The chain of infection and how to break it: Dental assisting

The chain of infection is a six-link chain that represents conditions that must be present for an infection to develop, and a break anywhere in the chain can stop it.

In the dental setting, there is a high risk of infection due to the types of procedures performed and the close contact the dental team has with patients.

As a dental assistant, you play an important role in implementing infection control strategies to break the chain of infection.

Now the 6 links in the chain of infection are an infectious agent. A reservoir, a portal of exit.

A mode of transmission. A portal of entry and a susceptible host.

Infectious agents include pathogens, which are microorganisms that can cause disease. The pathogens commonly found in the dental office are bacteria, viruses, and fungi.

For a pathogen to cause an infection, it needs to be present in sufficient numbers, and it must have a high degree of virulence, which is the severity of disease the microorganism can cause.

The place where microorganisms typically live and reproduce is called a reservoir. The main reservoirs in the dental office are organic materials such as blood and saliva.

In fact, universal precaution guidelines are based on the principle that all blood and body fluids should be considered potentially infectious.

Other reservoirs can include contaminated surfaces, such as hands, dental instruments, frequently touched items like computer keyboards, tables, trays, sinks, and the dental chair.

Now, to be infectious, microorganisms need to have a portal of exit, or a way to leave its reservoir. In the dental office, pathogens most often exit through the mouth, nose, and blood.

After the pathogen exits the reservoir, it needs to spread through a mode of transmission, like through the air or through contact with a person or a contaminated object.

Next, the way microorganisms enter a person's body is through a portal of entry. These include inhaling them through the nose and mouth and through contact with the mucous membranes of the eyes, nose, and mouth and contact with breaks in the skin like cuts, scrapes, and needle sticks.

The final link is a susceptible host or the person at risk of infection. Factors that increase susceptibility include a weakened immune system, chronic illnesses like diabetes or cancer, being very young or very old, and other factors like stress, fatigue, malnutrition, or not being immunized.

Transmission of pathogens can occur in the dental setting in multiple ways and can affect all individuals, including patients, visitors, and the dental team.

Airborne and droplet-related spread can occur through coughing or sneezing, and microorganisms in blood and saliva can also be spread through aerosols, sprays, and spatter generated by routine use of dental instruments like a high-speed handpiece, ultrasonic scalar, or air water syringe.

Direct transmission occurs when a pathogen is passed from person to person through direct physical contact or through respiratory droplets spread between two people who are in close proximity.

In contrast, indirect transmission occurs when a pathogen is transmitted to a person who comes in contact with a contaminated surface, like when a dental instrument that wasn't properly sterilized is used to care for a patient.

Now, disrupting just one link in the chain of infection can prevent transmission of infectious microorganisms. This can be done by following standard precaution guidelines, including using proper hand hygiene techniques, disinfecting environmental surfaces, implementing sharp's safety procedures, proper use of personal protective equipment or PPE, and using respiratory hygiene and cough etiquette.

So let's look at some examples of infection control procedures you'll use in your dental setting. The most fundamental way you can prevent the spread of infection is by paying close attention to hand hygiene, by using proper hand washing techniques, and using an alcohol-based hand rub.

This not only breaks the reservoir link by eliminating pathogens from your hands, but it can break the mode of transmission link by preventing transfer of pathogens from your hands to your patients and other members of your dental team.

Other ways to break the reservoir and transmission links include ensuring all work surfaces in the operatory are thoroughly cleaned between patients and making sure instruments are sterilized.

You should also properly dispose of contaminated medical waste. On top of that, using a pre-procedure antibiotic mouth rinse before dental procedures can reduce the number of microorganisms in the patient's mouth.

Along with these measures, be sure to implement safety procedures when handling syringes and other sharp objects to prevent needle stick injuries.

Other methods involve using devices like a dental dam during certain procedures can help prevent the patient from swallowing or inhaling contaminated fluids and debris produced during the procedure, as well as using a high volume evacuation device, which can greatly reduce the aerosols produced by procedures like drilling and scaling.

You'll also need to know what type of PPE should be used for each task. PPE, like masks, face shields, goggles, glasses, gloves, and protective clothing, work together to create a barrier between you and the clinical environment.

When used correctly, PPE breaks the portal of entry link by protecting your skin, eyes, and mucous membranes from potentially infectious microorganisms.

Use of a mask will also address the portal of exit by providing a physical barrier to pathogens leaving your mouth when talking, coughing, or sneezing, and when not using a mask, be sure to always use respiratory hygiene methods when coughing.

Finally, you can break the susceptible host link in the chain of infection by taking care of your health. This includes healthy eating habits, getting enough rest, engaging in physical activity, managing stress, and staying up to date on vaccinations.

As a dental assistant, you'll play a key role in preventing the spread of infections. You'll stay up to date with infection control protocols and take steps to maintain a clean care environment.

As you care for patients and interact with the dental team, you'll promote a safe working environment for the dental team and the patients you care for.

All right, as a quick recap, the chain of infection is a six-link chain that represents the conditions that must be present for an infection to develop.

A break anywhere in the chain can stop the transmission of infection. In the dental setting, there's a high risk of infection due to the types of procedures performed and the close contact the dental team has with patients.

As a dental assistant, you'll play an important role in implementing infection control strategies to break the chain of infection.