Infection Control In Dentistry
Author Dr. Bhuvan Venigalla MDS,
Associate Professor, Dept Cons & Endodontics
Infection Control In Dentistry
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Infectious / Transmissible / Communicable Diseases
- A Global ConcernInfectious Diseases
- Hepatitis B - HIV - Herpes Simplex - Varicella, Zoster - Tuberculosis - Rubella, Rubeola - Mumps
Patient
Health care environment
Health care Instruments worker & equipment
Modes of Contamination
Airborne Dental Unit Water spray system
Saliva, Tissues, Blood, Plaque, Cut tooth debris
Based on size of droplets
Aerosol
Mist
Spatter
Aerosol - 5µm-50µm - Remain for hours - Respiratory infection
- Hepatitis B ?
Mist - ≥ 50µm - visible in beam of light - droplets settle down in 5 -15 min - TB ?
Spatter/Splash
- > 50µm - Visible splash
- HIV ?
Barrier Protection
• Masks ( Wear masks till in operatory )
• Gloves
• Protective eyewear
• Gowns
• Pre-treatment mouth rinse
• Rubber Dam
• High velocity vacuum suction
• Adequate air circulation
Penny wise ,
Pound foolish !!
Ignorance
Digital / Hand to Surface Contamination
Of patients and personnel
Surfaces that usually remain contaminated
Hand pieces, Lamp handles, 3-way syringe
switches and handles, Seat edges, Tubes,
Knob controls, Drawers, Operatory telephones,
rests of dentists and assistants etc…
Surfaces where contamination can be avoided
Amalgam mixing equipment, Light cure units,
Camera equipment
• Controlling contamination of equipment and personnel
• Barrier protection of personnel and equipment
• Instrument sterilization
• Adapt methods to avoid direct contact of
surfaces and materials
Patient vulnerability – low
Personnel vulnerability – more if not immunized and
protected with barriers
A Remedy ?
Infection Control - A way to build practice
Organizations Related to Infection Control
OSHA - Occupational Safety and Health Administration
CDC - Centre for Disease Control
ADA - American Dental Association
AADS - American Association of Dental Schools
Other Dental Office Requirements
• Complete First Aid kit• Full Oxygen tank• Pocket resuscitation
masks• Fire evacuation plan• Actual personnel
training updated
• Clear passage ways• Maintain radiation and
nitrous oxide safety standards
• OSHA posters• Copies of OSHA blood
borne pathogens standard of 1991
Gloves:
• Must wear treatment gloves
• If a leak is detected – remove gloves, wash hands, put on fresh gloves
• To be disposed after use
• Prevent painful herpetic infections( whitlow) to fingers and hands
• Must not be washed with hand soaps - reduces glove integrity
• Do not touch anything with gloved hands
• While cleaning and sorting used sharp instruments, wear puncture
resistant Nitrile latex gloves – washed, disinfected and autoclaved
Personal barrier protection
• Grasp temple pieces of eyewear and strings of masks to remove them• Change mask between every case or when soiled• Eyewear disinfected with 1:50 or 1:100 solution of hypochlorite bleach• Hair put back
Protective Eyewear, Masks, and Hair protection
• Goggles, Glasses with Side shields
• Masks for aerosols• Dome shaped - for HB
and HIV infection,• Rectangular shaped-
for Measles, Influenza, TB..
• Face shields for spatter• Eyewear put on before
gloving and removed with clean hands
Wearing & Removing gloves
Hand washing
• Remove watches, jewelry, rings, and wash hands with a cleanser
• Lather for 10 sec, rub all surfaces, and rinse
• Repeat at least once
• Hand cleansers - 3% PCMX (p-chloro, meta xylenole) – preferable, non-irritating, effective
• Chlorhexidine gluconate (4%)
Protective Overgarments
• Protects clothing and skin • Changed when soiled or moist• Spatter on wrists and forearms prevented
by long sleeves – tucked in gloves• Gown should cover arms and chest upto
neck and also lap• Cotton or synthetic fiber which is thick
is preferred• Used garments laundered regularly
– hot water at 70 degree C or cool water with 50-150ppm chlorine
• Hot air dryer or ironing also useful
• Infected blood and other liquids poured down general sanitary drain, but not mercury, silver or other heavy metals
• Add 3 ounces of 5% hypochlorite to every 30 ounces surgical aspiration bottles before disposal
• Masks, gloves, blood / saliva soaked sponges, cotton rolls, … discarded in safe containers kept for them
• Pathologic waste, excised tissues need separate disposal
• Local environmental agencies control disposal
Waste Disposal
• Needles and sharps into hard walled, leak-proof, and sealable containers
• Avoid carrying unsheathed needles to prevent injury to others
• Pointed instruments without hollow lumen are less capacity to transmit infected blood
• While passing needles turn sharp curved ends away from recipient’s hand
• Two handed resheathing is not advisable• If burs are left in hand-pieces, point
them away from your body and hands
Needle Disposal
Aseptic Techniques
• Remember what is touched during treatment• Touch only what need to be touched• Clean and sterilize what is touched• Use single-use covers on non-sterilizable instruments• Use paper towels, plastic bags over gloves if needed to touch
these equipment, drawers while working on patients• Scrub and disinfect non critical surfaces• Use wrists, arm or paper towel to handle faucet handles or
soap dispensers• Use paper towels to handle phones, drawer pulls, charts…• As needed use any water based tuberculocidal disinfectant
Operatory asepsis
• Disposable covers
• White paper sheets for work benches and operatory
• Commercial plastic bags for chair backs, control units, …
• Plastic restaurant bags fit suction handles and air water syringe handles
• Discard and replace after each appointment
Sterilization
• Steam pressure (Autoclave)• Chemical vapour pressure (Chemiclave)• Dry heat (Dryclave)• Ethylene oxide
Autoclave
• Light load - 121˚C at 15 lbs for 15 min• Wrapped instruments -134˚C at 30lbs for 7min• Most rapid and effective for cloth and towels• Temperature sensitive instruments not indicated• Burs and carbon steel instruments may rust
Chemiclave • Chemical vapour at 131˚C & 20lbs for
30 min• Newer models - Aldehyde vapors• Carbon steel, burs and pliers • Load only dry instruments
Boiling water• Spores not killed• High level disinfection• Instruments submerged completely at
98 -100˚C for 10 min
Dry Heat• Above 160˚C for 30 - 90 min• Foil wraps and nylon bags used• No rust, corrosion• No instrument damage
Ethylene oxide• Best for complex and delicate materials• Below 100˚C for hours and at room
temp overnight• Porous & plastics to be aerated 24hrs
UV Light - not effective against HIV, bacterial spores
Sterilization indicators – change color
Disinfectants• 2 – 3 % Gluteraldehydes • Kill bacterial spores in 6-10 hrs• High level disinfection of plastic cheek
retractors, mirrors
Ultra Sonic Cleaners
- best way for sharp instruments
- fast and thorough cleaning
- no damage
Hand piecesScrub – Disinfect – Sterilize
• Autoclave – most rapid• Fiber optics - detergents & alcohol• Ceramic bearing turbine – avoid chemicals
Ethylene oxide (ETOX)• Gentlest method
Inherent water system contamination
• Biofilm• Microbial filters• Biocide solutions overnight• Iodophore, Sod.Hypochlorite
Impression disinfection
• Trays in plastic bags during try-in
• Custom trays preferred
• Send impressions in biohazard-labeled plastic bag
• Submerge in 2%Potassium sulfate
“If not do good, Do no harm”
A Hope !!
Thank u