CONTENTS

1. INTRODUCTION 2. INFECTION CONTROL IN DENTAL OFFICE 3. BASIC INFECTION CONTROL PROCEDURES 4. PERSONAL PROTECTION NEEDLE STICK INJURIES HAND CARE USE OF MASKS 5. CLEANING AND DISINFECTION OF OPERATORY DENTAL UNIT HAND PIECE ASEPSIS AIR WATER SYRINGES ULTRASONIC SCALERS

X-RAY E UIPMENT AND FILMS COUNTER TOP AND SURFACES !. DISINFECTION OF IMPRESSIONS ". DISINFECTION OF PROSTHESIS# CROWN AND BRIDGES $. INFECTION CONTROL IN DENTAL LABORATORY. CLEANING AND DISINFECTION AIR %ENTILATION&SUCTION SYSTEMS E UIPMENTS&INSTRUMENTS FLOORS&SURFACES '. CHARACTERISTICS OF DISINFECTING CHEMICALS 1(. THE COMMANDMENTS OF PRACTICAL INFECTION CONTROL DENTISTRY 11. CONCLUSION 12. REFERENCES

INTRODUCTION Infection control has become a widely discussed topic in dentistry. Most of this discussion however has been devoted to general dentistry and oral surgery. Little has been written about infection control in a dental discipline such as

Prosthodontics. With the evolution of highly pathogenic and invasive micro organism, every specialty of dentistry carries its own risks. Research has now evolved in prosthodontics to directly relate the evidence concerning the pathogenicity and invasiveness of infectious diseases. Routinely dental care professional are at an increased risk of cross infection while treating patients. his occupational

potential for disease transmission becomes evident initially when one reali!es that most human microbial pathogens have been isolated from oral secretions. "ecause of repeated e#posure to the microorganisms present in blood and saliva, the incidence of certain infectious diseases has been significantly higher among dental professionals than observed for the general population. $epatitis ", tuberculosis and simple# virus infections are well recogni!ed and indicate the need for increased understanding of modes of disease transmission and infection control procedures by dental care providers. he use of effective infection control procedures in the dental office and the dental laboratory will prevent cross contamination that may e#tend to dentists, dental office staffs, dental technician and patients. In this dental discipline there are two areas where the infection control protocol re%uires to be implemented. &. 'ental office (. Laboratory

INFECTION CONTROL IN DENTAL OFFICE D)*+,- .//01)2 he first step involves) Identifying high risk patients and sources of infection. *nderstanding which disease has a high susceptibility for transmission and their routes of transmission. +creening new patients prior to treatment by taking an oral and written medical history. ,ontinuing to update all patients- medical histories at each recall appointment.

he following groups have been identified as high risk in relation to $I. and $"./ 0ny one with multiple se# partners and homose#uals. Intravenous drug abusers. Persons receiving transfusion of blood products. $ealth care workers who may come into contact with blood saliva and other body fluid 1 secretions.

o set the standard of infection control it is necessary to have a knowledge about the microorganisms, their mode of spread and preventive measures against them and their habitats. he pathogenic capabilities of the microorganisms depend on virulence, host resistance and concentration. 0t present most serious of these diseases are $". and 0I'+. $". is a disease, challenging dentist and their staff. 0I'+ is a potential threat because of the increasing fre%uency with which 0I'+ patients seek dental treatment for intra oral symptoms.

HEPATITIS C It is transmitted through contaminated needles, syringes, contaminated blood and accidental needle stick $,. has been demonstrated in saliva he onset of $,. can be incidious with no clinical symptoms P3)4)*+0.* Measures recommended for $". can be applied

HEPATITIS D $'. is also called delta hepatitis virus It cannot cause infection e#cept in presence of $". infection P3)4)*+0.* 0ll measures used to prevent hepatitis " can be used HEPATITIS E

2ormerly known as enterically transmitted non 0 non " hepatitis $3. is transmitted by contaminated water, as well as person to person by the fecal, oral route

P3)4)*+0.*

+anitary disposal of waste $and washing especially before handling food

he second and third stage of 0I'+ may be detected by dentists undertaking oral and facial e#amination. $owever evidence suggests that the causative agent of 0I'+ is probably difficult to transmit during routine dental procedures. +tudies have shown that the second and third stage of 0I'+ patients evidence a high infection rate with secondary infections like $"., $erpes, candidiasis, oral hairy Leukoplakia, venereal diseases and ". D050*/)1+0.* ,*6 ,*+05)75052 0ntisepsis is a procedure which inhibits or destroys microbes on living tissues.

'isinfection may also be used as antiseptics or vice versa depending on their to#icity. %,30.85 6050*/)1+,*+5 85)6 0* 6)*+05+392

4luteraldehyde, ,hlorine compounds, Iodophors, Phenolics, 0lcohol 56789 ,hlorhe#idine etc. M)+:.65 ./ D050*/)1+0.*2

&. $eat (. Physical :. ,hemical D050*/)1+0.* ;9 :),+

Pasteuri!ation "oiling water B.0-0*< =,+)3. If the boiling period is short bacterial spores can survive, boiling water is therefore inade%uate for

sterili!ation of dental instruments. $eat sterili!e all metal and heat;stable instruments that contact oral tissues, contaminated appliances, or potentially contaminated appliances should be heat sterili!ed after each use 3#amples/ facebow fork, metal impression trays, burs, polishing points, rag wheels, laboratory knives

P:9501,- >)+:.65-U-+3,5.*012 his is an effective way of disrupting microbial cell membrane and is used for removing debris before autoclaving. C:)>01,- >)+:.652 ,hoosing a chemical disinfectant should be done carefully because a disinfectant used for one propose may not be e%ually effective for another. 2urther, the antimicrobial activity of a chemical disinfectant falls drastically in the presence of organic debris. Li%uid ,hemical +terilant1'isinfectants <nly for heat;sensitive critical and semi;critical devices

Powerful, to#ic chemicals raise safety concerns

$eat tolerant or disposable alternatives are available

M.6) ./ ,1+0.* ./ 1:)>01,- 6050*/)1+,*+2 ,hemical used as disinfectant cause protoplasmic poisons in : different ways. &. Membrane active disinfectant damages bacterial cell membrane 5chlorhe#idine, %uaternary ammonium compound, alcohol phenols9 (. 2i#ation of the cell membrane and blockage of egress of cellular components 52ormaldehyde and 4luteraldehyde9 :. <#idi!ing agent ; o#idi!e the cellular constituent 5hypochlorite9 C.*60+0.*5 6)+)3>0*0*< +:) )//)1+04)*)55 ./ , 6050*/)1+,*+2 &9 +pectrum of activity of the disinfectant vary widely 3#/ some are more active against 4ram =ve than 4ram ;ve bacterial ( 9 +atisfactory contact of the contaminated surface with the disinfectant for a specified period of time. :9 <rganic 'ebris, air, greasy material prevent this so thorough cleaning before 'isinfection is necessary. >9 ,oncentration; ade%uate concentration of disinfectant is essential and should be for effectiveness. ?9 0ctivity of disinfectant is often p$ dependent 53#/ 4lutaraldehyde acts only at alkaline p$, phenol at acid p$9. @9 Aeutrali!ation / 0 wide range of substances including hard water soaps and detergent may neutrali!e the disinfectant. 69 +tability/ 0ll disinfectants are not stable especially when diluted and may deteriorate with storage. +olution should be freshly prepared and marked with an e#piry date. B9 +peed of action varies according to the concentration used. $ypochlorite have rapid action but are corrosive at high concentration. 4lutaraldehyde is slow acting but is an effective sporocidal agent. P.+)*19 ./ , 6050*/)1+,*+2 accurately dispensed

'isinfectant can be generally categori!ed as having high, intermediate or low potency depending on their ability

to kill various groups of organisms.

A-1.:.-2

hose which can destroy mycobacterium groups are considered high potency disinfectant.

3thyl alcohol or propyl alcohol 56789 alcohol combined with aldehyde is used in dentistry for surface disinfectant.

5is not recommended as it evaporates relatively %uickly and leaves no residual effect9 A-6):96)2 G-8+,3,-6):96)

It can be used either alone or in combination with others. 0lthough less reactant than formaldehyde. It may cause

skin sensiti!ation.

C:-.3:)?060*)

0ntiseptic and pla%ue control agent ;(8 is used as dental disinfectant. Its efficiency in the oral cavity is mainly due to absorption on to hydro#y apatite and salivary mucus.

H97.1:-.30+) acts by releasing halide ions.

,orrodes metals and %uickly in; activated by organic matter 5betadine9

3ach dental discipline is challenged by some what different organisms.

$"., " and 0I'+ are the serious ones. " may become a particular challenge to prosthodontic practice in future because the organisms are transmitted

in sputum and older persons are susceptible to ac%uiring the disease B,501 0*/)1+0.* 1.*+3.- 73.1)683)52 Practical points/ o be simple, economical and easily understood by all staff. P3)4)*+04) >),583)5 R05@ ,3),5 &. (. :. >. ?. @. 6. B. $ands;;;;;;;;;;;;;;;; gloves 3ye;;;;;;;;;;;;;;;;;;;;; spectacles 'irect splatter;;;;;;;;;masks1spectacles 0erosol;;;;;;;;;;;;;;;;;masks Instruments;;;;;;;;;;;;sterili!ation Aeedle stick inCuries;;good techni%ue ,ontaminated surfaces;;'isinfection ,ontaminated waste;;;;;;safe disposal

Most government entities, private agencies and health care professional organi!ations list si# infection control procedures as mandatory for control of infectious diseases in dental practice regardless of disciplines. personnel 5' P9 &. 0ll ' P should wear late# e#amination gloves during patient treatment (. 0ll ' P should wear protective eye ware during patient treatment. :. 0ll ' P should wear masks covering the nose and mouth >. 0ll items used in the oral cavity should be sterili!ed in a heat or heat pressure sterili!er whenever possible. hey are 'ental treatment

systems recommended for use in dentistry include chemical vapor sterili!ers, dry heat sterili!ers and steam

autoclaves ?. 0ll touch and splash surface should be disinfected with an accepted disinfectant whenever sterili!ation is not possible.

Presently available chemical meeting these criteria are 4luteraldehyde, sodium hypochlorite, iodophors synthetic

phenolic compound etc. @. ,ontaminated materials to be disposed off carefully by placing it in a sealed appropriate marked container. Incineration is desirable whenever available waste from high risk cases must be sterili!ed and then incinerated.

PERSONAL PROTECTION2 1. N))6-) 5+01@ 0*A830)52 Risk areas. Reheating local anesthetic needles. Washing blood contaminated instruments $andling instruments P3)4)*+0.* *se of needle guard. "ayonet techni%ue 5one handed introduction of needle into the sheath D T3),+>)*+ 5)B8)*1) /.3 0*A830)52

Wash in running water and encourage wound to bleed ,over the wound +eek medical advice ,ounseling

ake blood sample from recipient

Prophylactic hepatitis "; .accine or hyper immuno gamma globulin are advised Identify instrument or needle est for hepatitis " virus and $I. ake blood sample from donor Record details of inCury in an accident book

Intact skin surface is the main barrier for protection against pathogens. he p$ of skin is maintained by perspiration and the normal p$ is between ?.?;@.?

0t $igher p$ B, the keratin becomes weak and the skin surface is relatively porous 'amage to the skin is easily caused while handling laboratory e%uipment in prosthodontics. ,uts and burns can

easily occur which can predispose to infections such as dermatitis, psoriasis. +kin flora includes species of gram =ve cocci, belonging to staphylococcus, cornybacterium, yeast and yeast like fungi, staphylococcus aureus are regarded as transient and so are organisms like actinobacter and enterobacteriacea species. H,*6 1,3)2

$and washing &. Eeep nails short (. Remove Cewellery :. ,over all cuts and abrasions >. Wet hands thoroughly ?. 0pply disinfectant to palms, back;finger webs, then tips of fingers. @. Rinse thoroughly 6. 'ry thoroughly B. Wash before and after each session F. *se an emollient hand cream after each session. &7. Preferably use li%uid soap rather than bar soaps A-1.:.- ;,5)6 :,*6 6050*/)1+,*+52 &. +imilar to hand washing (. 0llow time for alcohol if visibly stained with blood or saliva :. 'o not use if hands is visibly stained with blood or saliva >. 'o not use in presence of naked flames A*+05)7+015 85)62 &. ,hlorhe#idine (;&>8 with isopropyl alcohol of p$ ?;@.? (. Povidone iodine 6.?8;&78 :. 0lcohols ; ethyl and isopropyl alcohol 68 >. Phenolic compound ?. $e#achlorophene ; absorbed into blood through intact skin hence to#ic with repeated use. @. Parachlor meterylenol (8 5P,M9 G-.4)5

Minimi!e the risk of health care personnel ac%uiring infections from patients Prevent microbial flora from being transmitted from health care personnel to patients Reduce contamination of the hands of health care personnel by microbial flora that can be transmitted from one

patient to another

G-.4)5C

0re not a substitute for handwashingG

he type of gloves available are late#, non;sterile and sterile .inyl 4eneral purpose utility gloves +urgeons sterile gloves

N.* 5+)30-) -,+)? <-.4)5C

,an be used for e#amination purpose. Prosthodontic treatment and laboratory work. 4loves which are manufactured by a double dip, process have less irritating cataly!ing coagulants. Ideal gloves are those that are sterile and can be thrown away after use. ,heaper gloves are less well fitting and tactile sensation may be lost. +ome are corrugated and dimpled for grip and are easier to wash.

Rewashing can decontaminate the gloves but after the washing the gloves deteriorate and the glove surface becomes sticky and porous.

0fter contact with a patient, glove should be removed hand washed and disinfected and new gloves applied

again before treating the ne#t patien

'ouble gloving is recommended when thoperator has dermatological lesions, or when the patient is medically

compromised .

E//)1+ ./ -,+)? <-.4)5 ,* >,*078-,+0.* ./ 0>73)550.* >,+)30,-C

+ulphur contamination from natural late# gloves inhibits the setting of addition silicone impression. Late# gloves are not to be worn while mi#ing or handling vinyl polysilo#ane putties Putties should not be disposed while wearing late# gloves as the entire Car can get contaminated. Late# gloves do not affect the setting of condensation silicone. 0lternative suggestions are

.inyl gloves without +ulphur containing stabili!ers, used as over gloves. +hould not be contaminated with powder

from late# gloves. R)1.>>)*6,+0.*5 /.3 G-.40*<

Wear gloves when contact with blood, saliva, and mucous membranes is possible

Remove gloves after patient care


M,5@52

Wear a new pair of gloves for each patient

0cts as a barrier against aerosol and splatter. It is essential to wear a mask when using hand price air water syringe or ultrasonic sealer. Washing contaminated instruments 3mptying suction

A* 06),- /,1) >,5@52

+hould have a bacterial filtration efficiency of F?8 or more 'oes not contract nostril or lips $as high filtration of small particles and tolerable, breath ability ,lose fit around entire periphery 'o not cause fogging of eye glasses.

W:0-) 850*< >,5@52 &. *se a new mask for each patient. (. When a mask become wet replace it immediately or else it will collapse against the face and may not act as a barrier. :. Remove mask with gloved hand and then discard both as contaminated waste. >. 'o not touch masks during procedure. If touched, hands should be washed each time. ?. 'iscard masks as soon as e#ternally contaminated @. 'o not pull the mask down the face or leave it hanging around the neck . T97) ./ >,5@5 ,4,0-,;-)2

+imple paper masks;Limited protection due to poor fit. heatre type mask;Ineffective as a microbiological barriers. 'ome type mask;,lose the nose and mouth completely not to wear

E9) 73.+)1+0.*2

3ssential against direct trauma, aerosols splatter debris. *se protective glasses with side pieces ,oated safety glasses have the advantage of being fog and scratch resistant

Mask with face shield or visor can be used

'econtaminate used glasses with water and detergent and then with a tuberculocidal disinfectant which does not

attack plastic or later the ability to transmit light. P3.+)1+04) 1-.+:0*<2 &. <ffice coats wear a uniform or gown or coat (. ,hange daily more often when visibly contaminated with blood :. Long sleeves are more protective to the e#posed areas from saliva and blood contamination. >. uck the bottom of the sleeves into the gloves ?. ,lothing should be made from light material with high collars, minimum of seams buttons or buckles. @. +oiled clothing should be cleaned with hot water at B7H , for &7 mins using strong detergent and bleach if possible. H),6 1.4)352 I $air should be short and away from face J It should not interfere with vision or encroach on the operating area. I $ead caps can be used during invasive procedure which are likely to involve e#tensive blood 1 saliva. A660+0.*,- 73)1,8+0.*5C I Pre;treatment tooth brushing I (8 chlorhe#idine as a pre;treatment mouth wash. I $igh volume aspiration I ,orrect use of rubber dam. I 3fficient air filtration and ventilation laminar air flow and electrostatic precipitation units.

C-),*0*< ,*6 D050*/)1+0.* ./ +:) .7)3,+.392 ,leaning and 'isinfection of the operatory is of vital importance in disease containment and infection control. he staff member in charge of this task carries a heavy ethical responsibility. Plan the office layout splitting it into. &. <perators area (. 'ental assistants area :. +terili!ation and storage *tilities must be located at appropriate places, use separate sinks for hand washing and instruments washing preferably elbow and foot operated. Manual ,leaning

+oak until ready to clean Wear heavy;duty utility gloves, mask, eyewear, and protective clothing

A8+.>,+)6 C-),*0*<

*ltrasonic cleaner Instrument washer Washer;disinfector D)1.*+,>0*,+0.* ./ )*403.*>)*+,- 583/,1)52

he theory behind surface cleaning and 'isinfection include the following.

Mechanical removal of organic debris 5pre cleaning9 J Wetting the surface with appropriate disinfectants and 0llow time for a residual effect of the disinfectant.

D050*/)1+,*+5 85)62 &/&7 solution of sodium hypochlorite 5freshly prepared daily9 iodophors mi#ed with distilled or sterile water synthetic phenol. S73,9 =07) 573,92 When cleaning remember to spray, wipe, spray the disinfectant solution. *se >#> gau!e s%uares to wipe surfaces in overlapping strokes. *sing a systematic pattern contact all surfaces at least twice. disinfectant solution to dry on the surface. Ideally wait for &7 mins. S83/,1)5 +. ;) 6050*/)1+)62 +urfaces that were touched during any procedure should be disinfected. hese surfaces include any and all surfaces in the operatory. K Light handles and switches ,hair switches and stool levers ubing attached to hand pieces, air water L;ray head and tube. ray , tray arm and bracket table ,ounter tops, cabinet and drawers ,linical ,ontact +urfaces T:) 6)*+,- 8*0+2 syringe and high velocity suction system. hen spray again. 0llow the

Molinari suggests the following measures for controlling infection in the dental unit.

E,1: >.3*0*<2

2lush your water lines for :;? mins and use this Jspray;wipe ; sprayJ techni%ue on all Jhigh touchJ non sterili!able

surfaces and e%uipment . 0llow at least &7 min for the 'isinfection solution to air dry.

B)+=))* 7,+0)*+5C

2lush your water lines for at least &? sec, sterili!e or disinfect the hand piece and : way syringe. Remove all disposable covers and disinfect all Jhigh touchJ areas with an approved surface disinfectant siphon

disinfecting solution through the high velocity evacuation system 0t the end of each day flush your water line for : mins run an ample amount of disinfection solution through the suction lines.

'isinfect the floor around the base of the chair use the Jspray wipe sprayJ method on all counter tops and high

touch areas.

Weekly;'isinfect both inside and outside of all drawers and cabinets. 'isinfect the entire floor of the operatory

and office laboratory. H,*6 70)1) ,5)75052 +terili!ation is the preferred method of treating hand piece when possible. 2irst flush the hand piece by running water thorough it for (7;:7 sec. discharge the water into the sink or a container, ne#t scrub the hand piece thoroughly with detergent and hot water to remove gross debris and adherent material. If the hand piece cannot be sterili!ed it must be high level disinfected with a chemical germicide which is tuberculoidal. Wrap the hand piece in solution soaked gauges and seal in a plastic bag or other impervious container. Leave undisturbed for the amount of time recommended by the manufacturer. 2ollowing completion of high level disinfection and prior to use. Remove any chemical residue by rinsing with sterile water or wiping the hand price with alcohol with alcohol soaked gauge. &.Pre;manufactured disposable disinfectant sleeves/ 0fter flushing the hand piece place it an individual disinfectant hand piece sleeve. which contains a combination of

alcohol and two synthetic phenols recogni!ed by the 3P0 as a broad spectrum hospital grade antimicrobial agent as tuberculocidal seal the sleeve for &7 months. 0fter &7 min or ready for the ne#t patient clean the hand piece and blot it dry with a paper towel. (. Late# sheath is a thin sheath of late# that covers all of the high speed hand piece, e#cept the bur.

It is disposed off after each patient and a fresh sheath is placed when disinfecting the operatory. A03 & =,+)3 5930*<)5 ,*6 8-+3,5.*01 5),-)352

he units should be flushed as described for hand pieces. here attachments should be sterili!ed, if not possible

disinfected in the same manner as the hand pieces.

+crubbing thoroughly, wiping with a disinfecting solution and removing any residue by rinsing with sterili!ed water

or wiping with alcohol. If possible removable tips should be used. X-3,9 )B807>)*+ ,*6 /0->52

Protective covering or disinfectants should be used to prevent microbial contamination of collimating tubes. Intraorally contaminated film packet should be handled in a manner to prevent cross contamination. ,ontaminated packet should be opened in the dark room using disposable gloves. he film should be dropped out of the packet without touching the film he contaminated packet should be accumulated in a disposable towel. 0fter the packets have been opened they should be discarded and the gloves are removed. hen films can processed without contaminating the dark room, e%uipment with microorganism from the patient. ,ounter tops and surfaces that may have become contaminated with blood or saliva should be pre cleaned to

remove organic matter and their disinfected with a suitable chemical germicide. D050*/)1+0*< 73.5+:)505 13.=* ,*6 ;306<)5 &. 0ll to be washed carefully before placement into mouth, then disinfected. (. 0fter removal from mouth.

a. *ltrasonic cleaning for two min with a mild detergent or ultrasonic cleaning fluid. b. Rinse under tap water, shake off e#cess water, immerse for &7 min inAa<,I or iodophors.

:. 0ntimicrobial agents incorporated in prosthetic materials to combat infections. a. issue conditioners sustained release system of antifungual agents 5chlorho#idine, clotrima!ole9 incorporated into tissue conditioners helps to treat denture stomatitis. b. 'enture adhesives ; he#a chlorophane c. 2acial silicone elastomers Aystifin and clotrima!ole in elastomers are effective against penicillin species. d. ray adhesives ; phenolic compounds >. 0ntimicrobial rinses a. ,hlorhe#idine (8 E//)1+5 ./ 6050*/)1+,*+5 ./ 73.5+:)5052

I6.7:.3 .* M)+,- ,orrosive on repeated e#posure ,hange in fle#ibility of clasps due to tarnish and corrosion 4lutaradehyde (8 and phenolic buffer change disinfectant solution every day contra indicated.

D)*+83) 1-),*)352

'eposit of dentures a. +oft debris b. $ard deposit of calculus essentially comprise of inorganic portion ,aP<>, ,a,<s

<rganic portion which bonds the deposit to proteins. R)B803)>)*+ ./ 1-),*5)352

the denture comprises &?;:78 of the total deposit, consist of micro

Aon to#ic, bactericidal, dissolves organic and inorganic portions, shelf life, harmless to prosthetic materials.

D050*/)1+0.* ./ 0>73)550.*52

Impression must be rinsed to remove saliva, blood and debris and disinfected before being sent to the laboratory. +aliva contains &7 bacteria 1 ml drained from mucosal surfaces and teeth. +imple washing removes F78 surface

bacteria. "y disinfection &778 removal is achieved . I33)4)350;-) :963.1.--.062 &. &7 min immersion1spray with sodium hypochlorite (. $ouse hold bleach &;&7 dilution, iodophors, synthetic phenols by spray. :. 'o not submerge or soak in disinfectant, wrap the impression in a disinfectant soaked paper towel and place in a sealed plastic bag for &7 min. Remove wrapped impressions unwrap, rinse thoroughly shake e#cess water and pour the model. >. +pray disinfection has a better antimicrobial effect. 'oes not affect the dimensional stabilities much as immersion. Impregnation of antimicrobial compounds into alginate 3#/ 'imethyl ammonium chloride. A<,32

+odium hypochloride &/&7 for &7 mins. ldophor&/(&:

P.-958-7:06)52

4enerally stable when immersed in standard disinfectants, rinse, in sodium hypochlorite &/&7 for &7min. Rinse

again to remove residual Water.

'isinfection the custom tray can interfere with the bond of some impression material to the custom tray. P.-9)+:)32

Prolonged immersion surface leads to distortion

If longer than &7 mins dimensional changes occur due to hydrophilic nature. +hort term disinfection can affect the surface properties of impression materials. o minimi!e dimensional change with Polyether impressions a chlorine compound product with a short

disinfection time 5(;: months9 should be selected or impression should be disinfected with spray. A660+0.*,- 50-01.*)2

+usceptible to damage to neutral gluteraldehyde immersion longer than &? min. hydrophilic become hydrophobic. 0lternative; idophor +pray is best for additional silicone

C.*6)*5,+0.* 50-01.*)2

*naffected by immersion disinfectant (8 gluteraldehyde satisfactory sodium hypochlorate &/&7 D050*/)1+0.* ./ <9758> 1,5+52 &. 0dditional of disinfectant to the water (. 0dditional of disinfectant to the water = over night gas sterili!ation but :. 'isinfectants incorporated into gypsum cast Iodophors &.6@ for &hr Phenol ?8 Aa<,&?.(?8 effective at & hr 4luteraldehyde (8 it is impractical for routine use.

>. ,hloramine,

7.(?8 has also been added to dental stone used for pouring irreversible hydrocolloid impression.

D050*/)1+0.* ./ 78>01)2

0dd three parts of green soap to the disinfectant solution 5? parts of Aa<, & to &77 parts of distilled water9 before mi#ing the pumice.

his helps to keep the pumice suspended , pumice must be changed daily and the lathe should disinfected unit

doses of pumice may be used in each case and then discarded. ,hange pumice daily Machine should be cleaned and disinfected daily Ao need for separate pans for new and e#isting prostheses if isolated properly 0t a minimum clean and disinfect pumice brushes and rag wheels daily. 'aily heat sterili!ation is preferable . INFECTION CONTROL IN THE DENTAL LABORATORY

Infection control in dental laboratories has attracted increasing interest. +everal well documented instances have prove that persons can contact infection disease by handling contaminated materials. hus dental lab personnel have the moral and legal responsibility to prevent cross contamination via the dental lab DENTAL LABORATORY

0ll disinfection procedures are accomplished prior to delivery to lab 'one in dental operatory or professional work area Recommend a sign and monitor system be implemented stating Only Biologically Clean Items Permitted

INCOMING ITEMS

OUTGOING ITEMS

,lean and disinfect before delivery to patient 0fter disinfection/ rinse and place in plastic bag with diluted mouthwash until insertion 'o not store in disinfectant before insertion Label the plastic bag/ This case shipment has been disinfected with ______ for _____ minutes

C-),*0*< ,*6 6050*/)1+0.*2

3ffective cleaning and disinfection will help to maintain a sanitary environment as well as to minimi!e the

potential for cross contamination of infectious diseases via the laboratory.

0ll laboratory personnel must observe procedures that maintain a hygienic and sanitary environment. *tility gloves that are puncture resistant must be worm to protect hands from contamination by pathogens

L,;.3,+.39 5,*0+,+0.* >),583)5 >85+ 0*1-86) +:05 /.--.=0*< ,3),5

0ir ventilation and +uction system 3%uipmentsa and instruments 2loor and surfaces. A03 4)*+0-,+0.* & 581+0.* 595+)>52

0ir ventilation filters and vacuum bags or suction unit filters should be changed and 1 or cleaned regularly to

improve their effectiveness and efficiency. EB807>)*+5 & 0*5+38>)*+5C

Laboratory personnel should clean and disinfect e%uipment and instruments that have been contaminated by

pathogens. +uch laboratory e%uipments and instruments include grinding lathes , hand pieces ,ultra sonic units, packing bo#es, trash containers, utility gloves, pumice pans, laboratory pans, protecting eye wear, vibrator, cast trimmers,

articulators, face bow transfers, %uick polymeri!ation unit pots burs and stones, polishing rag wheels , bristle brushes ,mi#ing bowls and spatulas. Research data have shown that e#ternal surface of laboratory lathes and hand pieces can be disinfected using surface disinfecting chemicals laboratory personnel should follow the lathe and hand piece manufactures instruction for proper maintenance cleaning disinfection and compatibility with disinfecting chemicals hand piece should be heat sterili!ed if possible. &. horoughly scrub the e#ternal portion of the lathe and or hand;piece with detergent or disinfectant and rinse with water to remove adherent materials. (. horoughly spray or wipe lathe and 1or hand piece with absorbent material 53#) disposable paper towel) saturated with a surface disinfectant that is recommended by the manufactures. 0llow at least a ten months contact time and then rinse with water and dry. Make sure that the surface disinfecting chemicals being recommended by the lathe and 1 or hand piece manufactures is an accepted procedure. :. 'epending on the lathe and1or hand piece, apply lubrication before use 5follow manufactures instructions9. >. *se plastic wrap, aluminum foil, or other materials impervious to water to cover the cleaned and wiped lathe and 1 or hand piece. Replace the cover after each use. F-..35&583/,1)52

he laboratory personnel should be re%uired to clean and disinfect floors and other surfaces/ generally all

surfaces should be cleaned and disinfected at the end of each work day, other significant practices include. &. *sing disposable over gloves when answering a telephone call if interrupted while performing a task re%uiring glove wearing. (. 0void from eating drinking applying cosmetics or lip balm and handling contact lenses at prohibited areas in the dental laboratory or work areas when there is potential for occupational e#posure :. using stone that has not been poured against an impression to make slurry water. >. Mi#ing polishing pumice with antiseptic li%uid soap. ?. *sing puncture resistant utility gloves to retrieve items immersed in disinfecting solution. 0void using disposable gloves because disinfecting solutions cause deterioration of glove materials, resulting in minute punctures in the gloves during laboratory procedures there by contaminating the hands. @. Refraining from placing the ceramic brush in the mouth when building ceramic restorations 6. Refraining from using saliva to polish a wa# pattern. B. Replacing contaminated pumice after each use when polishing repaired and new prosthesis. F. Replacing e#pired disinfecting solution according to the manufactureMs instructions.

&7. *sing separate pumice pans for polishing repaired and new prosthesis as indicated. &&. *sing spray bottle instead of gau!e and other applicators to carry disinfecting solutions when cleaning and disinfecting. he rationale for using spray bottles is to allow the disinfectant to better penetrate e%uipment crevices. 0dditionally, spray bottles protect the disinfectant solution from being activated or absorbed by gau!es disposable paper towel or sponges. &(. 'iluting disinfecting solutions with water following the manufacturerMs instructions to prevent impairment of the cleaning and disinfecting efficiency. &:. *sing mechanical shell blaster only on disinfected dental items. It is important to use effective disinfecting chemical that have the ability to penetrate and preclean contaminated surfaces such surface disinfecting chemicals include iodophors phenolicm, chlorine solutions and gluteraldehyde etc. 'isinfecting chemicals should indicate on the label that they kill mycobacterium tuberculosis.

his is significant because the tubercle bacillus is an intra cellular bacteriaG parasite that presets a sever

challenge to chemical disinfectants used in dental offices and laboratories and is considered to be the ne#t most resistant micro organism after bacterial endospores. he mycobacterium tuberculocidal action assures that the product is an intermediate or highest level disinfectant and that it will destroy all pathogenic potentially threatening dentistry. 'isinfecting chemicals should also posses the following additional characteristics. &. he widest possible antimicrobial spectrum (. 0 rapidly lethal action on all vegetative forms and spores of bacteria and fungi, proto!oa etc. :. 0ctivity in the presence of organic matter such as blood, sputum and compatibility with soap detergents and other chemicals encountered in use. >. 0 non;corrosive nature especially with regard to instruments, e%uipment and other metallic surfaces. he disinfection also should not alter the integrity of impression materials 3#/ dental stone. ?. 0 resident effect to combat pathogens on treated surfaces. @. 3asy to use 6. 0 pleasant odor affordability he commandments of practical infection control in dentistry/ odayMs minimum re%uirements for a practical dental office infection control 1 e#posure systems. 3ach dental facility should have a comprehensive e#posure control plan. things. &. Information and training he written e#posure control plan should address the following

(. *niversal precaution :. 3#posure determination >. $epatitis " vaccination ?. Personal protective e%uipments @. 3ngineering and work practice control 6. $ouse keeping B. Post e#posure evaluation and follow up F. Medical records &7. "ioha!ard communication I*/.3>,+0.* ,*6 +3,0*0*<2

3mployers shall ensure that employee with occupational e#posure participate in a training program that must be

provided at no cost to the employees and during working hrs. U*04)35,- 73)1,8+0.*52

*niversal precautions shall be observed to prevent contact with blood and other potentially infections materials.

*nder circumstances in which differentiation between body fluid types is difficult or impossible all body fluid must be considered potentially infections. E?7.583) 6)+)3>0*,+0.*2 3ach employer who has employees with occupational e#posure must prepare an e#posure determination which shall contain a list of all Cob classification in which all employees have occupation e#posure and a list of all tasks and procedures in which occupational e#posure occurs. his e#posure determination shall be made without regard to the use of personal protective e%uipment H)7,+0+05 B 4,110*,+0.*2

he employer shall make available hepatitis " vaccine and vaccination series to all employees who have

occupational e#posure. his must be provided at no cost to the employee and at a reasonable time and place. P)35.**)- 73.+)1+04) )B807>)*+52

he employer shall provide at no cost to the employee appropriate personal protective e%uipments such as

gloves, gowns, laboratory coats, face shield masks and eye protection etc. E*<0*))30*< ,*6 =.3@ 73,1+01) 1.*+3.-52

3ngineering and work practice control shall be used to eliminate or minimi!e employee e#posure.

he

engineering and work practice control in effect must be e#amined at regular intervals to ensure their continued effectiveness.

H.85) @))70*<2

3mployee shall ensure that the worksite maintained in a clean and sanitary condition

P.5+ )?7.583) )4,-8,+0.* ,*6 /.--.= 872 0fter a report of an e#posure incident the employer immediately shall offer the e#posed employee a confidential medical evaluation and follow up. M)601,- 3)1.3652

e#posure.

he employer shall establish and maintain an accurate medical record for

each employee with occupational

B0.:,D,36 1.>>8*01,+0.*2

Wearing labels or color coding shall be used on containers of regulated waste, refrigerators and free!es

containing blood or other potentially infections material and other container used to store, transpo

CONCLUSION 'ental officer and commercial laboratories should work closely together to co;ordinate control of potential cross infection between the two disciplines. he control of infectious disease in prosthodontics is not difficult.

'ental personnel have the moral and legal responsibility for protecting himself, his patient from infectious disease.