Chapter 17: Laboratory and Radiographic Asepsis

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Laboratory and Radiographic Asepsis
Chapter 17
1

Learning Objectives
Lesson 17.1: Laboratory
and Radiographic Asepsis
1. Describe how to properly disinfect microbially
soiled prostheses and impressions.
2. Describe an acceptable laboratory receiving area.
3. List how to properly sterilize laboratory items
used intraorally and correct disinfection
procedures for laboratory items not used
intraorally.
4. Design a system of proper environmental barriers
and disinfection used during radiographic
processes and the aseptic processing of
radiographic films.
2

Protective Barriers
 Any instrument or piece of equipment used in
the oral cavity is a potential source of cross-
infection
 All items coming from the oral cavity must be
sterilized or disinfected before being worked on
in the laboratory and before being returned to
the patients
 Two criteria for successful lab infection control
include:
 Use of proper methods and materials
 Coordination between dental offices and dental
laboratories
3

Protective Barriers
 Asepsis procedures vary for each type of dental
material, but general recommendations for
procedures and materials can be made.
 Laboratory infection control also involves,
depending on need, the wearing of personal
protective barriers such as gloves, safety eyewear,
gowns, and masks.
 Wearing barriers when handling contaminated items
until they have been decontaminated is a must.
4

Receiving Area
 The dental team should create a receiving
area to handle all items sent to the laboratory
or handled in the laboratory areas within the
dental practice
 This area needs:
 Running water
 Handwashing facilities
5

Receiving Area
 To cover the area and the counter surfaces
with impervious paper and to clean and
disinfect the area regularly is the best
practice.
 The amount of cleaning and disinfection
depends on the rate of use of the area.
 PPE should be worn when handling items
received in the laboratory unit until they have
been disinfected.
6

Microbially Soiled Prostheses
and Impressions
 Any prosthesis or impression coming from the
oral cavity is a potential source of infection
 Most prostheses and appliances cannot
handle heat sterilization
 Alternative techniques: Disinfection by immersion
or spraying
7

and Impressions
 What are examples of dental prostheses?
 Impressions, bite registrations, and occlusal rims
 Cleaning, disinfecting, and rinsing of all
dental prostheses and prosthodontic
materials should be done using an EPA-
registered disinfectant having at least an
intermediate level of activity (tuberculocidal
claim) before handling the items in the
laboratory.
8

and Impressions
 Heavily soiled prostheses may require the
safe procedure of using zippered plastic bags
and being put into an ultrasonic cleaner.
 Prostheses should never be sent out or
returned in the disinfectant solution.
 If the impression is sensitive to immersion,
the impression can be sprayed with a
disinfectant but not as effective as immersion.
9

Using a Zippered Bag
10

Grinding, Polishing, and Blasting
 Operation of a dental lathe provides
opportunity for the spread of infection and
injury
 Rotary action of the wheels, stones, and bands
generates aerosols, splatter, and projectiles
11

 When using the lathe, protective eyewear
should be worn.
 The front Plexiglas shield should be properly
placed and the ventilation system should be
operating properly. The use of a mask is
highly recommended.
 The lathe unit must be disinfected twice a
day.
12

 Polishing of appliances and prostheses
before delivery is a necessary activity.
 If the item being polished has been prepared
aseptically, the risks of infection are reduced
to a minimum.
13

Lathe Maintenance
14

Intermediate Cases
 Some prosthetics undergo an intermediate
wax try-in stage
 Disinfection is very important to reduce
contamination
15

Intermediate Cases
 The complete and partial dentures often
undergo an intermediate wax try-in stage.
 Crowns, splinted bridges, and partial denture
frameworks often are “test seated” before
cementation or soldering.
 During the try-in step, prosthesis will become
soiled with oral fluids.
 One must disinfect the items before returning them
to the laboratory for further processing.
16

Return of Completed Cases
 Appliances and prostheses being returned
to the patient are not free of microbial
contamination
17

Return of Completed Cases
 Organisms can come from other cases and from
the operator’s body if aseptic procedures are not
followed rigorously.
 Many patients have open oral lesions or are
traumatized sufficiently during treatment so as to
facilitate easier microbial penetration.
 A growing number of patients also have impaired
immune defense systems or are on chemotherapy
programs that render them more susceptible to
infectious diseases.
 The best location for disinfection procedures is
chairside. 18

Chain of Asepsis
 All laboratory infection control activities are
designed to accomplish a single goal:
Breaking the chain of disease transmission
19

Chain of Asepsis
 If the person-to-person flow of infection can
be interrupted, the safety of the work
environment is improved. The chances of
patient acquisition of disease during
treatment also are greatly reduced.
 Infection control processes can be effective
only when performed well consistently.
20

Chain of Asepsis
 For dental laboratory asepsis to be
successful, offices and laboratories must
perform essential tasks.
 An overall increase in efficiency could be
realized when offices and laboratories
formally and properly coordinate their efforts.
21

Radiographic Asepsis
 Proper infection control methods and
materials for dental radiology differ little from
those used for procedures more likely to
result in blood exposure
 One difference: It involves the handling of
hazardous materials
22

 Consistent use of the most effective and
efficient types of personal protective
equipment (e.g., gloves, masks, gowns, and
eyeglasses) decreases the chances of
exposure to infectious agents.
 The team must use appropriate
environmental covers and perform cleaning
and disinfection.
23

 For dental radiology, only a limited number of
items require sterilization.
 The team should use heat-tolerant or disposable
intraoral devices whenever possible (e.g.,
filmholding and positioning devices) and should
clean and heat sterilize heat-tolerant devices
between patients.
 Employees must know which chemical
components are hazardous and how to properly
use material safety data sheets.
24

Unit, Film, and Patient Preparation
 Plan ahead: Acquire all necessary
disposables and heat sterilize materials and
accessories
 For large surfaces, better to use covers than
to disinfect
25

 Discuss wearing gloves of some type when
taking radiographs and when handling orally
soiled radiographic films.
 Because taking radiographs is a clinical activity,
one also must consider the protective gowns
and masks worn for restorative procedures.
 Protective eyewear is a barrier against contact
with patient fluids but also prevents exposure to
hazardous chemicals.
26

 Many of the items used to take radiographs
are used once and thrown away.
 Few reusable items touch nonintact skin or
mucous membranes or enter normally sterile
body tissues.
 These items, however, still require
sterilization.
27

Plastic Covers
28

Taking of Radiographs
 Use films held within FDA-cleared barrier pouches
 Placement of plastic drapes, bags, or tubing over
the x-ray unit (tube head, arm, and cone), chair
head rest, and control panel probably is better than
disinfection because of the numerous and large
surfaces touched during the process.
 Exposed films have to be oriented so as to
differentiate them easily from unused ones.
 A possible solution is to place exposed films into a
disposable plastic cup or onto a labeled paper
towel.
29

Film with FDA Barrier
30

Aseptic Techniques When
Handling Digital Sensors
 Digital radiographic sensors and associated
computer hardware can be used in place of x-
ray films
 Must prevent the sensor from becoming
contaminated
31

Aseptic Techniques When
Handling Digital Sensors
 Digital sensors are used over and over on multiple
patients.
 Sensors cannot be heat sterilized or chemically
disinfected.
 In these cases the only alternative is to prevent the
sensor from becoming contaminated by using FDA-
cleared barriers.
 Consult with the sensor manufacturer for proper
covering or decontamination of the particular type of
sensor and computer hardware being used.
32

Darkroom and Daylight Loader Asepsis
 Like laboratory asepsis, it’s important to avoid
cross-contamination in the processing of film
 Transport exposed films to the darkroom in a
plastic cup or folded paper towel
 With dayloaders, there is limited operational
space, so chances increase for cross-
contamination
33

Darkroom and Daylight Loader
Asepsis
 Avoid touching any surfaces, such as doors,
tabletops, or film processing equipment, with
soiled gloves during transport.
 Open the films onto a new paper towel or
sheet using disposable gloves, and drop the
films out of the packets without touching
them. Accumulate the contaminated packets
in a disposable towel or in a cup and, after
opening all packets, discard the packets and
remove the gloves.
34

Asepsis
 Daylight loaders attached to automatic
processors or with “portable darkrooms,”
which contain small beakers or cups of
developing solutions.
 These units are equipped with portals that
allow penetration of hands and arms with a
maximum exclusion of light.
 This feat is accomplished using cloth or
rubber sleeves, cuffs, or flaps.
35

Asepsis
 Orally soiled disposable items such as
gloves, paper towels, or x-ray film covers are
in most locations not considered to be
infectious medical waste.
 This means that such items do not require
special handling, storage, and neutralization
procedures before disposal.
36

Chapter 17: Laboratory and Radiographic Asepsis

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