infection control measures important as procedure important, we should follow all the protocol which gives proper sterilization and aseptic condition. now a days implant surgery is most common daily practices done by the dentist in the clinics and it becomes more critical to have a sound knowledge about infection control.

1. Abhay Kr. Dixit
JR-1
Department of Prosthodontics

2. CONTENTS
1) INTRODUCTION
2) CLASSIFICATION OF INSTRUMENTS
3) PRINCIPLES OF INFECTION CON
4) PERSONAL BARRIER PROTECTION
5) STERILIZATION
6) DISINFECTION
7) STORAGE OF STERILIZED ITEMS
8) EMERGENCY & EXPOSURE INCIDENT PLAN
CLINICAL WASTE DISPOSAL
9) CONCLUSION

3. INTRODUCTION
WHAT IS INFECTIN?
Infection is the invasion of an organism's body
tissues by disease-causing agents
Infections are caused by infectious agents
including viruses, viroids, prions, bacteria&
nematodes

4. DEFINITIONS
 INFECTION CONTROL
 STERILIZATION
 DISINFECTION
 ASEPSIS

5. Classification of Instruments
CRITICAL: Which come contact with blood and
oral fluid eg. forcep, scalpel ,burs , bone chisel
SEMI-CRITICAL: Do not penetrate to the soft
tissue but come contact with saliva eg. mouth
mirror, plastic instrument suction tips , hand
piece , wax knife
NON-CRITICAL: Which do not come contact with
body eg. chairs and supporting instrument
'according to the centre of disease controle'

6. Pathway of cross
infection
 Patient Dentist [common]
 Dentist Family [not uncommon]
 Dentist Patient [rare]
 Patient 1 Patient 2

7. Principles of infetion
control
 principle 1: stay healthy
 principle 2 : avoid contact with blood
 principle 3: limit the spread of blood
 principle 4 : make object safe for use
 principle 5 : patient screening

8. Strategy to achieve infection
control
 All patient must be screend
 Barriers for personal protection
 Carefull aseptic technique
 sterlization and disinfection
 Disposal of contaminated waste safely
 Laboratory asepsis

9. Screening of patient

10. PERSONAL BARRIER
PROTECTION
 PPE is essential to protect the skin and the
mucous membranes of personnel from exposure
to infectious.
 The various 5 barriers PPE are
1. Head cap
2. masks,
3. Gloves,
4. protective eye wear, &
5. over garments

11. HAND CLEANSERS
 CHLORHEXIDINE BASED
2- 4% chlorhexidine gluconate with 4% isopropyl
alcohol in a detergent solution with a pH of 5.0 to 6.5.
 POVIDONE IODONE
contain 7.5-10% povidone
 PARACHLOROMETEXYLENOL
bactericidal and fungicidal at 2% concentration.
 ALCOHOL HAND RUBS
ethyl alcohol and isopropyl alcohol are widely
used at 70% concentration

12. HAND WASHING

13. STERILIZATION
 Heat sterilize all metal and heat-stable instruments
that contact oral tissues, contaminated appliances,
or potentially contaminated appliances after each
use.
 Examples: facebow fork, metal impression trays,
burs, polishing points, rag wheels, laboratory
knives.

14. Type of sterlization
Mechanical Chemical
1. Sunlight
2. Drying
3. Dry heat
4. Moist heat
5. Filtration
6. Radiation
7. Ultrasonic and sonic vibrations
1. Alcohol
2. Aldehyde
3. Dyes
4. Halogens
5. Phenols
6. Surface active agents
7. Metallic salts
8. Gases

15. Flaming
A simple & effective method
Tips of the instruments are held
in a Bunsen flame till they
become red-hot.
These materials may be dipped
in a disinfectant before flaming

16. INCINERATION
This is an excellent method for safely destroying
materials such as contaminated cloth, animal
carcasses and pathologic materials.

17. HOT AIR OVEN
• This is the most widely used
method of sterilization by dry
heat.
• A holding period of
• 160oC( 320oF) for 1 hr
• used to sterilize
• glassware,
• swabs,
• liquid paraffin,
• dusting powder,
• fats and grease

18. GLASS BEAD AND HOT SALT
STERLISER
The glass bead steriliser uses a
metal cup with glass beads of 1 mm
diameter in it
The hot salt container uses ordinary
table salt
The temperature range for both
varies from 425oF to 475oF
Both are used to sterilise
endodontic instruments

19. Moist Heat
 Moist heat kills microorganisms by
denaturing proteins..
 Moist heat penetrates material much
more rapidly than dry heat because
water molecules conduct heat better
than air.
 Broadly divided into 3-
below , at and above 100*C

20. PASTEURIZATION
Its purpose is to reduce the
bacterial population of a liquid such
as milk and destroy organisms that
may cause spoilage
Spores are not affected by this
method

21. Boiling water is not considered as a sterilizing agent. It
is considered as a method for disinfection
A minimum exposure period of 30min. is recommended
to kill vegetative bacteria.
Sodium bicarbonate 2% conc. is added to increase the
efficiency of process.

22. STEAM UNDER PRESSURE
(AUTOCLAVE)
 The basic principle is that when the
pressure of a gas increases the
temperature increases
 Pressure in autoclave – 15lbs/sq. inch
Temperature - 121*C Time - 15 min
 FLASH METHOD 30lbs,3 min,131*C

23. DISINFECTION
Disinfection does not necessarily kill all
microorganisms, especially resistant
bacterial spores.
It is less effective than sterilization,

24. Levels of Disinfection
 High level: inactivates bacterial spores and all forms of
bacteria,fungi,and viruses depending on contact time can be
either a disinfectant or a steriliant, eg.
glutaraldehyde and oxidising agent
 Intermediate level: inactivates all forms of microorganisms
except spores,kills mycobacterium tuberculosis ,bovis, eg.
clorine compound and alcohol
 Low level: inactivates vegetative bacteria and some lipophilic
viruses but is not tuberculocidal or sporocidal, eg.
Quaternary ammonium compound

25. CHEMICALS & THEIR ADVANTAGES
DISADVANTAGES
CHEMICAL ADVANTAGE DISADVANTAGE
CHLORINES Rapid action, Broad
spectrum, Economical
Prepare solution
daily, Diminished
activity by organic
matter ,Corrosive
IODOPHORES Broad spectrum, Few
reactions, Residual
biocidal activity
contact time critical
Discoluration Prepare
solution daily
SYNTHETIC
PHENOLS
Rapid action Broad
spectrum Compatible
with most metal
Degrades certain type
of plastic over time
Difficult to rinse Film
accumulation Alchol
base products are fair
to poor cleaning ability

26. Item Recommended
Method
Alternative Method
Dental chairs Clean with detergent
and
water
If there is visible blood
or pus,
clean and disinfect
with 0.5%
sodium hypochlorite or
2%
glutaraldehyde, rinse
Dental mirrors Clean with detergent
water, autoclave, store
covered pack or
container

27. Item Recommended
Method
Alternative
Handpieces
Air motor
handpieces
for slow speed
Flush for 30 sec.,
Clean with detergent
water, oil, and
autoclave
and
Flush or 30 sec.,
Clean with detergent
and
water, oil, surrounding
the
handpiece by a gauze
pad
soaked in 2%
glutaraldehyde
for 10 mins., rinse
with water
Articulators Wipe with 70% ethyl
alcohol
Burs – diamond Clean with metallic
brush and
detergent, autoclave
Burs - steel
tungsten-carbide
Clean with metallic
brush and
detergent, rinse, dry
and dry

28. Item Recommended
Method
Alternative
Denture Clean
with detergent and
water
If contaminated with
blood,
immerse in 0.1%
sodium
hypochlorite for 10
mins. and
rinse
Polishing stones Clean with detergent
&
water, autoclave
Wax bite block, Rinse, immerse in
0.1%
sodium hypochlorite
for 10
mins., rinse

29. Dental implant
 Effect of different sterilization modes on the
surface morphology,ion release, and bone reaction
of retrieved micro-implants by Noha El-
Wassefya; Abeer El-Fallalb; Mahasen Taha
 SEM analysis indicated that the processes of
sterilization did not alter the micro-implant surface
topography
 The autoclave-sterilized micro-implants showed
better histologic results than the micro-implants
sterilized by gamma rays or ultraviolet rays.

30. DENTAL LABORATORY
 All disinfection procedures are accomplished prior
to delivery to lab.
 Done in dental operatory or professional work
area.
 Recommend a sign and monitor system be
implemented stating
“Only Biologically Clean Items Permitted”

31. INCOMING ITEMS
 Rinse under running tap water to remove
blood/saliva
 Disinfect as appropriate,
 Rinse thoroughly with tap water to remove
residual disinfectant,
 No single disinfectant is ideal or compatible with
all items &
 Annotate the DD Form ....... “Disinfected with
______ for _____minutes”

32. OUTGOING ITEMS
 Clean and disinfect before delivery to patient,
 After disinfection: rinse and place in plastic bag
with diluted mouthwash until insertion,
 Do not store in disinfectant before insertion &
 Label the plastic bag: “This case shipment has
been disinfected with ______ for _____ minutes”

33. IMPRESSIONS
 Many studies have been performed to evaluate
effects of various disinfectants on different types of
impression materials,
 Research findings have been contradictory,
 No single disinfectant is compatible with all
impression materials,
 The least distortion is associated with products
having the shortest contact times

34. Variables affecting
Impression materials
 Composition and concentration of disinfectants,
 Exposure time and compatibility of various
disinfectants with specific impression materials &
 Physical/chemical properties can vary in a given
category of material or disinfectant.
 The ADA recommends chemical disinfection of all
impressions and dental prostheses An acceptable
disinfectant is sodium hypochlorite

35. METHODS OF DISINFECTION
1. Spraying,
2. Dipping/Immersing

36. SPRAY TECHNIQUE
 Rinse entire impression/tray under running tap
water after removal from oral cavity.
 Trim excess impression material from noncritical
areas ,Reduces number of microorganisms and
organic debris present.
 Place impression in bag and liberally spray the
entire impression/tray.
 Seal bag to create “charged atmosphere”
 Reduces exposure to vapors and liquid

37.  Remove from bag at end of exposure time; rinse
and pour.
 Once stone has set, remove cast from impression.
 Dispose of impression material and disposable
tray (if applicable) in general waste &
 Sterilize reusable tray (if applicable).

38. Advantages and Disadvantages
Advantage Disadvantage
Uses less disinfectant, –
Same disinfectant can often be
used to disinfect environmental
surfaces
Probably not as effective as
immersion, –
Can be released into air
increasing occupational exposure.

39. DIPPING/IMMERSION
TECHNIQUE
 Select disinfectant with short exposure time to
minimize distortion and deterioration of surface
quality of resulting stone cast.
 Follow same procedures as above except fully
immerse or dip impression in disinfectant for
recommended exposure time
 Do not use water based glutaraldehyde solutions
with a pH of 8 or higher for since this might affect
the gypsum surface.

40. DENTAL CASTS
 Very difficult to disinfect.
 Cast should be fully set (at least 24 hours) before
disinfection.
 Is preferable to disinfect impression.
 If casts must be disinfected: – Place casts on end
to facilitate drainage, – Spray with iodophor or
chlorine product, then rinse.
 Another option – Soak casts for 30 minutes in
0.5% concentration of sodium hypochlorite and
saturated calcium dihydrate solution (SDS) – SDS
is produced by placing uncontaminated, set
gypsum (i.e. stone) in a container of water.

41. DENTAL PROSTHESIS
 Do not exceed manufacturer’s recommended
contact time on metal components to minimize
corrosion.
 There is little effect on chrome-cobalt alloy with
short-term exposures (10 minutes).
 Do not store in disinfectant before insertion.
 Store in diluted mouthwash until insertion.

42. IMPRESSION TRAYS
1. Precleaning removes bio-burden and any
adherent impression material.
2. Ultrasonic cleaning can aid in removing
residual set gypsum.
3. Chrome-plated or aluminum trays – Clean,
package & heat sterilize.
4. Single-use trays – Discard after one use.
5. Custom acrylic trays – Can be disinfected (by
spray or immersion), then rinsed (if to be used for
second appointment).

43. WAX BITES/RIMS, BITE
REGISTRATIONS
Immersion disinfection may cause distortion to some items –
Use spray disinfection
Heavy-body bite registration materials – Usually not
susceptible to distortion and can be disinfected in same
manner as an impression of the same material.

44. impression material glutarldehyde idophores sodium
hypochlorit
e
ALGINATE
POLYSULFIDE
SILICON
POLYETHER
REVERSIBLE
HYDROCOLLOID
COMPOUND
NO
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
prosthetic materials
COMPLETE DENTURE
R.P.D
F.P.D
STONE CAST
WAX RIM BITE
NO
NO
YES
NO
NO
YES
YES
NO
YES
YES
YES
NO
NO
YES
NO

45. CLEANING AND DISINFECTION
STRATEGIES FOR BLOOD SPILLS
 Strategies for decontaminating spills of blood and
other body fluids differ by setting and volume of
the spill.
 The person assigned to clean the spill should
wear gloves and other PPE as needed.
 Visible organic material should be removed with
absorbent material (e.g., disposable paper towels
discarded in a leak- proof, appropriately labeled
container).

46. POST EXPOSURE
PROPHYLAXIS
Management of exposure includes:
 General wound care and cleaning.
 Counseling of the exposed worker regarding blood
borne pathogens.
 Source patient testing for HBV,HCV and HIV (consent
required).
 Post exposure assessment and prophylaxis for the
health care worker.

47.  Postexposure prophylaxis is started
ideally within 2 h and not later than 72 h
after exposure.
 WHO Recommended the use of
HAART regimens for all significant-risk
 occupational exposures when the HIV
is evaluated within 36 hours of
exposure.

48. Bio-Medical Waste
Management

49. Tips for protecting dental
instruments
 Clean as soon as possible to remove corrosive
materials such as blood.
 Keep instruments from knocking against each
other as much as possible during the cleaning
process.
 Do not store for longer period of time in water or
chloride solutions.
 Only use cleaning solutions that are
recommended for dental or medical instruments.

50.  Rinse well after cleaning.
 Use distilled or deionised water in steam
sterilizers to avoid water spotting of instruments
and damage to sterilizer.
 Use rust inhibiters for carbon steel items.
 Dry items prior to processing through dry heat or
chemical vapour temperature.

51. CONCLUSION
 As we have discussed lots of infections &
preventive methods , which will make sure the
safety for both the doctors & patients.
 So, it is the duty & responsibility for each & every
doctor and a technician to follow the infection
control protocol such as sterilization & disinfection
methods in order to protect the patients from
contagious disease & microorganisms.

52. We further assure the sterility of our
instruments through the use of several
monitoring processes
 Mechanically:We pay careful attention to the time,
temperature, and pressure of the sterilization
equipment.
 Chemically:We use heat-sensitive indicators that
change color when a certain temperature is
reached.
 Biologically:We conduct weekly spore testing to
ensure the most resistant microbial contaminants
are eliminated during sterilization, signifying that
common potential pathogens have also been
killed.

53. REFERENCES
 The art & science of operative dentistry-
Sturdevant
 Textbook of microbiology – C.P.BAVEJA
 Davidsons principles and practice of medicine
 Practical Infection Control in Dentistry -James A.
Cottone 6.
 CDC. Guidelines for infection control in dental
health-care settings – 2003. MMWR 2003; 52(No.
RR-17):1–66. Available at
www.cdc.gov/oralhealth/infectioncontrol.
 Infection Control Cover Story JADA VOL.134, MAY
2013.
 Textbook of DENTAL MATERIALS PHILLIP'S
 Google