Dental Infection Control Procedures PDF

instrumentation. The constant dangers of cross-contamination in dental practice among patients, dentists, and ancillary staffhave been pointed out by Murray and Slack; they reported the possibility of absorbent cotton pledgets, air syringes,glass s...

instrumentation. The constant dangers of cross-contamination in dental practice among patients, dentists, and ancillary staffhave been pointed out by Murray and Slack; they reported the possibility of absorbent cotton pledgets, air syringes,glass slabs,and hand towels acting as sources of contamination. The Centers for Disease Control and Prevention (CDC), in its infection control guidelines,indicated that dental impressions are potential sources of cross contamination and should be handled in a manner that prevents exposure to practitioners, patients, and the environment. Based on the corroboration of data and regulationconfined to the province, appreciative standards of Dental Infection Controland Occupational Safety must be followed by the dental team for patient and dental healthcare safety. The aim of dental infection control The aim is to control infectionscaused by patient exposure to pathogenic microorganisms or transmitted to the dentist or laboratory staff via occupational exposure. Issues of Concern Infections could be transmitted in the dental operatory through several routes: 1. Direct contact with blood, oral fluids, or other infectedmaterials. 2. Indirect contact with contaminated objects,such as instruments, environmental surfaces,or equipment. 3.Contact of conjunctival, nasal, or oral mucosa with droplets, such as spatter, containing microorganisms from an infected person and propelled by coughing, sneezing, or talking. 4. Inhalation of airborne microorganisms that can remain suspended in the air for long periods. 47 Infection Control Procedures. PatientScreening.. Personal hygiene. Personal protection. Instrument processing. Surface asepsis. Patient treatment. Laboratory disinfection. Patient Screening Initial patient screening is accomplished by the dentist during history-taking interactions before entering the operatory. The dentist's review of the patient's medical history is mandatory at the onset of every clinical appointment. Multiple reviews give the dentist opportunitiesto establish baseline medical history data and to compare individualpatientresponses over an extended period of time as well as a briefreview of any infectious disease the patient is suffering.Thermal monitoring at the screening stage has become mandatory due to Covid-19. Personal Hygiene The dentist's personal hygiene is an absolute necessity.As patients become more aware of the potential danger to themselves from materials and instruments that are not disinfected or sterilized, their confidence and acceptance of dental treatment become directly proportional to the image the clinician presents.Specific notes of hygiene include Hair is cleared away from the face.Ifa clinician's hair falls in such a way that it may contact the patient or dental equipment, it is fixed at the back of the head, or a surgicalcap is worm. Facial hair is covered by a face mask or shield. Jewelry is removed from the hands, arms, or facial area during patient treatment. Fingernails are kept clean and short to prevent perforation of gloves and 48  accumulation of debris.Fingernail polish is not worn. Thorough forearm and hand washing are mandatory before and after treatment. Personal Protection equipment Dental personnel are required to have current immunizations against communicable diseases,including hepatitis B. Gloves, are worn at all times. Masks areworn in the treatment area and when the dentist is manipulating the prostheses in the laboratory.Glasses with solid side protection must be worn by the patient, faculty member, and resident. The use of disposable plastic face shields is highly recommended. Sharps disposal protocol is followed. Outer barrier garments for aerosol protection are worn at all times when treating a patient and always changed between patients. Instrument Processing Presoaking and cleaning Packaging Sterilization Common Methods of Sterilization Steam at 121degrees C for 20 to 30 minutes or 134 degrees C for 2 to 10 minutes. Advantages- good penetration. Precautions -carbon steel corrodes, damage to plastic and rubber items, packs wet after the cycle, hard water spots instruments. Unsaturated chemical vapor - 20minutes at 134C. Unsaturated chemical vapor -20 minutes at 134 C. Advantages -no corrosion ofcarbon steel, packs are dry after cycle. Precautions –may damage plastic and rubber items. Dry heat (Oven Type)- 1 to 2 hours at 160 C Advantages -no corrosion of carbon steel, packs dry afterthe cycle Precautions – may damage plastic and rubber items, do not open door during the cycle. 49 Dry heat (rapid heat transfer type) 6 to 12 minutes at 191C. Advantages – short cycle. Precautions – may damage plastic and rubber items. Glass bead sterilizers: Used in endodontics to sterilize reamers, files though their efficacy is debatable when compared with autoclaving. Surface Asepsis There are two general approaches to surface asepsis: Clean and disinfect contaminated surfaces,and prevent surfaces from becoming contaminated by theuse of surface covers. A combination of both may also be used. According to Miller and Palenik in 2016, the following chemicals are suitablefor surface and equipment asepsis: Chlorine- e.g., sodium hypochlorite. Phenolic compounds. Water-based – Water with ortho-phenylphenol or tertiary amylphenol or 0 benzyl-p-chlorophenol. Alcohol-based -Ethyl or isopropyl alcohol with ortho-phenylphenol or tertiary amylphenol lodophor -butoxy polypropoxy polyethoxy ethanol iodine complex Patient Treatment Before seatingthe patient, the operatory and chair are cleaned and wiped with a disinfectant solution;the area is sprayed and left for a minimum 10 minutes. The dental chair is covered with a plastic sheath, which is removed after treatment. Subsequent to treatment, the protective covers are removed, and the room is sprayed, wiped with phenol solution,and left to dry. Allpatientsrinse with chlorhexidine gluconate 0.12% before treatment. Patients wear protectiveeyewear. Hands arewashed with an antimicrobialcleanser before gloving. 50  Once gloved, only the patient and barrier-covered areas or areas that have been cleaned and disinfectedare touched. The patient chart is not touched with contaminated gloves. If an entry must be made in the chart,gloves must be removed or a clean glove is placed over the contaminated glove and removed after finishingthe chart. Alternatively,an appropriate barrier must be used on the pen and overtheportion of the record that is to be touched. The doctor should not leave the operatory without removing their gloves and outer barrier garments. Large, nonsterilizable items used in the operatory, such as impression material dispensing guns, articulators, face bows, water bath, siliconespray bottles, tooth shade, and mold guides are disinfected by wiping, spraying, or immersion with the appropriate disinfectant solution. All items leaving the clinic after being used in direct patient care or touched during patient care procedures that cannot be subjected to sterilization procedures are disinfected or placed in the phenol disinfectionsolutionwithin a sealed plastic bag before departure. New latex gloves are worn forthe disinfection procedures. Items bagged in disinfectionsolutionmust remain in solutionfor 10 minutes. Metal impression trays are hung and autoclaved before use. Adhesives for impression trays are used in individual dose quantities to prevent cross contamination. Polyvinylsiloxane, polysulfide, impression compound, and ZOE impression materials are thoroughly rinsed with water and immersed in a 5.25% sodium hypochlorite solutionfor 10 minutes. Alginate and polyether impressions are rinsed with water, sprayed with a 5.25% sodium hypochlorite solution and sealed in a plastic bag for at least 10 minutes. Wax,ZOE, and resin centricrelation records are rinsed under water and sprayed 51  with a 5.25% sodium hypochlorite solution and placed in a plastic bag for 10 minutes. Stone casts requiringdisinfectionare sprayed with a 5.25% sodium hypochlorite solution and allowed to sit for at least 10 minutes. Complete dentures and provisional restorations that leave the operatory are immersed in a 5.25% sodium hypochlorite solution for 10 minutes. Removable partial dentures with metal bases are sprayed with 2% glutaraldehyde solution and held in a plastic bag for 10 minutes. Laboratory Norms All prostheses that enter and leave the laboratory should be disinfected.Within the laboratory,the prosthesis of cach patient is kept separate through barrier, disinfection, and sterilization systems. All prostheses entering the laboratory are scrubbed with disinfectant solution. Those leaving the laboratory are immersed in a 5.25% sodium hypochlorite solutionfor a minimum of 10 minutes. New gloves should be worn in the laboratory area for grinding and polishing procedures and then discarded when the practitioner leaves the laboratory. Protective clothing is worn in the laboratory and discarded before the dentist leaves the laboratory area. Laboratory countertops are cleaned and wiped with a disinfectant solution at the end of each day. Individually packaged cold sterilized laboratory burs are available in the laboratory. After the desired procedure is accomplished, the laboratory bur is cleaned and placed in a new bag for sterilization. The burs are used for one patientonly and then resterilized. 52 For polishing the lathe: When the technician uses pumice, he/she places a clean plastic container containing an individualdose of pumice. A phenol solution is used to wet thepumice to desired consistency. Individualy packaged sterile polishing wheels, designated for use with pumice, are available. The wheel wet with water soften is to it before use. If prosthesis becomes contaminated during laboratory procedures, it is disinfected,and the laboratory procedure continued. The final polish is accomplished using a sterile wheel with non-contaminated acrilustre. The acrilustre is applied to the sterile wheel once before polishing to eliminate cross-contamination. Clean-up involves disposal of the plastic container and thecontaminated pumice. Wheels are removed, rinsed with water, and bagged forautoclaving. Before returning to the main clinic, all items are disinfected by immersion or spray and placed in a lock-tight bag. All information regarding disinfection procedures that are performed on prosthodontic items sent to an outside laboratory should be clearly writtenon the prescriptionform and the plastic bag. All items received from a laboratory are treated as contaminated unless the resident is informed otherwise by the dental laboratory. Before impressions are poured in the laboratory, hydrophilic impression materials are sprayed with a sodium hypochlorite solution (5.25%) and placed in a plastic bag for a minimum time of I minute. Hydrophobic impression materials are immersed in the disinfectant solution for 10 minutes. 53