{ Infection Control

Disease Transmission and Sterilization

Tiffany Baggs, RDH, BASDHJoy Davis, RDH, BASDH

Objectives for DHCP

Responsibility of entire dental team

Work practices prevent cross-contamination

An approach to infection control in which all human blood and certain human body fluids are treated as if known to be infectious.

Universal Precautions

Protects the DHCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion

Blood All body fluids (except sweat) Non-intact skin Mucous membranes

Standards of care -Level of clinical performance expected for the safe, effective and ethical practice of dental hygiene. (CODA)

Standard Precautions

P.P.E. Clinical attire Hair Face mask Protective eyewear Gloves CDC recommendations

Personal Protective Equipment

Introduction of microorganisms, blood or infectious material onto a surface or into tissue

Cross-contamination Person to person Person to inanimate object Inanimate object to another person

Brainstorm – Consider a dental appointment what all might occur that would cause cross contamination to happen?

Contamination

Disease Transmission

Number of organisms, duration of exposure

Virulence of the organism Immune status of host Host general physical health and

nutritional status

Factors Influencing the Development of Infection

Abnormal physical conditions Systemic diseases

Drug therapy Prostheses and transplants

Factors That Alter Normal Defense

Dust-borne organisms Aerosol production

Aerosols: biologic contaminants, solid or liquid, invisible, remains suspended in air for long periods of time

Spatter : larger than aerosols, may be visible

Origin: breathing, speaking, coughing, sneezing

Contents: microorganisms, Cavity preparation, ultrasonic scaling

Air-borne Infection

Pre-procedural oral hygiene measures Tooth brushing and flossing Antiseptic mouth rinse WHY? (chlorhexidine,

Listerine) Interruption of transmission

Rubber dam, high volume evacuation, manual scaling

Clean water Run waterlines 2-3 minutes before first patient,

30 seconds between patients Protection of the clinician: PPE Protection of the patient: protective eyewear.

WHY?

Prevention of Transmission

Use waterlines that meet EPA regulatory standards for drinking

Biofilms form in tubing and waterlines that lead to hand-pieces, air-water syringes, & ultrasonic

Human pathogens including Pseudomonas, Legionella, Non-TB, & Mycobacterium species

Source of infections immuno-compromised patient

Waterlines

Use enclosed water systems Flush lines Avoid heating units Educate

http://www.osap.org/?page=Issues_DUWL

Free from contamination of microorganisms

Chain of asepsis: a procedure that avoids transfer of infection

Includes sterile conditions Elimination of infection is the key to

Asepsis not necessarily Sterile.

Sterilization Process by which all forms of life, including bacterial

spores, are destroyed by physical or chemical means

Disinfection An agent (chemical, x-ray, ultraviolet light) Destroys microorganisms but may not kill bacterial

spores Substance applied to inanimate objects

SanitationThe process by which organisms on inanimate objects is reduced to a safe level, cleaning process

Cleaning proceduresInstrument washer or thermal disinfectors (Miele)

Ultrasonic processing- Used in most dental offices, Prior to sterilization

Manual cleaning- Wet 2X2 (Nitrile gloves)

Instrument Cleaning

Miele

To prevent contamination of sterilized instruments as soon as they are removed from sterilizer.

Provide a means of storing instruments to have them available for patient appointment use

WHY?

Purpose of Packaging

Process by which all forms of life, including bacterial spores, are destroyed by physical or chemical means

Approved methods moist heat- steam under pressure; dry heat-

oxidation, chemical vapor Method selection

All items can not be sterilized by certain methods. IMPORTANT CONCEPT

Tests for sterilization External chemical indicator Internal chemical indicator

Both Biologic monitor- Spore testing

Sterilization

Method Time Temperature

Pressure

Moist Heat-Steam Under Pressure

15-30 min

20 min

250 F121 C270

15 PSI

Dry heat oven

120 min 320 F160 C

No pressure

Unsaturated Chemical Vapor

20 min 270 F132 C

20-40 PSI

Methods of sterilization

Glutaraldehydes- (High) Alkaline, acidic, and neutral (Cold sterile soak)

Chlorines- dentures, water purification

Iodophors- broad spectrum, surface disinfectant

Phenolics- Synthetic (water or alcohol based)

Chemical Disinfecting Agents

Surface Disinfection

Use Mode of Action Preparation

Iodophor Broad spectrum w/residual biocidal activity

Iodine released slowly from compound to create disinfecting action.

1 part Iodophor concentrate to 213 parts water

Phenols (water, or alcohol based)

Broad spectrum w/residual biocidal activity

Destroys cell wall & precipitate protein.

Chlorine Compounds

Disinfection; clean water lines, and dentures

Microorganisms destroyed primarily by oxidation of microbial enzymes and cell wall components.

Mixed Daily

Glutaraldehyde High level disinfectants

Kill microorganisms by damaging their proteins and nucleic acids.

Two solutions activate when mixed together. 28 day life.

Instrument Cleaning and Processing

Steps for labeling packaged Instruments….

Surface Category

Definition Sterilization/ Disinfection

Examples

Critical Penetrate soft tissue or bone

Sterilize or dispose

NeedlesCuretsExplorersProbes

Semi-Critical Touch intact mucous membrane, oral fluidsDoes not penetrate

Sterilize orHigh level

Xray bite blockUltrasonic handpieceMouth mirror

Non-Critical Does not touch mucous membrane

Cleaning and TBIntermediate level disinfectant

Light handlesXray partsSafety goggles

Environmental

No contact with patient

Cleaning and intermediate to low disinfection

Counter tops Equip. surfaces Housekeeping surfaces

Inanimate Objects

The End!