Beruflich Dokumente
Kultur Dokumente
dental clinic
By
Hesham
Dameer
CHAIN OF INFECTION
All links must be connected for infection
to take place
Pathogen
(sufficient virulence
& adequate numbers)
Susceptible Host
Entry
(portal that the
pathogen can
enter the host)
Source
(allows pathogen to
survive & multiply)
Mode
(of transmission
from source to host)
Definitions:
CDC:
Center of Disease Control and Prevention .
ADA:
American Dental Association.
ADAA:
American Dental Assistants Association.
OSHA:
Occupational Safety and Health Administration.
OSAP:
Organization for Safety and Asepsis Procedures.
EPA:
Environmental Protection Agency.
FDA :
Food and Drug Administration.
NIOSH:
National Institute for Occupational Safety and
1) Hand washing
2) Gloves
3) Face masks
4) Protective eye wear
5) protective clothing
Standard Precautions
1. IMMUNIZATION
2. PATIENT SCREENING
3. HAND WASHING
4. BARRIER TECHNIQUES Personal Protective Equipment (PPE)
Rubber dam, Pre-procedural rinsing
5. NEEDLE & SHARP INSTRUMENT SAFETY
Occupational Exposure To Blood/Body Fluids
7. SURFACE DISINFECTION
8. radiographic asepsis
9. laboratory asepsis
10. infectious dental waste management & disposal
Pretreatment Period
It is the period of protective
equipment :
An essential pretreatment procedure is the
preparation of all personnel involved in
patient care. This includes the utilization of
personal protective equipment (gown,
eyewear, mask and gloves) and hand
hygiene.
Visibly dirty
After touching
contaminated objects
with bare hands
Before and after
patient treatment
(before glove
placement and after
glove removal)
Personal protective
equipment ( PPE )
Examples of PPE :
1- Protective clothing
2- Surgical masks
3- Face shields
4- Protective eyewear
5- Disposable patient treatment gloves ,
and
1) Protective clothing :
2) Gown
3) Surgical scrubs
2) Protective masks :
Purpose the mask worn over the nose and
mouth to protect the person from inhaling
infectious organisms spread by the aerosol
spray of the handpiece or air-water syringe .
Types the two most common types of masks
are the dome-shaped and flat types .
The dome-shaped
Flat types
3) Protective eyewear :
Purpose eyewear is worn to protect the eyes
against damage from :
Aerosolized pathogens .
Flying sharp debris such as scrap amalgam
and tooth fragments .
Splattered solutions
Caustic chemicals
Guidelines for the use of protective eyewear :
1) OSHA requires the use of eyewear with both
front and side protection ( solid side shields ) .
2) Members who wear correction glasses or
contact lenses must wear protective eyewear
with a side shields or a face shield .
3) It must be cleaned
and decontaminated
after each treatment or
patient visit according to
the manufactures
instructions .
Types :
Two types of protective
eyewear used during
patient care :
1) Glasses with
protective side shield ,
and
2) Clear face shields .
Face shields :
a chin-length plastic face
shield that protects your
eyes, nose, and mouth from
spatter may be worn and
replace the protective
eyewear .However , a shield
cannot replace the mask
because it does not protect
against inhalation of
contaminated aerosol
Patient eyewear :
Patients should be provided with protective
eyewear because they may subjected to eye
damage from :
1) Handpiece spatter
2) Splashed dental materials
3) Airborne bits of acrylic or tooth
fragments
4) Gloves :
Purpose :
Gloves must be worn by the dentist , dental
assistant , and dental hygienist during all
dental treatment to avoid contact with the
patients blood , saliva , or mucous
membranes or with contaminated items or
surfaces .
Types :
The type of gloves used in dental
practice
should be determined by the
various procedures that are performed in the
practice as follow :
1) Examination gloves usually are latex or
vinyl . These are the gloves most frequently
To prevent contamination , an
Overgloves is worn while using a
pen .
4) Utility gloves are made from a punctureresistant , heavy material which are not used
for direct patient care . Utility gloves may be
washed , disinfected , or sterilized and reused
and must be discarded when they become old .
B) Transfer surfaces :
are touched by contaminated instruments
such as instruments trays .
Surface barriers :
Surface barriers are
used to prevent
contamination on the
surface underneath .
All the surface barriers
should be resistant to
fluids in order to
prevent microorganisms
in saliva , blood , and
other liquids from
soaking through the
barrier and reach the
surface underneath .
Chair Drapes
Film Dispenser
Cleaning and disinfection of the dental
treatment room surfaces are important
components in an effective infection control
program .
Precleaning
Precleaning means that all contaminated
surfaces must be precleaned before they can
be disinfected . Precleaning reduces the
number of microbes and remove blood ,
saliva , and other body fluids .
Precleaning techniques are most
effective when used on contaminated surfaces
that are smooth and easily accessible for
cleaning .
Disinfectants
Disinfectants are chemicals that destroy or
inactivate most species of pathogenic
( disease-causing ) micro-organisms . In
dentistry , only those products that registered
with the U.S Environmental protection Agency (
EPA ) with tuberculocidal action should be used
to disinfect dental treatment areas .
Ideal surface disinfectant
The ideal surface disinfectant must be rabidly
kills a broad spectrum of bacteria , has residual
activity , minimal toxicity , odorless ,
inexpensive and does not damage surfaces to
be treated .
Disinfectant such as :
Iodophors :
Iodophors are EPA-registered hospital
disinfectants with tuberculocidal action .
It is recommended for disinfecting surfaces
after dental treatment .
Iodophors are usually effective within 5 to 10
minutes .
Non-irritant and non-toxic .
Unstable solution must be changed
regularly .
Because they contain iodine , iodophors may
corrode or discolor certain metals and
temporarily may cause red or yellow stains on
Sodium hypochlorite :
Sodium hypochlorite is a fast-acting , economic
and broad-spectrum intermediate-level
disinfectant .
Disinfectant effect observed after 10 minutes .
The Centers for Disease Control and prevention
( CDC ) currently recommended the use of up
to 1 100 dilution of sodium hypochlorite for
surface decontamination .
The disadvantages
Unstable solution need daily preparation .
It has a strong and unpleasant odor .
Irritant for skin and eyes .
Corrosive for some metals .
Alcohol :
Ethyl alcohol and isopropyl alcohol have been
used over the years as skin antiseptics and
surface disinfectants . However , alcohol are not
effective in the presence of blood and saliva
droplets because of the rapid rate of
evaporation will limits the antimicrobial activity
of alcohol . In addition , alcohols are damaging
to certain materials , such as plastics and vinyl .
The American Dental Association ( ADA ) ,
CDC , and OSAP do not recommend alcohol as
an environmental surface disinfectant .
Chlorine dioxide :
Chlorine dioxide can be used as an effective ,
rapid-acting , environmental surface
disinfectant ( 3 minutes ) or as a chemical
sterilant ( 6 hours ) .
The disadvantages
(1) it must be prepared fresh daily .
(2) it is corrosive to aluminum containers
2) Semicritical instruments
are those that do not penetrate soft tissues or
bone but contact oral tissues, such as
amalgam condensers, air/water syringe , tips
mirrors, intraoral radiography accessories,
digital radiography sensors, and other dental
high-technology instruments . These devices
should also be sterilized after each use. In
some cases, however, high-level disinfection is
appropriate. A high-level disinfectant is
registered with the U.S. Environmental
Protection Agency (EPA) as a
"sterilant/disinfectant" and must be labeled as
such.
3) Noncritical instruments
are those that come into contact only with
intact skin such as external components
of X-ray heads. Such devices have a
relatively low risk of transmitting infection
and, therefore, may be reprocessed
between patients by intermediate-level or
low-level disinfection.
Managing contaminated
sharps :
Contaminated needles and other disposable
sharps , such as scalpel blades , orthodontic
wires , and broken glass must be placed into
a sharps container .
OSHA , CDC and the EPA classify sharps as
infectious waste .
According to OSHA regulations , disposable
sharps must be placed in a puncture
resistant , closable , and color-coded or
labeled with the biohazard symbol container
immediately after use .
Biohazard symbol
Holding solution :
A holding solution is a
liquid disinfectant/sterilizing solution used to
soak contaminated instruments before they are
cleaned and sterilized. It has the purpose to:
Decrease infectious microbes on instruments .
Loosen and minimize debris before scrubbing
or
Hand scrubbing
Ultra-sonic cleaning
Ultrasonic cleaning is recommended in place
of hand-scrubbing in order to reduce direct
staff contact with contaminated instruments.
The ultrasonic cleaner works by producing
sound waves which causes formation of
bubbles in liquid . The bubbles are too small
to be seen .
The mechanical cleaning action of the
bubbles combined with the chemical action of
the ultrasonic solution removes the debris
from the instruments .
Instruments should be processed in the
ultrasonic cleaner until they are visibly clean .
Automated
washer
It looks similar to a
household dishwasher.
It uses a combination of
very hot water together
with a detergent to
remove the organic
material. It is
considered as
disinfector because it
subjects the
instruments to a level
of heat that kills most
Packaging instruments
Before sterilization the instruments must be
packaged to protect them from becoming
contaminated after sterilization .
They can be contaminated by aerosols in the
air , dust , or contact with nonsterile
surfaces .
An additional advantage to packaging
instruments is that they can be grouped into
.special setups
Sterilization monitoring
Sterilization monitoring
Because sterilization failure can occur at any
time, it is critical to determine that dental
instruments are properly sterilized or not
because microorganisms can not be seen by
.naked eye
Nowadays, three forms for sterilization
:monitoring are used
PHYSICAL
CHEMICAL
BIOLOGICAL
:Physical monitoring
Physical monitoring of the
sterilization process
involves looking at the
gauges and readings on
the sterilizer and recording
the temperatures,
pressure, and exposure
time. Remember that the
temperature recorded is
for the chamber, not the
inside of the pack.
Therefore, problems with
overloading or improper
packaging would not be
Chemical monitoring:
Chemical monitoring involves the use of heatsensitive chemicals that change color when
. exposed to certain conditions
The two types of chemical indicators are
process
indicators and process integrators.
Process indicators
This is used externally outside the
instruments packages like autoclave tape and
color change marking. Its aim is to determine if
the package is processed or not.
They simply identify instrument packs that
Process integrators
Process integrators are placed inside
instrument packages. They respond to a
combination of pressure, temperature, and
time. All sterilization factors are integrated.
Examples of process integrators include
strips, tabs, or tubes of colored liquid.
Biologic monitoring
This is the best way to determine if
. sterilization has occurred
Biologic monitoring , or spore testing, is the
only way to determine if sterilization has
occurred. The CDC, American Dental
Association recommend at least weekly
.biologic monitoring of sterilization equipment
Biologic indicators (BIs), also known as spore
tests, are vials or strips of paper that contain
harmless bacterial spores (spores are highly
.resistant to heat)
:Method
Three BIs are used in testing. Two BIs are
placed inside instrument packs, and the
Flash Sterilization
involves sterilizing unpackaged instruments
using short exposure times. The instruments
are placed in the chamber unwrapped. The
sterility of the instruments is defeated
immediately when the instruments are
removed from the sterilizer.
Flash sterilization should be used only for
instruments that are to be used promptly on
removal from the sterilizer.
Dry-heat Sterilizers
Dry-heat sterilizers operate by heating air and
transferring that heat from the air to the
instruments. This form of sterilization requires
higher temperatures than steam or chemical
vapor sterilization . temperature ranges
between (160 C to 190 C) .
The total cycle time :
placing instruments in oven, heating to 170 C,
timing for 1 hour, and then cooling it from 2
2.5 hours .
The advantage of dry heat is that the
instruments will not rust if they are thoroughly
dry before they are placed in the sterilizer.
STERILIZATION FAILURE
Best
wishes for
you
Dr. Hesham Dameer
Ase
el