Infection Control

Introduction
Infection control in health care continues to be the subject of intensive research and debate. Implementing safe and realistic infection control procedures requires the full compliance of the whole dental team. These procedures should be regularly monitored during clinical sessions and discussed at practice meetings. The individual practitioner must ensure that all members of the dental team understand and practice these procedures routinely. Every practice must have a written infection control policy, which is tailored to the routines of the individual practice and regularly updated. The policy should be kept readily available so that staff can refer to it.

Because treatment of hepatitis B, AIDS, and herpes is symptomatic at best, prevention of the processes is the most important aspects of the discussions of these diseases. Even if a curve were available, protection from the untoward effects and discomfort for each disease would be desirable. The following recommendations should be used routinely in the care of all patients in dental practice to control the spread of infection.

Always obtain a complete medical history. Include specific questions about lymphadenopathy, recent weight loss, and infections. Use protective attire and barrier techniques. To protect yourself and patients, wear gloves, surgical masks, and protective eyewear. Change gloves between patients to minimize the transmission of disease from ne patient to another.

For routine dental procedures, handwashing with ordinary soap before gloving and after degloving is adequate. Handwashing is important even after gloves have been used because there may be small tears or openings in the gloves that would allow microorganisms to enter. Use disposable needles. Do not recap needle; this will minimize needlestick injuries. Do not purposely bend or break needles. Dispose of them in a special puncture-resistant container after each patient.

Decontamination of surfaces should be accomplished through a solution of sodium hypochloride (household bleach). Dilutions of 1:10 to 1:100 have been shown to be effective. Caution should be used because sodium hypochloride is corrosive to metals, especially aluminum. All instruments should be scrubbed to remove blood and saliva before sterilization. It is recommended that heavy rubber gloves (household gloves) be worn for this purpose to prevent inadvertent skin punctures.

Disinfection or sterilization of instruments should occur at the highest appropriate level for the material in question. Use the autoclave, dry heat or chemical vapor for metal and heat-stable dental instruments and immersion in boiling water for 10 minutes or disinfectant or sterilant chemical for the exposure time recommended by the chemicals manufacturer for instruments and materials that cannot be heat sterilized. Dental handpieces must now be sterilized as well. Manufacturers have responded to the need for increased levels of infection control by producing handpieces that can be sterilized, not just disinfected.