emergency Medical Release Form, a Patient Medical History Form, and an After-Action Mission Report Template Asking the important questions is the first step in planning. Use sample forms to guide you as you collect information. Now that you know what s coming, let s proceed... Guide for Safety and Infection Control for Oral Healthcare Missions 1 Section I Introduction to this Guide Notes 2 Guide for Safety and Infection Control for Oral Healthcare Missions Section II Advance Preparation In preparing for your trip, considering the locale and its resources, food hygiene, population needs, and transporation requirements can help you pack for safety. Local Resources When planning for a trip to a site that has not previously been used for a healthcare mission, ask and answer important questions: Is the location urban or rural? What type of structure will be used as the treatment center (for example, hut, tent, community hall, church)? Working in a new geographic area can expose workers to new health challenges. What are the sleeping and eating arrangements for the team members? Will you need to take an electrical generator? What is the local water quality? Do you need to take drinking water or bring water treatment chemicals? What are the local toilet and sewage disposal facilities? Are local sources for dental materials and supplies available? Are needles, affordable fluoridated toothpaste, toothbrushes, anesthetic, and medication available? For an extensive list of trip-planning considerations, see the Main Checklist (Appendix A, page 23). Accommodations Find out where the dental care team will be staying and what supplies will be available. For example, are mosquito nets supplied, or will you need to pack some? Ask about laundry. It can impact the amount of clothing to pack and in turn, the bulk of luggage each person will need. Food Hygiene Ensure that facilities are available for safe food storage, preparation, cooking, and refrigeration, and plan your meals accordingly. Gastrointestinal infections are the most frequent cause of illness on humanitarian missions. Taking one over-the-counter upset-stomach/antidiarrhea tablet (active ingredient: bismuthsubsalicylate) each day prophylactically is reported to have helped many people avoid illness. Check with your primary physician before leaving on the trip to determine if antibiotics are indicated as a precaution in case of gastrointestinal infection on the trip. Food Hygiene Basics Avoid eating uncooked vegetables, fish, or shellfish. Wash fruits, vegetables, and other foods in previously boiled water before preparing. Always use a clean surface for food preparation. Guide for Safety and Infection Control for Oral Healthcare Missions 3 Section II Advance Preparation Local Advance Arrangements Ensure that advance arrangements have been made for arrival and set-up at the locale. Have your letter of invitation or support from local sponsors. For info on VISA requirements, contact the Make a site visit, if possible. appropriate foreign consular office from the listing Obtain a special permit to practice, if necessary. at Have a current VISA and passport. (The U.S. Department of State maintains a list of foreign consular offices in the U.S. Visit s/cpr/rls/fco/ for information. Contact the appropriate office for VISA requirements, travel information, and travel restrictions for your destination country.) Identify available resources (electricity, potable water, food, accommodations, etc.) Review waste disposal resources for the area. Identify sanitary facilities for restrooms, showers, etc. Identify sources for referral for advanced care. Identify and plan for the needs of the local population. (For example, if the need is mostly for extractions, handpieces and portable units may not be necessary.) The Main Checklist in Appendix A (page 23) provides additional guidance. Population Needs Estimate the number of patients you expect to treat. The estimated number of patients that can be treated and the type of treatment to be provided affects the number and type of instruments, equipment, barrier precautions, and materials you will need for your mission. Use Appendix B, OSAP s Instrument Calculation Tool (page 27), to determine the amount of materials needed for your mission stay. Remember: Factors such as available resources, the time required to process instruments, the capacity per cycle of cleaning and sterilization equipment, and the number of staff available for instrument processing also should be considered in estimating the patient count. Creating a Patient Chart For the same reasons they are mandatory in your home country, an individual patient record is necessary for care provided during missions. Dental care workers must be able to account for examination findings and the care delivered. The sample Patient Medical Review Form Use the sample Patient Medical Review Form (Appendix D, page 31) as a baseline for your patient records. (Appendix D, page 31) can serve as a baseline for your patient record. Request assistance in translating your chart to the primary language of the locale you are serving. If possible, have an interpreter available to assist patients in completing the medical history form, or have the form translated into the language of the local population. 4 Guide for Safety and Infection Control for Oral Healthcare Missions Advance Preparation Section II At minimum, obtain for each patient: Personal information, such as name and address/location. Vital signs. Record vital signs as part of the patient intake process. NOTE: Be sure to include adequate supplies such as blood pressure devices in your supply list. Medical history. While standard screening questions may be impossible for your patients to understand, a basic set should be included. Appendix D (page 31) provides a sample Patient Medical Review Form that can be translated into the local language. Treatment record. Keep track of treatment provided to each patient on a standard treatment record form. Transportation Requirements Transportation requirements become easier to estimate once you have chosen a site and know the number of people traveling. However, a number of other criteria can have an impact on your transportation needs. To a great extent, the mode of transportation and type of location determines the materials and equipment you can bring with you. For example, when traveling to remote locations that require air and ground transportation, the mode of ground transportation determines the types of equipment and supplies that may be reasonably carried to the location. When traveling on small planes with strict weight limits, you must carefully calculate the weight of materials that you intend to bring and adjust accordingly. Because transportation requirements can limit the number of supplies you bring with you, it also puts limits on the number of patients and types of treatment you can provide at your destination. As such, let the most basic forms of transporation you will be using drive the types of items you bring. Transportation restrictions can limit the amount of supplies you re able to bring and in turn, the number of patients you can treat during the mission. For your first mission or for your first mission to a specific region or location start small. Select a site that is relatively easy to reach. As you gain experience, you may wish to progress, choosing more challenging journeys to more remote areas. Safe Packing Airlines require that sharps be packed with checked luggage; such items are not allowed in carry-on luggage and will be confiscated at the airport security checkpoint. Have each team member pack their personal sharps in a small, labeled plastic container. Place all these containers in a single check-in container so they can be easily distributed at the destination. If the sharps are not checked-in, they will be confiscated by security. Supplies and Medications Keep an inventory of everything you take to ease your passage through airport security and customs. If you decide to leave things behind, don t forget to cross them off your inventory. List all the drugs you are carrying. Accounting for what you use can be important to some of the donors and suppliers who discount their products for humanitarian aid projects. Guide for Safety and Infection Control for Oral Healthcare Missions 5 Section II Advance Preparation Notes 6 Guide for Safety and Infection Control for Oral Healthcare Missions Section III Team Health and Safety Before your trip, you and your team members should visit your primary physicians and dentists to be sure you are in good overall health and require no special medical management. Inform your physicians that you will be traveling to an area with limited resources and ask about any health advisories for the area. Additional medications, such as antibiotics and antidiarrhea medications, may be recommended. Ask your physician if health advisories are in effect in the areas where you will be traveling. Routine Immunizations Before traveling, all workers should receive routine vaccinations or have documented immunity to hepatitis A, poliomyelitis, hepatitis B virus, measles (rubeola), German measles (rubella), tetanus, diphtheria, whooping cough (pertussis), and mumps. Update team health information, including vaccination information, at least annually. Special Considerations Working in a new geographic area can expose workers to new health challenges from different disease vectors. Malaria, Dengue fever, and yellow fever are among the most common diseases transmitted by mosquito bite. To determine current precautions for the location you re visiting, check the Centers for Disease Control and Prevention (CDC) Traveler s Health website (www.cdc.gov/travel) at least two months before departing for your trip. Malaria prophylaxis should begin one week before your trip and continue for one month after returning. No medication is available for Dengue fever prophylaxis, though like malaria, the disease also is carried by mosquitoes. Mosquito repellents with 30% DEET are recommended when traveling to areas where Dengue fever is common. Covering exposed skin also is encouraged. Immunizations for Travelers Hepatitis A Poliomyelitis Hepatitis B Measles (rubeola) German measles (rubella) Tetanus Diphtheria Whooping cough (pertussis) Mumps A vaccine is available to prevent yellow fever. The vaccine must be administered at an approved yellow-fever vaccination center. Depending on where you are traveling, you may need a completed International Certificate of Vaccination, signed and validated with the center s stamp at the time of inoculation. The certificate becomes valid 10 days after administration of the vaccine and remains so for up to 10 years. Worker Health Information Copy and complete a Worker Health Information Form (Appendix E, page 33) before leaving on the mission. One person on the team should be assigned the primary responsibility for overseeing the medical needs of the team members, including maintaining the confidential medical history forms for each member. Keep health Update worker health information including current vaccinations at least annually. Guide for Safety and Infection Control for Oral Healthcare Missions 7 Section III Team Health and Safety records in a safe location and restrict access to a need-toknow basis. Keep worker health records in a safe location Update individual health records at least annually to and restrict access to a need-to-know basis. ensure that they reflect the current health status of each team member. In addition to the medical history, each oral health mission worker should complete an Emergency Medical Release Form (Appendix F, page 35) authorizing, by signature, medical treatment by emergency personnel, a physician, or a medical treatment facility in the event that permission for treatment cannot be provided or obtained in a timely manner. Prepare for Emergencies Before leaving on the trip, prepare for the possibility that someone may become seriously ill and require a level of care beyond the capacity of the local facilities. Make provisions for rapid evacuation. Be sure several team members know the emergency plan, and list appropriate telephone numbers in several places and with different people. Prepare emergency kits and keep them on hand in treatment areas. Stock kits with: Prepare emergency and first aid kits and keep them on hand in patientcare areas. pocket masks with one-way valves for cardiopulmonary resuscitation (CPR); emergency medications (may be purchased as a kit, such as those used in dental offices); epinephrine; injectable diphenhydramine and an over-the-counter antihistamine; and syringes. In addition to emergency and first-aid kits, be prepared to manage occupational exposures to blood and body fluids. Necessary postexposure supplies include: hepatitis B immune globulin (HBIG) and vaccine against hepatitis B virus (HBV) for exposures involving workers whose response to the HBV vaccine series is unknown; OraQuick rapid HIV-1 antibody tests (made by OraSure) for source-patient and baseline worker testing for HIV (NOTE: Someone on the team must be qualified to administer the test); combination zidovudine-lamivudine drugs and protease inhibitors for postexposure prophylaxis (to be used as warranted). NOTE: Check with an expert before the mission to determine the appropriate drug combinations for the most likely exposure scenarios, or ensure that an expert will be available during the mission. Alternatively, consult the U.S. Centers for Disease Control and Prevention s postexposure prophylaxis hotline: Make sure that all team members have discussed the risks and side effects of postexposure treatment with a qualified healthcare professional before leaving for the mission. 8 Guide for Safety and Infection Control for Oral Healthcare Missions Team Health and Safety Section III Advance Tr
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