Infection control in dental practice

بسم الله الرحمن الرحيم

Professor Abdulwahab Al-kholani

1. Background2. Personnel Health Elements3. Bloodborne Pathogens4. Hand Hygiene5. Personal Protective Equipment (PPE)6. Latex Hypersensitivity/Contact Dermatitis7. Sterilization and Disinfection8. Environmental Infection Control9. Dental Unit Waterlines10. Sterilization and High-Level Disinfection (summary)11. Processing of Instruments 12. Sterilization Failure

Dr. Abdulwahab Al-kholaniProfessor Abdulwahab Al-kholani

Cross-contamination cycle


Why Is Infection Control Important in Dentistry?

Dr. Abdulwahab Al-kholani

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



Direct contact with blood or body fluids

Contact of mucosa of the eyes, nose, or mouth with droplets or spatter

Indirect contact with a contaminated instrument or surfaces

Inhalation of airborne microorganisms

Mode of transmission


Disease Transmission Chain or Cycle:



How to Break the Chain of Infection How to Break the Chain of Infection

Personnel Health Elements of an Infection Control ProgramEducation and trainingImmunizations (vaccination)Exposure prevention and postexposure managementMedical condition management and work-related

illnesses and restrictionsHealth record maintenance


Preventing Transmission of Bloodborne Pathogens

Are transmissible in health care settingsCan produce chronic infectionAre often carried by persons unaware of their

infection

Bloodborne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV):


Patient DHCP

DHCP Patient

Patient Patient



Potential Routes of Transmission of Bloodborne Pathogens


Concentration of HBV in Body Fluids

High Moderate Low/Not Detectable

Blood Semen Urine Serum Vaginal Fluid Feces Wound exudates Saliva Sweat

Tears Breast Milk


Hepatitis B Vaccine Vaccinate all DHCP who

are at risk of exposure to blood

Test for anti-HBs 1 to 2 months after 3rd dose


Post-exposure ManagementWound managementExposure reportingAssessment of infection risk

Type and severity of exposureBloodborne status of source personSusceptibility of exposed person


Blood borne pathogen


Why Is Hand Hygiene Important?Hands are the most common mode of

pathogen transmissionReduce spread of antimicrobial resistance


Why Is Hand Hygiene Important?


Hands Need to be Cleaned WhenVisibly dirtyAfter touching contaminated

objects with bare handsBefore and after patient

treatment (before glove placement and after glove removal)


Hand Hygiene DefinitionsHandwashing

Washing hands with plain soap and waterAntiseptic handwash

Washing hands with water and soap or other detergents containing an antiseptic agent

Alcohol-based handrubRubbing hands with an alcohol-containing

preparationSurgical antisepsis

Handwashing with an antiseptic soap or an alcohol-based handrub before operations


Hand Hygiene


Good Better Best

Plain Soap Antimicrobial soap

Alcohol-based handrub


Special Hand Hygiene ConsiderationsUse hand lotions to prevent skin dryness Consider compatibility of hand care products

with gloves (e.g., mineral oils and petroleum bases may cause early glove failure)

Keep fingernails shortAvoid artificial nails Avoid hand jewelry that may tear gloves


Special Hand Hygiene Considerations


Avoid artificial or long nails

Avoid hand jewelry that may tear gloves


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


Masks, Protective Eyewear, Face Shields


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 patientsClean reusable face protection between patients; if

visibly soiled, clean and disinfect


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


Wearing Personal Protective Equipment


Removing Personal Protective Equipment


GlovesMinimize the risk of (HCP) acquiring

infections from patientsPrevent microbial flora from being

transmitted from (HCP) to patientsReduce contamination of the hands of

(HCP) by microbial flora that can be transmitted from one patient to another

Are not a substitute for hand washing!


Recommendations for Gloving

Wear gloves when contact with blood, saliva, and mucous membranes is essential

Remove gloves after patient treatment Wear a new pair of gloves for each patient


Recommendations for Gloving

Remove gloves that are torn, cut or punctured

Do not wash, disinfect or sterilize gloves for reuse



Personal Protective Equipment (PPE)

Latex AllergyType I hypersensitivity to natural

rubber latex proteinsReactions may include nose, eye,

lips and skin reactionsMore serious reactions may

include respiratory distress–rarely shock or death

Vinyl gloves is recommended for hypersensitive dentist or patient


InstrumentsCritical Instruments Semi-Critical Instruments Non-Critical Instruments

Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth)

Examples: include surgical instruments, scalpel blades, needles periodontal scalers, and surgical dental burs

Autoclaving, heat sterilize between uses or use sterile single-use, disposable devices

Contact mucous membranes but do not penetrate soft tissue

Examples: Dental mouth mirrors, amalgam condensers, and dental handpieces

Heat sterilize or high-level disinfect

Contact intact skin

Examples: X-ray heads, facebows, pulse oximeter, blood pressure cuff

Clean and disinfect using a low to intermediate level disinfectantProfessor Abdulwahab Al-kholani

Instrument Processing AreaUse a designated processing area to control

quality and ensure safetyDivide processing area into work areas

Receiving, cleaning, and decontamination Preparation and packaging Sterilization Storage


Instrument Processing Area


Automated Cleaning

Ultrasonic cleanerInstrument washerWasher-disinfector


Manual Cleaning

Soak until ready to clean

Wear heavy-duty utility gloves, mask, eyewear, and protective clothing


Preparation and PackagingCritical and semi-critical items that will be stored

should be wrapped or placed in containers before heat sterilization

Hinged instruments opened and unlockedPlace a chemical indicator inside the packWear heavy-duty, puncture-resistant utility gloves


Heat-Based SterilizationAutoclaving (steam under

pressure )

Dry heat


Liquid Chemical Sterilant/Disinfectants

Only for heat-sensitive critical and semi-critical devices

Powerful, toxic chemicals raise safety concerns

Heat tolerant or disposable alternatives are available


Sterilization Monitoring Types of IndicatorsMechanical

Measure time, temperature, pressureChemical

Change in color when physical parameter is reachedBiological (spore tests)

Use biological spores to assess the sterilization process directly


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


Categories of Environmental Surfaces

Clinical contact surfacesHigh potential for direct

contamination from spray or spatter or by contact with DHCP’s gloved hand


Housekeeping surfacesDo not come into contact with

patients or devicesLimited risk of disease

transmission



Clinical Contact Surfaces


General Cleaning Recommendations

Use barrier precautions (e.g., heavy-duty utility gloves, masks, protective eyewear) when cleaning and disinfecting environmental surfaces

Physical removal of microorganisms by cleaning is as important as the disinfection process

Follow manufacturer’s instructions for proper use of disinfectants

Do not use sterilant/high-level disinfectants on environmental surfaces


Cleaning Clinical Contact Surfaces

Risk of transmitting infections greater than for housekeeping surfaces

Surface barriers can be used and changed between patients


Cleaning Housekeeping Surfaces

Routinely clean with soap and water or disinfectant routinely

Clean mops and cloths and allow to dry thoroughly before re-using

Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations


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


Regulated Medical Waste Management

Properly labeled containment to prevent injuries and leakage


Preparing the dental operatory


Dental Unit Waterlines and BiofilmMicrobial biofilms form in

small bore tubing of dental units

Biofilms serve as a microbial reservoir

Primary source of microorganisms is municipal water supply


Dental Unit Water Quality

Using water of uncertain quality is inconsistent with infection control principles

Untreated dental units cannot reliably produce water that meets drinking water standards


Sterile Irrigating SolutionsUse sterile saline or sterile

water as a coolant/irrigator when performing surgical procedures

Use devices designed for the delivery of sterile irrigating fluids


Instruments must be cleaned well before sterilization


Clean gross deposits of materials or tissues with gauze

soaked in holding solution.Soak instruments in

holding solution

Instruments


Holding Solution 1. Prevents tissues, fluids, and debris from

drying.

2. Reduces the amount of viable micro-organisms during cleaning.


Instruments


BiB Forte should be prepared fresh daily by diluting 50 ml / 1

litre

Holding solution


Instruments


1. Alcohol alone not effective for biological debris.

2. Gluteraldehyde effective but toxic.

3. Sodiumhypocloride (Clorox©) corrosive.

Holding Solution


Instruments


Scrub with brush under running water.

Washing instruments Washing hands

Two sinks

Heavy duty gloves to protect from sharp injury


Instruments&

Burs, Barbed Broaches and Files


Ultrasonic cleaners

1. Reduce chances of hand injury.

2. Reduce splatter in environment

3. More effective in cleaning small crevices


Instruments&

Burs, Barbed Broaches and Files


1- Flush hand-piece into container for 30 seconds

2- Lubricate hand-piece2- Lubricate hand-piece 3- Reattach hand-3- Reattach hand-piece and spray piece and spray excess oil out by excess oil out by air onlyair only

4- Wipe clean4- Wipe clean 5- place in 5- place in envelopeenvelope


Hand-pieces

Hand-pieces


IMPORTANT

To prevent damage to the hand-pieces:

Always keep bur inside hand-piece when

flushing it.


DO NOT PLACE HAND-PIECES IN WATER


Hand-pieces


Heat sealing Auto-sealing Sealing tape

Packaging & sealing


Double fold then tape along the edge

Packaging & sealing


Packaging & sealing


Chemical indicator

Changes color after entering the autoclave

Packaging & sealing



Sterilization FailureImproper Cleaning of InstrumentsImproper Packaging MaterialsImproper Sterilization Parameters

TimeTemperatureAnd/or pressure

Improper Selection of Sterilization Method



Sterilization and High-Level Disinfection:



Questions?

Infection control in dental practice

Education

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