REVIEW OF INFECTION

CONTROL
RISK
Are you at risk in your future practice?
You must know the risk
Reduce the risk
Health and Welfare Canada released the first set of
recommendations for the prevention of the spread of
HIV in health care settings in 1987
It was soon recognized that these recommendations
would be useful in preventing the transmission of other
blood borne pathogens (such as Hepatitis B and C
This became known as The Principle of Universal
Precautions
Standard Precautions
This is a standard of precaution with blood and body
fluids to be used with all patients at all times
Applies to all body fluids and is useful in Denturism due
to the constant presence of saliva
Assumes that all blood or body fluids are potentially
infectious
Use of infection control precautions should be
consistently used for all patients
Medical history, examination and laboratory tests cannot
reliably identify all infected persons
Components of Infectious Disease
A Susceptible Host
A person lacking effective resistance to a particular
pathogen
A Portal of Entry
Modes of transmission include direct and indirect
contact
 Inhalation
 Percutaneous injury
 Ingestion
 Placental Transmission

A Causative Agent
Any microbe capable of causing disease
Modes of Transmission
 Direct Contact
There is a touch from one person to another
 Indirect Contact
Occurs when there is a transfer via a medium, whether the
medium is animate or inanimate (e.g.. a chart)
 Inhalation
Can occur directly by inhaling what the infected host has
exhaled
Indirectly by disturbing the areas which will reintroduce the
pathogen into the air
 Percutaneous injury
Contact through the skin. Exposure when an object that has
caused the abrasion has been contaminated
Ingestion
Droplets or particles of saliva or blood are swallowed
Placental transmission
From mother to unborn child
DISEASES
Tuberculosis (TB)
Viral Hepatitis
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C (HBC)
Hepatitis D (HDV)
Hepatitis E (HEV)
Herpes Virus Diseases
Herpes Simplex Type I Virus (HSV-1)
Herpes Simplex Type II Virus (HSV-2)
 Primary Herpetic Gingivostomatitis
 Herpetic Whitlow
 Ocular Herpes
Human Immunodeficiency Virus (HIV)
New Emerging Diseases
Severe Acute Respiratory Syndrome (SARS)
Prion Diseases
 Creutzfeldt-Jacob Disease (CJD)
Survival Times of Pathogens
 Tuberculosis
6 – 8 months in dried sputum protected from sunlight
 HIV
90 – 99 % reduction in several hours
 HBV
Can survive at 42 % humidity for 7 days
 Staph Aureus
Five days on a dried surface
 Herpes Virus
When dried (e.g.. on chart) 3 hours
When mixed with fluid, 4 + hours
 Rhinovirus
Up to 14 hours in fluid
Common Dental Disinfectants
Sodium hypochlorite
Hypochlorite
Diluted bleach
Iodophor
Glutaraldehyde
Paracetic acid
Ortho-phthaladehyde
Best to Control Transmission
Barrier
Immunization
Practice Universal Precautions
Wash hands
Wear over gloves
Chemical treatment
Personal Protection Equipment (PPE)
Glasses
Masks
Gloves
Clinical attire
Closed toed shoes
Over-gloves
Double gloving
To contain contaminants
Basic Practices
 Gloves should be worn in treating all patients
 Masks should be worn to protect oral and nasal mucosa from
splatter of blood and saliva
 Eyes should be protected with some type of covering to protect
from splatter of blood and saliva
 Sterilization methods known to kill all life forms should be used
on dental instruments.
Steam autoclave, dry heat oven, chemical vapour sterilizers and
chemical sterilants
 Attention to clean-up of instruments and surfaces in the operatory
Scrubbing with detergent solutions and correctly wiping down
surfaces with disinfectants
 Contaminated disposable materials must be handled carefully and
discarded to minimize contact. Sharps in special containers
Clinical Attire
Gowns and Uniforms – vulnerable to contamination
by splash, splatter, or aerosols during patient contact
Scrubs for clinic, scrubs and lab coat for lab, apron
Closed at the neck,
No pockets that can be filled with items that can become
contaminated – pens or keys
Able to withstand high temperature laundering with
bleach
Commercial laundry services are ideal, but if washed at
home, launder separately and treat with disinfectant
(bleach)
Clinical attire is never worn outside the practice
 Contamination from a splatter can be carried from the treatment
area
Hair
Off the shoulders and fastened away from face, to avoid
contaminants from splatters
Facial hair – neatly trimmed and covered by face mask
or shield
 Beards and moustaches should be completely covered by mask

Jewellery
Remove all exposed jewellery and rings
Personal Barrier Protection
Facemask – used to prevent airborne infections and splatter
from entering the nose and mouth, especially when working
on previously worn dentures (repairs and adjustments)
used for all patient care procedures and all grinding and
polishing procedures
Guidelines for infection control – 95% of 1 p particle size
For TB – N95 Respirator mask
Glass fibre and synthetic fibre are most effective
Mask lining must be impervious to moisture (fluid resistant) –
it must be changed when it becomes wet from splatter or
exhaled moist air,
Must be changed after each patient or once an hour
 Mask should not touch nostrils or lips, or tongue when
speaking
Mask is well adapted to face and fit snugly (no tenting at
sides of mouth)
Avoid repositioning the mask – if you must, do not
handle in moist areas
Do not leave contaminated mask lowered around neck
Do not wear contaminated mask out of operatory
For removal, handle contaminated mask only by the
elastic tie strings and place in waste receptacle
immediately
Eyewear for Patient and DHCP
To prevent physical injury or infection of the eyes,
from splashes, splatter or aerosols from washing,
polishing or grinding procedures
Wide coverage, preferably with side shields
Shatterproof
Lightweight
Easily disinfected
Consider face shield during procedures that may spray
After each patient, rinse, clean and disinfect protective
eyewear (check for compatibility)
Gloves
 Must be used when any potential exists for contact with blood,
saliva, mucus membranes, bodily fluids or broken skin
 Store gloves in a dry, well-ventilated, cool area, away from
lights, heat and windows
 Petroleum jelly, alcohol products can break down glove integrity
 EXAMINATION GLOVES
Latex or non-latex
Non-sterile,
Single use, and replaced after 1 hour of use
If it becomes torn, cut or punctured, remove immediately, wash
hands thoroughly and place new gloves
OVERGLOVES
Wearing 2 pairs (double gloving)
Loose gloves that go over contaminated treatment gloves
to allow handling of objects - e.g. Pen, chart
STERILE SURGICAL GLOVES
Pre-sterilized
Heavier material than examination gloves
UTILITY GLOVES
Heavy, puncture resistant
Good for clean up
CHEMICAL BARRIER
Hand Care
Hands can act as a reservoir for micro-organisms,
especially under the fingernails
Act as a means of disease transmission
Fingernail care
Trim nails short to minimize collecting organisms under
them and to protect glove integrity
Clean under nails daily, taking care not to cause skin
perforations
Artificial nails have been linked to outbreaks of fungal
and bacterial infections
Wrist Watch and Jewellery
Remove at the beginning of the day
Micro-organisms can be lodged in the crevices
Can compromise the integrity of gloves and fit
Hand Hygiene
Water temperature used to wash hands should be cool,
not warm or cold
Hands should be thoroughly dry before gloving
Consider the absorbency of the disposable towels
If using hand lotions, consider the compatibility of the
lotions you select and their effect on glove integrity
Hand Washing Principles
 Effective and frequent hand washing will reduce the bacteria on the
skin
The preferred method depends on the procedure being preformed
 Hand washing is the single most critical measure for reducing the risk
of transmitting organisms to patients and DHCP
 Hand washing should occur
At the beginning of the day
When hands are visibly soiled
After bare-handed touching of objects that may be contaminated
Before leaving the operatory or the dental lab
Before and after each patient (before glove placement and after glove
removal)
Before donning gloves or re-gloving
Immediately after removing gloves that are torn, cut or punctured
Hand Washing Guidelines
FOR BEGINNING OF THE DAY
 Remove jewellery
 Fix hair back
 Gently clean under the fingernails (take care not to abrade the
tissue)
 Apply face mask and eyeglasses
 Adjust water temperature
 Wash using anti-microbial or non-antimicrobial soap
 After washing, dry hands taking care not to contaminate hands
Use a separate disposable towel for each hand
 Use paper towel to turn off hand faucet
Hand Washing Guidelines
Beginning and end of day Between Patient
Lather hands (15 seconds) Lather hands (10 seconds)
Rinse (15 seconds) Rinse (10 seconds)
Repeat 2 more times Repeat 2 more times
Dry Dry
90 SECONDS TO 60 SECONDS TO
COMPLETE COMPLETE
PROCEDURE PROCEDURE
Use cool water Use cool water
temperature temperature
Alternative to Hand Washing
Alcohol rubs (hand sanitizers)
If hands are not visibly soiled they may be considered an
appropriate choice
Germicidal as well as antiseptic ingredient such as
chlorhexidine, quaternary ammonium compounds or triclosan
60 – 90 % ethanol or isopropanol
Apply an adequate amount to the palm of one hand and rub
hands together, covering all surfaces, including between
fingers and wrists.
If hands feel dry after 10 – 15 seconds, an insufficient
volume of product was used (follow manufactures directions)
Think About It...
Always look and think first!
Stay safe by protecting yourself
Enjoy what you do
Do no harm!
In the Clinic
Infection Control in the Clinic
Report to the clinic 15 to 30 minutes before start time to
prepare for clinical treatment
Be sure to come with:
Proper Attire
 Clean lab coat with name tag, over Trillium College Scrubs (white t-
shirt or long sleeved turtle neck under is acceptable)
 White shoes (no open toes) and full socks (must cover ankles)
 Hair properly secured
 No jewellery (as per protocol)
Safety glasses (baggie)
Infection Control Procedures Manual
Clinic pen
Armamentarium needed for appointment - mixing bowl,
prosthesis
Entering the Clinic
On entering the clinic, student removes their lab coat
and hangs it in the designated area
Proceed to the dental unit
Perform proper hand washing technique
Let’s begin
In summary, the process is;
Clean
Wipe
Disinfect
When performing all sanitation, it is mandatory to
wear Personal Protective Equipment - PPE
Gloves
Mask
Safety glasses
The Treatment Unit and Equipment
Don PPE,
Purge water lines for 2 minutes into cuspidor (before
and after client procedure)

CHANGE GLOVES
Treatment Area
Optim 33TB (accelerated hydrogen peroxide 0.5%) is
the hard surface cleaner and disinfectant used
CLEAN – cleaning precedes all disinfection and
sterilization
With a disinfectant gauze (squeeze excess) wet the
following surfaces and allow soaking for 30 seconds
Bracket table and attachments
Suction holders – tubing, air/water syringe handle
Light handles and switch (not light cover)
Mobile unit
Counter tops, sink, faucet, and handles
Cuspidor

WIPE DRY
With paper towel, using overlapping strokes

DISINFECT
Re-wipe all items as in “clean” stage with fresh
disinfectant soaked gauze
Allow areas to remain wet for 1 minute

CHANGE GLOVES
The Chairs (Client and Operator)
Spray CHAIR-CARE cleaner
CLEAN - on paper towel and wipe down upholstery on
bother chairs (client and operator)
Include chair adjustment levers

WIPE DRY
with paper towel

DISINFECT
Do it again, spray and wipe dry

REMOVE GLOVES AND WASH HANDS

Infection Control Barrier
Place Infection Control Barriers (no gloves)
Head rest cover
Tray barrier sleeve
Tray cover

Place Blue Barrier Film

Light handles – both sides
Unit control panel
Bracket table handles – both sides
Operator chair – adjustment lever
Portable mobile unit – sides
Cuspidor – on/off water switch
Gather Materials
Set out all required items for the procedure (no gloves)
From mobile unit
From central supply area – use transfer forceps for
retrieving all supplies from central area
Prepare the clean side of the work area
Tray cover
Hand mirror
Patient bib with napkin holder
Cotton tip applicator, with Vaseline in medicine cup
Over gloves on each side of mobile unit attached with tape

Set out instruments to be used on bracket table

cover with client bib
Begin Treatment
Report to Reception Area
Greet patient
Accompany them to chair

Seat patient
Wash hands

Update client medical history

Place PPE
Face mask
Safety glasses
Examination gloves
During Treatment
Always remove gloves or place over-
gloves when leaving chair side for any
reason
On Completion of Treatment
Client
Clean client’s face
Turn off light
Remove client’s bib

Self
Remove PPE
 Gloves
 Face mask
 Safety glasses – place on clean paper towel
Wash hands

Escort patient to reception area for dismissal

Ensure that an appointment has been provided if necessary
Return to dental unit for cleaning of unit
Wash hands

Don new PPE

Disinfect Impressions
Rinse to thoroughly clean impression
Spray with evenly with Lab-X to ensure wetness on all
surfaces. Maintain wetness for 3 minutes.
Clean bowl and spatula (while waiting)
Rinse impression for at least 30 seconds (count it out)
Wrap with wet paper towel
Clean, with soap and water, dry with paper towel
the napkin holder
Safety glasses
Hand mirror
Place items in top drawer of mobile unit

Purge lines for at least two minutes into cuspidor prior

to removing air/water syringe tip
Flush HVE system tubing with MICOVAC solution
according to manufacture’s directions

CHANGE GLOVES
Remove all barriers
Place in non-biohazard waste (regular garbage) under sink
Empty solids container basket
Into white bio-hazard bag (on side of bracket table)
Rinse and place back in holder
Secure the white plastic bag with masking tape and place in
yellow biohazard container in clinic
Place all disposable sharps into the yellow sharps
container (under sink)

CHANGE GLOVES
Clean, Wipe and Disinfect the operatory and work
area as per protocol
Remove the non-biohazard garbage from the garbage
container
Secure bag and dispose in large containers in clinic
Return chair to fully elevated position
Place light over bracket table
Place rheostat on paper towel on dental chair
Ensure MASTER SWITCH is turned OFF