INFECTION

CONTROL IN
DENTISTRY
Dr. SV.SATISH
Professor & HOD
Dept of Conservative Dentistry &
Endodontics Navodaya Dental College
 Definitions
• INFECTION Also
“exposure control plan”called
CONTROL by
OSHA
requireis aoffic program
d e that is protect
against
designerisksto of exposure to
personnel
d
infection.
Codes of Diseases
Transmission
Direct contact with blood or body
fluids

Indirect contact with a

contaminated instrument or
surface

D Contact of mucosa of the eyes,

nose, or
mouth with droplets or spatter
 MODES OF TRANSMISSION:

Six links in chain of transmission of

infection
OBJECTIVES OF INFECTION
CONTROL
Reduc
e
Why is infection control necessary in
dentistry ?
•DentaI staff and patients may be
exposed to a wide variety of pathogenic
microorganisms .
• Who is responsible for
infection control in the dental office ?
— Each member of the dental team must
follow the recommended guidelines .
• What should be done to prevent
the transmission of disease in the
dental office ?
The mo5t effective ways to
transmission
prevent the of diseases
includes :
1)Hand washing
2)Gloves
3)Face masks
4)Protective eye wear
5)Protective clothing
6)Instrument sterilization and
di5infection
 Diseases Transmission in Dental
Office Transmission in Dental Office
Diseases
The dental office should have an infection
control program to prevent the transmission
of disease from the following :
Patient to dental
team Dental team
to patient Patient
to patient
Dental office to
community
( include dental
team's
•To prevent such infections, following
is a list of all those procedures and
precautions that together constitute
infection control.
•These
guidelines because
we are never certain of the
patient's status, either because
they themselves do not know or
because they have chosen not to
inform their healthcare providers of
their condition.

•Following these
guidelines for every patient is
called "Standard Precautions".
1.
Immunization
2. Patient
screening
3.Hand washing
4.Barrier techniques
• Personal Protective Equipment (PPE)
• Rubber dam, Pre-procedural rinsing
5.NeRdle & sharp instrument safety
• Occupational Exposure To Blood/Body
Fluids
6. Instruments sterilization and disinfection
7. Surface disinfection
8.Radiographic asepsis
9.Laboratory asepsis
10.Infectious dental waStR management &
disposal
Personal protective equipment (
•OSHA requires the employer to provide
employees with appropriate personal
protective equipment .

•ExampIes of PPE:
1 Protective clothing
2 Surgical masks
3 Face shields
4 Protective eyewear
5Disposable patient treatment gloves
6- Heavy-duty utility gloves
These PPE must be used whenever
you : Performing tasks that
could produce splash or
• spatter .
Any contact with body
Perform
fluids other clinical activities
that require handling contaminated
item5 e.g. radiographs ,
impressions , dentures or
contaminated equipment and
surfaces .
Hand washing is the single most
important procedure for preventing
the spread of infection. So , you must
wash your hands each time before you
put on gloves and immediately after you
remove gloves .
• Hand washing is also required if you
touch contaminated instruments
or surfaces during working

• We should always use liquid soap

during hand washing . Bar soap
should never be used because it may
transmit contamination.
 HANDS NEED TO BE CLEANER
WHEN
• Visibly dirty
• After touching
contaminated objects
with bare hands
• Before and after
patient treatment
(before glove
placement and after
glove removal)
 OPERATORY
• Inthe ASEPSIS
dental operatory,
environmental surfaces (i.e., a
does not or
surface contact patientsthat
equipment ca
become contaminated during patient n
directly)
care.
• Certain surfaces, especially ones
touched frequently (e.g., light
handles, unit switches, and drawer
knobs) can serve as reservoirs of
microbial contamination, although they
have not been associated directly with
transmission of infection to either
personnel or patients.
• Transfer of microorganisms
from contaminated
environmental surfaces to patients
occurs primarily through personnel
hand contact
A. infection Control During
the Pretreatment Period
•The process of infection control
begins during the period of preparation
for clinical treatment.
•Paying attention to infection control at
this time has several payoffs.
• In addition to reducing the
risk of transmission of infectious
agents during patient care, thinking
ahead will make the treatment
session more efficient and will also
make the post treatment infection
control process easier and more
effective.
1. Remove
the dental procedure
unnecessa area :
items
The dental procedure area
from
should be arranged to
facilitate a thorough cleaning
following each patient.
2 Preplan the materialsneeded
. treatmen during
- t.Set out all instruments,
medications, impression materials, and
other items that are needed for a
procedure.
search for ahead item
Thinking minimizes
or to the
cabinets
need to and
additional s gloves
enter
become drawers onc have
contaminated. e
3. Utilize disposable items whenever
possible: The use of disposable
items saves time during cleanup
and decontamination and
solves the problem of proper
reprocessing.
• 4. Use prearranged tray set-ups for
routine or frequently performed
procedures.
—Helps to eliminate the need
to go into cabinets once
you have started a procedure.
5.Use individualized, sterilized
bur blocks for
each individualized
•Using procedure bur blocks containing
only the burs required for that procedure
helps to eliminate the contamination of
other, unneeded burs and to make clean-up
easier.
6. If indicated, have the rubber dam
setup on the tray.
When a rubber dam will be used during a
clinical procedure, it also should be
included on the tray setup. In addition,
include those items needed for high-
velocity evacuation.
7. Identify those items that will become
contaminated
•While preparing the dental procedure area
during treatment.
prior to beginning a clinical procedure, consider
which items will become contaminated during
treatment.
•ExampIes of such surfaces include
countertops, light handles, X-ray unit heads, tray
tables etc.
•Decide whether to use a barrier, e.g., plastic
wrap to prevent contamination of these surfaces
and items or to disinfect them when the
procedure is complete.
Surface
barriers : barriers are
•Surface
used to prevent
contamination on the
•AII
surfacethe surface
underneath.
barriers should be
resistant to fluids in order

to
prevent E
microorganisms
in
saliva, blood, and
other liquids soaking
through the
8. Review patient records before
initiating treatment and place
radiographs on the view box.

•Do not leave the record on the

countertop or handle it after beginning
treatment.
•Place the record in a drawer or out
of the dental procedure area, so
that it doesn't become contaminated.
•Entries into the record should be
done before and after the procedure.
9. Prepare personnel involved
in patient care.
• 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.
 B. Infection Control during the
treatment Period (Chairside
Infection Control ):

The infection control procedures

described in the previous period will
help you to reduce the risk of
transmission
During treatmentof infectious
there agents.
addition
are
precautions thatcan al
reduce
be infection
taken to
risks. further
1. Use care when receiving,
handling, or
passing sharp instruments
2. Take special precautions with
syringes and needles.
3. Use a rubber dam whenever possible
4. Avoid touching unprotected
switches, handles and other
equipment once gloves have been
contaminated.
S. Avoid entering cabinets once gloves
have
been contaminated.
C. Infection Control During the
Post-
Treatment Period
0 Continue to wear personal protective
equipment during clean-up: After patient
care is completed, begin the cleaning
and disinfection process by
removing contaminated gloves
used during treatment,
wash your hands and use the utilit
gloves before beginning the clean up.
Continue to wear protective eyewear,
0 Remove all disposable barriers : All
of the barriers placed before
treatment, including light handle
covers and countertop barriers,
should be removed.
0 Clean and disinfect all items not
protected by barriers.
 Cleaning and disinfection of
the dental treatment room
components
surfaces are in an
important
effective
infection control program

0 The laboratory studies have

proved that microorganisms
may survive on environmental
surfaces for long time . For example,
Mycobacterium tuberculosis may
survive for weeks
 DENTAL INSTRUMENTS
Classification based on risk of
transmission and need of sterilization

-CRITICAL
-SEMI-CRITICAL
-NON-CRITICAL
 CRITICAL
INSTRUMENTS
Penetrate MUCOUS
MEMBRANES or CONTACT
BONE, BLOODSTREAM, or other
normally
sterile
tissues

• HEAT STERILIZE between uses or use sterile

single- use, DISPOSABLE devices

Examples include SURGICAL

INSTRUMENTS, SCALPEL BLADES,
PERIODONTAL SCALERS, AND
SURGICAL DENTAL BURS
 SEMI—CRITICALINSTRUMENTS
• Contact MUCOUS MEMBRANES but do
NOT PENETRATE SOFT TISSUE

• HEAT STERILIZE or HIGH-LEVEL DISINFECT

• Examples: DENTAL MOUTH MIRRORS,

AMALGAM CONDENSERS, DENTAL
HANDPIECES AND
 NONCRITICAL
INSTRUMENTS
AND
Contact intact SKIN

Clean and disinfect using a

LOW TO INTERMEDIATE LEVEL
DISINFECTANT

• Examples: X-RAY HEADS, FACEBOWS,

PULSE OXIMETER, BLOOD PRESSURE CUFF
 STERILIZATI
• ON
Stages for instrument
sterilization:
1. Presoaking
2. Cleaning
3. Corrosion control and
lubrication
4. Packaging
5. Sterilization
6. Handling sterile instruments
7. Storage
8. Distribution
 Agents used in sterilization

• Physical agents:
1. Sunlight
2. Drying
3. Dryheat: flaming, incineration, hot air
4. Moist heat: pasteurization, boiling,
steam under pressure, steam under
normal pressure.
5. Filtration: candles asbestos pads,
membranes
6. Radiation
• Chemical agents:
1. Alcohols: ethyl, isopropyl,
trichlorobutanol
2. Aldehydes: formaldehyde,
glutaraldehyde
3. Dyes
4. Halogens
5. Phenols
6. Surface-active agents
7. Metallic salts
 The 4 accepted
METHODS OF
STERILIZATION
• Steam pressure sterilization are:
(autoclave)
• Chemical vapor pressure
sterilization-
(chemiclave)
• Dry heat sterilization (dryclave)
• Ethylene oXide sterilization
 AUTOCLA
•VE
Sterilization with STEAM UNDER
PRESSURE
bS
• Time required at 121 0 C in
of
m i n s at
Advantages
pressure.
• Rapid and effective
• Effective for sterilizing cloth
surgical packs and towel
packs

Disadvantages
• Items sensitive to heat
cannot be sterilized
 CHEM C V
SterilizationNG
by CHEMICAL VAPOR
UNDER PRESSURE
• operates at 131* C and 20 lbs of
pressure.
• They have a cycle time of half an
hour.
• Advantages
• Carbon steel and other carbon sensitive
burs, instruments and pliers are sterilised
without rust or corrosion
• Disadvantages
• Items sensitive to will
elevated temperature be
damaged
•• Instruments mustclothing
Towel and heavy be verycannot
lightly be
packed.
sterilized.
 D Heat
ConventionalSterilization
dry heat ovens:
• Achieved at temperature above 1600 C.
• Have heated chambers that allow air to circulate
by gravity flow.
• 6-12mins is required for sterilization
• Disadvantages
• Without careful calibration, more
chances
sterilization failures
The most accurate way to
calibrate a sterilization cycle is by
using external temperature gauge
(pyrometer) attached to a
thermocouple wire.
ETHYLENE OXIDE STERILIZATION
(ETO)
• Advantages. • Disadvantages:
1. Operates 1. Potentially
effectively at low mutagenic
temperatures and
2. Gas is Carcinogeni
extremely c.
penetrative 2. Requires
3. Can be used for aeration
sensitive Chamber,cycle

equipment like time IBStS hOUFS

handpieces. 3. Usually only
 Sterilization
Monitoring
Types of indicators
Mechanical
Measure time, temperature,
pres Chemical
Change in color when
physical
parameter is reached
Biological (spore tests)
Use biological spore5 to
assess the
Sterilization proce5s
directly
AUTOCLAVE S6°
C
CHEMICAL
VAPOP DRY 37"
C
HEAT

ETHYLENE
Gamma 31°
OXIDE
radiation c

X Sterilization monitoring has four

components:
1. a sterilization indicator on the
instrument bag, stamped with the date
it is sterilized,
2.daily color-change process-indicator
strips,
 STORAGE AND CARE OF
STERILE
• Storage INSTRUMENTS
areas should be dust
proof, dry, well ventilated and
easily accessible for routine
dental use.
• Sterile materials should be stored
atleast 8-10 inches from the floor,
atleast 18 inches from the ceiling,
and atleast 2 inches from the
outside walls.
• Items are not stored in any location
they
where can become
• wet.
Items should be positioned so
that packaged items are not
crushed, bent, crushed,
compressed or punctured.
• Outside shipping containers and
corrugated cartons should not
be used as containers in
sterile storage areas.
• Ultra violet chambers and
formalin chambers are now
 DISINFECTION

• Disinfection is always at least a

two-step procedure:
• The initial step involves vigorous
scrubbing of the surfaces to be
disinfected and wiping them clean.
• The second step involves wetting the
surface with a disinfectant and
leaving it wet for the time
prescribed by the manufacturer.