14188109 infection control in dental practice

8/3/2019 14188109 Infection Control in Dental Practice

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Introduction

Objective

Patient perception and need for infectioncontrol

Infection control in your dental office

OSHA regulation

Universal prevention

Methods of infection control

Disposal of wastes


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Introduction

Why do we need to know aboutinfection control ?

The goal of infection control is to

eliminate or reduce the number ofmicrobes shared between people.

Implementing safe and realistic infection

control procedures requires the fullcompliance of the whole dental team.


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Patient perception and need for infectioncontrol.

It is the duty of every dental practitionerto cure for all patients including those withinfections diseases.

As a result of frequent medical coveragethe public is now aware of the need fordentist to practice good infection control.

Displaying an infection controlstatement may be helpful to really patientanxiety and gain their confidence.


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Routine Procedures.

Through medical history

Asymptomatic carriers

Acceptance of patient

It is unethical to refuse dental care to

those patient with a potentially infections

disease on the grounds that it could

expose the dental clinician to personal

risk.


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Confidentiality Those with HIV

infectionInfected dental health care locker

most avoid exposure prone procedures.


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Exposure risk and effect of infection on

dentistry.

Every health care specialty that

involves contact with mucosa blood or

blood contaminated body fluid is now

regulated.

The goal is to ensure compliancewith universal barriers and other

methods to minimize infection risks.


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Environment of dental office

Ventilation The recommended freshair supply rate of ventilation systemsshould not fall below 5-8 liters persecond per occupant.

Recycling air conditioning systemsare not recommended.

Floor Covering

The floor covering should beimpervious and non slippery.

Carpet must be avoided.


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Air borne contamination

High speed hand piece is capable of

creating air borne contaminants frombacterial residents from saliva.

Aerosols

Particle size range from 50 um toapproximately 5 um. That can remainsuspended in the air and breathed for hrs.

Cross infections.

Patients infected usually are notaware of the source of their infection.


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Personal Vulnerability

Immunization - Hepatitis B infection

Anti HBs levels must be measured2-4 months after complete immunizationcourse.

HBS level > 100 M/U/ml willprovided adequate protection.

Single booster dose 5 years aftercompletion of primary course isrecommended for all health care workers.


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Concept of Infection

The number of organisms required

to cause an infection is termed as Theinfective dose.


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Infections diseases of concern in dentistry.

Bacteria Viruses

N.Gonorrhoeae Hepatitis B,C,D

T. Pallidum H.I.V.

M. Tuberculosis Cytomegalo virus

Strep. Pyogenes Measles

Mumps

Rubella

Herpes


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General Principles

Universal precautions use of mouthmask, head cap, protective eye weregloves are recommended.

Hand washing and care of handsSir William Osler onceremarked that Soap and waterand common sense are the

best disinfectants.Use of commonly availableantiseptic hand wash likechlorhexidine is generally

enough.


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OSHA (Occupational safety and Health

agency) regulation.Exposure and control plan

Emergency and exposure incident plan

OSHA required records.


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Methods of Infection control

Sterilization Sterilization is thedestruction or complete removal of allforms of micro organisms.

Disinfection Disinfection is thedestruction of many microorganisms butnot usually the bacterial spores.


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Choice of equipments

Choice of equipments dependsupon the requirement of the practioner.

Water supplies

The ADA council on scientific affairsrecommends to improved the design ofdental equipment of that water deliveredto patients during non surgical dental

procedures contains no more than 200colony forming units / ml (cfu/ml) ofbacteria at any point of time in theunfiltered output of dental unit.


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Pre-Sterilization Cleaning

Bio-films of vegatitive form of bacteriasspores and the organic matter formed onthe surface of the instrument have to bewashed with the suitable disinfectant

before proceeding with the sterilizationprocess.


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Physical agents

Heat Moist, Dry

Ionizing radiations

X-rays, beta rays

gamma rays

Ultraviolet rays

Filtration

Chemical agents

Agents acting on cell

membrane

Surface acting agents,Phenols, Organic solvents

Agents that denatureproteins

Acids and alkalies

Agents acting on

functional group ofproteins

Heavy metals

Oxidizing agents, Dyes,

Alkylating agents.

ST

ERILIZA

TION


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Steam Pressure Sterilization (Autoclaving)

Long cycle of 15 min 121 degree Celsiusand 15 lbs pressure.

Short cycle of 7 min 134 degree Celsiusand 30 lbs pressure.

Advantage of autoclaves - Most rapid andeffective methods for sterilization ofcommonly used dental equipments.

Disadvantages of Autoclaves Can causerusting of carbon steel instruments.

Dental burs can be autoclaved after dipping

it into 2 % sodium nitrite sol.


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Dry Heat Sterilization Hot air oven

Dry heat at 160 degree Celsius for

commonly used for this purpose. Microbialinactivation by dry heat is primarily anoxidation process.

Employed for sterilization of glassware,glass syringes, oils and oily injection aswell as metal instruments.

Chemiclaving

Using ethylene oxide gas131 degree celcius 20 pounds pressure isuse for this purpose. Heat sensitive plasticinstrument are sterilized by this method.


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New methods of sterilization

Using - ultra violet light and gamma rays

Not effective against RNA viruses likeHIV and bacterial spores.

Ultrasonic sterilization.Not commonly employed in dentalpractice.

Glass bead sterilizer used forsterilization of endodontic files.


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Types of instruments and sterilizationmethods.

Hand piece Should be well disinfectedbefore sterilization

Hot oil sterilization can be used for this.

Autoclaving is commonly carried out.

Sterilization of impression (VinylPolysiloxane) or Rubber Based

Impression. These are sterilized bydipping them in 2 % gluteraldehydesolution for minimum of 2 hours.

These should be wrapped in sterile bag.


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Disposal of waste / infected material

Waste material are first assorted as

infected or and non infected.They are then accordingly disposed of intocolor coated bags. yellow, red, blue/white,translucent, black.

Sharp objects like BP Blades are disposedof into puncture proof metal boxes.

Needled are destroyed using needledestroyer.

Use of disposable needled syringes arepreferable.


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Mercury containing amalgam wastes aredisposed of into sulphide solution.

Needle stick injury one of the mostcommon hazard which dental professionaland other medical professional usually

come across.The risk of transmission of HIV andHepatitis B is most dangerous.

For Hepatitis B It is always better forany health care worker to be wellvaccinated with HBs vaccine.


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For HIV as soon as one comes acrossneedle stick injury

1. Hands should be washed thoroughlywith the available disinfectant.

2. The area of the injury should be

squeezed of for allowing blood to flowout of it.

3. The patient can be ask for his HIV or

Hepatitis B status.

4. The senior medical incharge should beinformed about the accident.


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5. HIV postexposure chemoprophylaxis forhealth workers.

Basic (28 days) Zidovudine + Lamivudine

Expanded (28 days) As above + Indinaviror nelfinavir or neviriapine

6. PCR (polymerized chain reaction) candetect the presence of HIV p24 antigenwithin 24 hrs of initial infection.

7. Check up with ELISA in every sixmonths.

8. The risk of HIV transmission by needle

stick injury is only 0.03 %


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References :

Textbook of Oral and MaxillofacialSurgery Neelima Anil Malik

Sturdevants - Art & Science of OperativeDentistry - Fourth edition

Medical problems in dentistry

Shully and cowsan.

14188109 infection control in dental practice

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