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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 provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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Infection control in orthodontic office /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

  • 1. Infection control in orthodontic office www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. Content Infection  Principles of infection transmission  Principles of infection control  Infection control in orthodontic office  Sterilization & disinfection  Studies on infection control in orthodontic office  www.indiandentalacademy.com
  • 4. Infection  “Multiplication & survival of microorganisms on or in the body” Cross infection  “The passage of microorganisms from one person to other”. www.indiandentalacademy.com
  • 5. History of sterilization  Leeuwenhoek(17 century)   Described microbes(shape-cocci,bacilli,spiral)   Simple microscope Father of bacteriology Edward Jenner(1749-1823)  Modern method of vaccination-small pox  Originally vaccination-injection cowpox-prevent smallpox www.indiandentalacademy.com
  • 6. Tyndall First-sterilization method Fractional sterilization Pasteur(1822-1895) Father of microbiology Introduced-techniques of sterilization Steam sterilizer,hot air oven,autoclave Pasteurization www.indiandentalacademy.com
  • 7.  Joseph listure(1827-1912)  Father of antiseptic surgery  Disease-invading organisms-germ theory of disease  Diluted phenol-wound infection www.indiandentalacademy.com
  • 8.  Robert koch(late19-early20)  Staining bacterial smears  Pure culture technique  Koch's postulate www.indiandentalacademy.com
  • 9. Infection control  “Governing or limiting of the spread of infections via different channels, in a specific or general environment”. www.indiandentalacademy.com
  • 10. Goals  risk of cross contamination  To correct break in aseptic technique  To use universal precautions  To protect pt’s & personnel- Infection www.indiandentalacademy.com
  • 11. Principles of Infection Transmission 1. A Source Infection 2. A Mode / Vehicle 3. Root of transmission www.indiandentalacademy.com
  • 12. Source of Infection 1. With Overt Infection  Droplets, Discharges from mouth / Portals 2. Prodromal Stage of Infection  Viral Infection – Measles, Mumps, Chicken Pox 3.Carriers Convalescent / Asymptomatic  Hepatitis B www.indiandentalacademy.com
  • 13. Universal Infection Control Patient Carrier ????? Reservoir of Pathogens Universal Precaution www.indiandentalacademy.com
  • 14. Dentist Patient Microorganism Blood Respiratory Oral www.indiandentalacademy.com
  • 15.  HIV  HBV  HSV-1,2  CMV  TB-bacilli  Streptococci & Staphylococci www.indiandentalacademy.com
  • 16. Route of Transmission Direct Contact Indirect Contact •Blood •Contaminated instruments •Oral fluids •Operatory Equipments •Other Secretions •Aerosols www.indiandentalacademy.com
  • 17. www.indiandentalacademy.com
  • 18. Aerosols  Influenza, Common cold, TB  High speed Instruments > 100 µ  Spatter < 100 µ - Common www.indiandentalacademy.com
  • 19. Chain of Infection Susceptible Host Virulent Pathogen Portal of Entry www.indiandentalacademy.com
  • 20. Index Case Other Patients Dentist Infection Control www.indiandentalacademy.com
  • 21. Infection Control Protocol 1. Pt Evaluation 2. Personal Protection 3. Sterilization & Disinfection 4. Safe Disposal of Waste 5. Lab Asepsis www.indiandentalacademy.com
  • 22. Pt Evaluation  Medical History www.indiandentalacademy.com
  • 23. Personal Protection 1. Personal Hygiene 2. Clinic Clothing 3. Barrier Protection 4. Immunization Procedures www.indiandentalacademy.com
  • 24. Personal Hygiene  Scrubbing  Touching  Cover – Cuts & Bruises  Washing – Hands  Finger nails www.indiandentalacademy.com
  • 25. www.indiandentalacademy.com
  • 26. 2.Clinic Clothing •Uniform •Daily change •Washing •OSHA-clinic premises www.indiandentalacademy.com
  • 27. Barrier Protection 1. Gloves 2. Eye Shields 3. Face mask 4. Rubber dam isolations www.indiandentalacademy.com
  • 28. Gloves  Disposable – new pair  Latex / Vinyl  Change – Long Procedures  After removal – washing hands www.indiandentalacademy.com
  • 29. Eye Shields  Dentists – Support Personnel  Spatter – Debris  High speed Instrumentation  OSHA-fitted-solid side shields www.indiandentalacademy.com
  • 30. Face Mask  High speed instrumentation  Aerosol – inhalation  RTI  Life – 30 to 60 minutes www.indiandentalacademy.com
  • 31. Vaccines for Dentists  CDC & OSHA Recommendation Vaccines • HBV, •Influenza, •rubella www.indiandentalacademy.com •Measles
  • 32. Sterilization & disinfection www.indiandentalacademy.com
  • 33.  Sterilization “The process by which an article surface or medium is freed of all microorganisms either in vegetative or in spore state”.  Disinfection “Destruction of all pathogenic organisms capable of giving rise to infection”. www.indiandentalacademy.com
  • 34.  Antisepsis “Indicate the prevention of infection ,usually by inhibiting the growth of bacteria”. www.indiandentalacademy.com
  • 35. Physical agents 1. Sunlight 2. Drying 3. Dry heat 4. Moist heat 5. Filtration 6. Radiation 7. Ultrasonic & sonic vibrations www.indiandentalacademy.com
  • 36. Chemical agents 1. Alcohols 2. Aldehydes 3. Dyes 4. Halogens 5. Phenols 6. Surface active agents 7. Metallic salts 8. Gases www.indiandentalacademy.com
  • 37. 1.Sunlight  Bactericidal & germicidal  U.V rays & heat rays 2.Drying  Moisture- bacterial growth  Spores- unaffected www.indiandentalacademy.com
  • 38.  3.Heat Most reliable  Factors 1) Nature of heat- 2) Temperature & time 3) Number of microorganisms 4) Characteristics of organisms 5) Type of material from which the organisms - eradicated www.indiandentalacademy.com
  • 39. 1.Nature of heat Dry Heat Moist Heat • Coagulation of Proteins • Electrolytes •Denaturation & Coagulation of Proteins • Oxidative damage www.indiandentalacademy.com
  • 40. 2.Time & Temperature  Time α 1 Temperature Thermal Death Time “Minimum time required to kill a suspension of organisms at a predetermined temp in a specific environment” www.indiandentalacademy.com
  • 41. 3. No of Micro-organisms  Sterilization time α No of Microorganisms 4.Characteristics of Microorganisms Sterilization time Spore α Strain www.indiandentalacademy.com
  • 42. 5.Type of Material - Host Organic Content Spore Difficult to Eradicate www.indiandentalacademy.com
  • 43. Heat Dry Heat Moist Heat 1.Flaming 1.Pasteurization 2.Incineration 2.Boiling 3.Hot air oven 3.Steam 4.Autoclave www.indiandentalacademy.com
  • 44.  Flaming  Bunsen flame – Red hot  Forceps point  Spatulas  Scalpel  Needles www.indiandentalacademy.com
  • 45.  Incineration  Burning  Solid dressings  Bedding  Pathological material www.indiandentalacademy.com
  • 46.  Hot air oven  Widely used – 160ºC / 1 hr  Electricity  Even distribution of air  Dry  Forceps  Scissors  Scalpels  Syringes  Swabs www.indiandentalacademy.com
  • 47. Moist Heat  Pasteurization (< 100ºC)  63 ºC / 30 min  Non-sporing MO  TB-Bacilli  Brucella  Salmonella www.indiandentalacademy.com
  • 48.  Boiling (100ºC)    x  Disinfection Surgical Instruments Steam (> 100ºC)  Steam Condenses to Water Microbicidal Activity Liberate Latent Heatwww.indiandentalacademy.com
  • 49. Steam at atmospheric pressure  Free steam-culture media  90 mins  Sugar containing medias  100ºC / 20 mins  3 successive days  Tyndalisation www.indiandentalacademy.com
  • 50. Steam Sterilizers  Types  Lab Autoclaves  Hospital dressing sterilizer  Bowl & Instrument sterilizer  Rapid cooling sterilizer www.indiandentalacademy.com
  • 51. Autoclave  Principle  > 100ºC Under pressure Pressure - Inside Closed chamber Temperature Saturated Steam Penetrating power www.indiandentalacademy.com
  • 52.  Materials  Instruments  Dressings  Lab ware Types of Autoclaves High vaccum Downward displacement www.indiandentalacademy.com
  • 53. High vaccum Vaccum suction Downward displacement Steam enters top of chamber Air – Evacuated Downward displacement of air EX- Central Sterile supply units in hospitals EX- Automatic Bench top Autoclave www.indiandentalacademy.com
  • 54. www.indiandentalacademy.com
  • 55. Sterilization Cycle 1. Heating Period 2. Holding Period 3. Cooling Period www.indiandentalacademy.com
  • 56. Sterilization Efficacy (Monitoring)  Spores of Bacillus Stearo-thermophilus www.indiandentalacademy.com
  • 57. Time-Temp Temperature Holding Time (Min) 120ºC 15 126ºC 10 134ºC 3 www.indiandentalacademy.com
  • 58. Filtration  Heat labile substances  Antibiotic solutions  Sera  Carbohydrate solution Types-Candle filters -Asbestos filters -Sintered glass filters -Membrane filters www.indiandentalacademy.com
  • 59. Radiation  Ionization   X-rays, γ-rays, cosmic rays  Highly lethal to DNA Non-ionizaion  EMR  wavelength > visible light  Ex- IR, UV.   Hospital wards, OT www.indiandentalacademy.com
  • 60. Ultrasonic's & Sonic rays  High frequency of sound waves beyond the range of human ear.  Variable sensitivity towards Micro-organisms  Commonly used in dentistry. www.indiandentalacademy.com
  • 61. Chemical Sterilization  Chemical agents – Requirements 1. Wide spectrum 2. Active – Organic matter 3. Speedy Action 4. High penetrating power 5. Stable 6. Non-corrosive www.indiandentalacademy.com
  • 62. Mode of action  Protein coagulation  Disruption of cell-membrane  Removal of Sulfates groups  Substrate competition (Competitive Inhibition) www.indiandentalacademy.com
  • 63. Types of Chemical agents  Alcohols  Aldehydes  Dyes  Halogens  Phenols  Surface actives agents  Gases  Metallic salts www.indiandentalacademy.com
  • 64.  Alcohols  Ethyl alcohol & Isopropyl alcohol  Skin Antiseptics  60-70%  Denaturation of Proteins  No action on spores www.indiandentalacademy.com
  • 65.  Sterilium  Bacteria,antibiotic resistant bacteria,tubercle bacilli,fungi,viruses  Composition 2 propanol-4.5gm 1propanal-30gm ethyl-hexadecyl-dimethyl www.indiandentalacademy.com
  • 66.  Aldehydes  Formaldehyde  Against Amino group in Protein Bactericidal & Sporicidal  Preserve anatomical specimen's  10 % formalin  Gluteraldehyde  Similar to Formaldehyde  Effective against TB-bacilli, fungi & Virus www.indiandentalacademy.com
  • 67.  Korsolex  Total bactericidal,fungicidal,tuberculocidal,sporicidal, viricidal(HBV,HIV,polio etc)  Mainly contains gluteraldehyde-7gm/100gm,rust inhibitor  www.indiandentalacademy.com Ortho-pliers, cutters,arch wires
  • 68. Chemical sterilization for Orthodontic appliances  Bands  Plastic boxes – Dipping gluteraldehyde  Least critical Instruments  Soaking in 2% Gluteraldehyde (100 mins)   8% Formaldehyde in Alcohol 2% Aqueous soln of Activated Gluteraldehyde Removable  Immerse Iodophors / Chlorine www.indiandentalacademy.com
  • 69. Dyes  Anilines  Acridine  Bacteriostatic (High dilution)  Bactericidal (Low dilution) www.indiandentalacademy.com
  • 70. Halogens  Iodine (Aqueous / Alcoholic soln.)    Skin disinfectant Bactericidal & Moderately Sporicidal Chlorine  Water supply  Swimming pools  Food industry www.indiandentalacademy.com
  • 71. Phenols  Coal tars – Lister  Cell membrane damage  Microbicidal  Hospitals  Ex – Chlorheixidine  G +VE www.indiandentalacademy.com
  • 72. Gases  Ethylene oxide   Heart , lung machines, respirators, dental equipments   Colorless – highly penetrating gas – all type of MO Explosive Formaldehyde   Fumigation of OT β- propiolactone  More effective for fumigation  Low penetrating power www.indiandentalacademy.com
  • 73. Surface active agents  Wetting agents, Detergents & Emulsifiers 1. Anionic (Soap) 2. Cationic 3. Nonionic 4. Amphoteric   Commonly used  Cationic – Cell membrane Alkaline pH www.indiandentalacademy.com
  • 74. Metallic Salts  Action α CONC  Salts of Heavy mestals – greater action  Salts of Hg, Cu, Ag  Disinfectants www.indiandentalacademy.com
  • 75. Stages of sterilzation  Pre-sterilzation cleaning  Packing  The sterilization process  Aseptic storage www.indiandentalacademy.com
  • 76. Pre-sterlization cleaning  Remove-contaminated instruments  Heavy duty household gloves,eye shields&face masks-cleaning.  Sharps-carefull  Needles- capped. www.indiandentalacademy.com
  • 77.  In dentistry  Methods  Manual scrubbing  Ultrasonic cleaning.  Cleaning efficiency  Aerolization  Sharp injuries www.indiandentalacademy.com
  • 78. Packing  Open tray system-sealed - bags  Perforated trays-fitted covers  Individual packing-bags www.indiandentalacademy.com
  • 79. Sterilization process (Dentistry)  Moist heat(autoclave)  Dry heats  Gaseous chemicals(chemiclave) www.indiandentalacademy.com
  • 80. Glass bead Sterilizer 218-246ºC for 3-5 seconds Glass beads 1.2 – 1.5 mm Hottest pasrt  Peripherally Larger the instruments  Longer the time www.indiandentalacademy.com
  • 81. Chemiclave  Formaldehyde+alchohol+acetone+ketone+steam -138kpa-127ºC  Dual-toxic chemicals – heat – 30 mins  Faster  Non corrosive. www.indiandentalacademy.com
  • 82. Autoclave Sterilization cycle Residual moisture Long term effect on instruments Cycle interuption Chemiclave Hot-air oven Short (3-30 mins) Present Intermediate (30-45 mins) Present Long (> 60 mins) Corrosion / Rust Minimal Corrosion / rust Temper / Brittleness of Sharp edges Not possible Not possible Possible Chemical hazards Spontaneous combustiion of vapor >125ºC Other hazards Nil www.indiandentalacademy.com Nil
  • 83. Monitering Sterilization  Process / Chemical Indicators    Liquid / Paper Assure the efficacy of Sterilization cycle Biological Indicators  Prove the Sterilization  Bacteriospores – Placed – most difficult areas  Weekly based www.indiandentalacademy.com
  • 84. Storage of Sterilized Instruments  Sterilized instruments  Stored in a sterile state  Closed protected area of clinic with minimal air flow – Cabin / Drawer www.indiandentalacademy.com
  • 85. Office Disinfection/ Lab asepsis  Wipe – 70% Isopropyl alcohol  Chair  Table  Light handles  Spittoon  3 way - Syringe www.indiandentalacademy.com
  • 86.  Hand piece  Straight tubing  Non-retraction valve  Minimize the no of tubing & wires  Flush with running water-20-30sec  Sterilization-autoclave,dry heat,chemical www.indiandentalacademy.com
  • 87. Impression disinfection  Immerse –   4% Formaldehyde (10 mins)   0.5 – 1% Sodium hypochlorite ( 60 mins) Gluteraldehyde Spraying  0.5% Chlorhexidine in 70% Alcohol  UV – Disinfection unit  Antiseptic alginate impression material www.indiandentalacademy.com
  • 88. Disposal of Waste  Sharp instruments & Needles, tissues / blood  Disposed with special Precaution  Disposable Needles, scalpels / other sharp items  Placed into Puncture resistant container  Clinical + Domestic waste www.indiandentalacademy.com
  • 89. Classifcation of Dental instruments 1. Critcal Instruments -Surgical / Penetrating mucosa -Scalpels, Burs, Scalars, chisels -Bands, Band-removers, Ligature directors, band forming pliers 1. Semi-Critical -Instruments touching mucosa -Mirrors, Retractors 3. Non-critical -Ligature tire, Distal end cutters, tying pliers www.indiandentalacademy.com
  • 90. ADA-Reccomendations for Infection control in Dental office –JADA 1996 Instruments Autoclave Hot air oven Chemiclave Burs _ ++ ++ Handpieces ++ _ + Impression trays ++ + ++ Mirrors _ ++ ++ Saliva ejectors _ _ _ www.indiandentalacademy.com
  • 91. Orthodontic pliers -High quality SS ++ -Low quality SS _ -With Plastic parts _ _ ++ ++ __ ++ ++ __ Water air syringe tips ++ ++ ++ www.indiandentalacademy.com
  • 92. Studies on Infection control in orthodontic office www.indiandentalacademy.com
  • 93. Sterilization & Disinfection in Orthodontic office – a practical approach -Payne GS , AJO 1986 Rinsing in Running water Draining Ultrasonic cleaner – 5 mins www.indiandentalacademy.com Running water
  • 94. Dried Alcoholic solution – remove residual water Dry Chemiclave - 20 mins www.indiandentalacademy.com
  • 95. Glass bead Sterilization of Orthodontic bands -Smith GE, AJO 1986  Purpose of Study 1. Determining bead sterilization – Ortho bands 2. Minimal time – bands inoculated – bacteria & spores 3. Compare bead sterilization with other methods for sterilizing orthodontic bands www.indiandentalacademy.com
  • 96.  10 bands – bacillus subtilis spores / staph albus  10 controls- Inoculated –nt in sterilizer  Bands placed 1 at a time  226ºC -15, 30, 45, 60 secs  BHI broth - 37ºC / 3 days www.indiandentalacademy.com
  • 97.  Results :-  15 secs – Bacterias  45 secs – Spores  5 bands – simultaneously – twice the time  Other techniques  5 sec tap water rinse  10 sec soap scrub  30 min – alcohol flame www.indiandentalacademy.com Ineffective in killing Bacteria & spores
  • 98. Sterilization of Orthodontic Instruments & Bands in Cassetes Hohit WF et al 1990 AJO  OMS-ASAPsys Cassette Contaminated instruments  Dried Placed in cassettes Ultrasonically cleaned Rinsed & Dried www.indiandentalacademy.com
  • 99. Steam, Chemical vapor, Dry heat Instruments  Cultured Results 1. Residual spores – Ultrasonic's – Killed 2. 3 Types of Sterilization  Equally effective www.indiandentalacademy.com
  • 100. Effect of clinical use &sterilization on selected orthodontic arch wires Smith GA et al 1992, AJO  Study method  3 types of nitinol,1type of β-titanium,1-stainless steal wires-clinically treated  20 wires  5 wires-control(unused)  Autoclave,cold sterilization,disinfection,dry heat www.indiandentalacademy.com
  • 101.  Subjected-load deflection,tension,corrosion tests  Results  No clinical significance-property-new&used www.indiandentalacademy.com
  • 102. Comparison of 3 dry heat covection sterilizers 1. 2. 3. Cox Sterilizer Dentronix –DDS Feberware Carcao G JCO 1993: 27 ; 259 1. Spores  All the 3 units  100% 2. Tested for Hardness Surface discoloration Dulling Hinge looseness www.indiandentalacademy.com
  • 103. Effects of 3 types of Sterilization on Orthodontic pliers - Mazzocchi AR, JCO 1994  Design  Testing Distal end cutters & Ligature cutters – 500 cycles of Autoclave, Chemiclave and dry heat sterilization  Each instrument was checked for  Hardness  Surface discoloration  Tarnish  Before & After Sterilization www.indiandentalacademy.com
  • 104.  Results  All cutters - Hardness – Greatest (Autoclaved ) -Least (Dry heat) Surface discoloration Worst discoloration - All Pliers  Chemiclave instruments www.indiandentalacademy.com
  • 105. Infection control in orthodontic office in CANADA -Mccarthy GM et al , AJO 1997   Comaprison of Infection control methods Between General Dentists and Orthodontics www.indiandentalacademy.com
  • 106. Orthodontists General Dentists Gloves 85% 92% Masks 38% 75% Protective eye wear 60% 84% Changing gloves after each patient Heat sterilization of hand piece Hep B vaccination 84% 96% 57% 84% 94% 92% Addn Precaution HIV 80% 78% www.indiandentalacademy.com
  • 107. Blood & Hepatitis B Contamination through aerosols during debonding -(Toroglu MS et al, Angle Orthodontist 2003, vol 73, 571) Study design:-26 Patients (16 yrs) -Aerosol samples collected – Saliva ejectors -Serum, excess fluid and aerosol samples of 3 hepatitis B carrier is tested -ELISA / PCR www.indiandentalacademy.com
  • 108.  Results  Blood – All aerosols & Excess flluids  Hbs Ag – 2 Hepatitis B Carriers  HBV – DNA  1 excess fluid sample  Both  1 hepatitis B carrier www.indiandentalacademy.com
  • 109. HIV – HBV  Special Precaution  Routes of transmission – Dentistry  Blood  Aerosols  Rotary instruments  Saliva Evidence ???????? www.indiandentalacademy.com
  • 110. Precaution 1. In relation to Blood – Body fluids  Barrier methods 2. In relation to Injection & Skin Piercing  Needle – Extra care -Disposed in Puncture proof container 3. Effective use of Sterilization & Disinfection Autoclave  Dry heat  Chemiclave  Gluteraldehyde  www.indiandentalacademy.com
  • 111. References  Essential microbiology for dentistry-L.P samaranayake  Text book of microbiology-Ananthanarayan&paniker  Medical microbiology- Satish gupte  Principles of endodontics- Grossmen  Comparison of 3 dry heat convection sterilizers-George carcao,JCO-1993 www.indiandentalacademy.com
  • 112.  Bead sterilization of orthodontic bands-Jerald E smith, AJO1996  Effect of 3 types of sterilization on orthodontic pliers-Mazzocchi etall, JCO1994  Possibility of blood & hepatitis contamination through aerosoles generated during debonding procedures-Toroglu et all, AJO2003  Sterilization &disinfection in orthodontic office: A practical approach-Payne s, AJO1986 www.indiandentalacademy.com
  • 113.  Infection control in orthodontic office in canada-Mc carthy et all AJO1997  Effect of clinical use & sterilization on selected orthodontic arch wires-Glenn et all AJO1992  Infection control recommondations for the dental office & dental laboratory-Assosiation report JADA 1996  HIV disease in India-Hand book for dental proffesionls- D.C.I publication www.indiandentalacademy.com
  • 114. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com