Infection control in dentistry

Done by:
M.Janani sri
3rd year
B.D.S
Table of contents:
• Introduction
• Categories under risk
• Vaccines for dental health care workers
• Personal barrier techniques
• Use and care of instruments
• Sterilization and disinfection of instruments
• Cleaning and disinfection of dental unit and environmental surfaces
• Disinfection and dental laboratory
• Use and care of handpieces
• Handling of biopsy specimens
• Use of extracteted teeth in dental educational settings
• Conclusion
 Introduction

• Infection : Process of invasion of the tissue by organisms characterized by their

multiplication in the body of the host to produce disease.
• Infection control statergy - for all health care workers
• Centres for disease control and prevention- blood and body fluid precautions -universal
precautions
• 1970-1987: Dental health care worker to patients - Hbv
• After 1987 it is not reported - universal precautions
Categories of task in relation to risk
According to risk of infection:
• Category -1: Tasks involve exposures to blood,body fluids and tissues Eg :Dental
hygienist, Dentist
• Category-2: Tasks do not involve routine exposure to blood , body fluids tissues but
unplanned category 1 tasks can occasionally required. Eg:Clerical and Non
professional workers,
• Category-3: No exposure to blood,body fluids and tissues. Eg: Front
office receptionist, Book keeper
• The American Dental Association (ADA) and occupational safety and
health act (OSHA) guidelines - All category 1 and 2 trained in Infection control to
prevent themselves and patients.
Vaccines for Dental health care workers

• OSHA blood borne pathogens final rule : Employers makes Hepatitis B vaccinations
available without cost to their employees
• CDC recommends all DHCW’s ( exposed or non exposed to blood ) in occupational
setting -vaccinated for Hepatitis B
• Vaccines against other vaccine preventable disease like Mumps, measles, rubella and
tetanus are given.
Personal barrier techniques for infection control
• Washing and Care of hands:Before and after each patient and after
barehanded touch of inanimate object contaminated with blood or body fluids
• Soap and water :remove transient micro organisms acquired Nope.
directly or indirectly
• Soap an. Surgical procedures- Antimicrobial surgical hand scrub
• Punctured or cut gloves removed as soon as patient safety permits , wash hands and
reglove to complete procedure
• DHCW’s - exudative lesions or weeping dermatitis in hands prevented from all direct
patient contact
• Gloves: Medical gloves (Latex / Vinyl) always worn by DHCW’s. Non
sterile - non surgical procedures. Sterile -surgical procedures(not to be washed
before use and not reused).Washing causes wicking. Disinfecting treatment-
deterioration of gloves.
• Gowns: Protective clothing- reusable or disposable gowns should be worn.When
likely to be soiled with blood or body fluids.Reusable - washed in normal laundry
cycle. Clothing changed at least daily or after soiled and removed when entering
personal exit areas.
• Masks and protective eye wear: splashing or spattering of blood and body
fluids common in dentistry. Changed between patients.
Use and care of Instruments
• Sharp instruments( needles scalpel blades) - contaminated should be handled with care to
prevent injuries .
• Used needles should never be recapped.
• One handed scoop technique or mechanical device - holding needle sheat is employed
• Used disposable syringes ,needles and scalpel blades- Puncture resistant containers
• For non disposable syringes - recapped and removed to prevent injuries
• For multiple injection with single needle- placed where it will not contaminate or needlestick
injury
Sterilization and disinfection of instruments
• Sterilization:Destroys /eliminates all forms of microbial life. Physical and chemical
methods . Steam under pressure, dry heat and liquid chemicals
• Chemical destroys all forms of micro organism-chemical sterilants
• Disinfection: Eliminates many or all pathogenic microorganisms except bacterial
spores on inanimate objects.
• Health care settings- liquid chemical or wet pasteurization.
• High level disinfectants - 2% glutaraldehyde 20 mins kills all microorganisms except
large number of bacterial spores.
• Low level disinfectants - <10 mins kills most vegetative bacteria ,some fungi, some
viruses. Phenols and iodophores
• Intermediate level disinfectants - cidal for vegetative bacteria , most viruses, most
fungi but not kill bacterial spores. Alcohol and chlorine
Classification of dental instruments
• Depending on their risk of transmitting infection and need to sterilise between use - 3
categories :critical , semi critical, Non critical
• Critical: Penetrate soft tissues and bone ,sterilize after each use. Eg:forceps scalpels , bone
chisels , scalers and burs.
• Semi critical: Do not penetrate soft tissue / bones but contact oral tissue. Sterilized after
each use with high level disinfectants. Eg: mouth mirrors and amalgam condensers
• Non critical: Instruments / medical devices such as external components of x-ray heads.
Low risk . Intermediate or low level disinfectants, detergent and water used based on
nature and surface
• Before sterilization - clean thoroughly to remove debris
• Placing instrument into water or disinfectant as soon as use prevent drying and make
cleaning easy.
• Use of covered ultrasonic cleaners - increases efficiency of cleaning and reduce
handling of sharp instruments.
• All critical and semicritical dental heat stable instruments should be
sterilized.
• 3 common methods :
• steam autoclave
• Dry heat
• Chemical vapour
• Other methods: Exposure to ethylene oxide gas , boiling water, Ionizing radiation.
 Autoclave
• Efficient, reliable, rapid method except for oils,greases and powders
• 121 degree celcius 15 lbs 15 mins - all micro organisms destroyed
• Major problem: excess moisture ,air entrapment and severe wetting
• Spore strips - deepest layer to check sterilization
• Bacillus stearothermophillus
Unsaturated chemical vapour steriliser
• Special chemical solution :Formaldehyde and alcohol
• Advantage :reduced corrosion of metal items.
• Specified wrapping material should be used
Dry heat steriliser
• Standard operates temperature of 320 degree Fahrenheit for exposure times of 60-120 minutes
• Closed containers can be used
• Another type - utilizes a controlled internal air flow system
• Warms faster at 375 degree F
• Unwrapped - 6 min , wrapped -12 min
• 0.5 inc space between each pack to achieve sterilization in least time
• Sterilization monitoring done periodically with biological and heat sensitive chemical
indicators.
• Chemical indiactors recommended for use in dental practices
• For heat sensitive instruments - 10 hours exposure to liquid germicide classified as
sterilant
• Sterilisation -> aseptic rinsing -> drying -> placed in sterile container
• Following this steps carefully decrease chance of recontamination
• Storage- wrapped / bagged with muslin or clear pouches sealed with tape
Cleaning and disinfection of dental unit and environmental
surface
• Impervious backed paper, aluminium foil ,plastic covers used to protect surfaces ( X-ray unit head). If
contaminated during use difficult to clean.
• Between patients the coverings should be removed , discarded and replaced
• Dental until surface cleaned with disposable towelling with appropriate cleaning agent after daily work activities.
Surface is disinfected with germicide
• A chemical germicide “ hospital disinfectant” labeled for tuberculoidal activity used disinfecting surface soiled
with patient material.
• Effective against many bacteria amd viruses
• Sodium hypochlorite ( bleach) : concentrations 500-800 ppm of chlorine are effective on surfaces - intermediate
level disinfectants
• Quaternary ammonium compounds : used for floors and walls - low level disinfectants
• Intermediate and low level disinfectants not recommended for critical and semicritical dental instruments
 Disinfection and dental laboratories
• Lab materials and items (rpd ,fpd,orthodontic appliance ) used in mouth cleaned and
disinfected before and after being manipulated
• Communication between dental office and dental laboratory personnel regarding the
handling and decontamination of supplies and materials is important.
• Splash shields should be used in dental lab
• Receiving area : should be seperate from production area. Work surfaces should be
cleaned and disinfected daily
• Incoming area: all incoming cases should be disinfected by dental offices unless
employee knows case is disinfected.containers sterilised after each use.
• Production area: person working in this area should wear clean uniform / lab coat ,
face mask , protective eye wear and disposable gloves
• Unused materials , instruments, attachments of new prostheses should be maintained
seperate from used ones
• Brushes and other equipments should be disinfected at least once daily
• Each outgoing case disinfected before returned to dental office.
 Use and care of handpieces
• All high speed and low speed dental handpieces - Routine between patient heat process capable of
sterilisation is done.
• Manufactures instructions for cleaning and sterilization should be followed - effectiveness and longevity
• If Internal surfaces of high and low speed hand pieces components gets contaminated , with further use
the patient materials gets exposed .
• Restricted physical access to internal surface limits cleaning and disinfection.
• One way flow check valve / anti retraction valves should be installed to prevent fluid aspiration - reduce
risk of transfer of infective material
• High speed hand peices should be run to discharge water and air for minimum 20-30 seconds after use on
each patient .
• Enclosed container / high velocity evacuation considered to minimize the spread as spray,spatter and
aerosols.
• Microbial accumulation in waterline - removing hand pieces and allowing water lines to run and
discharge for several minutes in each clinic day
• Sterile saline / water - used as coolant /irrigator during surgical procedure (cutting bone)
• Removable parts from intraoral instruments (scalar tips) - cleaned and sterilised
• Permanent attached heat sensitive components - covered with impervious barrier changed after every use
Handling of Biopsy specimens
• Specimes put in sturdy container with secure lid to prevent leaking during transport.
• Care should be taken during collecting specimens - to avoid contamination outside container-
if contaminated cleaned and disinfected and placed in impervious bag.

Use of extracted teeth in dental educational settings

• All persons who collect, transport, manipulate extracted teeth should handle them with the
same precautions as a specimen for biopsy.
• Extracted teeth used in pre clinical exercise should be first cleaned of adherent patient material
by scrubbing with detergent and water or ultrasonic cleaner.
• Stored in fresh solution of sodium hypochlorite or liquid germicide for clinical specimen
fixation.
• Specimen handled with gloves , protective masks and shields
• Work space and equipments should be cleaned and decontaminated.
Conclusion
Thank you