Dental Infection Control and Immunization

Immunization

• Dental personnel should maintain up-to-date immunization records, including vaccination against:
  • Hepatitis B
  • Rubella
  • Measles
  • Mumps
  • Influenza
  • Poliomyelitis
  • Tetanus/diphtheria
  • COVID-19

Patient Screening

• Complete medical history to determine infectious status and update during recall visits

Hand Hygiene

• Most important aseptic procedure in preventing healthcare-associated infections
• Reasons:
  • Hands are the most common mode of pathogen transmission
  • Reduces the spread of antimicrobial resistance
• Components of good handwashing:
  • Cleaning nails and skin thoroughly to remove all visible soil
  • Rinsing well to remove all visible soap
  • Drying thoroughly to reduce skin chapping
• The 5 moments for hand hygiene approach defines key moments for hand hygiene
• Recommendations:
  • Artificial nails are contraindicated
  • Colored nail polish is contraindicated
  • Nails should be short
  • All hand jewelry should be removed

Personal Protective Equipment (PPE)

• Designed to protect skin and mucous membranes from infectious agents
• Primary PPE used in healthcare settings:
  • Gloves
  • Surgical masks
  • Protective eyewear
  • Face shields
  • Protective clothing
• Less frequently used PPE:
  • Shoe and head covers
• A new pair of gloves is worn for each patient
• Gloves should be removed when leaving the clinic

Order of Wearing and Removing PPE

• Wearing:
  1. Protective clothing
  2. Mask
  3. Protective eyewear
  4. Gloves
• Removing:
  1. Gloves
  2. Protective eyewear
  3. Mask
  4. Protective clothing

Dealing with High-Risk Patients

• Use double mask and double gloves techniques
• Schedule the last appointment for them
• Practitioner with cuts on skin of hands should be prohibited from attending operative procedures
• Golden rule: Treat all patients as if they are infectious and follow routine cross-infection control

Needle and Sharp Instrument Safety

• Sharp ends of instruments should be angled away from both the doctor and coworkers
• Sharp instruments should not be passed over the patient's face
• Used needles should not be bent or broken prior to disposal
• Unsheathed needles should be placed directly into the designated, puncture-proof disposal container (safety box)
• Techniques for needle recapping:
  1. One-handed "scoop" technique
  2. Mechanical device designed to hold the needle sheath

Instrument Sterilization and Disinfection

• Sterilization:
  • A process that destroys all forms of life, especially microorganisms
  • Used for equipment and surfaces that can be sterilized
• Disinfection:
  • A process that destroys or inhibits most pathogenic agents on an object by chemical or physical means
  • Used for equipment and surfaces that cannot be sterilized
• Sanitization:
  • The process of removing organic debris so that disinfection can occur
• Bacteriostatic: An agent that inhibits the increase in the number of bacteria
• Bactericidal, fungicidal, virucidal: An agent that destroys bacteria, fungi, or viruses, respectively

Unsaturated Chemical Vapor (Chemiclave)

• Advantages:
  • Relatively quick
  • Minimal rust and corrosion
  • Works with paper-packaged articles
  • Has monitoring capabilities
• Disadvantages:
  • Produces an offensive odor
  • Does not penetrate fabric wrapping
  • Damages plastics
  • High cost of special solutions

Recommended Methods of Sterilization

• Handpieces: High-speed, low-speed, and surgical handpieces must be subjected to heat sterilization
• Other items that require heat sterilization:
  • All band and orthodontic instruments
  • All burs and bur changers, including contaminated laboratory burs and diamond abrasives
  • All endodontic instruments
  • Air-water syringe tips
  • Metal impression trays
  • Surgical instruments
  • Ultrasonic periodontal scalers and tips
  • Electrosurgery tips

Chemical Sterilization

• Some items that may be chemically sterilized:
  • Glass mixing slabs
  • Metal or plastic spatulas
  • Mirrors for intraoral photography
  • Some cheek retractors
  • Handles for brush tips

Single Use Items and Laboratory Asepsis

• Single use or disposable items must be discarded and not reused
• Laboratory asepsis:
  • Cross-contamination from impression, jaw relation records, and casts is possible
  • Clean and disinfect, then thoroughly rinse before sending to the laboratory
  • Impressions, prosthesis, or appliances should be disinfected as soon as possible after removal from the patient's mouth

Tips for Dental Tubes Hygiene

• Internal surfaces of handpiece and ultrasonic scaler may become contaminated with patient material during use
• Run handpieces to discharge water and air for a minimum of 20-30 seconds after use on each patient
• Disinfect low-volume suction lines between patients using a small amount of waterline cleaner/disinfectant for 2 minutes

Use of Extracted Teeth in Dental Educational Settings

• Collect extracted teeth in a sealed container and avoid contamination of the outside of the container
• Clean teeth by scrubbing with detergent and water, then store and immerse in a fresh solution of sodium hypochlorite (diluted 1:10 with tap water)
• Persons handling extracted teeth should wear gloves and other PPE
• After completion of work activities:
  • Dispose of gloves properly
  • Wash hands
  • Clean and disinfect work surfaces and equipment