PolymeracÏnõÂ lampa v ordinaci zubnõâho leâkarïe a riziko prïenosu. Dental light-curing units and the riskof infections

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PolymeracÏnõÂ lampa v ordinaci zubnõÂho leÂk arÏe a riziko

prÏe-nosu infekcÏnõÂho agens

Dental light-curing units and the riskof infections

*MUDr. Eva Sedlata JuraÂskovaÂ, **Doc. RNDr. Ivanka MatousÏkovaÂ, Ph.D. *Ortodonticke oddeÏlenõ Kliniky zubnõÂho leÂkarÏstvõ LF UP Olomouc

*Department of Orthodontics, Institute of Oral Medicine, Medical Faculty of Palacky University, Olomouc **UÂstav preventivnõÂho leÂkarÏstvõ LF UP Olomouc

**Department of Preventive Medicine, Medical Faculty of Palacky University, Olomouc

Souhrn

CõÂl:CõÂlem studie bylo upozornit na duÊlezÏity vyÂznam hygieny v ordinaci zubnõÂho leÂkarÏe, a to konkreÂtneÏ ve vztahu k zubnõÂm polymeracÏnõÂm lampaÂm jako mozÏneÂmu zdroji infekcÏnõÂho agens a naÂsledneÂho sÏõÂrÏenõ nemocnicÏnõÂch naÂkaz.

MateriaÂl a metodika:Do souboru bylo zahrnuto 59 bakteriaÂlnõÂch steÏruÊ z povrchu polymeracÏnõÂch lamp.

VyÂsledky: Z kultivacÏnõÂch vyÂsledkuÊ prÏevazÏujõÂ grampozitivnõÂ bakterie s dominancõÂ koagulaÂza negativnõÂch stafy-lokokuÊ (CoNS). V jednom prÏõÂpadeÏ byl prokaÂzaÂn Staphylococcus aureus. Pouze v jednom prÏõÂpadeÏ byla prokaÂzaÂna gramnegativnõÂ bakterie, a to kmen Pseudomonas aeruginosa. Dle bakteriaÂlnõÂ kultivace byly pouze dveÏ polyme-racÏnõÂ lampy kultivacÏneÏ negativnõÂ.

ZaÂveÏr:Epidemiologicke sÏetrÏenõ ukaÂzalo sÏpatnou konecÏnou dekontaminaci polymeracÏnõÂch lamp a jejich ne-vhodne ulozÏenõ po skoncÏenõ pracovnõ doby, kdy jsou vystaveny spadu prachovyÂch cÏaÂstic jako mozÏneÂho nosicÏe infekcÏnõÂho agens(Ortodoncie 2013, 22, cÏ. 1, s. 28-33).

Abstract

Aim:The study aims to focus on the importance of hygiene in the dentist offices, specifically in relation to den-tal light-curing units as a potential source of infectious agent and the resulting spread of hospiden-tal infections.

Material and methods:The sample included 59 bacterial swabs from polymerization lamps surfaces.

Results:Within cultivation results gram-positive bacteria prevail dominated by coagulase-negative staphylo-cocci (CoNS). In one case Staphylococcus aureus was proved. Only in one sample a gram-negative bacterium was proved, specifically genus Pseudomonas aeruginosa. Bacterial cultivation showed that only two polymeri-zation lamps had negative results.

Conclusion: Epidemiological examination proved unsatisfactory final decontamination of polymerization lamps and their inappropriate deposition after office hours - they were exposed to dust particles that are potential carriers of infectious agent(Ortodoncie 2013, 22, No. 1, p. 28-33).

KlõÂcÏova slova:polymeracÏnõ lampa, infekcÏnõ agens

Key words:light-curing units , infectious agent

UÂvod

DodrzÏovaÂnõ dezinfekcÏnõÂch a sterilizacÏnõÂch postupuÊ, ktere je soucÏaÂstõ provoznõÂho rÏaÂdu kazÏde ordinace zub-nõÂho leÂkarÏe, je jednõÂm z nejduÊlezÏiteÏjsÏõÂch opatrÏenõ k za-mezenõ prÏenosu infekcÏnõÂho agens. Ordinace zubnõÂho leÂkarÏe je rizikovyÂm pracovisÏteÏm, kde muÊzÏe dochaÂzet

Introduction

To avoid potential transmission of infections, every dentist should follow strict disinfection and steriliza-tion protocols. Dentist surgery is a risky workplace where infectious agent may be transmitted - due to some procedures - via airflow and the following

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sedi-mentation of microaerosol on the surfaces and objects near the dentist chair, including the wear and face of an attending dentist. Infectious agent is often transmitted through direct or indirect contact.

Our work pays attention to possible transmission related to the use of light-curing units. The aim of epi-demiological examination was to assess the effective-ness of the final decontamination performed at the end of dentist's office hours.

Method

Epidemiological examination was performed at the Institute of Oral Medicine in Olomouc, departments of conservative dentistry, prosthodontics, pediatric den-tistry, periodontics and orthodontics. The examination was carried out before the staff and patients appeared, i.e. between 6:00 a.m. and 7:00 a.m. At the time poly-merization lamps should be decontaminated with di-sinfection cleaner based on alcohol which is meant for quick disinfection. It eliminated bacteria, viruses, spores, mykobacteria and fungicides. Swabs were ta-ken from polymerization lamps in all the departments mentioned.

There were two types of light-curing units:

1) An old type - halogen polymerization lamp (fig.1) Localization - number of swabs: light guide - 23, protective shield - 8, body - 3, protective glasses - 6 v souvislosti s urcÏi tyÂmivyÂkony k prÏenosu infekcÏnõÂho

agens proudeÏnõÂm vzduchu a naÂsledne sedimentaci mi-kroaerosolu na povrchy a prÏedmeÏty v okolõ krÏesla, vcÏetneÏ odeÏvu a oblicÏeje osÏetrÏujõÂcõÂho leÂkarÏe. VelmicÏa-sto muÊzÏe take dojõÂt k prÏenosu infekce kontaktem, jak prÏõÂmyÂm, tak neprÏõÂmyÂm.

V nasÏem cÏlaÂnku chceme upozornit na mozÏny prÏe-nos infekcÏnõÂho agens v souvislosti s pouzÏõÂvaÂnõÂm poly-meracÏnõÂch lamp. CõÂlem epidemiologickeÂho sÏetrÏenõ bylo oveÏrÏit uÂcÏinnost provaÂdeÏne konecÏne dekontami-nace, ktera se uskutecÏnÏuje na koncipracovnõ doby.

Metodika

Epidemiologicke sÏetrÏenõ probõÂhalo na Klinice zub-nõÂho leÂkarÏstvõ FN Olomouc a LF UP v Olomoucina kon-zervacÏnõÂm, protetickeÂm, pedostomatologickeÂm, paro-dontologickeÂm a ortodontickeÂm oddeÏlenõÂ. Vlastnõ sÏe-trÏenõ bylo provedeno v dobeÏ prÏed prÏõÂchodem zdravotnickyÂch pracovnõÂkuÊ na pracovisÏteÏ ipacientuÊ k osÏetrÏenõÂ, mezisÏestou a sedmou hodinou ranõÂ, kdy meÏly byÂt polymeracÏnõ lampy dekontaminovaÂny na koncipracovnõ doby prÏedesÏleÂho dne dezinfekcÏnõÂm prÏõÂ-pravkem na baÂzialkoholu, ktery je urcÏen k okamzÏiteÂmu pouzÏitõ pro rychlou dezinfekci. Ma baktericidnõÂ, viru-cidnõÂ, sporiviru-cidnõÂ, mykobaktericidnõ a fungicidnõ uÂcÏi n-nost. SteÏry byly odebraÂny z polymeracÏnõÂch lamp, ktere byly k dispozici u stomatologickyÂch souprav na vsÏech vyÂsÏe uvedenyÂch oddeÏlenõÂch.

SÏetrÏenõÂ probõÂhalo na dvou typech polymeracÏnõÂch lamp:

1) starsÏõÂtyp - halogenova polymeracÏnõÂlampa (obr. 1) Lokalizace pocÏet provedenyÂch steÏruÊ: sveÏtlovod -23, ochranny sÏtõÂt - 8 steÏruÊ, teÏlo lampy - 3 steÏry a 6 steÏruÊ z ochrannyÂch bryÂlõÂ.

2) novy typ - LED polymeracÏnõ lampa (obr. 2) Lokalizace - pocÏet provedenyÂch steÏruÊ: sveÏtlovod (plastova cÏocÏka) 10 steÏruÊ, prÏidrzÏovacõ a ochranny si

-Obr. 1.Halogenova polymeracÏnõ lampa.

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2) A new type - LED polymerization lamp (fig.2) Localization - number of swabs: light guide (plastic lenses) - 10, protecting and supporting silicon volute of the lamp - 4, disposable plastic wrap - 5.

Microbial contamination was found in 33 polymeri-zation lamps, from the surface of which 59 swabs were made.

Swabs were done with cotton-wool swabs wetted in sterile physiological solution. Prime cultivation was performed in a liquid medium (thioglycolate buillon) at 37°C for 48 hours. Then there was inocculation into firm ground - blood agar and Sabouraud agar with chloramphenicol. Cultivation was performed under the same circumstances as mentioned above. The fi-nal evaluation was made after 48 hours for blood agar, and on the 5th day for Sabouraud agar. Qualitative evaluation of colonies proved by cultivation was made according their biochemical characteristics with La-chema tests. Differentiation of staphylococci into coa-gulase-positive and coagulase-negative was done with help of latex agglutination with STAPHYTEC PLUS set.

Results

The results show strong prevalence of gram-posi-tive bacteria; the group is dominated by coagulase-ne-gative staphylococci (CoNS). Staphylococcus aureus likonovy prstenec lampy - 4 steÏry, jednoraÂzovy PVC

ochranny naÂvlek polymeracÏnõ lampy - 5 steÏruÊ.

MikrobiaÂlnõÂ kontaminace byla stanovena u 33 poly-meracÏnõÂch lamp, z jejichzÏ povrchuÊ bylo provedeno cel-kem 59 steÏruÊ.

SteÏry byly zhotoveny vatovyÂmivyÂteÏrovkami, ktere byly prÏedem zvlhcÏeny ve sterilnõÂm fyziologickeÂm roz-toku. Primokultivace probõÂhala v tekuteÂm pomnozÏova-cõÂm meÂdiu (thioglykolaÂtovy bujon) prÏiteploteÏ 37°C po dobu 48 hodin. NaÂsledovalo vyocÏkovaÂnõ na pevnou puÊdu - krevnõÂagar a Sabouraudovu puÊdu s chloramfeni-kolem. Kultivace probõÂhala za stejnyÂch podmõÂnek jak uvedeno vyÂsÏe. KonecÏne hodnocenõ naÂruÊstu mikrobiaÂl-nõÂch koloniõ na krevnõÂm agar bylo po 48 hodinaÂch, Sa-bouraudova puÊda byla hodnocena 5. den kultivace. Kvalitativnõ hodnocenõ kultivacõ prokaÂzanyÂch koloniõ bylo provedeno na zaÂkladeÏ jejich biochemickyÂch vlast-nostõ mikrotesty Lachema. RozlisÏenõ stafylokokuÊ na kmeny koagulaÂza pozitivnõ a koagulaÂza negativnõ bylo provedeno pomocõÂlatexove aglutinace setem STAPHY-TEC PLUS.

VyÂsledky

Z kultivacÏnõÂch vyÂsledkuÊ je patrna jasna prÏevaha grampozitivnõÂch bakteriõ a v teÂto skupineÏ dominujõ koa-gulaÂza negativnõ stafylokoky (CoNS). Jen v jednom prÏõÂ-padeÏ byl prokaÂzaÂn Staphylococcus aureus. Pouze

Tab. 1.Zastoupenõ bakteriaÂlnõÂch kmenuÊ na povrchu halogenove po-lymeracÏnõ lampy

Tab. 1.Bacterial tribes found on the halogen polymerization lamp surface

Lokalizace steÏru - sveÏtlovod (n=23) Location of swab - light guide

Cultivation results n % Staphylococcus aureus 1 4.4 CoNS * 13 56.5 Enterococcus sp. 1 4.4 Bacillus subtilis 9 39.1 Pseudomonas aeruginosa 1 4.4 Negative cultivation 2 8.7

Lokalizace steÏru - ochranny sÏtõÂt (n=8) Location of swab - protective shield

Cultivation results n %

CoNS * 5 62.5

Bacillus subtilis 5 62.5

Negative cultivation 3 37.5

Lokalizace steÏru - teÏlo lampy (n=3) Location of swab - body of lamp

Cultivation results n %

Bacillus subtilis 3 100

Lokalizace steÏru - ochranne bryÂle (n=6) Location of swab - goggles

Cultivation results n %

CoNS * 5 83.3

Micrococcus sp. 1 16.6

* CoNS = koagulaÂza negativnõÂ stafylokok coagulase-negative staphylococcus

Tabulka 2.ZastoupenõÂ bakteriaÂlnõÂch kmenuÊ na povrchu LED poly-meracÏnõÂ lampy.

Table 2.Bacterial tribes on LED polymerization lamp. Lokalizace steÏru - sveÏtlovod (n=10)

Location of swab - light guide

Cultivation results n %

CoNS * 3 30.0

Micrococcus sp. 2 20.0

Bacillus subtilis 6 60.0

Lokalizace steÏru - ochranny silikonovy prstenec Location of swab - protective sillicon ring (n=4)

Cultivation results n %

CoNS * 4 100.0

Bacillus subtilis 3 75.0

Lokalizace steÏru - jednoraÂzovy ochranny naÂvlek Location of swab - disposable protective wrap (n=5)

Cultivation results n %

CoNS * 2 40,0

Bacillus subtilis 4 80,0

* CoNS = koagulaÂza negativnõÂ stafylokok coagulase-negative styphylococcus

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was found only in one case. Again, only in one case, a gram-negative bacterium was proved - Pseudomo-nas aeruginosa. In both cases these bacteria should be considered as pathogens. In both halogen and LED lamps more species were detected on the light guide surface (table 1 and 2).

In halogen lamps there were taken 23 swabs from the light guide; only in two the cultivation was negative. In LED lamps there were taken 10 swabs from the light guide; all cultivations proved positive findings.

Swabs were taken from 6 goggles (protective glas-ses) that were placed on the working table. In five the cultivation proved coagulase-negative staphylococ-cus, in one Micrococcus sp.

Discussion

In oral cavity we can find similar amount of bacteria as in large intestine, i.e. 1011 per one gram of wet tis-sue weight. There are both aerobic and anaerobic bac-teria [1]. Apart from bacbac-teria, saliva is a very dangerous biological matter - if blood is present, saliva may con-tain a cause of viral hepatitis B and C, as well as HIV. Infectious agent of viral character is hard to prove under normal conditions; however, we should always bear in mind a potential risk of its transmission. At the same time it holds true that in the population the number of immunosupressed patients increases. In these people bacteria that are normally categorized as non-pathogenic or conditionally pathogenic may elicit disease.

The aim of our study was to bring attention to poten-tial transmission of an infectious agent related to the use of polymerization lamps. Current literature, Czech or foreign, does not deal with the problem. Therefore, we cannot compare our results with other studies. Only in instruction manuals by individual manufactu-rers of light-curing units we can read the warning about the necessary disinfection or sterilization.

In our results there are only two cases with proven pathogenic bacterial tribe (Staphylococcus aureus, Pseudomonas aeruginosa). All positive cultivation fin-dings show ineffective final decontamination after office hours as well as inappropriate storage of the lamp. Mostly they were placed on the working table and thus exposed to dust particles which may bear in-fectious agent. Dental surgeries should follow regula-tions establishing disinfection and sterilization proce-dures for the repeatedly used tools and instruments. In the Czech Republic this is a part of legislation - Ordi-nance No. 195/2005 Sb., regulating the conditions for the prevention of origin and transmission of conta-gious diseases, and hygienic requirements for the ope-ration of health-care facilities and institutions of social care [2]. The problem arises from the fact that not all v jednom prÏõÂpadeÏ byla prokaÂzaÂna gramnegativnõÂ

bak-terie, a to kmen Pseudomonas aeruginosa. V obou prÏõÂ-padech je nutne povazÏovat tyto bakteriaÂlnõ kmeny za patogennõÂ. BohatsÏõ druhove zastoupenõ bylo u obou typuÊ lamp prokaÂzaÂno na sveÏtlovodu (tab. 1, tab. 2).

U halogenove polymeracÏnõ lampy bylo provedeno 23 steÏruÊ sveÏtlovodu, pouze ve dvou prÏõÂpadech byla kultivace negativnõÂ. V prÏõÂpadeÏ polymeracÏnõ LED lampy bylo provedeno 10 steÏruÊ sveÏtlovodu, negativnõ kulti-vace nebyla aniv jednom prÏõÂpadeÏ.

SteÏry byly odebraÂny ze 6 kusuÊ ochrannyÂch bryÂlõÂ volneÏ polozÏenyÂch na pracovnõÂm stole. V peÏti prÏõÂpadech byl kultivacõÂ prokaÂzaÂn koagulaÂza negativnõÂ stafylokok, v jednom prÏõÂpadeÏ kmen Micrococcus sp.

Diskuse

UÂstnõ dutina ma podobne mnozÏstvõ bakteriõ jako tlu-ste strÏevo, tj. 1011 na gram vlhke vaÂhy tkaÂneÏ. Jsou zde prÏõÂtomne bakterie aerobnõ i anaerobnõ [1]. KromeÏ bak-teriõ jsou velmi nebezpecÏnyÂm biologickyÂm materiaÂlem sliny, ktere v prÏõÂpadeÏ prÏõÂtomnostikrve mohou obsaho-vat ipuÊvodce virove hepatitidy B a C a take puÊvodce HIV. InfekcÏnõ agens viroveÂho charakteru nenõ mozÏne beÏzÏneÏ prokaÂzat, pouze v souvislosti s biologickyÂm ma-teriaÂlem je nutne myslet na mozÏne riziko jeho prÏenosu. SoucÏasneÏ take platõÂ, zÏe v populacise zvysÏuje pocÏet imunosuprimovanyÂch pacientuÊ, kterÏõ jsou rovneÏzÏ pa-cienty zubnõÂch leÂkarÏuÊ. U teÂto skupiny lidõ pak bakterie, ktere jsou beÏzÏneÏ rÏazene mezinepatogennõ nebo pod-mõÂneÏneÏ patogennõÂ, mohou vyvolat onemocneÏnõÂ.

CõÂlem nasÏõ studie bylo upozornit na mozÏny prÏenos infekcÏnõÂho agens v souvislosti s pouzÏõÂvaÂnõÂm polyme-racÏnõÂch lamp. VsoucÏasne odborneÂliteraturÏe cÏeske iza-hranicÏnõ se naÂm nepodarÏilo najõÂt obdobnou studii. Ne-maÂme mozÏnost srovnat naÂminalezene vyÂsledky sÏe-trÏenõ s jinou podobnou studiõÂ. Pouze v technickyÂch naÂvodech jednotlivyÂch vyÂrobcuÊ polymeracÏnõÂch lamp je uvedeno upozorneÏnõÂo nutnostidezinfekce nebo ste-rilizace teÂto nezbytne stomatologicke pomuÊcky.

V nasÏich vyÂsledcõÂch jsme pouze ve dvou prÏõÂpadech prokaÂzaly patogennõ bakteriaÂlnõ kmen (Staphylococ-cus aureus, Pseudomonas aeruginosa). VsÏechny pozi-tivnõ kultivacÏnõ naÂlezy sveÏdcÏõ pro neuÂcÏinnou konecÏnou dekontaminaci po skoncÏenõ pracovnõ doby a take pro nevhodne ulozÏenõ polymeracÏnõÂch lamp. Ve veÏtsÏi neÏ prÏõÂ-paduÊ v dobeÏ provaÂdeÏnõ sÏetrÏenõ byly volneÏ polozÏene na pracovnõ desce a prÏõÂstupne spadu prachovyÂch cÏaÂstic, na kteryÂch muÊzÏe byÂt prÏõÂtomne iinfekcÏnõÂm agens. Pro ordinace zubnõÂch leÂkarÏuÊ existujõ zaÂsady dezinfekce a sterilizace opakovaneÏ pouzÏõÂvanyÂch pomuÊcek a naÂ-strojuÊ. V CÏeske republice jsou daÂny legislativou - Vy-hlaÂsÏka cÏ. 195/2005 Sb., kterou se upravujõ podmõÂnky prÏedchaÂzenõ vzniku a sÏõÂrÏenõ infekcÏnõÂch onemocneÏnõ a hygienicke pozÏadavky na provoz zdravotnickyÂch

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za-tools used in the dentist surgery may be disinfected or sterilized in accordance with the regulations. This ap-plies to polymerization lamps, that are often used both to cure filling materials and for teeth bleaching.

Only some producers included in their User's Guide detailed description of disinfection or other ways of decontamination. Everything depends on the material used and on the technology of production.

Some manufacturers recommend disposable pla-stic wraps protecting the lamp against liquid leak and preventing infectious agent transmission between in-dividual patients [3]. The disposable protective wraps are declared non-aseptic. The cultivation proved ge-nus coagulase-negative staphylococcus and tribe Ba-cillus subtilis. Similar findings were recorded for dispo-sable non-aseptic gloves. After the use they are put in waste marked ¹infectious materialª. We were told that disposable protective wraps are not used consistently by the dentists, and they are part of the polymerization lamp package only in some manufacturers. In some ty-pes of polymerization lamps it is possible to remove the light guide that may undergo sterilization. Howe-ver, chemical solutions or warm air cannot be used, only steam under pressure. Other parts, including the light guide between individual patients, are disinfected by means of a cloth with disinfection cleaner. The clea-ner must never get into the apparatus. Dissolving agents or abrasive cleaners must not be used [4, 5]. Di-sinfection cleaner with alcohol is recommended [3].

Our epidemiological examination proved pathoge-nic bacterial tribe only in two cases. They were Staphy-lococcus aureus and Pseudomonas aeruginosa. In both cases bacterial tribe was proved in the swab ta-ken from the light guide of the polymerization lamp. Due to the risk of small numbers we decided against statistical processing of the data.

Most bacterial tribes found belong to the group of non-pathogenic or conditionally pathogenic bacteria. Nevertheless, we believe that there exists the risk of in-fectious agent transmission between the patients. Our examination dealt only with bacterial contamination of polymerization lamps in use.

Conclusion

Epidemiological examination focused on bacterial contamination of polymerization lamps used in dentist surgery proved the following:

1. ineffective final decontamination of polymeriza-tion lamps at the end of office hours,

2. inappropriate storage of polymerization lamps when they are not used - they should be protected against dust particles fall-out.

To minimize the risk of infectious agent transmis-sion during the use of polymerization lamps according rÏõÂzenõÂ a uÂstavuÊ sociaÂlnõÂ peÂcÏe [2]. ProbleÂmem je, zÏe ne

vsÏechny pomuÊcky pouzÏõÂvane v ordinaci zubnõÂho leÂkarÏe je mozÏne dezinfikovat nebo sterilizovat podle legisla-tivy. To platõ i pro polymeracÏnõ lampy, ktere jsou v ordi-nacizubnõÂho leÂkarÏe velmicÏasto pouzÏõÂvaneÂ, a to jak k tvrzenõ vyÂplnÏovyÂch materiaÂluÊ, tak k beÏlenõ zubuÊ.

Pouze neÏkterÏõÂvyÂrobciv technickeÂm naÂvodu k pouzÏõÂ-vaÂnõÂ polymeracÏnõÂch lamp uvaÂdeÏjõÂ podrobneÏjsÏõÂ popis zpuÊsobu dezinfekce cÏijineÂho dekontaminacÏnõÂho po-stupu. VsÏe zaÂvisõÂ na pouzÏiteÂm materiaÂlu a technologii vyÂroby polymeracÏnõÂ lampy.

NeÏkterÏõ vyÂrobcidoporucÏujõ pouzÏõÂvat jednoraÂzove ochranne plastove naÂvleky, ktere chraÂnõ lampu prÏed zatecÏenõÂm kapaliny a zabranÏujõ prÏenosu infekcÏnõÂho agens mezijednotlivyÂmipacienty.[3] Tyto jednoraÂzove ochranne naÂvleky jsou deklarovane jako nesterilnõÂ. Kultivacõ jsme na nich prokaÂzaly kmen koagulaÂza ne-gativnõÂho stafylokoka a kmen Bacillus subtilis. Ob-dobne naÂlezy se vyskytujõÂu jednoraÂzovyÂch nesterilnõÂch rukavic. Po pouzÏitõ se odklaÂdajõ do odpadu, ktery nese oznacÏenõÂ- ¹infekcÏnõÂmateriaÂlª. Dle uÂstnõÂho sdeÏlenõÂ, nej-sou tyto jednoraÂzove ochranne naÂvleky zubnõÂmileÂkarÏi vzÏdy pouzÏõÂvaÂny a ne vsÏichni vyÂrobcije prÏiklaÂdajõ ke vsÏem typuÊm polymeracÏnõÂch lamp. U neÏkteryÂch typuÊ polymeracÏnõÂch lamp lze vyjmout sveÏtlovod, ktery lze sterilizovat. Sterilizace se nesmõ provaÂdeÏt chemickyÂmi prostrÏedky nebo horkyÂm vzduchem, pouze parou pod tlakem. Dezinfekce ostatnõÂch dõÂluÊ, vcÏetneÏ sveÏtlovodu mezijednotlivyÂmiosÏetrÏenõÂmipacientuÊ, se provaÂdõ ubrouskem napusÏteÏnyÂm dezinfekcÏnõÂm prostrÏedkem. DezinfekcÏnõ prostrÏedek nesmõ proniknout do prÏõÂstroje. RozpousÏteÏdla cÏiabrazivnõ cÏisticÏe se nesmõ v zÏaÂdneÂm prÏõÂpadeÏ pouzÏõÂvat [4, 5]. DoporucÏen je dezinfekcÏnõ pro-strÏedek na baÂzialkoholu [3].

PrÏinasÏem epidemiologickeÂm sÏetrÏenõ jsme pouze ve dvou prÏõÂpadech kultivacõ prokaÂzaly patogennõ bakte-riaÂlnõ kmen. Jednalo se o kmen Staphylococcus au-reus a kmen Pseudomonas aeruginosa. V obou prÏõÂpa-dech byl bakteriaÂlnõ kmen prokaÂzaÂn steÏrem sveÏtlovodu polymeracÏnõ lampy. Z duÊvodu rizika malyÂch cÏõÂsel zde nebylo provedeno statisticke vyhodnocenõÂ.

VeÏtsÏina naÂmiprokaÂzanyÂch bakteriaÂlnõÂch kmenuÊ patrÏõÂ do skupiny nepatogennõÂch nebo podmõÂneÏneÏ patogen-nõÂch bakteriõÂ. PrÏesto se domnõÂvaÂme, zÏe zde existuje ri-ziko prÏenosu infekcÏnõÂho agens mezipacienty. V nasÏem epidemiologickeÂm sÏetrÏenõÂ jsme prokazovaly pouze bak-teriaÂlnõÂ kontaminaci pouzÏõÂvanyÂch polymeracÏnõÂch lamp.

ZaÂveÏr

Epidemiologicke sÏetrÏenõÂ, ktere bylo zameÏrÏeno na bakteriaÂlnõ kontaminaci polymeracÏnõÂch lamp pouzÏõÂva-nyÂch v ordinaci zubnõÂho leÂkarÏe prokaÂzalo:

1. neuÂcÏinnou konecÏnou dekontaminaci polymeracÏ-nõÂch lamp po skoncÏenõÂ pracovnõÂ doby a

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to the manufacturers mentioned above we recom-mend:

1. to use disposable protective wraps which are part of polymerization LED lamps package (fig.3)

2. to follow recommendations of manufacturers gi-ven above dealing with continuous and final deconta-mination of polymerization lamps,

3. to store the polymerization lamp when not in use so that it is protected against dust particles pollution.

Authors have no commercial, proprietary or financial interest in products or companies mentioned in the article.

2. sÏpatne ulozÏenõ polymeracÏnõÂch lamp v dobeÏ, kdy nejsou pouzÏõÂvaÂny, meÏly by byÂt chraÂneÏny protispadu prachovyÂch cÏaÂstic.

Pro minimalizaci rizika prÏenosu infekcÏnõÂho agens prÏi pouzÏõÂvaÂnõ polymeracÏnõÂch lamp dle vyÂsÏe uvedenyÂch vyÂ-robcuÊ je mozÏne doporucÏi t:

1. pouzÏõÂvat jednoraÂzove ochranne naÂvleky, ktere jsou soucÏaÂstõ polymeracÏnõÂch LED lamp (obraÂzek 3)

2. dodrzÏovat vyÂsÏe uvedena doporucÏenõ vyÂrobce pro pruÊbeÏzÏnou ikonecÏnou dekontaminaci polymeracÏnõÂch lamp a

3. polymeracÏnõÂ lampu v dobeÏ, kdy nenõÂ pouzÏõÂvaÂna uklaÂdat tak, aby byla chraÂneÏna protispadu prachovyÂch cÏaÂstic.

AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na pro-duktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.

Literatura/References

1. BednaÂrÏ M. a kol.: LeÂkarÏska mikrobiologie. 1. Vyd. Praha: Marvil, 1996. s. 361-4.

2. VyhlaÂsÏka cÏ. 195/2005 Sb., kterou se upravujõ podmõÂnky prÏedchaÂzenõ vzniku a sÏõÂrÏenõ infekcÏnõÂch onemocneÏnõ a hy-gienicke pozÏadavky na provoz zdravotnickyÂch zarÏõÂzenõ a uÂstavuÊ sociaÂlnõ peÂcÏe.

3. SDI, SDI Radii plus

4. 3M ESPE EliparTM S10. 3M ESPE AG Dental Products. p.9

5. 3M Unitek, OrtholuxTM Luminous Curing Light

MUDr. Eva Sedlata JuraÂskova Ortodonticke oddeÏlenõÂ

Kliniky zubnõÂho leÂkarÏstvõÂ LF UP

ROD OSTRAVA

PrÏehled chystanyÂch domaÂcõÂch akcõÂ 2013:

25.±26. 10. 2013 Doc. MUDr. Olga JedlicÏkovaÂ, CSc.

¹FunkcÏnõÂ aparaÂtyª PrÏehled chystanyÂch zahranicÏnõÂch akcõÂ 2013:

26.±30. 6. 2013 89th Congress of the European Association of Orthodontics

Reykjavik, Island

* * *

Informace: ROD Ostrava ± BeÏlova Olga, MojmõÂrovcuÊ 799/45, 709 00 Ostrava-Mar. Hory Tel.: 777 727 152, 800 100 793, e-mail: obchod@rod-ostrava.cz

CÏlensky poplatek pro rok 2013 cÏinõ 1500,- KcÏ nebo 65,- EUR. CÏlenove v zameÏstnaneckeÂm vztahu 800,- KcÏ nebo 35,- EUR.

Postgraduanti, duÊchodci a zÏeny na materÏske dovolene 300,- KcÏ nebo 15,- EUR. RegistracÏnõ polatek cÏinõ 500,- KcÏ nebo 20,- EUR.

PrÏedplatne cÏasopisu Ortodoncie pro necÏleny CÏOSje 1000,- KcÏ za rok nebo 40,- EUR.

UÂhrada poplatku do 28. 2. 2013, cÏ. uÂ.: 32932021/0100, konst. symbol: 0558, variab. symbol: rodne cÏõÂslo. PrÏi nezaplacenõ prÏõÂspeÏvkuÊ po dvou põÂsemnyÂch urgencõÂch bude ukoncÏeno cÏlenstvõ v CÏOS.

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