current concepts in asepsis and infection control in a dental clininc
TRANSCRIPT
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INFECTION CONTROL IN INFECTION CONTROL IN DENTAL PRACTICEDENTAL PRACTICE
Dr Arun George MDS Maxillofacial Surgeon, IndiaMar Baselios Dental College
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STERILIZATION
INSTRUMENT MANAGEMENT
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Why Is Infection Control Why Is Infection Control Important Important
in Dentistry?in Dentistry? Both patients and dental health care personnel (DHCP) can be exposed to pathogens Contact with blood, oral and respiratory secretions, and contaminated equipment occurs Proper procedures can prevent transmission of infections among patients and DHCP
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Dental patients and dental health care workers may be exposed to a variety of microorganisms such as bacteria, viruses, and fungi during dental treatment
Among these, the diseases of foremost concern are infections caused by
Human immunodeficiency virus (HIV) Hepatitis viruses B, C, and D Mycobacterium tuberculosis
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Infections may be transmitted in the dental operatory through the following routesDirect contact with blood, oral fluids, or other secretionsIndirect contact with contaminated instruments, operatory equipment, or environmental surfacesContact with airborne contaminants present in either droplet spatter or aerosols of oral and respiratory fluids
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Modes of TransmissionModes of Transmission
Direct contact with blood or body fluids Indirect contact with a contaminated
instrument or surface Contact of mucosa of the eyes, nose, or
mouth with droplets or spatter Inhalation of airborne microorganisms
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Route of transmissionRoute of transmission
Inoculation: Direct contact of previously damaged skin
or mucous membrane with a lesion, organism, or debris while performing intra-oral procedures.
Accidental self injury with a contaminated needle, or sharp instruments
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InhalationInhalation of microorganisms aerosolized from a patient’s blood or saliva occurs when using high speed or ultrasonic instruments
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Universal precautionsUniversal precautions
Universal precautions are a set of precautions designed to prevent transmission of HIV, HBV, and other blood borne pathogens when providing first aid or health care
Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV, and other blood borne pathogens
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Universal precautions - involve the use of protective barriers such as gloves, gowns, aprons, masks, or protective eye wear
Needles, scalpels, and other sharp instruments or devices
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Hand Hygiene & Personal HygieneHand Hygiene & Personal Hygiene
Hands are the most common mode of pathogen transmission
Reduce spread of antimicrobial resistance
Prevent health care-associated infections
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Personal HygienePersonal Hygiene
Visibly dirtyAfter touching
contaminated objects with bare hands
Before and after patient treatment (before glove placement and after glove removal)
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Personal hygienePersonal hygieneAll dental staff who come into direct
contact with patients should practice meticulous personal hygiene
Fingernails must be kept short and jewellery on the hands and watches should be removed since they tend to trap organisms and may tear the gloves
Hair should be put up tightly
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Hand Hygiene DefinitionsHand Hygiene Definitions
Handwashing– Washing hands with plain soap and water
Antiseptic handwash– Washing hands with water and soap or other detergents
containing an antiseptic agent
Alcohol-based handrub– Rubbing hands with an alcohol-containing preparation
Surgical antisepsis– Handwashing with an antiseptic soap or an alcohol-based
handrub before operations by surgical personnel
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Barrier techniquesBarrier techniques
The proper use of barrier techniques as part of universal precautions is extremely important
The wearing of gloves, masks, protective eyewear, and clinic attire by all personnel who have direct contact with the patient is required for all treatment, regardless of their nature
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Gloves Gloves Surgical glovesExamination glovesUtility gloves: heavy rubber gloves used for
cleaning instruments and environmental surfaces
Gloves can be autoclaved and reused; but they must be discarded if they are cracked, discolored or have punctures, tears or other evidences of deterioration
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Aerosols Aerosols
Aerosol is defined as small droplets, usually 50 μm or less in diameter, which can remain suspended in air for some time.
The smaller particles of an aerosol have the potential to penetrate and lodge in the smaller passages of the lungs and are thought to carry the greatest potential for transmitting infections
Diseases such as tuberculosis, influenza, and SARS (Severe Acute Respiratory Syndrome) are known to be spread by droplets or aerosols
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Dental handpieces, airotors, air/water syringes, and ultrasonic scalers produce large amounts of aerosols.
The risk of infection from aerosols can be minimized by
Use of protective barriers Pre-procedural rinsing with 0.2% chlorhexidine;
reduces the bacterial count in the aerosols Proper patient positioning Use of saliva ejectors and high volume suctions
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Saliva EjectorsSaliva Ejectors
Previously suctioned fluids might be retracted into the patient’s mouth when a seal is created
Do not advise patients to close their lips tightly around the tip of the saliva ejector
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HIGH VOLUME EVACUATION (SUCTION)
SALIVA EJECTOR
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Biofilms Biofilms Adhesion of bacteria and
other microorganisms to solid surfaces in aqueous environments can result in the formation of a slime-like material called biofilm
Biofilm protects the bacteria from disinfectants and can trap other potentially infective microorganisms
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Biofilms can form within dental water lines by two ways
Bacteria may be pulled into the water lines during treatment from the patient’s mouth which may later transmit to other patients
Bacteria present in the main water supply can concentrate in the dental unit water line especially in warm and stagnant conditions
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Biofilm formation can be minimized by Independent water reservoirs for the dental
unit Using sterile water Drain and flush water lines for several
minutes before beginning clinic each day After each patient, run high-speed
handpieces and scalers for a minimum of 20-30 seconds to discharge contaminated water and air that may have entered the water line
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Dental Unit Waterlines Dental Unit Waterlines and Biofilmand Biofilm
Microbial biofilms form in small bore tubing of dental units
Biofilms serve as a microbial reservoir
Primary source of microorganisms is municipal water supply
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Flushing the scalers and handpieces (bleeding) for 30 seconds between each patient can discharge the contaminated water that have entered the water line
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Handling of sharp instrumentsHandling of sharp instrumentsCare must be taken while handling needles and
other sharp instruments during and after procedures, while cleaning used instruments, and during disposal of used needles.
Forceps must be used to handle sharp instruments
Disposable needles, scalpel blades and other sharp items should be discarded into puncture-resistant containers that are easily accessible for disposal
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When recapping needles, both hands should never be used; instead, a one-handed “scoop technique” or another instrument should be used
Wrong method“scoop technique”
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Never touch sterile instruments or other materials like cotton with contaminated gloved hand or used instruments
Sterilized materials and instruments should be handled with a sterilized cheatel forceps, which should be stored with the tip immersed in a disinfectant solution
Handling sterile instruments
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Chittle ForcepsChittle Forceps
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Anaesthetic SolutionAnaesthetic Solution
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Local AnaestheticLocal Anaesthetic
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Special ConsiderationsSpecial Considerations Dental handpieces and other
devices attached to air and waterlines
Dental radiology Single-use (disposable)
Devices Preprocedural mouth rinses Oral surgical procedures
Handling biopsy specimens Handling extracted teeth Laser/electrosurgery
plumes or surgical smoke Dental laboratory Mycobacterium
tuberculosis Creutzfeldt-Jacob Disease
(CJD) and other prion-related diseases
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Sterilization Sterilization
Process by which all forms of microorganisms including viruses, bacteria, fungi, and spores over articles or surfaces are destroyed
Articles or objects free of living organisms are termed sterile
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Methods of sterilizationMethods of sterilization
Moist heat (autoclaving) Dry heat (hot-air oven)Chemicals (chemiclaving)
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Most preferred method of sterilizationSteam Under pressure
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Recommended sterilization Recommended sterilization cycles for autoclavingcycles for autoclaving
Temperature Time Pressure
Unwrappedinstruments
1340C 3 min 30 psi
Wrappedinstruments
1210C 15-20 min
15 psi
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Packaging and sealing of Packaging and sealing of instruments instruments
Instruments should be carefully packaged in functional sets before sterilization.
This packaging protects the instruments after sterilization and before use at chair side
A variety of packaging materials are available
Self-sealing, paper-plastic, peel pouches are the most convenient
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Some packaging materials have indicators which change color when sterilization is completed
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Boiling Boiling
Immersion of instruments in boiling water does not achieve sterilization as many of the bacterial spores can withstand boiling
Cross infection from contaminated water containing bacterial spores not killed by boiling is also a possibility
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Classification of Instruments to Classification of Instruments to be Sterilizedbe Sterilized
Dental instruments are classified into three categories depending on their risk of transmitting infection and the need to sterilize them between use
critical Semi-critical Non-critical
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Critical Critical Surgical and other instruments used to penetrate
soft tissue or bone Should be sterilized after each use
Examples are Forceps, periosteal elevators, cross bars Scalpels, scissors, suture needles Bone chisels Surgical burs Scaling instruments Endodontic instruments
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Semi-criticalSemi-critical Instruments that do not penetrate soft tissue or
bone but contact oral tissues These instruments should also be sterilized after
each useExamples are Mouth mirrors Burs Handpieces Tweezers Restorative instruments Impression trays
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Non-criticalNon-critical Those items, which do not come into contact with
body fluids Have a relatively low risk of transmitting infectionExamples are Medication bottles Light cure tips Glass slab and cement spatula Instrument trays Orthodontic pliers Dapen dish
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Surface asepsisSurface asepsis
Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs)
Change surface barriers between patients
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Disinfection of Dental Disinfection of Dental EquipmentsEquipments
Clinical contact surfaces and dental equipments that are not covered should be cleaned and disinfected with a hospital level disinfectant (activity against HIV, HBV, and Mycobacterium tuberculosis) after each patient.
Sodium hypochlorite (household bleach) is an effective and economical surface disinfectant
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DISINFECTANTS
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AntisepticsAntisepticsBiguanides:
ChlorhexidineLow toxicity
– Used on skin and mucous membranes
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Clinical Contact SurfacesClinical Contact Surfaces
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Housekeeping SurfacesHousekeeping Surfaces
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Spray-wipe-spray techniqueSpray-wipe-spray technique Spray the disinfectant
solution on the surface Using a gauze piece, wipe
the surfaces in overlapping strokes
Spray again Allow the disinfectant to dry
on the surface for about 10 minutes
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Autoclaving
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U V ChamberU V Chamber
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Instrument StorageInstrument Storage
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Autoclaved TowelAutoclaved Towel
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GlovesGloves
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Hand DisinfectantsHand Disinfectants
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Alcohol Alcohol
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Dental Handpieces and Other Devices Dental Handpieces and Other Devices Attached to Air and WaterlinesAttached to Air and Waterlines
Clean and heat sterilize intraoral devices that can be removed from air and waterlines
Follow manufacturer’s instructions for cleaning, lubrication, and sterilization
Do not use liquid germicides or ethylene oxide
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Handpiece Disinfection & OilingHandpiece Disinfection & Oiling
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Air CompressorAir Compressor
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Waste ManagementWaste Management
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Sharp InstrumentsSharp Instruments
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Dental Chair CareDental Chair Care
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ApronApron
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Infection Control Program GoalsInfection Control Program Goals
Provide a safe working environment– Reduce health care-associated
infections – Reduce occupational
exposures
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