For preventing infection in dentistry

1. Infection control
in dental practice
Dr. Afroza Hoque

2. Content of curriculum
• Infection control in dental practice and
• Occupational hazards
• Communicable & Non-communicable Disease in related to
dentistry Sterilization
• Safety measure in dental practice
Teaching hours
• L=2
• T=5

3. Learning objectives according to
2016 BDS Curriculum
• Define Infection prevention and control
• Define sterilization
• Classify sterilization
• Define occupational hazard
• List occupational hazards in dentistry
• Describe Preventive of occupational hazards in dentistry
• Control of HIV AIDS, Hepatitis B, C & others Bacterial and fungal infection
• Waste management in dentistry

4. Infection prevention and control
Definition
Infection prevention and control (IPC) is a practical, evidence-
based approach which prevents patients and health workers
from being harmed by avoidable infection and as a result of
antimicrobial resistance. (WHO)

5. Objective of Infection control
The purpose of infection prevention and control in dental practice is
to prevent/minimize the transmission of disease-producing agents
such as bacteria, viruses, and fungi from-
• one patient to another, from dental practitioners and dental staff
to patients, and
• from patients to dental practitioners and/or other dental staff.
• In addition, infection prevention and control also involves
measures that limit the spread of infectious agents.

6. Mode of Transmission
Infections could be transmitted in the dental operatory through several routes:
1. direct contact with blood, oral fluids, or other infected materials,
2. indirect contact with contaminated objects, such as instruments,
environmental surfaces, or equipment,
3. contact of conjunctival, nasal, or oral mucosa with droplets, such as spatter,
containing microorganisms from an infected person and propelled by
coughing, sneezing, or talking, or
4. inhalation of airborne microorganisms that can remain suspended in the air for
long periods.

10. Standard precautions

11. Standard precautions

12. Definitions
Sterilization:
A physical or chemical process that completely destroys or removes
all microbial life, including spores.
Disinfection:
It is killing or removing of harmful microorganisms
Disinfectant:
Products used to kill microorganisms on inanimate objects or
surfaces. Disinfectants are not necessarily sporicidal, but may be
sporostatic, inhibiting germination or outgrowth.

13. Cont’d
Antiseptic: A product that destroys or inhibits the growth of
microorganisms in or on living tissue.
Aseptic: Characterized by the absence of pathogenic microbes.

16. Heat

20. OCCUPATIONAL HAZARD

21. Learning objectives
• Define occupational hazard
• List occupational hazards in dentistry
• Describe Prevention of occupational hazards in dentistry

22. Define occupational hazard
• It can be defined as a risk to a person usually arising out of
employment it can also refer to a work material, substance,
process or situation that predisposes or itself causes
accidents or disease at a work place.

23. List of occupational hazard in
dentistry
1. Physical
2. Chemical
3. Biological
4. Psychological
5. Musculoskeletal disorders

24. 1. Physical hazards:
• Sources of physical injury can include debris from the oral
cavity striking the eyes, cuts from sharp instruments, or
puncture wounds from needles or other sharp instruments.
• Such injuries can result in the transmission of serious
infectious disease to the dental worker.
• It comprises: Heat and cold, Light, Noise, Vibration,
Ultraviolet radiation and Ionizing radiation

25. 2. Chemical hazards
Hazardous chemical agents used in clinical dentistry include
mercury, powdered natural rubber latex (NRL),
3.1 Mercury
• It is use in dental amalgam has the potential for continuous
occupational exposure of a dental practitioner to mercurial vapor
which can be absorbed via the skin and lungs. The active
component in the mercurial vapor has an affinity for brain tissue.

26. Chemical hazards
3.2 Latex hypersensitivity
• Gloves and mask form an integral part of dentist’s protective
equipment. Latex gloves dusted with corn starch powder are
most often used.

27. Chemical hazards
Chemical hazards act in three ways:
a. Local action
b. Inhalation Gases, Dusts, and Metals and their compounds
c. Ingestion.

28. Chemical hazards….
Local action
Some chemicals are absorbed through the skin and cause systemic
effects. Occupational dermatitis are due to machine oil, rubber, x-
rays, caustic alkalis and lime.
Inhalation
• Gases: Carbon di- oxide, carbon monoxide, cyanide gas, sulphur
dioxide etc. causes gas poisoning.
• Dusts: Inorganic dusts such as silica causes silicosis.

29. Chemical hazards….
• Metals and their compounds: Toxic hazards occur from lead,
mercury, cadmium, manganese, arsenic, chromium
etc.
Ingestion
Occupational diseases may also result from ingestion of
chemical substances such as lead, mercury, arsenic, zinc,
cadmium, phosphorous, etc.

30. 3. Biological hazards
Dental patients and dental health care workers may be exposed to a variety
of microorganisms via blood or oral or respiratory secretion. It includes
➢ Cytomegalovirus,
➢ Hepatitis B virus (HBV),
➢ Hepatitis C virus (HCV),

31. Cont’d
➢ Her-pes simplex virus types 1 and 2,
➢ Human immunodeficiency virus (HIV),
➢ Mycobacterium tuberculosis,
➢ Staphylococci,
➢ Streptococci,
➢ other viruses and bacteria especially those that infect the
upper respiratory tract.

32. 4. Psychological Hazards
Dentists encounter numerous sources of professional stress,
anxiety, and depression, beginning in dental clinic.
Prevention
• The goal of coping with stress is to offset the negative effects of
stress by using appropriate coping strategies.
• Coping can be done by, participating in activities that make to feel
better, going to movies or participating in religious, social or other
activities.

33. 5. Musculoskeletal Disorders
Musculoskeletal disorders and diseases of PNS
• At work, the dentist assumes a strained posture both while
standing and sitting close to a patient, while providing care
which causes an overstress of the spine and limbs and the
peripheral nervous system (PNS).

34. Cont’d
• This results in back pain syndrome, neck discopathy,
cervico cranial pains and carpel tunnel syndrome.
Carpel tunnel syndrome:
• It is a defect of the median nerve and cubital nerve. In its
early phase, it is manifested as paresthesia of thumb and
index finger which is accompanied by disorders of the
thumb and index finger.

35. Cont’d
• Carpel tunnel syndrome is
also seen in dental
professionals due to the
Vibrations of hand
instruments.

36. Carpel tunnel syndrome

37. Prevention of occupational hazards
in dentistry
Physical Hazard
1. Light
Poor illumination:
• Causes- eye pain, eye strain, headache and eye fatigue
Excessive brightness
• Causes- discomfort and visual fatigue

38. Cont’d
Prevention of poor illumination and excessive brightness-
• Sufficient and suitable lighting
• Natural or artificial is advised

39. Cont’d
2. Exposure to sound
• Causes- temporary and permanent hearing loss
Prevention
• Personal protection by using ear plugs and muffs which
reduce high intensity sounds by 30 to 35 dB.

40. Cont’d
3. Radiation
Dental personnel are exposed to both ionizing and
non-ionizing type of radiations
a. Non- ionising radiation injury - Exposure to Dental Curing
Light and Lasers
• Causes- conjunctivitis and keratitis
Prevention: Protective eye wear during usage

41. Cont’d
b. Ionizing radiation injury - Exposure to radiation
• Causes- acute erythema, dermatitis, chronic skin cancer, bone
marrow suppression, damaged to eye including cornea.
Radiation effects are cumulative, and this damage is totally
painless yet life threating.
Prevention: Lead gloves and lead apron.

42. Cont’d
4. Exposure to cuts from sharp medical instrument Includes –
needle prick injuries and injuries from sharp objects and
spicules of bone and teeth Needle cut injuries are also known
as percutaneous injuries; they are most efficient method of
transmitting blood-borne infections.
Prevention: Safe working procedures and wearing of double
gloves.

43. Cont’d
5. Aerosols: It is Defined as particles less than 50
micrometers in diameter. These are ejected from
operating site and suspended in the air and are airborne
infection in dentistry. Therefore, Aerosols are
contaminated with bacteria and blood.

44. Cont’d

45. Prevention of Neck, Shoulder and
Back Disorders
Ergonomic dental chair recommendations for
minimizing the risks of back injuries focus on
improving working posture and equipment
design. These include:
1. Change Posture
2. Use Support
3. Safe reaching: Keep the items used most
frequently within a distance of about 20
inches (50 cm). Use assistants to help
move equipment into this zone.

46. Prevention of Neck, Shoulder and
Back Disorders
4. Normal arm posture - Keep elbows
and upper arms close to the body
and don’t raise and tense the
shoulders when working.
5. Use Comfortable Equipment - Use
equipment that isn’t too heavy.
6. Manage Time - Avoid long
appointments

48. Conclusion
• Precaution has to be taken while practicing to prevent occupational hazards.
• Dental clinic design has to be made with, sufficient lighting, ventilation,
engineering control measure and equipped with appropriate personal
protective.
• More effort should be made by management officials to educate the staff
about the importance of Hepatitis B vaccination.
• All staff members should also be alerted to the danger of chronic mercurial
poisoning and its prevention.

49. Waste
management

50. Definition
• Waste Management is collection, transport, processing, recycling
of disposal of waste material. This term usually relates to
materials produced by human activity and is generally
undertaken to reduce effect on health, the environment and
aesthetics.
• Practice of waste management may differ in developing nation to
under developing nation, urban to rural area and residential to
industrial setup.

51. Categories of waste
• Discarded sharps
• Laboratory and associated waste
• Human tissue including solutions containing blood
• Cytotoxic waste
• Pharmaceutical waste
• Chemical waste
• Radiation waste
• General waste

56. Management of dental waste
• Use a color-coded or labeled container that prevents leakage
(e.g., biohazard bag) to contain non sharp regulated medical
waste.
• Used disposable needle syringe combinations, empty or partially
used cartridges of local anaesthetic solution, burs, needles,
scalpel blades, orthodontic bands, endodontic files and other
single use sharp items must be discarded in clearly labelled ,
puncture and leak proof containers.

57. Management of dental waste
• Pour blood, suctioned fluids or other liquid waste carefully into a
drain connected to a sanitary sewer system.
• Sharps containers must be placed in a safe position within the
treatment room to avoid accidental tipping over and must be out
of the reach of small children. Sharps containers must be sealed
when they have been filled to the line marked on the container,
and then collected by licensed waste contractors for disposal
according to local waste management regulations.

58. Summary

60. Control of HIV AIDS, Hepatitis B, C & others
Bacterial and fungal infection