Infection Control in Dentistry: Protecting Patients and Dental Personnel

2. Introduction • Rationale for infection control • Cross-infection • Objective of infection control • Universal precautions • Classification of instruments • Instrument processing procedures • Disinfection CONTENTS

3. Dentistry is a high risk profession because of the possibility of contracting infections from the oral cavity. • Widespread increase in serious transmissible diseases over the last few decades have created global concern and impacted the treatment mode. • Because of greater exposure to saliva, blood and injury from sharp instrumentation, infection incidence among the dental personnel seems to provide the most sensitive barometer of infection transmission in dentistry and its control. INTRODUCTION

4. Need For Protection

5. Blood (saliva)-borne pathogens Air-borne pathogens Pathogens transmitted by skin contact Protection From What?

6. DIRECT CONTACT INDIRECT CONTACT SPREAD OF INFECTION DROPLET INFECTION (SPATTER)

7. Cross-infection is transmission of infectious agents arising among patients & staff within a clinical environment. CROSS-INFECTION

8. Pathways of cross contamination • 1-Patient to dental team 2-Dental team to patient 3-Patient to patient • 4-Dental office to community including the dental teams families.

9. Routes of spread Purpose of infection control is to prevent the transmission of disease-producing micro-organisms from one patient to another patient, from dental care provider to patient, and from patient to dentist or other dental staff. Infection control is about limiting or controlling some of the factors that influence the transmission of infection or that contribute to the spread of micro-organisms

10. Spread of microorganisms can be reduced by:

11. Antisepsis –the destruction of pathogenic microorganisms existing in their vegetative state on living tissues Antiseptic – chemical applied on living tissue (skin or mucous membrane)to reduce the number of microorganisms present, by inhibition of their activity or by destruction Aseptic technique – the method which prevents contamination of wounds & other sites, by ensuring that only sterile objects and fluids come into contact with them; and that the risks of air borne contamination are minimized. Terminologies

12. Why Is Sterilization & disinfection Important? 1-to avoid contamination by microorganisms during endo therapy. 2- break in sterile technique could be a cause of post treatment infection.

13. OBJECTIVES of Infection control: 1)Prevention of spread of microorganisms from their host 2)Removal of microorganisms from objects and surfaces. Decontamination cycle

14. Steps in instrument processing

15. Facilitates cleaning by preventing the debris from drying • Holding solutions can be: (1)neutral pH detergents (2) water (3) enzyme solution • Discard solution atleast once a day. • Avoid soaking for long time Presoaking (Holding)

16. Methods : (1)manual scrubbing (2) ultrasonic cleaning (3)mechanical instrument washer • If an item is not cleaned it cannot achieve sterility when autoclaved. • Washer disinfectants more efficient at pre-sterilization cleaning than ultrasonic cleaners. Cleaning The process which physically removes contamination but does not necessarily destroy microorganisms.

18. Protecting: Ourselves Operator/technician Patient Other patients Other staff Community Protecting Whom?

19. Prevention of microorganisms from their hosts • Killing or removal of microorganisms from objects and surfaces OBJECTIVE OF INFECTION CONTROL

20. Immunization • Use of personal protective barrier techniques-protective gowns,facemask,protectiveeyewear,gloves • Maintaing hand hygiene Universal Precautions

21. BARRIER TECHNIQUE: Protective gown • Wear long-sleeved reusable or disposable gowns, clinic jackets, or lab coats to protect skin of the forearms and clothing likely to be soiled with blood, saliva, or OPIM • Change immediately if visibly soiled Personal Protection Equipment

22. A surgical mask that covers both the nose and mouth should be worn by the clinician during procedures • Prevent splatter from contaminating the face • Should be changed regularly and between patients • If mask becomes wet it should be changed between patients or even during treatment • To remove mask, grasp it only by its strings, not by the mask itself Face masks

23. Do not touch or adjust mask during procedure. Should be worn properly & adjusted before gloving.

24. Hair should be neatly tied back and kept out of treatment field. • should be covered with head cap to avoid hair contacting the patients mouth. • If not covered the hair may act as a source of infection, may be rubbed to the face • Personnel must protect their hair with surgical cap while encountering heavy spatter e.g., Ultrasonic scaling device. Head caps

25. Protect eyes against foreign bodies, splatter and aerosols • Eyewear with solid side shields or chin-length face shields must be used for optimal protection • Contaminated glasses should be washed with soap water and disinfected • Do not touch the eyewear with ungloved hands Protective eyewear

26. Practical points & essentials of Glove use: • Wash hands before wearing gloves • Choose a glove that fits. • Replace glove immediately if torn • Wash hands immediately after glove removal • Treat gloves as surgical waste and dispose of them accordingly Gloves

27. Hand hygiene plays a central role in the reduction of cross-contamination & in infection control • Two types of microorganisms- Transient flora- colonize on superficial layers of skin Resident flora-attached to deeper layers of skin • Types of hand scrubs- Alcohol based hand rub Antimicrobial soap Antiseptic Hand hygiene

28. At the beginning of patient • Between patient contacts • Before putting on gloves • After touching inanimate objects • Before touching eyes,nose,fave or mouth • After complation of treatment • After glove removal • After barehanded contact with contaminated equipment or surfaces and before leaving treatment areas Indications

30. Classification of Instruments

31. CDC Recommends • Critical and semicritical instruments are to be heat sterilized • Semicritical items sensitive to heat should be treated with high level disinfectant after cleaning • Noncritical items can be treated intermediate to low level disinfectant after cleaning

32. STERILIZATION • CDC Guidelines • Critical – items that penetrate soft tissue, contact bone or bloodstream or other normally sterile tissues. • Semi-critical – Items that contact mucosa or non-intact skin but will not penetrate soft tissue or enter normally sterile tissue

33. STERILIZATION • ALL critical items and any semi-critical items that CAN be sterilized SHOULD be sterilized prior use/ reuse. • Semi-critical items that can not stand the heat of sterilization must be “high level disinfected” • Only some older slow speed handpiece motors remain in this category. • Good progress by manufacturers

34. Personnel Health Elements • Bloodborne Pathogens • Hand Hygiene • Personal Protective Equipment • Latex Hypersensitivity/Contact Dermatitis • Sterilization and Disinfection • Environmental Infection Control

35. CDC Recommendations • Improve effectiveness and impact of public health interventions • Inform clinicians, public health practitioners, and the public • Developed by advisory committees, ad hoc groups, and CDC staff • Based on a range of rationale, from systematic reviews to expert opinions

36. Why Is Infection Control Important in Dentistry? • Both patients and dental health care personnel (DHCP) can be exposed to pathogens • Contact with blood, oral and respiratory secretions, and contaminated equipment occurs • Proper procedures can prevent transmission of infections among patients and DHCP

37. Elements of Standard Precautions • Handwashing • Use of gloves, masks, eye protection, and gowns • Patient care equipment • Environmental surfaces • Injury prevention

38. Personnel Health Elements of an Infection Control Program • Education and training • Immunizations • Exposure prevention and postexposure management • Medical condition management and work-related illnesses and restrictions • Health record maintenance

39. Why Is Hand Hygiene Important? • Hands are the most common mode of pathogen transmission • Reduce spread of antimicrobial resistance • Prevent health care-associated infections

40. Modes of Transmission • Direct contact with blood or body fluids • Indirect contact with a contaminated instrument or surface • Contact of mucosa of the eyes, nose, or mouth with droplets or spatter • Inhalation of airborne microorganisms

41. It is the collection of procedures which prepare the contaminated instruments for reuse This procedure should be carefully performed so as to prevent: • transmission of disease agents to the patients. • to keep instrument damage to minimum Instrument Processing Procedures

42. 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 by surgical personnel

43. Personal Protective Equipment • A major component of Standard Precautions • Protects the skin and mucous membranes from exposure to infectious materials in spray or spatter • Should be removed when leaving treatment areas

44. Masks, Protective Eyewear, Face Shields • Wear a surgical mask and either eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth • Change masks between patients • Clean reusable face protection between patients; if visibly soiled, clean and disinfect

45. Protective Clothing • Wear gowns, lab coats, or uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material • Change if visibly soiled • Remove all barriers before leaving the work area

46. Recommendations for Gloving • Wear gloves when contact with blood, saliva, and mucous membranes is possible • Remove gloves after patient care • Wear a new pair of gloves for each patient

47. Recommendations for Gloving Remove gloves that are torn, cut or punctured Do not wash, disinfect or sterilize gloves for reuse

48. Sterilization and Disinfection of Patient Care Items

49. Critical Instruments • Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth) • Heat sterilize between uses or use sterile single-use, disposable devices • Examples include surgical instruments, scalpel blades, periodontal scalers, and surgical dental burs

50. Semi-critical Instruments • Contact mucous membranes but do not penetrate soft tissue • Heat sterilize or high-level disinfect • Examples: Dental mouth mirrors, amalgam condensers, and dental handpieces