Manal Infection Control

8/3/2019 Manal Infection Control

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INFECTION CONTROL IN

FIXED PROSTHODONTICS

Prepared & Presented By:


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LAYOUT


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OBJECTIVES

Protect one self, staff and patients Use of protective gear and proper

sterilization to minimize infection risks Ensuring the patient the highest

standard of care

Providing a relaxed and non-threateningenvironment to minimize patientsanxiety.


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OBJECTIVES

To fulfill these objectives, a basic understandingof microbiology is essential.

There are 3 types of microorganisms: Pathogenic Potentially pathogenic Non-pathogenic

Opportunistic infections occur in thosewhose immune systems are compromised(eg. Oral Candidiasis: fungi)


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MODES OFTRANSMISSION

Direct: person to person Indirect: contact with objects that are

contaminated Air-borne: spray or splatter contact

with mucous membranes, or contactwith aerosols

A high speed handpiece is capable ofcreating air-borne:

Bacteria: from water-spray system Microbial contaminants: from saliva,

tissues, blood, plaque and debrisfrom cutting carious teeth

These exist in the form of spatter,

mists and aerosols.


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Aerosols(50mm-55mm) may carry agents ofrespiratory infection, borne by the patient (air-

borne or blood-borne). Mists(50mm) are likely to transmit active

pulmonary/pharyngeal tuberculosis from thecough of a patient.

Spatter has a trajectory of 3 ft from thepatients mouth. It is a potential route ofblood-borne pathogens.

MODES OFTRANSMISSION


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Hand washing Mouth rinse

Rubber dam High-velocity air

evacuation

Gloves

GownsMasks

Protective eyewearAdequate air circulation

PRE-TREATMENT

DURINGTREATMENT

PREVENTION


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HBV CONCENTRATION IN BODYFLUIDS

Blood

Serum

WoundExudates

HIGH

Semen

VaginalFluid

Saliva

Moderate

Urine

Feces

Sweat

TearsBreastmilk

LOW


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HIV RISK FOR DENTALPERSONNEL

Precautions must be made to minimize injury byneedles or sharp instruments used to treat HIV infectedpatients.

Patients seriously ill with AIDS may harbor transmissible

respiratory infections such as tuberculosis and CMVinfections.

Personnel without adequate barrier protection shouldavoid exposure to coughing , saliva spatter and heavyaerosol from HIV infected person with signs of

respiratory infections.

Pregnant women should especially be cautious oftransmitting CMV infection to new-bornUSING INFECTION CONTROL MEASURES ,

THE RISK FOR INFECTION TRANSFER IS

VERY LOW.


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HIV INFECTIONCONTROL

HIV is killed by all methods of

sterilization. When used properly, all

disinfectants except somequaternary ammoniumcompounds, are said to

inactivate HIV in less than 2minutes.

In dried infected blood, 99% ofHIV has been found to be

inactive in appx. 90 minutes.However when kept wet, thevirus may survive for 2 or moredays. Hence caution is requiredwith container of used needles

in which the virus may remainwet.

Barriers have provedsuccessful in protecting

dental personnel.HIV has been found tomostly be transmitted byblood contaminated fluidsthat have been heavilyspattered or splashed.


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CRITICAL ITEMS

Instruments that cut or penetrate through tissues

Require thorough cleaning and sterilization


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Items handled by gloved handscoated with blood and saliva ormay touch mucosa.

Air-water syringe tip Suction tip

Handpieces

Lamp handles

Must be removed to clean andsterilize unless disposable orcan be protected using plasticcovers.

SEMI-CRITICALITEMS


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Items not ordinarily touched duringtreatment.

Environmental surfaces: Chairs Floor/walls

Supporting equipment of dental unit

NON-CRITICALITEMS

Contaminated items require cleaning and disinfection. Wear gloves to clean. Uncovered chair arms may become contaminated with

spatter.


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ASEPTICTECHNIQUES

Prevents cross-contamination.

All items touched with saliva MUST be freeof contamination before treating nextpatient.

Contaminated items can be:

Discarded/Removed

Protected by disposable covers

Cleaned

Sterilized

Clinician should NOT directly touch items thathe/she does not want to contaminate


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BETWEEN PATIENTAPPOINTMENTS

Whatever is touched iscontaminated.

Directly touch ONLY what hasto be touched.


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BETWEEN PATIENTAPPOINTMENTS

Use one of the following to control contamination:

a) Clean and sterilize

b) Protect surfaces and equipments, that

are not sterilized, with disposable,single-covers. Discard after every

appointment.

c) Use paper towel/plastic bags over gloves to

handle equipments briefly(cabinets/drawers)

d) Scrub and disinfect noncriticalsurfaces (countertops, door

handles, light switches etc.)


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DISINFECTANTS

Regarding disinfection, these two principlesshould be remembered:

1. Disinfection cannot occur until fresh disinfectant isreapplied to a thoroughly cleaned surface.

2. Disinfection does not sterilize.


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MUST be active against:

Mycobacterium species

Polioviruses

Staphylococcus species

Pseudomonas species

HIV (within 1-2 mins)

Activity is reduced by organicdebris/blood.

Most water-based disinfectantsare effective for removing dried

blood.

DISINFECTANTS


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Major categories of chemicaldisinfectants:

1. Chlorine compounds

2. Iodophors3. Combination synthetic phenolics

4. Glutaraldehydes

5. Phenolic/alcohol combinations

These can be used usingdifferent methods of disinfectionlike spraying and immersiontechniques.

DISINFECTANTS


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Some drawbacks of chemicaldisinfectants:

Not readily compatible withirreversible hydrocolloids

Potentially harmfulto usershealth and environment

May have unpleasant odor

Take time

Expensive

DISINFECTANTS


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Factors influencingdisinfectants effectiveness:

1) Type of micro-organism2) Number of micro-organism

3) Concentration ofdisinfectant

4) Length of exposure time ofdisinfectant

5) Amount of organic matter[bio-burden] remaining

DISINFECTANTS


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70-79% ethyl alcoholMOST effective on cleaned

surfaces

Chlorine and iodine:

React and absorbed by plastic ofdispensing bottles.

Glutaraldehydes (conc.) Used for instrument disinfection

Highly toxic 20 min.s to kill mycobacterium species

DISINFECTANTS


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Education and training

Immunizations Exposure prevention and post-exposure

management

Medical condition management and work-related illnesses and restrictions Health record maintenance

PERSONNEL HEALTHELEMENTS


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PERSONNEL BARRIER

PROTECTION

Hand washing

GlovesEyewear

Masks

Hair protectionProtective over-garment


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HAND WASHING

Hands must be washed when: Visibly dirty

After touching contaminated objects with barehands

Before and after patient treatment (before gloveplacement and after glove removal)

GOOD BETTER BEST

Plain Soap Anti-microbial Soap Alcohol-based Soap

http://www.cdc.gov/handhygiene/materials.htm


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HAND WASHING

Hand cleansers containing a mild antiseptic such as:

1. 3% parachlorometaxylenol (PCMX) orChlorhexidine:

Preferred to control transient pathogens

Suppress overgrowth of skin bacteria.

2. Hand cleansers with 4% chlorhexidine:

Special cleansing (e.g. for surgery gloves leak or clinician

experiences injury) Can be hazardous to eyes.

3. Alcohol rubs:

Effective against pathogens

Less drying to the hands


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ALCOHOL-BASED SOAP

Benefits

Rapid and effectiveantimicrobial action

Improved skin

condition

More accessiblethan sinks

Limitations

Cannot be used ifhands are visibly

soiled

Store away fromhigh temperatures

or flames

Hand softeners andglove powders may

build-up

SPECIAL HAND


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SPECIAL HANDHYGIENE

Keep fingernails short

Avoid artificial nails

Avoid hand jewellery that

may tear gloves Use hand lotions to prevent

skin dryness

Consider compatibility of

hand care products withgloves (e.g., mineral oilsand petroleum bases maycause early glove failure)


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GLOVES

OSHA regulations specifies thatall clinical personnel MUSTwear treatment gloves duringall treatment procedures and

each appointment. Gloves must meet new FDA

regulations .

Puncture-resistant utility glovesshould be worn.

If a leak is detected, gloves areremoved, hands are washed,and fresh gloves are used onDRY hands.


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Gloves must NOT bewashed

Must NOT be used formore than one patient.

Gloves help preventpainful and

transmissible herpeticinfections to fingers(WHITLOW) andhands.

GLOVES


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Pinch the palm side of the outer cuffsurface with the gloved fingers of the

other hand.

REMOVAL OF GLOVES

Pull off the glove, inverting it.

Remove both gloves simultaneously in thesame manner.

Alternately, after removing one, insert

bare fingers under the cuff to grasp andpull off the remaining glove.

Discard gloves safely.


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May consist ofgoggles or glasseswith solid side-

shields.Should be worn with

clean hands before

gloving and removedwith clean handsafter gloves areremoved.

EYE WEAR


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Should be worn to protect against aerosols.

Edges of the rectangular mask should be pressedclose around the bridge of the nose and face.

Face Shields are also used for heavy spatter.

MASK

HAIR


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Hair should be kept back, outof the treatment field,

because hair can entrapheavy contamination.

Personnel should protect theirhair with a surgical cap when

encountering heavy spatter(e.g. from an ultrasonicscaling device).

HAIRPROTECTION


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OVER-GARMENT

Sleeves with knit cuffs that tuckunder gloves are preferred.

Simple light-weight garment

Must cover the arms and chest upto the neck and the lap whenseated, provide more adequateprotection.

Garments should be changed andskin be washed as soon aspossible in case of treatments thatproduce spatter that wets or

penetrates the garment.

An over-garment must be

protective of clothing andskin


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OVER-GARMENT

Wear gowns, lab coats,or uniforms that cover

skin and personal clothinglikely to become soiledwith blood, saliva, orinfectious material

Change if visibly soiled

Remove all barriersbefore leaving the work

area

DISPOSAL OF CLINICAL


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DISPOSAL OF CLINICALWASTE

Contaminatedmaterials such asblood-soaked orsaliva-soaked

sponges, and cottonrolls must bediscarded safely.

Excised tissuerequire separatedisposal and may notbe discarded into the

trash.


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NEEDLE DISPOSAL

Goals for needle disposal are:

Dispose off needles in a hard-walled, leak-proof, and sealable

container which has the OSHAbiohazard label.

Locate the needle-disposalcontainer in the operatory closeto where the needle will be used

Avoid carrying unsheathedcontaminated needles orcontainers in a manner that couldendanger others.

PRECAUTIONS TO AVOID


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PRECAUTIONS TO AVOIDINJURY

The same principlesthat apply toneedles should be

reasonablytranslated andapplied, however toused burs, wires,

and sharpinstruments fromthe operatory.

Great care should be used

in passing instruments andsyringes with unsheathedneedles to anotherindividual.

PRECAUTIONS TO AVOID


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PRECAUTIONS TO AVOIDINJURY

Sharp and curved ends shouldbe turned away from therecipients hand.

Burs should be removed from

handpieces when finished or ifleft in the handpiece in thehanger, the bur should bepointed away from the handsand body.

Hanging handpieces upsidedown in some types ofhangers can angle the buraway from the operator.

HANDPIECE SURFACE CONTAMINATION


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HANDPIECE SURFACE CONTAMINATIONCONTROL

Blood and saliva contaminate thesurfaces of handpieces duringvarious dental treatments.

Irregular surfaces and especiallycrevices around the bur chuck aredifficult to clean and disinfect,especially by a brief wipe with adisinfectant-soaked sponge.

Submersion of a high-speedhandpiece in a high-leveldisinfectant has not been an optionaccepted by manufacturers.

Only STERILIZATIONcan approach

complete infectioncontrol of handpiece

surfaces.

INSTRUMENT PROCESSING


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INSTRUMENT PROCESSINGAREA

Use a designated processingarea to control quality andensure safety.

To prevent cross-

contamination, the instrumentprocessing area should bephysically or spatially dividedinto regions for:

Receiving, cleaning, anddecontamination

Preparation and packaging

Sterilization

Storage

DISINFECTION OF IMPRESSIONS &


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DISINFECTION OF IMPRESSIONS &PREOSTHESES

All prosthesis removed from themouth should be carefully rinsedunder running water, cleaned ofdebris in an ultra-sonic cleanerwhenever possible, anddisinfected.

All impressions should be rinsedand disinfected before the dentalstone models are fabricated.

Working pumice should be

discarded after use Lathe attachments such as stones,

acrylic burs, and rag wheels,should be removed from the latheafter each use and stored in a

disinfectant.



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Lathe shields and air filtrationsshould be used to containcontaminated splashes andairborne contamination.

Care should be exercised to cleanand disinfect touch and splashsurfaces in the laboratory.

Clothing worn during patienttreatment should be covered with adisposable apron, specially whencontaminated impressions andprosthesis are handled.




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Impressions can also be disinfected and sterilized using ultra-violet radiation and gas [ethylene dioxide] in closedchambers.

A cast from a properly disinfected

impression may subsequentlybecome contaminated by atechnician and/or a clinician.

Also the prosthesis will becomecontaminated by patient after try in;

this can re-contaminate the castafter repositioning.

In practice, it is thus, difficult tochemically disinfect thecontaminated gypsum casts.


MICROWAVE


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MICROWAVEIRRADIATION

Studies have been carried out todisinfect contaminated gypsumcasts through microwaveirradiation.

Unlike impression disinfection,this method can be used toeliminate cross-contamination viathe cast, as it can be repeated atevery stage as required.

So far it has been observed thatmicrowave irradiation of the castsfor 5 minutes at 900W gives highlevel disinfection of the gypsum

casts.


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STERILIZATION

Autoclavesterilizationof handpieces One of the most rapid methods.

Works at 121*C for 20 min and 15 lbpressure.

All stainless steel instruments & burs canbe autoclaved.

Chemical vapor pressure sterilization

Recommended for some types of

handpieces Works at 131*C for 30 min and at 20lb

pressure by using aldehyde vapours.

Carbon steel and other corrosion sensitiveburs can be sterilized.


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SUMMARY

All dental disciplines must be considered with the dangersinvolved in the spread of certain infectious diseases.

Prosthodontists and their personnel may be exposed tocertain diseases such as Hepatitis and Tuberculosis.

Dentists must ensure that they at least follow the basicinfection control procedures.

Additional infection control procedures should be observedin the fabrication and handling of dental impressions andprosthesis.

Dental offices and labs should work closely together to co-ordinate control of potential cross-infections between thetwo disciplines.


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Manal Infection Control

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