infection control


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Infection control for dental facilities

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infection control

  1. 1. Infection Control is a way to minimize the transmission of microbes in the dental office.
  2. 2. Diseases could be transmitted in a dental setting in three ways –  from patient to dental-care provider,  from patient to patient, and  from dental-care provider to patient Dentist Patient Dental nusre
  3. 3.  Air borne contamination- High speed hand pieces capable of producing air contaminants e.g. aerosols and spatter. › protection by: masks and high volume suction devices.  Direct-when there is direct contact with body fluids  Indirect-touching the saliva contaminated operatory surfaces, handles, dental charts and other equipment
  4. 4.  Detailed medical history  Consider every patient a potentially infected patient.  Hand washing instructions- at least 10 seconds, rubbing all surfaces of hand  Personal Barrier protection: › Gloves › Protective eye wear › Face Masks, Face shields › Hair protection (head cap) › Protective over garment
  5. 5.  Disposal in special sharps bin  Careful passing of instruments  Needle stick injury precautions › Two handed recapping of needle not permitted
  6. 6. What are different infection control procedures?
  7. 7.  Disinfection? › Cleaning an article of some or all of the pathogenic organisms which may cause infection › Common disinfectants: alcohol, gluteraldehyde, chlorhexidine › high level disinfection for 20 -90 minutes can be done with gluteraldehyde dip for plastic instruments. Does not kill spores. › Surface disinfection with alcohol / chlorhexidine
  8. 8.  Sucction devices  Napkins  Paper glasses  Plastic wraps over all unsterilizable surfaces and equipment  Rubber cup  Needles/ syringes
  9. 9. Any process that effectively kills or eliminates transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) from a surface, equipment or medication
  10. 10.  Instrument manual washing  Cleaning › cleaned in a ultrasonic cleaner  Packaging wrapping into plastic bags and sealed
  11. 11. Four basic types:  Steam sterilization (Autoclave)  Chemical vapor pressure sterilization (chemiclave)  Dry heat sterilization (dry clave)  Ethylene oxide sterilization (ETOX)
  12. 12.  Sterilization with steam under pressure  Regular cycle: 121oc for 15 mins and 15 lbs pressure  Short cycle: 134oc for 7 mins and 30lbs pressure  Most effective method of sterilization  Surgical instruments and clothes can also be sterilized  Can rust carbon steel instruments and burs  Items sensitive to elevated temperatures cannot be sterilized
  13. 13.  Sterilization by chemical vapor such as formaldehyde under pressure  131oc at 20lbs pressure cycle time of 30 mins.  Corrosion sensitive burs can be sterilized without corrosion  Towels and clothes cannot be sterilized
  14. 14.  Achieved by 160oc for 30 mins  Short cycle up to 191oc for 6 mins  Carbon steel instruments can be sterilized  Heat sensitive items like plastics and rubber can be damaged by high temperatures
  15. 15.  Best method for sterilizing complex instruments and delicate materials  Automatic devices operate for several hours or overnight at temperature below 100oc  Very expensive equipment
  16. 16. Do all dental instruments need to be sterilized?
  17. 17.  Critical Penetrates soft tissue, contacts bone, enters into or contacts the blood stream or other normally sterile tissues. E.g. Surgical instruments, periodontal scalers, endodontic files. Sterilization is a must.  Semi critical Contacts mucous membrane or non intact skin, will not penetrate soft tissue, contact bone enters into or contacts the blood stream or other normally sterile tissues. E.g. Dental mouth mirror, amalgam condenser, dental handpieces . should be sterilized  Non critical Contacts intact skin. E.g. Radiograph head/ cone, blood pressure cuff, facebow, pulse oximeter. Need to be disinfected only
  18. 18. Where should infectious waste go?
  19. 19. •Needles, syringes or sharp instruments - Sharp items (needles, scalpel blades, discarded endodontic files and other sharp instruments) should be discarded in the sharps container, incinerated later. •Infected blood and other liquid waste can be poured down in sanitary sewer •Contaminated gloves, masks and other items should be discarded safely
  20. 20.  Water used for mouth rinse should be of potable standard.  Water required for irrigation for tooth preparation and ultrasonic scaling should be no less than potable standard.  Air and water lines should be flushed for a minimum of two minutes at the start of the day and for 30 seconds between patients
  21. 21.  Tubing of high volume suction and saliva ejectors: › flushed with water after every patient. › flushed with Sodium Hypochlorite (0.1%) periodically.  The filters of vacuums should be cleaned of debris once a week.
  22. 22. Is there a way to ensure that sterilization has worked?
  23. 23.  chemical,  mechanical and  biological monitors according to the manufacturer’s instructions.  If spore test found positive, sterilizer should not be used until it has been inspected or repaired.
  24. 24. Do we need to take additional precautions for known infected patients?
  25. 25.  These patients should be scheduled at the end of the list.  Operators and assistants should wear two pair of gloves, plastic gown, cap mask, protective eyewear.  High volume suction should be used, rubber dam should be applied to minimize the formation of aerosols.  All used instruments should be packed in a labeled plastic wrap.  After the procedure, all equipment and surfaces inside the operatory should be cleaned and decontaminated with appropriate disinfectant (0.5% Na Hypochlorite).
  26. 26. Impressions should be: › rinsed thoroughly to remove visible blood and debris. › sprayed with disinfectant › Sealed in zip locked bag before sending to laboratory
  27. 27. Who sets infection control guidelines?
  28. 28.  CDC- Centers for disease control and prevention  OSHA- Occupational safety and health Administration  WHO- World Health Organization  PMDC- Pakistan Medical and dental council  Hospital in-house infection control committee
  29. 29. That’s all for today!