Major reason for failures in the field of medicine is infections. So its a prime duty to know and follow the protocols to infection control, in the dental field as well.

1. INFECTION
CONTROL IN
DENTAL
PRACTICE
DR.AASHNA DHINGRA
PostGraduate Student
DEPT. OF PUBLIC HEALTH DENTISTRY

2. CONTENTS
• Introduction
• History
• Disease transmission
• Infectious diseases - Virus, bacteria
• Cross contamination
• Immunization
• Case history
• Handcare
• Personal protective equipment
• Sterilization methods
NEXT
• Instrument processing
• Dental office design
• Dental Lab infection
control
• Management of accidental
injuries
• Waste Management

3. INTRODUCTION
field of surgery that involves exposure to blood
and infectious material
blood, saliva, other oral fluids, body fluids,
indirect contact with contaminated instruments
or environmental surfaces.
unique nature of dental procedures,
instrumentation - strategies - preventing disease
transmission and work-related infections among
dental health professionals and their patients.

4. INTRODUCTION
strategies - immunization, hand hygiene,
personal and environmental barriers, effective
cleaning, disinfection and sterilization
procedures to reduce exposure to infectious
agents.

5. Rationale …
CDC (center for disease control and
prevention)
focus on the use of “Universal Precautions”
arises from the fact that many persons with
blood borne diseases cannot be identified due
to subclinical and undiagnosed infections.

6. HISTORICAL PERSPECTIVE
Antony van Leeuwenhoek, 1685 - made 1st microscope, examined dental
plaque.
Louis Pasteur, 1800s - introduced steam sterilizer, hot air oven & autoclave.
Joseph Lister, 1900s - used carbolic acid on fractures to reduce mortality.
Semmelweis, 1861 - importance of hand washing.
W.D. Miller, 1891 - recommended that microbiology should be made an
integral part of dental field.
Robert Koch - transmission of TB through air droplets.
Alexander Fleming, 1929 - discovered penicillin - treatment of simple
infections
Appleton - 1st to declare that sterilization by heat - optimum method or
dental instruments.
1991 - universal precautions: latex gloves, management of infectious sharps
and wastes.

7. DISEASE TRANSMISSION
the presence of a susceptible host.
the presence of pathogenic micro-organisms.
there must be a portal of entry via which
organisms invade and colonize the
susceptible host.
Infections are spread if the following criteria are satisfied:
GOAL : to eliminate one, two or all of the
above criteria

8. INFECTIOUS DISEASES
1. VIRUS 2. BACTERIA 3. FUNGUS 4. PARASITE 5. PROTOZOA
PATHOGENIC CAPABILITY
VIRULENCE
disease producing capacity of a pathogen.
e.g.. HBV- infected blood from razor of a paper cut is sufficient
to transmit the disease.
HOST RESISTANCE
ability of person to fight disease.
Immunocompromised persons have lower resistance.
CONCENTRATION

9. VIRUS
SOURCE OF
INFECTION
INFECTION
HAV Food/Water Infectious hepatitis
HBV
Blood/Body
Fluids
Serum Hepatitis
HCV Blood
Post transfusion nonA
nonB hepatitis
HDV Blood Delta hepatitis
HEV Water
Enterically transmitted
nonA nonB hepatitis
HIV Blood AIDS

10. VIRUS SOURCE OF INFECTION INFECTION
HSV1
Oro-nasopharyngeal
secretions
Oral herpes/whitlow
HSV2 Genital Secretions Genital Herpes
CMV Saliva/Blood Disease in fetus
Ep. Barr V Saliva/Blood Infectious Mononucleosis
Rubella V.
Oro-nasopharyngeal
secretions
Meningitis/Parotitis
Mumps V
Oro-nasopharyngeal
secretions
Meningitis/Parotitis
Influenza V.
Oro-nasopharyngeal
secretions
Flu/Common Cold
HZV Lesion/droplet spread Chicken pox
Papilloma V Lesion Mucosal/skin papillomas
Coxsackie V.
Oro-pharyngeal
secretions
Hand, foot & mouth
disease/herpangina blood

11. HEPATITIS B
WHO: > 1million deaths/year.
India: southern part > northern parts
- carrier rates.
Disease state: HbsAg positive when
tested on @ least 2 occasions. (6
months apart)
Transmission: Infected body fluids.

12. HEPATITIS B
Risk for dental Team
Injuries - contaminated sharps
(needlesticks, instrument pucntures.
cuts & lacerations)
Blood and saliva contamination - cuts
and cracks on skin or ungloved hands
Spraying of blood/saliva on open
lesions or mucous membranes.
Risk for Patient:
extremely low
1974-85.
Risk: when patient is not vaccinated.

13. HIV
India: 1986. 1st case - chennai..Mumbai.. now 3rd largest burden of
AIDS (2.3million)
“shared needle”
“saliva in dentistry” : potentially infectious (commonly contains
blood)
Risk for dental team: A documented case- seroconversion (HIV
negative at time of exposure later becoming HIV positive) following a
percutaneous occupational exposure to blood/body fluids.
Risk to dental patients: ext. low…Florida - dentist with HIV infected 6
patients during 1987 -1990.

14. (CNN): Nearly 600 patients who received
dental care at a Wisconsin Veterans Affairs
medical center may have been exposed to HIV,
hepatitis B and C and now face an anxious
wait to find out if they were infected.

15. Documented routes for HIV and HBV
transmission in dental practices :
1. Percutaneous inoculation
2. Contact with and open wound, non-intact
skin, mucous membranes to blood or body
fluids.
Blood is single most source of HIV and HBV
transmission in dental practices.
Risks of accidental percutaneous injury
during dental procedures cannot be reduced
to zero.

16. HSV 1
Most common infectious herpes virus - clinical dental staff.
Type I (oral) 90% v/s Type II (genital)
“direct contact” of abraded skin or with infected secretions.
Large number of virus particles - shed through lesions.
Herpetic Whitlow
Herpetic Conjunctivitis
• Serious - causes blindness
• Herpes virus splashes into
eyes during procedure.

17. CHICKEN POX
- Varicella Zoster V.
- highly contagious…airborne route
- Non-immune dental staff - inhalation
of aerosols.
COXSACKIE VIRUS INFECTION
- Coxsackie Virus
- Found in saliva…spread via direct contact or aerosols.
- Danger…non-immune female staff of childbearing age.
INFECTIOUS
MONONUCLEOSIS
- Ep. Barr Virus.
- Droplets trasmission….dental
staff at risk.

18. BACTERIA
SOURCE OF
INFECTION
INFECTION
Mycobacterium
Tuberculosis
Oro-pharyngeal
secretions
Tuberculosis
Treponema
Pallidium
Oro-pharyngeal
secretions
Syphilis
Neisseria
Gonorrhea
Oro-pharyngeal
secretions
Gonorrhea
Pseudomonas/
Actinobacter/Strep.
pneumonia
Oro-pharyngeal
secretions
Pneumonia
Strep. Pyogenes
Nasopharyngeal
secretions
Rheumatic fever
Clostridium
tetani
Fomites Tetanus
Ability of some bacterias to form spores…multiply rapidly…capable of
becoming virulent under favorable conditions.
Killing Spores - particular importance in dental office.

19. TUBERCULOSIS
• Droplet nuclei..projected from patient (coughing)
or splatter from a dental procedure.
• Adequate respiratory precautions.
SYPHILIS
• Secondary syphilis - oral lesions.
• Transmission to dental staff - Rarely
reported….even though they hardly wore
gloves when it was a pandemic.
GONORRHEA
• Oral sores and throat lesions.
• Can be transmitted to dental personnel.
• Avoid elective dental procedure.

20. • Air/water syringes may be contaminated with bacteria….biofilm
occasionally release bacteria.
• Retraction of oral bacteria back into the hand piece and air/water
syringe may occur if they are turned off in the mouth.
• Dental unit should be flushed thoroughly with fresh water before
and after use and esp. prior to 1st treatment in morning.
• Particularly important when immunocompromised patients are
being treated.

21. OTHER
INFECTIONS
SOURCE OF
INFECTION
INFECTION
Candida
albicans
Oro-pharyngeal
secretions
Candidiasis
Pneumocystis
carinii
Nasopharyngeal
secretions
Pneumocystitis pneumonia
CANDIDIASIS
• normally found in oral cavity….not an invasive pathogen.
• Oral thrush (1st manifestation of AIDS)
• Spread to dental team….direct contact with lesions or sprays or
aerosols of infected saliva.

22. A total office infection program should be
designed to prevent or at least reduce the spread
of disease agent from:
Patient to dental team
Dental team to patient
Patient to patient
Dental office to community, including dental
team’s families.
PATHWAYS FOR CROSS CONTAMINATION

23. Patient to Dental Team
• Most difficult to control.
• Direct contact (touching) - patient’s saliva or
blood.
• Droplet infection: sprays, splatter or aerosols
from patient’s mouth.
• Indirect contact: cuts or punctures with
infected sharps.

24. Dental Practice

25. IMMUNIZATION for Healthcare Providers
Healthcare workers are at potential risk for many vaccine
preventable diseases.
Hepatitis B: two doses 4 wks apart, 3rd dose after 5
months. (IM)
Rubella, Measles, Mumps..live virus vaccine : one dose
(SC), no booster.
Tetanus: two doses 4 wks apart, 3rd dose after 6-12 months,
booster every 10 months. (IM)
AIDS vaccine: recently in USA- called HGP-30.
Taking protection measures prior to beginning work

26. CASE HISTORY TAKING for
INFECTION CONTROL
Dates of visit, Age, Ethnic origin, Marital status, Address,
Occupation - relevance to cross infection.
History of Traumas, previous surgeries, blood transfusion.
Pts. suffering from influenza, measles, chicken pox- transmit
to dental personnels.
Addision’s disease, P-J syndrome, Cushing’s disease -
immunocompromised state.
Family History: diseases acquired through proximity ..TB,
Hep.B: horizontal transmission i.e. between spouses,
patients, patients to healthcare providers.

27. HANDCARE - HAND WASHING
Hands - major reservoir of pathogens.
CDC published Guidelines for Hand Hygiene in Healthcare
Settings.
alcohol based hand sanitizer replaced traditional hand
washing.
Clinician’s professionalism - clean finger nails, washing
hands before donning gloves, well kept hair, clean clothes.
Avoid - hand jewelry, examine hands for cuts and bruises,
hangnails. Cover bruises with medicated band aid/dressing.

28. Hands should be washed with water and
antimicrobial soap (CHG: 0.75 to 4%…FDA) -
liquid soap or foam.
Remove jewelry and wrist watch and examine
hands.
Wet hands with warm water.
Dispense adequate amount of soap
Thoroughly rub both surfaces of hands including
fingers for 30-60sec.
Wash hands with warm water and remove soap
Dry hands with paper towels.
Wear single use disposable gloves.
2-6 minutes
for surgical
Sterile Surgical
gloves without touching
their outer surface.

29. Personal Protective
Equipment (PPE)
1. GLOVES
- Skin harbors resident and transient bacterial flora
(Semmelweis and Lister).
- Contamination - blood, saliva and dental plaque.
- Can infect host - by passing through dermal defects.
- Blood from fingernails can remain impacted under
practitioner’s fingernails for 5 days or longer.
- CDC guidelines 2003…medical gloves (latex/vinyl)
must always be worn by DCHWs.
- Washing of gloves …..”Wicking” - not recommended.
- Discarding of gloves - such that contaminated contents
remain contained within it and not touch other surfaces.

30. Personal Protective
Equipment (PPE)
2. MASKS
- Dental aerosols - liquid or solid airborne particles…source
of microorganisms.
- Highest concentration…within 2 feet of patient.
- smaller than 50um…cannot be seen
- Masks: reduce inhalation and also protect mucosa of
mouth and nose.
- Should be changed between patients and during treatment
if it becomes wet.

31. Personal Protective
Equipment (PPE)
3. PROTECTIVE EYEWEAR
- Large particles of debris and saliva can be
ejected towards oral health care providers.
- Contaminated with bacteria…can
physically damage the eyes.
- Protective eyewear indicated: to prevent
physical injury as well as infection.
- Particular concerns: herpes simplex
viruses and staph. aureus, Hep.B

32. Personal Protective
Equipment (PPE)
4. CLOTHING
- Disposable gowns, lab coats should be
worn while dealing with blood or other
body fluids.
- Reusable protective clothing should be
washed in proper laundry cycles.
- Protective garments and devices should
be removed before personnel exit areas of
the dental office used for patient care
activities.

33. STERILIZATION METHODS
1. Steam Sterilization
- Effective sterilization…Moist heat..oldest
and most effective.
Do not disinfect what you can sterilize.

34. STERILIZATION METHODS
1. Dry Heat Sterilization
- HOT AIR OVEN
160 deg.C
2 hours
2. RAPID HEAT TRANSFER STERILIZATION
1900 deg.C
12 minutes.
3. Unsaturated chemical vapor sterilization
(chemiclave)
Heat, water and chemical synergism.
Formaldehyde, ketone, acetone is used to
produce sterilizing vapors.
Do not disinfect what you can sterilize.

35. STERILIZATION METHODS
CHEMICAL STERILIZATION
Published guidelines for infection control recommend
use of chemical sterilants when it is not possible to heat
sterilize contaminated items.
Do not disinfect what you can sterilize.

36. Spaulding’s classification
Item
Category
Identification Items
Potential
Risk
Method
CRITICAL
Touches bone or
penetrates soft
tissue
Mirrors, explorer,
needles, surgical
instruments
Very high
to high
Sterilization
SEMI-
CRITICAL
Touches bone or
penetrates soft
tissue
Hand pieces,
ultrasonic cleaner
Moderate
Sterilization or
high level
disinfection
NON-
CRITICAL
Has contact with
intact skin
Counter, light,
handles, chair
surface
Low to
none
Intermediate to
low level
disinfection/
simple cleaning

37. Public Health Perspective
The first adage of patient care is “do no harm” but infection
spreading through healthcare setting is contributing to the
erosion of trust and confidence among patients.
Public health care professionals must take all care necessary
on the field while working to regain the lost confidence of
the community.
PH Dentist is at risk …field/community settings…so should
be aware of infection control practices.

38. References..
Giguère, A., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M.,
Grudniewicz, A., ... & Gagnon, M. P. (2012). Printed educational
materials: effects on professional practice and healthcare
outcomes. The Cochrane Library.
Puttaiah, R., Shetty, S., Bedi, R., & Verma, M. (2010). Dental
infection control in India at the turn of the century. World
Journal of Dentistry, 1(1), 1-6.
Miller, J. T., Rahimi, S. Y., & Lee, M. (2005). History of infection
control and its contributions to the development and success of
brain tumor operations. Neurosurgical focus, 18(4), 1-5.
Miller, C. H., & Palenik, C. J. (2014). Infection Control and
Management of Hazardous Materials for the Dental Team5:
Infection Control and Management of Hazardous Materials for
the Dental Team. Elsevier Health Sciences.

39. CONTENTS
• Regulatory bodies
• Instrument processing
• Dental office design
• Dental Lab infection control
• Management of accidental
injuries
In PREVIOUS
• Introduction
• History
• Disease transmission
• Infectious diseases -
Virus, bacteria
• Cross contamination
• Immunization
• Case history
• Handcare
• Personal protective
equipment
• Sterilization methods

40. REGULATORY BODIES FOR INFECTION CONTROL
1. the Centers for Medicare & Medicaid Services (CMS),
2. the Occupational Safety and Health Administration (OSHA),
3. the Centers for Disease Control and Prevention (CDC),
4. the Healthcare Infection Control Practices Advisory Committee
(HICPAC),
5. the National Healthcare Safety Network (NHSN),
6. the World Health Organization (WHO);
7. the Infectious Diseases Society of America (IDSA), and
8. the Association for Professionals in Infection Control and
Epidemiology (APIC)

41. REGULATORY BODIES FOR INFECTION CONTROL
Clayton, J. L., & Miller, K. J. (2017). Professional and Regulatory Infection Control
Guidelines: Collaboration to Promote Patient Safety. AORN journal, 106(3), 201-210.

42. INSTRUMENT PROCESSING
a procedure that prepares contaminated instruments for reuse.
• Holding (presoaking)
• Precleaning
• Corrosion control, drying, lubrication
• Packaging
• Sterilization
• Sterilization monitoring
• Handling processed instruments
• Instrument protection

43. Handling (Presoaking)
If instruments cannot be cleaned immediately
after use - place them in a solution to prevent
drying of the saliva and blood.
Holding solution : germicidal solution
(glutaraldehyde)
INSTRUMENT HANDLING

44. Pre cleaning
“dirty instruments”
1. Manual scrubbing instruments:
to remove the debris instruments are
thoroughly brushed while submerged in
cleaning solution.
- chances of cuts/punctures through gloves.
2. Ultrasonic cleaning:
u/s energy- produces billions of tiny
bubbles in the cleaning solution - create high
turbulence at instrument surface (10-15 min)
3. Instrument washer:
high pressure washer - in large facilities like
hospitals and dental schools)
INSTRUMENT HANDLING

45. Corrosion control,
drying and lubricaton
carbon steel
spraying of sodium nitrite
(anti rust agent)
thoroughly dry the
instruments and use dry heat
or unsaturated chemical
vapor sterilization
INSTRUMENT HANDLING

46. Packaging
organizing instruments in
functional sets and wrapping
them or placing them in
sterilization pouches, bags,
trays or cassettes.
to prevent from being
contaminated after
sterilization while being
distributed to chair side.
INSTRUMENT HANDLING

47. Sterilization Monitoring
To achieve sterility assurance: biological, chemical and physical
monitoring.
1. Biological Monitoring:
processing highly resistant bacterial spores through sterilizer and
then culturing the spores to determine if they have been killed.
Bacillus stearithermophillus (steam/chemical vapor st.)
Bacillus subtilis (dry heat or ethylene oxide gas st.)
2. Chemical monitoring:
uses heat sensitive chemicals - change color or form when exposed to
certain temperatures. (autoclave tape, indicator strips, colored tubes)
3. Physical monitoring:
observing the gauges and displays, recording temperature, pressure,
exposure time.
INSTRUMENT HANDLING

48. Handling Processed Instruments
Instrument sterilization should be maintained until packs are opened for
use at chair side.
1. Drying and cooling:
wet paper may ‘draw’ microorganisms through the wrap.
- use of fan blower in sterilization room or a programmed drying cycle in
steam sterilizer.
2. Storage:
sterile packages - in dry, enclosed, low dust areas.
instrument packages must be checked for tears and punctures.
Oldest sterile pack - should be used first: ‘first in - first out’ system of
stock rotation
3. Distribution:
instruments from sterile packs - placed on disinfected trays.
INSTRUMENT HANDLING

49. Instrument Protection
SS instruments - least affected to corrosion from
moisture and heat.
Carbon steel instruments - corrode and lose
sharpness during steam sterilization. (cutting
efficiency)
- best: dry heat or chemical vapor sterilizer.
Efforts should be made to rinse away debris, chloride
salts, alkaline detergents prior to heat processing of
instruments.
INSTRUMENT HANDLING

50. DENTAL OFFICE
DESIGN
• Floor plan and traffic flow
• Materials
• Fixtures
• Operatory design
• Instrument Recirculation
Center (IRC)

51. Floor plan and Traffic Flow
- Consultation areas should be located closest to
the administrative and reception areas - patient
education room - full treatment operatories.
- Longer appointments - most distant operatory
- directs heaviest flow of patient away from
extensive treatment areas.
- Utility room containing central vacuum and air
compressor - best located adjacent to laboratory.

52. MATERIALS
- floors, walls, surfaces, cabinets should be
capable of being quickly cleaned and disinfected.
- carpet: X treatment areas.
- High vinyl floor coverings recommended.
- Vinyl, glass, resin laminates, stainless steel -
used for cabinets and counters. Also available as
coating for structures.

53. FIXTURES
- sink faucets, soap dispenser should be foot or
arm operated.
- ‘No touch’ wall mounted towel dispensers.
- puncture resistant leak proof biohazard waste
containers - used.

54. OPERATORY DESIGN
- operator leaves operating field : average 10 times during
a procedure - cross contamination.(2 handed dentistry)
- adequate surface to accommodate sterile trays and
armamentarium
- minimize number of drawers.
- positive ventilation in work areas to control noxious
vapors.
- Heating, ventilation and air conditioning systems
should have filters to prevent transfer of microbes - filters
maintained properly.

55. WASTE MANAGEMENT
Sink traps and evacuation lines - rinsed thoroughly daily.
Disinfectant solution - iodophor
Pathologic waste (teeth and other tissues) - wrapped
after treatment and disposed appropriate bag (yellow)
AMALGAM management: never in infectious waste
collection - if incinerated…mercury vapors…released
into environment

56. DENTAL OFFICE DESIGN
Use of sterilizable trays.
or Protected with
disposable coverings
Between clinical
sessions - work surface -
ethyl alcohol (70%).
If visible blood - NaOCl
(0.5%)
SURFACE Disinfection

57. DENTAL OFFICE DESIGN
barrier protection - light
handles, chair switches, head
rests, unit controls, air-water
syringe.
effective cover - impermeable
to water.
between patients - covering
should be removed.
Waterline asepsis: flushing of
syringes with hypochlorite
solution - removes biofilm.
SURFACE Disinfection

58. DENTAL LAB INFECTION CONTROL
ADA (1985) - first published recommendations for
infection control in dental laboratory.

59. DENTAL LAB INFECTION CONTROL
Impression and appliances - rinsed thoroughly - remove all
blood and debris.
Gloves - while handling impressions and pouring models.
Silicone, polysulphur - can be disinfected by total immersion
in glutaraldehyde (2%) or NaOCl (0.1%)
Alginate, polyether - submerging for several seconds in NaOCl
(0.1%) (wrapped in hypochlorite saturated paper towel)

60. Dental impressions : running water - reduces number of
microorganisms significantly, but does not decontaminate it.
1. Immersion
2. Spraying
3. Short term submersion
ADA council of dental materials recommends (1991) that all dental
impressions be disinfected by immersion.
DENTAL LAB INFECTION CONTROL
DISINFECTANT
SOLUTIONS
• Glutaraldehyde
• Iodophor
• 0.5% NaOCl
• Phenolic
compounds
DENTAL IMPRESSIONS

61. ADA - sterilization of removable prosthesis
: Ethylene oxide or immersion in iodophors or
chlorine compounds (disinfection).
DENTAL PROSTHESIS AND APPLIANCES
DENTAL LAB INFECTION CONTROL
WAX BITES AND WAX RIMS
DENTAL CASTS and IMPRESSION TRAYS
rinse - spray - rinse - spray
Iodophor
spraying until wet
immersing in 1:10 dil. of NaOCl or iodophor

62. Contaminated with Candida Albicans, S.Mutans,
Lactobacilli or Saliva
1. Handle with gloved hands
2. 0.1, 0.25 or 0.5 NaDC (sodium
dichloroisocyanurate) - 1,2 or 5min
3. Polyvinyl Pyrolidine Iodine (PVPI) - 5min
4. AIP alcohol-phenol-iodine disinfectant
DENTAL X RAY FILMS

64. MANAGEMENT OF
ACCIDENTAL INJURIES

65. RISK OF INJURIES??
RISK of Occupational Transmission: Likelihood of
acquiring infection after a single contact.
Percutaneous injuries : burs, needles, sharp
instruments or during use of wires.
Experience (as measured in years of dental practice
does not affect the risk of injury among dentists or oral
surgeons)

66. If …exposure occurs…
Immediately :
• Wash needle sticks and cuts with soap and
water
• Flush splashes on nose, mouth, or skin with
water.
• Irrigate eyes with clean water, saline, or
sterile irritants.
Report the exposure to the dept (occupational health, infection control)
Prompt post exposure treatment if recommended - should be started soon.

67. BLOOD BORNE
PATHOGEN
EXPOSURE TIME TREATMENT
HBV
within 24 hrs,
no later than 1
weak
HBIG +/ Hep.B vaccine
HCV
There is no post exposure
treatment that can prevent
infection
HIV Within hours
4 weeks course of 2
antiretroviral drugs/3
antiretroviral drugs for
exposures that pose greater
risk

68. SUMMARY
All dental staff must be aware of procedures to
prevent transmission of infection through oral
cavity.
Dental public health professionals are
challenged to implement effective infection
control measures during field procedures.
Public health dentists remain responsible for
overall management of a community program
and maintaining a safe work environment.

69. References..
Giguère, A., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M.,
Grudniewicz, A., ... & Gagnon, M. P. (2012). Printed educational
materials: effects on professional practice and healthcare
outcomes. The Cochrane Library.
Puttaiah, R., Shetty, S., Bedi, R., & Verma, M. (2010). Dental
infection control in India at the turn of the century. World
Journal of Dentistry, 1(1), 1-6.
Miller, J. T., Rahimi, S. Y., & Lee, M. (2005). History of infection
control and its contributions to the development and success of
brain tumor operations. Neurosurgical focus, 18(4), 1-5.
Miller, C. H., & Palenik, C. J. (2014). Infection Control and
Management of Hazardous Materials for the Dental Team5:
Infection Control and Management of Hazardous Materials for
the Dental Team. Elsevier Health Sciences.