details description about infection control Dr. Rachael Gupta MDS FIRST YEAR PEDODONTICS

1. Rachael S Gupta
1

2. INFECTION CONTROL –
Also called “exposure
control plan” by OSHA is a
required office program
that is designed to protect
person against risks of
infection.
OSHA-OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

3. What are the consequences of
unsterilization ?

4. CROSS-TRANSMISSION risks of infections
like
Herpes simplex (HSV)
direct contact with herpetic ulcers or infectious splatters from
herpetic lesions or saliva

5. • The frequency of herpetic whitlow was
observed to be higher among practicing
dentists compared to the normal population
Healthcare-associated viral and bacterial infections in dentistry
A.M.G.A. Laheij,1,* J.O. Kistler,2 G.N. Belibasakis,3 H. Välimaa,4,5 J.J.
de Soet,1 and European Oral Microbiology Workshop (EOMW)
2011
Acquired immune deficiency virus (HIV)
CAUSED THROUGH INFECTED BLOOD AND BODY FLUID AND RARELY BY SALIVA

6. Hepatitis B
patient-to-dentist transmission of HBV in an oral
surgery practice is mostly seen
Healthcare-associated viral and bacterial infections in dentistry
A.M.G.A. Laheij,1,* J.O. Kistler,2 G.N. Belibasakis,3 H. Välimaa,4,5 J.J.
de Soet,1 and European Oral Microbiology Workshop (EOMW)
2011
Hepatitis C ,hepatitis D are rare
Yellowish eyes (jaundice) in hepatitis B
Chickenpox -Varicella-zoster virus (VZV) are rare

8. What is sterilization?
-The use of a physical or chemical
procedure to destroy all
microorganisms including large
numbers of resistant bacterial
spores.
Centers of
disease control(CDC GUIDELINES)

9. What is Disinfection ?
Disinfection is less lethal than
sterilization, because it destroys the
majority of recognized pathogenic
microorganisms, but not necessarily all
microbial forms (e.g., bacterial
spores).(CDC guidelines 2008)
•Should be used on heat sensitive items of
equipment.
•Disinfectants is chemical agent

10. Asepsis: preventing excess of organisms into
patient’s uninfected tissues.
Antisepsis: the prevention of infection by
inhibiting the growth of bacteria in wound or
tissues
Antiseptics-
can be safely applied to skin or mucous
membrane .
Bactericidal agents-those are able to kill bacteria
Bacteriostatic agents- only prevent multiplication
of bacteria may however alive
Disinfectants-
Agents used on nonvital objects

11. The general principles for asepsis were laid down-
OLIVER WENDELL USA(1843) AND
IGNAS PHILLIP (1818-1865)
LOUIS PASTEUR-CHEMIST FROM FRANCE (1822-95)
FATHER OF MODERN MICROBIOLOGY –
Studied and made enquiry into origin of microbes.
He introduce the technique of sterilization and
developed the steam sterilizer, hot air oven,
JOSEPH LISTER(1827-1912)
FATHER OF ANTISEPTIC SURGERY
Involve use of carbolic acid hazardous but milestone in
evolution in surgical practice
He utilized phenol as much as possible to abolish microorganisms from
the walls of OT
Louis Pasteur
Joseph lister

13. DRY HEAT:
1. RED HEAT
held vertical In flame of Bunsen
burner until red hot
Metallic objects like-
• Inoculating wires
• Tips of forceps
• Needles, straight wires
2. FLAMING only exposed to flame
for few sec and not heat to red hot
• Glass slides
• Scalpels
• Needles

14. 3.HOT AIR OVEN (160 DEGREE -1 HOUR)
Glass wares
• Syringes
• Petri dishes
• Test tubes
• Flasks
Surgical instruments
• Extraction Forceps and elevators
• Scalpels
• Scissors
Oily fluids, Chemicals-powders
Filling instruments, tray, mouth mirror and probe,
Impression trays.
PRECAUTIONS:
• Articles should be dry
• Should not be overheated
• Keep space
• After disconnection allowed to cool for 1-2 hrs
• Rubber ,volatile substances should not be placed

15. 4.Incineration
•Destruction of infective materials
Solid dressings
Beddings ,Sputum and stool
MOIST HEAT
a) At a temperature below 100’c
• Serum or body fluids-56’c-1 hr
• Bacterial vaccines-60’c-1 hr
• Pasteurization of milk-72’c-30 sec
b) At the temperature 100’c-10 to 30 min –boiling
(inadequate sterilization)
• Injection needle
• Metal & Surgical instruments except scissors, knives, and surface needles
c)At a temperature above 100’c

16.  Three major factors for effective autoclave:
1. Pressure: 15psi.(pounds per sq inch)
2. Temperature: 121oC
3. Time: 15 mins.
 Higher temperature and pressure require shorter
time for sterilization.
Pressure (psi)
•15
•20
•20
Temperature (°C)
•121
•126
•134
Time (mins)
•15
•10
•3
Effective against
•Vegetative bacteria including TB
•Viruses
•HBV AND HCV
•Heat resistant spores-cl.tetani, cl.perfringes
Autoclave
A sterilizer with steam under pressure
• The principle is based on the fact that with increasing the
pressure, the boiling
point of water is increased(temp is directly related to
pressure)

17. Inner tank capacity up to 240 liters or more
Rectangular & Cylindrical Type
Horizontal
rectangular high
pressure autoclave

18. Classification Suitable for Processing Used by
N Type (Downward
Displacement)
Unwrapped solid
instruments for immediate
use.
S Type (Vacuum) single wrapped solid and
hollow items.
Medical Surgeries
Pediatrist
Tattooist
Body Pierces
B Type (Vacuum) Unwrapped & wrapped solid
and hollow instruments.
Porous loads, e.g. drapes &
gowns.
Dentists
Plastic surgeons

19. USES OF AUTOCLAVE
•Metal instruments (unwrapped) – 20 min
•Syringes(unwrapped)- 20 min
•Metal and trays(wrapped) -30 min
•Rubber gloves( dry, powdered, individually packed)-30 min
•Threads(linen, silk nylon) and metal wires-20 min
• Linen, towels, gowns dressings, gauze, cotton – 45 min

20. Filtration helps to remove bacteria such as sera and solutions of sugars or antibiotics used
for preparation of culture media.
20
Candle Filter
Sintered Glass Filters Membrane Filters
Asbestos Filter

21. RADIATION-
a)Ionizing radiation
•radiation tracks in the DNA leading to its death
•Gamma rays, x ray are used
•Dose of 2- 5 radiation is adequate to kill both vegetative and spores form of bacteria
TO STERILIZE-
•Disposable plastic syringes Swabs
•Suture materials Surgical instruments
•Iv set Surgical blades
•Cement
b)Non ionizing radiation
•Infra red
•Ultraviolet
•Sunrays
Denaturation of bacterial protein
(damage to dna by inhibition of dna replication)
Infrared- rapid mass sterilization of syringes
Ultraviolet- disinfection of
•Operation rooms
•Wards

23. Inorganic –boric
acids
Organic-
benzoic acid
salicylic acid
Na and k
Hydroxides
2)ALKALIES 3)ALCOHOLS
Ethyl alcohols 70%
Isopropyl alcohols 70%
Methyl alcohols 70%
4)ALDEHYDE
Formaldehyde 4%
Gluteraldehyde 2%
1)ACIDS
5)SURFACE ACTING AGENT
Anionic –common soap
Cationic –cetrimide
Nonionic - polysorbates
Amphoteric -tego compound
6)PHENOL
Carbolic acid
Cresol( Lysol)
Chloroxylenol
Chlorhexidine
chlorocresol
7)halogens
Chlorine &chloramines
Iodine & iodophore
8)Oxidizing agents
Hydrogen peroxide
Potassium permanganate
Zinc permanganate
9) dyes
•Acriflavin
•Proflavin
•Methylene blue
•Crystal violet
•Brilliant green
10)Heavy metals
Silver nitrate
Mercurial comp
11)gases
Ethylene oxide
Formaldehyde
Beta propriolactone

24. 1.Ethanol/isopropyl alcohol
3-5 min
•Denatured and coagulation of the cell wall
protein of bacteria
•Skin antiseptic
•Alcoholic handwash
•Emergency disinfection of surgical
instruments in vicinity of patient
2.Povidone iodine
2%-15 min
5% - 2-3 min
•Effective gram positive,negative,bacterial
,fungi,viruses,spores,protozoa
•It’s action retain as long as color remain
•Surface disinfectant
•Topical antiseptic
•Surgical scrub
•Low conc.mucous membrane antiseptic
•Instrument trays,handpiece n others

25. 3.Glutaraldehyde 2%- 10- 30 min
•Damage the cell wall membrane
•Complete sterliziation- 10 hrs
a)Glutaraldehyde 2.5%
(new generation cidex activated GTA)
Providing superior rate of action against all
Microbes including m.tuberculosis
•Metal instruments
•Face masks
•Rubber tubing
4.Formalin 4% -30 min
•Destroy/modify function group of
protein in microorganisms
•Tubings-cord, cables, adapters, connectors, wires
•Surgical instruments
•Clothing’s and bedding
•furniture

26. 5.Hydrogen peroxide 1 % to 6% 30 min
Destroy/modify the function group of
microorganisms
It is not antiseptic but cleansing agent
Destroy anaerobic organisms
6.Savlon
•Cetrimide
•Isopropyl alcohol
Reduces surface tension and damage
cell wall membrane
•Detergent-disinfectant-antiseptic
•Cleansing &disinfection of surgical instruments
•Storage of previously sterilized instruments
•Disinfection &prolong storage of thermometer &
cheatle forceps
7.Chlorhexidine – 2 min
Cell wall membrane damage
•Disinfection of surgical instruments
8.Cresol(lysol)_
Cell wall membrane damage
•Cleaning &disinfect floor of wards&OT
•Sterilization of infected glass ware

27. 9.Chloroxylenol(dettol)
Cell wall membrane damage
Used as disinfectant
10. Sodium hypochlorite sol.-0.5 1% Wiping of surfaces &spills

28. CLASSIFICATION
OF INSTRUMENTS
Critical
instruments
Semi-critical
Instruments
Non-critical
Instruments
Penetrate the soft
tissue
 Contact the bone
 Enter into or contact
the blood stream
They should be
thoroughly cleaned and
heat sterilized if they
are to be reused.
Eg: Surgical instruments,
Scalers, Scissors
Surgical dental burs
Scalpel blades
Forceps
Bone grafts
 Contact the mucous
membrane but will not
penetrate the soft
tissue
Eg : Mouth mirror,
impression trays,
handpieces, probe,
tweezers
 Come into contact
with intact skin
Eg : X-Ray tubes, Light
handles, Counter tops
Spaulding’s classification

30. Sterilization of endodontic instruments
COLD STERILIZATION-
USES chemical solution to sterilize instruments
Solutions are-
Quaternary ammonia compound-vegetative microorganism
Ethyl alcohol and isopropyl alcohol-v microorganism and tubercle
bacilli
Alcohol formalin solution –all above n spores
Orthophenylphenol and benzyl para chlorophenol all but not spores
Sporicidin-
Phenol-7.05%
Sodium tetra borate-2.35%
Glutaraldehyde-2%
Sodium phenate-1.2%
Disinfect 10 min at room temp and sterilizes in 6.75 hrs
HOT SALT STERILIZER/ GLASS BEAD STERILIZER
Absorbent points, broaches, files, reamers and other root canal
instruments
HOT SALT- instrument are quarter inch below salt’s surface and in
peripheral area

31. Consist metal cup consist tab salt 218’c to 246’c
broaches, files and reamers -5 sec
Absorbent point- 10 sec
Uses table salt
GLASS BEAD STERILIZER-
TEMP- 218-246’C
Glass beads 1mm in size larger are not effective due to larger air
spaces in beads
RC instruments- 5 sec
Absorbent point- 10 sec
Gutta perch cone immersing in 5.2% sodium hypochlorite for 1 min
followed rinsing
by h202 and drying

33. ROTARY INSTRUMENTS - BURS
• Diamond and carbide burs:
After use they are placed in 0.2%
gluteraldehyde and sodium phenate for at
least 10 minutes,
cleaned with a bur brush
Sterilize in an autoclave or dry heat
• Steel burs:
May get damaged by autoclaving. Can be
sterilized by using a glass bead sterilizer at 2300C
for 20-30 seconds.
33

34.  Impression trays are sterilized as follows
metallic – autoclave/hot air oven
plastic – ethylene oxide
 Disinfection of alginate impressions –
Methods
- Spraying
- Immersion
Iodophors, sodium hypochlorite (1:10 concentration ) ,
phenols, formaldehyde, glutaraldehyde.
34

35. DENTAL CASTS
CDC(MMWR),dec19,2003vol.52
• Spraying until wet or
Immersing in a 1:10
dilution of sodium
hypochlorite or an
iodophor then rinse
• Casts to be disinfected
should be fully set (i.e.
stored for at least 24
hours)
35
• ADA recommends use of
 Chlorine compounds
 Iodophors
 Combination of synthetic
phenols
 Glutaraldehyde.

36. NEW METHODS OF STERILIZATION
• Peroxide vapor sterilization - an aqueous
hydrogen peroxide solution boils in a
heated vaporizer and then flows as a
vapor into a sterilization chamber
containing a load of instruments at low
pressure and low temperature
• OZONE -
• Ozone is the most powerful oxidative agent that occurs
naturally. With its extra free radical oxygen
molecule, ozone is able to destroy germs, viruses, and
microbes that may cause surface or air contaminations.
• Ozone Parameters - The cycle time is approximately 4.5
hours, at a temperature of 850F – 940F.

37. Plasma Sterilization
• Plasma is basically ionized gas. When
you apply an electric field to a gas, it
gets ionized into electrons and ions.
• Plasma is usually comprised of UV
photons, ions, electrons and neutrals.
• Their combined photolytic, chemical
and electric action efficiently kills
most micro-organisms.

39. Dental treatment room surfaces :
Dental treatment room surfaces are classified as either :
• Clinical contact surfaces or
• General housekeeping surfaces .
Clinical contact surfaces are those that are touched by contaminated
hands , instruments or by spatter during treatment . It should be cleaned
and disinfected between patients .
All the other surfaces , such as the walls and floors , are considered
general housekeeping surfaces
Clinical contact surfaces :
The clinical surfaces can be classified into three categories :
A) Touch surfaces : are directly touched and contaminated during
treatment procedures . Touch surfaces include ;
Dental light handles
Dental unite controls and
Chair switches

40. B) Transfer surfaces :
are touched by contaminated instruments such as instruments trays .
C) Splash , spatter , and droplet surfaces : a major example .
Touch and transfer surfaces should be either barrier-protected or cleaned and
disinfected between patients . In the same time , splash , spatter , and droplet surfaces
should be cleaned at least once daily .
. Disposable plastic wrap,
plastic sheets,aluminium foils
tubing, plastic-backed paper are
Used as barrier

41. Most dental offices use a combination of surface disinfection and
surface barriers .

42. Sticky tape as a plastic barrier is frequently
used to protect smooth surfaces , such as
electrical switches on chairs and x- ray unite

43. DENTAL RADIOGRAPHY INFECTION CONTROL

44. •Gloves should be worn
•Powder-free gloves- powder can affect the film’s emulsion layer
and cause image artifacts.
•additional PPE when treating patients with gagging problems or
respiratory infections (e.g., common cold)
•.
•Alcohol-based hand rubs where multiple patients are seen in a short
period of time.
•Radiography equipment should be protected with surface barriers that
are
changed between patients. Disposable plastic wrap, plastic sheets or
tubing, plastic-backed paper or other material impervious to moisture
must be cleaned and disinfected with an intermediate-level
disinfectant

45. Standard Protocols

46. when you
don't wash
your hands.
You're Infecting Everyone You Touch
HEPATITIS A
TYPHOID
EYE INFECTION’S
AND VARIOUS OTHER HAND DISEASES

47. Hand washing is not just
about good hygiene, it's
about infection control.

48. 1.Handwashing and hand care :
 Hegde et al in their study stated that the bar soap
is a reservoir of microorganisms and washing
hands with such a soap may lead to spread of
infection. (Microbial contamination of "in use" bar
soaps in dental clinics. Indian J Dent Res
2006;17:70-3)
 As alternatives for the adjuncts used for hand
washing the dentists could use a disinfectant which
is not exposed to the environment, the liquid soap,
surgical scrubs.

49. Microbial flora of skin in 1938 consist of
Transient flora- Resistant microorganisms
Which colonize superficial layers of
skin are easier to remove by routine
hand washing Attached to deeper layers of skin
are more resistant to removal
Routine hand washing/non surgical
procedure/hand antisepsis-
antimicrobial soap and water
If hand are not visibly soiled
An alcohol based hand rub
Surgical hand antisepsis eliminate
transient flora and reduce
resident flora
Resident flora elimination depend
on-
Antiseptic agent include duration
Technique of scrubbing
Condition of hands
Technique of drying and gloving

50. Hand Hygiene
HANDWASHING IS THE SINGLE MOST IMPORTANT MEASURE
FOR PREVENTING INFECTION.
50
Less frequently missed
Least frequently missed
Most frequently missed

51. • ROUTINE HANDWASH
• HYGIENIC HANDWASH/ANTISEPTIC
HANDWASH
• SURGICAL HANDWASH
SCRUB METHOD

53. SCRUB METHOD

55. no headcap
No drape
No mouthmask

56. 1- Protective clothing
2- surgical masks
3- Face shields
4- Protective eyewear
5- Gloves .
protective clothing
mask
eyewear or face
shield
gloves

57. 1) Protective clothing :
Purpose : to protect the skin
exposure to saliva , blood ,
aerosol , and other
contaminated materials .
Types
1) Laboratory coats
2)Gown
3)Surgical scrubs

58. Gown type Situation and Rationale
Cotton/linen, reusable or disposable, long-sleeved
isolation gowns
Use if contamination of uniform or clothing is likely
or anticipated
Fluid resistant isolation gown or plastic apron over
isolation gown
Use if contamination of uniform or clothing from
significant volumes of blood or body fluids is likely
or anticipated (fluids may wick through non-fluid
resistant reusable or disposable isolation gowns)
Fluid impervious gowns e.g., Gortex® Use if extended contact or large volume exposure
(e.g., large volume blood loss during resuscitation of
MVA victim or surgical assist)

59. Guidelines for the use of protective clothing
1) It should not be worn out of the office for any reason .
2) It must not be worn during eating or in resting rooms .
4) It should be washed and laundered separately
Protective clothing requirements :
1) Should be made of fluid-resistant material ( cotton ,
cotton/polyester, or disposable jackets or gowns .
2) Clothing should have long sleeves and a high neckline
to minimize the amount of uncovered skin .
3) Must cover dental personnel at least to the knees when
seated

60. 2) Protective masks :
Purpose the mask worn over the nose and mouth to
protect the person from inhaling infectious organisms
spread by the aerosol spray of the handpiece or air-water
syringe .
According American Society for Testing and Materials
Types of mask
1) Maximum filtration mask- N95
High fluid resistance – 160 mm hg
Filtration efficiency-99.9%
Indicated airborne diseases- TB

61. 2)ASTM LEVEL 3
High fluid resistance – 160 mm hg
Filtration efficiency- greater or equal to 98%
Heavy and moderate amounts of fluid, spray
& aerosols
3)ASTM LEVEL 2
Moderate fluid resistance -120 mm hg
Filtration efficiency- greater or equal to 98%
Moderate and light amount of fluid, spray &
aerosols
4)ASTM LEVEL 1
Low fluid resistance – 80 mm hg
Filtration efficiency – greater or equal to 95%
Low amounts
5) low performance
Surgical molded utility mask
Physical barrier only
No level performance
No filtration efficency
Short produres that do not produce fluid
6)Minimum performance
Utility mask
Physical barrier only
No level performance, No filtration efficency
Barrier for dry short procedure
Level 3
Level 2
Level 1
Low performance

62. Guidelines for the use of protective masks :
o Masks should be changed for every patient
• Handled by touching only the side edges to avoid
contact with the more heavily contaminated body
of the mask.
•conform to the shape of the face .
•should not contact the mouth when being worn
because the moisture generated will decrease the
mask filtration efficiency .

63. 3) Protective eyewear :
Purpose eyewear is worn to protect the eyes against damage from :
• Aerosolized pathogens .
• Flying sharp debris such as scrap amalgam and tooth fragments .
• Splattered solutions
Guidelines for the use of protective eyewear :
1)correction glasses or contact lenses must wear protective
eyewear with a side shields or a face shield .
2) It must be cleaned and decontaminated
Types :
1) Glasses with protective side shield
2) Clear face shields .

64. Face shields :
a chin-length plastic face shield
that protects your eyes, nose, and
mouth from spatter may be worn
and replace the protective
eyewear .However , a shield
cannot replace the mask because
it does not protect against
inhalation of contaminated
aerosol
Face shield worn in addition to the mask

65. Patient eyewear :
Patients should be provided with protective eyewear
because they may subjected to eye damage from :
1) Handpiece spatter
2) Splashed dental materials
3) Airborne bits of acrylic or tooth fragments

66. 4) Gloves :
Purpose :
Gloves must be worn by the
dentist , dental assistant , and
dental hygienist during all dental
treatment to avoid contact with
the patient’s blood , saliva , or
mucous membranes or with
contaminated items or surfaces .
Types :
Examination gloves
Sterile surgeon’s
gloves
Nonmedical gloves

69. Guidelines for the use of gloves :
• Discarded after a single use.
• Torn or damaged gloves must be replaced immediately .
• Do not wear jewelry under gloves because , it may tear
the gloves .
• If the procedure is long , change the gloves each hour .
•Hands must be washed after glove removal and dried
well before regloving .
the health care providers may experience
serious allergic reactions to latex . The person
who is sensitive to latex can substitute with
gloves made from vinyl , nitrile and
other non-latex containing materials .

71. Managing contaminated sharps :
Contaminated needles and other disposable sharps ,
such as scalpel blades , orthodontic wires , and broken
glass must be placed into a sharps container .
OSHA , CDC classify sharps as infectious waste .
According to OSHA regulations , disposable sharps
must be placed in a puncture resistant , closable , and
color-coded or labeled with the biohazard symbol
container immediately after use .
Biohazard symbol

73. • Divided into two categories :
A) Bio-hazardous materials.
B) Non-bio-hazardous materials.
A) Bio-hazardous materials consist of waste materials :
– 1. Soaked with blood or other body secretions.
– 2. Capable of causing infectious disease.
– 3. Having a poisonous effect.
– 4. Human tissue removed during surgery.
– 5. Teeth and associated tissues.
– 6. Gloves.
Biomedica Wastemanagement
l waste management:

74. • B) Non-bio-hazardous materials
consist of waste materials :
– 1. Matrix bands.
– 2. Masks, caps, gloves, patient’s napkin’s.
– 3. Impression materials.
– 4. X- ray packets & surface covers.

75. COLOUR TYPE OF
CONTAINER
WASTE CATEGORY TREATMENT
OPTIONS
YELLOW PLASTIC BAGS Human and animal
wastes, Microbial and
Biological wastes and soiled
Wastes, eg. human tissues,
body parts, organs, lab
cultures, specimens,
items contaminated
with blood
Incineration, deep
burial
RED DISINFECTED
CONTAINER/P
LASTIC BAGS
Microbiological and
Biological wastes,
Soiled wastes, Solid waste, eg.
Disposable items like
catheters, IV set, lab
cultures , specimens etc.
Autoclave

76. COLOUR CODE TYPE OF
CONTAINER
WASTE CATEGORY TREATMENT
OPTIONS
BLUE/WHITE
TRANSPARENT
PLASTIC
BAG,PUNCTURE
PROOF
CONTAINER
Waste sharps and solid
waste, eg. .Sharps,
needles , scalpels,
disposable items like
catheter, IV set etc
Autoclave/
Chemical Treatment
Destruction
BLACK PLASTIC BAG Discarded medicines,
incinerated ashes,
chemicals used for
disinfection etc.
DISPOSAL IN
SECURED LAND FILLS

77. References
New CDC guidelines for selected infection control procedures, chris
miller.
CDC guidelines for infection control in dental health care settings,
Dec19, 2003/vol.52.
OSHA Guidelines for Infection control procedures
Textbook of microbiology by Prof. CP Baveja.(3rd edition)
Operative dentistry chp- infection control by Studervant.(4th edition)
Sterilization and disinfection of dental instruments by ADA
Healthcare-associated viral and bacterial infections in dentistry
A.M.G.A. Laheij,1,* J.O. Kistler,2 G.N. Belibasakis,3 H. Välimaa,4,5 J.J. de
Soet,1 and European Oral Microbiology Workshop (EOMW) 2011
Essentials of preventive and community dentistry Soben peter (3rd
edition)