Rationale Chain of infection Routes of disease transmission CDC and OSHA Spauldings classification Sterilization protocol Methods of sterilization-physical and chemical agents New methods of sterilization Sterilization of scaler handpeice and inserts Infection control Infectious diseases commonly encounterd in dentistry Medical history and dental safety Immunization of personnel involved in dental care Infection control practices Hand hygiene Personal protective equipments Surface barriers Waste management in dental practice Cdc guidelines-special considerations

1. PRESENTED BY:
DR. THASLIM FATHIMA
FIRST YEAR POSTGRADUATE
DEPARTMENT OF
PERIODONTOLOGY
RRDCH
STERILIZATIONINFECTION CONTROL
1

2. • HISTORY
• RATIONALE
• CHAIN OF INFECTION
• ROUTES OF DISEASE TRANSMISSION
• CDC and OSHA
• SPAULDINGS CLASSIFICATION
• STERILIZATION PROTOCOL
• METHODS OF STERILIZATION-PHYSICAL AND CHEMICAL AGENTS
• NEW METHODS OF STERILIZATION
• STERILIZATION OF SCALAR HANDPEICE AND INSERTS
• INFECTION CONTROL
• INFECTIOUS DISEASES COMMONLY ENCOUNTERD IN DENTISTRY
• MEDICAL HISTORY AND DENTAL SAFETY
• IMMUNIZATION OF PERSONNEL INVOLVED IN DENTAL CARE
• INFECTION CONTROL PRACTICES
• HAND HYGIENE
• PERSONAL PROTECTIVE EQUIPMENTS
• SURFACE BARRIERS
• WASTE MANAGEMENT IN DENTAL PRACTICE
• CDC GUIDELINES-SPECIAL CONSIDERATIONS

4. “
In the late 1860s, Louis Pasteur, a French chemist, proved that
bacteria were the cause of disease in humans and animals.
He also developed the process of pasteurization which uses heat
to kill microorganisms in milk.
His theories led Joseph Lister, an English surgeon, to develop
“antiseptic technique” for performing surgery.
Aseptic veterinary surgery began to be practiced in the 1940s.
The use of surgical gowns, caps, masks, and gloves became
routine in the 1960s.
HISTORY
4

5. “control”
RATIONALE
R

6. 6
THE CHAIN OF
INFECTION
PORTAL OF ENTRY
To cause infection, pathogens must have a portal of
entry,or a means of entering the body.

7. In dentistry, diseases can be transmitted from patient-to-patient, dentist to patient, and
patient to dentist, when adequate precautions are not followed Common modes of disease
transmission in the order of severity are-
Percutaneous (high risk)
• Inoculation of microbes from blood and saliva transmitted through needles and sharps
Contact (high risk)
• Touching or exposing non-intact skin to infective oral lesions, infected tissue surfaces or
infected fluids, splash and spatter of infected fluids
Inhalation of Aerosols or droplets (moderate risk)
• Breathing bioaerosols suspended in the clinics ambient air laden with infective material
while using handpieces and scalers or droplet nucleii from coughing
Indirect contact through fomites (low risk)
• Touching contaminated inanimate surfaces in the dental treatment room or operatory

8. 8 8
Roles and Responsibilities of the CDC
and OSHA in Infection Control

9. DEFINITIONS
The destruction or
removal of all pathogenic
organisms, or organisms
capable of giving rise to
infection.
Disinfection
The process by which an article,
surface or medium is freed of all
living microorganisms either in
the vegetative or spore state.
Sterilization
Term used to indicate
the prevention of
infection, usually by
inhibiting the growth
of bacteria in wounds
or tissues.
Asepsis
Decontamination
The process of
rendering an article
or area free of
danger from
contaminants,
Including microbial,
chemical,radioactive
and other hazards.

10. 10
The first level of
decontamination
is called
sanitization
• a process of thorough physical
cleaning to reduce the quantity
of microbes
The next level is
dinfection
• a process that kills all vegetative
microorganisms, fungi and some
viruses but not necessarily bacterial
endospores using chemical
germicides, radiation, ultraviolet
rays or heat
The third level is
sterilization

11. 11
Instrument and operatory surfaces
1 2 3 4

13. Physical agents
• Sunlight
• Drying
• Dry heat-
Flaming,Inceneration,Hot air.
• Moist heat-
Pasteurisation,boiling,steam
under normal pressure, steam
under high pressure.
• Filtration- candles, asbestos
pads,membranes
• Radiation
Chemical agents
• Alcohol-Ethyl, isopropyl,
trichlorobutanol
• Aldehydes-Formaldehyde,
glutaraldehyde
• Dyes
• Halogens
• Phenols
• Surface active agents
• Metallic salts
• Gases: Ethylene oxide,
formaldehyde, beta
propiolactone,hydrogen
peroxide

14. Most reliable method of sterilization and should be the method of choice.
MECHANISM OF ACTION:
Dry heat-protein denaturation,
oxidative damage and toxic
effect of elevated level of
electrolytes.
Moist heat- due to denaturation
and coagulation of protein
DRY HEAT
MOIST
HEAT

15. “1. FLAMING: Instruments are held over Bunsen flame until red hot.
Items: Tips of Forceps, Spatulas, Inoculating loops and wires
2. INCINERATION: It is a process that involves the combustion of organic
substances contained in waste materials.
Items: contaminated cloth, animal carcasses and pathological material.
3. HOT AIR OVEN: Hot air ovens are electrical devices that uses dry heat to
sterilize articles.
Generally, they can be operated from 160-180⁰C. Holding period: 2 hours
• Items: glassware, forceps, scissors, scalpels, all-glass syringes, swabs, liquid
paraffin, dusting powder, fats, grease
DRY HEAT
15

16. “
MOIST HEAT
Categorized into 3 groups:
Temperature below 100⁰ C
Temperature at 100⁰ C
Temperature above 100⁰ C
1.Temperature below 100⁰ C
Pasteurisation of milk
Milk is heated at 63⁰C for 30 minutes (holder method) ;
or
72⁰ C, 15-20 seconds(flash method)
followed by cooling quickly to 13⁰C or lower.
Target: All non-sporing pathogens like mycobacteria, brucellae, salmonellae are
destroyed.
16

17. 2.Temperature at 100⁰ C
Boiling-
• Vegetative bacteria are killed almost immediately at 90-100⁰C.
• Not recommended for sterilising but used for disinfection.
• Sterilization may be promoted by addition of 2% sodium
bicarbonate to the water. Holding period: 10-30 minutes.
Steam at atmospheric pressure (100⁰C)
• Used to sterilize culture media.
• Koch or Arnold steamer is used.
• Holding period: 100⁰ C, 20 minutes on three successive days
(intermittent sterilization or tyndallisation).
• Principle: first exposure kills vegetative bacteria and the next exposure will
kill vegetative bacteria that matures from the spores. 17

18. “
3.Temperature above 100⁰ C
Steam under pressure
Sterilization by steam under pressure is carried out at temperatures between 108⁰C
and 147⁰C by an autoclave/steam sterilizer.
18
15 mins 121⁰C 15 lbs
10 mins 126⁰C 20 lbs
3 mins 134⁰C 30 lbs

19. • Water boils when its vapour pressure equals that of
the surrounding atmosphere.
• Thus, when pressure inside a closed vessel
increases, the temperature at which water boils also
increases.
• Saturated steam has penetrating power.
• When steam comes in contact with a cooler surface
it condenses to water and gives up latent heat to
that surface.
• The large reduction in volume sucks in more steam
to the area and the process continues till the
temperature of that surface is raised to that of
steam and thus it helps in killing the microbes.
Principle:
19

20. Advantages of Autoclaves
1. Autoclaving is the most rapid and
effective method for sterilizing cloth
surgical packs and towel packs.
2. Is dependable and economical
3. Sterilization is verifiable.
Disadvantages of Autoclaves
1. Items sensitive to the elevated
temperature cannot be autoclaved.
2. Autoclaving tends to rust carbon
steel instruments and burs.
3. Instruments must be air dried at
completion of cycle
AUTOCLAVE
20

21. Mechanical techniques Chemical indicators Biological indicators
There are 3
methods of
monitoring
• • •

22. “
RADIATION
Non-ionising radiation
1. Infrared radiations are used for rapid mass sterilization of pre-packed items such as
syringe,catheters.
2. Ultraviolet radiations are used for disinfecting enclosed area such as entryways,
operation theatres and labs.
Ionising radiation
• Gamma rays, X rays and cosmic rays are highly lethal to DNA and have a very high
penetrating power.
• Since there is no appreciable increase in temperature,this method is referred to as cold
sterilization.
• Used for sterilising plastics, syringes, swabs, catheters, animal feeds, cardboard, oils, and
metal foils.
22

23. CHEMICAL
AGENTS

24. “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
The ideal disinfectant has the following properties:
1. Broad spectrum of activity
2. Acts rapidly
3. Non corrosive
4. Environment friendly
5. Is free of volatile organic compounds
6. Nontoxic & nonstaining
DISINFECTION
24

25. “
High-level disinfection: Disinfection process that inactivates vegetative bacteria,
mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores.
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.
Low-level disinfectant: Can kill most bacteria,some viruses and some fungi.
Liquid chemical germicide.
LEVELS OF DISINFECTION
25

26. 1.Alcohol
26
 Frequently used are Ethyl alcohol ,Isopropyl alcohol
 These must be used at concentration 60-90%.
 Isopropyl alcohol used in disinfection of clinical thermometer.
 Methyl alcohol is effective against fungal spores, treating cabinets and incubators.
 Methyl alcohol is also toxic and inflammable.

27. 2.Aldehydes
27
Formaldehyde:
 It is bactericidal and sporicidal and also has a lethal effect on viruses.
 Used to preserve anatomical specimens,to destroy anthrax spores on hair and wool.
 10% formalin containing sodium tetraborate is used to clean metal instruments.
 Formaldehyde gas is used for sterilizing heat sensitive catheters and for fumigating wards and laboratories.

28. 3.DYES:
28
2 groups of dyes:
1. Aniline dye
2. Acridine dye
Both are bacteriostatic in high dilution but are of low bactericidal activity.
 Aniline dye
• Brilliant green,malachite green and crystal violet.
• More active against gram +ve than gram-ve organisms.
• Their lethal effects on bacteria are believed to be due to their reaction with the acid groups in the cell.
 Acridine dyes
• Proflavine,Acriflavine, Euflavine, Aminacrine
• These impair the DNA complexes of the organisms and thus kill or destroy the reproductive capacity of the cell.

29. 4.Halogens
Iodine
Chlorine

30. 5.Phenols
• These are obtained from distillation of coal tar between 170⁰ and 270⁰ C.
• Lethal effects are due to their capacity to cause cell membrane damage,
releasing cell contents and causing lysis.
• Low concentration will precipitate proteins.
• Cresols (Lysol) are active against a wide range of organisms.
Sterilization of glass ware,cleaning floors.
• Chlorhexidine is a non toxic skin antiseptic which is most active against gram
positive organisms
• Chloroxylenol

31. Ethylene oxide Formaldehyde gas
150g of KMnO4 280ml
of formalin
Beta propiolactone (BPL)
GASES
31

32. RECOMMENDED CONCENTRATION
OF DISINFECTANTS
%
DISINFECTANT CONCENTRATION
Gluteraldehyde 2%
Phenol 5%
Sodium hypochlorite 0.5-5%
Chlorhexidine 1-4%
Povidine Iodine 10%
Alcohol 70-80%

33. temperature of 131ºC 20 psi
30 minutes

34. hydrogen peroxide solution
34
NEW METHODS OF
STERILIZATION 1
2
3

35. 35
For sterilization,radiofrequency energy is
applied to create an electromagnetic field.
Into this hydrogen peroxide vapours are
introduced which generates a state of plasma
containing free radicals of hydrogen and
oxygen.
This state has a sterilizing action on the articles.
4

36. “
36

37. Reprocessing of High-Speed, Slow-Speed Handpieces and Scaler handpieces

39. INFECTION
CONTROL

40. all
The rationale for treating all patients as potentially infectious is due to
the fact that most patients are unaware of their infectious disease
status.

41. 41

42. Human Immunodeficiency Virus (HIV)
Infection control
Avoiding exposure to blood and bodily fluids is the primary way to prevent transmission of HIV in dental care settings.
Standard precautions should be followed with all patients, whether or not they have been diagnosed with HIV.
Dental personnel should wear PPE
After a needlestick exposure to HIV-infected blood, the average risk of HIV transmission is approximately 0.3%.
CDC recommends high-level disinfection for HBV-, HCV-, HIV- or TB-contaminated devices
In the case of exposure to material known or suspected to be infected with HIV, the incident should be reported to a supervisor (if
applicable) and the exposed individual should consult with a doctor immediately.
Antiretroviral drugs may be prescribed as post exposure prophylaxis (PEP) within the first 72 hours of exposure in order to help prevent HIV
infection.

43. “
DENTAL PATIENT MANAGEMENT
1. A comprehensive intraoral soft tissue, periodontal and hard tissue examination should be
conducted at an HIV-positive patient’s initial assessment
2. If any oral manifestations of HIV are present, the first priority is to relieve pain and treat infections
3. To help prevent further disease, dentists can provide counselling about modifiable risk factors,
such as use of tobacco, alcohol, or other drugs that may increase risk of oral abnormalities or
complications
4. Implement oral hygiene regimens.
5. Dentists should continuously monitor dental and oral health for disease progression
43

44. “
DENTAL PATIENT MANAGEMENT..
• All dental practioners should be able to provide routine dental care for adult or pediatric HIV-
positive patients.
• Nearly all patients with HIV are able to tolerate routine dental care and procedures, including oral
surgery.
• Still, dental treatment planning must be done on an individual basis, in conjunction with
consultations with the patient and their physician as appropriate
• HIV and antiretroviral therapies may be associated with abnormal bleeding, glucose intolerance, or
hyperlipidemia.
• Other conditions that may require modification of dental treatment are reduced platelet count
<60,000 cells/mL, which may affect clotting, or white-blood-cell neutrophil counts <500 cells/mL,
which may require antibiotic prophylaxis.
• Preoperative scaling may be performed before oral surgical procedures to help reduce the risk of
postoperative complications.
44

47. 47

48. “
MEDICAL HISTORY AND DENTAL SAFETY
While taking medical history the clinician should not discriminate an infectious
disease patient with reference to the potential of spreading the disease in the clinic.
The reason one should look out for patients with infectious diseases is to protect
them from other acquiring other infectious disease conditions, as they usually are
medically compromised.
While speaking to patients with infectious diseases one must maintain a high level of
professionalism and confidentiality in acquiring the patient’s trust and confidence.
48

49. “
IMMUNIZATION OF PERSONNEL
INVOLVED IN DENTAL CARE
We as health care workers are at a high risk of preventable infectious diseases and
therefore must adopt this first line of defense.
Other than the common vaccinations (childhood vaccines), the clinicians should also
be regularly vaccinated against other conditions such as Influenza on an annual
basis.
49

50. “
Proposed protocol for HBV vaccine for Dental Undergraduate &
Postgraduate students and Dental Teaching Faculty in India
It is mandatory for every dental student undergraduate and postgraduate and dental
teaching faculty to be vaccinated against Hepatitis B with a three dose regimen and a
booster.
All non teaching faculty which include dental assistants, dental hygienists, dental
mechanics and all those who come directly in contact with patient care, cleaning and
sterilization of instruments and all those who are in the clinical area or the pre clinical
area of the dental teaching institution must to be vaccinated against Hepatitis B.
It is also mandatory for the institution managements including government owned
institutions to provide free Hepatitis B vaccine to all its students both undergraduate
and postgraduate, teaching and non teaching faculty.
50

51. “If a health care worker who is immunized against polio is exposed to the oral secretions of a
patient with active polio, Oral polio vaccine (live attenuated virus) or Inactivated Polio virus
vaccine boosters are needed.
If a person is not immunized against HBV and is exposed to an infected patient’s body fluids,
a combination of Hepatitis B vaccine and an immunoglobulin (HBIg) must be administered
immediately.
If the exposed person does not want to take the vaccine, two doses of the HBIg
immunoglobulin must be given (in most cases, dose 1 within 24 hours and dose 2 given 25
to 30 days after exposure).
51

53. Infection Control
Practices

54. Chlorhexidine Gluconate 4%,
or other Iodine based
surgical soaps
about 2
to 6 minutes using a single-
use disposable sponge
54

55. “What should one use?
Chlorhexidine Gluconate (CHG) at 0.75% to 4% concentration that may be dispensed
as liquid soap or foam, Parachlorometaxylenol (PCMX) liquid, Iodine liquid or
Triclosan liquid, gel or foam.
CHG at 4% is marketed for surgical scrub as opposed to routine handwashing and
the latter may show residual effect or substantivity (remains on the skin as a
protectant) on the skin after 4-5 repeated washes.
55

56. “
Alcohol-Based Hand Rubs
56

57. Personal Protective Equipment
Examples of PPE include-
• Protective clothing,
• surgical masks, face shields,
• protective eyewear,
• disposable patient treatment gloves, and
• heavy-duty utility gloves
• Types of protective clothing can include smocks, pants, skirts, laboratory coats,
surgical scrubs (hospital operating room clothing), scrub (surgical), hats, and shoe covers.
PPE

61. Protective Clothing Requirements
• To minimize the amount of uncovered skin, clothing
should have long sleeves and a high neckline.
During high-risk procedures, protective clothing must
cover dental personnel at least to the knees when seated.
• Buttons, trim, zippers, and other ornamentation (which
may harbor pathogens) should be kept to a minimum.
Contaminated linens that are removed from the office for
laundering should be placed in a leakproof bag

64. The passing of the liquids from the outer layer of the mask on to the inner surface is called
“strike-through” and this should be avoided by using masks that are impervious for liquid passage.
The surgical mask may have three layers— the outer (esthetic layer), the middle (fluid shield
layer), and the inner layer (that is soft and compatible with the skin of the face).
Whenever one uses a mask, a work practice must be to dispose the mask after treating one patient.
If the procedure extends beyond 25-30 minutes, one may need to replace the mask with a new one.

65. The two most common types of
masks are the:
domeshaped and flat types.
Some operators prefer the
domeshaped type,
particularly during lengthy
procedures, because it conforms
(“molds”) more effectively to the
face and creates an air space
between the mask and the
wearer
When not in use, face masks
should never be worn below the
nose or on the chin.
Remember, the outer surface
of the mask is highly
contaminated
65

66. prevents injury from splattered solutions and caustic
chemicals.
permanent visual impairment or
blindness.

67. The CDC Guidelines recommend that you clean your
eyewear with soap and water, or, if visibly soiled, you can
clean and disinfect reusable facial protective wear between
patients.
• If you wear prescription glasses, you must add protective side
and bottom shields.
• Protective eyewear that can be worn over prescription glasses
is also available.
• If you wear contact lenses, you must also wear protective
eyewear with side shields or a face shield.
67

68. Patient Eyewear

69. Examination Gloves
latex or vinyl
GLOVES
Overgloves
• also known as “food
handler gloves,” are
made of lightweight,
inexpensive, clear
plastic.
• These may be worn
over contaminated
treatment gloves
(overgloving) to
prevent the
contamination of
clean objects
handled during
treatment
Sterile Surgical
Gloves
• used in hospital
operating rooms,
should be worn for
invasive
procedures
involving the
cutting of bone or
significant
amounts of blood
or saliva,such as
oral surgery or
periodontal
treatment
Utility Gloves
• not used for direct
patient care.
• 1) when the
treatment room is
cleaned and
disinfected
between patients,
• (2) while
contaminated
instruments are
being cleaned or
handled, and
• (3) for surface
cleaning and
disinfecting
Non–Latex-
Containing Gloves
person who is
sensitive to latex can
substitute with gloves
made from vinyl,
nitrile, and other non–
latex containing
material
69

71. “
OPENING CONTAINERS
• During the procedure, it may become necessary to open containers of
materials or supplies.
• When opening a container, use overgloves, a paper towel, or a sterile gauze
sponge to remove the lid or cap.
• While doing this, take care not to touch any surface of the container.
• Use sterile cotton pliers to remove an item from the container.
• If the container or bottle is touched, it becomes contaminated and must be
disinfected at the end of the procedure
71

72. Irritant Dermatitis
• Frequent handwashing with
soaps or antimicrobial agents
• Irritation caused by the
cornstarch powder in gloves
• Excessive perspiration on the
hands while wearing gloves
• Failure to dry hands thoroughly
after rinsing
Irritant dermatitis
Type I type IV

73. Type IV Allergic Reaction
• Most common type of latex allergy, is a
delayed contact reaction that involves
the immune system.
• It may take 48 to 72 hours for the red,
itchy rash to appear.
• Reactions are limited to the areas of
contact
• The chemicals used to process the latex
in these gloves cause an immune
response;
Type I Allergic Reaction
• Most serious type of latex allergy and can
result in death.
• This reaction occurs in response to the
latex proteins in the glove
• A severe immunologic response occurs,
usually 2-3minutes after latex allergens
contact the skin or mucous membranes
• coughing, wheezing, runny eyes and
nose,shortness of breath, and respiratory
distress
• The primary cause of death associated
with latex allergies is anaphylaxis.
Anaphylaxis is the most severe form of
immediate allergic reaction. Death results
from closure of the airway caused by
swelling

74. “Treatment
• No specific cure has been identified for latex
allergy.
• The only options are prevention, avoidance of
latex-containing products, and treatment of the
symptoms.
74

75. SURFACE BARRIERS
The turn around time for an operatory if a disinfectant is used (8-15 minutes) is
longer than the time taken for removal of barriers, placing new surface barriers,
disposal of the waste, return of the used instrument to the instrument
reprocessing area (3-5 minutes)

76. “
76

77. “
CDC, guidelines for disinfection & sterilization in health care facilities 2008
Cleaning and disinfection strategies for blood spills
 Visible organic material should be removed with absorbent material (e.g., disposable paper
towels discarded in a leak-proof, appropriately labelled container).
 Nonporous surfaces should be cleaned and then decontaminated with either an hospital
disinfectant effective against HBV and HIV or an 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.
77

78. “Waste Management
in the Dental Office
Because of the high probability that blood may be carried in saliva during dental
procedures, CDC Guidelines and OSHA BBP Standard regulations consider saliva in
dentistry to be a potentially infectious body fluid.
Saliva-coated items should be treated as potentially infectious waste and
disposed of as contaminated waste.
78

81. SEGREGATION OF HOSPITAL WASTE IN COLOR CODED BAGS
YELLOW RED BLUE BLACK WASTE
DISPOSAL
Incineration
Chemical
disinfection and
then sent for
shredding
Needles-burnt
Syringes-shredding
Landfill

82. Preprocedural Mouth Rinses
• reduces the number of microorganisms released in the form of aerosol or spatter
• can decrease the number of microorganisms introduced into the patient’s bloodstream
during invasive dental procedures

83. latent TB Infection
 The CDC recommends that elective dental treatment be delayed until the patient
is noninfectious.
 For patients who require urgent dental care, the CDC recommends referring the
patient to a facility with TB engineering controls and a respiratory protection
program.

84. wear
full PPE
high volume
evacuation system as close as possible to the site
improving air circulation

86. CONCLUSION

87. “• CDC, guidelines for disinfection & sterilization in health care facilities
• Dental Infection Control & Occupational Safety Dental Infection Control & Occupational
Safety For Oral Health Professionals,Dental Council of India, Anil kohli & Raghunath
puttaiah
• Operative dentistry, infection control, 4th edition, Sturdevent
• Textbook of microbiology, sterilization and disinfection, 9th edition, Ananthanarayan
• Dental Hygiene theory and practice, Darby and Walsh,3rd edition
• Essentials of Public Health Dentistry 5th Edition,Soben Peter
• Sterilization and disinfection of dental instruments by ADA
• Modern Dental Assisting 11th Edition, Doni Bird Debbie Robinson
• Sterilization of UltraSonic Scaler Inserts Z. Haydu
REFERENCES
87

88. THANK YOU