infection control in dentistry pracman.pptx

INFECTION CONTROL IN DENTISTRY CONTENTS  Introduction  Mode of Transmission  Mode of Infection control  Objective of Infection control  Operatory Asepsis  Personal Protection Barrier  Sterilization  Disinfection  Laboratory Infection Control  Clinical Waste Disposal....

INFECTION CONTROL IN DENTISTRY CONTENTS  Introduction  Mode of Transmission  Mode of Infection control  Objective of Infection control  Operatory Asepsis  Personal Protection Barrier  Sterilization  Disinfection  Laboratory Infection Control  Clinical Waste Disposal. 2  Definitions INFECTION CONTROL – Also called “exposure control plan” by OSHA is a required office program that is designed to protect personnel against risks of exposure to infection. 3 STERILIZATION: Use of a physical or chemical procedure to destroy all microorganisms including substantial numbers of resistant bacterial spores. 4  Sterilization means the destruction of all life forms. (Ronald B Luftig). Sterilization is the process of killing or removing all viable organisms. (MIMS – PLAYFAIR) 5  STERILE: – Free from all living microorganisms; usually described as a probability (e.g., the probability of a surviving microorganism being 1 in 1 million). 6 DISINFECTION: Destruction of pathogenic and other kinds of microorganisms by physical or chemical means. 7  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). Disinfection is a process of removing or killing most, but not all, viable organisms. 8  DISINFECTANT: A chemical agent used on inanimate objects to destroy virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., bacterial endospores). 9  ASEPSIS: prevention of microbial contamination of living tissues or sterile materials by excluding, removing or killing microorganisms. 10 Modes of Diseases Transmission  Direct contact with blood or body fluids  Indirect contact with a contaminated instrument or surface  Contact of mucosa of the eyes, nose, or mouth with droplets or spatter 11  MODES OF TRANSMISSION: Infectio us agent Suscepti Reservo ble host irs Chain of infecti on Portal of Portal entry of exit Means of transmis sion Six links in chain of transmission of infection 12 OBJECTIVES OF INFECTION CONTROL Reduce Implem Protect ent Simplify 13 Why , Who and what Why is infection control necessary in dentistry ? Dental staff and patients may be exposed to a wide variety of pathogenic microorganisms. 14  Who is responsible for infection control in the dental office ? – Each member of the dental team must follow the recommended guidelines. 15  What should be done to prevent the transmission of disease in the dental office ? 16 The most effective ways to prevent the transmission of diseases includes : 1) Hand washing 2) Gloves 3) Face masks 4) Protective eye wear 5) Protective clothing 6) Instrument sterilization and disinfection 17  Diseases Transmission in Dental Office Diseases Transmission in Dental Office The dental office should have an infection control program to prevent the transmission of disease from the following : Patient to dental team Dental team to patient Patient to patient Dental office to community ( include dental team’s family ) Community to dental office to patient 18  To prevent such infections, following is a list of all those procedures and precautions that together constitute infection control. 19  These guidelines should be followed each time treatment is performed because we are never certain of the patient's status, either because they themselves do not know or because they have chosen not to inform their healthcare providers of their condition. Following these guidelines for every patient is called "Standard 20  Standard Precautions 1. Immunization 2. Patient screening 3. Hand washing 4. Barrier techniques - Personal Protective Equipment (PPE) Rubber dam, Pre-procedural rinsing 5. Needle & sharp instrument safety Occupational Exposure To Blood/Body Fluids 6.Instruments sterilization and disinfection 7.Surface disinfection 8. Radiographic asepsis 9. Laboratory asepsis 10.Infectious dental waste management & disposal 21 Personal protective equipment ( PPE ) OSHA requires the employer to provide employees with appropriate personal protective equipment. Examples of PPE: 1- Protective clothing 2- Surgical masks 3- Face shields 4- Protective eyewear 5- Disposable patient treatment gloves 22 6- Heavy-duty utility gloves These PPE must be used whenever you :  Performing tasks that could produce splash or spatter.  Any contact with body fluids  Perform other clinical activities that require handling contaminated items e.g. radiographs , impressions , dentures or contaminated equipment and surfaces. 23 HAND HYGIENE Hand washing is the single most important procedure for preventing the spread of infection. So , you must wash your hands each time before you put on gloves and immediately after you remove gloves. 24  Hand washing is also required if you touch contaminated instruments or surfaces during working We should always use liquid soap during hand washing. Bar soap should never be used because it may transmit contamination. 25  HANDS NEED TO BE CLEANED WHEN Visibly dirty After touching contaminated objects with bare hands Before and after patient treatment (before glove placement and after glove removal)  OPERATORY ASEPSIS In the dental operatory, environmental surfaces (i.e., a surface or equipment that does not contact patients directly) can become contaminated during patient care. 27  Certain surfaces, especially ones touched frequently (e.g., light handles, unit switches, and drawer knobs) can serve as reservoirs of microbial contamination, although they have not been associated directly with transmission of infection to either personnel or patients. 28  Transfer of microorganisms from contaminated environmental surfaces to patients occurs primarily through personnel hand contact 29 A. Infection Control During the Pretreatment Period The process of infection control begins during the period of preparation for clinical treatment. Paying attention to infection control at this time has several payoffs. 30  In addition to reducing the risk of transmission of infectious agents during patient care, thinking ahead will make the treatment session more efficient and will also make the post treatment infection control process easier and more effective. 31 1.Remove unnecessary items from the dental procedure area : The dental procedure area should be arranged to facilitate a thorough cleaning following each patient. 32 2. Preplan the materials needed during treatment. - Set out all instruments, medications, impression materials, and other items that are needed for a procedure. - Thinking ahead minimizes the need to search for additional items or to enter cabinets and drawers once gloves have become contaminated. 33 3. Utilize disposable items whenever possible: The use of disposable items saves time during cleanup and decontamination and solves the problem of proper reprocessing. 34  4. Use prearranged tray set-ups for routine or frequently performed procedures. – Helps to eliminate the need to go into cabinets once you have started a procedure. 35 5.Use individualized, sterilized bur blocks for each procedure Using individualized bur blocks containing only the burs required for that procedure helps to eliminate the contamination of other, unneeded burs and to make clean-up easier. 36 6. If indicated, have the rubber dam setup on the tray. When a rubber dam will be used during a clinical procedure, it also should be included on the tray setup. In addition, include those items needed for high-velocity evacuation. 37 7. Identify those items that will become contaminated during treatment. While preparing the dental procedure area prior to beginning a clinical procedure, consider which items will become contaminated during treatment. Examples of such surfaces include countertops, light handles, X-ray unit heads, tray tables etc. Decide whether to use a barrier, e.g., plastic wrap to prevent contamination of these surfaces and items or to disinfect them when the procedure is complete. 38 Surface barriers : Surface barriers are used to prevent contamination on the surface underneath. All the surface barriers should be resistant to fluids in order to prevent microorganisms in saliva, blood, and other liquids from soaking through the barrier and reach the surface underneath. Chair Drapes 39 40 41 42 8. Review patient records before initiating treatment and place radiographs on the view box. Do not leave the record on the countertop or handle it after beginning treatment. Place the record in a drawer or out of the dental procedure area, so that it doesn’t become contaminated. Entries into the record should be done before and after the procedure. 43 44 9. Prepare personnel involved in patient care. An essential pretreatment procedure is the preparation of all personnel involved in patient care. This includes the utilization of personal protective equipment (gown, eyewear, mask and gloves) and hand hygiene. 45 46  B. Infection Control during the treatment Period (Chairside Infection Control ) : The infection control procedures described in the previous period will help you to reduce the risk of transmission of infectious agents. During treatment there are additional precautions that can be taken to further reduce infection risks. 47 1. Use care when receiving, handling, or passing sharp instruments 2. Take special precautions with syringes and needles. 3. Use a rubber dam whenever possible 4. Avoid touching unprotected switches, handles and other equipment once gloves have been contaminated. 5. Avoid entering cabinets once gloves have been contaminated. 48 49 50 C. Infection Control During the Post- Treatment Period  Continue to wear personal protective equipment during clean-up: After patient care is completed, begin the cleaning and disinfection process by removing contaminated gloves used during treatment, wash your hands and use the utility gloves before beginning the clean up. Continue to wear protective eyewear, mask, and51  Remove all disposable barriers : All of the barriers placed before treatment, including light handle covers and countertop barriers, should be removed.  Clean and disinfect all items not protected by barriers. 52  Cleaning and disinfection of the dental treatment room surfaces are important components in an effective infection control program  The laboratory studies have proved that microorganisms may survive on environmental surfaces for long time. For example, Mycobacterium tuberculosis may survive for 53 54 STERILIZATION AND DISINFECTION OF DENTAL INSTRUMENTS  DENTAL INSTRUMENTS Classification based on risk of transmission and need of sterilization -CRITICAL -SEMI-CRITICAL -NON-CRITICAL 56  CRITICAL INSTRUMENTS Penetrate MUCOUS MEMBRANES or CONTACT BONE, BLOODSTREAM, or other normally sterile tissues HEAT STERILIZE between uses or use sterile single-use, DISPOSABLE devices Examples include SURGICAL INSTRUMENTS, SCALPEL BLADES, PERIODONTAL SCALERS, AND SURGICAL DENTAL BURS 57 SEMI-CRITICAL INSTRUMENTS Contact MUCOUS MEMBRANES but do NOT PENETRATE SOFT TISSUE HEAT STERILIZE or HIGH-LEVEL DISINFECT Examples: DENTAL MOUTH MIRRORS, AMALGAM CONDENSERS, AND DENTAL HANDPIECES 58 NONCRITICAL INSTRUMENTS AND DEVICES Contact intact SKIN Clean and disinfect using a LOW TO INTERMEDIATE LEVEL DISINFECTANT Examples: X-RAY HEADS, FACEBOWS, PULSE OXIMETER, BLOOD PRESSURE CUFF 59  STERILIZATION Stages for instrument sterilization: 1. Presoaking 2. Cleaning 3. Corrosion control and lubrication 4. Packaging 5. Sterilization 6. Handling sterile instruments 7. Storage 8. Distribution 60  Agents used in sterilization Physical agents: 1. Sunlight 2. Drying 3. Dryheat: flaming, incineration, hot air 4. Moist heat: pasteurization, boiling, steam under pressure, steam under normal pressure. 5. Filtration: candles asbestos pads, membranes 6. Radiation 7. Ultrasonic and sonic vibrations 61  Chemical agents: 1. Alcohols: ethyl, isopropyl, trichlorobutanol 2. Aldehydes: formaldehyde, glutaraldehyde 3. Dyes 4. Halogens 5. Phenols 6. Surface-active agents 7. Metallic salts 8. Gases: ethylene oxide, formaldehyde, beta propiolactone. 62 The 4 accepted METHODS OF STERILIZATION are: Steam pressure sterilization (autoclave) Chemical vapor pressure sterilization- (chemiclave) Dry heat sterilization (dryclave) Ethylene oxide sterilization 63 AUTOCLAVE Sterilization with STEAM UNDER PRESSURE Time required at 1210 C is 15 mins at 15 lbs of pressure. Advantages Rapid and effective Effective for sterilizing cloth surgical packs and towel packs Disadvantages Items sensitive to heat cannot be sterilized It tends to corrode carbon steel burs 64 and instruments  CHEMICLAVING Sterilization by CHEMICAL VAPOR UNDER PRESSURE operates at 1310 C and 20 lbs of pressure. They have a cycle time of half an hour. 65  Advantages Carbon steel and other carbon sensitive burs, instruments and pliers are sterilized without rust or corrosion Disadvantages Items sensitive to elevated temperature will be damaged Instruments must be very lightly packed. Towel and heavy clothing cannot be sterilized. 66 67  Dry Heat Sterilization Conventional dry heat ovens: Achieved at temperature above 1600 C. Have heated chambers that allow air to circulate by gravity flow. 6-12mins is required for sterilization 68  Disadvantages Without careful calibration, more chances sterilization failures – The most accurate way to calibrate a sterilization cycle is by using external temperature gauge (pyrometer) attached to a thermocouple wire. 69 70 ETHYLENE OXIDE STERILIZATION (ETO) MOBILE FUMIGATOR 71  Advantages: Disadvantages: 1. Operates 1. Potentially effectively at mutagenic and low carcinogenic. temperatures 2. Requires 2. Gas is extremely aeration penetrative chamber ,cycle 3. Can be used for time lasts hours sensitive 3. Usually only equipment like hospital based. handpieces. 72  Sterilization Monitoring Types of Indicators Mechanical –Measure time, temperature, pressure Chemical –Change in color when physical parameter is reached Biological (spore tests) –Use biological spores to assess the sterilization process directly  STERILIZATION METHOD SPORE TYPE INCUBATION TEMPERATURE AUTOCLAVE Bacillus 56°C stearothemophilus CHEMICAL VAPOR DRY HEAT Bacillus subtilis 37°C ETHYLENE OXIDE Gamma radiation B. Pumilus E601 370C Sterilization monitoring has four components: 1.a sterilization indicator on the instrument bag, stamped with the date it is sterilized, 2.daily color-change process-indicator strips, 3.weekly biologic spore test, and 4.documentation notebook. 74 STORAGE AND CARE OF STERILE INSTRUMENTS Storage areas should be dust proof, dry, well ventilated and easily accessible for routine dental use. Sterile materials should be stored atleast 8-10 inches from the floor, atleast 18 inches from the ceiling, and atleast 2 inches from the outside walls. 75  Items are not stored in any location where they can become wet. Items should be positioned so that packaged items are not crushed, bent, crushed, compressed or punctured. Outside shipping containers and corrugated cartons should not be used as containers in sterile storage areas. 76  DISINFECTION OF DENTAL UNIT AND ENVIRONMENTAL SURFACES 77  DISINFECTION Disinfection is always at least a two- step procedure: The initial step involves vigorous scrubbing of the surfaces to be disinfected and wiping them clean. The second step involves wetting the surface with a disinfectant and leaving it wet for the time prescribed by the manufacturer. 78  The ideal disinfectant has the following properties: 1. Broad spectrum of activity 2. Acts rapidly 3. Non corrosive 4. Environment friendly 5. Is free of volatile organic compounds 6. Nontoxic & nonstaining 79  High-level disinfection: Disinfection process that inactivates vegetative bacteria, mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores. 80 Intermediate-level disinfection: Disinfection process that inactivates vegetative bacteria, the majority of fungi, mycobacteria, and the majority of viruses (particularly enveloped viruses) but not bacterial spores. 81  Low-level disinfectant: Liquid chemical germicide. OSHA requires low-level hospital disinfectants also to have a label claim for potency against HIV and HBV. Gigasept which contains succindialdehyde and dimethoxytetrahydrofuran are used for disinfection of plastic and rubber materials eg: dental 82  BASICS OF LABORATORY IC Need COORDINATION between DENTAL OFFICE AND LAB Use of proper methods/materials for handling and decontaminating soiled incoming items All contaminated INCOMING ITEMS should be cleaned and DISINFECTED before being HANDLED BY LAB PERSONNEL, and before being returned to the patient 83 84  INCOMING ITEMS Rinse under running tap water to remove blood/saliva Disinfect as appropriate Rinse thoroughly with tap water to remove residual disinfectant No single disinfectant 85  OUTGOING ITEMS Clean and disinfect before delivery to patient After disinfection: rinse and place in plastic bag with diluted mouthwash until insertion Do not store in disinfectant before insertion Label the plastic bag: “This case shipment has been disinfected with ______ for _____ minutes” 86 REFERENCES: Operative dentistry, infection control, 4th edition, sturdevent. Sterilization and disinfection of dental instruments by ADA Disinfection & sterilization of dental instruments TB MED 266, 1995 CDC, guidelines for disinfection & sterilization in health care facilities 2008. CDC guidelines for infection control in dental health care settings, Dec19, 2003/vol.52. 87