Infection Control In Dentistry

Author Dr. Bhuvan Venigalla MDS,

Associate Professor, Dept Cons & Endodontics

Infection Control In Dentistry

Infectious / Transmissible / Communicable Diseases

- A Global Concern

Infectious Diseases
Hepatitis B HIV Herpes Simplex Varicella, Zoster Tuberculosis Rubella, Rubeola Mumps

Patient

Health care environment

Health care worker

Instruments & equipment

Modes of Contamination
Dental Unit Water spray system Airborne
Saliva, Tissues, Blood, Plaque, Cut tooth debris

Aerosol
Based on size of droplets

Mist Spatter

Aerosol - 5m-50m
- Remain for hours - Respiratory infection - Hepatitis B ?

Mist

- 50m
- visible in beam of light - droplets settle down in 5 -15 min
- TB ?

Spatter/Splash
- > 50m - 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

Ignorance

Penny wise ,
Pound foolish !!

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

A Remedy ?
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

Infection Control - A way to build practice

Organizations Related to Infection Control

OSHA - Occupational Safety and Health Administration CDC ADA AADS
- Centre for Disease Control - American Dental Association - 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

Personal barrier protection

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

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
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

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

Waste Disposal
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

Needle 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 recipients hand Two handed resheathing is not advisable If burs are left in hand-pieces, point them away from your body and hands

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 - 121C at 15 lbs for 15 min Wrapped instruments -134C 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 131C & 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 -100C for 10 min

Dry Heat Above 160C 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 100C 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 pieces
Scrub 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 biohazardlabeled plastic bag Submerge in 2%Potassium sulfate

A Hope !!

If not do good, Do no harm

Thank u