Infection Control

Ms. Myan Mirghani

B.D.S, MD in OMFS (SMSB)
• Objective:
• Elimination or reduction in spread of infection
from all types of microorganism.
• It is duty of every dental practitioner to care
for all patients, including those with infectious
diseases.
• Infection:
• Infection is the deposition of organism in the
tissue and their growth resulting in a host
reaction.
• In case the response of host is minimal or nil,
it is usually termed as ‘’colonization’’
• The number of organisms required to cause an
infection termed ‘’the infective dose ‘’.
• The infective dose is depend on:
- Virulence of the organism
- Susceptibility of the host.
- Other important and relevant factors(age,
preexisting disease and drug therapy, etc)
• Infection control:
• Involve two basic factors:
- Prevention of spread of microorganism from
their hosts(patients and clinicians).
- Killing or removal of microorganism from
object and surfaces.
• Cross-infection:
• Defined as the transmission of infectious
agents among patients and staff within a
clinical environment.
• Pathways of cross-infection:
1. Patients to practitioner.
2. Practitioner to patient.
3. Patient to patient.
4. Clinic to community.
5. Clinic to practitioner’ family.
6. Community to patient.
• The likely source of infection is usually a
person who is in the prodromal phase of an
infection attend to the clinic.
• Healthy carriers, who are important factors in
the transmission of disease can be classified as
follows:
1. convalescent.
2. Asymptomatic carriers.
• Rout of transmission:
i. Direct contact with blood and oral secretion.
ii. Indirect contact with contaminated
instrument and environmental surfaces.
iii. Inhalation of aerosolized infective droplets.
iv. Direct inoculation into cuts and abrasion via
contaminated instruments.
• The chain of infection:
1. pathogen.
2. Exposure.
3. Susceptible host.
• Infectious disease of concern in dentistry:
- Bacterial infection:
 TB(inoculation & inhalation).
 Syphilis(inoculation).
 Gonorrhea(inoculation).
 Legionellosis(inhalation).
- Viral infection:
 Herpes virus infection( herpes simplex type
1&2, varicella zoster[VZV], Epstein-Barr virus
[EBV], Cytomegalovirus[CMV], human herpes
virus 6 [HHV6]).
 Influenza, rhino and adenoviruses.
 Rubella.
 Coxsackie.
 Human T-lymphotropic virus 1[HTLV-1].
 Hepatitis B virus[HBV].
• All members of the dental team should be vaccinated against
hepatitis B and maintain this vaccination schedule.
 Hepatitis C virus[HCV].
 Human immunodeficiency virus [HIV].
• Universal precaution for infection control:
i. Personal protective barrier technique.
ii. Immunization.
iii. Routine hand-washing.
• Hand-washing and care of hand:
• must always be washed:
i. At the beginning.
ii. Between patient contact.
iii. Before putting on sterile gloves.
iv. After skin contact with blood or other body fluid.
v. After touching inanimate objects.
vi. Before touching eye, nose, face or mouth.
vii. Before leaving the clinic
viii. Before eating, drinking, smoking, or inserting contact lens
ix. After any break in the routine or chain of asepsis.
• Hand wash technique:
i. Remove all jewellery.
ii. Clean fingernail.
iii. Scrub hand, nails and forearm.
iv. Rinse hand thoroughly with running water.
v. Dry hand with towel.
 A combination of liquid soap and an antimicrobial
agent , is more effective than soap alone.
 Gloves should be removed as soon as patient contact is
over.
• Hand care:
- Gloving is an important aspect.
- Dry hand after washing and before gloving.
- Torn, cut or punctured gloves must be removed
immediately.
- Any laceration , abrasion and cuts must be covered
with protective adhesive waterproof dressings prior to
donning gloves.
- Hand-cream must be used and fingernails should be
short and clean.
• Personal protection:
 clinical attire.
 Face mask.
 Head cap.
 Protective eyewear.
 Gloving.
 eating , drinking, or application of cosmetics in
clinical area including clinical laboratories is not
recommended.
• Prevent Environmental Contamination:
• At the end of treatment session of each patient and at
the completion of each session of daily work, dental
unit surface should be cleaned and disinfected, all
instrument should be cleansed and sterilized.
• Sharp instrument such should be considered
potentially infective and handled with care to
prevent injuries.
• All patients should be handled as if they were an
infection risk or as carriers of blood-born pathogen.
• Sterilization is defined as the process by
which an article, surface or medium is freed of
all microorganisms.
• Sterilization is the total destruction of all
microbes including the more resilient forms
such as bacterial spores, mycobacteria non-
lipid viruses, and fungi.
• Disinfection means destruction of most or all
pathogenic organisms.
• Use of physical procedure or chemical agents
to destroy most microbial forms, bacterial
spores and other relative resistant organisms
(eg: mycobacteria, non lipid viruses, fungi);
may remain viable.
• The term antiseptic is used to indicate the
prevention of infection, usually by inhibiting
the growth of bacteria.
• Classification of Instrument Sterilization :
• The categorization of instrument depends on
the contact with different tissue types to
determine whether sterilization / disinfection
is required. The categories are as follows.
1. Critical items : Instrument that touches
sterile areas of the body enter the vascular
system and those that penetrates the oral
mucosa. eg : scalpel, curettes, burs
2. Semi – critical items : Instrument that
touches mucous membrane and oral fluids but
do not penetrate tissue, Eg.: saliva ejectors,
radiograph, bite blocks, mirror etc.
3. Non-critical items : Those items that does not
come in contact with oral mucosa but are
touched by saliva / blood contaminated hands
while treating patient, eg ; Chair light, switches
etc. These should be properly disinfected.
• Method of sterilization:
1-heat:
A-moist heat(steam)
B-dry heat
2-gas sterilization
3-by low temperature steam and formaldehyde.
4-irradiation
 needle-stick injury
• Measures for prevention:
- Ensuring that the needles and surgical blades
are sheathed or covered, when not in use.
- Keeping full control of sharp instrument
- Keeping gloved fingers behind the cutting edges
of instrument.
- Adequate retraction.
- Over-gloving or using double gloves, whenever
indicated.
• Post-accidental management chemoprophylaxis:
i. Remove the gloves.
ii. Wash site of injury under running water with soap
and water.
iii. Avoid scrubbing, and encourage bleeding.
iv. Applied antiseptic(it is controversial).
v. Inform the patient.
vi. It is necessary to take blood specimens of both the
patient and injured person, and tested for HBV &
HIV.
• Prophylactic requirement for HBV:
if the patient is known or suspected HBV carrier,
the prophylactic requirement will depend upon
the immune status of the clinician:
i. Who never had vaccination should receive
hepatitis B immunoglobulin(HBIG) Within 48
hours of Exposure and a course of HB
vaccination should begin as soon as possible.
ii. Those who have been vaccinated, the
management depend on the antibody response.
a. The antibody titre more than 100mu/ml within
the previous year>> no further action is necessary.
b. If blood testing not done within the year, or, if
there is low antibody titre >>a booster dose of
vaccine followed by retesting of antibody titre .
c. Those who fail to respond to the vaccine >>
should given protection with HBIG.
• Presently, there is no prophylaxis for HCV
infection.
• The management would consist of monitoring
liver functions and testing for anti-HCV
antibodies. There is little evidence to suggest
that such cases may respond favourably if
treated at the earliest sign of infection with
interferon-a.
• HIV post-exposure prophylaxis(PEP)/
chemoprophylaxis for health workers:
i. Exposure has occurred with the mucous membrane or
skin( few drops of blood)>> there is negligible risk, risk
or drug toxicity may outweigh benefit of PEP regimen.
ii. Exposure has occurred( skin or mucous membrane),
with large volume of blood >> the basic PEP regimen is
recommended.
iii. Exposure is percutaneous >> the basic PEP regimen +
expanded regimen.
• The risk of acquiring HIV infection can be
negligible, if the health worker observe
adequate safety measures.
• The infectivity of HIV (0.4) is less than that of
HBV (6 to 30 %).
• The precautions required for attending
patients which HIV/AIDS infection and HBV
infection are identical.
THANK YOU