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

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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

  1. 1. Infection control in orthodontic office www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 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. 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. 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. 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. 7.  Joseph listure(1827-1912)  Father of antiseptic surgery  Disease-invading organisms-germ theory of disease  Diluted phenol-wound infection www.indiandentalacademy.com
  8. 8.  Robert koch(late19-early20)  Staining bacterial smears  Pure culture technique  Koch's postulate www.indiandentalacademy.com
  9. 9. Infection control  “Governing or limiting of the spread of infections via different channels, in a specific or general environment”. www.indiandentalacademy.com
  10. 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. 11. Principles of Infection Transmission 1. A Source Infection 2. A Mode / Vehicle 3. Root of transmission www.indiandentalacademy.com
  12. 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. 13. Universal Infection Control Patient Carrier ????? Reservoir of Pathogens Universal Precaution www.indiandentalacademy.com
  14. 14. Dentist Patient Microorganism Blood Respiratory Oral www.indiandentalacademy.com
  15. 15.  HIV  HBV  HSV-1,2  CMV  TB-bacilli  Streptococci & Staphylococci www.indiandentalacademy.com
  16. 16. Route of Transmission Direct Contact Indirect Contact •Blood •Contaminated instruments •Oral fluids •Operatory Equipments •Other Secretions •Aerosols www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. Aerosols  Influenza, Common cold, TB  High speed Instruments > 100 µ  Spatter < 100 µ - Common www.indiandentalacademy.com
  19. 19. Chain of Infection Susceptible Host Virulent Pathogen Portal of Entry www.indiandentalacademy.com
  20. 20. Index Case Other Patients Dentist Infection Control www.indiandentalacademy.com
  21. 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. 22. Pt Evaluation  Medical History www.indiandentalacademy.com
  23. 23. Personal Protection 1. Personal Hygiene 2. Clinic Clothing 3. Barrier Protection 4. Immunization Procedures www.indiandentalacademy.com
  24. 24. Personal Hygiene  Scrubbing  Touching  Cover – Cuts & Bruises  Washing – Hands  Finger nails www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. 2.Clinic Clothing •Uniform •Daily change •Washing •OSHA-clinic premises www.indiandentalacademy.com
  27. 27. Barrier Protection 1. Gloves 2. Eye Shields 3. Face mask 4. Rubber dam isolations www.indiandentalacademy.com
  28. 28. Gloves  Disposable – new pair  Latex / Vinyl  Change – Long Procedures  After removal – washing hands www.indiandentalacademy.com
  29. 29. Eye Shields  Dentists – Support Personnel  Spatter – Debris  High speed Instrumentation  OSHA-fitted-solid side shields www.indiandentalacademy.com
  30. 30. Face Mask  High speed instrumentation  Aerosol – inhalation  RTI  Life – 30 to 60 minutes www.indiandentalacademy.com
  31. 31. Vaccines for Dentists  CDC & OSHA Recommendation Vaccines • HBV, •Influenza, •rubella www.indiandentalacademy.com •Measles
  32. 32. Sterilization & disinfection www.indiandentalacademy.com
  33. 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. 34.  Antisepsis “Indicate the prevention of infection ,usually by inhibiting the growth of bacteria”. www.indiandentalacademy.com
  35. 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. 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. 37. 1.Sunlight  Bactericidal & germicidal  U.V rays & heat rays 2.Drying  Moisture- bacterial growth  Spores- unaffected www.indiandentalacademy.com
  38. 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. 39. 1.Nature of heat Dry Heat Moist Heat • Coagulation of Proteins • Electrolytes •Denaturation & Coagulation of Proteins • Oxidative damage www.indiandentalacademy.com
  40. 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. 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. 42. 5.Type of Material - Host Organic Content Spore Difficult to Eradicate www.indiandentalacademy.com
  43. 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. 44.  Flaming  Bunsen flame – Red hot  Forceps point  Spatulas  Scalpel  Needles www.indiandentalacademy.com
  45. 45.  Incineration  Burning  Solid dressings  Bedding  Pathological material www.indiandentalacademy.com
  46. 46.  Hot air oven  Widely used – 160ºC / 1 hr  Electricity  Even distribution of air  Dry  Forceps  Scissors  Scalpels  Syringes  Swabs www.indiandentalacademy.com
  47. 47. Moist Heat  Pasteurization (< 100ºC)  63 ºC / 30 min  Non-sporing MO  TB-Bacilli  Brucella  Salmonella www.indiandentalacademy.com
  48. 48.  Boiling (100ºC)    x  Disinfection Surgical Instruments Steam (> 100ºC)  Steam Condenses to Water Microbicidal Activity Liberate Latent Heatwww.indiandentalacademy.com
  49. 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. 50. Steam Sterilizers  Types  Lab Autoclaves  Hospital dressing sterilizer  Bowl & Instrument sterilizer  Rapid cooling sterilizer www.indiandentalacademy.com
  51. 51. Autoclave  Principle  > 100ºC Under pressure Pressure - Inside Closed chamber Temperature Saturated Steam Penetrating power www.indiandentalacademy.com
  52. 52.  Materials  Instruments  Dressings  Lab ware Types of Autoclaves High vaccum Downward displacement www.indiandentalacademy.com
  53. 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. 54. www.indiandentalacademy.com
  55. 55. Sterilization Cycle 1. Heating Period 2. Holding Period 3. Cooling Period www.indiandentalacademy.com
  56. 56. Sterilization Efficacy (Monitoring)  Spores of Bacillus Stearo-thermophilus www.indiandentalacademy.com
  57. 57. Time-Temp Temperature Holding Time (Min) 120ºC 15 126ºC 10 134ºC 3 www.indiandentalacademy.com
  58. 58. Filtration  Heat labile substances  Antibiotic solutions  Sera  Carbohydrate solution Types-Candle filters -Asbestos filters -Sintered glass filters -Membrane filters www.indiandentalacademy.com
  59. 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. 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. 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. 62. Mode of action  Protein coagulation  Disruption of cell-membrane  Removal of Sulfates groups  Substrate competition (Competitive Inhibition) www.indiandentalacademy.com
  63. 63. Types of Chemical agents  Alcohols  Aldehydes  Dyes  Halogens  Phenols  Surface actives agents  Gases  Metallic salts www.indiandentalacademy.com
  64. 64.  Alcohols  Ethyl alcohol & Isopropyl alcohol  Skin Antiseptics  60-70%  Denaturation of Proteins  No action on spores www.indiandentalacademy.com
  65. 65.  Sterilium  Bacteria,antibiotic resistant bacteria,tubercle bacilli,fungi,viruses  Composition 2 propanol-4.5gm 1propanal-30gm ethyl-hexadecyl-dimethyl www.indiandentalacademy.com
  66. 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. 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. 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. 69. Dyes  Anilines  Acridine  Bacteriostatic (High dilution)  Bactericidal (Low dilution) www.indiandentalacademy.com
  70. 70. Halogens  Iodine (Aqueous / Alcoholic soln.)    Skin disinfectant Bactericidal & Moderately Sporicidal Chlorine  Water supply  Swimming pools  Food industry www.indiandentalacademy.com
  71. 71. Phenols  Coal tars – Lister  Cell membrane damage  Microbicidal  Hospitals  Ex – Chlorheixidine  G +VE www.indiandentalacademy.com
  72. 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. 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. 74. Metallic Salts  Action α CONC  Salts of Heavy mestals – greater action  Salts of Hg, Cu, Ag  Disinfectants www.indiandentalacademy.com
  75. 75. Stages of sterilzation  Pre-sterilzation cleaning  Packing  The sterilization process  Aseptic storage www.indiandentalacademy.com
  76. 76. Pre-sterlization cleaning  Remove-contaminated instruments  Heavy duty household gloves,eye shields&face masks-cleaning.  Sharps-carefull  Needles- capped. www.indiandentalacademy.com
  77. 77.  In dentistry  Methods  Manual scrubbing  Ultrasonic cleaning.  Cleaning efficiency  Aerolization  Sharp injuries www.indiandentalacademy.com
  78. 78. Packing  Open tray system-sealed - bags  Perforated trays-fitted covers  Individual packing-bags www.indiandentalacademy.com
  79. 79. Sterilization process (Dentistry)  Moist heat(autoclave)  Dry heats  Gaseous chemicals(chemiclave) www.indiandentalacademy.com
  80. 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. 81. Chemiclave  Formaldehyde+alchohol+acetone+ketone+steam -138kpa-127ºC  Dual-toxic chemicals – heat – 30 mins  Faster  Non corrosive. www.indiandentalacademy.com
  82. 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. 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. 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. 85. Office Disinfection/ Lab asepsis  Wipe – 70% Isopropyl alcohol  Chair  Table  Light handles  Spittoon  3 way - Syringe www.indiandentalacademy.com
  86. 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. 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. 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. 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. 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. 91. Orthodontic pliers -High quality SS ++ -Low quality SS _ -With Plastic parts _ _ ++ ++ __ ++ ++ __ Water air syringe tips ++ ++ ++ www.indiandentalacademy.com
  92. 92. Studies on Infection control in orthodontic office www.indiandentalacademy.com
  93. 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. 94. Dried Alcoholic solution – remove residual water Dry Chemiclave - 20 mins www.indiandentalacademy.com
  95. 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. 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. 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. 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. 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. 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. 101.  Subjected-load deflection,tension,corrosion tests  Results  No clinical significance-property-new&used www.indiandentalacademy.com
  102. 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. 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. 104.  Results  All cutters - Hardness – Greatest (Autoclaved ) -Least (Dry heat) Surface discoloration Worst discoloration - All Pliers  Chemiclave instruments www.indiandentalacademy.com
  105. 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. 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. 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. 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. 109. HIV – HBV  Special Precaution  Routes of transmission – Dentistry  Blood  Aerosols  Rotary instruments  Saliva Evidence ???????? www.indiandentalacademy.com
  110. 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. 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. 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. 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. 114. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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