INFECTION CONTROL

WHAT IS INFECTION CONTROL

• Infection control refers to policies and procedures used to minimize
the risk of spreading infections, especially in hospitals and healthcare
facilities.
Infection:
Invasion of the body by harmful microorganisms or parasites.

Transmission:
Passing of a pathogen causing communicable disease from infected host
individual to another.
 MODES OF TRANSMISSION OF
INFECTIONS
1-Direct transmission
A-Direct contact (touching-kissing-sexual)
B-droplet spread (sneezing-coughing)
2-Indirect transmission
A-airborne (tiny particles staying in air for a long time)
B-vehicle borne (objects or surfaces)
C-vector borne (carrier living organism)
 ROOTS OF ENTRY
The three principal routes of entry of microorganisms into the body are:
1. Inhalation
a. Direct inhalation:
• Inhalation of small particles of moisture (spatter) generated
from coughing or sneezing, or from aerosolized water during
dental procedures.
• The risk of disease transmission is usually limited to persons
close to the droplet source.
b. Indirect inhalation:
• Inhalation of particles <5 microns in diameter formed by
dehydration of droplets containing microorganisms that can
remain suspended in the air for long periods.
2. Ingestion:
Whereby droplets of saliva/blood or particles from instruments are
swallowed.

3. skin or mucous membrane:

(Autoinoculation/percutaneous injury)
➢Autoinoculation occurs when the operator touches his/her mucous
membrane or nonintact skin surface with contaminated items.
➢Percutaneous injuries are those that occur as a result of breaking the
skin with a contaminated sharp instrument.
 AIM OF INFECTION CONTROL

➢Infection control aims to create and maintain a safe clinical

environment to eliminate the potential for disease transmission from
the dentist to the patient, the patient to the dentist, or from patient to
patient.
❖ Dental procedures and instruments are associated with widely
variant amounts of body fluids. Hence, infection control should be
procedurally based and not patient-based.
 STANDARD PRECAUTIONS
Standard Precautions are the minimum infection control practices
that apply to all patient care, regardless of suspected or confirmed
infection status of the patient. Standard Precautions include:
1. Hand hygiene.
2. Use of personal protective equipment (e.g., gloves, masks, eyewear).
3. Respiratory hygiene/cough etiquette.
4. Sharps safety .
5. Safe injection practices.
6. Sterile instruments and devices.
7. Clean and disinfected environmental surfaces.
COMPONENTS OF INFECTION CONTROL

1. Immunization
2. Patient screening
3. Hand hygiene
4. Barrier techniques(PPE)
5. Needle and sharp instrument safety
6. Instrument sterilization and disinfection
7. Surface disinfection and general operatory asepsis
8. Radiographic asepsis*
9. Laboratory asepsis*
10. Disposal of contaminated wastes
 1. Immunization
➢Dental personnel can reduce the risk of infectious diseases by maintaining
their health and immune status.
➢Following the series of hepatitis B vaccinations, there should be confirmation
that an adequate antibody titer has been reached (10 Units/liter).
➢ Dental personnel should maintain up-to-date immunization records that
include vaccination against:
a. Hepatitis B
b. Rubella
c. Measles
d. Mumps
e. Influenza
f. Poliomyelitis
g. Tetanus/diphtheria
 2. Patient Screening

➢ Complete medical history should be taken for every new patient and
updated during recall appointments to determine infectious status.
➢ Blood Screening is beneficial when patients report positive disease
status for blood-borne disease.
 3. Hand Hygiene
➢Hand hygiene in health care facilities is the most important aseptic
procedure in the prevention of health care associated infections.
➢ Hand hygiene significantly reduces microbes on the hands and
protects both patients and the dental staff.
➢The purpose of washing is:
1-to Reduce transient and resident flora for the duration of a
procedure to protect the operator if there is nonintact skin on the
hand.
2-to Reduce the number of organisms to which the patient is
exposed if the gloves are nonintact.
Handwashing products
➢ include plain soap and agents with antimicrobial activity.
➢The wearing of gloves does not replace handwashing but is an
adjunct providing consistent protection from blood-borne pathogens.

Hand hygiene is important because:

1. Hands are the most common mode of pathogen transmission
2. Reduce the spread of antimicrobial resistance
3. Prevent health care associated infections
➢ Although handwashing depends primarily on a mechanical effect
and any liquid soap is acceptable, thorough handwashing with a
chemically active anti-microbial soap is recommended because skin
bacteria can rapidly multiply under gloves if hands are washed with
non-antimicrobial soap.
➢Bar soaps are not recommended.
 Effective antimicrobial agents in hand soap:
a. (2-4)% Chlorhexidine
b. (0.3-1)% Triclosan
c. 0.6% Parachlorometaxylenol (Pcmx)
d. (60-70)% Propanol
• In addition, chlorhexidine and triclosan exhibit substantivity or a
residual effect.
Components of Good Handwashing Include
1. Cleaning nails and skin thoroughly to remove all visible soil.
2. Rinsing well to remove all visible soap.
3. Drying thoroughly to reduce the risk of skin chapping.
Indications for Hand Hygiene
a. When hands are visibly soiled
b. After barehanded touching of objects likely to be contaminated
by blood, saliva, or respiratory secretions
c. Before and after treating each patient and before leaving any area
in the healthcare facility.
d. Before putting on gloves
e. Immediately after removing gloves
 Barrier Techniques — Personal Protective
Equipment (PPE)
➢Personal protective equipment (PPE) is designed to protect the skin
and the mucous membranes of the eyes, nose, and mouth from
exposure to blood.
➢ Use of PPE is dictated by the exposure risk posed by the
procedure, not by the known or suspected serologic status of the
patient.
➢ Primary PPE used in health care settings includes gloves, masks,
protective eyewear, face shields, and protective clothing (e.g. long
long-sleeved gowns, jackets).
➢Shoe and head covers are less frequently used types of PPE but should
be considered if contamination is likely.
➢ Personal protective equipment should be placed in the following
order:
1. Clothing
2. Mask
3. Glasses
4. Wash hands, place gloves.

➢ Removal of PPE:
1. Gloves
2. Mask
3. Glasses
4. Clothing, Wash hands.
1. Protective Clothing
➢ Protective outerwear is worn to reduce exposure to debris in the spatter.
➢ Clinic outerwear is to be fully buttoned, has long sleeves with elasticized
cuffs and a high neck.
➢In all cases, clothing must be changed daily, although clothing that has
become visibly soiled must be changed immediately.
➢Contaminated clinical wear should be taken home in a plastic bag
and laundered using a high-temperature cycle (60-70°C) with a
normal bleach concentration followed by machine drying (100°C or
more), (or dry cleaned).
➢Use of disposable gowns may be considered when performing
surgical procedures and treating known carriers of infectious diseases
(e.g. HIV positive and HBsAg positive patients).
 2. Masks
Dental health care workers must wear masks when:
1- a spatter of blood or body fluids is likely (e.g. when using handpieces).
Protection from these masks only affords protection for those particles 5 μm
and larger.
2- Masks must also be worn if dental personnel have transmissible
respiratory infections.
To ensure the effectiveness of masks in protection:
1. Place by covering the mouth and nose completely and adjust
firmly on the bridge of the nose
2. Once placed, masks should not be touched
3. Visibly soiled or moist masks should be changed •
4. When a mask is no longer necessary for patient care it should be
removed and discarded
5. Masks should be removed and discarded when using the phone
or leaving the clinic
6. Masks that have been removed should be discarded, not handled
bare-handed except for removal.
 3. Protective Eyewear

Protective eyewear must be worn by patients and all clinical

personnel:
1. When performing procedures that can cause spatter or aerosols.
2. When performing procedures that produce projectiles.
3. When it is likely that eyes will be exposed to any type of physical
injury or splashes from toxic chemicals (e.g. sodium hypochlorite)
➢Everyday eyewear may not provide sufficient protection from spatter
(special protective glasses or goggles are required). .
➢All eye protection must be disinfected between patients to avoid
possible contamination or infection.
 4. Gloves

➢Gloves reduce hand contamination, particularly from pathogens that

result in infection.
➢The use of gloves does not eliminate the need for handwashing both
before placement and following removal of gloves.
➢Gloves should not be used when greeting patients, or handling records
or radiographs.
➢Gloves are task-specific.
➢Gloves reduce hand contamination by 70 to 80%,prevent
cross-contamination and protect patients and dentists from
infection.

The different types of gloves worn in the dental office are:

1- Examination gloves
2- Over or cover gloves
3- Utility gloves
4-Surgical gloves
1-Examination/treatment gloves
➢(latex, vinyl, nitrile, neoprene)
➢ use:
1- contact with blood, saliva, mucous membranes or
2-blood/saliva-contaminated objects or surfaces are expected
3- under utility gloves during cleaning.
➢ A new pair of gloves is worn for each patient
➢Once treatment gloves have been placed, nothing else should be
touched other than the patient and instruments and supplies that
have been prepared for the use of that patient.
➢Treatment gloves are covered with over gloves when leaving the
operatory to access any other part of the clinic (except when using the
telephone).
➢ Treatment gloves (and masks) should be removed when leaving the
clinic.
➢ Gloves (and mask) should be removed when using the telephone
➢ Hands are washed before placement and immediately following
removal of gloves.
2- Over gloves/cover gloves
➢The purpose of these gloves is:
1- to reduce the number of treatment gloves used,
2- to use time more efficiently when supplies or equipment
need to be accessed
3-to reduce the number of washes required due to glove
changing
➢ Care must be taken to avoid contamination of the outside of
the over gloves by touching your clothing, hair, mask,or
glasses.
➢Over gloves are not used directly on any item that will be
used in the mouth, e.g. rubber dam, fluoride trays.
Over gloves are used when:
1. Supplies or equipment are retrieved or returned from the unit.
2. The operator is charting
Any item that will be used directly in the mouth is not to be handled
directly with over gloves.
3- Utility gloves
➢Heavy-duty utility gloves should be used during all disinfection and
cleaning procedures to reduce the increased risk of percutaneous
injury during instrument cleaning.
➢For postoperative cleaning, treatment gloves are worn under utility
gloves to afford protection to the operator when placing the utility
gloves in their sterilization bag.
4-Sterile surgical gloves
➢ Sterile surgical gloves should be worn when performing oral surgical
procedures.
➢ The effectiveness of wearing two pairs of gloves to prevent disease
transmission during oral surgical procedures is unclear.
 5. Needle and Sharp Instrument Safety

➢Needle stick/sharp instrument injuries are of

major concern to healthcare workers.

➢ Sharp ends of any instrument or device should

be angled away from both the doctor and the
coworkers when receiving, handling or passing
such instruments.

➢ Used needles should not be bent or broken

before disposal.
➢Unsheathed needles are placed directly into
the designated, puncture-proof disposal
container along with any other sharp
instruments

➢ to recap a needle between injections, a one-

handed “scoop” technique or a mechanical
device designed to hold the needle sheath is
recommended.
➢ Sharp instruments or corrosive liquids should not be passed over the
patient’s face.
 Occupational exposure to blood/body fluids:
Exposures to human blood/body fluids include :
1-puncture wounds due to a needle stick or sharp instrument
2-scratches
3-exposures due to a splash of body fluid onto any mucous membrane
and/or non-intact skin.
These incidents are termed “significant exposures”.
Postexposure Protocol for Occupational Exposure to Blood/Body
Fluids
1. Stop the procedure immediately
2. Inform patient
3. Remove gloves
4. Injuries to the skin should be washed well with soap and running
water and bleeding can be encouraged while washing.
5. First aid measures should be applied to stop bleeding if required
6. Mucous membranes should be flushed well with
water(When splashes have occurred to the eye, the eyewash
station is to be used to thoroughly flush the eyes)
7. Clinical support staff should be notified to arrange for
the completion of the treatment
8. The clinical support staff should ask the patient to
submit blood for the appropriate blood tests for HIV, etc
 6. Instrument Sterilization and Disinfection
Sterilization:
A process which will destroy all forms of life of microorganisms.
Disinfection
The destruction or inhibition of most pathogenic agents on inanimate
objects by chemical or physical means(spores are not removed)
Used for instruments, equipment, and surfaces that do not require
sterility or cannot be practically sterilized
Sanitization
The process of removing organic debris and some bacteria
Classification of dental instruments:
according to their use which in turn determines how they will be
decontaminated, Dental instruments are classified into three categories

1-Critical:
Surgical and other instruments used to penetrate soft tissue or bone are
classified as critical and should be sterilized after each use.
These devices include :
forceps, scalpels, bone chisels, scalers, and burs.
2-Semicritical:
➢Instruments such as mirrors and amalgam condensers that do not
penetrate soft tissues or bone but contact oral tissues are classified as
semicritical.
➢These instruments should be sterilized after each use.
➢If, however, sterilization is not feasible because the instrument will be
damaged by heat, the instrument should receive, at a minimum, high-
level disinfection.
3-Noncritical:
➢Instruments or medical devices such as external components of x-ray
heads that come into contact only with intact skin are classified as
noncritical.
➢ Because these noncritical surfaces have a relatively low risk of
transmitting infection, they may be reprocessed between patients with
intermediate-level or low-level disinfection or detergent and water
washing, depending on the nature of the surface and the degree and
nature of the contamination
 Sterilization
➢Instruments which can tolerate heat are generally sterilized
by one of the following methods
1. Steam under pressure.
2. Dry heat.
3. Chemical vapor.

➢Instruments that cannot tolerate heat are processed with:

1- high-level disinfectants
2-low temperature sterilization(e.g. ethylene oxide gas ).
1. Steam, Vapor Under Pressure (Autoclave)
➢ exposure to direct steam contact at the required temperature and
pressure for the specified time.
➢High temperature of the steam, 121 to 132°C .
➢ The time required to kill microorganisms is 3 to 20 minutes,
depending on the type of sterilizer and wrapping.
2-Dry heat
➢Dry heat is less efficient than moist heat because as proteins
dehydrate and dry, their resistance increases.
➢A higher temperature is required for a dry heat unit than for a steam
processor.
 3. Chemical Vapor (Chemiclave)
Chemical vapor sterilizers use a specific mixture of formaldehyde and
other chemicals with water under pressure at 132°C to achieve
sterilization.
Sterilization requires 20 to 40 minutes
 7. Surface Disinfection and General
Operatory Asepsis
➢ Contaminated surfaces are disinfected routinely following each
patient visit.
➢ These include but are not limited to the following:
countertops, mobile air/water syringe handles, suction and saliva
ejector couplings, dental chair, operator and assistant stools, soap and
towel dispenser areas and X-ray viewer and switch.
➢ Preclean and dry all surfaces prior to disinfection. this removal of
organic material(e.g. blood and body fluids) is critical since
disinfectants are not effective in the presence of organic matter.
➢ Water-based disinfectants, particularly those that contain a detergent
are more effective than alcohol-based disinfectants.
➢ Utility gloves are used during disinfection to reduce risk to the
operator from pathogens as well as the chemical disinfectant.
 10. Disposal of Contaminated Wastes

• Disposable materials such as gloves,

masks, wipes and surface covers
that are contaminated with body
fluids should be carefully handled
with gloves and discarded in
durable, impermeable plastic bags
to minimize human contact.
Biomedical waste or infectious waste includes:
1. Anatomical waste:
a. Human anatomical waste
Human tissues, organs and body parts, but excluding teeth, hair and
nails
b. Animal anatomical waste
2. Nonanatomical waste
a. Microbiology laboratory waste
Lab cultures, stocks or specimens, vaccines.

b. Blood and body fluid waste

blood and blood products, items saturated with blood, and body
fluids excluding urine or feces

c. Waste sharps
needles, syringes, blades or laboratory glass capable of causing cuts
or punctures.