cross infection control in operative dentistry and endodontics cross infection control in conservative dentistry prevention of cross infection

2. Cross Infection Control in
operative dentistry
Presented by : Dr. AMNA AMIR
(Operative Dentistry& Endodontics)
SOD,SZABMU Islamabad

3. CONTENTS
 INTRODUCTION
 CHAIN OF INFECTION
 METHODS OF DISEASE TRANSMISSION
 OSHA GUIDELINES
 HAND HYGIENE
 PERSONAL PROTECTIVE EQUIPMENT
 DENTAL WASTE MANAGEMENT
 INSTRUMENTS PROCESSING
 STERLIZATION IN DENTAL OPERATORY
 DISINFACTING SURFACES

5. What is Cross infection?
 “Transmission of infectious agents between patients and
dental staff within a clean environment”

6. Ways of Cross infection Control:
 Sterilization: process of killing all microorganisms both
vegetative or spore form.
 Disinfection: process that eliminates many or all pathogenic
microorganisms except bacterial spores.
 Antiseptic: alcohol based chemicals applied on skin or
mucous membrane surfaces for preventing infection by
controlling growth of bacteria.

7. Why infection control Important in
Dentistry?
 Both patients and dental staff are exposed to pathogens
 Contact with blood, saliva and aerosols and contaminated equipment
occurs
 To break chain of infection

9. Exposure risks in dental operatory:
 A) Airborne contamination
 B) Hand-to-surface contamination
 C) Cross infection
 D) Patient vulnerability
 E) Personnel vulnerability

10. A) Airborne Contamination
 A high speed handpiece is capable of
creating airborne contaminants in the form
of aerosols, mists and spatter
 These droplets varying in size remain
suspended in air, has potential of causing
infection to dental personnel.

11. B)Hand-to-surface contamination:
 With saliva contaminated hands the dentist could repeatedly
contact unprotected surfaces while doing procedures
 Amalgamators, light curing devices, camera equipment and
even mobile phones are also contaminated by soiled hands.

12. C) Cross infection:
 Direct contact: with blood or body fluids
 Indirect contact with contaminated instruments or surfaces
 Inhalation of airborne microbes
 Contact of mucosa of eyes, nose or mouth with droplets or
spatter(high speed handpiece/triple syringe)

13. D) Patient vulnerability
 Transmission of infections from dentist to patients
 It appears to be low
E) Personnel vulnerability
 Exposure of saliva, blood and possible injury from sharp
instruments during dental procedures or during handling of waste.
 Dental personnel is more vulnerable to infections if not had proper
immunization or used protective barriers

14. OSHA guidelines of Exposure Control:
 Use of universal precautions
 Use of personal protective equipment
 Standardized housekeeping
 Laundering of contaminated protective clothing
 Policy on general waste disposal
 Labelling procedure
 Policy on sterilization and disinfection
 Standardized hand washing protocols
 Hepatitis B (HBV)vaccination
 Postexposure evaluation and medical follow-up

15. Universal Precautions:
 Wash hands before & after every patient.
 Wear gloves when touching and examining the patient, while
performing procedures ,when touching contaminated items &
changing barriers and handling waste.
 Handle sharps with care
 Wear mask, eye protection or face shields
 Use of barrier tapes on all the surfaces that dentist and dental
assistant might touch while performing procedure on patient.
 Disinfecting surfaces with halogen compounds or aldehydes.
 Immunization

16. Hand Hygiene:
Wearing gloves DO NOT
replace need of hand
washing
Wash hands before
putting on gloves and after
removal.
Long fingernails can
harbour pathogens, nails
should be kept short.

17. Personal protective equipment(PPE):
 Protective clothing (scrubs &
overalls)
 gowns
 Face shields
 Protective eyewear
 Gloves
 Face mask
1. With at least 95% filtration
efficiency for particles 3-5
micrometres in diameter
2. CDC Recommendation for
changing mask after 20 min in
aerosol& 60 min in non-aerosol
environment.

18.  Single use.
 “Last to wear and first to remove”

19. Maintaining infection control while gloved:
 Anticipate required materials and have those items available on
chairside for procedure to save time and minimize cross-
contamination.
 Use paper towel, tongs or plastic bag over gloves to handle
equipment or to open cabinets and drawer to get things that were
not anticipated during setup.
 Use sterile cotton plier to remove an item from the container.
 Do not touch surfaces with contaminated gloves like door handles ,
x-ray monitor, mobile phones etc.

20. Setting chairside instrument tray:
 Don’t put the instrument pouch on napkin.
 Open instrument pouch with bare hands and discard the pouch.
 “Whatever is touched is contaminated”

22. Hospital waste categories and disposal

23. Managing Contaminated
Sharps:
 Contaminated needles and other
disposable sharps must be placed
into sharps container.
 The sharp container must be
leakproof and color-coded and
located as close as possible.
 Always use the single handed
scoop technique to remove
needle from plunger.

24. Flushing Dental Unit Waterlines:
HOW?
 Flush waterlines 2-4 minutes at the start and the end of each
working day and for 30 seconds between patients by
dispelling water into a sink.
 ADA recommends Dental unit waterline should be periodically flushed with
water or 1:10 dilution of 5% NaOCl to reduce biofilm formation.
WHY?

26.  Anti-retraction valves(one way flow check ) in triple syringe &
handpiece.
 Periodically disfunction..

27. Instruments Processing:
1) Pre-soaking:
 Placing the instruments in a presoak solution until time is available for full
cleaning prevents drying and begins to dissolve or soften the
debris.
 Presoak solutions used are detergents, enzyme cleaners, phenols, quaternary
ammonium compounds.
2) Cleaning:
 All items to be sterilized must be properly cleaned first to reduce bio-burden.
 Two methods
1. Hand scrubbing
2. Mechanical cleaning e.g. Ultrasonic cleaners

28. Manual cleaning Ultrasonic cleaning
 Takes 5-15 mins
 Safest
 9 times more efficient than hand
cleaning
 Time consuming
 Accidental punctures with sharp
instruments

29. 3) Packaging:
3) Sterilization:
4 accepted methods of sterilization-
1)Steam pressure sterilization(Autoclave)
2)Chemical vapour pressure sterilization(Chemiclave)
3)Dry heat sterilization(Dryclave)
4)Ethylene oxide sterilization(ETOX)

35. Endodontic instruments sterilization
 Steam under pressure
autoclaving reliably produce
completely sterile
instruments
 Operates at 121°C at
15Ibs pressure for 15
minutes.

36. Sterilization of Burs in Autoclave:
 Burs can be protected from rusting by keeping them submerged in 2%
sodium nitrite solution.
 Steps:
 Ultrasonic cleaning rinse with tap water place burs in metallic/glass beaker
with a perforated lid  pour fresh nitrite soln. at the level 1cm above burs place
container in autoclave for sterilization.
 Fluid from container is discarded through the perforated lid
 Sterile forceps is used to place burs in sterilized bur holder or tray.

37.  Dry heat sterilization:
 Hot air ovens
 For carbide steel burs only to prevent rust & corrosion.
Disadvantage:
 Prolong time 160 °C for 60mins/ 170 °C for 30mins

38. Handpiece Sterilization:
(AUTOCLAVE)
 The internal surfaces of handpiece become contaminated with blood and
debris and limited access to internal surfaces limits its cleaning and
disinfection thus disinfection is not adequate.
 Handpiece must be first cleaned and then sterilized after each patient
 Cleaning can be done by wiping the handpiece with suitable disinfectant
like alcohol
 Lubricate handpiece before sterilization
 And then sterilize it by autoclaving.

39. Other methods:
 Chemical vapour pressure sterilization for ceramic bearing handpieces.
 ETOX gas sterilization.- overnight
NOTE: Anti-retraction valves should be installed(one-way flow check)to
prevent aspiration and transfer of potentially infective material to subsequent
patient.

40. Sterilization of Gatta Percha points:
 Presterilized Gutta percha points must be stored in sterile screw
capped vials containing Alcohol
 To sterilize contaminated Gatta percha cones freshly removed from
box, immerse in 5% NaOCl soln. for 1 min then rinse with
Hydrogen Peroxide and dry between 2 layers of sterile gauze.

41. Sterilization of Endodontic Files:
(Autoclave)
Pick used files with
tweezer
Place in glass
beaker containing
a nonphenolic
disinfectant
At the end of day
,discard solution
and rinse with tap
water
Add ultrasonic
cleaner ,place
beaker in
ultrasonic bath for
5-15 min
Discard solution,
rinse with tap
water
Pour files on clean
towel to dry
Transfer into metal
box(endobox) with
tweezers
Sterilization in
Autoclave

43. New advancements:
 Single use pre-sterilized endodontic files & burs
 Laser sterilization
 CO2 laser
 100% effective

44. Disinfecting Surfaces:
 Crucial for cross-infection control
 Daily cleaning at the end of operating day.
 All surfaces should be cleaned with detergent
 Disinfect dental units before starting patients, between patients and at the
end of day.
 If contaminated with blood/body fluids use phenols
 Walls must be wiped down to hand height everyday.
 Floors should be cleaned with warm water and detergents.
 Storage shelves and cabinets should be routinely cleaned and restacked.
 Every surface under barrier tape should be cleaned.

46. ATP bioluminescence

47. Thank you