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Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy
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Infection control in dentistry / /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy …

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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  • 1. INFECTION CONTROL IN DENTISTRY INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. CONTENTS INTRODUCTION HISTORY TRANSMISSION OF INFECTION IN DENTAL OPERATORY IMPACT OF HEPATITIS B & HIV SUMMARY OF CURRENT OSHA REGULATION OBJECTIVES OF INFECTION CONTROL PATIENT SCREENING PERSONAL BARRIER PROTECTION EMERGENCY & EXPOSURE INCIDENT www.indiandentalacademy.com PLAN
  • 3.  OPERATORY ASEPSIS CLINICAL WASTE DISPOSAL INSTRUMENT HANDLING & CLEANING STEAM PRESSURE STERILIZATION CHEMICAL VAPOR PRESSURE STERIIZATION DRY HEAT STERILIZATION MONITORS OF STERILIZATON HANDPIECE ASEPSIS GUIDELINES FOR STERILIZATION OF ENDODONTIC INSTRUMENTS CONCLUSION. www.indiandentalacademy.com
  • 4. 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. EXPOSURE – is defined as specific eye, mouth, other mucous membrane, non intact skin, or parenteral contact with blood or other potentially infectious materials. www.indiandentalacademy.com
  • 5.  UNIVERAL PRECAUTIONS - means that all patients and blood contaminated body fluids are treated as infectious. WORK PRACTICE AND ENGINEERING CONTROLS – are terms that describe precautions(e.g; careful handling of sharps) and use of devices to reduce contamination risks(high volume suction) www.indiandentalacademy.com
  • 6.  PERSONAL PROTECTIVE EQUIPMENT (PPE) – is a term used for barriers, such as gloves, gown, or mask. HOUSEKEEPING – is a term that relates to cleanup of treatment-soiled operatory equipment, instruments, counters, and floors, as well as to management of used gowns and waste. www.indiandentalacademy.com
  • 7.  STERILIZATION: Use of a physical or chemical procedure to destroy all microorganisms including substantial numbers of resistant bacterial spores. STERILE: Free from all living microorganisms; usually described as a probability (e.g., the probability of a surviving microorganism being 1 in 1 million). www.indiandentalacademy.com
  • 8.  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 www.indiandentalacademy.com endospores).
  • 9.  GERMICIDE: An agent that destroys microorganisms, especially pathogenic organisms. Terms with the same suffix (e.g., virucide, fungicide, bactericide, tuberculocide, and sporicide) indicate agents that destroy the specific microorganism identified by the prefix. Germicides can be used to inactivate microorganisms in or on living tissue (i.e., antiseptics) or on environmental surfaces (i.e., disinfectants). www.indiandentalacademy.com
  • 10. TRANSMISSION OF INFECTION  Infection transmission during dental procedures is dependent on four factors: 1. Source of infection – may be a patient or a member of the dental team who is suffering from, or is a carrier of, an infectious disease. SOURCEPatients suffering Patients in carriers from acute www.indiandentalacademy.com prodromal known unknown infection stage
  • 11. 2. Means of transmission – Micro organisms capable of causing disease are present in human blood and saliva.Contact with blood or saliva may transmit such pathogenic organisms causing infection.3. Route of transmission – Transmission may occur due to inhalation or inoculation.4. Susceptible host – Is a person who lacks effective resistance to a particular micro organism. E.g immunocompromised patients, pregnantwww.indiandentalacademy.com women and children.
  • 12. 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 www.indiandentalacademy.com
  • 13. Infection through any of these routes requires that all of the following conditions be present: An adequate number of pathogens, or disease- causing organisms, to cause disease. A reservoir or source that allows the pathogen to survive and multiply (e.g., blood). A mode of transmission from the source to the host. An entrance through which the pathogen may enter the host. A susceptible host (i.e., one who is not immune). www.indiandentalacademy.com
  • 14. INFECTIONS OF CONCERN IN DENTISTRY TRANSMITTED BY INHALATION Varicella virus Chicken pox Paramyxovirus Measles & mumps Rhino/ adeno virus Common cold Rubella German measles Mycobacterium Tuberculosis www.indiandentalacademy.com Candida sp. Candidosis.
  • 15. TRANSMITTED BY INOCULATIONHepatitis B,C,D Hepatitis B, hep C,virus Hepatitis DHerpes simplex I Oral herpes, herpetic whitlowHerpes simplex II Genital herpesHIV AIDS & ARCNeisseria GonorrheagonorrhoeaeTreponema Syphilispallidum www.indiandentalacademy.comS.aureus/albus Wound abscesses
  • 16. IMPACT OF HEPATITIS B Hepatitis B was first to gain attention as an infection risk for all health care personnel who have blood and body fluid contact. Infection can occur by –A. Percutaneous inoculation – contaminated needles, spatter of blood or blood contaminated saliva on broken skin.B. Non- percutaneous infection via intact barriers – contaminated fluids in contact with mucous membranes of eyes and mouth. www.indiandentalacademy.com
  • 17. C. Indirect transmission – the environment is regarded as contaminated after treatment of an HBV positive patient, since HBV is very stable outside the body. www.indiandentalacademy.com
  • 18. INFECTION RISKS FOR PERSONNEL FROM HBV One in three parenteral exposures of personnel to HB-infected blood has caused hepatitis B infection. Thus, of 300 persons parenterally exposed, 100 will be infected , instead of 1 person in 250 to 300 infected when exposed to HIV. With a 2% death probability, 2 of the 100 HBV exposed person may die compared with 1 HIV infected exposed person. www.indiandentalacademy.com
  • 19.  Thus, a parenteral blood exposure of a nonimmune person to HBV carries at least 2 times the mortality risk of a similar HIV exposure. In studies of personnel who sustained injuries from needles contaminated with blood containing HBV, the risk of developing clinical hepatitis if the blood was positive for both HBsAg and HBeAg was 22%--31%; the risk of developing serologic evidence of HBV infection was 37%-- 62%. www.indiandentalacademy.com
  • 20.  By comparison, the risk of developing clinical hepatitis from a needle contaminated with HBsAg-positive, HBeAg-negative blood was 1%--6%, and the risk of developing serologic evidence of HBV infection, 23%--37%. With the advent of vaccine, mortality rates may approach zero. www.indiandentalacademy.com
  • 21. SEROLOGICAL TESTS Testing for HBsAg is determines presence of infected persons whether they are symptomatic or not. Testing for HBeAg determines presence of an HB antigen in blood when Hb virus concentrations are high and relate to ability to infect others. Testing for anti-HBc – a marker for prevoius HB infection. www.indiandentalacademy.com
  • 22.  Testing for anti-HBs determines the presence of antibodies that can protect against future HB infection. Detection of anti-HBs means that the person is infected and recovered or has been immunised with a vaccine. www.indiandentalacademy.com
  • 23. IMMUNIZATION Passive immunization may be employed following any acute exposure with human serum immune globulin. Active immunization with two new genetically engineered vaccines derived from bread yeast, Engerix-B and Recombivax B is given. Vaccination requires one dose followed with another 1 month later and third dose 6 months later. www.indiandentalacademy.com
  • 24.  Health care personnel should be tested for anti- HBs 1--2 months after completion of the 3-dose vaccination series . Those who do not develop an adequate antibody response (i.e., anti-HBs <10 mIU/mL) to the primary vaccine series should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive. www.indiandentalacademy.com
  • 25.  Health care professionals can test their blood with radioimmunoassay for anti-HBs to check immunity after 3 years. If the test results are below 10 serum ratio units, a booster dose can be taken. www.indiandentalacademy.com
  • 26. IMPACT OF HIV The risk of HIV transmission in dental settings is extremely low. Prospective studies worldwide indicate the average risk of HIV infection after a single percutaneous exposure to HIV-infected blood is 0.3% (range: 0.2%--0.5%) . After an exposure of mucous membranes in the eye, nose, or mouth, the risk is approximately 0.1%. www.indiandentalacademy.com
  • 27.  Laboratory studies have determined if needles that pass through latex gloves are solid rather than hollow-bore, or are of small gauge (e.g., anesthetic needles commonly used in dentistry), they transfer less blood. In a retrospective case-control study, an increased risk for HIV infection was associated with exposure to a relatively large volume of blood, as indicated by a deep injury, or a procedure that involved a needle placed in a vein or artery. The risk was also increased if the exposure was to blood from patients with terminal illnesses, possibly reflecting the higher titer of HIV in late- stage AIDS.www.indiandentalacademy.com
  • 28.  In dried infected blood, 99% of HIV becomes inactive in about 90 mins. When kept wet, the virus may survive for 2 or more days. HIV is killed by all methods of sterilization. When used properly, all disinfectants except some quarternary ammonium compounds are said to inactivate HIV in less than 2 minutes. www.indiandentalacademy.com
  • 29. SEROLOGY OF HIV INFECTION HIV infection is detected by blood tests (enzyme- linked immunoassay [EIA], Western Blot, and fluorescent antibody tests) that detect antibodies formed against the virus. Tests for anti HIV antibody are often positive within 3 months after infection; most are positive by 6 months; 1% take up to 12 months to become positive. A second positive test is necessary to confirm positive serologies. www.indiandentalacademy.com
  • 30. FEDERAL OCCUPATIONAL SAFETY & HEALTH ADMINISTRATION (OSHA) The OSHA rule derives from the original Occupational Safety and Health Act passed by the U.S. Congress in 1970. The Act created the Occupational Safety and Health Agency (OSHA) in the U.S. Department of Labor . www.indiandentalacademy.com
  • 31.  The Act covers two regulated programs of compliance: (1) an OSHA Hazard Communications program concerning risks from environmental and chemical hazards in the workplace. (2) an OSHA bloodborne Pathogens, program that addresses control of "occupational exposure to blood and other potentially infectious materials.” www.indiandentalacademy.com
  • 32. SUMMARY OF THE CURRENT OSHA REGULATIONS Universal precautions must be observed to prevent contact with blood and other potentially infectious materials. Saliva is considered a blood- contaminated body fluid in relation to dental treatments. Engineering controls must be implemented to reduce production of contaminated spatter, mists, and aerosols. Examples are use of a rubber dam, high-volume suction. www.indiandentalacademy.com
  • 33.  Work practice control precautions must be implemented to minimize splashing, spatter, or contact of bare hands with contaminated surfaces. Needles must not be bent or cut. When it can be shown necessary, needles may be resheathed with mechanical aids or other one-handed techniques. Flush eye or mucosa immediately or as soon as feasible after any contact with blood or potentially infectious materials. Disposal of single-use needles, wires, carpules and sharps as close to the place of use as possible, as soon as feasible, in hard-walled, leakproof containers that are closable from which needles cannot bewww.indiandentalacademy.com easily spilled.
  • 34.  Containers must be red or bear a biohazard label and must be kept upright and closed when moved. Teeth must not be discarded into trash but can be given to the patient or discarded into sharps containers. Place blood and contaminated specimens (e.g., impressions that have not been well-cleaned and well-disinfected, teeth, biopsy specimens, blood specimens, and culture specimens) to be shipped, transported, or stored into suitable closed containers that prevent leakage. www.indiandentalacademy.com
  • 35.  Attend to housekeeping requirements including floors, countertops, sinks, and other environmental equipment that are subject to contamination. Also included are the use of protective covers that are changed after each appointment, or thoroughly clean and disinfect contaminated surfaces and operatory equipment items that cannot be covered, discarded, or removed and sterilized. www.indiandentalacademy.com
  • 36.  For OSHA purposes in dentistry, regulated waste also means: (1) liquid or semiliquid blood or other potentially infectious materials, (2) contaminated items that would release blood or other potentially infectious materials in a liquid or semiliquid state if compressed, and (3) items that are caked with blood or other potentially infectious materials and are capable of releasing these materials during handling. Properly dispose of such regulated waste in bio hazard labeled or red closable bags or other labeled containers that prevent leakage www.indiandentalacademy.com
  • 37. OBJECTIVES OF INFCTION CONTROL To protect the patient and members of the dental team from contracting infections during dental procedures To reduce the numbers of pathogenic micro- organisms in the dental operatory to the lowest possible level. To implement a high standard of infection control when treating every patient (universal precautions) To simplify infection control, thus allowing the dental team to complete treatment with minimal www.indiandentalacademy.com inconvenience.
  • 38. STRATEGY TO ACHIEVE INFECTION CONTROL All patients must be screened. Barriers for personal protection. Careful aseptic techniques. Sterilization & disinfection. Disposal of contaminated waste safely. Laboratory asepsis. www.indiandentalacademy.com
  • 39. PATIENT SCREENING All patients must be screened. A thorough medical history must be taken. Medical history serves several purposes:1. To detect any unrecognized illness that requires medical diagnosis and care.2. To identify any infection or high risk that may be important to a clinical person exposed during examination, treatment, or cleanup procedures.3. To assist in managing and caring for infected patients www.indiandentalacademy.com
  • 40. 4. To reinforce use of adequate infection control, bearing in mind that general history taking is not capable of detecting all infectious persons. www.indiandentalacademy.com
  • 41. PERSONAL BARRIER PROTECTION Personal protective equipment (PPE), or barrier precautions, are a major component of Standard precautions. Use of rotary dental and surgical instruments, air- water syringes creates a visible spray that contains primarily large-particle droplets of water, saliva, blood, microorganisms, and other debris www.indiandentalacademy.com
  • 42.  This spatter travels only a short distance and settles out quickly, landing either on the floor, operatory surfaces, dental health care personnel (DHCP), or the patient. PPE is essential to protect the skin and the mucous membranes of DHCP from exposure to infectious or potentially infectious materials. PPE should be worn whenever there is potential for contact with spray or spatter and should be removed when leaving treatment areas. The various barriers are gloves, masks, protective eye wear, surgical head cap & overgarments. www.indiandentalacademy.com
  • 43. GLOVES All clinical personnel must wear treatment gloves during all procedures. Types:1. Latex gloves2. Vinyl gloves3. Nitile gloves4. General purpose utility gloves Latex gloves are the preferred operatory gloves. Gloves manufactured by DOUBLE DIP process are better than single dip because they have less pinholes www.indiandentalacademy.com & use less irritating catalyzing coagulants.
  • 44.  Gloves powdered using cornstarch or cetylpyridium chloride is better than talcum powder (mineral) which may cause irritation. Medical gloves, both patient examination and surgeons gloves, are manufactured as single-use disposable items that should be used for only one patient, then discarded. Gloves should be changed between patients and when torn or punctured. Gloves must have < than 4% leak detectable by a water test.( FDA regulation). www.indiandentalacademy.com
  • 45. GLOVE INTEGRITY Patient examination and surgeons gloves commonly contact multiple types of chemicals and materials (e.g., disinfectants, composite resins, and bonding agents) that can compromise the integrity of latex as well as vinyl, nitrile, and other synthetic glove materials. Latex gloves can interfere with the setting of vinyl polysiloxane impression materials, although the setting is apparently not adversely affected by synthetic vinyl gloves. www.indiandentalacademy.com
  • 46.  Given the diverse selection of dental materials on the market, dental practitioners should consult glove manufacturers regarding the chemical compatibility of glove materials. Washing latex gloves with plain soap, chlorhexidine, or alcohol can lead to the formation of glove micropunctures. Because this condition, known as WICKING, can allow penetration of liquids through undetected holes, washing gloves is not recommended. www.indiandentalacademy.com
  • 47.  After a hand rub with alcohol, the hands should be thoroughly dried before gloving, because hands still wet with an alcohol-based hand hygiene product can increase the risk of glove perforation. The effectiveness of wearing two pairs of gloves in preventing disease transmission has not been demonstrated, but there is a lower frequency of inner glove perforation and visible blood on the hands when double gloves are worn. Additional protection might also be provided by specialty products (e.g., orthopedic surgical gloves and glove liners) www.indiandentalacademy.com
  • 48.  Natural rubber latex proteins responsible for latex allergy are attached to glove powder. Allergic patients and DHCP can experience cutaneous, respiratory, and conjunctival symptoms related to latex protein exposure. Nonlatex (e.g., nitrile or vinyl) powder-free and low-protein gloves can be used in these cases. While cleaning sharp instruments, puncture resistant utility gloves should be used. Nitrile latex gloves are preferred as they cam be washed & autoclaved. www.indiandentalacademy.com
  • 49. HAND WASHING Removes debris, blood and potentially transient micro-organisms from the hands & suppress overgrowth of skin bacteria. Hand hygiene (e.g., handwashing, hand antisepsis, or surgical hand antisepsisis considered the single most critical measure for reducing the risk of transmitting organisms to patients and health care professionals. The microbial flora of the skin, first described in 1938, consist of transient and resident microorganisms . Transient flora, which colonize the superficial layers of the skin, are easier to www.indiandentalacademy.com remove by routine handwashing.
  • 50.  They are often acquired by HCP during direct contact with patients or contaminated environmental surfaces; these organisms are most frequently associated with health-care--associated infections. Resident flora attached to deeper layers of the skin are more resistant to removal and less likely to be associated with such infections. For routine dental examinations and nonsurgical procedures, handwashing and hand antisepsis is achieved by using either a plain or antimicrobial soap and water www.indiandentalacademy.com
  • 51.  The purpose of surgical hand antisepsis is to eliminate transient flora and reduce resident flora for the duration of a procedure to prevent introduction of organisms in the operative wound, if gloves become punctured or torn. Skin bacteria can rapidly multiply under surgical gloves if hands are washed with soap that is not antimicrobial . Thus, an antimicrobial soap or alcohol hand rub with persistent activity should be used before surgical procedures. www.indiandentalacademy.com
  • 52.  Agents used for surgical hand antisepsis should substantially reduce microorganisms on intact skin, contain a nonirritating antimicrobial preparation, have a broad spectrum of activity, be fast-acting, and have a persistent effect. Persistence (i.e., extended antimicrobial activity that prevents or inhibits survival of microorganisms after the product is applied) is critical because microorganisms can colonize on hands in the moist environment underneath gloves. www.indiandentalacademy.com
  • 53.  At the beginning of a routine treatment period, watches and jewelry 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. Clean brushes can be used to scrub under and around the nails. Must be repeated at least once to remove all soil. Factors that can influence the effectiveness of the surgical hand antisepsis in addition to the choice of antiseptic agent include duration and technique of scrubbing, as well as condition of the hands, and techniques used for drying and gloving. www.indiandentalacademy.com
  • 54. METHOD AGENT PURPOSE TIME INDICATI (min) ONRoutine Water & plain Remove soil 15 sec Before &handwash soap & transient after treating microbes each pt. After bareAntiseptic Water & Remove/destr 15 sec handedhandwash antimicrobial oy transient touching of soap microbes & objects reduce contaminate resident flora d by bloodAntiseptic Alcohol based Remove/destr Rub or saliva.hand rub hand rub oy transient hands till When microbes & dry. visibly reduce soiled. www.indiandentalacademy.com resident flora
  • 55. METHOD AGENT PURPOSE TIME INDICATIONSurgical Water & Remove/de 2- 6 Beforeantisepsis antimicrobial stroy mins donning soap transient sterile microbes surgeon’s & reduce gloves for Water & resident surgical plain soap followed by flora procedures. alcohol hand (persistent effect) rub with persistent activity. www.indiandentalacademy.com
  • 56. HAND CLEANSERS CHLORHEXIDINE BASED – these contain 2- 4% chlorhexidine gluconate with 4% isopropyl alcohol in a detergent solution with a pH of 5.0 to 6.5. They have broader activity for special cleansing(e.g: for surgery, glove leaks, or when clincian experiences injury). But it can be hazardous to eyes. POVIDONE IODONE – contain 7.5-10% povidone iodine, uesd as a surgical handscrub. www.indiandentalacademy.com
  • 57.  PARACHLOROMETEXYLENOL(PCMX) – they are bactericidal and fungicidal at 2% concentration. Non irritating and recommended for routine use. ALCOHOL HAND RUBS- ethyl alcohol and isopropyl alcohol are widely used at 70% concentration. They rapidly germicidal when applied to the skin.. www.indiandentalacademy.com
  • 58. MASKS Masks protect the face from splatter and prevent inhalation of aerosols. Aerosols are airborne debris, smaller than 5ųm in dia, 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. www.indiandentalacademy.com
  • 59.  Masks with highest filtration are rectangular folded types. Dome shaped masks are adequate barriers against spatter but not against respiratory viruses. The masks outer surface can become contaminated with infectious droplets from spray of oral fluids or from touching the mask with contaminated fingers. Also, when a mask becomes wet from exhaled moist air, the resistance to airflow through the mask increases, causing more airflow to pass around edges of the mask. www.indiandentalacademy.com
  • 60.  When airborne infection isolation precautions are necessary (e.g., for TB patients), a National Institute for Occupational Safety and Health (NIOSH)-certified particulate-filter respirator (e.g., N95, N99, or N100) should be used. N95 refers to the ability to filter 1-µm particles in the unloaded state with a filter efficiency of >95% (i.e., filter leakage <5%), given flow rates of <50 L/min (i.e., approximate maximum airflow rate during breathing). www.indiandentalacademy.com
  • 61.  Available data indicate infectious droplet nuclei measure 1--5 µm; therefore, respirators used in health-care settings should be able to efficiently filter the smallest particles in this range. Face shields are appropriate for heavy spatter but should not be used without a mask. A new surgical mask has to be used for each patient. Mask must be changed every hour or sooner if it becomes wet. Masks must be discarded after the patient is dismissed. www.indiandentalacademy.com
  • 62.  Masks must be removed by grasping only the string or band at the sides or back of the head. Personnel must also protect their hair with a surgical cap when encountering heavy spatter. Appropriate work practices, including use of dental dams and high-velocity air evacuation, should minimize dissemination of droplets, spatter, and aerosols. www.indiandentalacademy.com
  • 63. www.indiandentalacademy.com
  • 64. PROTECTIVE EYEWEAR 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. Therefore both the clinician and patients use protective eyewear. www.indiandentalacademy.com
  • 65.  Protective eyewear consists of glasses with solid eyeshields. Eyewear must be put on with clean hands before gloving and must be removed after gloves are removed. Eyewear and shields must be cleaned and disinfected with water based disinfectant that is allowed to stand for 5 mins. Next it must be washed allowed to soak in 1:50 to 1:100 solution of 5% hypochlorite bleach and is rinsed and dried. www.indiandentalacademy.com
  • 66. 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. OSHA bloodborne pathogens standard requires sleeves to be long enough to protect the forearms when the gown is worn (i.e., when spatter and spray of blood, saliva to the forearms is anticipated). www.indiandentalacademy.com
  • 67.  A simple, lightweight garment that covers the arms and chest up to the neck as well as the lap when seated appears to provide adequate protection. Overgarments must be changed whenever becoming moist or visibly soiled. www.indiandentalacademy.com
  • 68. PRECAUTIONS TO AVOID INJURY EXPOSURE Engineering controls are the primary method to reduce exposures to blood from sharp instruments and needles. Work-practice controls establish practices to protect DHCP whose responsibilities include handling, using, assembling, or processing sharp devices. Needles are a substantial source of percutaneous injury in dental practice, and engineering and work-practice controls for needle handling are of particular importance www.indiandentalacademy.com
  • 69.  Work-practice controls for needles and other sharps include placing them in appropriate puncture-resistant containers located as close as feasible to where the items were used. Sharp end of instruments must be pointed away from the hand Avoid handling large number of sharp hands Work-practice controls include removing burs before disassembling the handpiece from the dental unit, restricting use of fingers in tissue retraction or palpation during suturing and administration of anesthesia, and minimizing uncontrolled movements of sharp instruments www.indiandentalacademy.com
  • 70.  Used needles should never be recapped or otherwise manipulated by using both hands, or any other technique that involves directing the point of a needle toward any part of the body. A one-handed scoop technique, a mechanical device designed for holding the needle cap to facilitate one-handed recapping, or an engineered sharps injury protection device (e.g., needles with resheathing mechanisms) should be employed for recapping needles between uses and before disposal www.indiandentalacademy.com
  • 71.  DHCP should never bend or break needles before disposal because this practice requires unnecessary manipulation. For procedures involving multiple injections with a single needle, the practitioner should recap the needle between injections by using a one-handed technique or use a device with a needle- resheathing mechanism. www.indiandentalacademy.com
  • 72. EMERGENCY & EXPOSURE INCIDENT PLAN Management of exposure includes:A. General wound care and cleaningB. Counseling of the exposed worker regarding bloodborne pathogensC. Source patient testing for HBV,HCV and HIV (consent required).D. Documentation of the incident and reviewE. Postexposure assessment and prophylaxis for the health care workerF. Baseline and follow up serology of the worker. www.indiandentalacademy.com
  • 73. HBV POSTEXPOSURE MANAGEMENT IF AND THENSource pt is Exposed worker not Worker should receive+ve for vaccinated vaccine seriesHBsAG  should receive single dose of HB immunoglobulin within 7 days. Exposed worker has Should be tested for anti- been vaccinated HBs & given 1 dose of vaccine & 1 dose of HBIG if < 10 IU www.indiandentalacademy.com
  • 74. IF AND THENSource pt Exposed worker Worker should be encouraged tois –ve for not vaccinated receive hepatitis B vaccine.HBsAg Exposed worker No further action is needed. has been vaccinatedSource pt Exposed worker Should receive HB seriesrefuses not vaccinated HBIG should be consideredtesting ornotidentified Exposed worker Management should be has been individualized. vaccinated www.indiandentalacademy.com
  • 75. HIV POSTEXPOSURE MANAGEMNT IF THEN ANDSource pt has Exposed worker should Exposed workerAIDS be counseled about risk of testing –ve infection. initially should OR Should be tested for HIV be retested 6Source pt is weeks, 12HIV+ve infection immediately weeks & 6 Should be advised to seek OR months after medical advice for any exposure.Source Pt refuses febrile illness within12to be tested weeks Refrain from blood donation & take appropriate precautions www.indiandentalacademy.com
  • 76. IF THEN ANDSource pt is tested Baseline& found -ve testing of the exposed worker with follow up testing 12 weeks laterSource cannot be Serologicalidentified testing must be done & decisions must be www.indiandentalacademy.com individualized
  • 77. OPERATORY ASEPSIS In the dental operatory, environmental surfaces (i.e., a surface or equipment that does not contact patients directly) can become contaminated during patient care. Certain surfaces, especially ones touched frequently (e.g., light handles, unit switches, and drawer knobs) can serve as reservoirs of microbial contamination, although they have not been associated directly with transmission of infection to either DHCP or patients. www.indiandentalacademy.com
  • 78.  Transfer of microorganisms from contaminated environmental surfaces to patients occurs primarily through DHCP hand contact. When these surfaces are touched, microbial agents can be transferred to instruments, other environmental surfaces, or to the nose, mouth, or eyes of workers or patients. Although hand hygiene is key to minimizing this transferal, barrier protection or cleaning and disinfecting of environmental surfaces also protects against health-care--associated infections. www.indiandentalacademy.com
  • 79.  Strategies for cleaning and disinfecting surfaces in patient-care areas should consider the 1) potential for direct patient contact; 2) degree and frequency of hand contact; and 3) potential contamination of the surface with body substances or environmental sources of microorganisms (e.g., soil, dust, or water) www.indiandentalacademy.com
  • 80.  Almost 40 years ago, Dr. E. H. Spaulding proposed a classification system for disinfecting and sterilizing medical and surgical instruments. This system, or variations of it, has been used in infection control recommendations and guidelines over the years. According to the CDC, patient-care items (eg, dental instruments, devices, and equipment) are categorized as critical, semicritical, or noncritical, based on the potential risk of transmitting infection if the item becomes contaminated during use. www.indiandentalacademy.com
  • 81.  Instruments that contact cut tissues or penetrate tissues are considered to be critical items that require thorough cleaning and sterilization for reuse. E.g dental burs, endodontic files etc. Semicritical items that touch mucosa are the air/water syringe tip, suction tips, prophy angle, and handpieces. Others (air/water syringe handle etc) are handled or touched interchangeably with treatment instruments that become contaminated with blood and saliva. www.indiandentalacademy.com
  • 82.  Semicritical items must be removed for cleaning and sterilization unless they are either disposable or can be protected from contamination with disposable plastic covers. Noncritical items are environmental surfaces such as chairs, benches, floors, walls, and supporting equipment of the dental unit that are not ordinarily touched during treatments. Contaminated noncritical items require cleaning and disinfection. www.indiandentalacademy.com
  • 83. 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. There is no such thing as a “one-step disinfectant” The disinfectant step must always be preceded by cleaning. www.indiandentalacademy.com
  • 84.  The ideal disinfectant has the following properties: Broad spectrum of activity Acts rapidly Non corrosive Environment friendly Is free of volatile organic compounds Nontoxic & nonstaining www.indiandentalacademy.com
  • 85.  High-level disinfection: Disinfection process that inactivates vegetative bacteria, mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores. FDA further defines a high-level disinfectant as a sterilant used for a shorter contact time. Intermediate-level disinfection: Disinfection process that inactivates vegetative bacteria, the majority of fungi, mycobacteria, and the majority of viruses (particularly enveloped viruses) but not bacterial spores. www.indiandentalacademy.com
  • 86.  Low-level disinfectant: Liquid chemical germicide registered with EPA as a hospital disinfectant. OSHA requires low-level hospital disinfectants also to have a label claim for potency against HIV and HBV if used for disinfecting clinical contact surfaces. www.indiandentalacademy.com
  • 87. Cleaning and Disinfection Strategies for Blood Spills Strategies for decontaminating spills of blood and other body fluids differ by setting and volume of the spill. The person assigned to clean the spill should wear gloves and other PPE as needed. Visible organic material should be removed with absorbent material (e.g., disposable paper towels discarded in a leak-proof, appropriately labeled container). www.indiandentalacademy.com
  • 88.  Nonporous surfaces should be cleaned and then decontaminated with either an EPA-registered hospital disinfectant effective against HBV and HIV or an EPA-registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate- level disinfectant). However, if such products are unavailable, a 1:100 dilution of sodium hypochlorite (e.g., approximately ¼ cup of 5.25% household chlorine bleach to 1 gallon of water) is an inexpensive and effective disinfecting agent. www.indiandentalacademy.com
  • 89. CLINICAL WASTE DISPOSAL Regulated medical waste is only a limited subset of waste: 9%--15% of total waste in hospitals and 1%--2% of total waste in dental offices. Examples of regulated waste found in dental- practice settings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items (e.g., needles, scalpel blades, and wires. www.indiandentalacademy.com
  • 90.  Regulated medical waste requires careful containment for treatment or disposal. A single leak-resistant biohazard bag is usually adequate for containment of nonsharp regulated medical waste, provided the bag is sturdy and the waste can be discarded without contaminating the bags exterior. Puncture-resistant containers with a biohazard label, located at the point of use (i.e., sharps containers), are used as containment for scalpel blades, needles, syringes, and unused sterile sharps. www.indiandentalacademy.com
  • 91.  All containers with blood or saliva (e.g., suctioned fluids) can be carefully poured down a utility sink or drain. Adding 5% hypochlorite in water to sutioned fluids is recommended before disposing nto the drain. Multiple bloodborne pathogens, particularly viruses, are not stable in the environment for long periods, and the discharge of limited quantities of blood and other body fluids into the sanitary sewer is considered a safe method for disposing of these waste materials. www.indiandentalacademy.com
  • 92. PRINCIPLES AND PROCEDURES FOR HANDLING AND CLEANINGINSTRUMENTS 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. Wear protective utility gloves at all times to handle contaminated containers and instruments. Organic debris on instruments is likely to reduce activity of the disinfectant. www.indiandentalacademy.com
  • 93.  Used instruments are commonly placed in an anti microbial solution as this softens and loosens debris. Next, move the cassettes or basket of instruments into an ultrasonic cleaning device for cleaning, rinse them, and then carefully inspect the instruments for debris. Use tongs to remove any instruments left uncleaned. Remove the debris from these instruments individually, keeping hands well protected with utility gloves. www.indiandentalacademy.com
  • 94.  Dip instruments likely to rust into a rust inhibitor solution. Drain & dry instruments with absorbent towel. Still wearing protective gloves, properly package the instruments together with internal and external sterilization indicators suited to the sterilization process use. Cloth packs, wraps, tubes of nylon film, or commercial paper/plastic bags are suitable for instrument containment if they are compatible with, the method and temperature of sterilization. www.indiandentalacademy.com
  • 95. ULTRASONIC CLEANERS AND SOLUTIONS Ultrasonic cleaning is the safest and most efficient way to clean sharp instruments. An ultrasonic cleaning device should provide fast and thorough cleaning without damage to instruments; have a lid, well-designed basket, and audible timer; and be engineered to prevent electronic interference with other electronic equipment www.indiandentalacademy.com
  • 96.  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 5 minutes or longer as directed by the manufacturer to give optimal cleaning. Devices, that-have less than two transducers do not pass the foil test and are not suitable for instrument cleaning. www.indiandentalacademy.com
  • 97. ULTRASONIC CLEANER FOIL TEST Remove the basket from the device. Add solution, to the tank, and operate the device for 5 minutes to expel dissolved gases. From a roll of aluminum foil, cut a sheet approximately 1 inch more than the depth of the solution in the metal tank . Cut the length 1 inch less than the length of the tank. Hold the foil like a curtain vertically sub-merged in the solution in the center of the tank approximately one-half inch above the bottom. www.indiandentalacademy.com
  • 98.  Operate the device for exactly 20 seconds. Upon close inspection, every square one-half inch of the foil should show small visible indentations or perforations if the ultrasonic device functions properly. www.indiandentalacademy.com
  • 99. STERILIZATION There are 4 distinct stages for instrument sterilization:1) Pre cleaning disinfection, using holding solutions2) Pre – sterilization cleaning.3) Sterilization4) Aseptic storage. www.indiandentalacademy.com
  • 100.  The four accepted methods of sterilization are :A. Steam pressure sterilization (autoclave)B. Chemical vapor pressure sterilization- (chemiclave)C. Dry heat sterilization (dryclave)D. Ethylene oxide sterilization Patient load, turnaround time for instrument reuse, size of instrument inventory and instrument variety, and instrument quality must all be balanced against the type and size of sterilizer selected. www.indiandentalacademy.com
  • 101. STEAM PRESSURESTERILIZATION (AUTOCLAVING) For a light load of instruments, the time required at 250° F (121° C) is a minimum of 15 minutes at 15 Ibs of pressure. Time for wrapped instruments can be reduced to 7 minutes if the temperature is raised to approximately 273° F (134° C) to give 30 pounds of pressure. Time required for the sterilizer to reach the correct temperature is not included. www.indiandentalacademy.com
  • 102.  Steam must enter and circulate around packs easily. Instrument pans or other impermeable instrument containers must be left open so steam can enter. Two basic types of steam sterilizers are the gravity displacement and the high-speed prevacuum sterilizer. Unlike hospital autoclaves, bench models depend on gravity flow to distribute steam throughout the load rather than first evacuating air from the sterilizer and then refilling it with steam. www.indiandentalacademy.com
  • 103.  Moist heat kills microorganisms through protein coagulation, RNA and DNA breakdown and release of low molecular weight intracellular constituents. Advantages of Autoclaves. Autoclaving is the most rapid and effective method for sterilizing cloth surgical packs and towel packs. Is dependable and economical Sterilization is verifiable. www.indiandentalacademy.com
  • 104.  Disadvantages of Autoclaves. Items sensitive to the elevated temperature cannot be autoclaved. Autoclaving tends to rust carbon steel instruments and burs. Instruments must be air dried at completion of cycle. www.indiandentalacademy.com
  • 105.  Sterilization of Burs in Autoclaves Burs can be protected by keeping them submerged in a small amount of 2% sodium nitrite solution. After ultrasonic cleaning, burs can be rinsed and placed into any small metal or glass beaker with a perforated lid. Place the container of burs and fluid into the sterilizer, and operate a normal sterilization cycle. Discard the fluid from the container through the perforated lid. www.indiandentalacademy.com
  • 106.  Use sterile forceps to place the burs into a sterilized bur holder or tray. Before use, any nitrite residue can be wiped away, or rinsed off with clean or sterile water, if desired . www.indiandentalacademy.com
  • 107. CHEMICAL VAPOR PRESSURE STERILIZATION (chemiclaving) The 1938 patent of Dr. George Hollenback and the work of Hollenback and Harvey in 1940s culminated in the development of an unsaturated chemical vapor system , also called Harvey Chemiclave. Principle is that although some water is necessary to catalyze the destruction of all microorganisms in a relatively short time, water saturation is not necessary. Kills microorganisms by destroys vital proteins. www.indiandentalacademy.com
  • 108.  Chemical vapor pres-sure sterilizers operate at 270° F (131° C) and 20 pounds of pressure. They must be used with a pre-scribed chemical and should be properly labeled to satisfy OSHAs Chemical Hazard Communication Standard. Newer models appear to handle aldehyde vapors also. Unsaturated chemical-vapor sterilization involves heating a chemical solution of primarily alcohol with 0.23% formaldehyde in a closed pressurized chamber www.indiandentalacademy.com
  • 109.  Advantages of Chemiclaves Carbon steel and other corrosion-sensitive burs, instruments, and pliers are said to be sterilized without rust or corrosion. Relatively quick turnaround time for instruments. Load comes out dry. Sterlization is verifiable. Disadvantages of Chemiclaves Items sensitive to the elevated temperature will be damaged. Vapor odor is offensive. Heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization. www.indiandentalacademy.com
  • 110. DRY HEAT STERILIZATION Conventional Dry Heat Ovens Dry heat sterilization is readily achieved at temperatures above 320° F (160° C) for 30 mins. Instrument loads may take 30- 90 mins to reach that temperature, so to provide a margin of safety, instruments must be sterilized at 160ºC for 2 hours. They have heated chambers that allow air to circulate by gravity flow (gravity convection). Packs of instruments must be placed at least 1 cm apart to allow heated air to circulate. www.indiandentalacademy.com
  • 111.  Kills microoragnisms primarily by an oxidation process. Protein coagulation also occurs depending on the water content of protein. High concentrations of mercury vapor can develop in a dry heat oven that has been used to sterilize amalgam instruments. Thus great care must be taken to scrap amalgam of any instrument. www.indiandentalacademy.com
  • 112.  Short-Cycle, High-Temperature Dry Heat Ovens It is a high-temperature process that uses a forced-draft oven (a mechanical convection oven that circulates air with a fan or blower) It reduces total sterilization time to 6 minutes for unwrapped and 12 minutes for wrapped instruments. These short-cycle high-temperature dry heat ovens operate at approximately 370° to 375° F . www.indiandentalacademy.com
  • 113.  Advantages of Dry Heat Sterilization Carbon steel instruments and burs do not rust, corrode, or lose their temper or cutting edges if they are well dried before processing. Industrial forced-draft hot air ovens usually provide a larger capacity at a reasonable price. Rapid cycles are possible at high temperatures. Low initial cost and sterilization is verifiable. Disadvantages of Dry Heat Sterilization High temperatures may damage more heat- sensitive items, such as- rubber or plastic goods. www.indiandentalacademy.com
  • 114.  Sterilization cycles are pro-longed at the lower temperatures. Must be calibrated and monitored. Too high temperature may cause instrument damage. www.indiandentalacademy.com
  • 115. ETHYLENE OXIDE STERILIZATION (ETO) Was first used in 1940’s by US army. Ethylene oxide sterilization is the best method for sterilizing complex instruments and delicate materials because of extreme penetrability of the ETO molecule and low temperature(70ºF- 140ºF). Kills microroganisms by reacting chemically with nucleic acids.the basic reaction is alkylation of hydroxyl groups. Sterilization requires several hours and seems ideal for handpiece sterilization. www.indiandentalacademy.com
  • 116.  Porous and plastic materials absorb the gas and require aeration for 24 hours or more before it is safe for them to contact skin or tissues.Advantages: Operates effectively at low temperatures Gas is extremely penetrative Can be used for sensitive equipment Sterilization is verifiableDisadvantages: Potentially mutagenic and carcinogenic. Requires aeration chamber ,cycle time lasts hours Usually only hospital based. www.indiandentalacademy.com
  • 117.  BOILING WATER Boiling water does not kill spores and cannot sterilize instruments. Boiling is a. method of high-level disinfection that has been used when actual sterilization cannot be achieved (e.g., in case of a sterilizer breakdown). Well-cleaned items must be completely submerged and allowed to boil at 98° to 100° C (at sea level) for 10 minutes. www.indiandentalacademy.com
  • 118. OTHER STERILIZATION METHODS Heat-sensitive critical and semicritical instruments and devices can be sterilized by immersing them in liquid chemical germicides registered by FDA as sterilants. Items need to be 1) rinsed with sterile water after removal to remove toxic or irritating residues; 2) handled using sterile gloves and dried with sterile towels; and 3) delivered to the point of use in an aseptic manner. www.indiandentalacademy.com
  • 119.  They can kill bacterial spores in 6 to 10 hours. Sterilants used for high-level disinfection of items for reuse are glutaraldehydes at 2% to 3% concentrations. High-level disinfection is used mainly for plastic items that enter the mouth and that cannot withstand heat sterilization like plastic cheek retractors and photographic mirrors. Disadvantages include prolonged time taken, irritating to skin & cannot be monitored with biological indicators. www.indiandentalacademy.com
  • 120.  NEW METHODS OF STERILIZATION Various new methods of sterilization are under investigation and development. www.indiandentalacademy.com
  • 121. MONITORS OF STERILIZATION There are 3 methods of monitoring sterilization: Mechanical techniques for monitoring sterilization include assessing cycle time, temperature, and pressure by observing the gauges or displays on the sterilizer and noting these parameters for each load . Correct readings do not ensure sterilization, but incorrect readings can be the first indication of a problem with the sterilization cycle. www.indiandentalacademy.com
  • 122.  Chemical indicators, internal and external, use sensitive chemicals to assess physical conditions (e.g., time and temperature) during the sterilization process. They allow detection of certain equipment malfunctions, and they can help identify procedural errors. External indicators applied to the outside of a package (e.g., chemical indicator tape or special markings) change color rapidly when a specific parameter is reached, and they verify that the package has been exposed to the sterilization process. www.indiandentalacademy.com
  • 123.  Internal chemical indicators should be used inside each package to ensure the sterilizing agent has penetrated the packaging material and actually reached the instruments inside. Biological indicators (BIs) (i.e., spore tests) are the most accepted method for monitoring the sterilization process because they assess it directly by killing known highly resistant microorganisms (e.g., Geobacillus or Bacillus species), rather than merely testing the physical and chemical conditions necessary for sterilization. www.indiandentalacademy.com
  • 124.  Spores dried on absorbent paper strips are calibrated to be killed when sterilization conditions are reached and maintained for the necessary time to kill all pathogenic microorganisms. Tests can be evaluated in the office. However, by sending the strip to a licensed reference laboratory for testing, the dentist obtains independent documentation of monitoring frequency and sterilization effectiveness. www.indiandentalacademy.com
  • 125. STERILIZATION SPORE TYPE INCUBATION METHOD TEMPERATUREAUTOCLAVE Baccilus 56°C stearothemophilusCHEMICALVAPORDRY HEAT Baccilus subtilis 37°CETHYLENEOXIDE www.indiandentalacademy.com
  • 126.  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. In dental offices, sterilization must be monitored weekly with biologic spore tests using heat- resistant spores and tested daily with color- change process-indicator strips. www.indiandentalacademy.com
  • 127. DENTAL UNIT WATERLINES Studies have demonstrated that dental unit waterlines (i.e., narrow-bore plastic tubing that carries water to the high-speed handpiece etc.) can become colonized with microorganisms, including bacteria, fungi, and protozoa. Protected by a polysaccharide slime layer known as a glycocalyx, these microorganisms colonize and replicate on the interior surfaces of the waterline tubing and form a biofilm, which serves as a reservoir that can amplify the number of free- floating (i.e., planktonic) microorganisms in water used for dental treatment. www.indiandentalacademy.com
  • 128.  It has been demonstrated that microbial counts can reach <200,000 colony-forming units (CFU)/mL within 5 days after installation of new dental unit waterlines , and levels of microbial contamination <106 CFU/mL of dental unit water have been documented. These counts can occur because dental unit waterline factors (e.g., system design, flow rates, and materials) promote both bacterial growth and development of biofilm. www.indiandentalacademy.com
  • 129.  In 1995, ADA addressed the dental water concern by asking manufacturers to provide equipment with the ability to deliver treatment water with <200 CFU/mL of unfiltered output from waterlines. This threshold was based on the quality assurance standard established for dialysate fluid, to ensure that fluid delivery systems in hemodialysis units have not been colonized by indigenous waterborne organisms. www.indiandentalacademy.com
  • 130. HANDPIECE ASEPSIS Oral fluid contamination problems of rotary equipment and especially the high-speed handpiece involve:1. contamination of hand-piece external surfaces and crevices,2. turbine chamber contamination that enters the mouth,3. water spray retraction and aspiration of oral fluids into the water lines of older dental units www.indiandentalacademy.com
  • 131. 4. growth of environmental aquatic bacteria in water lines, and5. exposure of personnel to spatter and aerosols generated by intraoral use of rotary equipment. www.indiandentalacademy.com
  • 132. HANDPIECE SURFACECONTAMINATION CONTROL Blood and saliva contaminate the surfaces of handpieces during various dental treatments. Irregular surfaces and especially crevices around the bur chuck are difficult to clean and disinfect, especially by a brief wipe with a disinfectant- soaked sponge. Submersion of a high-speed handpiece in a high- level disinfectant has not been an accepted option. Only sterilization can approach complete www.indiandentalacademy.com infection control of handpiece surfaces.
  • 133. TURBINE CONTAMINATION CONTROL Contaminated oral fluids may be drawn back- into the turbine chamber by negative pressure created either by a Venturi effect during operation or when the turbine continues to spin whenever the drive air is stopped. Oral fluids also may enter around worn bearing seals, or be aspirated into the vent holes in the top of older hand-chuck operated handpieces or possibly into the air-water spray orifice that communicates with the turbine chamber. www.indiandentalacademy.com
  • 134. WATER RETRACTION SYSTEM CORRECTION Dental unit water control systems made before the 1980s used water lines that easily expanded when air-water spray was used and gradually contracted when water pressure was relieved. Handpieces had a tendency to continue to drip immediately after having been used. To overcome the problem in those units, a device was installed that retracted water in the line whenever the spray was stopped but oral fluids also were retracted. www.indiandentalacademy.com
  • 135.  The minimal recommendation is to opearte the handpiece spray for 20 seconds between appointments to help expel any aspirated infectious microbes. Agencies recommend correcting-water retraction by placing a one-way check valve in the water line. Unfortunately check valves clog and fail . A simple, inexpensive water retraction testing device is available that takes only approximately 1 minute to use Since 1988, nearly all manufacturers have manufactured dental control units that simply cut off the water spray without retraction which is the www.indiandentalacademy.com best solution.
  • 136.  Scrub metal-bearing high-speed handpieces and the sheath or cone of the low-speed straight hand- piece at the sink with running water and detergent. Autoclave sterilization of handpieces is one of the most rapid methods. Chemical vapor pressure sterilization & ethylene oxide gas can also be used. Dry heat sterilization is not recommended. www.indiandentalacademy.com
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  • 139. INFECTION CONTROL FOR IMPRESSIONS To eliminate any chance of cross-contamination when sizing impression trays, place the tray in a plastic bag before it is tried in the mouth. Two choices that may be used for preparing a potentially infectious item for transport: send it well cleaned (rinsed) and undisinfected in a biohazard-labeled, heat-sealed, plastic bag; or de-bride, clean (rinse); and adequately disinfect it, place it in a sealed transport bag labeled with the precautions taken. www.indiandentalacademy.com
  • 140.  For rubber-based impression material, Remove the impression and while still wearing barriers (remove any attached debris and rinse the item well with running tap water for 15 seconds to remove saliva and blood and put in the bag. For Aqueous Impression Material Technique (Using Alginate [Irreversible Hydrocolloid], Reversible Hydrocolloid, or Polyether Impressions), thoroughly rinse the impression under tap water (15 seconds recommended) to remove any saliva or blood. www.indiandentalacademy.com
  • 141.  Disinfect the impression by spraying until thoroughly soaked with a hospital level disinfectant. Thoroughly rinse the disinfected impression under tap water because any residual disinfectant can adversely affect surface hardness of the stone cast. Another alternative is to submerge the impression into a 2% potassium sulfate solution for (up to) 20 minutes, and then remove, shake off excess, and pour the impression. www.indiandentalacademy.com
  • 142. www.indiandentalacademy.com
  • 143. Guidelines for Processing and Sterilization of Endodontic Files Clear all instruments of debris by counter-rotating in alcohol dampened 2x2 gauze pieces. Place the files in an available holding solution of 4% glutaraldehyde. Files are placed in stainless steel cassettes for routine ultrasonic cleaning. The cassette is then rinsed under running tap water and and allowed to soak for one hourin2.5%NaOCl(Household bleach diluted 1:1 with water), at room temperature www.indiandentalacademy.com
  • 144.  The cassette is then thoroughly rinsed under running tap water and autoclaved at 134ºC-138ºC for a minimum of 18 minutes. Root canal instruments can also be effectively sterilized in a dry heat ovens at 320ºF for 2 hours. The files are then inspected for damage, sorted by size and length, and placed in sterile sponges for use. www.indiandentalacademy.com
  • 145.  Chairside disinfection of files, absorbent points and other root canal instruments can be done before use in a hot salt sterilizer. It consists of a metal cup in which table salt is kept at a temperature between 425ºF(218ºC) and 475ºF(246ºC). At this temperature, root canal instruments like files may be immersed for 5 sec and absorbent points for 10 sec. www.indiandentalacademy.com
  • 146.  Pure sodium chloride salt is not used high heat causes fusion of the granules. Instead table salts having 1% sodium silicoaluminate, magnesium carbonate or sodium carbonate is used so that it pours easily. Advantages: Uses ordinary table salt which is readily available. Eliminates the risk of clogging the canal unlike glass beads. Small and convenient. Serves as an emergency backup. www.indiandentalacademy.com
  • 147.  Disadvantages: Only small sized and number of instruments can be sterilized Sterilization is non verifiable. Glass beads can be substituted for the salt if the beads are less than 1mm in diameter. Larger beads are not effective because of the large air spaces. The hottest part of the bath is in the outer rim, starting at the bottom layer of salt, so to use effectively, the instrument must be immersed at least quarter – inch below the surface in the peripheral area. www.indiandentalacademy.com
  • 148.  Gutta percha cones are sterilized by immersing in 5.2% sodium hypochorite for 1 min, rinsed with hydrogen peroxide and then dried between 2 layers of sterile gauze. Silver cones are sterilized by passing them through a bunsen flame 3 or 4 times. www.indiandentalacademy.com
  • 149.  Thank you for watching www.indiandentalacademy.com

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