Infection Control Final

8/9/2019 Infection Control Final

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Why do we need infection

control protocols• “Living on the edge”

• Contact with blood, oral and respiratorysecretions, and contaminated equipmentoccurs

• Proper procedures can prevent transmission

of infections.



! "#L$# W%&% &%'

# novel demonstration (rst was given by )amesCrawford in the *+-s using the wordings as, “if

saliva were red.”

Which demonstrated the cross contamination that

occurred from practitioners saliva covered (ngers.

# red dye was added to the patients saliva so that

the dentist/assistant could visuali0e salivary

contamination.





# few 'e(nitions• Sterilization:

# Process by which all microbial forms aredestroyed 1Patterson *+234

5he process by which an article,surface or medium is freed of all livingmicroorganisms either in the vegetative orspore state

• Disinfection: 5he destruction or removal of all

pathogenic organisms, or organisms capable ofgiving rise to infection.



• Sanitization:

5he term is sometimes used as a

synonym for disinfection, particularly withreference to food processing and catering.6

• Antisepsis: "eps 1 7ree8 word 4 9 putrid

:sed to indicate the prevention ofinfection, usually by inhibiting the growth ofbacteria in wounds or tissues. Chemical

disinfectants, which can be safely applied to s8inor mucous membrane and are used to preventinfection by inhibiting the growth of the bacteriaare called antiseptics.



• Bactericidal agents:

#gents, which are able to 8ill thebacteria

• Bacteriostatic agents:

#gents, which are used only to

prevent the multiplication of bacteriawhich may however remain alive.



#ntiseptic ; # chemical that is applied to living

tissue such as s8in and mucous membrane toreduce the number of microorganisms presentthrough inhibition of their activity ordestruction

'isinfectant ; # chemical used on non vitalob<ects to 8ill surface vegetative pathogenic

organisms, but not necessarily spore forms orviruses

'e(nition according to Patterson *+23



=istory of "terili0ation and#sepsisChlorine water ;Le!erne in *>?2

gna0 "emmelweis, in *>? began usingchlorinated lime

"urgical cleanliness ; )oseph Lister in *>@

odine as a wound dressing by 'avies in *>+2



gna0 "emmelweis ;!ather of nfectionControl!ather of nfection Control

'iscovered that the incidence of puerperalfever could be drastically reduced if the

physician washes his hands.=is concept was not accepted by the

medical and surgical community at thetime

Anly after Pasteur, Boch, and Lister hadproduced more evidence of the germtheory and antiseptic techniques was thevalue of hand washing appreciated.



odes of 5ransmission• n the dental setting, possible modes of

transmission include; – direct contact with blood, oral Duids, or other

patient materialsE – indirect contact with contaminated ob<ects

– droplet contact, 1spray or spatter containingmicroorganisms4

– inhalation of evaporated microorganisms1Fdroplet nuclei“4



Chain of nfection

Pathogen

Source

ModeEntry

Susceptible Host



Chain of nfection

Port of Exit

Transmission

Port of Entry

Susceptible host Reservoir



5he chain of infection

eGample

Port of Exit

Transmission

Port of Entry

Susceptible host Reservoir

=epatitis H

5he bloodstream

Hleeding wound

'irect via needle stic8

Puncture wound

:nvaccinated'ental wor8er

Infectious agent



Potential &outes of

5ransmission of HloodbornePathogensPatient Dentist/Assistant

Dentist/Assistant Patient

Patient Patient



"tandard Precautions• #pply to all patients

• ntegrate and eGpand :niversal Precautions

• !or diseases that are transmitted through airborne,droplet, or contact transmission, standardprecautions should be coupled with eGpanded ortransmissionIbased precautions.

• 1isolation4, adequate room ventilation, enhancedrespiratory protection for team members, orpostponement of nonIemergency dental procedures.



%lements of "tandard

Precautions• =andwashing

•

:se of gloves, mas8s, eye protection, andgowns

• Patient care equipment

• %nvironmental surfaces

•

n<ury prevention ;



=andwashing

• =and washing is the cornerstone of theinfection control

• !irst proposed by gna0 "emmelweis in *>?1!ather of nfection control4



• =and washing must be performedmeticulously so that every hand surface isadequately cleaned. "pecial attention must bepaid to hand surfaces usually neglected whenwashed.

• #fter removing the gloves, hands must be

carefully washed as very often there are poresin lateG allowing the penetration ofcontaminating matter.



ndications for hand hygiene include;

when hands are visibly soiled

after barehanded touching of inanimate ob<ects

li8ely to be contaminated by blood, saliva, orrespiratory secretions

before and after treating each patient

before donning gloves

immediately after removing gloves





Principles of =andWashing• &ubbing.

• Lathering

• &insing

• =and washing before gloving

• =and washing after glove removal



n oral surgical procedures, tearing of glovesoften occurs, causing an outpouring of

bacteria from the surgeons hands

=andwashing limits this bacterial

contamination and reduces epithelial debris



5ypes of =and Washing

=andwashingWashing hands with plain soap and water

#ntiseptic handwashWashing hands with water and soap or other

detergents containing an antiseptic agent

#lcoholIbased handrub&ubbing hands with an alcoholIcontaining preparation

"urgical antisepsis=andwashing with an antiseptic soap or an alcoholI

based handrub before operations by surgicalpersonnel



Antiseptics used in hand washing

ChlorheGidine ;5his is 3I?K ChlorheGidine gluconate

with ?K isopropyl alcohol in a detergent solutionwith a p= of I@..

Povidone iodine ;t contains .KI*-K Povidone

iodine, with -.KI*K available iodine..

ParachlorometeGylenol ;t is bactericidal and

fungicidal at 3K concentration.

#lcohol ;%thyl alcohol and isopropyl alcohol.

Hactericidal at -K concentration.



5echnique for =and Washing for minorprocedures

• Wet your hands

• &ub your hands together

• Continue rubbing your hands for at least 3- seconds.

• &inse your hands well under running water.

• 'ry hands using a clean towel or allow them to airdry.





Ather recommendations forhand hygiene• Beep (ngernails short with smooth, (led edges

to allow thorough cleaning and prevent glovetears .

• 'o not wear arti(cial (ngernails or eGtenderswhen having direct contact with patients at highris8

• #void wearing hand or nail <ewelry if it ma8esdonning gloves more diMcult or if it

compromises the (t and integrity of the glove.



5=%#5&%%55N:%55%



"C&:H" #O' "=A%"

"crubs comprise of pants/s8irt andshirt/blouse#rms should end ? inches above elbows

Legs should not drag on the Door

"hoes should be conducting.



"urgical hand scrubbing#ll subnail contaminants should be removed with

a nail brush

=ands are held upright

Wet hands and arms till few inches above elbows

"crubbing begins from the tip of one (nger

%ach (nger is divided into ? surfaces and eachsurface receives 2- stro8es



$entral, dorsal and lateral surfaces of the handare washed

#rm is divided into thirds and each surface isscrubbed again

"crubbing procedes from (ngers to elbows

5ime *- min for *st scrub, with min betweenuncontaminated proccedures

&inse eGcess soap but do not scrub

'ry with hand towel proceeding from (ngers toelbows



7owning'one after "crubbing

in and before glovingup

7own is folded withthe inside surfaceoutside

Anly the insidesurface is contactedwhile gowning



7owning with the help of the circulating nurse ;

Pic8 up the sterilegown after dryingscrubbed hands

"tep away from thearea

5he gown is held at

the nec8 ta8ing carethat only the insidesurface is touched



Let the gown unfold completely

Locate the arm holes and push hands throughthe holes ma8ing sure that the outside surfaceis not contacted

5he circulating nurse ad<usts the gown fromthe bac8 and pulls it over the shoulders andarms by holding the inside surface

5he circulating nurse secures the gown at thenec8 and waist level.







7loves#lways were lateG 1or vinyl4 gloves

=andwashing prior to gloving up

"ingle :se

!or patients with con(rmed =$, =C$,=H$,double gloves should be used











Preparation of "urgical

"itemportant to reduce contamination by

patients own normal Dora as well as resistanthospital acquired bacteria

=air/shaving should ideally be done <ust priorto surgical preparation

Circumoral preparation should precede intraoral preparation



odophore compounds are the most eectivefor s8in preparation

Hefore preparation, lubricating ointmentshould be applied to the eye, and the eyeshould be taped shut







Ance hand scrubbing has been performed theoperating surgeon and assistants have to wearsterile surgical gowns before wearing sterilegloves

Ance scrubbed and gowned, the bac8 and below

waist area is considered unsterile, so care mustbe ta8en to 8eep the arms above waist level, andnot to bac8 into any sterile equipment.

#lso, instruments should not be passed frombehind the surgeons bac8.

Coughing and snee0ing not allowed.



'rapingCovering a patient and surrounding areas with

a sterile barrier to create and maintain asterile (eld during a surgical procedure

Purpose ; isolates the surgical area from partsthat have not been prepared Q creates anarea of asepsis called a sterile (eld

%Gposes only the surgical site and covers theunprepared areas



nitial 'rape ; single thic8ness draw sheet **G *>- cms

!ront "heet ; 3nd drape ** G * cms.

=ead draped with double sheet ; 'rape aslower sheet, =and towel as upper sheet.







'o not let the gloved hand touch the s8in of thepatient

f a drape becomes contaminated, discard itimmediately.

f the end of a drape falls below waist level, do nothandle it further. 'rop it and use another drape.

f in doubt about sterility, discard the drape.

f a hole is found in a drape after it is laid down,cover the hole with another drape or discard the

entire drape.

" i l "it " bb d d



"urgical "ite "crubbed and'raped



Aperation &ooms

5raditionally called 5heatres because theearlier operation rooms were designed li8etheatres for teaching/viewing

'esign Concepts have now changed toinclude sterili0ation protocols and air Dowdynamics.

S i th A5



Sones in the A5Protective 0one

Clean Sone

#septic Sone

'isposal Sone

&eference ; ndian )ournal of #nesthesiology 3-- ; 'esigning an idealAperating &oom CompleG 1" " =arsoor*, " Hala Hhas8ar4

B i D i



Basic DesignHig enough for free circulation

5wo openings ;one towards scrub area

one towards sterile area.

"wing 'oors.

!loor should be arble or polished stone andwalls should be 7la0e tiled.

Oo false ceiling

$ til ti i th A5



$entilation in the A5$entilation in the A5 can be of 3 types ;

&eIcirculating

OonIrecirculating

'irectional !low ;Oegative Pressure ; !rom outside to inside. :sed for

highly infective rooms

Positive Pressure ; !rom nside to outside. :sed for A5s

• A& air changes are 3 changes per hour , positive pressurecompared with corridors temperature between *> Q 3?T Cand humidity of - to K

&eference ; #"# 7uidelines ; 3-*3 Aperating &oom 'esign anual

#ir !lo ' namics in A5



#ir !low 'ynamics in A5t can be

Conventional ; 5urbulent#irDow dynamics

Laminar ; !urther 3 types

=ori0ontal $ertical

&eference ; #"# 7uidelines ; 3-*3 Aperating&oom 'esign anual



Cl i d St ili ti f OT



Cleaning and Sterilization of OTComplexCleaning :

Disinfection :

Sterilization :









as8s



as8sas8s ; should withhold at least +K of the

microorganisms.

#irborn diseases ; fully adaptable to face, itmust be able to withhold particles and

microorganisms with a diameter up to *m, ata percentage of +K

f the mas8 gets wet it must be immediatelydiscarded and replaced.

&'outer facing (')lter



&'outer facing (')ltermedia*' #reatha#le )lm +'inner

facing



% P t ti



%ye Protection• &equired to protect the eyes from blood and

salivary spatter

• $arious types of glasses or plastic mas8s or

shields made of transparent materials.

• ust be rinsed with abundant water and getdisinfected

'ental Clothing



'ental ClothingAveralls/"crubs should cover a big part of the

dentists body and hands.

5hey must be changed on a daily basis and

de(nitely as soon as they get stained.

f the operation is eGpected to involve a largeamount of bleeding or the patient is li8ely to

be seropositive, it is highly recommended thatspecially designed singleIuse clothing beused.





%nvironmental "urfaces



%nvironmental "urfaces• ay become contaminated

• Oot directly involved in infectious disease transmission• 'o not require as stringent decontamination procedures

Categories of %nvironmental "urfaces

• Clinical contact surfaces

– =igh potential for direct contamination from spray or spatter

or by contact with gloved hand• =ouse8eeping surfaces

– 'o not come into contact with patients or devices

– Limited ris8 of disease transmission



Clinical Contact

"urfaces





7eneral Cleaning &ecommendations

• :se barrier precautions

• Physical removal of microorganisms by cleaning

• Proper use of hospital disinfectants 1%G. "avlonIChlorheGidine Q Cetrimide4

• 'o not use sterilant/highIlevel disinfectants on

environmental surfaces



:se and Care of "harp instruments



:se and Care of "harp instrumentsand Oeedles

should be used with special care so thatin<uries are prevented.

Place within a solid, hard plastic container

'o not cap, bend or destroy the needles.

'o not over(ll the plastic container, closetightly and, (nally, discard.



:sed needles must not be recapped with both

hands

Oeedle should never point towards the body.

5he Xone handX technique to recap the needleor a mechanical means designed to hold the

cap should always be used.

"coop method of recapping



"coop method of recappingneedles

"terili0ation and 'isinfection of



nstruments "paulding system 1*+34

Sterilization of instruments



Sterilization of instruments

Stages of sterilizations

• Pre cleaning disinfection1holding soln.4;

• Pre sterili0ation cleaning ;

• "terili0ation

• #septic storage

"5%&LS#5AO



82

E!T"#$IST% &R'

I$(I)I(* R!&I!TI$(S

+R!'S% *!##! R!'S

,-TR!.I$-ET R!'S

S

T

E

R

I

-I

)

!

T

I

$(

!*E(TS !/TI(* $( /E-- #E#0R!(E" S,R1!/E !/TI.E

!*E(TS% PE($-S% $R*!(I/

S$-.E(TS

HEAVY METALS

OXIDIZING AGENTS

DYES, ALKYLATING AGENTS

P'SI/!- !*E(TS /E#I/!- !*E(TS

1I-TR!TI$(

!*E(TS T!T !/TS $( 1,(/TI$(!-

*R$,P $1 PR$TEI(S

!*E(TS T!T &E(!T,RES PR$TEI(S

!/I&S% !-!-IES

",T-ODS OF ST,!/01T/O2 /2 OU!



83

/2T!,ST 1S C/2/C/12S

Moist heat (autoclaving)

Dry heat (Hot air oven)

Chemicals (chemiclaving )

DO NOT DISINFECT WHEN YO CAN STE!I"I#E



anual Cleaning

"oa8 until ready toclean

Wear heavyIduty utilitygloves, mas8, eyewear,

and protective clothing







=eatIHased "terili0ation"team under pressure 1autoclaving4;

oist =eat

7ravity displacement

PreIvacuum

'ry heat

:nsaturated chemical vapor

"team :nder Pressure ;



"team :nder Pressure ;

#utoclave• "terili0ation with "5%# :O'%& P&%"":&%• 5ime required at *3* deg C is * mins at * lbs of

pressure.

• #dvantages – &apid and eective – %ective for sterili0ing cloth surgical pac8s

and towel pac8s

• 'isadvantages – tems sensitive to heat cannot be sterili0ed – t tends to corrode carbon steel burs

and instruments

' t d l t th t i



84

'enatures and coagulates the protein

higher eMciency

:nwrapped items *23YC 2-lb/in3 2 min *3*YC *lb/in3 * min

Lightly wrapped *23YC 2-lb/in3 > min *3*YC *lb/in3 3- min

=eavily wrapped *23YC 2-lb/in3

*- min *3*YC *lb/in3 3- min!,%U/!,",2TS:

&each Q maintain holding time and temperature=ave means to remove air, chec8 eMciency#bility to destroy sporesLarge chamber si0ePreferably with a drying cycle

5ypes of #utoclave



5ypes of #utoclave• 'ownward 'isplacement;

• Positive Pressure 'isplacement ;

• Oegative Pressure 'isplacement ;

• 5riple $acuum #utoclave ;



• 5ype FOF vs. 5ype FH“ ; %ach autoclave can beclassi(ed as a type FOF unit or a type FHF unit. 5ypeFOF units do not use a vacuum to remove air fromthe sterili0ation chamber, whereas type FHF units

do use a vacuum pump. 5he dierence in operationmeans type FOF autoclaves are suitable for aspeci(c type of loadIIfor solid, unwrappedinstruments. 5ype FHF autoclaves can be used onwrapped and hollow instruments, which means a

piece of equipment can be sterili0ed now for uselater.

C-,"/C1 314OU! ST,!//0,!S



42

Aperate by heating a deodori0ed alcohol, formaldehyde, and ethylmethyl 8etone solution, to *23oc at 3-I?- lb/in3 for 3- minutes.

1dantages

o 2- min cycle

"hort Dash cycles of minutes

o 'ullness, rust not present

o nstruments are dry at the end of the cycle.

Disadantages

o good ventilation is essential

o eGtra cost

,T-5,2, O6/D, 71SST,!//01T/O2



43

ST,!//01T/O2

o # Dammable, eGplosive and toGic gas

o A# ; #l8ylation, denaturation of proteino ore potent in humid atmosphere

1dantage:

Can be used for any material

Disadantage:

5ime

Cost

5oGicity

'&R =%#5 "5%&L"#5AO



45

" " A• :nwrapped loads 9 *@-YI*-Y for * hr•

Wrapped V *hr, upto 3 hrs• Proteins dehydrate Q dry, resistance to denaturation increases• #cceptable items 9 paper bags, #l foil, poly(lm plastic tubing

• 1dantages 9

• neGpensive• 7reater capacity• nstruments dry at end of cycle• 'oesnt corrode / rust, dull

•Forced air con$ection %nits & rapid 'eat transfersterilisers:

• =igher temp 1*+-YC4• Controlled internal air DowI fan• @ min for unwrapped Q *3 min for wrapped instruments



=A5 H%#' / "#L5 "5%&LS%&"



47

=A5 H%#' / "#L5 "5%&LS%&"

!or endo (les Q rotary instruments

Consists of a metal cup 1 crucible 4in which glass beads or salt ismaintained

Heads can bloc8 root canal

5emp of 3*>I3?@YC 9

* sec immersion required

"O2/TO!/27 OF ST,!//01T/O2



Physical

Chemical

iological

(')sical: Periodical observations of display or gauges

C'e*ical:

=eat sensitive chemical indicators

Process indicators; Consists of a colour material eitherliquid/paper that changes colour upon eGposure toappropriate sterili0ation cycle, implying that the load hasbeen processed.





44

B!O2, TUB,S

glass tubes (lled with Duid Color change from red to

amber to green

Primarily used in hot airovens

3 typesIChanges color after * hr at

*-YC

Changes color after *3 min at*>-YCBOWIE DI! "APE

• !pplie to articles•0ro9n stripes appear on tape:

B/OO7/C1



;<<

• =eat resistant Hacterial spores of the genus Hacillus.

• f the spores are 8illed than the less resistant microbes are8illed.

• Hacillus stearothemophillus ; moist heat

• Hacilus "ubtilis ; dry heat sterili0ers., %5A units

• !ollowing each cycle the indicator strip should be sent forculture.



;<;

!ECENT AD,ANCES



;<2

-A..A !ADIATION CHA.BE!S

• :sed in many singleIuse medical supplies such as syringes,

catheters, $ sets, gloves, and face mas8s• 'oes not require a quarantine or postIsterili0ation treatment

• s easily validated

• Penetrates every crevice of instruments

• E/ BEA. !ADIATION

• syringes Q cardiothoracic devices

• "horter eGposure time

• 'osimetric release lets some products forgo sterility testing

• 'ensity of material 9 limiting factor

, lig't ca0inets



;<3

• %mission at 32.nm 1short wave ultraviolet4

• :sed because of their abiotic eect and ability toproduce photochemical changes in organic and

inorganic substances.

• Potential to cause s8in Q eye burns

'"O!%C5AO #O' '"O!%C5#O5"



;<5

*.'"O!%C5#O5"/"5%&L#O5"I

3.=A"P5#L '"O!%C5#O5" W5= 5:H%&C:LAC'#L#C5$5R

2.OAO 5H C'#L =A"P5#L '"O!%C5#O5"

?."#O5S%&"



;<6

/D,1 4!O4,!T/,S OF D/S/2F,CT12TS

• &apid disinfection

• Hroad spectrum biocidal action

• "ubstantivity

• OonIirritant• %conomical

• &euse life of atleast 3* days when diluted

• Change colour

• Contain detergent• #nticorrosive

• =ave %P# approval

7UT1!1D,-5D,



;<7

=igh level immersion disinfectant

#cidic 1p= ? to @.4, neutral 1p= to .4 and al8aline1p= . to >.4

%ectiveness increases as p= increases 9 greatest inal8aline

#l8aline 9 forms polymers which are not biocidal 9

prevented by stabilisers 1phenolic buer4

3Kw/v solution

*? to 2- days

#dvantages



;<=

#dvantages Wide spectrum "poricidal

#ctive in presence of organic matter Prolonged activated life "terilising heat labile materials 1plastic, rubber4

'isadvantages Longer immersion time rritant. Corrosive, 5oGic fumes Carcinogenic in animals

4-,2OS



;<8

• Lister in *>@ 9 cytoplasmic poisons

• *;23 dilution eective for @- days if unused• Wide spectrum

• 'isinfectant in *- minutes contact

• Combined with -K alcohol 9 hard surface disinf

• ChlorheGidine I biphenol I subcidal concentrationsdiminishes pathogenicity of bacteria 1=olloway, Huc8nelland 'enton, *+>@4

• =eGachlorophene 9 diphenyl al8ane9 highly bactericidal 93 to 2K eGcellent s8in disinfectant



C-O!/2, 4!,41!1T/O2S• Chlorine plus Water 9 oGidation into hypochlorous acid



;;<

Chlorine plus Water oGidation into hypochlorous acid

• Sodium Hypochlorite• Ane part of K OaACl Z + parts of water 1*;*- dilution 9 --- ppm of

sodium hypochlorite4

• #dvantages• &apid action• Hroad spectrum• %ective in diluted solution• %conomical

• 'isadvantages• Chemically unstable• 'iminished activity with organic matter• rritate s8in, eyes, mucous membrane• Corrosive• 'iscolouration• :npleasant persistent odour• 'egrades plastic and rubber



;;;

Chlorine dioxide• "odium chlorite and organic acid

• =igh level disinfectant• "prayed or wiped

• #dvantages;• nstrumental or environmental surface germicidal

• 'isadvantages ;• 'iscarded daily• !ailure to readily penetrate organic debris• Protective eyewear, gloves required• Corrosive• &equires adequate ventilation

Iodophores



;;2

• CompleG of iodine and other organic compounds1solubili0ing agents or carrier 9 polyvinyl pyrrrolidine

and ethoGylated non ionic detergents4• &elease iodine in small increments

• "low release provide continuous action

• #dvantages• Hroad antibacterial action

• Leaves a residual action

• OonIirritant

• %conomical

• 'isadvantages

• 'iscolours some surfaces when applied continuously

D,T,!7,2TS ;SU!F1C, 9 1CT/3, SUBST12S,S' Lower surface tension 9 eMcient cleaning



;;3

g #lter the osmotic barrier of cell membrane 9 increase cell permeability 5hree types

*.OonIionic 9 Oo antimicrobial activitity3.#nionic 9 %g. "ynthetic anionic detergents and soaps

2.Cationic 9 Nuaternary ammonium compounds 1N:#5s4

"terili0ation of =andpiece



• "tep *. &un, Wash, 'ry

"tep 3. &econnect, &un, 'isconnect

"tep 2. Lubricate, &econnect, &un

"tep ?. 'isconnect, Pac8 and seal, #utoclave



"terili0ation of Hurrs Clean and Wash 5hen "terili0e ;



Clean and Wash, 5hen "terili0e ;

*4 Carbon "teel burrs ; Chemiclave/%thelyneoGide/Chemical "olutions

34 "tainless "teel/5ungsten Carbide ; #utoclave

24 'ry heat ; #ll burrs.

?4 mmersion 'isinfection

"t il i ti



"terile rrigating

"olutions"terile "aline or "terile Water

:se devices designed for thedelivery of sterile irrigating Duids



"uction achines and



Hottles

"uction achine tubing and bottles harbour

bio(lms

Washed and Dushed with disinfectant

Oever be emptied into sin8s or open drains

'ental :nit Waterlines and Hio(lm



• icrobial bio(lms form in small bore tubing.

• #ssociated with higher baseline levels ofPseudomonas aeruginosa, !egionella

"neumo"hila, nontuberculous mycobacteria

and #canthamoe$a spp.

• Hio(lms can be controlled by ;•

Filters: • 1utoclaa#le systems

• Chemical products ;disinfectants<

Accupational nfections in'entistry



'entistry

• denti(ed ris8 of occupational eGposure tobloodIborne pathogens ; 1=$4 1=H$4 1=C$4.

• "harp in<uries occur because of a small

operating (eld, frequent patient movement,and the variety of sharp instruments used.



'ta"hylococcus aureus

' d &"# C f



• '. aureus and &"#; Common cause ofnosocomial infections.

• Aral, nasal passages ; Oatural habitat

• Can be transmitted to patient

ther acteria• Heta helolytic streptococci, 'tre"tococcus "neumoniae Haemo"hilus in*uen+ae,eisseria meningitidis Coryne$acterium

di"htheriae and ordetella "ertusis

$iral nfections



$iral nfections

#re transmissible in health care settings

Can produce chronic infection

#re often carried by persons unaware of their

infection

I.% 0.% /.

!actors nDuencingA ti l &i 8 f



Accupational &is8 of

Hloodborne $irus nfection!requency of infection among patients

&is8 of transmission after a bloodeGposure 1i.e., type of virus4

5ype and frequency of blood contact

/nfection of concern inDentistry



DentistryIn#ectiousOrganis$

Habitat "rans%

$ission

PotentialPathology

&accine

Hepatitis B Virus -iver B, S, T, Sw. Hepatocellularcarc!o"a

Y

Hepatitis C virus -iver B Hepatocellularcarc!o"a

N

Hepatitis D virus -iver B Hepatocellularcarc!o"a

Y

HSV I # II N$ N$S, B, S, Oral, e%e, &!'erle(o!(

N

HIV T)* +ell B AIDS N

Mea(le(-ueola/ N$ N$S, B, S, Ge!eral0e1 2e(cularra(3

Y

Mea(le(-uella/ N$ N$S, B, S, Ge!eral0e1 2e(cularra(3

Y

In#ectiousOrganis$

Habitat "rans%

$ission

PotentialPathology

&accine



Organis$ $ission Pathology

Neisseria

Gonorrhoeae

#outh%

(P

B, S, T, S". Gonorrhoeae N

Treponema

Palladium

0loo#outh

B S%p3l( N

Micobacterium

tuberculosis

Pharynx N$S Tuerculo(( N

I!&lue!0a 2ru( N$ N$S 4lu, +o""o! col1 N

-3!o 2ru( N$ N$S 4lu, +o""o! col1 N

A1e!o 2ru( N$ N$S 4lu, +o""o! col1 Y

#verage &is8 of Hloodborne



$irus 5ransmission after Oeedlestic8Source Ris>

0.

HBsAg' and HBeAg' (()*+%,-)*+ clinical hepatitis. ,+%0(+ serological e1idence o# HB&

in#ection

HBsAg' and HBeAg% -)*+%0)*+ clinical hepatitis. (,+%,+ serological e1idence o# HB&in#ection

/. -)2+ 3*+%+ range4

I. *),+ 3*)(+%*)5+ range4

Concentration of =H$ ind l id



Hody !luids =igh oderate Low/Oot

'etectable

Hlood "emen:rine

"erum $aginal !luid !eces

Wound eGudates "aliva

"weat 5ears

Hreastil8



=epatitis H $accine – $accination should result in serocoversion

– onitor 5itres

– $accinate all at ris8 of eGposure to blood

– Provide access to quali(ed health careprofessionals

– 5est for antiI=Hs * to 3 months after 2rddose

• "eroconversion I mmune



• Oo seroconversion ;

– "econd 2 dose series – Oo seroconversion ; Chec8 carrier state.

•Oonresponsive, non carriers to be advisedprecautions

=epatitis C



• =C$ transmission ris8 is *.>K ,Chronicity in >K

infected

• 'etermine === status

• L!5s and =C$ &O# PC& testing four wee8s aftereGposure, antibody =C$ testing at three and siGmonths postIeGposure.

• Haseline L!5s ,=C$ antibody test on the day of theeGposure

• Currently there is no P%P for =epatitis C

=$/#'"



=$/#'"• &is8 -.3 to -.2K for parenteral eGposures and

-.*K or less for mucosal eGposures.• =$ P%P ; Combination of 3/2 drugs• P%P started within *I3 hrs of eGposure• PostIeGposure prophylaGis for =$ is;

– &ecommended for signi(cant percutaneouseGposure to blood or body substances involvinga high ris8 of =$ transmission

– Aered 1but not actively recommended4 forocular mucous membrane or nonIintact s8ineGposure to blood or body substances

– Oot oered for eGposure to any nonIbloodyurine,saliva or faeces





For mouth:First aid in management of



For mouth:

"pit Duid out immediately

&inse 'o not use soap or disinfectant

Don@t

• 'o not panic

• 'o not suc8• 'o not squee0e

• 'o not use antiseptic

First aid in management of

exposure

P%P for =$• "anagement of exposure



• "anagement of exposure

– mmediate decontamination

– nitiation P%P

– Haseline bloodtests

– "ource of eGposure 9 $oluntary testing for ===

– %Gposed ndividual ;5esting for antibodies and titres

Categories of,xposure



,xposureild %Gposure ucous membrane/nonIintact s8in with smallvolumes

•a super(cial wound 1erosion of the epidermis4 witha plain or low calibre needle,•contact with the eyes or mucous membranes,subcutaneous in<ections following smallIbore

needles.oderate%Gposure

ucous membrane/non intact s8in with largevolumes A&percutaneous super(cial eGposure with solid needle%.g. ; a cut or needle stic8 in<ury penetrating gloves

"evere%Gposure percutaneous with large volume#n accident with a high calibre needle 1V*> 74visibly contaminated with bloodE'eep wound 1haemorrhagic wound and/or verypainful4E transmission of a signi(cant volume ofbloodE

#n accident with material that has previously been

Selection of 4,4



Selection of 4,4

depending uponSeerity of ,xposure

,xposure

Status of source

=$Z and

#symptomatic

=$Z and

Clinically

symptomatic

=$ status un8nown

ild Consider 3Idrug P%P

"tart 3Idrug P%P Consider 3Idrug P%P

oderate "tart 3IdrugP%P


"evere "tart 2IdrugP%P


P%P &egimen for =$



Medication 2-drug regimen 3-drug regimen

Zidovudine (AZT) 300 mg twice a

day

300 mg twice a day

Stavudine (d4T) 30 mg twice a

day

30 mg twice a day

Lamivudine (3TC) 150 mg twice a

day

150 mg twice a day

Protease Inhibitors 1st choice

Lopinavir/ritonavir (L!/r)400/100 mg twice a day or

"00/#00 mg once dai$y wit% mea$&

2nd choice

'e$inavir ('L)

1#50 mg twice a day or

*50 mg t%ree time& a day wit% empty

&tomac%

3rd choice

+ndinavir (+',)

"00 mg every " %our& and drin- ".10

g$a&&e& (15 $itre&) o water dai$y

P%P for =epatitis



• =epatitis H

– $accinnated ; Hooster. – f being vaccinated/nonIresponder ; hepatitis H

immune globulin 1=H74 and the vaccine1accelerated dose4.

– Bnown nonIresponders =H7 and thevaccine1accelerated dose4.

• =epatitis C

– Oo P%P – onthly =C$ &O# PC&,

– "eroconversion ; interferon, with possible ribavirin.

=erpes "impleG



• $esicular Duid ; the most infectious but viral

shedding continues from resolving 1crusting4herpetic lesions.

• 7loves ; 'o not give adequate protection

• "tandard Precautions and 5ransmissionIHasedPrecautions should be followed.

• %lective care should be deferred until alllesions heal.

$aricella/=erpes Soster



• "erious consequences in pregnant womenand immunocompromised persons of all ages.

• #irborne infection can occur

• "tandard Precautions and 5ransmission control

protocols must be followed

• 5he patient should be treated in isolation



PostI%Gposure %valuation and!ollowIup



!ollowIup

• %mployer must; – 'ocument eGposure and circumstances

– 'ocument source individual

– "ource individuals blood tested

– f source is 8nown to be infected, blood test isnot necessary.

– %mployees blood is tested.

–f employee refuses =$ testing, then blood isstored at least +- days.

– Con(dential medical evaluation

– When indicated use postIeGposure prophylaGis

which will prevent =$ infection

Conclusion



• Ta=e action to stay healthy

– 7et vaccinated against hepatitis H and othervaccine preventable diseases.

– &eport occupational in<uries and eGposuresimmediately.

– !ollow the advice of the medical care providerevaluating your occupational eGposure.

• 1oid contacting #loodA#ody ?uids – #lways use standard precautions and treat

every patient as if infectious. – Wear gloves, protective clothing, and face and

eye protection and handle sharps with care. – :se mechanical devices to clean instruments

whenever possible.

• imit the spread of contamination



p

– "et up the operatory before beginning treatment.

– Cover surfaces that will be contaminated – inimi0e splashes and spatter.

– Properly dispose of all waste.

• "a=e o#ects safe for use

– Bnow the dierent sterili0ation/decontaminationprocesses.

– He familiar with various chemical germicidesolutions.

– onitor processes to ma8e sure they are wor8ingas they should.



&eferencesA l d ill f i l " l i l 8i



Aral and aGillofacial "urgery $ol *; 'aniel Las8in

5eGtboo8 of Aral Q aGillofacial "urgery ; 7ustavBruger

Centre for 'isease Control and Prevention ;7uidelines for nfection Control 3--2

#ustralian 'ental Council ; 7uidelines for infectioncontrol 3--+

ndian )ournal of #nesthesiology

#merical "ociety of #nesthesiology ; 3-*3 operating

room design manual5eGtboo8 of icrobiology ; #nanthanarayan

Documents

Infection Control Final