Infection control

It refers to a comprehensive and

systematic

program

that

when

applied prevent the transmission of

infectious agents among persons
who are in indirect or direct contact
with the health care environment.

TRANSMISSION OF INFECTION
The two principle modes of disease transmission in which
infectious diseases are acquired in dentistry.
1. contact
A- direct contact: human-human touch. Contact with
microorganism 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.

THE THREE PRINCIPLE ROUTES OF ENTRY OF

MICROORGANISMS INTO THE BODY ARE:
1. INHALATION
Inhalation of small particles of moisture (spatter) generated when
a person cough or sneezes, or when water is aerosolized during
dental procedures. Risk of disease transmission is usually limited to
persons in close proximity to the droplet source.
2. INGESTION
Whereby droplets of saliva/blood or particles from instruments are
swallowed.
3. AUTOINOCULATION/PERCUTANOUS INJURY
Autoinoculation occurs as a result of the operator touching his/her
own mucous membrane or non intact skin surface with contaminated
patient care items or contaminated personal protective barriers.

Components of infection
control
Immunization

Patient screening
Hand hygiene
Barrier technique
Needle and sharp instrument safety
Instruments sterilization and disinfection
Surface disinfection and general operatory

asepsis
Radiographic asepsis
Laboratory asepsis
Disposal of contaminated waste

1. Immunization
Dental

personnel can reduce the risk of

contracting infectious diseases by maintaining
their health and immune status
Dental personnel should maintain up to date
immunization records, that include vaccination
against:
- Hepatitis B
- Rubella
- Measles
- Mumps
- Influenza
- Poliomyelitis
- Tetanus/diphtheria

2. Patient screening
Complete medical history should be taken

for every new patient and updated during

recall appointments to determine infectious
status.
Screening specially useful when patients
report positive disease status for blood
born disease, as there may be a
percutaneous injury to the operator during
dental treatment.

3.
Hand
hygiene

Hand hygiene in health care facilities is the most

important aspect in the prevention of infection. It
significantly reduce microorganisms on hand and
protect both patient and dental staff.
Hand hygiene is important because:
Hands are the most common mode of disease
transmission.
Hand washing products include plain soap and
agents with antimicrobial activity.
Although hand washing depends primarily on a
mechanical effect and any liquid soap is acceptable,
however skin bacteria can rapidly multiply under
gloves if hands are washed with soap that is
not antimicrobial. So hand washing with a
chemically
active
antimicrobial
soap
is
recommended.

The following agents have been found to be effective

2-4% chlorhexidine
0.3-1% triclosan
60-70% propanol
Components of good hand washing
- clean nails and skin thoroughly to remove all visible soil
- rinse well to remove all visible soap
- dry thoroughly.
Indications for hand hygiene
- when hands are visibly soiled
- after barehanded touching of inanimate objects likely to

be contaminated by blood, saliva, or respiratory

secretions.
- before and after treating every patient (before gloves
placement and after glove removal)

4. Barrier techniques - personal

protective equipment (PPE)
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
10

1- PROTECTIVE
OVERGARMENTS
Protective clothing (e.g., gowns, lab coats)

should be worn to prevent contamination

of street clothing and to protect the skin of
clinician from exposures to blood and body
substances.

12

2MASKS
Masks protect the face from splatter and prevent

inhalation of aerosols.
Aerosols are airborne debris, smaller than 5m
in diameter, that remain suspended in air.
Splatter are larger blood contaminated droplets
which may contain sharp debris.
A mask should have a bacterial filtration
efficiency of 95% or more.
It should have a close fit around the entire
periphery.
14

Precautions Protocol During

Patient Treatment

3- PROTECTIVE EYE WEAR

CAUSES OF EYE DAMAGE:

Aerosols and spatter may transmit infection

Sharp debris projected from mouth while

removing old restoration, or during scaling may

cause eye injury.
Injuries to eyes of patients may occur due to
dental procedures, especially in supine position.
Therefore both the clinician and patients must use
protective eyewear.
16

Eyewear must be put on with clean hands

before gloving and must be removed after

gloves are removed.
Eyewear and face shields must be cleaned
and disinfected with water based disinfectant
that is allowed to stand for 5 minutes.

17

4-All clinical
GLOVES
personnel must wear treatment gloves during

all procedures.
Types:
1. Examination/treatment gloves (latex or vinyl)
2. over gloves
3. Under gloves (cotton gloves worn under treatment gloves
for operators with discomfort to the skin), they are to be
replaced for every patient and washed with outerwear.
4. Surgical gloves
5. General purpose utility gloves
18

19

Guidelines for the Use of Gloves

All gloves used in patient care must be discarded after a single
use.
These gloves should not be washed, disinfected, or sterilized;
however,
they
may
be
rinsed
with
water
to remove excess powder.
Latex, vinyl, or other disposable medical-quality gloves may be
used for patient examinations and dental procedures.
Torn or damaged gloves must be replaced immediately.
Do not wear jewelry under gloves. (Rings harbor pathogens and
may tear gloves.)
Change gloves frequently (If the procedure is long, change
gloves about once each hour.)
Remove contaminated gloves before leaving the chairside
during patient care and replace them with new gloves before
returning to patient care.

Nonsterile exam
gloves

PPE should be placed in the following order

1. clothing
2. mask
3. glasses
4. wash hand, place gloves
Removal of PPE
1. gloves
2. clothes
3. mask
4. glasses
5. wash hands

Utility gloves are used in preparing instruments for

sterilization.

St
e
D ri
is li
in za
fe ti
ct o n
io &
n.
23

5. Sterilization & Disinfection

Sterilization

is defined as the process where all the living

microorganisms, including bacterial spores are killed. Used for all
instruments which come in contact with blood or saliva

Sterilization

can be achieved by physical, or chemical, or

physiochemical means. Chemicals used as sterilizing agents are called
chemisterilants.
Disinfection is the process of elimination of most pathogenic
microorganisms (excluding bacterial spores) on inanimate objects.
Disinfection can be achieved by physical or chemical methods.
Chemicals used in disinfection are called disinfectants. Different
disinfectants have different target ranges, not all disinfectants can kill
all microorganisms.

Dental instruments are classified into

three categories

( critical, semi-

critical, or noncritical ) depending on

their risk of transmitting infection and
on the need to sterilize them between
cases.

Critical instruments
Surgical and other instruments that touch

bone or penetrate soft tissue are classified

as critical and should be sterilized after
each use.

EXAMPLES :
Surgical instruments
Periodontal scalers
Scalpel blades
Forceps
Burs

Semi-critical instruments
Instruments that touch mucous membranes,

but do not touch bone or penetrate tissue .

If sterilization is not feasible because the

instrument will be damaged by heat, use

high-level disinfection.

EXAMPLES :
Mirrors.
Amalgam condensers.
Dental handpieces .

Non-critical instruments
Contact intact skin only and cleaned by

using intermediate-level or low-level

disinfection for them.

EXAMPLES :
x-ray heads.
Face-bows
Blood pressure cuff.

Steps for instruments

processing
1- soaking the used instruments in holding

solution till time of cleaning.

2- washing: all items should be washed
under soapy water.
3- drying
4- packing
5- sterilization
6- storage

Methods of cleaning
(washing)

1- manual cleaning: can cause spatter of

micro-organisms, not recommended.

2- dish washer
3- ultra-sonic cleaning: reduce the direct
contact with the instruments.

Drying
The cleaned instruments should be dried to

reduce the corrosion, prevent the rupture

of the paper wrap, and prevent the
dilution of the chemical agent
Rust inhibitor as sodium nitrite may be
added to non stainless steel items before
steam sterilization

Packing
It protects the sterilized instruments from

contamination
Includes: self sealing paper, biofilm peel

pouches, closed trays.

The choice between them depends on the

method of sterilization.

Methods of sterilization
1. Steam vapor under pressure (autoclave)
For sterilization to be effective, items being

processed, require exposure to direct steam

contact at the required temperature and
pressure for the specified time. Pressure serve
as mean to obtain the high temperature
needed to kill the micro-organisms.
High temperature of the stem 121-132 C. time
required to kill microorganisms is 3-20
minutes, depending on the type of sterilizer
and wrapping.

2. Dry heat oven:

It sterilize less effectively than moist heat.
A higher temperature is required for a dry

heat unit than for steam processor. In order

for sterilization to occur, the cycle must be
brought to correct temperature and then
maintained at this temperature.
Actual time needed to sterilize instruments
will depend on the size and arrangement of
the load, the type of wrapping materials
and unite efficiency. A typical dry heat
cycle is 1 hour at 170C OR 2 hours at 160C.

3. Chemical vapor (chemiclave):

Chemical vapor sterilizer use a specific

mixture of formaldehyde, alcohol, ketone,
acetone and water under pressure at
132C to achieve sterilization. Sterilization
require 20-40 minutes and the chemical
solution must only be used once.
4. Heat transfer (Bead type):
These sterilizer use extremely hot rapid
airflow
to
achieve
sterilization
in
approximately 6-minutes. They are used
only at chairside for files and burs

Cold sterilization
Used with the plastic items that are

damaged from the heat sterilizers.

2- 3.2% solution of Glutaraldehyde is
used for a contact time of 10 hours.

Surface
disinfection

Disinfectants Versus Antiseptics

Disinfectants are chemicals that are applied to

inanimate surfaces (such as dental equipment).

Antiseptics are antimicrobial agents that are
applied to living tissue.
Disinfectants and antiseptics should never be
used interchangeably because tissue toxicity
and damage to equipment can result.

Types of Chemical Disinfectants

1- Iodophors
2- Alcohols
3- Synthetic phenol compounds
4- Sodium hypochlorite (household bleach)

PRECAUTIONS TO AVOID
INJURY EXPOSURE

40

of s t e
a
al
os d w
isp ate .
D in ely
am saf
nt
co

43

Type of bags

Waste material

Yellow bag

Gloves, masks, head caps,

suction tips

Red bag

- Body tissues, blood soiled

materials ,extracted tooth

Blue bag

Needles syringes scalpels

blades glass endodontic files

Black bag

Discarded medicines,
incineration ash, chemicals
used in disinfection