INFECTION CONTROL IN DENTISTRY

by: drg. Christiana Cahyani Prihastuti, M.Phil

BLOK HEALTH MANAGEMENT – TA 2021/2022

 LEARNING OBJECTIVES

Students will be able to explain about:

●  Principles of infection control in Dentistry
●  Modes of infection transmission
●  Standard Precautions
●  Components of Infection Control
●  Personal Protective Equipments in
Dentistry
INFECTION
HealthcareCONTROL:
Infographics
WHY IS IMPORTANT IN DENTISTRY?

Both patients and dental

health care personnel (DHCP)
A can be exposed to pathogens

Contact with blood, oral and

B respiratory secretions, and
contaminated equipment
C
To prevent transmission of
infections among patients and
DHCP by proper procedures
THE PRINCIPLES OF INFECTION CONTROL:
Healthcare Infographics
AVOID CONTACT WITH
BLOOD & BODY FLUIDS
sharp instruments handling,
manage occupational exposures
to blood, and wear personal
protective equipment (PPE)
MAKE OBJECTS SAFE
FOR USE
Instrument cleaning &
sterilization, mucous membranes
antisepsis porcedures

01
02
STAY HEALTHY
Immunizations, post-
exposure management and
medical follow-up, routine
hand hygiene procedures
03
04
LIMIT THE SPREAD OF
CONTAMINATION
Surface covers or disinfection
procedure, minimum aerosols (high
volume evacuation, rubber dams),
medical waste disposal
TRANSMISSION OF INFECTION IN DENTISTRY
Healthcare Infographics
•  Two principles modes of disease transmission in Dental Practice:
1. CONTACT 2. DROPLET INFECTION

a. Direct Contact a. Splatter of blood,

Human-human touch saliva or nasal secretion
à into mucous membranes/ non-intact
skin

b. Indirect Contact b. Airborne by aerosols of

Human contact with microbes
contaminated objects
Healthcare
•  Routes of entryInfographics
of microorganisms into the body:

01 02 03

INHALATION INGESTION AUTOINOCULATION/

a.  Direct Inhalation: aerosol generated Swallow droplets of PERCUTANEUS INJURY
procedures (AGP), cough/sneezing saliva/blood or particles •  Autoinoculation by touching
generated à risk for people in close from instruments contaminated instruments
proximity to the droplet source or patient
•  Percutaneus injury from
b.  Indirect Inhalation: particles < 5 sharp objects
microns in diameter containing
microorganisms can remains in the air
or surfaces
•  Healthcare Infographics
The aim of infection control: to create and maintain a safe clinical
environment.

•  Dental procedures and instruments are associated with widely variant amount of
body fluids.
•  Hence, the infection control should be procedural-based and not patient-
based.
STANDARD PRECAUTIONS: apply to all patients
Healthcare Infographics
In 1983
UNIVERSAL
PRECAUTIONS
•  Prevention to bloodborne and body fluid-
borne infection (e.g. HIV, Hep-B)
•  Handwashing, PPE (gloves, faceshield),
avoid exposure to contaminated needles &
other instruments
•  By 1987: Body Substance Isolation (PPE ++
gown, aprons, surgical masks, goggles, hair
cover, shoe covers)
In 1996
STANDARD
PRECAUTIONS
•  21st century disease pandemic: Ebola
virus, avian flu, SARS, Zika virus, Corona
Virus
•  Precautions to airborne transmission
as well as bloodborne risks
•  5 moments of hand hygiene, PPE wear in
likely event of splash/ sprays.
COMPONENTS
Healthcare OF INFECTION CONTROL
Infographics
6. Instrument Sterilization
1. Immunization

2. Patient Screening 7. Surface Disinfection &

General Operatory Asepsis

3. Hand Hygiene 8. Radiographic asepsis

4. Personal Protective 9. Laboratory asepsis

Equipment (PPE)

5. Needle and Sharp 10. Disposal of Contaminated

Instrument Safety Waste
1. Immunization
Healthcare Infographics

Vaccination
Dental personnel should maintain up-to-
date immunization records that include
vaccination against:
Check up
•  Hepatitis B (Ab titer min.10 IU/L) Testing for tuberculosis is
•  Measles-Mumps-Rubella recommended following a suspected
•  Influenza exposure
•  Diphtheria-Poliomyelitis-Tetanus
•  ++ Covid
2. Patient Screening
Healthcare Infographics

•  Anamnesis: Complete medical history

for every new patient and updated
during recall appointments to
determine infectious status.

Healthcare •  Screening is especially useful when

patients report positive disease status
for blood borne, e.g. HIV, Hep-B
 … Patient Screening for Covid-19
Healthcare Infographics
3. Hand Hygiene
Healthcare Infographics
•  Hand hygiene is the most important aseptic procedure in the
prevention of health care associated infections.

•  Handwashing products include plain soap and agents with

antimicrobial activity.
a.  Chlorhexidine 2-4%
b.  Triclosan 0.3-1%
c.  Parachlorometaxylenol (Pcmx) 0.6%
d.  Propanol/ alcohol based 60-70%
Healthcare Infographics
4.Healthcare
Personal Protective Equipment (PPE) = Alat Pelindung Diri (APD)
Infographics
•  Personal protective equipment (PPE) is
designed to protect the skin and the
mucous membranes of the eyes, nose, and
mouth of dental health care provider from
exposure to blood.

•  Use of PPE is in correlated with the

exposure risk of the procedure, not by
the known or suspected serologic status of
the patient.
 APD Level 1 APD Level 2

Anamnesis, Consultation, DHE IO & EO examination, non-invasive, non-

aerosol generating procedures (non-AGP),
short time procedures
APD Level 3

Invasive procedures, AGP,

long-time procedure
 Healthcare Infographics …. Intraoral Barrier Techniques

1.  Rubber dam

A rubber dam should be used whenever possible for improved vision
and access and to reduce dental personnel’s exposure to
microorganisms in patient’s blood and saliva.

2.  Pre-procedural mouthrinse

Patient rinse with an antimicrobial mouthwash of povidone iodine 1%
or chlorhexidine gluconate 0.12% solution for 30 seconds prior to
intraoral procedures.
5. Needle andInfographics
Healthcare Sharp Instrument Safety
Needle stick or sharp instrument injuries are of major concern to health care workers.

Safety Recommendations:
•  Sharp ends of any instrument should be angled away when being passed between dentist and
assistant.
•  Unsheathed needles are placed directly into the puncture-proof disposal container along with any other
sharp instruments (e.g.acid etch applicator needles, endodontic files, burs, scalpel blades, and metal
matrices)
•  For procedures involving multiple injections with a single needle, the unsheathed needle should be
placed in a safe location.
Or, recap a needle between injections should using “one-handed scoop technique”

Avoid doing this!

 …Needle and Sharp Instrument Safety
Healthcare Infographics
Needle stick or sharp instrument Disposal:
•  Needles should not be bent or broken before disposal.
•  Blade should be removed from scalpel using hemostat
 …Needle and Sharp Instrument Safety
Healthcare Infographics

Postexposure Protocol for Occupational Exposure to Blood/Body Fluids

1.  Stop the procedure immediately
2.  Inform patient
3.  Remove gloves and apply first aid as required
4.  Injuries to the skin should be washed well with soap and running water and bleeding at
the injured site 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; (microbiology and serology) for HIV, etc.
6.Healthcare
Instrument Sterilization
Infographicsand Disinfection

•  Definitions
 …Instrument Sterilization and Disinfection
Healthcare Infographics
•  The Spaulding system is a standard system of classification for sterilization and
disinfection.
•  Dental instruments are classified into 3 categories - depending on their risk of
transmitting infection and the need for sterilization/disinfection between uses:

forceps, scalpels,
bone chisels, scalers,
and burs

mirrors, amalgam
condensers, etc

external components
of xray heads, etc
 Preparation for Instrument Sterilization/Disinfection
Healthcare Infographics

Initial Storage Removal of Inspection Wrapping Sterilization

Debris
Checking for Handling with 1. Sterilization:
Immersion in a sink
Scrubbing or using cleanlness, dryness, gloves Dry Heat/ Moist Heat/
of water or pre-soak
ultarsonic cleaner signs of rust or cracks Chemical Vapor
in disinfectant
2. Disinfection

STEP STEP STEP STEP STEP

STEP
01 02 03 04 04
05
 Healthcare Infographics …Sterilization Methods

1.  DRY HEAT

Dry heat cycle is 1 hour at 170°C or 2 hours at 160°.

 Healthcare Infographics …Sterilization Methods
2.  MOIST HEAT/ STEAM UNDER PRESSURE (AUTOCLAVE)

High temperature of the steam, 121 to 132°C for 3-20 minutes.

Healthcare Infographics …Sterilization Methods
 Healthcare Infographics …Sterilization Methods
3. CHEMICAL VAPOR

•  Chemical vapor sterilizers use a specific mixture of formaldehyde, alcohols, ketone,

acetone and water under pressure at 132°C for 20-40 minutes.

•  Or using Ethylene Oxide Gas: suitable for porous

materials, 61°C for min. 3 hours to 10-16 hours.
 Healthcare Infographics …Sterilization Methods

Heat Transfer (Bead Type)

•  The sterilizers use extremely hot rapid airflow to achieve sterilization in 6 minutes.
•  Inconsistent heating with significant temperature variation à only used at chair side for
files and burs.
 …Dental Instruments Sterilization/ Disinfection
Healthcare Infographics
Instruments that must be heat
sterilized:
1.  All hand and orthodontic
instruments;
2.  All burs and bur changers
3.  All endodontic instruments;
4.  Air-water syringe tips;
5.  High-volume evacuator tips;
6.  Surgical instruments;
7.  Ultrasonic periodontal scalers and
tips;
8.  Electrosurgery tips:
9.  Metal impression trays;
10.  Intraoral radiographic equipment
that can withstand heat
sterilization.
Instruments that must be
chemically sterilized:
1.  Glass mixing slabs;
2.  Metal or plastic spatulas;
3.  Plastic/glass items not meant
to be disposed of,
4.  glass dappen dishes that
cannot withstand heat;
5.  Mirrors for intraoral
photography;
6.  cheek retractors;
7.  Handles for brush tips.
Single Use items:
Disposable needles and
syringes; local anesthetic
carpules; saliva ejectors, high
volume evacuator tips and air
water syringe tips; polishing
disks, cups, points; cups and
brushes; fluoride trays;
disposable impression trays;
gloves, masks, orthodontic
wires, bands and brackets,
matrix bands.
Healthcare Infographics …Disinfection Methods

Disinfection using chemical to remove most forms of microbes on an instrument, device, or environmental
surface (operatory surface) that cannot be processed in a sterilizer (cannot withstand high temperatures or
big size).
Healthcare Infographics …Disinfection Methods
 Surface Disinfection
7.Healthcare and General Operatory Asepsis
Infographics
•  Contaminated surfaces (e.g. dental chair, doctor stools, mobile air/water
syringe handles, suction and saliva ejector couplings, soap and towel dispenser
areas and X-ray viewer and switch) are disinfected routinely following each
patient visit.

•  Pre clean and dry all surfaces (sanitization) followed with disinfection
using water based disinfectants; a detergent are more effective than alcohol
based disinfectants.

•  Wear utility gloves during disinfection .

•  Air dry the surface.

 RadiographicInfographics
8.Healthcare Asepsis

•  Wear gloves when exposing radiographs and handling contaminated film

packets. Use other PPE (e.g. protective eyewear, mask and gown) if there is a
risk of spattering of blood or other body fluids.

•  Use heat-tolerant or disposable intraoral devices whenever possible (e.g. film-

holding and positioning devices).

•  The film should be dried with a paper towel to remove blood or excess
saliva then placed in a container (e.g. disposable cup) for transport to the
developing area.

•  Consult with the manufacturer for methods of disinfection and sterilization of

digital radiology sensors and for protection of associated computer hardware.
 Laboratory Asepsis
9.Healthcare Infographics
•  Items such as impressions, jaw relation records, casts, prosthetic
restorations and devices that have been in the patient’s mouth are
potential sources for cross-contamination à should be properly disinfected
prior to shipment to a dental laboratory.

•  Clean and disinfect impressions, prostheses, or appliances as soon as possible

after removal from the patient’s mouth: using 1% povidone iodine or 0.12%
chlorhexidine digluconate

•  If laboratory items (e.g. burs, polishing points, rag wheels, or laboratory knives)
are used on contaminated appliances, prostheses, or other material: should be
heat-sterilized, disinfected between patients, or discarded.
10. Disposal of Infographics
Healthcare Contaminated Wastes
Biomedical waste or infectious waste includes:
1. Anatomical waste:
a . Human anatomical waste
Human tissues, organs and body
parts
b. Animal anatomical waste
2. Nonanatomical waste
a.  Microbiology laboratory waste
Lab cultures, stocks or specimens,
vaccines and materials in contact with
them
b.  Blood and body fluid waste
c.  Waste sharps
Clinical and lab materials: needles,
syringes, blades or laboratory glass
capable of causing cuts or punctures.
Healthcare Infographics … Categories of Biomedical Waste
Healthcare Infographics … Categories of Biomedical Waste
 … Color Coding for Biomedical Waste Disposal
Healthcare Infographics
 Dental
Practice
Room
Design

Desain Ruang Praktek à ruang Ventilasi Ruangan Kebersihan Ruangan à

tindakan, ruang ganti APD, ruang Barrier
dekontaminasi-sterilisasi
Wrapping dental unit&alat
yang sering digunakan
hanya barang yang
diperlukan saja à tanpa
aksesories, cover unit
 LEARNING OBJECTIVES
References:

Hupp, J. R., Tucker, M. R., & Ellis, E. (2013). Contemporary Oral and Maxillofacial
Surgery-E-Book. Elsevier Health Sciences.

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/
chemical.html

Marya, C.M. (2011). A Textbook of Public Health Dentistry. Jaypee Brothers Medical
Publishers.

Pengurus Besar Persatuan Dokter Gigi Indonesia. (2020). Panduan Dokter Ggi
dalam Era New Normal.