INFECTION CONTROL

IN DENTAL SETTINGS

ASHA C S
FIRST YEAR POST GRADUATE
DEPARTMENT OF PROSTHODONTICS
CONTENTS:

 INTRODUCTION

 FUNDAMENTAL ELEMENTS NEEDED TO PREVENT

TRANSMISSION OF INFECTIOUS AGENTS IN DENTAL SETTINGS

 RISK ASSESMENT

 CONCLUSION

 REFERENCE
 INTRODUCTION

Transmission of infectious agents among patients and dental

health care personnel (DHCP) in dental settings are rare.
However, from 2003-2015 transmissions in dental settings,
including patient-to-patient transmissions, have been
documented.
‣In most cases, investigators failed to link a specific lapse of
infection prevention and control with a particular transmission.

‣However, reported breakdowns in basic infection prevention

procedures included unsafe injection practices, failure to heat
sterilize dental handpieces between patients, and failure to
monitor autoclaves.
 These reports highlight the need for comprehensive training
 to improve understanding of underlying principles,
 recommended practices,
 their implementation, and
 the conditions that have to be met for disease transmission.
‣All dental settings, regardless of the level of care provided,
must make infection prevention a priority and should be
equipped to observe Standard Precautions and other infection
prevention recommendations.
FUNDAMENTAL ELEMENTS NEEDED TO PREVENT
TRANSMISSION OF INFECTIOUS AGENTS IN DENTAL
SETTINGS

1. ADMINISTRATIVE MEASURES

2. INFECTION PREVENTION EDUCATION AND TRAINING

3. DENTAL HEALTH CARE PERSONNEL SAFETY
4. PROGRAM EVALUATION
5. STANDARD PRECAUTIONS
6. DENTAL UNIT WATER QUALITY
 a.ADMINISTRATIVE MEASURES

1.Develop and maintain infection prevention and occupational health

programs.
2. Provide supplies necessary for adherence to Standard Precautions.
3.Assign at least one individual trained in infection prevention
responsibility for coordinating the program.
4. Develop and maintain written infection prevention policies and
procedures appropriate for the services provided by the facility and
based on evidence-based guidelines, regulations, or standards.

5. Facility should have system for early detection and management of

potentially infectious persons at initial points of patient encounter
 b.INFECTION PREVENTION EDUCATION AND
TRAINING

 Education on the basic principles and practices for preventing the

spread of infections should be provided to all DHCP.
 This includes :
■ Dentists.
■ Dental hygienists.
■ Dental assistants.
■ Dental laboratory technicians (in-office and commercial).
■ Students and trainees.
■ Other persons not directly involved in patient care but potentially
exposed to infectious agents.
 KEY RECOMMENDATIONS

1.Provide job- or task-specific infection prevention education

and training to all DHCP.

 This also includes those employed by outside agencies and

available by contract or on a volunteer basis to the facility.

2. Provide training on principles of both DHCP safety and

patient safety.

3. Provide training during orientation and at regular intervals

(e.g., annually).

4. Maintain training records according to state and federal

requirements.
 c.DENTAL HEALTH CARE
PERSONNEL SAFETY

1.There is a written policy regarding immunizing DHCP, including a

list of all required and recommended immunizations.

2. All DHCP are screened for tuberculosis (TB) upon hire regardless
of the risk classification of the setting
3. Referral arrangements should be in place to qualified health care
professionals to ensure prompt and appropriate provision of
preventive services, occupationally related medical services, and
postexposure management with medical follow-up.

4. Facility should have well-defined policies concerning contact of

personnel with patients when personnel have potentially
transmissible conditions
 d.PROGRAM EVALUATION

A successful infection prevention program depends on

■ Developing standard operating procedures.

■ Evaluating practices and providing feedback to DHCP.

■ Routinely documenting adverse outcomes (e.g., occupational exposures

to blood) and work-related illnesses in DHCP.
■ Monitoring health care associated infections in patients
Strategies and tools to evaluate the infection prevention
program can include:

-periodic observational assessments,

-checklists to document procedures, and

-routine review of occupational exposures to

bloodborne pathogens.
 Evaluation offers an opportunity to improve the
effectiveness of both the infection-prevention program
and dental practice protocols.

 If deficiencies or problems in the implementation of

infection prevention procedures are identified—further
evaluation and feedback, corrective action, and training is
needed to eliminate the problems.
 e.STANDARD PRECAUTIONS

 Standard Precautions are the minimum infection

prevention practices that apply to all patient care,
regardless of suspected or confirmed infection status of
the patient, in any setting where health care is delivered.

 Thesepractices are designed to both protect DHCP and

prevent them from spreading infections among patients.
Standard Precautions include—

1. Hand hygiene.
2. Use of personal protective equipment (e.g., gloves, masks,
eyewear).
3. Respiratory hygiene/cough etiquette.
4. Sharps safety (engineering and work practice controls).
5. Safe injection practices (i.e., aseptic technique for
parenteral medications).
6. Sterile instruments and devices.
7. Clean and disinfected environmental surfaces
 1.HAND HYGIENE

 Hand hygiene is the most important measure to prevent the spread of

infections among patients and DHCP.

 Education and training programs should thoroughly address indications

and techniques for hand hygiene practices before performing routine

and oral surgical procedures.

 Indications-”Five Moments for Hand
Hygiene”
WHO’s standard guidelines:

1. Before touching a patient

2. Before clean/aseptic procedures
3. After body fluid exposure/risk
4. After touching a patient
5. After touching patient’s surrounding
 Use soap and water when hands are visibly soiled (e.g.,
blood, body fluids); otherwise, an alcohol-based hand rub
may be used.

 Surgical Hand Scrub (3-5 min): This is indicated prior

to any surgical procedure and also in between the cases;

using 4% chlorhexidine hand wash

 2.PERSONAL PROTECTIVE EQUIPMENT

 Personal protective equipment (PPE) refers to wearable equipment that is

designed to protect DHCP from exposure to or contact with infectious agents.

 PPE that is appropriate for various types of patient interactions and effectively
covers personal clothing and skin likely to be soiled with blood, saliva, or
other potentially infectious materials (OPIM) should be available .
• These include gloves, face masks,
protective eye wear, face shields, and
protective clothing (e.g., reusable or
disposable gown, jacket, laboratory
coat)
 KEY RECOMMENDATIONS:

1. Provide sufficient and appropriate PPE and ensure it is

accessible to DHCP.

2. Educate all DHCP on proper selection and use of PPE.

3. Wear gloves whenever there is potential for contact with blood,

body fluids, mucous membranes, non-intact skin or contaminated
equipment.
• a. Do not wear the same pair of gloves for the care of more than one
patient.
• b. Do not wash gloves. Gloves cannot be reused.

• c. Perform hand hygiene immediately after removing gloves

4. Wear protective clothing that covers skin and personal

clothing during procedures or activities where contact with

blood, saliva, or OPIM is anticipated.

5. Wear mouth, nose, and eye protection during procedures that

are likely to generate splashes or spattering of blood or other
body fluids.
6. Remove PPE before leaving the work area.

 DHCP should be trained to select and put on appropriate PPE

and remove PPE so that the chance for skin or clothing
contamination is reduced.

 Hand hygiene is always the final step after removing and

disposing of PPE.
Training should also stress preventing further spread of
contamination while wearing PPE by:

■ Keeping hands away from face.

■ Limiting surfaces touched.

■ Removing PPE when leaving work areas.

■ Performing hand hygiene

 3.RESPIRATORY HYGIENE/COUGH
ETIQUETTE

These are the infection

prevention measures,
designed to limit the
transmission of respiratory
pathogens spread by droplet
or airborne routes.
 KEY RECOMMENDATIONS

1. Implement measures to contain respiratory secretions in

patients and accompanying individuals who have signs and

symptoms of a respiratory infection, beginning at point of

entry to the facility and continuing throughout the visit.

a. Place instruction boards at the entrance to patients with
symptoms of respiratory infection to—

i. Cover their mouths/noses when coughing or sneezing.

ii. Use and dispose of tissues.
iii. Perform hand hygiene after hands have been in contact
with respiratory secretions.
b. Provide tissues and no-touch receptacles for disposal of
tissues
c. Provide resources for performing hand hygiene in or
near waiting areas.
d. Offer masks to coughing patients and other symptomatic persons
when they enter the dental setting.

e. Provide space and encourage persons with symptoms of respiratory

infections to sit as far away from others as possible.
2. Educate DHCP on the importance of infection prevention
measures to contain respiratory secretions to prevent the spread of
respiratory pathogens when examining and caring for patients with
signs and symptoms of a respiratory infection
 4.SHARPS SAFETY

 Most percutaneous injuries among DHCP involve burs, needles, and

other sharp instruments.
 Most exposures in dentistry are preventable; therefore, each dental
practice should have policies and procedures available for addressing
sharps safety.
 Implementation of the OSHA Bloodborne Pathogens Standard
has helped to protect DHCP from blood exposure and sharps
injuries
 OSHA Bloodborne Pathogens Standard

 The Occupational Safety and Health Administration (OSHA)

bloodborne pathogens standard consists of
regulations designed to further the safety measures of universal
precautions and ensure the health and safety of employees by
reducing the risk of occupational exposure to bloodborne
pathogens in health care settings.
For HIV virus
After immediate exposure-
• Decontamination of wound
• Base line laboratory test for health care workers
• Selection of PEP regimen
• PEP regimen includes typically zidovudine and lamivudine
• Expanded regimen includes basic regimen plus nelfinavir and
efavirenz
• After this HIV screening at 6 weeks, 3 months, and 6 months
For HepatitisB

• Hepatitis B vaccine series: in non-HBV-immune health care

professionals
• Administration of prophylactic Hepatitis B immune globulin and
initiation of hepatitis B vaccines series should be done at different
sites.
• Following an exposure HB and HC serology should be
determined •
• HBV infections responds to 70-90% when HBIG
is administered within 7 days
Mycobacterium tuberculosis

• baseline tuberculosis skin test

• Elective dental treatment should be deferred

until the patient is non-infectious.

J Can Dent Assoc 2006; 72(1):53–60

Applying First Aid after an Exposure Incident

Procedural Steps
• Stop operations immediately.
• Remove your gloves.
• If the area of broken skin is bleeding, gently squeeze the
site to express a small amount of visible blood.
• Wash your hands thoroughly, using anti1nicrobial soap and
warm water.
•Dry your hands.

• Apply a small amount of antiseptic to the affected area.

Do not apply caustic agents such as bleach or disinfectant
solutions to the wound.

• Apply an adhesive bandage to the area.

Engineering Controls

 include all control measures that isolate or remove a hazard from

the workplace, and are frequently technology-based, such as

sharps disposal containers and self-sheathing needles.

Sharps with Engineered Sharps Injury Protections

This is a term which includes non-needle sharps or needle devices

containing built-in safety features that are used for collecting fluids
or administering medications or other fluids
This includes:

• syringes with a sliding sheath

that shields the attached needle

after use;

• needles that retract into a

syringe after use;

• shielded or retracting catheters
• intravenous medication (IV) delivery systems that use a
catheter port with a needle housed in a protective covering.
Needleless Systems:

 defined as devices which provide

an alternative to needles for
various procedures to reduce the
risk of injury involving
contaminated sharps.
 Examples include:

• IV medication systems which

administer medication or fluids through a
catheter port using non-needle
connections; and

• jet injection systems which deliver

liquid medication beneath the skin or
through a muscle.
When engineering controls are not available or appropriate, work-
practice controls should be used.
Work-practice controls are behavior-based and are intended to reduce
the risk of blood exposure by changing the way DHCP perform tasks,
such as using a one-handed scoop technique for recapping needles
between uses and before disposal.
Other work-practice controls include:

o not bending or breaking needles before disposal,

o not passing a syringe with an unsheathed needle by

hand,
o removing burs before disassembling the handpiece from
the dental unit,

o using instruments in place of fingers for tissue retraction

or palpation during suturing and administration of
anesthesia
o Place used disposable syringes and
needles, scalpel blades, and other sharp
items in appropriate puncture-resistant
containers located as close as possible
to the area where the items are used.
 5.SAFE INJECTION PRACTICES

 Safe injection practices are intended to prevent transmission of

infectious diseases between one patient and another, or between a
patient and DHCP during preparation and administration of parenteral
medications.
 KEY RECOMMENDATIONS

 1. Prepare injections using aseptic technique in a clean

area.

 2. Disinfect the rubber septum on a medication vial with

alcohol before piercing.

 3. Do not use needles or syringes for more

than one patient

 4. Medication containers should be entered

with a new needle and new syringe, even

when obtaining additional doses for the same

patient.
5. Use single-dose vials for parenteral
medications when possible.

6. Do not use single-dose (single-use)

medication vials, ampules, and bags or
bottles of intravenous solution for more
than one patient.
7. Do not combine the leftover contents of single-use vials
for later use.

8.Do not use fluid infusion or administration sets (e.g., IV

bags, tubings, connections) for more than one patient
6.STERILIZATION AND DISINFECTION OF
PATIENT-CARE ITEMS AND DEVICES

 Cleaning, disinfection and sterilization of dental equipment

should be assigned to DHCP with training in the required
reprocessing steps to ensure reprocessing results in a device
that can be safely used for patient care.
 Patient-care items (e.g., dental instruments, devices, and equipment)
are categorized depending on the potential risk for infection associated
with their intended use as:
 Critical items
 Semi critical items
 Non critical items
■ Critical items, such as surgical instruments and periodontal
scalers, are those used to penetrate soft tissue or bone.

 greatest risk of transmitting infection

 sterilized using heat.

a. Autoclaving if heat stable

b. Ethylene oxide /hydrogen peroxide gas plasma if heat
sensitive
■ Semi critical items
-come in contact with mucous membranes or non-intact skin
( chapped or abraded skin).
- e.g., mouth mirrors, amalgam condensers, reusable dental
impression trays

• These items have a lower risk of transmission

o Because the majority of semi critical items in dentistry are
heat-tolerant, they should also be sterilized using heat.

o If a semi critical item is heat-sensitive, it should be

processed using high-level disinfection.
Dental handpieces and associated attachments, including low-
speed motors , should always be heat sterilized between
patients and not high level or surface disinfected.
Digital radiography sensors are also considered semi critical and
should be protected with a Food and Drug Administration (FDA)-
cleared barrier to reduce contamination during use, followed by
cleaning and heat-sterilization or high-level disinfection between
patients.
■ Noncritical patient-care items

 that only contact intact skin.

 e.g., radiograph head/cone, blood pressure cuff, facebow

These items pose the least risk of transmission of infection.

.
There are three levels of disinfection:
high, intermediate, and low

•The high-level disinfection (HLD)

•kills all vegetative microorganisms, mycobacteria, lipid and nonlipid

viruses, fungal spores, and some bacterial spores
•Eg: -Glutaraldehyde solutions(2%)

•conditions for HLD range from 5–90 minutes at temperatures

ranging from 20°C–35°C

•contact time for sterilization is 10 hours at temperatures

ranging from 20°C–25°C
-Hydrogen peroxide solutions

used primarily for heat-sensitive and

submersible devices

2% HLD contact time of 30 minutes at 20°C

7.5% hydrogen peroxide has a sterilization

contact time of 6 hours at 20°C
Other HLD agents include:

0.55%–0.6% Ortho-phthalaldehyde (OPA) solutions

Peracetic acid–hydrogen peroxide solutions(ranging from 35%

peracetic acid and 6% hydrogen peroxide to 5% peracetic acid
and 26% hydrogen peroxide.)
•Intermediate-level disinfection

•kills mycobacteria, most viruses and bacteria, and is registered by

the Environmental Protection Agency (EPA) as a “tuberculocide.”

•Low-level disinfection kills some viruses and bacteria

 In the majority of cases, cleaning, or if visibly soiled, cleaning
followed by disinfection with an EPA(Environmental Protection
Agency)-registered hospital disinfectant is adequate.

 Protecting these surfaces with disposable barriers might be a

preferred alternative

Cleaning to remove debris and organic contamination from

instruments should always occur before disinfection or sterilization
 Automated cleaning equipment
(e.g., ultrasonic cleaner, washer,
disinfector) should be used to
remove debris to improve cleaning
effectiveness and decrease worker
exposure to blood
After cleaning, dried instruments should be inspected, wrapped,
packaged, or placed into container systems before heat sterilization.

Packages should be labelled to show the sterilizer used, the cycle or

load number, the date of sterilization, and, if applicable, the
expiration date.
This information can help
in retrieving processed
items in the event of an
instrument
processing/sterilization
failure.
KEY RECOMMENDATIONS

1.Clean and reprocess (disinfect or sterilize) reusable dental

equipment appropriately before use on another patient.

2. Clean and reprocess reusable dental equipment according to

manufacturer instructions
3. Assign responsibilities for reprocessing of dental equipment
to DHCP with appropriate training.

4. Wear appropriate PPE when handling and reprocessing

contaminated patient equipment.
5. Use mechanical, chemical, and biological monitors according to
manufacturer instructions to ensure the effectiveness of the
sterilization process.

 Maintain sterilization records in accordance with state and local

regulations
THE THREE MOST COMMONLY USED METHODS
OF STERILIZATION IN DENTISTRY ARE:

• The steam autoclaves

• The unsaturated chemical vapour
sterilizer(chemiclave)
• Dry heat/hot air oven
Other methods are:

• Exposure to ethylene oxide

• Boiling water
• Ionizing radiation
AUTOCLAVE:

 It is an efficient reliable and rapid method of sterilization except for

oils ,greases and powders.
 All living organisms are rapidly destroyed at 121o C temperature
and 15 lbs. pressure for 15 minutes.
 Working Principle:

 Water boils when its vapour pressure equals that of surrounding

atmospheric pressure
 Hence, when pressure inside a closed vessel increases, temperature at
which water boils also increases.
 Saturated steam has penetration power. When steam comes into
contact with a cooler surface it condenses to water and gives up its
latent heat to that surface
 Materials to be sterilized should be wrapped in

paper, muslin or steam permeable plastic

 The major problems are excess moisture, air and

severe wetting..
 To prove sterilization spore strips containing known numbers of
bacillus stearo-thermophilus should be placed in the deepest layer
of the sterilizer load.
 After sterilization, the strips are incubated. Absence of growth
proves sterilization.
This check of efficacy should be done weekly.
CHEMICLAVE

 This sterilizer uses a special

chemical solution containing
formaldehyde and alcohol.
 Operates at a temperature of 131oC
and 20pounds of pressure for 30
minutes
 The major advantage- greatly reduced corrosion of metal
items.
 Specified wrapping material should be used.
 Closed containers cannot be used, as the chemical
vapours must reach the surface of items being processed.
DRY HEAT STERILIZER(HOT AIR OVEN):

 These sterilizers use hot air to kill microorganisms and do not

cause corrosion.
 The standard hot air oven operates at an air temperature of about
160oC for exposure time of 60-120minutes.
 Glass wares , forceps, scissors, scalpels, swabs and some
pharmaceutical products like liquid paraffin, dusting powder, fat
and grease are sterilised

 Closed containers can be used.

Sterilization control

 Spores of non toxigenic strain

of clostridium tetani is used as a
biological test of dry heat
efficiency
Dental Laboratory

Laboratory materials and other items that have been used in the mouth
should be cleaned and disinfected before being manipulated in the
laboratory.

1. Use PPE when handling items received in the laboratory until they
have been decontaminated
2. Before they are handled in the laboratory, clean, disinfect, and
rinse all dental prostheses and prosthodontic materials (e.g.,
impressions, bite registrations, occlusal rims, and extracted teeth) by
using an EPA-registered hospital disinfectant having at least an
intermediate-level (i.e., tuberculocidal claim) activity
3. Consult with manufacturers regarding the stability of
specific materials (e.g., impression materials) relative to
disinfection procedures.
4. Include specific information regarding disinfection techniques used
(e.g., solution used and duration), when laboratory cases are sent off
site and on their return.

5. Clean and heat-sterilize heat-tolerant items used in the mouth (e.g.,

metal impression trays and face-bow forks)
6. Follow manufacturers’ instructions for cleaning and sterilizing or
disinfecting items that become contaminated but do not normally
contact the patient (e.g., burs, polishing points, rag wheels, articulators
and lathes).
If manufacturer instructions are unavailable, clean and heat sterilize
heat-tolerant items or clean and disinfect with an EPA-registered
hospital disinfectant with low- (HIV, HBV effectiveness claim) to
intermediate-level (tuberculocidal claim) activity, depending on the
degree of contamination.
 7. ENVIRONMENTAL INFECTION
PREVENTION AND CONTROL
 1. Establish policies and procedures for routine cleaning and
disinfection of environmental surfaces in dental health care settings.

a. Use surface barriers to protect clinical contact surfaces,

particularly those that are difficult to clean
 Impervious backed paper, aluminum foil, or plastic covers should
be used to protect items and surfaces (e.g., light handles) that may
become contaminated by blood or saliva.

 Between patients, the covering should be removed, discarded and

replaced with clean material.
b. Clean and disinfect clinical contact surfaces that are
not barrier-protected with an EPA-registered hospital
disinfectant after each patient. (Use an intermediate-
level disinfectant)
 After treatment of each patient and at the completion of daily work
activities, countertops and dental unit surfaces should be cleaned
with disposable toweling, using an intermediate level chemical
germicide which is classified as a ‘hospital disinfectant’ and
labelled for ‘tuberculocidal’ activity.
 These intermediate-level disinfectants include phenolics, iodophors,
and chlorine-containing compounds.

 A fresh solution of sodium hypochlorite(household bleach) prepared

daily is an inexpensive and effective intermediate-level germicide.
 Low-level hospital disinfectants that are not labeled for
"tuberculocidal" activity(e.g., quaternary ammonium compounds)
are appropriate for general housekeeping purposes such as
cleaning floors, walls and other housekeeping surfaces.
Management of Regulated Medical Waste in
Dental Health-Care Facilities

a. Use a color-coded or labeled container that prevents leakage

(e.g., biohazard bag) to contain non sharp regulated medical waste
b. Place sharp items (e.g., needles, scalpel blades, orthodontic bands,
broken metal instruments, and burs) in an appropriate sharps
container .

Close container immediately before removal or replacement

to prevent spillage or protrusion of contents during handling,
storage, and transport
c. Pour blood, suctioned fluids or other liquid waste carefully into
a drain connected to a sanitary sewer system, if local sewage
discharge requirements are met and the state has declared this an
acceptable method of disposal.
• Wear appropriate PPE while performing this task
 Chemical fumigation in the health care
environment
 Fumigation of hospital rooms with high concentrations of toxic chemicals has
been proposed to reduce microbial agents on hospital surfaces and to control
infections.
 studies have demonstrated that fumigation can be effective in inactivating
microbes on environmental surfaces.
 However, the current consensus of the
infection control community is that the
most important source of patient
infection is direct contact with health
care workers or when patients auto-
infect themselves
• Hospital fumigation uses the chemicals like chlorine dioxide
with hydrogen peroxide vapor, formalin with potassium
permanganate to clear the building's interior of all bacteria and
germs.
• With the correct safety measures, this fumigation is harmless
and will work effectively.
 DENTAL UNIT WATER QUALITY

• Dental unit waterlines

promote bacterial growth and
development of biofilm due to
the presence of long narrow-
bore tubing, inconsistent flow
rates, and the potential for
retraction of oral fluids.
 KEY RECOMMENDATIONS

1. Use water that meets EPA regulatory standards for drinking water
(i.e., ≤ 500 CFU/mL of heterotrophic water bacteria) for routine dental
treatment.

2. Consult with the dental unit manufacturer for appropriate methods

and equipment to maintain the quality of dental water.
3. Follow recommendations for monitoring water quality provided
by the manufacturer of the unit or waterline treatment product.

4. Use sterile saline or sterile water as a coolant / irrigant when

performing surgical procedures.
 RISK ASSESSMENT

 Infection Prevention Checklist

 to periodically assess practices in the facility and ensure they are

meeting the minimum expectations for safe care.

 In the course of auditing practices, facilities may identify with lapses

in infection control.
 Certain infection control lapses (e.g., reuse of syringes on more
than one patient) have resulted in bloodborne pathogen
transmission.
 Identification of such lapses warrants immediate consultation with
the state or local health department and appropriate notification and
testing of potentially affected patients .
FACE MASK:

Face masks are loose-fitting masks that cover the nose and
mouth and have ear ties at the back of the head

whereas

Respirators are tight-fitting face covering devices which

filter the air during inhalation and exhalation

Classification of masks

• developed by considering the size of pores and particles needed

to be filtered out.
• types of masks according to their specific uses and
characteristics :
• Dust Mask: flexible and disposable
masks
• designed to protect against dust, pollens,
molds and other irritants .
• They do not provide protection against
any chemicals or viruses
Single-Use Face Mask:

• These masks are disposable masks

used for single application.
• They are made of a single layer
nonwoven fabric or wood pulp tissue
paper and are very thin.
• They are generally used for protection against larger dust
particles, at construction sites and in other similar industries.

• It is not recommended to use such type of masks for

protection against viruses.
Surgical Mask (Medical mask):

According to the U.S. Food & Drug Administration (FDA)

- “a surgical mask is a loose-fitting, disposable device that creates a
physical barrier between the mouth and nose of the wearer and
potential contaminants in the immediate environment”
• The surgical mask is made of 3 layers .

• The innermost layer is made of an absorbent material that absorbs

moisture from the wearer’s breath.
• The middle layer is made of a melt blown material that acts as a
filter
• the outermost layer is made of a material that repels liquids
N95 Respirator (N95 Respirator
Mask or N95 Mask):
A respirator is a device designed to
achieve a very close facial fit and
very efficient filtration of airborne
particles and protect the wearer from
inhaling toxic chemicals and
infectious particles
 This includes airborne particles that may contain
biological material,
 e.g. Bacillus anthracis, Mycobacterium tuberculosis,
the virus that causes Severe Acute Respiratory
Syndrome (SARS), Avian Flu, Ebola Virus etc., or
even
 PM2.5 (particulate matter with diameter of 2.5
micron or less’
Its construction includes:
 an outer layer of spun bond fabric 40 GSM,
 a 75 GSM hot air cotton layer,
 28 GSM 100 per cent pure meltblown fabric,
 an innermost layer of spun bond hydrophobic fabric 20 GSM
 aluminium/plastic nose pin, and an optional respirator valve.
o N type respirators means they are ‘not oil resistant’.
o Depending on their filtration effectiveness, they are classified
into -N95 , N99 and N100.
o For instance, N95 mask can filter off at least 95% of particles
that are larger than 0.3 microns in size,
o N99 masks can filter off at least 99% of these particles
 International guidance recommends that surgical masks should not
be worn for more than 4 hours and a P2/N95 respirator not more than
8 hours continuously unless it is damaged, soiled or contaminated.

 The use of one mask for longer than 4 hours is risky and has the
chances of self-contamination and hence is not advised
Nasal Mask:
• Nasal masks are used for the treatment of
patients suffering from sleep apnea . Such
patients are prescribed for continuous
positive airway pressure (CPAP) therapy
which includes a mask that fits over the nose
or nose/mouth and a machine that supplies a
continuous flow of air through a tube to the
mask
CONCLUSIONS

 The aim of infection control is to control

iatrogenic, nosocomial infections, among patients,
and potential occupational exposure of care
providers to disease causing microbes during
provision of care.
A successful infection-control program depends on

• developing standard operating procedures,

• evaluating practices,
• routinely documenting adverse outcomes (e.g., occupational
exposures to blood) and
• work-related illnesses in DHCP, and
• monitoring health-care–associated infections in patients .
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1. Centers for Disease Control and Prevention. Guidelines for Infection

Control in Dental Health-Care Settings — 2003. MMWR 2003;52(No. RR-
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2. Larson, E., 1995. APIC guidelines for handwashing and hand antisepsis in
health care settings. American Journal of Infection Control, 23(4), pp.251-269.
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https://www.osha.gov/bloodborne-pathogens/quick-reference

4. Peter, S. (2015). Essentials of Public Health Dentistry (5th

ed., pp. 644-646). 10.1080/15459624.2011.547453. PMID:
21253983.
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fumigation in the health care environment. J Occup Environ
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