Infection Control in Dental

Health- Care
Infection Control Program Goals
 Provide a safe working environment

• Reduce health care-associated

infections

• Reduce occupational exposures

 Why Is 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
 Modes of 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
 CHAIN OF INFECTION
 All links must be connected for infection to take place

Pathogen
(sufficient virulence
& adequate numbers)
Susceptible Host Source
(i.e., one that is not immune) (allows pathogen to
survive & multiply)

Entry Mode
(of transmission
(portal that the from source to host)
pathogen can
enter the host)
Potential Routes of Transmission
of Bloodborne Pathogens
Patient DHCP

DHCP Patient

Patient Patient
Factors Influencing Occupational
Risk of Bloodborne Virus Infection
 Frequency of infection among patients
 Risk of transmission after a blood
exposure (i.e., type of virus)
 Type and frequency of blood contact
Concentration of HBV in Body Fluids

High Moderate Low/Not Detectable

Blood Semen Urine

Serum Vaginal Fluid Feces
Wound exudates Saliva Sweat
Tears
Breast Milk
 HCV Infection in
Dental Health Care Settings
 Prevalence of HCV infection among
dentists similar to that of general population
(~ 1%-2%)
 No reports of HCV transmission from
infected DHCP to patients or from patient
to patient
 Risk of HCV transmission appears very low
 (Infection Control Program)
Standard Precautions

1.Education and Training

2.Immunization
3.Patient Screening and evaluation
4. Hand Hygiene
5. Barrier Techniques
6. Needle & Sharp Instrument Safety
7. Instrument Sterilization and Disinfection
8.Environmental Infection Control ( Surface Disinfection)
9.Special Considerations
1.Education and Training
2. Immunization
vaccination against:
A) HEPATITIS B
B) RUBELLA
C) MEASLES
D) MUMPS
E) INFLUENZA
F) POLIO
G) TETANUS/DIPHTHERIA
3.PATIENT SCREENING
And evaluation
Hand Hygiene
Why Is Hand Hygiene Important?

 Hands are the most common mode of

pathogen transmission

 Reduce spread of antibiotic resistance

 Prevent health care-associated infections

 Hands Need to be Cleaned When

 Visibly dirty
 After touching contaminated objects with bare
hands
 Before and after patient treatment
(before glove placement and after glove removal)
 Hand Hygiene Definitions

 Handwashing
• Washing hands with plain soap and water
 Antiseptic hand wash
• Washing hands with water and soap or other
detergents containing an antiseptic agent
 Alcohol-based handrub
• Rubbing hands with an alcohol-containing
preparation
 Surgical antisepsis
• Handwashing with an antiseptic soap or an
alcohol-based handrub before operations by
surgical personnel
 Effective antimicrobials agents
A) 2-4% CHLORHEXIDINE

B) 0.3-1% TRICLOSAN

C) 0.6% PARACHLOROMETAXYLENOL (PCMX)

D) 60-70% PROPANOL
 Efficacy of Hand Hygiene
Preparations in Reduction of Bacteria
Good Better Best

Plain Soap Antimicrobial Alcohol-based

soap handrub
 Special Hand Hygiene
Considerations
1. Use hand lotions to
prevent skin dryness
2. Consider compatibility of
hand care products with
gloves (e.g., mineral oils
and petroleum bases may
cause early glove failure)
3. Keep fingernails short
4. Avoid artificial nails
5. Avoid hand jewelry that
may tear gloves
 5. BARRIER TECHNIQUES

1. Protective clothing

2. Masks
3. Protective Eyewear

Gloves )4
 Protective Clothing
 Wear gowns, lab coats, or
uniforms that cover skin
and personal clothing likely
to become soiled with
blood, saliva, or infectious
material

 Change if visibly soiled

 Remove all barriers before

leaving the work area
 Masks, Protective Eyewear, Face
Shields

 Wear a surgical mask and

either eye protection with solid
side shields or a face shield to
protect mucous membranes of
the eyes, nose, and mouth
 Change masks between
patients
 Clean reusable face protection
between patients; if visibly
soiled, clean and disinfect
 Gloves
 Minimize the risk of health care
personnel acquiring infections
from patients
 Prevent microbial flora from being
transmitted from health care
personnel to patients
 Reduce contamination of the
hands of health care personnel by
microbial flora that can be
transmitted from one patient to
another
 Are not a substitute for
handwashing!
 Types of gloves worn in the dental office
 Examination gloves
 Over or cover gloves
 Utility gloves
 Under gloves (DERMAL .COTTON)
 Surgical gloves .
 Heat resistance gloves
 Recommendations for Gloving

 Wear gloves when contact with

blood, saliva, and mucous
membranes is possible
 Remove gloves after patient care
 Wear a new pair of gloves for
each patient
 Recommendations for Gloving

Remove gloves that

are torn, cut or punctured

Do not wash, disinfect

or sterilize gloves for reuse
Latex Hypersensitivity
and Contact Dermatitis
 Latex Allergy

 Type I hypersensitivity to natural

rubber latex proteins
 Reactions may include nose, eye,
and skin reactions
 More serious reactions may
include respiratory distress–rarely
shock or death
 Contact Dermatitis
 Irritant contact dermatitis
• Not an allergy
• Dry, itchy, irritated areas
 Allergic contact dermatitis
• Type IV delayed hypersensitivity
• May result from allergy to chemicals used in glove
manufacturing
 General Recommendations
Contact Dermatitis and Latex Allergy
 Educate DHCP about reactions associated with
frequent hand hygiene and glove use
 Get a medical diagnosis
 Screen patients for latex allergy
 Ensure a latex-safe environment
 Have latex-free kits available (dental and
emergency)
 ( 6) Needle & Sharp Instrument Safety

 Engineering controls

 Work practice controls

 Engineering Controls

 Isolate or remove the hazard

 Examples:
• Sharps container
• Medical devices with injury protection
features (e.g., self-sheathing needles)
 Work Practice Controls

 Change the manner of performing tasks

 Examples include:
• Using instruments instead of fingers to
retract or palpate tissue
• One-handed needle recapping
 7) Instrument Sterilization And
Disinfection.
Sterilization
 A process that destroys all types and forms of microorganisms,
including virus, bacteria, fungi, and bacterial endospores
Bactericidal:
 A process or an agent that destroys (kills) bacteria.
Bacteriostatic:
 A process or an agent that inhibits growth or multiplication of
bacteria.
Contamination:
The introduction of an infectious agent into an area..
 Disinfection
 High-level sterilization:
 A process that kills some, but not necessarily all, bacterial
spores. It is tuberculocidal,
 Intermediate-level disinfection:
 A process that is capable of killing Mycobacterium
tuberculosis, hepatitis B virus, and HIV. It may not be
capable of killing bacterial spores.
 Low-level disinfection:
 A process that kills most bacteria, some fungi, and some
viruses. It does not kill M. Tuberculosis or bacterial
spores.
 Classification of instrument
sterilization
 Critical items: Instruments that touch sterile areas
of the body or enter the vascular system, or those
penetrate the oral mucosa (e.g. scalpels, curettes,
burs, and files).
 Semi-critical items: Instruments that touch mucous
membrane, but do not penetrate tissues (e.g.
amalgam condensers, and saliva ejectors).
 Non-critical items: Those items that do not come
in contact with oral mucous, but they are touched by
saliva or blood-contaminated hands while treating
patients (e.g. light switches, counter top, and
cabinets.) air oven.
Instrument preparation and Packaging
 cleaned and scrubbed by water and soup with a hard
brush after using and before sterilization from any
contaminated blood or saliva.

 The dental stuff should wear a heavy-duty rubber
gloves.
 Ultra sonic cleaning is the most effective way for
cleaning.

 The instrument should be suspended in a perforated

basket. Then packed after drying. Place a chemical
indicator inside the pack
 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
 Methods of sterilization:
 Autoclave (steam under pressure and heat).
 Chemclave (Chemical steam under
 pressure and heat).
 Dry heat (hot air oven).
 Intense dry heat (glass beads).
 Ethylene oxide gas.
Glutraldhydes.
Chlorine dioxide
Sodium hypochlorite
Iodophores
 Steam under pressure- Autoclave
 it utilize hot steam (121 C) under pressure 15
p.s.i. for 15 to 45 minutes.

 The mechanism of sterilization is simply the

moist heat kills microorganisms through protein
coagulation, RNA and DNA breakdown

 Instruments and package placed in an autoclave

must be arranged in a way that the steam
circulates around and through the load.
 Steam under pressure- Autoclave
 Fresh deionized distilled water should be used for
each cycle.
 Never allow any instrument contaminated with
amalgam to be sterilized in the autoclave, mercury
vapor is released during the heat of sterilization and
resulting in contamination inside the autoclave itself
that may remain inside the autoclave for many
cycles.
 When using shorter time and higher temperature
this named (flash sterilization).
 Steam under pressure- Autoclave
 Advantage:
 Quick turnaround time for the instrument.
 Excellent penetration of package.
 Will not destroy cotton or clothes.
 Disadvantage:
 Certain metals may corrode or dull, antirust
pretreatment is required.
 Can destroy heat-sensitive materials.
 Chemical Vapor Sterilizer
(Chemclave)
 They used a solution containing specific amounts of
various alcohol, acetone, ketone, and formaldehyde
 and water content.

 Sterilization occurs at 132 C under 20 psi pressure for

 20 minutes.

 A fresh mixture of solution should be used each cycle.

Careful arrangement of the instrument in a way that the
vapor circulate freely between the instruments. The
mechanism of sterilization that the chemical vapors kills
microorganism by destroying vital protein systems.
 Chemical Vapor Sterilizer
(Chemclave)
 Advantage:
 Will not corrode metals.
 Quick turnaround sterilization time.
 Loads come out dry.
 Disadvantage:
 Offensive vapor odor, the new chemclave
comes with built in filter that reduce the
amounts of vapors.
 Special expensive chemicals needed.
 Can destroy sensitive material.
 Prolonged dry heat (hot air oven)
 Hot air oven kills microorganisms through an
oxidation process, together with protein coagulation,

 Hot air oven sterilize the instruments at 160 C for 30
minutes, but the instrument takes 30 to 90 minutes to
reach this temperature.

 The instrument should arrange in the hot air oven in

a way that the air can circulate freely between the
instrument and do not contact each other.
 Prolonged dry heat (hot air oven)
 Advantage:
 Large load capability.
 Complete corrosion protection for the dry
instrument.
 Low initial cost.
 Disadvantage:
 Slow instrument time turnaround.
 Dry heat sterilizer must be periodically calibrated
and monitored, because if the temperature is too
high, instruments may be damaged.
 Not kill bacteria spores
 Rapid dry heat
 It is the same as previous prolonged
dry heat, but it have a small chamber
and high speed dry sterilizer which
have been developed primarily for
use in dentistry. It has small
chamber for the instrument.
 Intense dry heat
 It the methods to sterilize the endodontic
files was the use of a glass beads or salt
sterilizer. These sterilizers often need a
warm-up time and periodic calibration.
The sterilization here is affected by the
load in the sterilizers and the spaces
between the interments.
 Ethylene Oxide Gas
 The extreme penetrability of ethylene oxide
molecules and its effectiveness at low
temperature (70 C), make this type of
sterilization is ideal for sensitive instruments
(handpieces), because the high temperature
may damage the hanpeices (loss of torque,
turbine wear, and fiber-optic degradation).
 Glutaraldehyde Solutions:
 aqueous glutaraldehyde preparations is a
high-level disinfection or sterilization.

 The glutaraldhyde molecule has two active
carbonyl groups, which react with the protein
through cross-linking reactions.

 Shelf life of these solutions is 14 to 28 days.

 Glutaraldehyde Solutions:
 Advantage:
 Heat sensitive instruments.
 Noncorrosive and nontoxic.
 Disadvantage:
 Long immersion time.
 Glutaraldhyde solution has objectionable odor.
 Irritating to mucus membrane.
 Chlorine dioxide
 The Chlorine dioxide compounds disinfect
instruments and operatory surfaces in 1 to 3
minutes when used correctly.

 The solution requires no rinsing and leaves no

residual after use. This substances has been
reported to been nontoxic, nonirritating, and
nonsensitizing. The disadvantage is the corrosive
ability to some metal instruments.
 Sodium hypochlorite
 It is used in a dilutation 1:5 to 1:1 and time
required is 3 to 30 minutes, depending on the
amount of debris present.
 It is virucidal, bactericidal, and tuberculocidal.
 The major disadvantages were it is corrosive
action, should be prepared daily, strong
unpleasant odor.
 Can cause crack in the plastic chair under
prolonged usage.
 Iodophores
 A broad –spectrum disinfectant that is effective
against pathogens, including HBV, poliovirus
Mycobacterium tuberculosis, and herpes simplex
virus.
 The most effective dilution for hard surface is one part
to 213 parts of distilled water for 30 minutes.
 Iodophores have a built-in indicator, when the solution
is fresh; an amber color is present. With age, the
solution changes to light yellow, indicating the loss of
the Iodophores molecules.
 A mixture of Iodophores and alcohol enhance the
activity. The main advantage of the Iodophores is the
slow release of elemental iodine to enhance the
bactericidal activity.
8) Environmental Infection
Control
Categories of Environmental Surfaces
 Clinical contact surfaces
• High potential for direct contamination from
spray or spatter or by contact with DHCP’s
gloved hand
 Housekeeping surfaces
• Do not come into contact with patients or
devices
• Limited risk of disease transmission
Clinical Contact Surfaces
Housekeeping Surfaces
 General Cleaning Recommendations

 Use barrier precautions (e.g., heavy-duty utility gloves,

masks, protective eyewear) when cleaning and
disinfecting environmental surfaces
 Physical removal of microorganisms by cleaning is as
important as the disinfection process
 Follow manufacturer’s instructions for proper use of
hospital disinfectants
 Do not use high-level disinfectants on environmental
surfaces
 Cleaning Clinical Contact Surfaces
 Risk of transmitting infections greater
than for housekeeping surfaces
 Surface barriers can be used and
changed between patients
OR
 Clean then disinfect using an low-
(HIV/HBV claim) to intermediate-
level (tuberculocidal claim) hospital
disinfectant
 Cleaning Housekeeping Surfaces

 Routinely clean with soap and water or an

detergent/hospital disinfectant routinely
 Clean mops and cloths and allow to dry thoroughly
before re-using
 Prepare fresh cleaning and disinfecting solutions
daily and per manufacturer recommendations
 Medical Waste

 Medical Waste: Not considered infectious,

thus can be discarded in regular trash

 Regulated Medical Waste: Poses a

potential risk of infection during handling
and disposal
 Special Considerations
 Dental handpieces and other  Handling biopsy specimens
devices attached to air and
waterlines
 Handling extracted teeth

 Dental radiology
 Laser/electrosurgery
plumes or surgical smoke
 Aseptic technique for
parenteral medications
 Dental laboratory

 Single-use (disposable)
 Mycobacterium
Devices tuberculosis

 Preprocedural mouth rinses

 Creutzfeldt-Jacob Disease
(CJD) and other prion-
 Oral surgical procedures related diseases
Dental Handpieces and Other Devices
Attached to Air and Waterlines
 Clean and heat sterilize intraoral devices
that can be removed from air and
waterlines
 Follow manufacturer’s instructions for
cleaning, lubrication, and sterilization
 Do not use liquid germicides or ethylene
oxide
Components of Devices Permanently
Attached to Air and Waterlines
 Do not enter patient’s mouth but may
become contaminated
 Use barriers and change between uses
 Clean and intermediate-level disinfect the
surface of devices if visibly contaminated
 Saliva Ejectors

 Previously suctioned fluids

might be retracted into the
patient’s mouth when a seal is
created
 Do not advise patients to close
their lips tightly around the tip
of the saliva ejector
 Dental Radiology

 Wear gloves and other appropriate personal

protective equipment as necessary
 Heat sterilize heat-tolerant radiographic
accessories
 Transport and handle exposed radiographs so
that they will not become contaminated
 Avoid contamination of developing equipment
 Preprocedural Mouth Rinses

 Antimicrobial mouth rinses prior to a dental

procedure
• Reduce number of microorganisms in aerosols/spatter
• Decrease the number of microorganisms introduced
into the bloodstream

 Unresolved issue–no evidence that infections

are prevented
 Handling Biopsy Specimens

 Place biopsy in sturdy,

leakproof container
 Avoid contaminating the
outside of the container
 Label with a biohazard
symbol
 Extracted Teeth
 Considered regulated medical
waste
• Do not incinerate extracted teeth
containing amalgam
• Clean and disinfect before sending to
lab for shade comparison
 Can be given back to patient
 Handling Extracted Teeth
in Educational Settings

 Remove visible blood and debris

 Maintain hydration
 Autoclave (teeth with no amalgam)
 Use Standard Precautions
 Laser/Electrosurgery Plumes and
Surgical Smoke
 Destruction of tissue creates smoke that may
contain harmful by-products
 Infectious materials (HSV, HPV) may contact
mucous membranes of nose
 No evidence of HIV/HBV transmission
 Need further studies
 Dental Laboratory

 Dental prostheses,
appliances, and items used in
their making are potential
sources of contamination
 Handle in a manner that
protects patients and DHCP
from exposure to
microorganisms
 Dental Laboratory
 Clean and disinfect prostheses and
impressions
 Wear appropriate PPE until disinfection
has been completed
 Clean and heat sterilize heat-tolerant
items used in the mouth
 Communicate specific information about
disinfection procedures
 Transmission of
Mycobacterium tuberculosis
 Spread by droplet nuclei
 Immune system usually
prevents spread
 Bacteria can remain alive
in the lungs for many
years (latent TB infection)
 Post-exposure Management
 Wound management
 Exposure reporting
 Assessment of infection risk
• Type and severity of exposure
• Bloodborne status of source person
• Susceptibility of exposed person
 Post-exposure Management
Program
 Clear policies and procedures
 Education of dental health care personnel
(DHCP)
 Rapid access to
• Clinical care
• Post-exposure prophylaxis (PEP)
• Testing of source patients/HCP
Thank You