Infection Control
Lab 9
Introduction
Infectious diseases occur as a result of invasion of micro-organisms (m.o.) into
a living system or due to the actions of the products of micro-organisms or a
combination of both .
Typically,the(m.o.) that may responsible for disease in a human host are classified
into four groups:
1-Bacteria. 2-Viruses. 3-Fungi. 4-Protozoa.
The dental environment is associated with a significant risk of exposure to various m.o. ,
many infectious agents may be present in blood ,saliva or respiratory secretions.
Infectious diseases are always serious and can be life threatening hazard to the health
care workers, including dental health care workers .
Two issues need to be considered relating to this problem:
1-Transmission of infection from infected patients to dental health care workers.
2-Transmission of infection from infected workers to the general public.
Transmission of infection in the dental operatory through several means:
1-Direct contact (with skin mucous membranes ,blood ,saliva or other secretions).
2-Indirect contact (with contaminated instruments ,surfaces ,or operatory equipment).
3-Airborne contaminants (through inhalation of aerosols of oral and respiratory fluids).
4-Vehicle borne contaminants (ingestion of contaminated water ,food and drugs).
Prevalent infectious conditions:
The infectious diseases which are widely prevalent and to which the dental
health care workers are susceptible as follows:
• Hepatitis (B and C) .
• Herpes virus infections.
• Syphilis .
• Gonorrhea .
• Acquired Immune Deficiency Syndrome (AIDS).
• Tuberculosis
Infection control:
Itis controlling the spread of disease agents by performing specific procedures.
The approaches of infection control in dentistry is directed towards protection of
patients and dental team from infectious diseases,
the procedure of infection control are designed to kill or remove microbes or to
protect against contamination.
Personal Protective Equipment (PPE):
Are used in health care settings to create a barrier between health care
workers and an infectious agent from the patient.
All PPE should be removed before dental health care persons ( DHCP)
leave patient-care areas.
a)Gloves protect the dental team members from direct contact with patient microbes
and they protect patients from contact with microbes on the hands of the dental
team members
b)Masks
Face masks prevent spatter from patients mouths or splashes of contaminated
solutions and chemicals from contacting the mucous membranes of the mouth and
nose.
c)Protective clothing
Its worn under conditions of generating sprays, splatter, splashes or spills of body
fluids ,contaminated solutions or chemicals
d)Eyewear
All dental team should wear protective eyewear in the form of glass or face shield to
prevent trauma to the eye tissue from flying droplets or aerosols.
Hand Hygiene: Proper cleaning of hands to remove dirt, organic
materials, or microorganisms , Proper hand washing destroys pathogens,
removes blood, debris and contaminating microorganisms and prevents
accumulation of blood on damaged hand skin.
Antiseptics used for hand wash are as example: Chlorhexidine (2-4%)
with 4% isopropyl alcohol, Povidone iodine (7.5 -10%).
Drying is also an essential part of hand hygiene process. One should use
good quality soft, disposable paper towels.
Patient Placement: Patients with known or suspected infection who pose a
risk for transmission to others must be isolated. They should be placed in a
single-patient room if available or with patients with the same infection. To
control the source of infection when droplet or airborne transmission is
suspected, it is advised to place a mask on the patient immediately.
Practice Careful Aseptic Techniques: During treatment and clean-up, blood and saliva-
contaminated blood can be spread by anything that has been in patient’s mouth.
Practicing aseptic techniques helps in limiting the spread of blood and saliva. This is done
by:
• Careful handling of sharp instruments: The sharp end must always point away from
the hand, pass syringes with needles pointing away from anyone, pick up instruments
individually.
• Avoiding injuries: recap dental syringes using One handed technique or Scoop
technique.
All materials of dental chair should withstand repeated disinfection ,all chair
functions should be controlled from foot switch to avoid contamination of hand
operated switches .Common switches or latches in the chair have a number of
cracks so that harbor (m.o.) , these switches should be covered by disposable
covers and the underside of chair arms should be properly cleaned and disinfected.
Aerosol contamination can be minimized by:
[Link] mouth rinses- 2% chlorhexidine reduces the bacterial load in
dental aerosol.
[Link] volume evacuation (HVE)- reduces contamination by more than 90%.
[Link] rubber dam- an effective method to reduce contamination by saliva and
blood.
[Link] and air filtration- by filtering recirculated air and by introducing a
substantial proportion of fresh air in each air change will substantially reduce
residual contamination.
Sterilization of Instruments:
1-Pre-soaking and cleaning: Pre-soaking of contaminated instruments keeps them wet
until a thorough cleaning can occur. This procedure prevents blood and saliva from drying
on the instruments and facilitates cleaning of instrument which is achieved by
(a) Hand scrubbing of contaminated instruments.
(b) Ultrasonic cleaning is a mechanical cleaning system that reduces handling of
contaminated instruments and has been shown to be effective in removing dried blood
and saliva.
2) Packaging
After cleaned instruments have been rinsed and dried , they are to be
packaged before [Link] packaging protects the inst. from
becoming contaminated after sterilization and before use at chairside .
3) Sterilization
Heat sterilization
The common heat sterilizing methods available for dental office are:
-Steam 20-30 min .at 121 °C or 2-10 min. at 134 °C .
-Moist heat (autoclave) 15-30 min .at 121 -132 °C .
-Chemical vapor (Chemiclave) 20-40 min. at 134 °C.
-Dry heat (oven type) 2 hrs. at 160°C . or 170 for 1 hour.
Sterilization: It is a process of removing or killing all viable microorganism including
large number of resistant bacterial spores using physical and chemical procedure.
Disinfection: It is a process of removing or killing most, but not all, viable organism
([Link] spores) using physical & chemical procedure.
Some Infectious Diseases of Concern to Dental Practitioners:
Hepatitis B (HBV)
• It is critical that healthcare workers who are at high risk of percutaneous
exposure to HBV get vaccinated. This includes those in the dental practice.
Healthcare works should also receive post vaccination testing to ensure the
presence of anti-HBs, therefore confirming their immunity.
Hepatitis C Virus
• All health care personals should adhere to the appropriate standard
precautions by using personal protective equipment, to avoid both exposure to the
patient and to the healthcare practitioner. Transmission via blood splatter has been
reported.
Herpes Simplex Virus (HSV)
• The Herpes Simplex Virus (HSV) is often categorized into two distinct types:
HSV-1 and HSV-2.
Transmission occurs through direct contact with a lesion, mucosal surface, or
the secretions (oral or genital) of an infected host.
Recurrent HSV-1 infection
Infected individuals with active symptoms of oral herpes should avoid oral contact with
others and avoid sharing objects that have possibly been in contact with saliva.
Thanks
For listening