EBOH GRACE

MAHARJAN SAHISTA
CROSS-CONTAMINATION CYCLE
Why is Infection Control Important in Dentistry?
 Both dentists and patients can get infected by exposure to pathogens.

 Close contact with blood, contaminated equipment, oral and

respiratory secretions can occur.

 Treatments carried out properly can protect patients and dental experts
from transmission of infection.
 Dental patients and dental health care workers may be
exposed to a variety of microorganisms such as bacteria,
viruses, and fungi during dental treatment.
 Among these, the diseases of foremost concern are
infections caused by
 Human immunodeficiency virus (HIV)
 Hepatitis viruses B, C, and D
 Mycobacterium tuberculosis
 Indirect contact with a contaminated
instrument or surfaces

Inhalation of
Direct contact with blood Mode of airborne
or body fluids transmission micro-organism

Contact of mucosa of the eyes, nose, or

mouth with droplets or spatter
 Route of transmission

Inoculation:
• Direct contact of previously damaged skin or mucous
membrane with a lesion, organism, or debris while
performing intra-oral procedures.
• Accidental self injury with a contaminated needle, or
sharp instruments

Inhalation
• Inhalation of microorganisms aerosolized from a
patient’s blood or saliva occurs when using high speed
or ultrasonic instruments
Elements of Standard Precautions..

 Aseptic Techniques
 Hand Hygiene
 Use of masks, gloves, eye
protection and gowns.
 Waste Management
 Injury Prevention
Why Is Hand Hygiene Important?
 Hands are the most common mode of pathogen transmission.
 Prevent health care-associated infections
 reduce spread of antimicrobial resistance.

Hands Need to be Cleaned When

 Visibly dirty
 After touching contaminated objects with bare hands
 Before and after patient treatment
(before glove placement and after glove
removal)
HAND HYGIENE DEFINITIONS
Handwashing
• Washing hands with plain soap and water
Antiseptic handwash
• Washing hands with water and soap or other detergents
containing an antiseptic agent
Alcohol-based handrub
• Rubbing hands with an alcohol-containing preparation
Surgical antisepsis
• Handwashing with an antiseptic soap or an alcohol-based
handrub before operations
Special Personal Hygiene Considerations
• All dental staff who come into direct contact
with patients should practice meticulous personal
hygiene.
• Avoid artificial or long nails. Fingernails must be
kept short and jewelry on the hands and watches
should be removed since they tend to trap
organisms and may tear the gloves.
• Hair should be put up tightly.
Some Specific Precautions..
Before Treatment
 Pass running water through every watersystem.

 Clean the working surfaces and dental equipment to disinfect them.

 Keep minimum equipment out for usage during the treatment.

 Sterilise the instruments and dispose them in possible cases.

During Treatment
 Open cuts and abrasions of the skin should be
properly dressed up.

 Avoid touching materials other than

instruments with hand gloves on.

 Working distance should be maintained to

avoid contamination from the patient’s mouth.

 Blood flow and fluid spillage should be taken

care of immediately.
 THE USE OFPPE
• Gloves – Use when touching blood, body fluids, secretions,
excretions, contaminated items; for touching mucus
membranes and nonintact skin.

• Gowns – Use during procedures and patient care activities

when contact of clothing/ exposed skin with blood/body
fluids, secretions, or excretions is anticipated.

• Mask, goggles or face shield – Use during patient care

activities likely to generate splashes or sprays of blood, body
fluids, secretions, or excretions

Masks, Gloves, Gowns, Protective Eyewear, Face Shields are

the major component of standard precautions.
Wearing Personal ProtectiveEquipment
Removing Personal ProtectiveEquipment
Common Methods of sterilization
 Steam (Autoclave)

M o s t preferred method of sterilization is autoclaving.

Temperature Time Pressure

Unwrapped
1340C 3 min 30 psi
instruments

Wrapped
1210C 15-20 min 15 psi
instruments

Advantages – good penetration

Precautions – carbon steel corrodes, damage to plastic and
rubber items, packs wet after the cycle, hard water spots
instruments.
 Unsaturated chemical vapor – 20 minutes at 134 C
Advantages – no corrosion of carbon steel, packs are dry after
cycle
Precautions – may damage plastic and rubber items.

 Dry heat (Oven Type) – 1 to 2 hours at 160 C

Advantages – no corrosion of carbon steel, packs dry after the
cycle
Precautions – may damage plastic and rubber items, do not
open door during the cycle.

 Dry heat (rapid heat transfer type)- 6 to 12 minutes at 191 C

Advantages – short cycle
Precautions – may damage plastic and rubber items.
Packaging and sealing of instruments
• Instruments should be carefully packaged in functional
sets before sterilization.
• This packaging protects the instruments after sterilization
and before use at chair side.
• A variety of packaging materials are available.
• Self-sealing, paper-plastic, peel pouches are the most
convenient.
• Some packaging materials have indicators which change
color when sterilization is completed.
 Classification of Instruments to
be sterilized
 Dental instruments are classified into three
categories depending on their risk of
transmitting infection and the need to
sterilize them between use.
 critical
 Semi-critical
 Non-critical
 Instruments
Critical Instruments Semi-Critical Non-Critical
Instruments Instruments
 Penetrate mucous  Contact intact
 Contact mucous
membrane or contact skin
membranes but do
bone, the bloodstream,
not penetrate soft
or other normally sterile
tissue
tissues of the mouth.

  Examples: mouth  Examples: X-ray

Examples: include
surgical instruments, miror, Dental heads, facebows,
scalpel blades, needles amalgam , condensers pulse oximeter,
periodontal scalers, and and dental handpieces. blood pressure
surgical dental burs. cuff

 Autoclaving, heat  Clean and

 Heat sterilize or high-
sterilize between uses or level disinfect disinfect using a
use sterile single-use, low to
disposable devices. intermediate
level disinfectant
 Surface asepsis
Use surface barriers to protect clinical
contact surfaces, particularly those that are
difficult to clean (e.g., switches on dental
chairs).
 Change surface barriers between patients.
Disinfection of Dental Equipments
Clinical contact surfaces and dental
equipments that are not covered should be
cleaned and disinfected with a hospital level
disinfectant (activity against HIV, HBV, and
Mycobacterium tuberculosis) after each
patient.
Sodium hypochlorite (household bleach) is an
effective and economical surface disinfectant.
DISINFECTANTS
 Antiseptics
Bisguanides:
Chlorhexidine
Low toxicity
– Used on skin and
mucous membranes
 Handling of sharp instruments
 Care must be taken while handling needles and other
sharp instruments during and after procedures, while
cleaning used instruments, and during disposal of used
needles.

 Forceps must be used to handle sharp instruments.

 Disposable needles, scalpel blades and other sharp items

should be discarded into puncture- resistant containers
that are easily accessible for disposal.
 When recapping needles, both hands should
never be used; instead, a one-handed “scoop
technique” or another instrument should be
used.

“scoop technique”
Wrong method
 Handling sterile instruments

 Never touch sterile

instruments or other materials
like cotton with contaminated
gloved hand or used
instruments.
 Sterilized materials and
instruments should be handled
with a sterilized cheatel
forceps, which should be
stored with the tip immersed
in a disinfectant solution.
Instruments must be cleaned well
before sterilization
 Sterilization Failure
• Improper Cleaning of Instruments
• Improper Packaging Materials
• Improper Sterilization Parameters
• Time
• Temperature
• And/or pressure
• Improper Selection of Sterilization
Method
Storage of Sterile and Clean Items and
Supplies
Use date- or event-related shelf-life practices.
Examine wrapped items carefully prior to use.
When packaging of sterile items is damaged, re-
clean, re-wrap, and re-sterilize.
Store clean items in dry, closed, or covered
containment.
Medical Waste
 Medical Waste: Not considered infectious, thus
can be discarded in regular trash.

 Regulated Medical Waste: Poses a potential risk

of infection during handling and disposal.

Properly labeled containment to prevent

injuries and leakage.