Hygiene regulations and practices in dentistry on the example of laboratory dental restoration procedures

Uvod: Za vsako dejavnost so predpisane higienske zahteve, s katerimi morajo biti zaposleni seznanjeni in jih pri delu upoštevati. V zdravstveni dejavnosti poznamo standardne varnostne ukrepeto so prakse minimalne preventive okužb, ki veljajo za celotno oskrbo bolnikov, ne glede na domnevni ali potrjeni status okužbe pacienta, v katerem koli okolju, kjer se izvaja zdravstvena oskrba. Te prakse so zasnovane tako, da ščitijo tako zdravstvene delavce kot preprečujejo širjenje okužb od delavcev na paciente. Namen: S tem diplomskim delom želimo preveriti izvajanje obstoječih smernic higienskega dela in higienskih pristopov v zobozdravstvu. Prilagodili smo jih poklicu laboratorijskega zobnega protetika za oris praktične uporabnosti. S kratko spletno anketo smo želeli ugotoviti, katera pravila in prakse higienskega dela se v zobnih laboratorijih izvajajo in kako pogosto. Metode dela: V diplomskem delu smo uporabili deskriptivno metodo. Informacije za teoretični del smo zbrali s pregledom literature v knjižnici Zdravstvene fakultete, Mestne knjižnice Ljubljana, v strokovnih bazah Google Učenjak in PubMed ter nekaj spletnih virov. V iskanju smo zajeli predvsem članke iz strokovnih znanstvenih revij, izdanih večinoma med letoma 2009 in 2019. Prav tako smo uporabili kavzalno-neeksperimentalno metodo dela. Izvedli smo spletno anketo o higienskem delu v zobnih laboratorijih v času pred epidemijo. Na dva meseca aktivirano spletno anketo se je od izbranih 169 zobnih laboratorijev odzvalo 44 laboratorijev, izmed katerih smo dobili 30 ustreznih enot. V praktičnem delu smo izdelali 4-členski fiksnoprotetični nadomestek z nosilno konstrukcijo iz zlitine Cr-Co in faseto iz kompozitnega materiala. Rezultati: Za učinkovito higiensko delo v zobnih laboratorijih je treba narediti načrt. Obstoječe smernice je treba prilagoditi delu zobnega laboratorija in s tem zajeti faze dela, v katerih pridemo v stik s kontaminiranimi predmeti, pa tudi faze dela, za katere ne vemo, ali vsebujejo možnost okužbe. Osnova higienskega dela je učinkovita higiena rok, kamor spadajo kratko pristriženi nohti, umivanje rok z milom, razkuževanje rok z antiseptikom in nošenje rokavic. Potrebnoa sta tudi čiščenje in razkuževanje delovnih površin ter miz med fazami dela protetičnega nadomestka. Polovica anketiranih zobnih laboratorijev obriše delovne površine večkrat dnevno, vendar ne glede na potek dela. Samo tretjina jih čisti z razkužilom. Več kot polovica anketiranih zobnih laboratorijev pri obdelavi z brusnimi sredstvi nosi ustrezno zaščitno opremo – zaščitno masko in očala. Pri delu smo namesto tega uporabljali stekleno pregrado. Priporočljive hitrosti brusnih sredstev in polirnih elementov pri obdelavi smo večinoma upoštevali. Po izbruhu virusa covid-19 je večina anketiranih zobnih laboratorijev poostrila umivanje in razkuževanje rok, nošenje zaščitne maske le približno polovica. Razprava in zaključek: V primerjavi rezultatov lastnega dela in anketne raziskave s teoretičnimi izhodišči smo ugotovili, da prakse higienskega dela niso skladne s pravili. Glede na različne odgovore anketirancev sklepamo, da nimajo v vseh zobnih laboratorijih izdelanega svojega načrta higienskega dela, ki bi temeljil na skupnih smernicah. Težave so lahko nezadostna usposabljanja, pomanjkljivi načrti dela, vplivajo lahko tudi malomarnost delavcev in finančno stanje zobnega laboratorija. Predlagamo sestavo priročnika, v katerem bi bile opisane faze izdelave vseh protetičnih nadomestkov, s pripisanimi higienskimi fazami dela. Izvajanje higienskih faz ob izdelavi protetičnih nadomestkov prispeva h kakovostnejši zobozdravstveni oskrbi in varnosti tako pacientov kot vseh zaposlenih, obenem pa ne predstavlja prevelikih časovnih obremenitev.Introduction: To every activity there are hygiene requirements prescribed, which employees must be aware of and consider during their work. In the field of healthcare, there are Standard Safety Measuresthese are the minimum infection prevention practices that apply to the entirety of patient care, regardless of the presumed or confirmed status of the patient’s infection, in any environment where healthcare is provided. These practices are designed both to protect healthcare professionals and prevent the spread of any employee infections to patients. Purpose: With this diploma dissertation we want to examine the implementation of existing guidelines in hygienic work and hygienic approaches in dentistry. We adapted them to the profession of a laboratory dental prosthetics technician in order to outline their practical applicability. Through a short online survey, our aim was to find which rules and practices of hygienic work are implemented in dental laboratories and the incidence of these. Methods: The dissertation was prepared using the descriptive method. Information for the theoretical part was collected by reviewing the literature available in the Faculty of Health library, the Ljubljana City Library, in the Google Scholar and PubMed professional databases, and in certain online resources. In particular, the search included articles in professional scientific journals, published mainly in the years 2009–2019. The causal non-experimental work method was also used. We conducted an online survey on hygienic work in dental laboratories in the pre-epidemic period. Out of 169 dental laboratories, 44 responded to the online survey activated for two months, and of these, 30 suitable units were obtained. In the practical part, a 2-part fixed prosthetic replacement was made, where the supporting structure was made of Cr-Co alloy and facets of composite material. Results: A plan needs to be devised for effective hygienic work in dental laboratories. Existing guidelines should be adapted to the work of the dental laboratory and should thus cover the work stages where one comes into contact with contaminated objects, as well as work stages for which we do not know whether they pose the risk of infection. The basis of hygienic work is effective hand hygiene, which includes clipping the fingernails short, washing hands with soap and water, disinfecting hands with an antiseptic and wearing gloves. It is also necessary to clean and disinfect work surfaces and tables during the prosthetic replacement work stages. Half of the surveyed dental laboratories wipe work surfaces several times a day, regardless of the work process. Only a third use a disinfectant to wipe the surfaces. Over a half of the surveyed dental laboratories use appropriate protective equipment when using abrasive tools – a protective mask and goggles. During our work, we used a glass barrier instead. The recommended speeds of drills and polishing elements were mostly followed during the work process. After the COVID-19 outbreak, most of the surveyed dental laboratories tightened hand washing and disinfection measures, while only about half reported wearing a protective mask. Discussion and conclusion: Comparing the results of our own work and the survey research with theoretical starting points, we found that the practices of hygienic work do not uniformly comply with the rules. Based on the different answers of the respondents, we conclude that not all dental laboratories have devised their own plan of hygienic work, which would be based on common guidelines. The issue may be in insufficient training, deficient work plans, and the negligence of workers and the financial situation of the dental laboratory may also have an impact. We propose that a handbook be prepared, which would describe the stages of the production of all prosthetic replacements, with the assigned hygienic work stages. The implementation of hygienic work stages in the production of prosthetic replacements contributes to better dental care and safety both of patients and all employees, while not representing excessive time burdens