Professional Documents
Culture Documents
CONTENTS
INTRODUCTION
INFECTION
TRANSMISSION OF INFECTION
MODE OF TRANSMISSION
MODE OF INFECTION CONTROL
INFECTION CONCERN IN
DENTISTRY
OBJECTIVES OF INFECTION
CONTROL
PERSONAL BARRIER
PROTECTION
OPERATORY ASEPSIS
STERILIZATION
DISINFECTION
INSTRUMENT HANDLING &
CLEANING
MONITORS OF STERILIZATON
CLINICAL WASTE DISPOSAL
INTRODUCTION
Microorganisms are ubiquitous.
Since pathogenic microorganisms cause contamination,
infection and decay, it becomes necessary to remove or
destroy them from materials and areas.
DEFINITIONS
INFECTION CONTROL Also called exposure control plan by
OSHA is a required office program that is designed to protect
personnel against risks of exposure to infection.
tissues or
sterile materials by excluding, removing or killing microorganisms.
TRANSMISSION OF INFECTION
MODES OF TRANSMISSION:
Infectious
agent
Susceptible
host
Reservoirs
Chain of
infection
Portal of
entry
Portal of exit
Means of
transmission
Chicken pox
Paramyxovirus
Rhino/adeno virus
Common cold
Mycobacterium
Tuberculosis
Rubella
German Measles
Candida sp
Candidosis
TRANSMITTED BY INOCULATION
Hepatitis B,C,D
Hepatitis
Herpex simplex I
Herpex simplex II
Genital herpes
HIV
Neisseria gonorrhoeae
Gonorrhoeae
Treponema pallidum
Syphilis
S.aureus/ albus
Wound abscess
CROSS
INFECTION
Disease
Hepatitis A
Work restriction
Restrict from patient contact, contact with
patients environment, and food-handling.
Duration
Until 7 days after onset of jaundice
Hepatitis B
Personnel with acute or chronic hepatitis B
surface antigenemia who do not perform
exposure-prone procedures
Personnel with acute or chronic hepatitis B e
antigenemia who perform exposure-prone
procedures
No restriction
Hepatitis C
HIV
Rubella
Active
Carrier state
Tuberculosis
Active disease
PPD converter
No restriction
Active
Zoster (shingles)
Localized, in healthy person
Generalized or localized in
immunosup- pressed person
Postexposure (susceptible personnel)
Protect
Implement
Simplify
PPE
Aseptic techniques
Sterilization &
disinfection
disposal
Laboratory asepsis
CONTINUED
Phenolic related essential oils
Bis-biguanides
Quaternary ammonium compounds
Halogens
Oxygenating agents
A commercial mouthrinse containing 0.05 percent CPC when used as
a preprocedural mouthrinse was equally effective as CHX in reducing
the levels of spatter bacteria generated during ultrasonic scaling.
Magda Feres et all, JADA 2010
HAND HYGIENE
Clean brushes can be used to scrub under and around the nails.
Must be repeated at least once to remove all soil.
HAND CLEANSERS
ALCOHOL HAND RUBS- ethyl alcohol and isopropyl alcohol are widely
used at 70% concentration. They are rapidly germicidal when applied to the
skin.
The various barriers are gloves, masks, protective eye wear, surgical
head cap & overgarments
GLOVES
Types:
1. Latex gloves
VINYL GLOVES
NITRILE GLOVES
NEOPRENE
STEPS IN GLOVING
Latex hypersensitivity
Patients with latex allergy can be scheduled for the first appointment
of the day to mini- mize their inadvertent exposure to airborne latex
particles.
Have emergency treatment kits with latex free products available at all
times.
MASKS
Types:
1. Surgical masks (required to have
fluid-resistant properties).
1. Procedure/isolation masks
Made up from a melt blown placed between non-woven fabric
Layers of a Mask
1. an outer layer
2. a microfiber middle layer - filter large wearer-generated particles
3. a soft, absorbent inner layer - absorbs moisture.
Available in 2 sizes: regular and petite.
EYE WEAR
CAUSES OF EYE DAMAGE:
1. Aerosols and spatter may transmit infection
2. Sharp debris projected from mouth while using air turbine
handpiece, ultrasonic scaler may cause eye injury.
OVER GARMENTS
Gown type
FOOTWEAR
AND
THEN
THEN
AND
OPERATORY ASEPSIS
In the dental operatory, environmental surfaces (i.e., a surface or
equipment that does not contact patients directly) can become
contaminated during patient care. Certain surfaces, especially ones
touched frequently (e.g., light handles, unit switches, and drawer
knobs) can serve as reservoirs of microbial contamination, although
they have not been associated directly with transmission of infection
to either personnel or patients.
CDC CLASSIFICATION
Category
Definition
Critical
Semicritical
Noncritical
DISINFECTION
Disinfection is always at least a two-step procedure:
The initial step involves vigorous scrubbing of the surfaces to be
disinfected and wiping them clean.
The second step involves wetting the surface with a disinfectant and
leaving it wet for the time prescribed by the manufacturer.
Low-level disinfectant: Liquid chemical germicide. OSHA requires lowlevel hospital disinfectants also to have a label claim for potency
against HIV and HBV.
Strategies for decontaminating spills of blood and other body fluids differ by
setting and volume of the spill.
The person assigned to clean the spill should wear gloves and other PPE as
needed.
Dip instruments likely to rust into a rust inhibitor solution. Drain & dry
instruments with absorbent towel.
An ultrasonic cleaner uses sound waves, that are outside the human hearing
range to form oscillating bubbles, a process called cavitation.
Ultrasonic cleaning is the safest and most efficient way to clean sharp
instruments.
Operate the ultrasonic cleaner for 3-6 minutes for loose instruments 10-20
mins for cassettes or longer as directed by the manufacturer to give optimal
INSTRUMENT WASHER
Instrument washers use high-velocity hot water and a detergent to
clean instruments.
Types:
1. Counter top model
2. Resembles a kitchen dish washer
THERMAL DISINFECTORS
These devices may look like the instrument washers described above;
however, there is one important difference.
Metallic nanoparticles bits of material so small that hundreds would fit inside
the period go into a container of water.
Sunlight focused into the water quickly heats the nanoparticles, which
scientists are terming nanoheaters.
A layer of steam forms on the nanoheaters and buoys them up to the waters
surface. They release the steam and sink back down into the water to repeat
the process.
INSTRUMENT PROCESSING
ETO
Paper, cloth
Radiation sterilization
STERILIZATION
Stages for instrument sterilization:
1. Presoaking
2. Cleaning
3. Corrosion control and lubrication
4. Packaging
5. Sterilization
6. Handling sterile instruments
7. Storage
8. Distribution
Chemical agents:
1. Sunlight
2. Drying
3. Dryheat: flaming, incineration, hot air
trichlorobutanol
2. Aldehydes: formaldehyde,
glutaraldehyde
3. Dyes
4. Halogens
5. Phenols
6. Surface-active agents
6. Radiation
7. Metallic salts
Advantages of Autoclaves.
1.
2.
3.
Sterilization is verifiable.
Disadvantages of Autoclaves.
1.
2.
3.
TYPES OF AUTOCLAVE
DOWNWARD DISPLACEMENT
The steam is then released into the sterilization chamber in a pressurized blast,
forcing the air out through the drain hole and starting the sterilization process
CLASSIFICATION OF A AUTOCLAVE
Classification
Suitable for
Processing
Eschmann Model
Used by
N Type (Downward
Displacement)
Unwrapped solid
instruments for
immediate use.
S Type (Vacuum)
Medical Surgeries
Podiatrist
Tattooist
Body Pierces
B Type (Vacuum)
Unwrapped &
wrapped solid and
hollow instruments.
Porous loads, e.g
drapes & gowns.
Dentists
Plastic surgeons
Day surgeries
The 1938 patent of dr. George hollenback and the work of hollenback
and harvey in 1940s culminated in the development of an unsaturated
chemical vapor system , also called harvey chemiclave.
Advantages
1. Carbon steel and other corrosion-
Disadvantages
1. Items sensitive to the elevated
2.
3.
4.
2.
MOBILE FUMIGATOR
Advantages:
1. Operates effectively at low
Disadvantages:
1. Potentially mutagenic and
temperatures
2.
3.
4.
carcinogenic.
2.
3.
Sterilization is verifiable
GAMMA RADIATION
The Nature of Gamma Radiation A form of pure energy that is generally
characterized by its deep penetration and low dose rates, Gamma Radiation
effectively kills microorganisms throughout.
2. rapid processing
3. uniform dose distribution
4. system flexibility
UV RADIATION
FLASH STERILIZATION
Currently, the time required for flash sterilization depends on the type of
sterilizer and the type of item (i.e., porous vs non-porous items).
Uses:
Flash sterilization is considered acceptable for processing cleaned patientcare items that cannot be packaged, sterilized, and stored before use.
It also is used when there is insufficient time to sterilize an item by the
preferred package method.
Pure oxygen reactive ion etching type of plasmas were applied to inactivate
a biologic indicator, the Bacillus stearothermophilus, to confirm the efficiency
of this process.
The sterilization processes took a short time. In situ analysis of the microorganisms inactivating time was possible using emission spectrophotometry.
The increase in the intensity of the 777.5 nm oxygen line shows the end of
the oxidation of the biologic materials.
EFFECT OF STERILIZATION ON
INSTRUMENTS
Sterilization
Type of instrument
Stainless steel
Carbon steel
No visual change
Dry-Heat Sterilizers
Liquid Chemicals
Performic Acid
Filtration
Microwave
dose of
energy in the form of light. The UV light will alter the DNA of the
pathogens. Not effective against RNA viruses like HIV.
OZONE
Ozone sterilization is the newest low-temperature sterilization method
recently introduced in the US and is suitable for many heat sensitive
and moisture sensitive or moisture stable medical devices
Storage areas should be dust proof, dry, well ventilated and easily accessible for
routine dental use.
Sterile materials should be stored atleast 8-10 inches from the floor, atleast 18
inches from the ceiling, and atleast 2 inches from the outside walls.
Items should be positioned so that packaged items are not crushed, bent, crushed,
compressed or punctured.
Items are not stored in any location where they can become wet.
Outside shipping containers and corrugated cartons should not be used as
containers in sterile storage areas.
Ultra violet chambers and formalin chambers are now commonly used for storage of
instruments.
MONITORS OF STERILIZATION
There are 3 methods of monitoring sterilization:
Mechanical techniques
Chemical indicators
1. Internal
2. External
Biological indicators
STERILIZATION METHOD
AUTOCLAVE
SPORE TYPE
INCUBATION TEMPERATURE
Bacillus stearothemophilus
56C
Bacillus subtilis
37C
B. Pumilus E601
370C
CHEMICAL VAPOR
DRY HEAT
ETHYLENE OXIDE
Gamma radiation
HANDPIECE ASEPSIS
Oral fluid contamination problems of rotary equipment and especially the high-speed
handpiece involve:
ULTRASONIC SCALARS
CONCLUSION
Infection control has helped to allay concerns of the health care personnel
and instill confidence and in providing a safe environment for both patient
and personnel.
REFERENCES:
Pathways of the pulp, 9th edition, armamentarium & sterilization. Cohen
Operative dentistry, infection control, 4th edition, sturdevent.