1.infection control

1

CHAITANYA.P

I MDS

Dept of Public Health Dentistry

• Mention different sources & mode of spread of hep.B

infection encountered in dental practice & add a note on

laboratory diagnosis & prophylaxis of hepatitis. APR

2011

• Post exposure prophylaxis of HIV. OCT 2013

• Bio-medical waste management. OCT 2012, APR 2014

• Dry sterilization of instruments. APR 2014

• Infection control in dental practice. DEC 1997, FEB 2013

• Methods of sterilization. AUG 2013, OCT 2011

• Sterilization & disinfection in paediatric dentistry. 2007-

2008

• Occupation hazards among oral health care

professionals. OCT 2011

2

• INTRODUCTION

• TRANSMISSION OF INFECTION

• MODE OF TRANSMISSION

• INFECTION CONCERN IN DENTISTRY

• OBJECTIVES OF INFECTION CONTROL

• PERSONAL BARRIER PROTECTION

• EMERGENCY & EXPOSURE INCIDENT PLAN

• OPERATORY ASEPSIS

3

• DISINFECTION

• INSTRUMENT HANDLING & CLEANING

• STERILIZATION

• MONITORS OF STERILIZATON

• STORAGE OF STERILIZED ITEMS

• HANDPIECE ASEPSIS

• CLINICAL WASTE DISPOSAL

• CONCLUSION.

4

• Microorganisms are ubiquitous.

• Since pathogenic microorganisms causecontamination, infection and decay, it becomesnecessary to remove or destroy them frommaterials and areas.

• This is the objective of infection control andsterilization.

5

Ref: C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006

Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd

edition, 2005

INFECTION CONTROL – Also called “exposure controlplan” by OSHA, is a required office program that is designedto protect personnel against risks of exposure to infection.

EXPOSURE – is defined as specific eye, mouth, other mucousmembrane, non intact skin, or parenteral contact with blood orother potentially infectious materials.

Occupational Safety & Health Administration(OSHA)

6

Ref : C.P BAVEJA, Text book of microbiology, pg:-20-22,2nd edition, 2006


edition, 2005

Ref ; Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol 1, 2013

UNIVERAL BIOSAFETY PRECAUTIONS - means that allpatients and blood contaminated body fluids are treated asinfectious.

CONTROLWORK PRACTICE AND ENGINEERING –are terms that describe precautions(e.g; careful handling ofsharps) and use of devices to reduce contamination risks(highvolume suction)

7


Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-4-6, 3rd edition,

2005


Ref : Chitra Chakravathy, textbook of oral & maxillofacial surgery, pg:-3-12, 2nd

edition,2011

PERSONAL PROTECTIVE EQUIPMENT (PPE) –is a term used for barriers, such as gloves, gown, ormask.

HOUSEKEEPING – is a term that relates to cleanupof treatment-soiled operatory equipment, instruments,counters, and floors, as well as to management of usedgowns and waste.

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STERILIZATION: Use of a physical or chemicalprocedure to destroy all microorganisms includingsubstantial numbers of resistant bacterial spores.

Sterilization means the destruction of all life forms.

(Ronald B Luftig)

Sterilization is the process of killing or removing allviable organisms.

(MIMS – PLAYFAIR)

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DISINFECTION: Destruction of pathogenic and otherkinds of microorganisms by physical or chemical means.Disinfection is less lethal than sterilization, because itdestroys the majority of recognized pathogenicmicroorganisms, but not necessarily all microbial forms(e.g., bacterial spores).

Disinfection is a process of removing or killing most, butnot all, viable organisms.(MIMS-PLAYFAIR).

Disinfection refers to the destruction of pathogenicorganisms.(Ronald B Luftig).

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DISINFECTANT: A chemical agent used on inanimateobjects to destroy virtually all recognized pathogenicmicroorganisms, but not necessarily all microbial forms(e.g., bacterial endospores).

• DECONTAMINATION: Is the process of removal ofcontaminating pathogenic microorganisms from thearticles by a process of sterilization or disinfection. It isthe use of physical or chemical means to remove,inactivate, or destroy living organisms on a surface sothat the organisms are no longer infectious.

• ASEPSIS: Is the employment of techniques (such asusage of gloves, air filters, uv rays etc) to achievemicrobe-free environment

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• Antisepsis is the use of chemicals (antiseptics) to makeskin or mucus membranes devoid of pathogenic

microorganisms.

• Bacteriostasis is a condition where the multiplicationof the bacteria is inhibited without killing them.

• Bactericidal is that chemical that can kill or inactivatebacteria. Such chemicals may be called variouslydepending on the spectrum of activity, such asbactericidal, virucidal, fungicidal, microbicidal,

sporicidal, tuberculocidal or germicidal.



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12

Infection transmission during dental procedures isdependent on four factors:

1. Source of infection – may be a patient or a member ofthe dental team who is suffering from, or is a carrier ofan infectious disease.

SOURCE

13

Patients suffering from acute infection

Patients in prodromal stage

carriers

known unknown

Ref ; C.P.Baveja, text book of microbiology, 2nd edition, pg:-49-50, 2006

Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-33-35 , 3rd

edition, 2005

2. Means of transmission – Micro organisms capable ofcausing disease are present in human blood and saliva.Contact with blood or saliva may transmit suchpathogenic organisms causing infection.

3. Route of transmission – Transmission may occur due toinhalation or inoculation.

4. Susceptible host – Is a person who lacks effectiveresistance to a particular micro organism. E.g immunocompromised patients, pregnant women and children.

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• 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

15

Infection through any of these routes requiresthat all of the following conditions be present:

An adequate number of pathogens, ordisease-causing organisms.

A reservoir or source that allows the pathogento survive and multiply (e.g., blood).

A mode of transmission from the source tothe host.

An entrance through which the pathogen mayenter the host.

A susceptible host (i.e., one who is notimmune).

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17

TRANSMITTED BY INHALATION

Varicella virus Chicken pox

Paramyxovirus Measles & mumps

Rhino/ adeno virus Common cold

Rubella German measles

Mycobacterium Tuberculosis

Candida sp. Candidosis.


18

TRANSMITTED BY INOCULATION

Hepatitis B,C,D virus Hepatitis B, hep C,

Hepatitis D

Herpes simplex I Oral herpes, herpetic whitlow

Herpes simplex II Genital herpes

HIV AIDS

Neisseria gonorrhoeae Gonorrhea

Treponema pallidum Syphilis

S.aureus/albus Wound abscesses


19

Disease Work restriction Duration

Hepatitis A Restrict from patient contact,

contact with patient’s environment,

and food-handling.

Until 7 days after onset of

jaundice

Hepatitis B

Personnel with acute or

chronic hepatitis B surface

antigenemia who do not

perform exposure-prone

procedures

No restriction

Personnel with acute or

chronic hepatitis B

antigenemia who perform

exposure-prone procedures

Do not perform exposure-prone

invasive procedures

Until hepatitis B antigen is

negative

Hepatitis C No restrictions on professional

activity. HCV-positive health-care

personnel should follow aseptic

technique and standard

precautions.

Hands (herpetic whitlow) Restrict from patient contact and

contact with patient’s environment.

Until lesions heal

Ref : Cross infection control, journal of dental nursing, pg:-392-397, vol 9, no.7,

july 2013

20

HIV Do not perform

exposure-prone invasive

procedures.

Rubella

Active Exclude from duty Until 5 days after rash

appears

Postexposure (susceptible

personnel)

Exclude from duty From seventh day after

first exposure through

twenty-first day after last

exposure


july 2013

To protect the patient and members of thedental team from contacting infections duringdental procedures

To reduce the numbers of pathogenic micro-organisms in the dental operatory to thelowest possible level.

To implement a high standard of infectioncontrol when treating every patient (universalprecautions)

To simplify infection control, thus allowing thedental team to complete treatment withminimal inconvenience.

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Screening

PPE

Aseptic techniques

Sterilization & disinfection

disposal

Laboratory asepsis

• Personal protective equipment (PPE), or barrierprecautions, are a major component of Standardprecautions.

• PPE is essential to protect the skin and the mucousmembranes of personnel from exposure to infectious orpotentially infectious materials.

• The various barriers are gloves, masks, protective eyewear, surgical head cap & overgarments

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CHLORHEXIDINE BASED – these contain 2- 4%chlorhexidine gluconate with 4% isopropyl alcohol in adetergent solution with a pH of 5.0 to 6.5. They havebroader activity for special cleansing(e.g: for surgery,glove leaks, or when clinician experiences injury). But itcan be hazardous to eyes.

POVIDONE IODONE – contain 7.5-10% povidoneiodine, used as a surgical hand scrub.

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2005


Ref : Chitra Chakravathy, textbook of oral & maxillofacial surgery, pg:-12-13 ,2nd

edition,2011

PARACHLOROMETEXYLENOL(PCMX) – theseare bactericidal and fungicidal with 2%concentration. Non irritating and recommended forroutine use.

ALCOHOL HAND RUBS- ethyl alcohol andisopropyl alcohol are widely used at 70%concentration. They are rapidly germicidal whenapplied to the skin.

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edition,2011

All clinical personnel must wear treatment gloves during all procedures.

Types:

1. Latex gloves

2. Vinyl gloves

3. Nitile gloves

4. General purpose

utility gloves

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• Masks protect the face from splatter and preventinhalation of aerosols.

• Aerosols are airborne debris, smaller than 5ųm india, that remain suspended in air.

• Splatter are larger blood contaminated dropletswhich may contain sharp debris.

• A mask should have a bacterial filtration efficiencyof 95% or more.

• It should have a close fit around the entireperiphery.

CAUSES OF EYE DAMAGE:

Aerosols and spatter may transmit infection

Sharp debris projected from mouth while using air turbinehandpiece, ultrasonic scaler may cause eye injury.

Injuries to eyes of patients caused by sharp instrumentsespecially in supine position.

Therefore both the clinician and patients must use protectiveeyewear.

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Gown type Situation and Rationale

Cotton/linen, reusable or

disposable, long-sleeved isolation

gowns

Use if contamination of uniform or

clothing is likely or anticipated

Fluid resistant isolation gown or

plastic apron over isolation gown

Use if contamination of uniform or

clothing from significant volumes

of blood or body fluids is likely or

anticipated (fluids may wick

through non-fluid resistant

reusable or disposable isolation

gowns)

impervious gowns e.g., Gortex®

Fluid

Use if extended contact or large

volume exposure (e.g., large

volume blood loss during

resuscitation of MVA victim or

surgical assist)



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Most hospitals have their own policies regarding footwear.

Footwear with open heels and/or holes across the top canincrease the risk of harm to the person wearing them due tomore direct exposure to blood/body fluids or of sharps beingdropped for examples.



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• Engineering controls are the primary method toreduce exposures to blood from sharpinstruments and needles

• Work-practice controls establish practices toprotect personnel whose responsibilities includehandling, using, or processing sharp devices.

• Sharp end of instruments must be pointed awayfrom the hand

• Avoid handling large number of sharpdevices.


edition, 2005


• Management of exposure includes:

A. General wound care and cleaning.

B. Counseling of the exposed worker regarding bloodborne pathogens.

C. Source patient testing for HBV,HCV and HIV (consentrequired).

D. Documentation of the incident and review.

E. Post exposure assessment and prophylaxis for the healthcare worker.

F. Baseline and follow up serology of the worker.

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2005


Ref : Neelima malik, textbook of oral & maxillofacial surgery, pg:-70-101 ,2nd

edition,2011

35

IF AND THEN

Source pt is +ve for HBsAG

Exposed worker not vaccinated

Worker should receive vaccine series

should receive single dose of HB immunoglobulin within 7 days.

Exposed worker has been vaccinated

Should be tested for anti-HBs & given 1 dose of vaccine & 1 dose of HBIG if < 10 IU

36

IF AND THEN

Source pt is –ve for HBsAg


Worker should be encouraged to receive hepatitis B vaccine.

Exposed worker has

been vaccinated

No further action is needed.

Source pt refuses testing or not identified


Should receive HB series

HBIG should be considered

Exposed worker has been vaccinated

Management should be individualized.

37

IF THEN AND

Source pt has AIDS

OR

Source pt is HIV+ve

OR

Source Pt refuses to be tested

Exposed worker should be

counseled about risk of infection.

Should be tested for HIV infection immediately

Should be asked to seek medical advice for any febrile illness within12 weeks

Refrain from blood donation & take appropriate precautions

Exposed worker testing –ve initially should be retested 6 weeks, 12 weeks & 6 months after exposure.

38

IF THEN AND

Source pt is tested & found -ve

Baseline testing of the exposed worker with follow up testing 12 weeks later

Source cannot be identified

Serological testing must be

done &

decisions must

be individualized


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• In the dental operatory, environmental surfaces (i.e., asurface or equipment that does not contact patientsdirectly) can become contaminated during patient care.

• Certain surfaces, especially ones touched frequently (e.g.,light handles, unit switches, and drawer knobs) can serveas reservoirs of microbial contamination, although theyhave not been associated directly with transmission ofinfection to either personnel or patients.

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• Transfer of microorganisms from contaminatedenvironmental surfaces to patients occurs primarilythrough personnel hand contact.

• Dr. E. H. Spaulding(1939) proposed a classificationsystem for disinfecting and sterilizing medical and surgicalinstruments. This system, or variations of it, has been usedin infection control over the years.

Disinfection of surgical instruments in a chemical solution

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Category Definition Dental instrument or item

Critical Penetrates soft tissue, contacts

bone, enters into or contacts the

bloodstream or other normally

sterile tissue.

Surgical instruments, periodontal

scalers, scalpel blades, surgical

dental burs

Semicritical Contacts mucous membranes or

nonintact skin; will not penetrate

soft tissue, contact bone, enter into

or contact the bloodstream or other

normally sterile tissue.

Dental mouth mirror, amalgam

condenser, reusable dental

impression trays, dental handpieces

Noncritical Contacts intact skin. Radiograph head/cone, blood

pressure cuff, facebow, pulse

oximeter


Ref : Chrish H.Miller, Charles John Palenik, infection control, pg;-24-26, 3rd edition, 2005


Ref : Neelima malik, textbook of oral & maxillofacial surgery, pg:-70-101 ,2nd edition,2011

• Disinfection is always at least a two-step procedure:

• The initial step involves scrubbing of the surfaces to bedisinfected and wiping them clean.

• The second step involves wetting the surface with adisinfectant and leaving it wet for the time prescribed bythe manufacturer.

• There is no such thing as a “one-step disinfectant” Thedisinfectant step must always be preceded by cleaning.

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• The ideal disinfectant has the following properties:

Broad spectrum of activity

Acts rapidly

Non corrosive

Environment friendly

Is free of volatile organic compounds

Nontoxic & nonstaining

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LEVEL SPECTRUM USE EXAMPLES

Low level Bacteria except

mycobacteria

and spores.

Some fungi and

some

Viruses.

Surfaces without

blood

Quaternary

ammoniums,

some phenolics,

some iodofors

Intermediate

level

Mycobacteria,

not spores.

Most fungi and

most viruses.

Surfaces with

blood

Quaternary

ammoniums

with alcohol,

chlorines,

phenolics,

iodofors

High level All microbes

except spores

Immersion Glutaraldehyde,

strong

peroxides,

ophthaldehyde

Ref: Cohen: Pathways of the Pulp, 9th Edition pg:-1-9,2007

• Strategies for decontaminating spills of blood and otherbody fluids differ by setting and volume of the spill.

• The person assigned to clean the spill should wear glovesand other PPE as needed.

• Visible organic material should be removed withabsorbent material

e.g., disposable paper towels discarded in a leak-proof,appropriately labeled container.

45

• Nonporous surfaces should be cleaned and thendecontaminated with either an hospital disinfectanteffective against HBV and HIV or an disinfectant with atuberculocidal claim (i.e., intermediate-level

disinfectant).

• However, if such products are unavailable, a 1:100dilution of sodium hypochlorite (e.g., approximately ¼cup of 5.25% household chlorine bleach to 1 gallon of

water) is an inexpensive and effective disinfecting agent.

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Steam sterilization cellulose, cotton/polyester

cloths, window packs,

perforated rigid containers with

bacterial filters, glass

containers for liquids

Dry heat (hot air oven) Metal canisters and tubes of

aluminium foil, glass tubes, bottles

ETO Paper & Plastic, perforated rigid

containers with bacterial filters

Low temperature steam Paper, cloth

Radiation sterilization Polyethylene, PVC, polypropylene,

foil.


• Ultrasonic cleaning is the safest and most efficient wayto clean sharp instruments.

• An ultrasonic cleaning device should provide fast andthorough cleaning without damage to instruments; havea lid, well-designed basket, and audible timer; and beengineered to prevent electronic interference with otherelectronic equipment

49

• Operate the tank at one-half to three-fourths full of cleaningsolution at all times- Use only cleaning solutionsrecommended by ultrasonic device manufacturers.

• Operate the ultrasonic cleaner for 5 minutes or longer asdirected by the manufacturer to give optimal cleaning.

• Devices, that-have less than two transducers do not pass thefoil test and are not suitable for instrument cleaning.

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Stages for instrument sterilization:

1. Presoaking

2. Cleaning

3. Corrosion control and lubrication

4. Packaging

5. Sterilization

6. Handling sterile instruments

7. Storage

8. Distribution



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Physical agents:1. Sunlight

2. Drying

3. Dryheat: flaming, incineration, hot air

4. Moist heat: pasteurization, boiling, steam under pressure, steam under normal pressure.

5. Filtration: candles asbestos pads, membranes

6. Radiation

7. Ultrasonic and sonic vibrations

Chemical agents:1. Alcohols: ethyl, isopropyl,

trichlorobutanol

2. Aldehydes: formaldehyde, glutaraldehyde

3. Dyes

4. Halogens

5. Phenols

6. Surface-active agents

7. Metallic salts

8. Gases: ethylene oxide, formaldehyde, beta propiolactone. 53

The four accepted methods of sterilization are :

A. Steam pressure sterilization (autoclave)

B. Chemical vapor pressure sterilization- (chemiclave)

C. Dry heat sterilization (dryclave)

D. Ethylene oxide sterilization

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Advantages of Autoclaves.

Autoclaving is the most rapid and effective method forsterilizing cloth surgical packs and towel packs.

Is dependable and economical

Sterilization is verifiable.

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Disadvantages of Autoclaves.

Items sensitive to the elevated temperature cannot beautoclaved.

Autoclaving tends to rust carbon steel instruments andburs.

Instruments must be air dried at completion of cycle.

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Advantages1. Carbon steel and other

corrosion-sensitive instruments are said to be sterilized without rust.

2. Relatively quick turnaround time for instruments.

3. Load comes out dry.

4. Sterilization is verifiable.

Disadvantages1. Items sensitive to the

elevated temperature will be damaged. Vapor odor is offensive, requires aeration.

2. Heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization.

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• Conventional Dry Heat Ovens

• Short-Cycle, High-Temperature

Dry Heat Ovens

Advantages1. Carbon steel instruments and

burs do not rust, corrode, if they are well dried before processing.

2. Industrial forced-draft hot air ovens usually provide a larger capacity at a reasonable price.

3. Rapid cycles are possible at high temperatures.

4. Low initial cost and sterilization is verifiable.

Disadvantages1. High temperatures may

damage more heat-sensitive items, such as- rubber or plastic goods.

2. Sterilization cycles are prolonged at the lower temperatures.

3. Must be calibrated and monitored

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METHOD TEMPERATURE(ºc

)

HOLDING

TIME(MINS)

AUTOCLAVE 121 15

126 10

134 3

HOT AIR OVEN 160 45

170 18

180 7.5

190 1.5

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MOBILE FUMIGATOR

63

Advantages:1. Operates effectively at

low temperatures

2. Gas is extremely penetrative

3. Can be used for sensitive equipment like handpieces.

4. Sterilization is verifiable

Disadvantages:1. Potentially mutagenic and

carcinogenic.

2. Requires aeration chamber ,cycle time lasts hours

3. Usually only hospital based.

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Sterilization Type of instrument

Stainless steel Carbon steel

Saturated steam at 250°F Amorphous substance

formed near cutting edge;

no dulling.

Dulling and oxidation of

cutting surfaces

Formalin-alcohol vapor at

270°F

Cracking of wire edge; no

dulling.

Some oxidation of surfaces;

no dulling.

Dry heat at 320°F Chipping of wire edge; no

dulling.

No visual change.

Dry heat at 340°F Chipping of wire edge; no

dulling.

No visual change

65Ref : C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition, 2006


• Gamma radiation

• Dry-Heat Sterilizers

• Liquid Chemicals

• Performic Acid

• Filtration

• Microwave

• U.V radiation

• Flash sterilization

• Glass Bead “Sterilizer”

• Vaporized Hydrogen Peroxide

• Formaldehyde Steam

• Gaseous Chlorine Dioxide

• Vaporized Peracetic Acid

• Infrared radiation

• Oxygen plasma sterilization

66

Ref : C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition,

2006


Various new methods of sterilization are underinvestigation and development.

1. Peroxide vapor sterilization - an aqueous hydrogenperoxide solution boils in a heated vaporizer and thenflows as a vapor into a sterilization chamber containinga load of instruments at low pressure and lowtemperature

2. Ultraviolet light - exposes the contaminants with alethal dose of energy in the form of light. The UV lightwill alter the DNA of the pathogens. Not effectiveagainst RNA viruses like HIV.



• Ozone sterilization is the newest low-temperature sterilization methodrecently introduced in the US and issuitable for many heat sensitive andmoisture sensitive or moisture stablemedical devices

• Ozone sterilization is compatible withstainless steel instruments.

• Ozone Parameters • The cycle time isapproximately 4.5 hours, at atemperature of 850F – 940F.

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INSTRUMENTS NORAMAL IF NOT TIME

Mouth mirrors,

condensers, ball

burnisher, tweezer,

explorer.

Autoclave / dry heat

sterilization /

Boiling water,

savlon, lysol, dettol.

H2O2, spirit lamp,

Gluteraldehyde

Boiling water-1hr

lysol- un diluted

30mins. Diluted

1:100 for 1-2hrs.

Extraction forceps,

elevators, scalar tips

Autoclave / dry heat

sterilization /

Boiling water,

savlon, lysol, dettol.

H2O2, spirit lamp,

Gluteraldehyde,

Savlon –35ml

savlon with 1lit for

30mins.

Cotton , pt drapes. Autoclave , ETO ETO Korsolex-

disinfection – 5% for

30 minutes.

sterilization – 10 %

for 5 hours

Burs ,files Glass bead

sterilizer, dry heat

sterilization(except

hand files)

Gluteraldehyde

(KORSOLEX)

Ref: A MANUAL OF INFECTION CONTROL, pg:11-25, 2013

• The storage area should contain enclosed storage forsterile items and disposable (single-use) items.

• Storage practices for wrapped sterilized instruments canbe either date- or event-related

• Dental supplies and instruments should not be storedunder sinks or in other locations where they might becomewet.



• There are 3 methods of monitoring sterilization:

• Mechanical techniques

• Chemical indicators

1. Internal

2. External

• Biological indicators



STERILIZATION METHOD SPORE TYPE INCUBATION TEMPERATURE

AUTOCLAVE Bacillus stearothemophilus 56°C

CHEMICAL VAPOR

DRY HEAT Bacillus subtilis 37°C

ETHYLENE OXIDE

Gamma radiation B. Pumilus E601 370C

Sterilization monitoring has four components:

1. A sterilization indicator on the instrument bag, stamped with the date it is sterilized,

2. Daily color-change process-indicator strips,

3. Weekly biologic spore test, and

4. Documentation notebook.



• Oral fluid contamination problems of rotary equipment andespecially the high-speed handpiece involve:

• contamination of hand-piece external surfaces andcrevices,

• turbine chamber contamination that enters the mouth,

• water spray retraction and aspiration of oral fluids into thewater lines of older dental units

• growth of environmental aquatic bacteria in water lines

• exposure of personnel to spatter and aerosols generated byintraoral use of rotary equipment.

73Ref : Cross infection control, journal of dental nursing, pg:-392-397, vol 9, no.7,

july 2013


july 2013 74

75

YELLOW

BAG

RED BAG BLUE BAG BLACK

BAG

ORANGE

BAG

•Human

anatomical

waste

•Animal

waste

•Microbiolog

y and

biotechnolog

y waste

•Solid

waste( items

contaminate

d with body

fluids)

•Microbiolog

y and

biotechnolog

y waste

•Solid waste

(tubings, iv

catheters)

•Waste

sharps

•Solid waste

(tubings, iv

catheters)

•Discarded

medicines

and

cytotoxic

drugs

•Incineration

ash

•Chemicals

used in

disinfection

&

insecticides

• Animal and

slaughter

house waste

Ref. Guidelines on HIV testing, National AIDS Control Organization (NACO), march 2007, pg :-32 Ref. Preventive and social medicine, K.PARK, pg.738-739, 22nd edition, 2013

• Ibrahim Ali Ahmad, Elaf Ali Rehan and Sharat Chandra

Pani conducted A pilot-tested questionnaire concerning

various aspects of infection control practices was

distributed to 330 dental students. The response rate was

93.9% (n = 311). About 99% of students recorded the

medical history of their patients and 80% were vaccinated

against hepatitis B. The highest compliance (100%) with

recommended guidelines was reported for wearing gloves

and use of a new saliva ejector for each patient. Over 90%

of the respondents changed gloves between patients, wore

face masks, changed hand instruments, burs and hand

pieces between patients, used a rubber dam in restorative

procedures and discarded sharp objects in special

containers. A lower usage rate was reported for changing

face masks between patients (81%), disinfecting

impression materials (87%) and dental prosthesis (74%)

and wearing gowns (57%). Eye glasses and face shield

were used by less than one-third of the sample

76Ref: International Dental Journal 2013; 63: 196–201

1. Protect every dental film with plastic barrier previously to

its use.

2. Place carefully the protected film inside the patient’s

mouth wearing glove;

3. Take the patient to the work area and place the lead

apron and thyroid collar;

4. After the exposure, take the dental film out of the

patient’s mouth and remove the plastic barrier, avoiding

touching the dental film package

5. Place the uncontaminated film inside a plastic cup

6. Discard contaminated gloves and wash hands

7. Take the cup with uncontaminated films to the processing

chamber

77Ref:RGO - Rev Gaúcha Odontol., Porto Alegre, v.61, n.4, p. 607-612,

2013

Luciana Maria Paes da Silva Ramos FERNANDES

Ronald Ordinola ZAPATA

Izabel Regina Fischer RUBIRA-BULLEN

Ana Lúcia Álvares CAPELOZZA discussed various steps in

Infection control in dental radiology

• Pervasive increases in serious transmissible diseases overthe last few decades have created global concern andimpacted the treatment mode of all health carepractitioners.

• Emphasis has now expanded to assuring and demonstratingto patients that they are well protected from risks ofinfectious disease.

• Infection control has helped to allay concerns of the healthcare personnel and instill confidence and in providing asafe environment for both patient and personnel.

78

1. C.P BAVEJA, Text book of microbiology, pg:-20-27,2nd edition,

2006

2. Chrish H.Miller, Charles John Palenik, infection control, pg;-4-50,

3rd edition, 2005

3. Daniel M. Laskin, oral and maxillofacial surgery, pg:-346-355, vol

1, 2013

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