This document discusses infection control in healthcare settings. It begins by outlining the history and evolution of understanding of hospital-acquired infections. It then defines key terms related to infection control like nosocomial infections, clinical waste, and emerging infectious diseases. The document discusses the chain of infection and stages of infection. It emphasizes the importance of standard precautions like hand hygiene and use of personal protective equipment. It also discusses additional transmission-based precautions needed for certain infectious diseases. The goal of infection control is to break the chain of infection and prevent spread of disease.

1. -SHARMISTHA DASGUPTA
I MDS
DEPT OF PERIODONTICS

2. • Background
• Glossary
• Chain of Infection
• Stages of Infection
• Infection Control
Practices
• Standard Precautions
• Additional transmission
based precautions
• Patient placement and
transportation
• Care for Health care
professionals
• Infections with multidrug
resistant organisms
• Infectious Diseases
related to Dentistry
• Need for Immunization
• Rationale for Practical
infection control in
dentistry
• Conclusion
• References

3. • The scientific study of hospital or nosocomial cross-infection
began during the first half of the 18th century
• However it was only 100 years later in 1858 that Florence
Nightingale promoted the case for hospital reform
• The real understanding of hospital infection followed upon
the discoveries of Pasteur, Koch and Lister and the
beginning of the ‘Bacteriological Era’
• The close of the 19th century saw the triumphs of hospital
reform and asepsis and seemed to herald the final victory
over hospital cross-infection

4. • However, the victory was short-lived. It was soon realised
that infections occurred not only in obstetric and surgical
patients, but in general medical and dental patients as well,
and that air could also be a source of infection.
• Streptococcal, staphylococcal and then Gram-negative
bacilli as a cause of hospital infection became a focus of
attention, as did antibiotic-resistant organisms

5. The World Health
Organization has recognized
Severe Acute Respiratory
Syndrome (SARS) as the
first serious and readily
transmissible disease to
emerge in the 21st century

6. Hence, the emergence of such life-
threatening infections and re-emerging infectious
diseases like tuberculosis have highlighted the need for
efficient infection control programmes in all health care
settings and capacity building for health care workers so
they can restrict the spread of infection.

7. • INFECTION CONTROL:
Policies and procedures used to minimize the risk of spreading i
nfections especially in hospitals and human or animal health
care facilities
• INFECTIOUS DISEASE:
A disease
due to organisms ranging in size from viruses to parasites;
it may be contagious in origin,
resulting from nosocomial organisms,
or due to endogenous microflora from the nose, throat, skin, or
bowel
• EMERGING INFECTIOUS DISEASE:
A disease that is endemic in a given population but that has
begun increasing in frequency or developing resistance to drug
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition.
© 2003 by Saunders, an imprint of Elsevier, Inc.

8. • ENDEMIC INFECTION: A characteristic of a particular
population, environment, or region
• EPIDEMIC INFECTION: The occurrence of more cases of a
disease than would be expected in a community or region
during a given time period
• PANDEMIC INFECTION: An epidemic that becomes very
widespread and affects a whole region, a continent, or the
world due to a susceptible population
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh
Edition. © 2003 by Saunders, an imprint of Elsevier, Inc.

9. • NOSOCOMIAL INFECTION:
An infection acquired in a health care facility by a patient
who was admitted for a reason other than that infection
• CLINICAL WASTE:
Also known as “infectious waste” - includes waste directly
associated with blood, body fluids secretions and
excretions, and sharps
• WASTE MANAGEMENT:
All the activities, administrative and operational, involved in
the production, handling, treatment, conditioning, storage,
transportation and disposal of waste generated by health-
care establishment
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition.
© 2003 by Saunders, an imprint of Elsevier, Inc.

10. • Infection can be
defined as the
process of lodgment
and multiplication of a
microorganism within
or on a host

12. Interval
between
exposure to
microorganis
m and 1st
appearance
of signs and
symptoms
Set of
symptoms
similar to
other
diseases
indicates the
onset of
disease
Symptoms
are fully
developed
and can be
differentiate
d from other
symptoms
Patient's
symptoms
begin to
subside.
Infection
remains,
although
patient shows
improving
Recovery and
recuperation
from effects
of disease

13. The purpose of infection control is to reduce the occurrence of
infectious diseases
The most important step is to break the chain of infection
These diseases are usually caused by bacteria or viruses and
can be spread by human to human contact, animal to human
contact human contact with an infected surface, airborne
transmission through tiny droplets of infectious agents
suspended in the air and by common vehicle like food and

14. • Facilities, equipment, and
procedures necessary to
implement standard and
additional (transmission-based)
precautions for control of
infections
• Cleaning, disinfecting and
reprocessing of reusable
equipment
• Waste management
• Protection of health care
workers from transmissible
infections

15. Transmission of infections in health care facilities can be
prevented and controlled through the application of basic
infection control precautions which can be grouped into:
Standard Precautions which must be applied to all patients
at all times, regardless of diagnosis or infectious status,
and
Additional Precautions (transmission-based) which are
specific to modes of transmission (airborne, droplet and

16. • Treating all patients in
the health care facility
with the same basic level
of “standard” precautions
involves work practices
that are essential to
provide a high level of
protection to patients,
health care workers and
visitors

17. 1. Hand hygiene
2. Gloves
3. Facial protection
(eyes, nose, and
mouth)
4. Gown
5. Prevention of needle
stick injuries
6. Respiratory hygiene
and cough etiquette
7. Environmental
cleaning
8. Linens
9. Waste disposal
10. Patient care
equipment

18. • Appropriate hand
hygiene can minimize
micro-organisms
acquired on the hands
during daily duties and
when there is contact
with blood, body fluids,
secretions and known
and unknown
contaminated equipment

19. Hand washing (40–60
sec): wet hands and
apply soap; rub all
surfaces and rinse
hands and dry
thoroughly with a towel
Hand rubbing (20–30
sec): apply enough
product to cover all
areas of the hands and
rub hands until dry

20. • This approach
recommends health-care
workers to clean their
hands
1. Before touching a
patient,
2. Before clean/aseptic
procedures,
3. After body fluid
exposure/risk,
4. After touching a
patient, and
5. After touching
patient surroundings

23. • Sterile or clean fitted covering
for the hands, with a separate sh
eath
for each finger and thumb
• Gloves are worn to protect the
health care personnel from urine,
stool, blood, saliva, and drainage
from wounds and lesions of patie
nts

25. Examination Gloves
Chemotherapy Gloves
Surgeon’s Gloves
Glove liners/Undergloves
Radiographic Protection Gloves
Cleaning and other non-medical Gloves

27. good

28. • Specialty medical
gloves
• These gloves are tested
with chemotherapeutic
agents
• These gloves are
chemically resistant and
can resist the
permeation of chemical

29. • Under the proposed FDA
l999 regulation, surgical
gloves would be
classified as follows:
Powdered Surgeon's
gloves
Non- Powdered
Surgeon's gloves
Special Surgeon’s Gloves
Microsurgery Gloves
Orthopedic Surgeon’s
Gloves
Autopsy Surgeon’s

31. • Glove liners or undergloves are worn with patient
examination or surgeon’s gloves
• They may be made of materials such as cotton to prevent
the medical glove from contacting the user’s hand, or
they may be made of materials that provide added
protection by reducing the risk of a cut or puncture wound
during surgical or examination procedures and by
absorbing perspiration
• Because glove liners and undergloves contact the skin,

32. • They offer some degree of
protection to the hand from
radiation exposure as well
as protection from
transmission of infectious
agents
• The use of these gloves
includes surgical
procedures that require the
use of fluoroscopy or
radiography

33. • Gloves that are used for
cleaning or handling
surfaces or 3-8 items
contaminated with patient
waste or fluids
• They are not regulated by
the FDA

35. • The use of gloves when not indicated represents a
waste
of resources and does not contribute to a reduction of
cross-transmission
• It may also result in missed opportunities for hand
hygiene
• The use of contaminated gloves caused by
inappropriate

36. • Wear a surgical or
procedure mask and
eye protection (face
shield, goggles) to
protect mucous
membranes of the
eyes, nose, and mouth
during activities that are
likely to generate
splashes or sprays of
blood, body fluids,
secretions, and

37. • Bacterial Filtration Efficiency - measures the filtration
efficiency by percent of a mask using live bacterial cells that
vary in size from 1to 5 microns
• Particulate Filtration Efficiency - measures the percent
efficiency at which a facemask filters particulate matter
passing through; particles range in size from 0.1 to 1 micron
• Breathability/ Pressure difference - measures the
differences of air pressure on both sides of a mask; measures
the pressure drop across the facemask and is expressed in
mm air/cm2
• Fluid Resistance - is defined as the ability of a facemask’s
material construction to minimize fluid traveling through the
material and potentially coming into contact with the user of
the facemask
• Flammability - flammability of masks is tested after exposure

38. • Face masks are part of the personal
protective equipment and are
mandatory as they do reduce the risk
of cross-contamination. However,
surgical face masks are not
completely effective in preventing
exposure to aerosols or splatter
• OSHA states that aerosols are
potential harbingers of infection and
that face masks are not effective in
protecting users because they do not
seal tightly against the face, and
aerosols can be inhaled through gaps
between the mask and the face
during normal breathing

39. N95 or higher filtering face piece respirator certified by the CDC/National
Institute for Occupational Safety and Health (NIOSH). A respirator is
designed to protect the person wearing the respirator against breathing in
very small particle aerosols that may contain viruses. A respirator that fits
snugly on the face can filter out virus-containing, small-particle aerosols
that can be generated by an infected person, but compared with a face
mask it is harder to breathe through a respirator for long periods of time.
Respirators are not recommended for children or people who have facial
hair.

40. 1. Clean hands before touching
mask
2. Orient mask for placement
3. Holding mask by earloops,
place loops around each ear
4. Mold malleable strip at top
edge of mask to shape of nose
5. Pull bottom of mask over
mouth and chin

41. 1. Avoid touching front of
the mask that is now
contaminated
2. While only touching
earloops, lift mask off
ears and remove from
face
3. Dispose off used mask
in the correct color
coded waste bin

42. • The ideal routine includes donning a face mask prior to
beginning patient treatment and leaving the mask
untouched until the treatment is concluded and the
patient is dismissed
• By leaving the mask in place, the clinician is offered
some protection from the particles that remain airborne
for several minutes
• Conversely, removing the mask during treatment or prior
to the conclusion of treatment opens the pathway for
exposure to potentially harmful pathogens

43. • Protection of the skin and
prevention of soiling of clothing
during procedures that are
likely to generate splashes of
blood, body fluids secretions
or excretions
• A plastic apron may be worn
on top of the gown to protect
exposure to blood, body fluids,
secretions and excretions

44. • Launder gowns and aprons appropriately if they are
reusable, according to the hospital guidelines
• Do not reuse disposable gowns and aprons. They should
be disposed of according to the health care facility
protocol.

45. • Use care when:
Handling needles,
scalpels, and other
sharp instruments or
devices
 Cleaning used
instruments

46. 1. Immediately clean the
wound thoroughly with
soap and water
2. Obtain the patient’s
permission for blood
testing on the same day
and arrange for pretest
counselling. The blood
should be tested for
Hepatitis B antigen and
HIV.

47. 3. The blood of the exposed person should also be tested
for Hepatitis and HIV the same day as the exposure
4. The exposed recipient should be notified of the signs
and symptoms associated
5. The patient should be prophylactically put on Anti-
retroviral drugs

49. • Persons with respiratory
symptoms should apply
source control measures:
Cover nose and mouth when
coughing/sneezing with
tissue or mask, dispose of
used tissues and masks, and
perform hand hygiene after
contact with respiratory

50. • Health-care facilities should:
Place acute febrile respiratory symptomatic patients at
least 1 meter (3 feet) away from others in common
waiting areas, if possible
Post visual alerts at the entrance to health-care facilities
instructing persons with respiratory symptoms to practice
respiratory hygiene/cough etiquette
Consider making hand hygiene resources, tissues and
masks available in common areas and areas used for the
evaluation of patients with respiratory illnesses

51. Use of adequate procedures for the routine
cleaning and disinfection of environmental and
other frequently touched surfaces

52. • Clinical contact
surfaces
These have a high
potential for direct
contamination from
patient materials either by
direct spray or spatter
generated during dental
procedures.
These surfaces can later
contaminate other
instruments, devices,
hands, or gloves.
• Housekeeping
surfaces
They do not come into
contact with patients or
devices used in dental
procedures. Therefore, they
have a limited risk of
disease transmission.

54. • Examples: Light
handle, countertop,
bracket tray, dental
chair, and door handle

55. • Examples of
housekeeping
surfaces are walls,
sinks, and floors

56. • Handle, transport, and
process used linen in a
manner which:
Prevents skin and mucous
membrane exposures and
contamination of clothing
Avoid transfer of pathogens
to other patients and the
environment

57. • Ensure safe waste management
• Treat waste contaminated with blood, body fluids,
secretions and excretions as clinical waste, in
accordance with local regulations
• Human tissues and laboratory waste that is directly
associated with specimen processing should also be
treated as clinical waste
• Discard single use items properly

59. • Handle equipment soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin
and mucous membrane exposures, contamination of
clothing, and transfer of pathogens to other patients or
the environment
• Clean, disinfect, and reprocess reusable equipment
appropriately before use with another patient

60. • While maintaining Standard Precautions
• Additional precautions include:
· Airborne precautions
· Droplet precautions
· Contact precautions

61. • Occurs when droplet
nuclei <5 micron in size
are disseminated in the
air
• These droplet nuclei can
remain suspended in the
air for some time

62. • Implement standard precautions
• Anyone who enters the room must wear a special,
high filtration, particulate respirator (e.g. N 95) mask
• Minimize dispersal of the nuclei by masking the
patient with a surgical mask
• Place patient in a single room that has a monitored
negative airflow pressure, and is often referred to as
a “negative pressure room”. The air should be
discharged to the outdoors or specially filtered before
it is circulated to other areas of the health care
facility.

63. • Droplet transmission occurs
when there is adequate
contact between the mucous
membranes of the nose and
mouth or conjunctivae of a
susceptible person and large
particle droplets (> 5
microns)
• Droplets are usually
generated from the infected
person during coughing,
sneezing, talking or when
health care workers
undertake procedures such

64. • Implement standard precautions
• Place patient in a single room (or in a room with another
patient infected by the same pathogen)
• Wear a surgical mask when working within 1-2 meters of
the patient
• Place a surgical mask on the patient if transport is
necessary
• Special air handling and ventilation are not required to
prevent droplet transmission of infection

65. • Mode of infection is by
Physical contact
• Diseases which are
transmitted by this
route:
 Colonization or
infection with multiple
antibiotic resistant
organisms
 Enteric infections

66. • Implement standard precautions
• Place patient in a single room (or in a room with another
patient infected by the same pathogen)
• Wear clean and sterile gloves when entering the room
• Wear a clean and sterile gown when entering the room if
substantial contact with the patient, environmental surfaces
or items in the patient’s room is anticipated

67. • Direct or percutaneous inoculation by a contaminated
needle or sharp object
• Non- needle percutaneous inoculation (scratches, burns,
dermatitis)
• Infectious blood or serum onto mucosal surfaces
(intraoral, oral mucosa)
• Indirect transfer of infectious serum via environmental
surfaces (splatter)

68. Appropriate or selective placement of patients is
important in preventing the transmission of
infections in the hospital setting. General principles
in relation to the placement of patients include the
following:
 Spacing between beds
 Single rooms
 Anterooms
 Cohorting

69. • In open plan wards
there should be
adequate spacing
between each bed to
reduce the risk of
cross contamination/
infection occurring
from direct or indirect
contact or droplet
transmission
• Optimum spacing
between beds is 1-2
meters

70. • Single rooms reduce
the risk of transmission
of infection from the
source patient to others
by reducing direct or
indirect contact
transmission.

71. • Single rooms used for
isolation purposes
may include an
anteroom to support
the use of personal
protective equipment

72. • For infection control purposes, if
single rooms are not available,
or if there is a shortage of single
rooms, patients infected or
colonized by the same
organism can be cohorted
(sharing of rooms)
• When cohorting is used during
outbreaks these room/s should
be in a well-defined area (a
designated room or designated
ward), which can be clearly
segregated from other patient
care areas in the health care
facility used for non-infected

73. • Limiting the movement and transport of patients
from the isolation room/ area for essential
purposes only will reduce the opportunities for
transmission of micro-organisms in other areas of
the hospital
• If transportation is required, suitable precautions
should be taken to reduce the risk of transmission
of micro-organisms to other patients, health care
workers or the hospital environment (surfaces or
equipment)
• For example: when transporting a patient with
pulmonary tuberculosis (open/active) placing a

74. • The risk of transferring infection from instruments and
equipment is dependent on the following factors:
(1) The presence of micro-organisms, the number and
virulence of these organisms
(2) The type of procedure that is going to be performed
(invasive or non-invasive)
(3) The body site where the instrument and equipment will
be used (penetrating the mucosal or skin tissue or used on
intact skin)

75. • Any instrument or equipment entering into a
sterile part of the body must be sterilized
• Where the instrument or equipment will be in
contact with mucous membranes or non-intact
skin, it must have undergone disinfection
• Where there will be contact with intact skin,
disinfection or cleaning should be used

76. • Hence reprocessing of instruments and equipment in an
effective way includes:
(1) Cleaning instruments and equipment immediately after
use to remove all organic matter and chemicals
(2) Disinfection
(3) Sterilization

77. • The overuse and misuse of antimicrobials has resulted
in the development of antimicrobial resistance in many
parts of the world
• In health care settings, the spread of resistant
organisms is facilitated when handwashing, infection
control precautions, and equipment cleaning are
suboptimal
• The strategies for control of antimicrobial resistance
thus consists of:
 Appropriate use of antimicrobials
 Strengthening of basic infection control measures

78. • Antibiotic use must be justifiable on the basis of the clinical
diagnosis and known or expected infecting micro-
organisms
• Appropriate specimens for bacteriological examination must
be obtained before initiating antibiotic treatment in order to
confirm the treatment
• The selection of an antibiotic must be based not only on the
nature of the disease and that of the pathogenic agent, but
on the sensitivity patterns, patient tolerance, and cost
• The correct dose must be used (low dosages may be
ineffective for treating infections, and encourage the
development of resistant strains, while excessive doses
may have adverse effects, and may not prevent resistance)

79. • Methicillin-resistant Staphylococcus aureus (MRSA):
Epidemic strains of MRSA have tremendous potential for
nosocomial transmission. MRSA strains are often resistant
to several antibiotics and are often sensitive only to
vancomycin and one or two other antibiotics. Once
introduced into a hospital they spread rapidly, since
transmission is usually through the hands of health care
staff.

80. • Multidrug-resistant tuberculosis (MDR-TB)):
TB is caused by infection with Mycobacterium tuberculosis.
It affects one third of the world’s population. Of particular
concern is the rise in drug-resistant TB and multidrug-
resistant TB (MDR-TB). Multidrug-resistant TB is resistant
to any combination of anti-TB drugs that includes Isoniazid
and Rifampicin (the two most effective anti-TB drugs)

81. • Health care professionals are at risk of acquiring infection
through occupational exposure
• Hospital employees can also transmit infections to
patients and other employees
• Thus, an employee’s health programme must be in place
to prevent and manage infections in hospital staff

82. • Common Cold
• Tuberculosis
• Chicken Pox
• Meningitis
• Measles
• Mumps
• Herpetic infections
• Infectious mononucleosis
• Hepatitis B
• HIV
• Meningitis
• Other diseases

83. • Caused by H. influenzae, Rhinovirus, Adenovirus etc
• Some of these viruses have been isolated in dental
aerosols and contaminated waterlines
• Positive correlation between incidence of common cold
epidemic and oral health care personnel who treated them
• In another study, dental students experienced a higher
incidence of respiratory disease than their medical and
pharmacy counterpart
• Similarly, dental hygienists experienced a higher incidence
of respiratory disease than dieticians
Streptococcal pharyngitis may also be caused due to
infection with Streptococcal pyogenes isolated from dental
aerosols

84. • Caused by Mycobacterium tuberculosis
• Inhalation of a small number of bacilli may lead to
bacterial multiplication in the bronchioles, alveolar ducts
or alveoli
• Studies show more prevalence of Tuberculosis in dental
students than their medical counterparts
• Spread through aerosols and infected waterlines

85. CHICKEN POX: It is caused by Varicella Zoster and
transmitted by droplet inhalation or direct skin contact. Oral
lesions may affect tongue and oral mucosa.
HERPANGINA: It is caused by Coxsakie virus. It is a common
viral disease of the oral cavity and oropharynx.
MUMPS: It is caused by Paramyxovirus. It is characterized by
swelling of the parotid glands. It can be transmitted by direct
contact with droplets of saliva upto 1 week after the parotid
swelling is noted.
MEASLES: It is caused by Rubeola virus. It characterized by
presence of Koplik’s spots intraorally.

86. • Caused by Herpesvirus1 and 2
• They may produce skin, oropharyngeal and genital
lesions with CNS involvement
• Constitute a major problem for the dental profession due
to the possibility of spread of infection through oral
lesions

87. • Herpes labialis is the
most common type of
recurrent herpetic
infection. It is
characterized by
marked local
symptoms and may/
mayn’t accompanied
by systemic illness

88. • Herpetic Whitlow is a type of
Herpesvirus1 infection that
affects one or several
fingers. It is characterized by
an extremely painful finger
with vesicles containing a
clear fluid.
• More number of dentists
experience herpetic whitlow
as compared other types of
herpetic infections in their
age/sex matched controls

89. • Caused by Epstein
Barr virus
• Oral manifestations
include acute
gingivitis, stomatitis
and palatal petechiae
• Mode of transmission
is person-to-person
spread by
oropharyngeal route
via saliva

90. • The route of transmission for hepatitis B virus is through
body substances such as blood and blood products, saliva,
cerebrospinal fluid etc
• Immunization is the best way of preventing transmission to
health care staff. All health care staff at risk must be
vaccinated.
• More prevalence of dentists in acquiring Hepatitis B as
compared to other health care professionals
• CDC has stated that Hepatitis B is an excellent prototype
when designing infection control procedures in dentistry

91. • Caused by Human Immunodeficiency Virus
• Infection with human immunodeficiency virus
(HIV) predisposes people to certain oral health
problems
• HIV-positive patients can receive routine dental
care
• Careful medical histories can capture insight
about patients to help identify those who require
treatment plans adapted to their unique medical
condition
• Dentists and all staff with direct patient contact

92. • Transmission of meningococci to health care staff is most
likely within 24 hours of the patient acquiring the disease,
prior to the patient receiving appropriate
antibiotic/chemoprophylaxis
• Health care workers in close respiratory contact with
such cases should receive chemoprophylaxis with
ciprofloxacin or an effective alternative agent

93. • Transmission of these micro-organisms may be
uncommon, but policies to manage staff exposure should
be developed
• Vaccination of hospital staff against varicella is
recommended. Influenza vaccinations should be given
yearly.
• Rabies vaccinations may be appropriate in some facilities
in countries where rabies is enzootic

94. • Dentistry is a health care profession which has the
potential to expose the practitioner to infectious diseases
• Immunizations substantially reduce both the providers’
susceptibility to these diseases as well as the potential
for disease transmission to other dental health care
providers and patients
• Thus, immunizations are an essential part of the
prevention and infection-control programs

95. • MMR (Mumps, measles and Rubella): administered
to young infants (2 to 6 months old) in the
anterolateral thigh
• DPT (Diphtheria, pertussis and tetanus): 0.5 mL
administered subcutaneously, preferably into the
outer aspect of the upper arm. The recommended
age for vaccination is 12 to 15 months.
• OPV (Polio): 0.5mL at ages 2 months, 4 months, 6–
18 months, and 4–6 years
• VARICELLA ZOSTER: Two 0.5 ml doses SC 4-8
weeks apart

96. Hepatitis B recombinant vaccine
• Three dose schedule: 1 mL administered intramuscularly
(IM) in the deltoid muscle; 0,1,6 months – second dose
administered 1 month after first dose; third dose
administered 5 months after second.
• Booster doses not necessary for persons who have
developed adequate antibodies to hepatitis B surface
antigen (anti-HBs)

97. General routes for transmission of microbial agents in
dentistry:
1. Direct contact with Infectious lesions or infected saliva
or blood
2. Indirect transmission via transfer of microorganisms
from a contaminated object
3. Spatter of blood, saliva, or nasopharyngeal secretions
directly onto broken or intact skin or mucosa
4. Aerosolization, the airborne transfer of microorganisms

98. • A novel demonstration was first developed by Crawford in
the 1970s using the premise “If saliva were red”
• He had practitioners dip their fingers into red poster paint
before starting their normal clinical treatment
• The paint was subsequently deposited on the various
surfaces of the operatory as the treatment progressed
• This demonstrated the cross-contamination that occurred
from the practioner’s “saliva covered” fingers

100. • Routine examination of patients and oral prophylaxis also
expose dental professionals and patients to potentially
infectious fluids
• When in a similar study, at the University of Detroit by
Molinari and York, red dye in water was used to simulate
patient saliva, cross contamination by simulated saliva
was evident

102. • Ultrasonic
instrumentation
produces a cloud of
debris containing
splatter and aerosols
that floats in the
dentist’s breathing
space
• Splatter and aerosol
include blood, bacteria,
and pathogens that are
found in the saliva and
periodontal pockets

103. Aerosol
• Aerosols are particles
that can be as small as
0.5 microns, and they
are capable of
remaining airborne for
hours
• If an aerosolized
particle is 0.5 microns,
there will be 2,000
particles in the space of
1 mm
• Particles this small can
pass through the filters
of standard face masks
and enter the clinician's
airway
Splatter
• Particles greater than
50 microns and is
generally composed of
heavy particles
• Splatter is ballistic in
nature and remains
airborne only briefly
• Personal protective
equipment including
gloves, masks,
eyewear, and gowns
protect clinicians from
these visible particles

104. • The number of aerosolized particles that reach the
clinician's breathing space must be limited. Dental
hygienists can reduce particles by using high volume
evacuators.
• Routinely using preprocedural mouthrinses with patients
• Barrier techniques with Facemask, Head cap, Gloves
and Apron
• Regular flushing of the dental waterlines after dental
treatment

105. 1. Hepatitis B vaccine
2. Comprehensive medical
history and examination
3. Antiseptic mouthrinse
4. Antiseptic handwash
5. Disposable face mask
6. Disposable gloves
7. Protective eyewear
8. Appropriate clinical
attire
9. Rubber dam
10. Sharps disposal system
11. Sterilizable handpieces
12. Ultrasonic cleaner
13. Instrument packaging
14. Heat sterilizer
15. Sterilization monitoring
16. Glutaraldehyde solution
17. Surface cleaner
18. Surface disinfectant
19. Surface covers
20. Medical waste disposal
system
21. OSHA poster

106. • Dentists must utilize effective infection control practices
in the procedures
• It is important that the entire dental set up becomes
familiar with the rationale behind each step and decision
to carry out a comprehensive infection control program
• Periodic review of the protocols used is necessary to
ensure that all the necessary steps are accomplished
without unplanned redundancy

107. • Practical Infection Control In Dentistry by James A.
Cottone, Geza T. Terezhalmy and John A. Molinari
• Practical Guidelines for Infection Control in Health Care
Facilities by World Health Organization
• Medical Glove Guidance Manual by U.S. Department of
Health and Human Services, Food and Drug Administration
• Control of Hospital Infection : A practical handbook, 3rd ed.
London, Chapman & Hall
• Hospital Infection Control : Policies and practical
procedures, London, Saunders, Philpott-Howard JN,

108. • Edelstam, J. et al. Glove powder in the hospital environment –
consequences for healthcare workers. Int. Arch. Environ. Health 2002; vol.
75: 267-271
• Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in
dental healthcare settings—2003. MMWR Recomm Rep. 2003;52(RR-
17):1-61
• Jacks M. A laboratory comparison of evacuation devices on aerosol
reduction. J Dent Hyg. 2002;76:202-206.
• Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol
contamination during dental procedures. J Am Dent Assoc. 1994;12:579-
584.
• Timmerman MF, Menso L, Steinfort J, van Winkelhoff AJ, van der Weijen
GA. Atmospheric contamination during ultrasonic scaling. J Clin
Periodontol. 2004;31:458-462.
• Fine DH, Yip J, Furgang D, Barnett ML, Olshan AM, Vincent J. Reducing