Infection Control

Dr Khansa Ababneh
 Specialties
 Dentists

 Dental hygienists

 Dental Assistants

 Dental technicians

 Radiographic technicians
A High Risk Profession
Need For Protection
 Protection From What?
 Blood (saliva)-borne pathogens

 Air-borne pathogens
 Pathogens transmitted by skin contact
 Protecting Whom?
 Protecting:

 Ourselves
 Patient
 Other patients
 Other staff
 Our families
Infectious diseases
 Viral

 Bacterial

 Parasitic
Viral infections
 HIV (AIDS)

 Hepatitis Viruses

 Papilloma viruses (HPV)

 Measles, Rubella, Mumps

 Hepatitis A, B, C, E, G, H
 Only vaccination against HBv is
available !!

 Protect Yourself!
 Herpes viruses
 Herpes simplex (HS type
1 & 2)

 Varicella & zoster (human

HV 3)

 Epstein-Barr virus (human

HV 4)
 Infectious mononucleosis

 Cytomegalovirus CMV
(human HV 5)
AIDS
Bacterial Infections
 Tuberculosis (TB)
 Legionnaire’s disease
 Infected aerosols!
 Cross-Infection

Patient Operator

Other personnel
 During surgical procedures
 Pathogenic MO introduced into wounds

Bloodstream
Wound Breakdown
Delayed Healing
 In UK
 Working Groups:

 EAGA (Expert Advisory Group on AIDS)

 ACDP (Advisory Committee on dangerous pathogens)

 Advisory Group on Hepatitis

 Microbiology Advisory Committee

 Health Services Advisory Committee (HSAC)

 Joint Committee on Vaccination & Immunisation

(JCVI)

 Control of Substances Hazardous to Health

(COSHH)
 Whose Responsibility?
 Health authorities must draw their own
detailed local guidelines to prevent spread of
Hepatitis and AIDS viruses.

 All employers have a legal obligation to ensure

that all their employees are appropriately
trained and proficient in the procedures
necessary for working safety.
  Every member of the
dental/medical staff has a legal and
moral duty to ensure that all
necessary steps are taken to
prevent cross-infection to protect
the patient, colleagues and
themselves
“Getting Rid” of
Microorganisms
 Definitions
 Sterilization

 Disinfection

 Asepsis
 Sterilization
Removal/destruction of all
microorganisms
 Disinfection
Destruction of the pathogenic MO in
their non-sporing state
 Asepsis
A method of surgery
which is designed to
prevent the
introduction of
infection into a
wound during
surgery or wound
dressing
 Mouth cannot be sterilized but the
number of MO can be reduced by
scaling one week before surgery + CHX
mw.

 Local defence mechanisms can cope with

endogenous infection, but not exogenous
infections
Cannot autoclave patients
 General Guidelines
Before procedures:
 Hands must be cleansed:
(soap + water)/(surgical
scrub) & wear
clean/sterile gloves

 Instruments must be
sterilized

 Before sterilization,
instruments must be
CLEANED from debris
and blood deposits
Sterilization of Disposable Items

 Gamma irradiated
 Reliable manufacturer and unbroken rapping
 Suitable for scalpel blades and sutures
Autoclaving (moist heat) sterilization

 Boiling water alone is INSUFFICIENT to kill

spores and viruses
 Effective autoclaving: Temperature = 134ºC,
Pressure= 32 lb/sq (Psi), Time =3.5 minutes
 If instrument will not be used immediately, must
have a drying phase
 Autoclaving may reduce sharpness of instruments
and promote rusting
 Dry heat sterilization
 Takes place in a “Hot Air Oven”

 Suitable for instruments with a sharp

cutting edge

 For effective heat sterilization:

Temperature = 160º C, Time = 60 minutes
 Chemical disinfection
 Suitable for working surfaces & instruments

 Limitations:
 The object to be disinfected must be thoroughly cleaned

 Efficient at certain Concentration & Temperature

 Each agent needs a certain minimum exposure time

 Certain chemicals may damage certain surfaces

 Shelf-life
Chemical Disinfectants

Alcohols, Aldehydes, Biguanides,

Halogens, Phenolics, Quaternary
Ammonium Compounds
 Alcohols
 Isopropyl alcohol &
70% ethyl alcohol

 Effective against
Gram negative (G-ve)
bacteria on clean
surfaces
 Not active against
fungi
 Suitable for skin
preparation before
venepuncture
 Aldehydes
 Glutaraldehyde (Cidex),
&
Formaldehyde (formalin)

 Active against G-ve

bact., spores, viruses
(HB, HIV) & fungi

 Require 3 hours of
exposure

 Suitable for non-

autoclavable instruments

 Blood/saliva spillages
 Biguanides
 Chlorhexidine
 Active against Staph. aureus & some G-Ve bacteria
 Active against fungi & viruses ONLY at very high conc
 Inactivated by soap and pus
 Antiseptic: Used for disinfecting skin and mucous
membranes e.g.:
 Savlon®: 0.5%CHX + cetrimide
 Hibiscrub®: 4%CHX + detergent
 Hexana®, Corsodyl® mw =0.2% CHX
 Halogens I
 Sodium hypochlorite, 10000 ppm
of available chlorine
 Activeagainst bacteria, spores, fungi
and viruses (HB, HIV)

 At least 20 minutes of exposure time

 Inactivated by blood, pus and dilution

 Halogens II
 Iodophors & iodine
 Active against
bacteria, spores &
some viruses & fungi

 Can be inactivated by
pus and blood

 Suitable for skin preparation,

mouthwash & as a surgical
scrub (7.5% Povidone-iodine=
Betadine)
 Phenolics

 Hexachloraphane

 Active against staph aureus, limited

activity against G-ve bacilli

 Used as a surgical scrub (Phisomed®)

Quaternary Ammonium Compounds
 Cetrimide (+0.5%CHX= Savlon®)

 Active against staph aureus

 Easily inactivated by water and soap

 Can be contaminated by pseudomonas

 Hand disinfection
 Jewellery removed &
nails short

 Hibiscrub, Phisomed
or Betadine
 If above is not
available: Soap with
hexachloraphane for
5 min in running
water followed by
70% alcohol or
Hibisol®
(2.5%CHX+70%
alcohol)
 Preparation of operation site
 Circumoral skin with same agent used
for hand disinfection

 Oral mucosa disinfection with 0.2-0.5%

CHX mw, or iodine mw

 Needle puncture site: CHX mw & dry

area
 Key Points in
Infection Control
UNIVERSAL PRECAUTIONS
 Universal Precautions
 CDC (Centers for Disease Control) in 1987:
 All patients be regarded as potentially infective
(HIV & Hepatitis…)

 “All health care workers should routinely use

appropriate barrier precautions to prevent skin
and mucous membrane exposure when contact with
blood or other body fluids of any patient is
anticipated”
Universal Precautions
 Staffmembers & patients
should be protected from
blood-borne (and all)
infections
 Equipment
 All working surfaces should be covered with
disposable material

 Disposable instruments should be used wherever

possible

 Anaesthetic cartridges and needles must not be re-

used for any other patient

 Used equipment should be identified as infected and

handled with gloves before discarding into an
impervious container, or washing and autoclaving.
 Sterilization
 Instruments must be placed in
impervious container before
sterilization
 Disposable instruments, dressings
etc. should be incinerated
 Heavy domestic rubber gloves should
be worn during instrument cleaning
 Non-disposable instruments should be
rinsed in an effective disinfectant
 Sterilization
 Non-disposable instruments and dental impressions
that cannot be sterilized by heat should be
disinfected by immersion for at least 1 hr (preferably
overnight) in a suitable disinfectant such as 10 %
hypochlorite

 Working areas are disinfected with hypochlorite

(1 per cent available chlorine)

 Since some viruses remain stable in blood stains for

up to 6 months at room temperature, spillage of blood
should be disinfected by dropping a napkin on the
area and flooding it with hypochlorite
 Protection of dental staff
 All staff must be educated about the possible
dangers of hepatitis, HIV and other infections,
their modes of transmission and the precautions
necessary to prevent cross-infection, particularly
vaccination against HBV.

 All members of the dental team should be fully

immunized against HBV

 Immunocompromised staff should be absolved

from the responsibility of treating infected
patients
 Should the skin be punctured by an
instrument that has been used on a patient,
the area of skin should be liberally rinsed in
water and the advice of the nearest Public
Health Laboratory or hospital microbiologist
sought. Where appropriate, blood from the
patient on whom the instrument was used, and
from the wounded person, should be tested
for HBeAg, and HIV antibodies to determine
the possible risks.
 Routine safe working practice
 Always cover cuts and grazes with waterproof
dressings

 Wear gloves if there is any chance of contact

with blood or body fluids
 Gloves must always be worn when touching blood,
saliva, teeth or mucous membranes or items that
have been in contact with them.
 Between patients the
gloves are removed, hands
washed and a new pair of
gloves put on before
proceeding
 When wearing gloves
contact with inanimate
objects should be avoided
as far as possible
 When gloves are torn, cut or
punctured, they must be
removed immediately, hands
thoroughly washed and re-
gloving accomplished before
completion of the procedure.
 Aerosol and Splashes
 If there is a risk of splashes
of blood or body fluid, also
wear masks and protective
spectacles or goggles

 Masks should be worn whenever

dental aerosol or tooth
fragments are generated

 Eye protection should be worn

by staff treating patients

 Eye protection for patients

 Sharps
 Dispose of needles
immediately into sharps
containers ; only re-sheath
local anaesthetic syringe
needles using an appropriate
sheath-holding device.
 Dispose carefully of all
surgical sharps, glass items,
burs, wire etc., into a
sharpsafe box

 Take extreme care with

sharp instruments.
 You
 Make sure working clothing is clean. Contaminated
clothing (e.g. blood-stained) must be changed
immediately.
 Hands should be washed thoroughly when entering or
leaving clinical areas and before eating or drinking.
Soap dispensers and taps should be operated by the
elbows or wrists not gloves or hands.
 All specimens for laboratory tests should be placed in
appropriate containers and sealed into plastic bags
separate from the request form
 Do not eat, drink, comb hair, brush teeth or apply
cosmetics in clinical areas
Smoking
Specific Precautions
 Before a session
 Run water through each water system

 Clean and disinfect with detergent:

4. Working surfaces 2. Dental equipment

 Reduce to a minimum the number of equipment laid out ready

for use.

 Wherever possible, instruments should be sterilizable or

disposable

 Cling-film should be placed across the chair buttons, light

handles, ultrasonic scaler handpiece and 3-in-1 syringe. The
film is changed after every patient.
 During a clinical session
 In a small area around the patient (includes the
dental unit and extends to include the waste disposal
bag), only essential equipment, instrument, materials
and personnel should be in this area of potential high
contamination. The contents of the remainder of the
treatment should be kept to a minimum

 Open cuts and fresh abrasions to the skin should be

covered with a waterproof dressing

 Touching anything other than “essential items” with

gloves/hands should be avoided.
 A good working posture should be maintained to
reduce facial contamination from the patient's mouth

 High volume suction should be used to reduce dental

aerosols

 Blood or body fluid spillage must be dealt with as

soon as it happens: Hypochlorite granules can be
sprinkled over the spillage. Alternatively,
disposable tissues can be placed over the spillage
and then strong hypochlorite poured on to paper
towels which are placed over the spill and left for
30 minutes.
 Clearing up and cleaning after
each patient
 It is during the clean up and disposal stage that the
greatest risk of injury or infection occurs

 It is advisable to wear heavy-duty rubber gloves and

to wash them during clean-up procedures to reduce
the spread of infection

 Remove sharps first and place in a sharp-safe box

 Sterilize detachable handpieces, ultrasonic scalers,

aspiration tips and 3-in-1 tip.
 Disinfect the chair, bracket table, including body of
the 3-in-1 syringe, slow speed motor and the holder,
operating light and spittoon

 Wipe all surfaces with detergent or hypochlorite

 Remove any residual cement or impression material

from handles etc., and wipe area with detergent
chloros

 Anything likely to be contaminated with blood, wipe

thoroughly with strong hypochlorite
 All
non-disposable garments can be
washed in a conventional automatic
washing machine, provided the
washing cycle includes a 10 min period
of 90°C water temperature.
 Immunization

Against Hepatitis B virus

Your Responsibility