INFECTION CONTROL IN SURGICAL

PRACTICE
 Physiological protection

Rapid epithelial turnover with desquamation

Salivary immunoglobulin A

Dilution by salivary flow

Availability for nutrients and attachment sites

 Hepatitis B Virus

Serum hepatitis

most serious occupational

hazard to a dental surgeon

Asymptomatic HBsAg positive

carrier present greater risk for health care workers

Pt with the history of hepatitis, multiple blood transfusion, parental drug

abuse, chronic liver failure, leukemia, should have routine HBsAg
because of high frequency of carrier state in these groups
 Transmission

introduction of infected blood into the blood stream of a susceptible

host

also by sexual contacts, mother to child

Infected individuals may also secrete large

amount in their saliva

0.000001 ml of infected blood is capable

of transmitting the virus
 No evidence of airborne HBV infection

Most patients recover within a few weeks without any sequel

4 to 10 % of patients fails to clear HBV by 6-9 months and consequently

develop a chronic carrier state.

This stage is very infectious as they harbor infective virions in the blood
indicated by the presence of Hbe Antigen
 Carrier

Any individual carrying the disease without being aware of it OR

Who has been exposed to the disease, but does not yet have any
clinical symptoms OR

Who has had the disease and has recovered

 HCV

HCV transmission is some how similar to the

hepatitis B

risk of exposure to HCV during surgical

procedure is less than HBV but more than HIV

PROPERTIES HEP B HEP C

Incubation period 45 to 150 days 15 to 160 days
Route of infection Oral, parenteral, sexual, Mainly parenteral
maternal
immunization effective Un-known
Carrier state Up to 10 % prevalence un
known
 HIV

low occupational hazard in dental surgery

Relative inability to survive out side the host

loses its infectivity once desiccated

No evidence support possibility of HIV

infection by saliva alone

Blood of the patients who are HIV +ve has a

very low concentrations of infectious particles
 Mycobacterial Organism

Tb is caused by mycobacterium tuberculosis

Transmission is by exhaled aerosols that carry M. tuberculosis bacilli

from infected lungs of one individual to another.

Droplets are produced by Breathing, coughing ,

sneezing and speaking

M. tb is not a highly contagious micro-organism,

however transmission can also occur via
in-adequately sterilized instruments because it
is highly resistant to desiccation and to most
chemical disinfectants.
 In most people the body contain the bacteria and prevent it from
multiplying.

The bacterium can live in the lungs of an infected person for years, even a
lifetime, without the person exhibiting any symptoms. This state is called
latent TB infection.
latent TB infection

have no symptoms
don't feel sick
Can't spread TB to others
10 % can develop active TB later in life if they do not receive treatment

A person with latent TB is not infectious, he or she can be treated in the dental
office under standard infection control precautions
 when the persons immune system is weakened allowing the bacteria to
become active and cause TB disease

HIV, diabetes, leukemias and lymphomas, prolonged corticosteroid

use, and other conditions).

Only a person with active TB can transmit the disease.

Active TB

have symptoms (productive cough, night sweats, fever, weakness or

fatigue, weight loss, pain in the chest)
feel sick
can spread TB to others
Any patient with symptoms suggestive of active TB disease should be..

removed from the area of other patients or staff

instructed to wear a surgical mask

assessed for the urgency of their dental care and promptly referred for
medical care.
 Standard precautions are insufficient to prevent transmission of the
bacterium.

Elective dental treatment should be deferred until the patient has been
declared non-infectious by a physician.

Treatment should be provided in a facility that has the capacity for

airborne infection isolation and has a respiratory protection program.

When treating a patient with active TB, dental health care personnel
should use respiratory protection (e.g., fitted, disposable N-95
respirators).

Standard surgical face masks are not designed to protect against TB

transmission.
N-95 Respirators
 Route of transmission

Microbial transmission by dental related secretions and exudate occur

by 2 general routes

1. Inoculation

Direct contact of previously damaged skin or mucous membrane with a

lesion, organism or debris while performing intra-oral procedures provide
a portal of entry for microorganism.

Accidental self injury with a contaminated needle, sharps, or flying debris

from the oral cavity provides another portal of entry.
 Micro-organisms transmitted by inoculation

Hepatitis B virus
Hepatitis C virus
Herpes simplex type I ( Oral herpes)
Herpes simplex type II (Genital herpes)
HIV (AIDS)
Treponema pallidum (syphilis)
Staph. Aureus (wound infectrions/ Abscess)
Pseudomonas aeruginosa (wound infection/ Abscess)
Clostridium tetani ( Tetanus)
2. Inhalation

This occurs when using high speed or ultrasonic equipment.

Microorganisms are aerosolized from patients blood or saliva

Potential dangers are often missed since much of the splatter coming
from the patients mouth is not readily noticed.
 Micro-organisms transmitted by inhalation

Mycobacterium tuberculosis
Varicella-zoster virus (Chickenpox )
Rubella virus (German measles)
Rubeola and mumps virus
Cytomegalovirus
 Modes of Disease transmission

4 most common ways of disease transmission are

1. Personal contact
From one person to another through direct contact like venereal
diseases, such as AIDS, herpes & syphilis.

Contacts with contaminated blood, saliva, or mucous may spread them

2. Carrier contact
Carrier is potentially very dangerous in the dental setting because he
has no idea that he is infected

Serum hepatitis and AIDS

AIDS is indeed a fatal disease but hepatitis is still the most important
infectious disease of concern in dentistry.
3. Droplet transmission

It occurs when a person breaths, talks, sneezes or coughs.

Common cold and flu viruses are thus easily transmitted from one
person to another.

Hand pieces also throw out a great deal of contaminated aerosol during
the course of a procedure.
4. Indirect transmission
Occurs through dirty hands, soiled laundary articles, contaminated
instruments or any thing touched during detal procedure.

Indirect transmission or cross contamination can occur from touching

any of the following during a surgical procedure.

- Face - Clothing
- Cabinets - Light handles
- X rays - Patient history sheets
- Cotton roll - Hair
- Medicament bottles - Anesthetic supplies
- Light switch - Exposed instruments
- Cellular phones - Ball pens
 Barrier techniques

Gloves, masks, protective eye wears, clinic attire must be

wear by all personnel who have direct contact with the
patient, regardless the nature of the procedure
 Gowns & protective apparel

High-necked, long sleeved, knee length

Seams, buttons, buckles should be kept minimum

Should never be used outside the work area after use

Tie is considered the most contaminated part of the apparel

 Hands & Gloves

Hands should be washed before gloving, after removal of gloves & after
touching inanimate objects likely to be contaminated by body fluids.

Gloves are meant to supplement, not replace the hygienic practice of

proper hand washing
 Masks and face shield

Face mask should be changed on every patient

Recommended is to change the mask after 20 minutes in aerosol and

60 minute in non-aerosol environment
 Eye protection

Susceptible to physical & microbial injury

Bacteria do not often infect the eyes but viruses are a great risk

Transconjunctival transmission of hepatitis B has been reported

Herpetic conjunctivitis is a potentially serious risk as it may

cause blindness

5 % of the patients with a history of herpes, shed virus in the

saliva even when there is no active lesion
 CDC Recommendations

For dental unit water lines

Flush water lines at the beginning of the day for 30 seconds (may
temporarily reduce the level of microbes in the water)

Flush air/water through handpieces for 20 seconds after each patient

(helps reduce any patient-borne microbes that may have entered the
handpiece and were "sucked back" down the dental unit line)

Do not use dental unit water for any procedure that involves cutting
to the bone