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Dental Ic


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Dental Ic

  1. 1. Egypt Sphinx Pyramids
  2. 2. Dental infection control Dr.Ashraf Selim Dental Surgeon infection control specialist
  3. 3. <ul><li>Challenge of infection control in Dental clinics </li></ul><ul><li>Dental Health Care Workers are subjected all times to all </li></ul><ul><li>means of infection transmission e.g. blood , respiratory </li></ul><ul><li>secretions , tissue fluids , mucous membrane and skin . </li></ul><ul><li>Dentists are treating patients of both sexes and of all ages </li></ul><ul><li>starting from newly born infants till very old aged patients. </li></ul><ul><li>Most of dental treatments are considered an emergency </li></ul><ul><li>cases so there is always no enough time to do Lab. tests to </li></ul><ul><li>evaluate the patient medical background . </li></ul>
  4. 4. <ul><li>DHCWs are dealing with a variety of materials including St.St. , </li></ul><ul><li>Rubber , Glass , Plastics , Wax , Plaster , Water lines , </li></ul><ul><li>Sophisticated electronic devices and different types of impression </li></ul><ul><li>materials . </li></ul><ul><li>The complex structure and design of Dental unit make it a real challenge </li></ul><ul><li>to DHCWs to deal with it because we are dealing with , Delicate Vinyl </li></ul><ul><li>,Narrow lumen rubber nodules , Light arm and handle , Two completely </li></ul><ul><li>separate and different water lines ( clean and soil ), Spittoon , Handle tray </li></ul><ul><li>… etc </li></ul><ul><li>All surfaces in the dental unit is subjected to infectious materials during </li></ul><ul><li>dental treatment duo the splatter emerging from the high speed rotary </li></ul><ul><li>dental equipments . </li></ul><ul><li>Also the housekeeping surfaces are subjected to infectious materials. </li></ul>
  5. 7. Why Is Infection Control Important in Dentistry?
  6. 9. <ul><ul><li>In a good ventilated area with reasonable air exchange. </li></ul></ul><ul><ul><li>It must be in a healthy, less contaminated area. </li></ul></ul><ul><ul><li>Walls and floors should be of vinyl {Antistatic + Antibacterial} In case of poly dental units the space between each unit and </li></ul></ul><ul><ul><li>the adjacent one is not less than 3 meters because the splatter </li></ul></ul><ul><ul><li>from the High speed dental hand piece travels at a very high </li></ul></ul><ul><ul><li>speed approximately 80 mile / hour for 3 m 2 around dental unit. </li></ul></ul><ul><ul><li>It must be constructed according to the demand of Infection </li></ul></ul><ul><ul><li>control in relation to dimensions and available spaces between </li></ul></ul><ul><ul><li>dental unit and the medical equipments and cabinets. </li></ul></ul>Clinic design
  7. 11. <ul><ul><li>Clinic must contain a non touchable or elbow faucet with </li></ul></ul><ul><ul><li>a source for fresh water. </li></ul></ul><ul><ul><li>Two wall dispenser at least above the water faucet one </li></ul></ul><ul><ul><li>with plain soap and the second filled with alcoholic based </li></ul></ul><ul><ul><li>solution. </li></ul></ul><ul><ul><li>Mounted holder for tissues {for Drying}. </li></ul></ul><ul><ul><li>We must have a separate room for sterilization. </li></ul></ul><ul><ul><li>No furniture in the clinic as desk, chairs…….Etc </li></ul></ul>
  8. 12. <ul><li>Sequences of dental infection control in dental clinic </li></ul><ul><li>Daily routine </li></ul><ul><li>At the beginning of each day : Fill a fresh purified water </li></ul><ul><li>bottle and attach to dental unit by using a suitable </li></ul><ul><li>disinfectant </li></ul><ul><li>e.g. Chlorine Dioxide, Chlorhexidine ..etc </li></ul><ul><li>Flush hand piece line and 3-in-1 line for 2-3 minutes. </li></ul><ul><li>Make up fresh solution of disinfectant for the suction </li></ul><ul><li>system </li></ul><ul><li>e.g. Sodium Hypochlorite , Chlorine Dioxide … etc </li></ul>
  9. 13. Before the procedure {Clinic preparation}. During procedures. After the procedures. Protocol of infection control in dental clinic
  10. 14. <ul><li>Clinic preparation </li></ul><ul><li>Cover all exposed surfaces {bracket table, light Hand... Etc} with aluminum </li></ul><ul><li>foil or disposable Covering Sheets. </li></ul><ul><li>Prepare all instruments which could be used during patient treatment. </li></ul><ul><li>All dental unit and dental water lines must be disinfected. </li></ul><ul><li>All instruments must be sterile. </li></ul><ul><li>Using Rubber Dam and high suction will minimize the splatter generated </li></ul><ul><li>thus decreasing the possibility of spread of infection. </li></ul><ul><li>Ask patient to use mouth wash prior to treatment to decrease microbial </li></ul><ul><li>count. </li></ul>
  11. 15. During procedures Serologic surveys have indicated that 10%-30% of health-care or dental workers show evidence of past or present HBV infection The {OSHA blood borne pathogens final rule}. DHCWs also are at risk for exposure to and possible transmission of other vaccine-preventable diseases accordingly, vaccination against influenza, measles, mumps, rubella, and tetanus may be appropriate for DHCWs.
  12. 16. <ul><li>Occupational exposure to blood </li></ul><ul><li>How can we prevent the risk of Exposure ? </li></ul><ul><li>1 - Needle sticks can be easily prevented by: </li></ul><ul><ul><li>Single hand recapping technique. </li></ul></ul><ul><ul><li>Disposing used needles in a safety boxes. </li></ul></ul><ul><li>2 - Using all PPE. </li></ul><ul><li>3 - Careful handling of sharp items. </li></ul>
  13. 18. <ul><li>If Exposure occurs : Immediately </li></ul><ul><ul><li>Wash needle sticks and cuts with soap and water. </li></ul></ul><ul><ul><li>Flush splashes to the nose or skin with water. </li></ul></ul><ul><ul><li>Irrigate eyes with clean water or saline. </li></ul></ul><ul><ul><li>No scientific evidence that using antiseptics or squeezing the wound will educe the risk of infection {CDC guideline}. </li></ul></ul><ul><li>Report the exposure to the infection control department to recommend the post-exposure treatment. </li></ul>
  14. 19. Dental Personal Protective Equipments DHCWs must use PPE for all Patients {Standard precautions}. Hand hygiene is the single most important measure to control infection . Gloves Gloves should be worn for all dental procedures and when handling items or surfaces contaminated with body fluids.
  15. 20. <ul><li>Gloves </li></ul><ul><li>Gloves should be worn for all dental procedures and when handling items or surfaces contaminated with body fluids. </li></ul><ul><li>REMEMBER </li></ul><ul><li>Do not re-use gloves. </li></ul><ul><li>If you leave the chair side removes gloves and dispose of them </li></ul><ul><li>immediately in the “Contaminated Waste” bin. </li></ul><ul><li>Don a fresh pair on return to the chair side. </li></ul><ul><li>Never handle charts when gloved. </li></ul><ul><li>Always remove gloves when using the telephone or computer </li></ul><ul><li>keyboard or mouse. </li></ul><ul><li>NB: No gloves or masks outside the clinical area </li></ul>
  16. 21. <ul><li>Face Masks </li></ul><ul><li>Masks protect both dentist and dental nurse from splashes, </li></ul><ul><li>sprays and aerosols. </li></ul><ul><li>Ensure mask is well fitting. </li></ul><ul><li>Change masks frequently/between patients. </li></ul><ul><li>Dispose mask in the contaminated waste bin. </li></ul><ul><li>Face mask with face shield is now replacing the ordinary mask </li></ul><ul><li>to provide maximum protection to the whole area or face and </li></ul><ul><li>neck region. </li></ul>
  17. 22. <ul><li>Protective Eye Wear </li></ul><ul><li>To be worn by dentist, dental nurse, and patient during </li></ul><ul><li>all operative procedures. </li></ul><ul><li>To be worn by dental nurse when cleaning contaminated </li></ul><ul><li>instruments. </li></ul><ul><li>Protective eye wear should be disinfected between </li></ul><ul><li>patients each member of staff should have his/her own </li></ul><ul><li>protective eye- wear. </li></ul>
  18. 23. <ul><li>Protective Clothing/ Uniforms </li></ul><ul><ul><ul><li>Change if visibly contaminated. </li></ul></ul></ul><ul><ul><ul><li>Ideally change daily. </li></ul></ul></ul><ul><ul><ul><li>Change clothes at work. </li></ul></ul></ul><ul><ul><ul><li>Avoid contamination to home/tea-room. </li></ul></ul></ul><ul><ul><ul><li>Work shoes should be considered. </li></ul></ul></ul><ul><ul><ul><li>Wear gloves when handling contaminated clothes . </li></ul></ul></ul><ul><ul><ul><li>Place in separate bag when transporting. </li></ul></ul></ul><ul><ul><ul><li>Wash in separate cycle – white cycle preferably. </li></ul></ul></ul>
  19. 26. <ul><li>After the procedures </li></ul><ul><li>After treatment... The operator must remove all </li></ul><ul><li>PPE and wash his hand to avoid self infection. </li></ul><ul><li>All disposable items must be discarded. </li></ul><ul><li>All covering barriers must be removed. </li></ul><ul><li>The whole dental unit must be cleaned and </li></ul><ul><li>disinfected using Suitable disinfectant </li></ul><ul><li>e.g. Combination of Alcohol + quats} or </li></ul><ul><li>chlorine dioxide foam / wipes. </li></ul>
  20. 28. <ul><li>All used instruments must be carefully placed in </li></ul><ul><li>a special tray to the sterilization room. </li></ul><ul><li>Flush suction with water. </li></ul><ul><li>Flush spittoon. </li></ul><ul><li>Prepare clinic for the next patient. </li></ul><ul><li>Waste amalgam should be placed in 'Amalgam </li></ul><ul><li>Safe' containers </li></ul>
  21. 29. <ul><li>End of the Day </li></ul><ul><ul><li>Run a suitable disinfectant solution of through </li></ul></ul><ul><ul><li>suction. </li></ul></ul><ul><ul><li>Remove and empty purified water bottle from unit </li></ul></ul><ul><ul><li>and disinfect it. </li></ul></ul><ul><ul><li>Disinfect all work surfaces and dental unit, base of </li></ul></ul><ul><ul><li>chair and pedals. </li></ul></ul><ul><ul><li>Disinfect heavy-duty gloves with suitable Disinfectant </li></ul></ul><ul><ul><li>and store in a labeled plastic bag. </li></ul></ul>
  22. 30. Procedures for Dental Instrument Sterilization Wear the personal protective equipment (PPE) when processing contaminated instruments including utility gloves. Procedures for Dental Instrument Sterilization Wear the personal protective equipment (PPE) when processing contaminated instruments including utility gloves.
  23. 31. <ul><li>Step 1 - Transport </li></ul><ul><li>Transport contaminated instruments to the processing area in a manner that minimizes the risk of exposure to persons and the environment. </li></ul><ul><li>Use a rigid, leak-proof container. </li></ul><ul><li>Use appropriate personal protective equipment. </li></ul>
  24. 32. <ul><li>Step 2 - Cleaning </li></ul><ul><li>Clean instruments with a hands-free, mechanical </li></ul><ul><li>process such as an ultrasonic cleaner or instrument </li></ul><ul><li>washer. </li></ul><ul><li>If instruments cannot be cleaned immediately, pre- </li></ul><ul><li>soaking or maintaining them in a moist environment </li></ul><ul><li>may improve the cleaning process. </li></ul><ul><li>Insure that instruments are rinsed thoroughly. </li></ul><ul><li>Visually inspect the instruments for residual debris or </li></ul><ul><li>damage. </li></ul><ul><li>Dry instruments before packaging. </li></ul><ul><li>Follow manufacturers' recommendations to lubricate </li></ul><ul><li>and/or use rust inhibitors. </li></ul>
  25. 33. <ul><li>Step 3 – Packaging </li></ul><ul><li>In a cleaned, low-contamination environment, wrap/package instruments in materials that are appropriate for the sterilization process to be used. </li></ul><ul><li>Loose instruments should be packaged so that they lay in a single </li></ul><ul><li>layer, not wrapped up so tightly as to exclude exposure to the sterilizing </li></ul><ul><li>agent. </li></ul><ul><li>Avoid excess packaging material by using a suitable size. </li></ul><ul><li>Chemical indicators are placed next to the instruments inside the </li></ul><ul><li>packages, If an indicator is not visible on the outside of the package, </li></ul><ul><li>place an external process indicator on the package. use of multi </li></ul><ul><li>parameter indicators (integrators) may provide a higher standard of </li></ul><ul><li>sterility assurance. </li></ul>
  26. 34. <ul><li>To maintain integrity of the package, follow only </li></ul><ul><li>manufacturers' recommendations for sealing the </li></ul><ul><li>package; and do not use staples, pins, or paper clips to </li></ul><ul><li>seal packages. </li></ul><ul><li>The shelf life of wrapped instruments processed through </li></ul><ul><li>a sterilizer is event-related, thus, the shelf life of a </li></ul><ul><li>package ends when the integrity of the package </li></ul><ul><li>becomes compromised, e.g., torn, punctured or moistened. </li></ul><ul><li>Packages are dated on the date processed using methods </li></ul><ul><li>that do not compromise the integrity of the wrapping </li></ul><ul><li>material </li></ul><ul><li>Do not mark on non-woven wrapping materials and do not </li></ul><ul><li>use ink on paper packaging materials. </li></ul>
  27. 35. <ul><li>Step 4 - Sterilization </li></ul><ul><li>Sterilization is to be accomplished using a suitable device </li></ul><ul><li>for the items to be sterilized. </li></ul><ul><li>Load the sterilizer according to manufacturers' instructions. </li></ul><ul><li>Do not overload the sterilizer. </li></ul><ul><li>Place packages on their edge, in single layers, or on racks to </li></ul><ul><li>increase circulation of the sterilizing agent around the instruments. </li></ul><ul><li>Use manufacturers' recommended cycle times for wrapped </li></ul><ul><li>instruments. </li></ul><ul><li>Operate the sterilizer according to manufacturers' instructions. </li></ul><ul><li>Allow packages to dry before removing them from the sterilizer. </li></ul><ul><li>Allow packages to cool before handling. </li></ul>
  28. 36. The need for High level disinfection for dental items. HLD is only indicated for Heat and Moisture sensitive items in dental clinic e.g. plastic composite instruments , glass slaps ….etc Remember : Nowadays mostly all dental items are autoclavable or Disposable .
  29. 37. <ul><li>Step 5 - Storage </li></ul><ul><li>Store instruments in a clean, dry environment in a </li></ul><ul><li>manner that maintains the integrity of the package. </li></ul><ul><li>Enclosed cabinets will increase the assurance that </li></ul><ul><li>sterility of the package is maintained. </li></ul>
  30. 38. <ul><li>Step 6 – Delivery </li></ul><ul><li>Deliver packages to point of use in a manner that </li></ul><ul><li>maintains sterility of the instruments until they are used. </li></ul><ul><li>Inspect the integrity of each package. </li></ul><ul><li>Open each package aseptically. </li></ul><ul><li>Check the chemical indicator to insure that the package </li></ul><ul><li>has been subjected to the sterilization. </li></ul>
  31. 39. Single-Use (Disposable) Devices Use single-use devices for one patient only and dispose it immediately after use, never clean, sterilize or reuse. E.g. anesthetic cartilage, Dental needle, saliva ejector and high suction tips, polishing brush, scalpel, suture needle.etc
  32. 40. Handling of Biopsy Specimens To protect persons handling and transporting biopsy specimens, each specimen must be placed in a sturdy, leak proof container with a secure lid for transportation. Care should be taken when collecting the specimen to avoid contaminating the outside of the container. If the outside of the container becomes visibly contaminated, it should be cleaned and disinfected or placed in an impervious bag the container must be labeled with the biohazard symbol during storage, transport, shipment, and disposal .
  33. 41. Biopsy container
  34. 42. Handling of Extracted Teeth Dispose of extracted teeth as contaminated medical waste. Do not dispose of extracted teeth containing amalgam in regulated medical waste intended for incineration.
  35. 43. <ul><li>The following apply when using extracted teeth in educational settings </li></ul><ul><li>Clean and place extracted teeth in a leak-proof container labeled </li></ul><ul><li>with a biohazard symbol. </li></ul><ul><li>Place amalgam-free teeth in a heat-resistant glass container. </li></ul><ul><li>Fill the container no more than half–way with distilled water or </li></ul><ul><li>saline, and loosely cover. </li></ul><ul><li>Process through a steam sterilizer at 121°C for 40 minutes using a </li></ul><ul><li>fluid or liquid cycle. </li></ul><ul><li>At the end of the cycle, remove the container slowly without shaking </li></ul><ul><li>to avoid the boiling over of the fluid. </li></ul><ul><li>If using extracted teeth containing amalgam, immerse in 10% </li></ul><ul><li>formalin for two weeks before use in an educational setting. </li></ul>
  36. 44. <ul><li>Dental Radiology </li></ul><ul><li>When taking X-Ray there is a risk of cross- </li></ul><ul><li>contamination of equipment and environmental </li></ul><ul><li>surfaces with blood or saliva if aseptic technique is </li></ul><ul><li>not practiced. </li></ul><ul><li>Gloves should be worn when taking radiographs and </li></ul><ul><li>handling contaminated film packets. </li></ul><ul><li>Other PPE should be used if the patient was for example </li></ul><ul><li>under oral surgery. </li></ul><ul><li>Intraoral radiograph accessories items (e.g., film-holding </li></ul><ul><li>and positioning devices) should be heat sterilized before </li></ul><ul><li>patient use. </li></ul>
  37. 46. <ul><li>After exposure of the radiograph and before glove removal, the film </li></ul><ul><li>should be dried with disposable gauze or a paper towel to remove </li></ul><ul><li>blood or excess saliva and placed in a container (e.g., disposable </li></ul><ul><li>cup) for transport to the developing area. </li></ul><ul><li>Radiograph tube head and control panel should be protected with </li></ul><ul><li>surface barriers hat are changed after each patient. </li></ul><ul><li>If barriers are not used, equipment that has come into contact with </li></ul><ul><li>DHCP’s gloved hands or contaminated film packets should be </li></ul><ul><li>cleaned and then disinfected with ILD wipe after each patient use. </li></ul><ul><li>Digital radiography sensors and other high-technology instruments </li></ul><ul><li>(e.g., intraoral camera, electronic periodontal probe, occlusal </li></ul><ul><li>analyzers, and lasers) come into contact with mucous membranes </li></ul><ul><li>are considered semi-critical devices and they should be cleaned </li></ul><ul><li>and ideally heat-sterilized or high level disinfected between patients. </li></ul>
  38. 47. <ul><li>Laser Safety </li></ul><ul><li>Use standard precautions when working in the area of </li></ul><ul><li>the laser. </li></ul><ul><li>Wear appropriate PPE including N-95 or N-100 </li></ul><ul><li>respirators. </li></ul><ul><li>Wear protective laser eyewear. </li></ul><ul><li>Implement local exhaust ventilation controls. </li></ul>
  39. 48. <ul><li>Regulated Medical Waste Management </li></ul><ul><li>Wearing All PPE with utility gloves is a must before dealing with dental wastes </li></ul><ul><li>Items to be disposed in specialized safety boxes : </li></ul><ul><li>Needles </li></ul><ul><li>Cartridges </li></ul><ul><li>Burs and prophylactic brushes </li></ul><ul><li>Extracted teeth/roots </li></ul><ul><li>Scalpel blades </li></ul><ul><li>Suture needles </li></ul><ul><li>Matrix bands </li></ul><ul><li>Orthodontic wires/bands </li></ul><ul><li>Files/reamers/spiral fillers </li></ul><ul><li>Irrigating syringes (single use) </li></ul>
  40. 49. <ul><li>Items might be contaminated with blood or saliva to be disposed in special colored contaminated </li></ul><ul><li>Waste package or container: </li></ul><ul><li>Saliva ejectors/disposable suction tips </li></ul><ul><li>Cups </li></ul><ul><li>Tissues </li></ul><ul><li>Gauze/cotton rolls </li></ul><ul><li>Gloves </li></ul><ul><li>Face masks </li></ul><ul><li>Sticky covers/cling film </li></ul><ul><li>Used disinfectant wipes </li></ul>