INFECTION CONTROL FOR

PROSTHODONTIC CLINIC

:under supervision of
Prof. Dr. Nabila Elkhodary

:Presented by
Mona El-halawany
INTRODUCTION

Diseases can be transmitted in dental clinic -

from patient  to patient
from patient  to dental health care workers (DHCWs)
.from DHCWs  to patients

The dental clinic procedures, instrumentation and patient -

care settings require specific strategies regarding the
.prevention of disease transmission
Dental! patients and DHCWs are exposed to variety of -
pathogenic microorganisms via contact with blood or
.oral and respiratory secretions
SOME ORGANISMS THAT MAY BE TRANSMITTED
.IN THE DENTAL CLINIC

1. Cytomegalo-Virus.
2. Hepatitis B virus (HBV).
3. Hepatitis C virus (HCV).
4. Herpes simplex virus.
5. Human immunodeficiency virus (HIV).
6. Mycobacterium tuberculosis.
7. Staphylococci and streptococci.
.Organisms causing upper respiratory tract infection .8
ROUTES OF DISEASE TRANSMISSION

:Organisms can be transmitted in dental clinic through -

Direct transmission .1
Direct physical contact with blood, oral fluids, or other
.patient materials

Indirect transmission .2
Contact with an intermediate contaminated object
.(instruments, equipment, or environmental surfaces)
Aerosolization .3
Contact of conjunctival , nasal or oral mucosa with droplets
(spatter) containing microorganisms generated from an
infected person and propelled a short distance (by
.coughing , sneezing or talking)

Airborne infective droplets .4

Inhalation of airborne microorganisms that can remain
.suspended in the air for long periods
UNIVERSAL PRECAUTION FOR INFECTION CONTROL

1. Vaccination

- DHCWs are at greater risk than the general population of

acquiring hepatitis B through contact with the patients.

- For this reason all dentists and their staffs, should be

vaccinated against hepatitis B.
BARRIER TECHNIQUE .2

a. Gloves:

Gloves should be used whenever -

the dentist put his hands in any patients mouth or touch
instruments, equipments or surfaces that may be
.contaminated with blood or saliva of the patient

A new pair of gloves is used for every patient -

Instruction for using gloves :

- Removal of rings and watches during gloving and

working .

- Wash hands before wearing gloves

by soap and water.

- never wash hands while wearing the

gloves.

Washing gloves cause wicking which increases the flow

of liquids through undetected holes in the gloves.
- Never reuse surgical or examination gloves.

- If the gloves are cut or punctured remove them

immediately and dispose them properly then wash
hands again and put on a new pair of gloves.

- Skin lesions in the hands of the operator or any personnel of

the dental team should be treated and he is not allowed to
work before subsidence of these lesions.

- When treatment is finished discards the gloves and

washes hands again.
: Hand Washing and Care of Hands

Hands should be washed before -

gloving and after removal of gloves
.using soap and water

An antimicrobial agent is used in washing hands before -

. and after any surgical procedure
HAND WASHING TECHNIQUE
: TYPES OF GLOVES

:A) Examination disposable gloves

Used for procedures involving contact with the oral

. mucous membrane
:B) Sterile disposable gloves

.Used in performing surgical procedures -

Generally this type of gloves is to be used whenever the -

procedure involve a break in the mucous membrane of
. the oral cavity is performed
:C) General purpose utility gloves

Used for cleaning instruments, equipments and -

.contaminated surfaces

Rubber household gloves are suitable and can be -

.decontaminated and reused
B. FACE PROTECTION :

- Chin length plastic face shield that protect the eyes,

the nose and the mouth from spatter must be used
whenever blood or oral fluids contaminated with blood
may be spattered (during using air motors) .
- When face shield is not available eye
glasses and face mask must be
used.

- A new surgical mask must be used

for every patient and if the mask
becomes wet during the treatment
of the patient it must be replaced.

- The eye glasses are disinfectant between patients.

C. CLOTHES PROTECTION

Protect clothes from contamination by covering them -

.with a gown or coat or wearing a uniform

Change work clothes at least once daily and more -

.often if they become visibly contaminated with blood
HANDLING OF SHARP INSTRUMENTS AND NEEDLES .3

- Do not try to recap the needle of the cartilage

syringe by its plastic cover using your two hands.

- Use one hand scope technique, table technique or

a mechanical device designed for this purpose.
- The needle should be recovered before removal from the
syringe.

- Used needles, scalpels, disposable syringes and similar

sharp items should be discarded in a puncture resistance
container.
CLEANING,DISINFECTION AND .4
STERILIZATION OF INSTRUMENTS AND DENTAL
CLINICS
: Cleaning .1
Cleaning is a process that reduces the number of -
microorganisms present by removing patients material that
is possibly contaminating the dental unit and
.environmental surfaces

This should be done between Patients and -

.at the end of the working day
METHODS OF CLEANING

1. A chemical germicide spray is used to spray

the dental chair and the practice table.

- An inexpensive methods is :
use of fresh solution of sodium hypocholorid ,
1/4 cup to 1 gallon of water , by swapping the surfaces.
This method gives an intermediate level of disinfection.

2. A germicide powder is used to disinfect the tube

of saliva ejector-and suctions.
3. Disposable towels are used to cover the
head rest

4. Aluminum foils or plastic covers are used to cover :

- The light handles
- Control buttons
- Handles of saliva ejectors and suction
- X ray handle
- Tube and control buttons
- The handpiece and light cure.
CLEANING PROCEDURE
1) Patient debris and body fluids must be removed from the
Instruments and surfaces by scrubbing them with hot water and soap,

- But this method forces someone to touch contaminated items when

organisms are most likely to be viable.
So, cleaning should be done with a disinfectant.

- The instruments placed directly into 3.2%

glutaraldehyde for 40 minutes then rinsed.

Transfer the instruments to an ultrasonic cleaner, which is )2

.excellent for cleaning but should not be considered a sterilizer
DISINFECTION .2

: Definition -
A process that kills disease causing organisms, but not
.necessary all microorganisms

:There are three levels of disinfection -

.low, intermediate and high
a) Low level disinfection:
Is the least effective disinfection process.
It dose not kill bacterial spores or mycobacterium tuberculosis.

b) Intermediate level disinfection:

Is a disinfection process that dose kill mycobacterium
tuberculosis but not bacterial spores.

c) High level disinfection:

Is a disinfection process that kill mycobacterium tuberculosis
and some, but not all, bacterial spores.
This process also kills fungi and viruses.
The concentration active ingredient and the contact - -

time are critical factors in the efficiency of the

.disinfectant
TYPES OF DISINFECTANTS

1) Ethyl alcohol,
2) Isopropyl alcohol
3) Chlorine
4) Iodophores and iodines
5) Glutaraldehyde (most common used liquid chemical in
dental clinics)
6) Phenolics
7) Quaternary ammonium compounds.
DISINFECTION PROCEDURE

1) 2% glutaraldehyde used for instruments soaking but not

to be used on environmental surfaces because it can
produce hypersensitivity reactions and release aldehydes.

2) Instruments immersed in glutaraldehyde for 40-60mts,

then they are rinsed , dried and packed before
sterilization.
Impressions should be rinsed then immersed in )3
disinfectant solution for 10-15 minutes then removed,
.rinsed and poured immediately
STERILIZATION .3

: Definition

The process by which all the microorganisms are

.eliminated from a surface of an instrument

.It is a process of yes or no , nothing can be half sterilized

 METHODS OF STERILIZATION IN DENTAL CLINIC

I. Heat
A. Boiling water :
- This method was used in the dental clinics in the past, now it is
seldom if ever used.

- It kills most bacteria within short time. However, bacterial spores

survive boiling for a very long time and viruses probably
survive indefinitely.

- For this reason boiling is considered a method for disinfection

and not for sterilization.
B. AUTOCLAVE (PRESSURE STEAM STERILIZER)

The most acceptable method for use in the dental clinics -

.nowadays

It works on the basis of the steam cooker and is an - -

extremely efficient method

.for sterilization of instruments -
The steam is at pressure of about 15 -30 lb/in 2. -
This pressure is enough to destroy all organisms
.and spores

Chemiclave is another method for sterilization -

where a chemical is used instead of water.
However, this method is not common in dental
.clinics
 C. HOT-AIR STERILIZER (DRY HOT OVEN)

.It is the most common method used in dental clinics -

:The disadvantages of this method are

1. In dry condition the organisms are

more harder to kill than when they
are wet.

2. Dry heat has very little power of penetration and unless a

very high temperatures are used the method is very slow.
3. After sterilization the instruments
need a considerable time to cool.

4. Not suitable for plastic instruments and instruments

which have soft solder.

5. The heating space is very irregular, the temperature

may reach very high degrees in one part and in other
part it may not reach the required degree. This is cold
“Cool spot”.
D. FLAMING

Irriadioplatinum hypodermic needles can be sterilized by

this method. However this is not advisable now as
.disposable needles are recommended
II.CHEMICAL METHODS

These methods involve the use of chemical liquid or gaseous

.compounds

.Ethylene Oxide Gas kills microorganisms

Total time from start of cycle t end of degas is 14 hours. It can be
.used for heat sensitive items

Disadvantage :
1. Very long cycle time.
2. If the cycle is interrupted before completion, there can be
possibility of ethylene oxide exposure.
Glutaral-dehyde (Cidex) used mostly for
disinfection as achieving sterilization will take
.long time (10-12 hours)
STERILIZATION PROCEDURES

:Critical instruments
Are those instruments that come in contact with
.bone or penetrate tissue

Forceps, scalpels and scalars are examples for

.critical instruments

.Heat sterilization is prefer­able

 :Semi critical instruments
These are instruments that will touch mucous
.membrane but will not penetrate the soft tissue

Mirrors, amalgam condensers and

.prosthetic impression trays

These instruments should be heat sterilized or if they

.will be damaged by heat, use high level disinfection
:Non-critical Instruments
Are those instruments and environmental surfaces
that will come in contact only with the intact skin
.of the patient

. Radiograph head/cone , facebow , pulse oximeter

An intermediate or low level disinfection is used

.for these instruments and equipments
STERILIZATION OF HAND PIECE

1. After each patient allow the handpiece to work

for 20-30 seconds to expel water and air.
- This will help to remove any contaminated
material.

2. After removal from the unite the handpeice is

cleaned, lubricated and wrapped
before placing in the autoclave.
SCALER TIPS AND AIR/WATER SYRINGE TIP

Scalers tips should be autoclaved

between patients while air/motor
syringe should receive a high level
.disinfection between patients

A disposable plastic cover can be

.Used for the air/water syringe tips
:DENTAL LABORATORY ITEMS

- Impression, casts, prosthetic devices and restorations that

have been in the patient’s mouth should receive an
intermediate level disinfection before sending to the
dental lab.

- The same should be done after manipulation of these

items in the dental lab.
Dental prostheses, impressions, appliances and other -
prosthodontic materials
e.g., occlusal rims, temporary prostheses, face bow forks or bite (
: should be )registrations

,Cleaned of all debris .1

.Disinfected with an intermediate-level disinfectant .2
.Thoroughly rinsed before being handled in the lab .3
Placed in sterilization bag or container prior to transportation .4
.to an off-site laboratory

Cleaning and disinfection should be done as soon as possible -

after removal from the patient's mouth and before drying of
.blood or other organic debris occurs
If laboratory items (e.g., burs, polishing points or -
laboratory knives) are used on contaminated appliances
or prostheses, they should be heat sterilized, disinfected
.between patients or discarded

Heat-tolerant items used in the mouth (e.g.,metal -

impression trays or face bow forks) should be cleaned
.and heat sterilized before being used on another patient

Items that cannot withstand heat sterilization (e.g., -

articulators) should be cleaned and disinfected according
. to the manufacturer's instructions
Appliances and prostheses delivered to the patient should -
.be free of contamination

Dental laboratory staff provides the disinfection using an -

intermediate level disinfectant then the item placed in a
.container before returning to the dental office

If such documentation is not provided, the dental office -

.should provide final disinfection procedures
REFRENCES

http://www. Jdentaled.org
http://www.healthmantra.com
http://www.CDC. gov
http://anshdental.com
http://delhidental.com
Thank You