INFECTION CONTROL IN

DENTISTRY

DR TAREK ABD ELBARY

Oral and MAXILLOFACIAL SURGERY
DEPARTEMENT
 INFECTION CONTROL
CONTENTS
 Introduction
 Mode of Transmission
 Mode of Infection control
 Objective of Infection control
 Operatory Asepsis
 Personal Protection Barrier
 Sterilization
 Disinfection
 Laboratory Infection Control
 Clinical Waste Disposal
• • INFECTION CONTROL
• Also called “exposure control plan” by OSHA
occupational safety and health administration is
a required office program that is designed to
protect person's against risks of exposure to
infection.

• STERILIZATION: •Use physical or chemical

procedure to destroy all microorganisms

including resistant bacterial spores.
 • Sterilization means destruction of all life
forms.
• Sterilization is the process of killing or
removing all viable organisms.

• • STERILE: Free from all living

microorganisms; (e.g., the probability of a
surviving microorganism being 1 in 1 million)
• DISINFECTION:
• •Destruction of microorganisms by physical or
chemical agents.
• Disinfection is less effective than sterilization,
because it destroys the majority of
microorganisms, but not necessarily all microbial
forms (e.g., bacterial spores).
• Disinfection is a process of removing or killing
most, but not all organisms.
• • DISINFECTANT: A chemical agent used to
destroy recognized pathogenic
microorganisms, but not necessarily all
microbial forms.
• • ASEPSIS: prevention of microbial
contamination of living tissues or sterile
materials by removing or killing
microorganisms.
 MODES OF Diseases TRANSMISSION
• Direct contact with blood or body fluids
• Indirect contact with a contaminated
instrument or surface
• Contact of mucosa of the eyes, nose, or
mouth with droplets or spatter
• Inhalation of airborne microorganisms
• Why infection control necessary in
dentistry ? •because Dental staff and patients
may be exposed to a wide variety of
microorganisms .
• • Who is responsible for infection control in
the dental office ? Each member of the
dental team must follow the recommended
guidelines .
• • What should be done to prevent
transmission of disease in the dental office ?
• The most effective ways to prevent the
transmission of diseases includes :
• 1) Hand washing
• 2) Gloves
• 3) Face masks
• 4) Protective eye wear
• 5) Protective clothing
• 6) Instrument sterilization and disinfection
• The dental office should have an infection
control program to prevent the transmission
of disease from the following :
• Patient to dental team
• Dental team to patient
• Patient to patient
• Dental office to community ( include dental
team’s family )
• Community to dental office .
 •To prevent infections, following list and
precautions that together constitute infection
control.
• 1. Immunization
• 2. Patient screening
• 3. Hand washing
• 4. Barrier techniques - • Personal Protective
Equipment (PPE) • Rubber dam, Pre-
procedures rinsing
• 5. Needle & sharp instrument safety •
Occupational Exposure To Blood/Body Fluids
• 6.Instruments sterilization and disinfection
• 7.Surface disinfection
• 8. Radiographic asepsis
• 9. Laboratory asepsis
• 10. Infectious dental waste management & disposal
Standard Precautions.
•Examples of Personal Protective Equipment PPE:
1- Protective clothing
2- Surgical masks
3- Face shields
4- Protective eye wear
5- Disposable gloves
• PPE must be used whenever you
Performing tasks that could produce splash or spatter
.
• Any contact with body fluids
• Perform other clinical activities that require handling
contaminated items e.g. radiographs , impressions ,
dentures or contaminated equipment and surfaces.

HAND HYGIENE
• Hand washing is the most important procedure for
preventing the spread of infection. So , you must wash
your hands each time before you put on gloves and
immediately after you remove gloves.
• OPERATORY ASEPSIS •
• In the dental operatory 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,) can
serve as source of microbial contamination,
although they have not been associated directly
with transmission of infection to either persons
or patients.
 A. Infection Control before treatment
Period
• In addition to reducing the risk of transmission of
infectious agents during patient care, many factors
will make the treatment session infection free and
will also make the postoperative infection control
process easier and more effective.
• 1. Remove unnecessary items from the dental
procedure area :
• The dental procedure area should be arranged to
facilitate cleaning following each patient.
• 2. Preplan the materials needed during treatment. - Set
out all instruments, medications, impression materials,
and other items that are needed for a procedure. -
minimizes the need to search for additional items or to
enter cabinets and drawers once gloves have become
contaminated.

• 3. Utilize disposable items whenever possible: The use of

disposable items saves time during cleanup and
decontamination and solves the problem of proper
reprocessing.
• 4. Use prearranged tray set-ups for routine or
frequently performed procedures. Helps to
eliminate the need to go into cabinets once you
have started a procedure.

• 5. Using individual bur blocks containing only

the burs required for that procedure helps to
eliminate the contamination of other,
unneeded burs and to make clean-up easier.
• 6. If indicated, have the rubber dam setup on the
tray. When a rubber dam will be used during a
clinical procedure, it also should be included on the
tray setup.

• 7. Identify items that will become contaminated

during treatment. While preparing the dental
procedure area prior to beginning a clinical
procedure, consider which items will become
contaminated during treatment. • Examples of such
surfaces include light handles, X-ray unit heads, etc.
Decide using a barrier, e.g., plastic wrap to prevent
contamination of these surfaces and items or to
disinfect them when the procedure is complete.
• Surface barriers : • Surface barriers are used to prevent
contamination on the surface underneath.
• All the surface barriers should be resistant to fluids in order to
prevent microorganisms in saliva, blood, and other liquids from
passing through the barrier and reach the surface underneath.
• 8. Review patient records before initiating treatment
and place radiographs on the view box.
• Do not handle records after beginning treatment.
Place the record in a drawer or out of the dental
procedure area, so that it doesn’t become
contaminated.
• Entries into the record should be done before and
after the procedure.
• B. Infection Control during the
treatment Period
• The infection control procedures described in the
previous period will help you to reduce the risk of
transmission of infectious agents.
• During treatment there are additional precautions
that can be taken to further reduce infection risks.
• 1. take care when receiving, handling sharp
instruments
• 2. Take a special precautions with syringes and needles.
• 3. Use a rubber dam whenever possible
• 4. Avoid touching unprotected switches, handles and other
equipment once gloves have been contaminated.
• 5. Avoid entering cabinets once gloves have been
contaminated.
Continue to wear personal protective equipment during clean-
up: After patient care is completed, begin the cleaning and
disinfection process by removing contaminated gloves used
during treatment, wash your hands and use the utility gloves
before beginning the clean up. Continue to wear protective
eyewear, mask, and gown.
 C. Infection Control During the Post-
Treatment Period
•  Remove all disposable barriers : All of the barriers placed
before treatment, including light handle covers should be
removed.
•  Clean and disinfect all items not protected by barriers.
•  Cleaning and disinfection of the dental treatment room
surfaces are important components in an effective infection
control program
•  studies have proved that microorganisms may survive on
environmental surfaces for long time . For example,
Mycobacterium tuberculosis may survive for weeks.
• STERILIZATION AND DISINFECTION
OF DENTAL INSTRUMENTS

• DENTAL INSTRUMENTS Classification based on

risk of transmission and need of sterilization

• -CRITICAL -SEMI-CRITICAL -NON-

CRITICAL
 CRITICAL INSTRUMENTS
penetrate mucous membranes or contact bone,
bloodstream, or other normally sterile tissues
• heat sterilize or use sterile single use,
• disposable devices
• examples include surgical instruments, scalpel
blades, periodontal scalers, and surgical
dental burs.
 SEMI-CRITICAL INSTRUMENTS
• • contact mucous membranes but do not
penetrate soft tissue
• • heat sterilize or high-level disinfect.
• examples: dental mouth mirrors, amalgam
condensers, and dental hand pieces.
•NONCRITICAL INSTRUMENTS
• Clean and disinfect using a LOW TO INTERMEDIATE LEVEL
DISINFECTANT •

• Examples: X-RAY HEADS, FACEBOWS, PULSE OXIMETER, BLOOD

PRESSURE CUFF.

• 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
• Agents used in sterilization
• • Physical agents:
• 1. Sunlight
• 2. Drying
• 3. Dry heat: flaming, incineration, hot air
• 4. Moist heat: pasteurization, boiling, steam under
pressure, steam under normal pressure.
• 5. Filtration: membranes
• 6. Radiation
• 7. Ultrasonic vibrations.
• Chemical agents:
1-Alcohols: ethyl, isopropyl, trichlorobutanol
2. Aldehydes: formaldehyde, glutaraldehyde
3. Dyes
4. Halogens
5. Phenols 6. Surface-active agents
7. Metallic salts
8. Gases: ethylene oxide, formaldehyde, beta propiolactone.

The 4 accepted METHODS OF STERILIZATION are:

• Steam pressure sterilization (autoclave)

• Chemical vapor pressure sterilization- (chemiclave)
• Dry heat sterilization (dryclave)
• Ethylene oxide sterilization.
• AUTOCLAVE
• • Sterilization with STEAM UNDER PRESSURE •
Time required at 1210 C is 15 mins at 15 lbs of
pressure.
• Advantages • Rapid and effective • Effective
for sterilizing cloth surgical packs and towel
packs
• Disadvantages • Items sensitive to heat
cannot be sterilized • It tends to corrode
carbon steel burs and instruments
• CHEMICLAVING
• Sterilization by CHEMICAL VAPOR UNDER
PRESSURE
• • operates at 1310 C and 20 lbs of pressure. • They
have a cycle time of half an hour.
• Advantages • Carbon steel and other carbon
sensitive burs, instruments and pliers are sterilized
without rust or corrosion
• • Disadvantages • Items sensitive to elevated
temperature will be damaged • Instruments must
be very lightly packed.
• Towel and heavy clothing cannot be sterilized.
• Dry Heat Sterilization; Conventional dry
heat ovens:
• • Achieved at temperature above 1600 C.
• • Have heated chambers that allow air to circulate by gravity
flow. •
• 6-12mins is required for sterilization
• • Disadvantages • Without careful calibration, chances for
sterilization failures.
ETHYLENE OXIDE STERILIZATION (ETO)
• Advantages:

1. Operates effectively at low temperatures

2. Gas is extremely penetrative
3. Can be used for sensitive equipment like
hand pieces.
4. Sterilization is reliable •
• Disadvantages:
• 1. Potentially carcinogenic.
• 2. Requires air chamber ,cycle time lasts hours
• 3. Usually only hospital based.

• Sterilization Monitoring Types of Indicators •

Mechanical –Measure time, temperature,
pressure • Chemical –Change in color when
physical parameter is reached • Biological
(spore tests) –Use biological spores to assess
the sterilization process directly.
•  Sterilization monitoring has four
components:
• 1. a sterilization indicator on the instrument
bag.
• 2. daily color-change process-indicator strips,
• 3. weekly biologic spore test, and
• 4. documentation notebook.
• STORAGE AND CARE OF STERILE
INSTRUMENTS

• • Storage areas should be dust free, dry, well

ventilated and easily accessible for routine
dental use.
• • Sterile materials should be stored at least 8-
10 inches from the floor, at least 18 inches
from the ceiling, and at least 2 inches from the
outside walls.
• • Items are not stored in any location where they
can become wet. • Items should be positioned so
that packaged items are not crushed, bent, crushed,
compressed or punctured
• . • 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.
• DISINFECTION OF DENTAL UNIT AND
ENVIRONMENTAL SURFACES

• DISINFECTION
• • Disinfection is always at least a two-step
procedure: •
• The initial step involves vigorous scrubbing of
the surfaces to be disinfected
• The second step involves wetting the surface
with a disinfectant and leaving it wet for the
time prescribed by the manufacturer.•
• The ideal disinfectant has the following
properties:
• 1. Broad spectrum of activity
• 2. Acts rapidly
• 3. Non corrosive
• 4. Environment friendly
• 5. Is free of volatile compounds
• 6. Nontoxic & non staining
• • High-level disinfection:
• Disinfection process that inactivates
vegetative bacteria, mycobacteria, fungi, and
viruses but not necessarily high numbers of
bacterial spores
• Intermediate-level disinfection:
• Disinfection process that inactivates
vegetative bacteria, the majority of fungi,
mycobacteria, and the majority of viruses
(particularly enveloped viruses) but not
bacterial spores.
• Low-level disinfectant: Liquid chemical
germicide. OSHA requires low-level hospital
disinfectants also for potency against HIV and
HBV.
• • Giga sept which contains succinialdehyde
and dimethoxytetrahydrofuran are used for
disinfection of plastic and rubber materials
• eg: dental chair
• BASICS OF LABORATORY infection control
• • Need COORDINATION between DENTAL OFFICE
AND LAB •

• Use of proper methods/materials for handling and

decontaminating incoming items •

• All contaminated INCOMING ITEMS should be

cleaned and DISINFECTED before being HANDLED BY
LAB PERSONNEL, and before being returned to the
patient
• INCOMING ITEMS • Rinse under running tap water
to remove blood/saliva • Disinfect as appropriate •
Rinse thoroughly with tap water to remove residual
disinfectant • No single disinfectant is ideal or
compatible with all items.

• OUTGOING ITEMS • Clean and disinfect before

delivery to patient • After disinfection: rinse and
place in plastic bag with diluted mouthwash until
insertion .