DENTISTRY DR ZIA UR REHMAN KHALIL ASSISTANT PROFESSOR COMMUNITY - - PowerPoint PPT Presentation

INFECTION CONTROL IN DENTISTRY

DR ZIA UR REHMAN KHALIL ASSISTANT PROFESSOR COMMUNITY AND PREVENTIVE DENTISTRY

CONTENTS

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• Introduction
• Mode of Transmission
• Mode of Infection control
• Objective of Infection control
• Operatory Asepsis
• Personal Protection Barrier
• Sterilization
• Disinfection
• Laboratory Infection Control
• Clinical Waste Disposal.

DEFINITIONS

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• INFECTION CONTROL – Also called

“exposure control plan” by OSHA is a required designed

• ffice

to program that is protect personnel against risks of exposure to infection.

The Occupational Safety and Health Administration (OSHA)

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STERILIZATION:

• Use
• f

a procedure physical

• r

chemical to destroy all microorganisms including substantial numbers of resistant bacterial spores.

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• Sterilization means the destruction of all life
• forms. (Ronald B Luftig).
• Sterilization

is removing all PLAYFAIR) the process viable

• rganisms.
• f

killing

• r

(MIMS –

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• STERILE:

–Free from all living microorganisms; usually described as a probability (e.g., the probability

• f

a surviving microorganism being 1 in 1 million).

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DISINFECTION:

• Destruction of pathogenic and other kinds
• f microorganisms by physical or chemical

means.

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• Disinfection is less lethal than sterilization,

because it destroys the majority of recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., bacterial spores).

• Disinfection is a process of removing or killing

most, but not all, viable organisms.

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• DISINFECTANT: A chemical agent used on

inanimate objects to destroy virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., bacterial endospores).

MODES OF DISEASES TRANSMISSION

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 Direct contact with blood or body fluids  Indirect contact with a contaminated

instrument or surface.eg dental assistant or sweeper

 Contact of mucosa of the eyes, nose, or

mouth with droplets or spatter

 Inhalation of airborne microorganisms

MODES OF TRANSMISSION:

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Chain of infection

Infectious agent Reservoirs Portal of exit Means of transmission

Six links in chain of transmission of infection

Portal of entry Susceptible host

The Chain of Infection Components

 Infectious Agent-any potential pathogen (bacteria,

virus, fungi, etc.)

 Reservoir-where the pathogen lives (a person, on

equipment, surfaces, instruments, etc)

 Portal of exit- how the infectious agent leaves its

reservoir and reach a new host.

 Transmission-direct, indirect, airborne, droplet  Portal of entry- how the infectious agent gets into the

new host (bloodstream, mucous membrane, etc.)

 Susceptible host-someone who is not immune

MODES OF TRANSMISSION:

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Chain of infection

Infectious agent eg Hep B Reservoirs

bloodstream

Portal of exit

Bleeding wound

Means of transmission Direct via needle stick

Six links in chain of transmission of infection

Portal of entry Puncture wound Susceptible host Unvaccinated Dental worker

OBJECTIVES OF INFECTION CONTROL

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Reduce Implement Simplify Protect

WHY , WHO AND WHAT

15 Why is infection control necessary in dentistry ?

• Dental staff and patients may be exposed to a wide

variety of pathogenic microorganisms .

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• Who is responsible

for infection control in the dental office ?

– Each member of the dental team must follow the recommended guidelines .

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• What

should be done to prevent the transmission of disease in the dental office ?

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The most effective ways to prevent the transmission of diseases includes : 1) Hand washing 2) Gloves 3) Face masks 4) Protective eye wear 5) Protective clothing 6) Instrument sterilization and disinfection

DISEASES TRANSMISSION IN DENTAL OFFICE

19 Diseases Transmission in Dental Office The dental office should have an infection control program to prevent the transmission of disease from the following :

• Patient to dental team
• Dental team to patient
• Patient to patient
• Dental office to community ( include dental team’s

family )

• Community to dental office to patient

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• To prevent such infections, following is a list
• f all those procedures and precautions that

together constitute infection control.

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• These guidelines should be followed each

time treatment is performed because we are never certain of the patient's status, either because they themselves do not know or because they have chosen not to inform their healthcare providers of their condition.

• Following

these guidelines for every patient is called "Standard Precautions".

• 1. Immunization
• 2. Patient screening
• 3. Hand washing
• 4. Barrier techniques -
• Personal Protective Equipment (PPE)
• Rubber dam, Pre-procedural rinsing
• 5. Needle & sharp instrument safety
• Occupational Exposure To Blood/Body Fluids

6.Instruments sterilization and disinfection 7.Surface disinfection

• 8. Radiographic asepsis
• 9. Laboratory asepsis

10.Infectious dental waste management & disposal

STANDARD PRECAUTIONS

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PERSONAL PROTECTIVE EQUIPMENT ( PPE )

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• OSHA requires the employer to provide employees

with appropriate personal protective equipment .

• Examples of PPE:

1 Protective clothing 2 Surgical masks 3 Face shields 4 Protective eyewear 5Disposable patient treatment gloves 6- Heavy-duty utility gloves

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These PPE must be used whenever you :

• Performing tasks that could produce

splash or spatter .

• Any contact with body fluids
• Perform
• ther

clinical activities that require handling contaminated items e.g. radiographs , impressions , dentures or contaminated equipment and surfaces .

HAND HYGIENE

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Hand washing is the single most important procedure for preventing the spread

• f
• infection. So , you must wash your hands each

time before you put on gloves and immediately after you remove gloves .

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• Hand washing is also required if you touch

contaminated instruments or surfaces during working

• We should always use liquid soap during hand

washing . Bar soap should never be used because it may transmit contamination.

• Visibly dirty
• After touching

contaminated objects with bare hands

• Before and after patient

treatment (before glove placement and after glove removal) HANDS NEED TO BE CLEANED WHEN

OPERATORY ASEPSIS

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• In

the dental

• peratory,

environmental surfaces (i.e., a surface or equipment that does not contact patients directly) can become contaminated during patient care.

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• Certain

surfaces, especially

• nes

touched frequently (e.g., light handles, unit switches, and drawer knobs) can serve as reservoirs of microbial contamination, although they have not been associated directly with transmission

• f infection to either personnel or patients.

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• Transfer
• f

microorganisms from contaminated environmental surfaces to patients occurs primarily through personnel hand contact

A. INFECTION CONTROL DURING THE PRETREATMENT PERIOD

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• The process of infection control begins during

the period of preparation for clinical treatment.

• Paying attention to infection control at this time

has several payoffs.

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• In

addition transmission to reducing

• f

infectious the risk

• f

agents during patient care, thinking ahead will make the treatment session more efficient and will also make the post treatment infection control process easier and more effective.

• 1. REMOVE UNNECESSARY ITEMS

FROM THE DENTAL PROCEDURE AREA The dental procedure area should be arranged to facilitate a thorough cleaning following each patient.

• 2. PRE PLAN THE MATERIALS NEEDED

DURING TREATMENT

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• Set
• ut

all instruments, medications, impression materials, and other items that are needed for a procedure.

• Thinking ahead minimizes the need to
• r to

search for additional cabinets and drawers items

• nce

gloves enter have become contaminated.

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• 3. Utilize disposable items whenever possible:

The use of disposable items saves time during cleanup and decontamination and solves the problem of proper reprocessing.

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• 4. Use prearranged tray set-ups for routine or

frequently performed procedures. –Helps to eliminate the need to go into cabinets once you have started a procedure.

5.Use individualized, sterilized bur blocks for each procedure

• Using individualized bur blocks containing only

the burs required for that procedure helps to eliminate the contamination of other, unneeded burs and to make clean-up easier.

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• 6. If indicated, have the rubber dam setup on

the tray. When a rubber dam will be used during a clinical procedure, it also should be included on the tray

• setup. In addition, include those items needed

for high-velocity evacuation.

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• 7. Identify those items that will become contaminated

during treatment.

• While preparing the dental procedure area prior to

beginning a clinical procedure, consider which items will become contaminated during treatment.

• Examples of such surfaces include countertops, light

handles, X-ray unit heads, tray tables etc.

• Decide whether to use a barrier, e.g., plastic wrap to

prevent contamination of these surfaces and items or to disinfect them when the procedure is complete.

Surface barriers :

• Surface barriers are used to

prevent contamination on the surface underneath.

• All

the surface barriers should be resistant to fluids in

• rder

to microorganisms in prevent saliva, blood, and other liquids from barrier surface soaking through the and reach the underneath. Chair Drapes 40

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• 8. Review

treatment view box. patient records before initiating and place radiographs

• n the
• Do not leave the record on the countertop or

handle it after beginning treatment.

• Place the record in a drawer or out of the

dental procedure area, so that it doesn’t become contaminated.

• Entries into

the record should be done before and after the procedure.

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• 9. Prepare personnel involved in patient

care.

• An essential pretreatment procedure is the

preparation of all personnel involved in patient care.

• This includes the utilization of personal

protective equipment (gown, eyewear, mask and gloves) and hand hygiene.

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• B. INFECTION CONTROL DURING THE

TREATMENT PERIOD (CHAIRSIDE INFECTION CONTROL )

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The infection control procedures described in the previous period will help you to reduce the risk of transmission of infectious agents. During treatment there additional are precautions that can be taken to further reduce infection risks.

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• 1. Use care when receiving, handling, or

passing sharp instruments

• 2. T

ake special precautions with syringes and needles.

• 3. Use a rubber dam whenever possible
• 4. Avoid

touching unprotected switches, handles and other equipment once gloves have been contaminated.

• 5. Avoid entering cabinets once gloves have

been contaminated.

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• C. INFECTION CONTROL DURING

THE POST- TREATMENT PERIOD

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 Continue to wear personal protective equipment during clean-up: After patient care is completed, begin the cleaning and disinfection process by removing contaminated gloves used during treatment, wash your hands and use the utility gloves before beginning the clean up. Continue to wear protective eyewear, mask, and gown.

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 Remove all disposable barriers : All of the barriers placed before treatment, including light handle covers and countertop barriers, should be removed.  Clean and disinfect all items not protected by barriers.

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

Cleaning and disinfection of the dental treatment room surfaces are important components in an effective infection control program  The laboratory studies have proved that microorganisms may survive

• n

environmental surfaces for long time . For example, Mycobacterium tuberculosis may survive for weeks

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STERILIZATION AND DISINFECTION OF DENTAL INSTRUMENTS

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DENTAL INSTRUMENTS

Classification based on risk of transmission and need of sterilization

• CRITICAL
• SEMI-CRITICAL
• NON-CRITICAL

CRITICAL INSTRUMENTS

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• Penetrate MUCOUS MEMBRANES or CONTACT

BONE, BLOODSTREAM, or other normally sterile tissues

• HEAT STERILIZE between uses or use sterile single-

use, DISPOSABLE devices

• Examples include SURGICAL INSTRUMENTS,

SCALPEL BLADES, PERIODONTAL SCALERS, AND SURGICAL DENTAL BURS

SEMI-CRITICAL INSTRUMENTS

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• Contact MUCOUS MEMBRANES but do NOT

PENETRATE SOFT TISSUE

• HEAT STERILIZE or HIGH-LEVEL DISINFECT
• Examples:

DENTAL MOUTH MIRRORS, AMALGAM CONDENSERS, AND DENT AL HANDPIECES

NON CRITICAL INSTRUMENTS AND DEVICES

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• Contact intact SKIN
• Clean

and disinfect using a LOW TO INTERMEDIATE LEVEL DISINFECTANT

• Examples: X-RA

Y HEADS, FACEBOWS, PULSE OXIMETER, BLOOD PRESSURE CUFF

STERILIZATION

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• Stages for instrument sterilization:
• 1. Presoaking
• 2. Cleaning
• 3. Corrosion control and lubrication
• 4. Packaging
• 5. Sterilization
• 6. Handling sterile instruments
• 7. Storage
• 8. Distribution

AGENTS USED IN STERILIZATION

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• Physical agents:
• 1. Sunlight
• 2. Drying
• 3. Dryheat: flaming, incineration, hot air
• 4. Moist heat: pasteurization, boiling, steam under

pressure, steam under normal pressure.

• 5. Filtration: candles asbestos pads, membranes
• 6. Radiation
• 7. Ultrasonic and sonic vibrations

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• Chemical agents:
• 1. Alcohols: ethyl, isopropyl, trichlorobutanol
• 2. Aldehydes: formaldehyde, glutaraldehyde
• 3. Dyes
• 4. Halogens
• 5. Phenols
• 6. Surface-active agents
• 7. Metallic salts
• 8. Gases: ethylene oxide, formaldehyde, beta

propiolactone.

THE 4 ACCEPTED METHODS OF STERILIZATION ARE:

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• Steam pressure sterilization (autoclave)
• Chemical vapor pressure sterilization-

(chemiclave)

• Dry heat sterilization (dryclave)
• Ethylene oxide sterilization

AUTOCLAVE

• Sterilization with STEAM UNDER PRESSURE
• Time required at 1210 C is 15 mins at 15 lbs of

pressure. Advantages

• Rapid and effective
• Effective for sterilizing cloth surgical

packs and towel packs Disadvantages

• Items sensitive to heat cannot be sterilized
• It tends to corrode carbon steel burs

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and instruments

CHEMICLAVING

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Sterilization by CHEMICAL VAPOR UNDER PRESSURE

• operates at 1310 C and 20 lbs of pressure.
• They have a cycle time of half an hour.

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• Advantages
• Carbon steel and other carbon sensitive burs,

instruments and pliers are sterilized without rust

• r corrosion
• Disadvantages
• Items sensitive to elevated temperature will be

damaged

• Instruments must be very lightly packed.
• Towel and heavy clothing cannot be sterilized.

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DRY HEAT STERILIZATION

69 Conventional dry heat ovens:

• Achieved at temperature above 1600 C.
• Have heated chambers that allow air to circulate by gravity

flow.

• 6-12mins is required for sterilization

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• Disadvantages
• Without careful calibration, more chances

sterilization failures – The most accurate way to calibrate a sterilization cycle is by using external temperature gauge (pyrometer) attached to a thermocouple wire.

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ETHYLENE OXIDE STERILIZATION (ETO)

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MOBILE FUMIGA TOR

DISINFECTION OF DENTAL UNIT AND ENVIRONMENTAL SURFACES

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DISINFECTION

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• Disinfection is always at least a two-step

procedure:

• The initial step involves vigorous scrubbing of

the surfaces to be disinfected and wiping them clean.

• The second step involves wetting the surface

with a disinfectant and leaving it wet for the time prescribed by the manufacturer.

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• The ideal disinfectant has the following

properties:

• 1. Broad spectrum of activity
• 2. Acts rapidly
• 3. Non corrosive
• 4. Environment friendly
• 5. Is free of volatile organic compounds
• 6. Nontoxic & nonstaining

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• High-level disinfection: Disinfection

process that inactivates vegetative bacteria, mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores.

INCOMING ITEMS

p

• Rinse under running tap

water to remove blood/saliva

• Disinfect as appropriate
• Rinse thoroughly with ta

water to remove residual disinfectant

• No single disinfectant is

ideal or compatible with all items

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OUTGOING ITEMS

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• Clean and disinfect before

delivery to patient

• After disinfection: rinse and

place in plastic bag with diluted mouthwash until insertion

• Do not store in disinfectant

before insertion

• Label the plastic bag: “This

case shipment has been disinfected with for minutes”

FLUSHING WATERLINES

• All dental waterlines and hand pieces should

be flushed in the mornings and between patients.

• Although this will not remove bio-films from

the lines, it may temporarily reduce the microbial count in the water.

FLUSHING WATERLINES

• It will help clean the hand piece waterlines of

materials that may have entered from the patient’s mouth.

• Flushing also brings a fresh supply of

chlorinated water from the main waterlines into the dental unit.

THANK YOU