INFECTION CONTROL AND

STERILIZATION
CONTENTS
• INTRODUCTION
• INFECTION
• TRANSMISSION OF INFECTION
• MODE OF TRANSMISSION
• MODE OF INFECTION CONTROL
• OBJECTIVES OF INFECTION CONTROL
• PERSONAL BARRIER PROTECTION
• EMERGENCY & EXPOSURE INCIDENT PLAN
• DISINFECTION
• STERILIZATION
• MONITORS OF STERILIZATON
• HANDPIECE ASEPSIS AND STERILIZATION IN ENDODONTICS
• CONCLUSION
 INTRODUCTION
 DEFINITIONS
• INFECTION CONTROL – Also called “exposure control plan” by OSHA is a
required office program that is designed to protect personnel against risks of
exposure to infection.

• STERILIZATION: Use of a physical or chemical procedure to destroy all

microorganisms including substantial numbers of resistant bacterial spores.

 Since pathogenic microorganisms cause contamination, infection and decay, it

becomes necessary to remove or destroy them from materials and areas.
 This is the objective of infection control and sterilization.
 DISINFECTION: Destruction of pathogenic and other kinds of microorganisms
by physical or chemical means. Disinfection is less lethal than sterilization,
because it destroys the majority of recognized pathogenic microorganisms, but
not necessarily all microbial forms (e.g., bacterial spores).

 DISINFECTANT: A chemical agent used on inanimate objects to destroy

virtually all recognized pathogenic microorganisms, but not necessarily all
microbial forms (e.g., bacterial endospores).

 ASEPSIS: prevention of microbial contamination of living tissues or sterile

materials by excluding, removing or killing microorganisms.
 OBJECTIVES
 Facilities, equipment, and procedures necessary to implement standard and additional
(transmission-based) precautions for control of infections
 Cleaning, disinfecting and reprocessing of reusable equipment
 Waste management
 Protection of health care workers from transmissible infections
 Infection control practices in special situations

 GOALS
 To reduce the dose of microorganisms
 minimize spraying or spattering of oral fluids
 Hand washing and surface precleaning and disinfection
 mouth masks, gloves, protective eye wear and clothing
 Instrument precleaning and sterilization
 REDUCE

PROTECT OBJECTIVE IMPLEMEN

S T

SIMPLIFY
MODES OF TRANSMISSION

 Direct contact: touching soft tissues or teeth

 Indirect contact: injuries with contaminated sharps or instruments
 Droplet spread :high speed hand pieces create air born contaminants
 Aerosols: invisible particles ranging 50 micro m to 5 mm remain suspended for
hours
 Mists : visible in beam of light >50 mm
 Spatter :> 50 mm ,visible with eye splashes
 INFECTIOUS
AGENT

SUSCEPTIBLE
RESERVOIRS
HOST

CHAIN OF
INFECTION

PORTAL OF PORTAL OF
ENTERY EXIT

MEANS OF
TRANSMISSIO
N
 INFECTION CONCERN IN DENTISTRY
 TRANSMITTED BY INHALATION

 TRANSMITTED BY INOCULATION
STRATEGY TO ACHIEVE INFECTION
CONTROL
SCREENING

PPE

ASEPTIC TECHNIQUES

STERILIZATION
AND DISINFECTION

DISPOSAL

LABORATORY
ASEPSIS
IMMUNIZATION SCHEDULE FOR
DENTIST
HYGIENE
 Following hygienic measures greatly reduce the number of live pathogens:
Personal hygiene
 Refrain from touching anything, not required for the procedure
 Keep hands away from eyes, nose, mouth & hair
 Special attention for cuts, pimples, scratches etc.
 Hair away from face- head caps
 No Jewellery
 Uniforms or scrubs
 Hand washing and care of hands
PREVENTION
 Preprocedural mouth rinse
 Get vaccinated against hepatitis B
 Take a detailed medical history.
 Make sure all the instruments are sterilized.
 Protect working surfaces.
 Make sure they have at their disposal all the disinfectant fluids and waste
containers
 Masks, face shields, eye wear
HAND HYGIENE

 For routine dental examination procedures, hand washing is achieved by using

either a plain or antimicrobial soap and water.
 The purpose of surgical hand antisepsis is to eliminate transient flora and reduce
resident flora to prevent introduction of organisms in the operative wound.
 At the beginning of a routine treatment period, watches and jewellery must be
removed and hands must be washed with a suitable cleanser.
 Hands must be lathered for at least 10 seconds, rubbing all surfaces and rinsed.
 PERSONAL BARRIER PROTECTION

 Personal protective equipment (PPE), or barrier precautions,

are a major component of Standard precautions.
 PPE is essential to protect the skin and the mucous
membranes of personnel from exposure to infectious or
potentially infectious materials.
 The various barriers are gloves, masks, protective eye wear,
surgical head cap & overgarments
 GLOVES

 Types:
 Latex gloves

 Vinyl gloves

 Nitrile gloves

 Neoprene

 Utility gloves
STEPS IN GLOVING
DEGLOVING
 MASKS
 Types:
 Surgical masks (required to have fluid-resistant properties).
 Procedure/isolation masks
 Made up from a melt blown placed between non-woven fabric Layers of a Mask
 an outer layer
 a microfiber middle layer - filter large wearer-generated particles
 a soft, absorbent inner layer - absorbs moisture.
Available in 2 sizes: regular and petite.
 EYE WEAR
 CAUSES OF EYE DAMAGE:
 Aerosols and spatter may transmit infection
 Sharp debris projected from mouth while using air turbine handpiece, ultrasonic scaler
may cause eye injury.
 Injuries to eyes of patients caused by sharp instruments especially in supine position
OVER GARMENTS
FOOTWEAR

 Most hospitals have their own policies regarding footwear.

 Footwear with open heels and/or holes across the top can increase the risk of
harm to the person wearing them due to more direct exposure to blood/body
fluids or of sharps being dropped for examples.
EMERGENCY & EXPOSURE INCIDENT
PLAN
Management of exposure includes:
 General wound care and cleaning.
 Counselling of the exposed worker regarding bloodborne pathogens.
 Source patient testing for HBV,HCV and HIV (consent required).
 Documentation of the incident and review.
 Postexposure assessment and prophylaxis for the health care worker.
 Baseline and follow up serology of the worker
HBV POST EXPOSURE MANAGEMENT
HIV POST EXPOSURE MANAGEMENT
CDC CLASSIFICATION
 PRINCIPLES AND PROCEDURES FOR HANDLING
AND CLEANING INSTRUMENTS AFTER TREATMENT
 The safest and most efficient instrument cleaning procedures involve ultrasonic cleaning of used
instruments kept in a perforated basket or cassette throughout the cleaning procedure.
 Used instruments are commonly placed in an anti microbial solution
 Next, move the or basket of instruments into an ultrasonic cleaning device, rinse them, and then
carefully inspect the instruments for debris.
 Drain & dry instruments with absorbent towel.
 Ultrasonic cleaning is the safest and most efficient way to clean sharp instruments.
 Operate the tank at one-half to three-fourths full of cleaning solution at all times- Use only
cleaning solutions recommended by ultrasonic device manufacturers.
 Operate the ultrasonic cleaner for 3-6 minutes for loose instruments 10-20 mins for cassettes or
longer as directed by the manufacturer
INSTRUMENT PROCESSING
STERILIZATION

Stages for instrument sterilization:

 1. Pre-soaking
 2. Cleaning
 3. Corrosion control and lubrication
 4. Packaging
 5. Sterilization
 6. Handling sterile instruments
 7. Storage
 8. Distribution
METHODS OF STERILIZATION

Microbial
Control
Methods

Mechanical
Physical Chemical
Removal
Agents Agents
Methods
` Physical Agents

Heat Radiation

Dry Moist Ionizing Non Ionizing

Incineration Steam Under X-ray, Cathode, UV

Pressure Gamma
Sterilization
Hot Air Oven Sterilization Disinfection

Boiling Water/ Hot

Water Pasteurization

Disinfection
 Chemical Agents

Gas Liquid

Sterilization Disinfection Animate Inanimate

Chemotherapy Sterilization

Antiseptics Disinfection
 Mechanical Removal
Methods

Filtration

Air Liquids

Disinfection Sterilization
In dentistry sterilization is usually by :

1) MOIST HEAT.(STEAM UNDER PRESSURE)

 Below 100 C : pasteurization
 At 100 C : Boiling
 Above 100 C : autoclave

2) DRY HEAT(HOT AIR OVEN)

3) GASEOUS CHEMICALS.
 AUTOCLAVE
Standard sterilization method in hospitals.
The autoclave is a tough double walled chamber in which air is replaced by pure saturated
steam under pressure.
Advantages
1 most rapid and effective method
for sterilizing cloth surgical packs
and towel packs.
2. Is dependable and economical
3. Sterilization is verifiable
Disadvantages
1. Items sensitive to the elevated
temperature cannot be autoclaved.
2. Autoclaving tends to rust carbon steel
instruments and burs.
3. Instruments must be air dried at
completion of cycle
MECHANISM OF ACTION OF AUTOCLAVE

Moist heat In the form of pressurized steam - increase in the pressure of the gas

increase in the temperature - As the water molecules in steam becomes more

energized, their penetration increases

Pressure Temperatu Time (Min.)

re Sterilization control
15psi 121* C 15
 Bacillus staerothermophilus
 Autoclave tape
20 psi 126* C 10  Thermocouple
 Browne's tube
32 psi 134* C 3
 DRY HEAT STERILIZATION
 Conventional Dry Heat Ovens
 Short-Cycle, High-Temperature Dry Heat Ovens
ADVANTAGES
 Carbon steel instruments and burs do
not rust, corrode, if they are well
dried before processing.
 Rapid cycles are possible at high
temperatures.
 Low initial cost and sterilization is
verifiable
DISADVANTAGES
 High temperatures may damage
more heat-sensitive items, such as
rubber or plastic goods.
 Sterilization cycles are prolonged at
the lower temperatures.
 Must be calibrated and monitored
 HOT AIR OVEN

 Hot air oven expose items to 160°C for 2 hours.

 It has electric element in the chamber as source of heat plus a fan to circulate air for
even distribution of heat in chamber.
 Oven without fan is dangerous.
 Advantage - non corrosive method
ARTICLES THAT CAN BE STERILIZED
 Surgical instruments
 Glass ware
 Oils grease powders
 Certain pharmaceutical products
Test for efficiency
 Chemical method: Browns’ tube develops GREEN spot at 160c after 1 hour
 Biological method:
 Clostridium tetani on a filter paper strip and place it inside the hot air oven along with oven
work for 160c for 1hour.
 Then filter paper is innoculated and incubated
GAMMA RADIATION
 The Nature of Gamma Radiation A form of pure energy that is generally
characterized by its deep penetration and low dose rates, Gamma Radiation
effectively kills microorganisms throughout.
 Benefits of Gamma Radiation include:
1. precise dosing
2. rapid processing
3. uniform dose distribution
4. system flexibility
5. dosimetric release–the immediate availability of product after processing.
6. Penetrating Sterilization: Even with High-Density Products Gamma Radiation is a
penetrating sterilant.
7. Substantial Decrease in Organism Survival: Gamma Radiation kills
microorganisms by attacking the DNA molecule.
 UV RADIATION
 The wavelength of UV radiation ranges from 328 nm to 210 nm .
Its maximum bactericidal effect occurs at 240–280 nm
•Inactivation of microorganisms results from destruction of nucleic
acid through induction of thymine dimers.
• UV radiation has been employed in the disinfection of drinking water
, air, titanium implants, and contact lenses.
• The application of UV radiation in the health-care environment (i.e.,
operating rooms, isolation rooms, and biologic safety cabinets) is
limited to destruction of airborne organisms or inactivation of
microorganisms on surfaces
STERILIZATION BY CHEMICAL
METHODS
Ethylene Oxide Chamber:
 may cause explosion if used pure so
mixed with an inert gas e.g. Neon,
Freon at a ratio of 10:90

 It requires high humidity and is used at

relative humidity 50-60% Temperature :
55-60°C and exposure period 4-6 hours.
CHEMICLAVE

 Chemical vapour sterilization.

 The combinations of formaldehyde 0.2%, alcohols72.3%, acetone, ketones and
steam at 138 kPa /20 psi serves as an effective sterilizing agent.
 Microbial destruction results from the dual action of the toxic chemicals and heat.
 It takes more time than autoclave but less time than hot-air oven that is 30 mins.
 127 -132 c at 20 to 40 psi for a period of 30 minutes.
 Instruments loosely packed
 DISINFECTION
Disinfection is always at least a two-step procedure:
 The initial step involves vigorous scrubbing of the surfaces to be disinfected and wiping
them clean.
 The second step involves wetting the surface with a disinfectant and leaving it wet for the
time prescribed by the manufacturer.

The ideal disinfectant has the following properties:

 Broad spectrum of activity
 Acts rapidly
 Non corrosive
 Environment friendly
 Is free of volatile organic compounds
 Nontoxic & non-staining
LEVELS OF DISINFECTION
DISINFECTANTS
Types of Disinfectants
Phenol and phenolics
 inactivate enzymes, or denature proteins.
 They are stable, persistent, and are not sensitive to organic matter.
Phenylphenol
 It is the main ingredient in most formulations of Lysol.
Triclosan
 It is a widely used in many household products.
 It has broad spectrum of activity, especially against gram positive bacteria.
 It is also effective against gram negative bacteria and fungi.
Biguanides
 Chlorhexidine, a member of the biguanide group
 It is frequently used for surgical skin preparation and surgical hand
scrubs.

Halogens
 Iodine is effective against  bacteria, fungi, and some viruses.
 iodophore  combination of iodine and an organic molecule. do not
stain and are less irritating than iodine.
 Ex:- Isodine and Betadine.
Chlorine  used as a gas or combination with other chemicals.
 Chlorine  disinfecting municipal water supplies, swimming pools, and sewage.
 Sodium hypochlorite  ordinary household bleach- is good disinfectant.

Alcohols
 Concentrations of 60% to 95% are effective.

 They are bactericidal and fungicidal but are not effective against endospores or
non-enveloped viruses.
52
GLASS BEAD STERILIZER:

 TEMPERATURE-218oC-246oC
 It is used to sterilize:
-Absorbent points
-Broaches
-Files, reamers and other Root canal instruments

52
 MONITORS OF STERILIZATION
 Sterilization monitoring has four components:
1. a sterilization indicator on the instrument bag, stamped with the date it is sterilized,
2. daily color-change process-indicator strips,
3. weekly biologic spore test, and
4. documentation notebook.
 HAND PIECES ASEPSIS
 Clean the handpiece by wiping visible debris using suitable disinfectant such as
alcohol.
 Run it for minimum of 30 seconds to discharge residual water and air. Clean it
thoroughly with soap and detergent solution.
 Reattach handpiece to the unit and run dry.
 Lubrication of handpiece should be done before sterilization using lubricant.
 Finally place the instruments in paper pack and seal it.
 Now handpiece can be sterilized by autoclaving.
STERILIZATION OF DIFFERENT
MATERIALS USED IN ENDODONTICS
 Gutta percha :
• dip in 5.2%sodium hypochlorite
• 1 min ethyl alcohol
• To sterilize gutta-percha cone freshly removed from the box- immerse in 5.2% sodium
hypochlorite for 1 min, then rinse with hydrogen peroxide and dry between 2 layers of sterile
gauze.
 Silver cones are sterilized by passing them through a flame 3-4 times or by immersion in
hot salt sterilizer for 5 secs.
 Rubber dam is sterilized by ethylene oxide.
 Carbon steel instruments and burs are best sterilized by dry heat or chemiclave.
 Sterilization dental cements, calcium sulphate is done by gamma radiation“
 Sterilization Of Burs In Autoclaves
• Burs can be protected by keeping them submerged in a small amount of 2% sodium
nitrite solution.
• Prepare fresh sodium nitrite solution by adding 20gms of crystal to 1 liter of water
and place it in a perforated beaker containing burs.

TulsaEndoSterilGuide8-10B
 Alginate:-
• Sodium hypo chlorite sprays • Iodophors • glutaraldehyde
• impressions even after general disinfection procedures like immersion for 10 min in 2%
glutaraldehyde or 1% sodium hypochlorite.
• Hygojet/MD520 system can be recommended for clinical or laboratory use; alternatively, the
use of surfactants like 0.25% benzalkonium chloride together with high or intermediate level
disinfectants like 2% glutaraldehyde or 1% sodium hypochlorite.

Egusa et al, Int J Prosthodont 2008

 Endo Instrument Sterilization:
Files must be sterilized before use.
ANSI/ADA Specification 28 recommends:
• Scrub the instruments with soap and warm water.
• Rinse thoroughly with distilled or deionized water.
• Allow to air dry.
• Place the instruments, unwrapped, in the autoclave tray.
• Use fresh distilled or deionized water.
• Steam Autoclave at 136° C (plus or minus 2° C) for 20 minutes.
•All rotary files are single patient use instruments.
• Recommended File Disposal: Place used files in a Biohazard Sharps container.

TulsaEndoSterilGuide8-10B
 FIBER POST DECONTAMINATION: Wipe the post with alcohol. Allow the post to
air dry for 30 seconds before use.

 ULTRASONIC IRRIGATION NEEDLE: Wipe needle and tubing with 70% isopropyl
alcohol.

 POST DRILLS STERILIZATION PROCEDURE: Using distilled or de-ionized

water, subject unwrapped instruments to a pressure of 220 kPa (2.2 bar) for 20 minutes at
a temperature of (136 ± 2)° C, or dry heat sterilize them at (180 ± 5)°C for 120 minutes.
TulsaEndoSterilGuide8-10B
 STERILIZATION OF ENDODONTIC FILES

 Aim of the study was to compare 4 different methods of sterilizing endodontic files in

dental practice . The present study it was observed that autoclaving and exposing to

laser give complete sterilization, where as Glass-bead sterilizer can be used as an

alternative when these two methods are not available, though autoclave is an effective

method for sterilizing endodontic files, the time taken by it to sterilize is more.

J Int Oral Health. 2013 Dec; 5(6): 108–112.

 The results of the study showed that the files sterilized by autoclave were 100% sterile

and those sterilized with GlutraMil showed 75% sterility with Quitanet showing only

25% sterility. So, the study concluded that autoclave could be used as a reliable

method of sterilization in clinical practice but GlutraMil and Quitanet Plus cannot be

relied upon completely.

World Journal of Dentistry 2:193-198 · July 2011

 Under the experimental conditions of this study rotary NiTi files were 100 per cent free of

biologic (stained) debris. The protocol comprises 10 vigorous strokes in a scouring sponge

soaked in 0.2 percent chlorhexidine solution, a 30 minute pre-soaking in an enzymatic

cleaning solution, 15 minutes ultrasonication in the same solution, and a 20 second rinse

in running tap water.

Australian Dental Journal 2014;49:(1):20-27

USE & CARE OF SHARP INSTRUMENTS
AND NEEDLES:

 Any sharps contaminated with patient blood & saliva should be considered
potentially infective & handled with care to prevent injuries, double gloving,
though recommended & careful handling of instrument required.

 Disposable syringes needles scalpel blades & other sharp items should be
discarded into puncture resistant biohazard container that is easily accessible
for disposal.

 Exchange sharps always by dish and not hand to hand.

UNIVERSAL PRECAUTIONS
 OSHA FOR DENTISTRY
 Require that universal precautions be observed to prevent contact with blood and other
potentially infectious material.
 Saliva is considered to be blood contaminated body fluid in relation to dental treatments.
 •Provide hepatitis b immunization to employees without charge within 10 days of
employment.
 •Implementing engineering controls to reduce production of contaminated mists and
aerosols.
 •Provide facilities and instructions for washing hands after removing gloves and for
washing skin immediately or as soon as feasible after contact with blood or potentially
infectious materials.
 •Prescribe safe handling of needles and other sharp items.
 •Contaminated equipment that has to be serviced must first be decontaminated or a bio
hazard label must be put on it.
 • Do not try to retrieve items from a sharps container
 •Provide vaccination for all employees under no cost against all infectious that could be
prevented by immunization.
 Provide PPE to employees and clear directions for use of universal precautions. Ensure the
correct use of PPE.
 •As soon as feasible the working surface and environment must be sanitized after
treatment. Provide a written schedule for cleaning.
CONCLUSION
 The sterilization and asepsis is a one of the most important step in the all
minor as well as major surgical procedures, so first most importantly;
steps should be taken to wash hands carefully and to wear gloves and
follow recommended aseptic practice.

 Whenever there is any contact between the hands unsterilized tools/fluids

care is taken not to contaminate the surgical area.

 Surfaces, units & controls should be cleaned & disinfected

THANK YOU