• IV drug abusers

• homosexuals and prostitutes

• haemophiliacs

• renal dialysis patients

• immunosuppressed transplant patients

• institutionalised patients

• recent history of jaundice

• immigrants from S.E. Asia/Africa

PROCEDURE IF HEPATITIS B CARRIER IS SUSPECTED:

1. contact GMP for update of medical information.

2. refer to hospital for viral tests prior to commencement of extensive dental treatment.

3. emergency pain relief procedures may be carried out but with full precautions if antigenic status is unknown.

INTERPRETATION OF SEROLOGICAL MARKERS OF HEPATITIS B:

1. patients who have surface antigen only (HBsAg) present no risk.

2. patients with HBsAg and core antigen (HBeAg) are HIGH risk and indicates acute infective stage or carrier.

3. HBsAg, HBeAg and antibody to core (HBeAb) are low risk

4. DNA polyherace (DNA-P) in the serum is like HBcAg, an indicator of high infectivity.

PREVENTION OF CROSS INFECTION:

a) Planning - make appointment last of day.

- select nursing staff who have been immunised against Hepatitis B

b) Setting up- protective clothing:disposable rubber gloves

gloves

face masks

gowns

eye shields

- all instruments should be either sterilisable or disposable.

- set out minimum of equipment necessary.

- rigid burn bin to collect sharps.

- two stout plastic bags to receive non-sharp disposables

- disposable metal foil dish for use as spittoon.

- portable suction system.

- plastic bag coverage over x-ray machine and handset controls.

- prepare intra-oral radiographs each in separate sealable plastic envelopes.

- have available sodium hypochlorite solution.

c) Treatment Procedures.

1. Plan treatment for a minimum of visits.

2. Use slow handpiece, scale by hand, avoid 3 in 1 syringe, ultrasonic instruments or air turbines.

3. Use silicone impression materials. Place these in 2% glutaraldehyde for 1 hour, rinse and place in a fresh solution for a further 3 hours.

Transport to laboratory labelled as Danger of Infection.

4. To avoid needle-stick injuries, needles should not be recapped, bent, broken or removed from disposable syringes.

d) Clearing away.

1. Place all sharps in burn bin.

2. Wearing operating gloves, transfer non-disposable instruments uncleaned to the autoclave and sterilise immediately.

3. Place all non-sharp disposables into the ready-for-use plastic bags.

4. Remove operating gloves and place in the same bags.

5. Wash carefully in Hibiscrub.

6. Wearing heavy-duty rubber gloves, remove instruments from steriliser. Clean instruments in detergent and warm water and re-sterilise.

7. All non-disposable items which cannot be autoclaved should be soaked in 10% solution of available chlorine (Domestos), washed in detergent then left to soak in a fresh solution for a further 10 hours (eg overnight).

8. Still wearing rubber gloves (above) wipe all surfaces: metallic surfaces 10% solution of available chlorine (Domestos), non-metallic surfaces sodium hypochlorite. Rinse and dry surfaces with alcohol.

9. Remove gloves, seal burn bin and plastic bags. Check that they are labelled in accordance with the code of practice: Danger of Infection.

ACCIDENTAL SPILLAGE OF BLOOD OR PUS:

1. Drop paper tissue onto surface.

2. Gently flood with 10% solution of available chlorine (Domestos) for at least 10 mins.

3. Wearing heavy rubber gloves wash area with detergent and water then dry thoroughly.

PROCEDURE IN THE EVENT OF NEEDLE-STICK INJURY:

1. Discard needle into sharps bin.

2. Encourage bleeding.

3. Wash thoroughly.

4. Further action depends on immunity:

a) if covered, no further action.

b) not immune, requires hyperimmune antiserum within 48 hours.

c) questionable immunity, check antibody levels.

5. Should an exposure of this type result in an illness then it will need to be reported formally by the employer to the Health and Safety Executive under the Health and Safety Regulations – 1985 – The Reporting of Injuries, Disease and Dangerous Occurances (RIDDOR).