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Infection Control In Dentistry

Author Dr. Bhuvan Venigalla MDS,

Associate Professor, Dept Cons & Endodontics

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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

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Patient

Health care environment

Health care Instruments worker & equipment

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Modes of Contamination

Airborne Dental Unit Water spray system

Saliva, Tissues, Blood, Plaque, Cut tooth debris

Based on size of droplets

Aerosol

Mist

Spatter

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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 ?

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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

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Penny wise ,

Pound foolish !!

Ignorance

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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

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• 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 ?

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Infection Control - A way to build practice

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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

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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

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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

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• 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

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Wearing & Removing gloves

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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%)

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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

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• 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

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• 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

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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

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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

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Sterilization

• Steam pressure (Autoclave)• Chemical vapour pressure (Chemiclave)• Dry heat (Dryclave)• Ethylene oxide

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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

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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

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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

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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

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Ultra Sonic Cleaners

- best way for sharp instruments

- fast and thorough cleaning

- no damage

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Hand piecesScrub – Disinfect – Sterilize

• Autoclave – most rapid• Fiber optics - detergents & alcohol• Ceramic bearing turbine – avoid chemicals

Ethylene oxide (ETOX)• Gentlest method

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Inherent water system contamination

• Biofilm• Microbial filters• Biocide solutions overnight• Iodophore, Sod.Hypochlorite

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Impression disinfection

• Trays in plastic bags during try-in

• Custom trays preferred

• Send impressions in biohazard-labeled plastic bag

• Submerge in 2%Potassium sulfate

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“If not do good, Do no harm”

A Hope !!

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Thank u


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