CROSS INFECTION

CONTROL
DR.MANISH KUMAR
PG STUDENT
DEPT.OF PROSTHODONTICS

Infection control the set of methods used to control and

prevent the spread of disease

Infections - are caused by pathogens (germs)

Communicable disease disease spread from one person to

another

Infectious disease disease caused by a pathogen (germ or

bacteria)

01/09/2009

Body fluids tears, saliva, sputum (mucus coughed up), urine,

feces, semen, vaginal secretions, pus or other wound drainage,
blood

Touching the infected person or their secretions

Touching something contaminated by the infected person.

Droplets coughing, sneezing, laughing, spitting, talking

01/09/2009

Any body opening of an uninfected person

which allows pathogens to enter

Nose, mouth, eyes, rectum, genitals and other

mucous membranes

Cuts, abrasions or breaks in the skin

01/09/2009

Anyone whose resistance to disease decreases

Reasons for lowered resistance: age, existing illnesses, fatigue

and stress

The elderly have weaker immune systems and a lower

resistance to pathogens

Elderly are hospitalized more often, increasing the chance for

hospital-acquired infections

Recovery longer in the elderly

01/09/2009

Patient screening
Equipment asepsis

Personal protection
INFECTION CONTROL

Instrument sterilization

Aseptic technique
Surface disinfection

TYPES OF CONTAMINATION

Air borne contamination (exposure concern

for personnel) - exist in the form of spatter,
mists and aerosols.

Digital contamination of surfaces (exposure

concern for both personnel and patients)

FEDERAL AND STATE REGULATIONS TO REDUCE

EXPOSURE RISKS FROM PATHOGENS IN BLOOD AND
OTHER SOURCES OF INFECTION

The term Infection control program (IC

program) recommended by the CDC & ADA
are designed to protect both patients and
personnel.
The federal Occupational Safety and Health
Administration (OSHA) uses Exposure
Control plan published in December 1991.

The OSHA rule derives from the original

Occupational Safety and Health Act passed
by the US. Congress in 1970.
The Act covers two regulated programs of
compliance:
An OSHA Hazard communications program and
An OSHA Blood borne pathogens program.

Summary of the current OSHA regulations:

Employers must provide hepatitis B immunization to

employees without charge within 10 days of employment.
Employers must require that universal precautions be
observed to prevent contact with blood and other
potentially infectious materials. Saliva is considered to be
a blood contaminated body fluid in relation to dental
treatments.
Employers must implement engineering controls to
reduce production of contaminated spatter, mists and
aerosols.

Employers must implement work practice control

precautions to minimize splashing, spatter or contact
of bare hands with contaminated surfaces.
Employers must provide facilities and instruction
for washing hands after removing gloves, and for
washing other skin immediately or as soon as feasible
after contact with blood or potentially infections
materials. Flush eye or mucosa immediately or as
soon as feasible after any contact with blood or
potentially infectious materials.

Employers must prescribe safe handling of needles and

other sharp items. Needles must not be bent or cut.
When it can be shown necessary, needles may be resheathed with mechanical aids.
Employers must prescribe disposal of single use
needles, wires, carpules and sharps as close to the
place of use as possible, as soon as feasible, in hard
walled, leakproof containers that are closable, from
which needles cannot be easily spilled. Containers must
be kept upright and closed when moved. Teeth must not
be discarded into trash but can be given to the patient or
discarded into sharps containers.

Employers must prohibit eating, drinking, handling contact

lenses, and application of facial cosmetics in contaminated
environments such as operatories and clean up areas. Ban
storage of food and drinks in refrigerators or other spaces
where blood or infectious materials are stored.
Place blood and contaminated specimens (eg;, impressions
that have not been well cleaned and well disinfected, teeth,
biopsy specimens, blood specimens and culture specimens) to
be shipped, transported or stored into suitable closed
containers that prevent leakage. An adequately strong plastic
bag can be used for impressions.

At no cost to employees, employers must

provide them with necessary personal
protective equipment (PPE) Ensure that
employees correctly use and discard PPE or
properly prepare it for reuse.
As soon as feasible after treatments, attend to
housekeeping requirements including floors,
countertops, sinks, and other environmental
equipment that are subject to contamination.

Employers must provide a written schedule for cleaning and

then using a decontaminating procedure for equipment, work
surfaces and contaminated floors. Broken glassware that may be
contaminated must be cleaned up with mechanical means, and
never with gloved hands.

Contaminated equipment that requires service must first be

decontaminated, or a biohazard label must be used to indicate
contaminated parts.

Contaminated sharps are regulated waste; discard in

hard-walled containers. Place reusable contaminated
sharps instruments into a basket in a hard-walled
container for transportation to the clean-up area.
Employers must provide laundering of protective
garments used for universal precautions at no cost to
employees. Bag all soiled liners where they are used
in color-coded bag recognized as requiring universal
precautions.

EXPOSURE ASSESSMENT
PROTOCOL
I. MEDICAL HISTORY
Purposes To detect any unrecognized illness that requires medical
diagnosis and care.
To identify any infection or high risk that may be important to
a clinical person exposed during examination, treatment or
cleanup procedures.
To assist in managing and caring for infected patients
To reinforce use of adequate infection control procedures

II. PERSONAL BARRIER PROTECTION

Gloves

Wear TREATMENT GLOVES during all treatment procedures. After

each appointment, or if leak is detected, remove gloves, wash hands and
put on fresh gloves.

They should be dispensed carefully to avoid contaminating others in the

box. Treatment gloves cannot protect against punctures.

Gloves that become penetrated or torn must be removed.

To open drawers or handling items adjacent to the operatory, use a paper

towel or food handlers overglove to control contamination.

Gloves must meet new FDA regulations ie., less than 4% can have a leak
detectable by a water test.

While cleaning and sorting used sharp instruments, wear puncture

resistant UTILITY GLOVES. Nitrile latex gloves are preferred.

Instructions for Handwashing

HAND CLEANSERS containing a mild
antiseptic like 3% PCMX or chlorhexidine
Lather hands for at least 10 seconds, rubbing
all surfaces and rinse.
Prior to surgery use a prescribed surgical
scrub, washing and rinsing from hands
toward elbows

PROTECTIVE EYEWEAR may be goggles

or glasses with solid side shields.
Wear a MASK to protect against aerosol.
FACE SHIELDS are appropriate for heavy
spatter.
PROTECTIVE OVER GARMENTS

III.DISPOSAL OF CLINICAL WASTE

Infected blood and other liquid clinical waste can
generally be poured down a sanitary sewer or drain
designed for the purpose, but not mercury and certain
chemicals. Adding 3 ounces of 5% hypochlorite in
water (house hold bleach) to each 30 ounces of fluid
collected in surgical aspiration bottles is
recommended before disposing the fluid down the
drain.
Contaminated materials such as used masks, gloves,
blood /saliva soaked sponges, cotton rolls etc must
be discarded safely.

IV.NEEDLE DISPOSAL

Dispose off needles in a hard walled leak proof container which has
the OSHA biohazard label.

Locate the needle disposal container in the operatory close to where

the needle will be used; and

Avoid carrying unsheathed contaminated needles or containers in a

manner that could endanger others or would allow the needle to be
accidently spilled.

Follow local regulations for disposal of the container.

V. PRECAUTIONS TO AVOID INJURY

EXPOSURE
STIK SHIELD - to re-sheath the needle
Remove burs from handpieces when finished;
or if left in the handpiece in a hanger, point the
bur away from your hands and body.

PROTECTION OF COMPLEX DEVICES

AGAINST CONTAMINATION

Cameras, light curing units, lasers, intraoral

cameras, air abrasion units- Clear plastic bags
of suitable size with a small hole to pull over
the lens holder of the camera are effective
single-use protective barriers.

PROCEDURES, MATERIALS AND DEVICES FOR

CLEANING INSTRUMENTS BEFORE

STERILIZATION
The safest and most efficient instrument cleaning
procedures involve ultrasonic cleaning of used
instruments kept in a perforated basket or cassette
throughout the cleaning procedure.
Wear protective utility gloves at all times to handle
contaminated containers and instruments.
Dip instruments likely to rust into a rust inhibitor
solution

A disinfectant holding solution for transporting and /

or soaking used instruments should :
contain a detergent,
be economical,
not corrode instruments in a reasonable time,
be one of the least inactivated by organic debris,
not give off toxic aldehyde vapors and
have 10 minutes well verified anti microbial claims
against TB and preferably against polio or coxsackie
virus.

SELECTION OF STERILIZATION METHODS AND

EQUIPMENT
Stainless steel instruments and mirrors can be sterilized by
any accepted method.
High and low-speed handpieces best autoclaved.
Burs can be safely sterilized by (i) dry heat or (ii) Chemical
vapor in a chemiclave or in a gas sterilizer (iii) but may corrode
or rust if not protected from steam in the autoclave.
Metal impression trays by any method, but dry heat above
3450F may remove soldered handles
Orthodontic pliers of high quality stainless steel will resist
corrosion in an autoclave: lower quality stainless steel
sterilized by dry heat or chemical vapor.
Towels and towel pack of instruments needed for surgery -best
sterilized by autoclaving

DENTAL CONTROL UNIT WATER SYSTEMS AND

HANDPIECE ASEPSIS

Hand piece surface contamination control

Only sterilization can approach complete infection control of
handpiece surfaces.
Turbine contamination control
Operating the handpieces between patients to flush the
handpiece is prescribed to reduce this risk.
Water retraction system correction
Since 1988, nearly all manufacture have manufactured dental
control units that simply cut off the water spray without retraction.
Inherent water system contamination
Clean water reservoir systems combined with disinfection or
sterilization of equipment downstream have been developed by at
least 2 companies ( ADEC, Portland, Oragon). Always remove the
handpiece before disinfecting the system.
Control of contamination from spatter and aerosol

ELIMINATION OF MICROORGANISMS FROM

DENTAL OPERATORY COMPRESSED AIR.

A device called Puril air has been devised that

heats every particle of inflowing compressed
air to 2500C and then forces it through a finepore ceramic filter.

DISINFECTION FOR VARIOUS

IMPRESSION MATERIALS
Material
Alginate

Polysulfide, Silicone

Polyether

ZOE paste

Impression compound

Method

Disinfectant

Immersion (<10min)
Chlorine compounds, iodophors, short
term glutaraldehyde exposure
Immersion, spray

Glutaraldehyde, chlorine compounds,

iodophors, phenolics, >30 min
exposure time not recommended.

Immerse with caution

Spraying, immersion

Chlorine compounds, iodophors,

short term exposure
Glutaraldehyde, iodophors,
phenolic spray .
Iodophors, chlorine compounds,
phenolic spray

CONCLUSION

Pervasive increases in serious transmission diseases over the last two

decades have created global concern and impacted the treatment mode
of health care practicioners.

Practitioners are advised to attend continuing education programs to

expand and update their infection control program.

The goal is to ensure compliance with universal barriers and other

methods to minimize infection risks, to provide a professional health
care atmosphere that conveys conscientious protection and treatment
according to sound principles of infection control in keeping with
current regulations.