Associate Professor Maha El Baz

Why is Infection Control Important in Dentistry?

v Because both patients and dental personnel can be

exposed to pathogens.

v The patient’s saliva, dental plaque, blood, pus, and

crevicular fluid are aerosolized and spattered.

v Microorganisms are always mixed with materials.

v This may result in infection as common cold,

pneumonia, TB, herpes, hepatitis, and AIDS.
Mechanisms of microorganism escape:
•Natural Oral activities such as sneezing, coughing, etc..
•Artificial Hands, instruments, etc.

Methods of microorganism entry:

•Inhalation and/or ingestion
•Contact with mucous membranes
•Penetration of intact or non-intact ( inflamed or
abraded) skin
How the organisms can be transmitted in the dental
settings:

1. Direct transmission:
Direct physical contact with blood, oral fluids

2. Indirect transmission:
Contact with an intermediate contaminated object as
(instruments, equipment or environmental surfaces).
3. Aerosolization:
Contact of conjunctival, nasal or oral mucosa with infected
droplets propelled a short distance by coughing, sneezing or
talking.

4. Airborne infective droplets

Inhalation of airborne microorganisms that remain suspended
in the air for long periods.
When the risks of disease transmission increase?

By increasing:
1-The dose or number of organisms.
2- Host susceptibility
3- The mode of transmission
4- Period of exposure (time-span).
5- Virulence and infectivity of the organism
 Therefore, the objectives of an infection
control program are:
1. Interrupt the spread & break the cycle of cross-
contamination

2. Handle every contaminated item as if carrying a

blood-borne infectious agent

3. Protect the patient, the dental health personnel and

the dentist from exposure to infection and disease
spread

4. Reduce the available number of microorganisms

5. Treat all patients as if infected with a pathogenic
microorganism
HOW? Through a practical approach which is:

1. Understanding the disease processes, routes of

transmission, incubation period and methods for
controlling transmission.
2. Educating and monitoring adequate infection control
and safety measures.
3. Follow the most recent infection control measures.
4. Immunization against diseases.
5. The use of aseptic protocols during treatment.
6. The use of practical barrier techniques.
7. Disinfection of contaminated surfaces and
equipment.
8. Sterilization of critical and semi-critical instruments.
1- Understanding the disease processes, routes of transmission,
incubation period and methods for controlling transmission.

• HBV is transmitted by percutaneous or mucosal exposure to infected

blood or other body fluid.
• Incubation period: Usually 24-180 days (average 60-90 days).
• The variation depends on the amount of virus in the inoculum, mode
of transmission, and other host factors.
• HBV can survive and remain infectious on environmental surfaces for
at least 7 days.
2- Educating and monitoring adequate infection control and safety
measures.

3- Follow the most recent infection control measures.

v A recent study by researchers revealed that the hepatitis C virus
(HCV) can remain infectious for up to 6 weeks on surfaces at room
temperature resulting in a much longer period for potential
transmission than was previously appreciated.
v Prior to this study, scientists believed that HCV could survive for up
to four (4) days on surfaces outside of the body.
 Acquired Immune Deficiency Syndrome (AIDS or HIV)
v HIV virus remains relatively stable in blood at room temperature up to
four weeks
v It may also persist for at least a week in dried blood at 4°C.
v Viral survival is influenced by virus titer, volume of blood, ambient
temperature, exposure to sunlight and humidity.
 Herpes Simplex Virus
Herpes viruses from cold sores around the mouth can survive for four
hours on plastic, three hours on cloth and two hours on the skin.
If you have a cold sore, try not to touch it.
If you do touch it, for example to apply cold sore cream, always wash
your hands immediately afterwards.
4- Immunization against diseases.
All dental care personnel should be adequately immunized
against:
• Hepatitis B Measles Mumps
• Rubella Varicella Influenza
v Dental health care personnel (DHCP) should be immunized and
tested for the presence of adequate amounts of hepatitis B
surface antibody approximately 1-2 months following
completion of the 3-dose vaccination series.
v Test for anti-HBs 1 to 2 months after the 3rd dose.
v DHCP who do not develop an adequate antibody response
(i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose
vaccine series or evaluated if they are HBsAg-positive.
v There is no vaccination against HCV or HIV(AIDS)
 5- The use of aseptic protocols during treatment:

SEPSIS is the presence of pathogens in blood or in other tissues.

ASEPSIS is the absence of pathogens & infection. It includes

techniques of barrier protection, disinfection & sterilization.

SANITIZING: is the process that reduces the microbial population on

an object to a safe level.

CROSS INFECTION: is the transmission of pathogens from the

dentist to the patient, patient to the dentist or from one patient to

another.

NOSOCOMIAL: is office or hospital acquired infections.

ZOONOSIS: is an infectious diseases of animals

(usually vertebrates), that can naturally be transmitted to humans.[

 Practical steps of asepsis:

1- HANDS
* It Should be cleaned
with brush & soap.
* Nails should be kept
short with smooth
edges to allow
thorough cleaning and
prevent gloves tear.
* Rings & bracelets
should be removed.
qHand washing should be done at the start of the day,
before gloving, after removal of gloves and after
touching any contaminated surface .

qHand washing with water and plain soap is adequate

for patient examination and non surgical procedures .

qFor surgical procedures, an anti-microbial hand scrub

should be used.
qScrub hands and forearms is carried out for length of
time recommended by manufacturer (usually 2-6
minutes).

qHand prep product that contains chlorhexidine

gluconate (CHG), provides persistent activity that
keeps bacterial counts on the hands low over time.
Frequently Missed Areas When Hand washing
 Hand washing Technique

Repeat
every
action
five
times
 Taps with touch free sensor

Disposable paper towels •

are preferred for drying.
6- The use of practical barrier techniques:
A. Gloves Personal Protective
B. Facial Protection Equipment
C. Personal and Hair Clothing
D. Wrapping non critical items
E. Limiting contamination can be done by:
i. Proper patient and dentist positioning
ii. Using an antiseptic mouth wash for patient rinsing
iii. Use of high volume evacuation
iv. Use of rubber dam
A-Gloves
q Gloves are mandatory to be used for patient examinations
and during the whole dental procedure.
q After each patient gloves must be removed and hands
must be washed and re-gloved with new ones.
q Do not wash gloves before use or for reuse.
q Remove gloves that are cut, torn or punctured.
Efficiency of different gloves types:
q Glove thickness was a major determinant of permeability.
q Latex surgical gloves were the least permeable .
q Leakage rates for powder-free gloves showed a leakage rate
of 16 % at minimal use and 45 % after 15 minutes of
simulated use.
q PVC or Vinyl gloves are made of petroleum-based film
which is not molecularly cross-linked, in contrast to natural
rubber latex gloves or other types of synthetic latex such as
nitrile.
q Because of this lack of cross-linking, the individual molecules
of vinyl tend to separate when the film is stretched or flexed.
q Such permeability increases the risk of cross-contamination
for both patients and healthcare workers.
Nitrile gloves are the most protective gloves when they
are compared with vinyl and latex gloves.
Nitrile gloves are preferred because of their barrier
protection properties.
q Overgloves (polyethylene) are worn when answering
phone or writing prescription.

q Holding restorative and impression materials or getting

any thing from inside the drawers should be done
while wearing overgloves.

q Provided that they are taken off and thrown before

reusing the patient items.
Heavy rubber (utility) gloves are used while
cleaning instruments and environmental
surfaces.
B- FACIAL PROTECTION
qFace masks protect the oral and
nasal mucosa from body fluid
spatters .

qMasks should be changed between

patients or when visibly soiled or
wet.

qThey should be taken off after

approximately 1 hour of use.

qProtective eye wear is indicated to

shield the eyes from spatters .
q Face shield
protects the face
from exposure to
blood.

q Face should be
washed
thoroughly
before leaving
the office.
C- Hair Clothing:

§ Hair should be kept away from operating field.

§ Covering hair protects it from aerosols.
§Pathogenic bacteria and some viruses,
especially hepatitis B, can survive for days on
clothing.
D- Protective
clothing:
q Reusable or disposable
gowns, or lab coats must
be worn in the dental
clinic .
q They should not be worn
outside the work area .
qLong-sleeves protect skin
of the forearms .
qThey should be changed
when visibly soiled or
penetrated by fluids as
blood or saliva.
 Protective Clothing
Long-sleeved protective clothing is indicated
with:
1. Use of handpieces
2. Ultrasonic scaling
3. Manipulation using sharp cutting
instruments (e.g: perio surgeries)
4. Spraying air and water into a
patient’s mouth
5. Oral surgical procedures
6. Manual instrument cleaning
 Personal Protective Equipment
(PPE)
Personal Protective Equipment Laundry

qRemove all PPE before leaving the work area.

qDo not store contaminated clothing or PPE in lockers
or offices.
qPlace contaminated laundry in an appropriately
labeled container.
qThey should not be washed in home washing machine
or with non similar clothing.
 OPERATORY ASEPSIS
THE GOLDEN RULE TO FOLLOW
v Any item is contaminated when:
i. It contact or penetrate the oral tissue

ii. It is touched by gloves

iii. It is splattered by oral fluids.

v A decision must be made whether this item must be

(a) discarded (b) covered, (c) disinfected or (d) sterilized
 OPERATORY ASEPSIS
1- CRITICAL ITEMS:

qThese are items that come in direct contact with blood or

saliva.

qThey may be discarded as: suction tips, cups, plastic

three way air tip, surgical blades, rubber dam sheets and
matrix bands

q Or sterilized as: excavators, cavitron tips, burs, stones,

endodontic files, rubber dam (clam, holder and frame),
headpiece, high volume suction, metallic three way air tip,
diagnostic and restorative instruments.
 OPERATORY ASEPSIS
2- Non-critical items:
vThese are items that do not penetrate the tissues but
may be touched or may become splattered with blood
or saliva during treatment.

vIn the majority of cases cleaning followed by

disinfection is adequate, but if cleaning or disinfection
of some non-critical items damage them, the use of
disposable barriers to protect these surfaces may be a
preferred alternative.
 OPERATORY ASEPSIS
2- Non-critical items:

• Disposable barriers as plastic and foil wrappers are used to

cover non-critical items as:
• Switches, controls, drawer knobs, headrest, light handles,
composite curing lamps, air/water syringe holder and buttons,
high & low volume suction holders, amalgamator, cavitron,
computer, bracket tables, dental unit buttons and handles, X ray
cone and buttons
 OPERATORY ASEPSIS
These disposable barriers should be placed after
surface disinfection and must be changed for
each patient.
 OPERATORY ASEPSIS

If an instrument fell on the floor, I should

never pick it up and place it near the
sterile instruments.

I should remove it after finishing the

procedure.
*