INFECTION CONTROL

IN DENTISTRY
REYES - SALAMAT
SALAMAT,
RENZY 06
Previous Centers for Disease Control and Prevention (CDC)
recommendations regarding infection control for dentistry
focused primarily on the risk of transmission of blood borne
pathogens among DHCP and patients and use of universal
precautions to reduce that risk
Standard precautions apply to contact with
1) blood
2) all body fluids, secretions, and excretions (except sweat),
regardless of whether they contain blood
3) non-intact skin; and 4) mucous membranes
Saliva has always been considered a potentially infectious
material in dental infection control; thus, no operational
difference exists in clinical dental practice between universal
precautions and standard precautions.
•Comprehensive and systemic program that, when applied prevents the
transmission of infectious agents among persons who are in direct or indirect
contact with the health care environment
•Why Infection Control Important in Dentistry?
•Both patients and dental health care personnel (DHCP) can be exposed to
pathogens
•Contact with blood, oral and respiratory secretions, and contaminated
equipment occurs
•Proper procedures can prevent transmission of infections among patients and
DHCP
•Principles of Infection Control
•Stay healthy
•Avoid contact with blood and body fluids
•Limit the spread of contamination
•Make objects safe for use
SALAMAT,
RENZY

TRANSMISSION OF INFECTION
1.Contact
a. Direct contact: Human-human touch. Contact with
microorganisms at the source.
b. Indirect contact: Human-object/animal-human touch. Contact
with contaminated items such as surfaces especially dental office
equipment and/or instruments including contaminated sharps.

2. Droplet Infection
a. Splatter of blood, saliva or nasal secretions onto broken
mucosa or skin.
b. Airborne by aerosols of microbes
SALAMAT,
REYES, AP
RENZY

PRINCIPLE ROUTES OF ENTRY OF MICROORGANISM

INTO THE BODY

Inhalation
Direct inhalation
Indirect inhalation
•Ingestion
•Autoinoculation/percutaneous injury
SALAMAT,
REYES, AP
RENZY

AIM
SALAMAT,
REYES, AP
RENZY

1. Immunization
Dental personnel can reduce the risk of contracting infectious
diseases by maintaining their health and immune status. Following
the series of hepatitis B vaccinations, there should be confirmation
that an adequate antibody titer has been reached (10 International
Units/liter)
2. Patient Screening
Complete medical history should be taken for every new patient
and updated during recall appointments to determine infectious
status
3. Hand Hygiene
Significantly reduces microbes on the hands and protects both
patients and the dental staff. The purpose of washing is twofold to
reduce the both transient and resident flora for the duration of a
procedure to protect the operator in the event that there is
nonintact skin on the hand.
SALAMAT,
REYES, AP
RENZY

The following agents have been found to be effective:

a. 2 to 4 percent Chlorhexidine
b . 0.3 to 1 percent Triclosan
c. 0.6 percent Parachlorometaxylenol (Pcmx)
d. 60 to 70 percent Propanol
SALAMAT,
REYES, AP
RENZY
a. Wet hands from fingertips to wrist with cool water
b. Place liquid soap on nailbrush and on hands
c. Clean the fingernails with brush until no visible soil remains, leave brush in sink
d. Scrub hands vigorously
e. Rinse with cool water until all traces of soap are removed
f. Dry thoroughly.

The wash without the use of a nail brush is used:

a. Prior to glove placement and following glove removal.
b. After bare handed touching of inanimate objects likely to be contaminated by blood or
saliva
c. Before leaving the dental operatory.

The shorter handwash technique is as follows:

a. Wash the hands using a liquid soap for 15 seconds
b. Rinse under running water for 10 seconds or until all traces of soap are removed
c. Dry thoroughly with one or two paper towels and ensure proper drying
SALAMAT,
REYES, AP
RENZY

4. Barrier Techniques — Personal Protective Equipment (PPE)

Designed to protect the skin and the mucous membranes of the
eyes, nose, and mouth of dental health care provider from exposure
to blood. Primary PPE used in health care settings includes gloves,
surgical masks, protective eyewear, face shields, and protective
clothing
1.Protective Clothing
Worn to reduce exposure to debris in spatter. Clinic outerwear is to
be fully buttoned, has long sleeves with elasticized cuffs and a high
neck
2. Masks
Worn when procedures that result in aerosol production are
performed. Protection from these masks only affords protection for
those particles 5 μm and larger. Masks must also be worn if dental
personnel have transmissible respiratory infections.
SALAMAT,
REYES, AP
RENZY

3. Protective Eyewear
When performing procedures that can cause spatter or
aerosols including laboratory procedures. When performing
procedures that produce projectiles including laboratory
procedures. When working with or in proximity to chemicals
which emit fumes especially in the laboratory. When it is likely
that unprotected eyes will be exposed to any type of physical
injury or splashes from corrosive or toxic chemicals.
SALAMAT,
REYES, AP
RENZY

4. Gloves
Reduce hand contamination and protect HCW particularly
from pathogens that result in infection. Gloves reduce hand
contamination by 70 to 80 percent, prevent cross-
contamination and protect patients and HCW from infection.
SALAMAT,
REYES, AP
RENZY

Over gloves/cover glove

These gloves help to use time more efficiently and to
protect the skin. The purpose of these gloves is to reduce the
number of treatment gloves used, to use time more efficiently
when supplies or equipment need to be accessed, and to
reduce the number of washes required due to glove changing
in short, to reduce resource use
SALAMAT,
REYES, AP
RENZY
Utility gloves
Heavy-duty utility gloves should be used during all disinfection
and cleaning procedures to reduce the increased risk of
percutaneous injury during instrument cleaning.

5. Intraoral Barrier Technique

•Rubber dam
•Preprocedural mouthrinse

5. Needle and Sharp Instrument Safety

Sharp ends of any instrument or device should be angled
away from both the doctor and the coworkers when receiving,
handling or passing such instruments. Center for Disease
Control and Prevention (CDC), recommends that for
procedures involving multiple injections with a single needle,
the unsheathed needle should be placed in a location where it
will not become contaminated or contribute to unintentional
needle sticks between injections
SALAMAT,
REYES, AP
RENZY

POSTEXPOSURE PROTOCOL FOR OCCUPATIONAL EXPOSURE TO

BLOOD/BODY FLUIDS
1. Stop the procedure immediately
2. Inform patient
3. Remove gloves and apply first aid as required
4. Injuries to the skin should be washed well with soap and running water and bleeding at the
injured site can be encouraged while washing
5. First aid measures should be applied to stop bleeding if required
6. Mucous membranes should be flushed well with water. When splashes have occurred to the
eye, the eyewash station is to be used to thoroughly flush the eyes
7. Clinical support staff should be notified to arrange for the completion of the treatment 8.
The clinical support staff should ask the patient to submit blood for the appropriate blood
tests; (microbiology and serology) for HIV
REYES, AP

6. Instrument Serilization and Disinfection

SALAMAT,
REYES, AP
RENZY

•Dental instruments are classified into three categories critical, semicritical, or noncritical depending
on their risk of transmitting infection and the need to sterilize them between uses.
SALAMAT,
REYES, AP
RENZY 06

PREPARATION FOR INSTRUMENT

STERILIZATION/DISINFECTION
Initial Storage:
Contaminated instruments should be immersed in a
sink of water (Faculty) or in a pre-soak disinfectant
immediately after use to avoid drying and hardening of
organic debris
SALAMAT,
REYES, AP
RENZY

Removal of Debris:
Debris must be removed prior to sterilization; otherwise the
item will not be sterile even though it has been processed.

Manual Scrubbing:
a. Must wear utility gloves to minimize risk of skin puncture
b Immerse instruments in detergent solution and scrub with
a soft brush, holding both brush and instrument under the
water surface to prevent aerosolizing and splashing
c. Rinse and dry instruments. Wet instruments increase the
risk of tearing any sterilization packaging system which utilizes
paper and may contribute to rusting of instruments in a dry
heat oven
d. Immerse, wash, and dry instrument trays or cassettes
SALAMAT,
REYES, AP
RENZY

Inspection
They should be checked for cleanliness and dryness, signs of
rust or cracks and proper opening and closing. Ensure that no
organic or inorganic matter remains.

Wrapping (bagging)
The principal objective in wrapping is to protect sterilized
instruments from environmental contamination
Cleaned instruments are not decontaminated and,
therefore, must be handled with gloves
Use correct packaging for sterilization needs
SALAMAT,
REYES, AP
RENZY

Sterilization
1. Steam under pressure — gravity displacement or
prevacuum sterilizer
2. Dry heat — static air or forced air
3. Unsaturated chemical vapor. \
To ensure the integrity of the sterilization process, the
operating and maintenance instructions supplied by the
manufacturer should be followed carefully
REYES, AP
06

STEAM, VAPOR UNDER PRESSURE

(AUTOCLAVE)
items being processed require exposure to direct
steam contact at the required temperature and
pressure for the specified time. Pressure serves as the
means to obtain the high temperatures needed to kill
microorganisms.
High temperature of the steam, 121 to 132°C (250 to
270°F).
REYES, AP
06
REYES, AP
06

DRY HEAT
Less efficiently than moist heat because as proteins
dehydrate and dry, their resistance to denaturation
increases
A higher temperature is required for a dry heat unit
than for a steam processor
A typical dry heat cycle is 1 hour at 170°C or 2 hours at
160°
REYES, AP
06

CHEMICAL VAPOR
use a specific mixture of formaldelhyde, alcohols,
ketone, acetone and water under pressure
132°C (270°F) to achieve sterilization (20 to 40
minutes)
chemical solution must only be used once
REYES, AP

HEAT TRANSFER (BEAD TYPE)

use extremely hot rapid airflow to achieve sterilization in
approximately six minutes.
only used at chair side for files and burs (inconsistent heating)
All instruments and all items that are able to withstand
repeated exposure to heat must be heat sterilized between
patients
The purpose of cleaning the instruments prior to sterilization is
to reduce the amount of blood, saliva, microbes and other
materials that can insulate microorganisms from the sterilizing
agent.
REYES, AP

SINGLE USE ITEMS

All single use or disposable items, labeled as such, used in
patient treatment must be discarded and not reused.
Disposable needles and syringes; local anesthetic carpules;
saliva ejectors, high volume evacuator tips and air water syringe
tips; polishing disks, cups, points; prophy angles, cups, and
brushes; fluoride trays; disposable impression trays; gloves,
masks, orthodontic wires, bands and brackets, matrix bands.

These items are neither designed nor intended to be cleaned,

disinfected, or sterilized for reuse.
REYES, AP

DISINFECTION
the use of a chemical to remove most forms of life on an
instrument, device, or environmental surface (operatory
surface).
This is done either because it cannot be processed in a sterilizer
due to its ability to withstand high temperatures or due to its
size.
REYES, AP
07
SURFACE DISINFECTION AND GENERAL
OPERATORY ASEPSIS
All those areas that were covered with barriers, bracket table,
countertops, mobile air/water syringe handles, suction and saliva
ejector couplings, dental chair, operator and assistant stools, soap
and towel dispenser areas and X-ray viewer and switch.
SANITATION - removal of organic material since disinfectant are
not effective in presence of organic material
Utility gloves are used during disinfection to reduce risk to the
operator from pathogens as well as the chemical disinfectant.
REYES, AP
REYES, AP
08
RADIOGRAPHIC ASEPSIS
WEAR:
gloves - when exposing radiographs and handling contaminated film
packets
PPE - spattering of blood
USE: heat tolerant or disposable intraoraal device
After exposure of the radiograph and before glove removal, the film
should be dried with disposable gauze or a paper towel to remove
blood or excess saliva and placed in a container
FDA cleared barrier with EPA registered hospital disinfetant
REYES, AP
09
LABORATORY ASEPSIS
impression , jaw relation records , casts and prosthetic restorations
and devices
should be thoroughly cleaned, disinfected with an EPA registered
hospital disinfectant with a tuberculocidal claim, and thoroughly
rinsed before being handled in the in-office laboratory or sent to an
off site laboratory.
BEST TIME TO CLEAN AND DISINFECT: after removal from px mouth
before drying of blood or bioburden can occur
general waste - disposable trays, impression materials
punctured resistant containers - in disposing sharp items
REYES, AP
10

DISPOSABLE OF CONTAMINATED WASTE

Disposable materials such as gloves, masks,
wipes, paper drapes and surface covers that
are contaminated with body fluids should be
carefully handled with gloves and discarded in
sturdy, impervious plastic bags to minimize
human contact.
REYES, AP
TREATMENT ROOM FEATURES
OBJECTIVE: should be to have materials, shapes, and
09
surface textures that facilitate the use of infection
control measures.
REYES, AP
REYES, AP
09
USE AND CARE OF HANDPIECES, ANTIRETRACTION VALVES, AND OTHER INTRAORAL
DENTAL DEVICES ATTACHED TO AIR AND WATER LINES OF DENTAL UNITS
ROUTINE STERILIZATION IS RECOMMENDED FOR ALL HANDPIECE
USED INTRAORALLY AND REUSABLE PROPHYLAXIS ANGLES
Surface disinfection by wiping or soaking in liquid chemical
germicides is not an acceptable method
antiretraction valves (one-way flow check valves) should be
installed to prevent fluid aspiration and to reduce the risk of
transfer of potentially infective material.
High speed handpieces should be run to discharge water and air for
a minimum of 20 to 30 seconds after use on each patient.
REYES, AP
REYES, AP

SINGLE USE DISPOSABLE INSTRUMENTS

should be used for one patient only and discarded appropriately. These items are neither designed nor intended to be
cleaned, disinfected, or sterilized for reuse.

HANDLING OF BIOPSY SPECIMENS

should be put in a sturdy container with a secure lid to prevent leaking during transport.
If the outside of the container is visibly contaminated, it should be cleaned and disinfected or placed in an impervious
bag.

USE OF EXTRACTED TEETH IN DENTAL EDUCATIONAL SETTINGS

All persons who collect, transport, or manipulate extracted teeth should handle them with the same pre- cautions as a
specimen for biopsy
Before extracted teeth are manipulated in dental educational exercises, the teeth first should be cleaned of adherent
patient material by scrubbing with detergent and water or by using an ultrasonic cleaner.
Teeth should then be stored, immersed in a fresh solution of sodium hypochlorite (household bleach diluted 1:10 with tap
water) or any liquid chemical germicide suitable for clinical specimen fixation.
REYES, AP

Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunization of human
beings or animals or in research activities.
The segregation, packaging, transportation and storage shall be done as under:

1. Biomedical waste shall not be mixed with other wastes.

2. Biomedical waste shall be segregated into containers/bags at the points of generation prior to its storage, transporta-
tion, treatment and disposal. The containers shall be labeled.
REYES, AP

Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunization of human
beings or animals or in research activities.
The segregation, packaging, transportation and storage shall be done as under:

1. Biomedical waste shall not be mixed with other wastes.

2. Biomedical waste shall be segregated into containers/bags at the points of generation prior to its storage, transporta-
tion, treatment and disposal. The containers shall be labeled.
T H A NK
YOU