nursepractitionerincriticalcaresterilization.pptx
KomalDagar18
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Sep 16, 2024
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About This Presentation
Nurse practitioner in critical care 2nd year topic: Sterilization and infection control related to intensive care unit in hospital.
Sterilization and infection control are the main and important topic to prevent the infection in critical care unit.
it is foremost step to break the chain of infection...
Slide Content
CONTENTS
HI
RATIONALE
CHAIN OF INFECTION
ROUTES OF DISEASE TRANSMISSION
+ CDC and OSHA
* SPAULDINGS CLASSIFICATION
* STERILIZATION PROTOCOL
+ METHODS OF STERILIZATION-PHYSICAL AND CHEMICAL AGENTS
+ NEW METHODS OF STERILIZATION
« STERILIZATION OF SCALAR HANDPEICE AND INSERTS
+ INFECTION CONTROL
* INFECTIOUS DISEASES COMMONLY ENCOUNTERD IN DENTISTRY
MEDICAL HISTORY AND DENTAL SAFETY
IMMUNIZATION OF PERSONNEL INVOLVED IN DENTAL CARE
INFECTION CONTROL PRACTICES
HAND HYGIENE
PERSONAL PROTECTIVE EQUIPMENTS
HI
RATIONALE
CHAIN OF INFECTION
ROUTES OF DISEASE TRANSMISSION
+ CDC and OSHA
* SPAULDINGS CLASSIFICATION
* STERILIZATION PROTOCOL
+ METHODS OF STERILIZATION-PHYSICAL AND CHEMICAL AGENTS
+ NEW METHODS OF STERILIZATION
« STERILIZATION OF SCALAR HANDPEICE AND INSERTS
+ INFECTION CONTROL
* INFECTIOUS DISEASES COMMONLY ENCOUNTERD IN DENTISTRY
MEDICAL HISTORY AND DENTAL SAFETY
IMMUNIZATION OF PERSONNEL INVOLVED IN DENTAL CARE
INFECTION CONTROL PRACTICES
HAND HYGIENE
PERSONAL PROTECTIVE EQUIPMENTS
1h
INTRODUCTION À >
AR,
INTRODUCTION À >
AR,
HISTORY
In the late 1860s, Louis Pasteur, a French chemist, proved that
bacteria were the cause of disease in humans and animals.
He also developed the process of pasteurization which uses heat
to kill microorganisms in milk.
His theories led Joseph Lister, an English surgeon, to develop
“antiseptic technique” for performing surgery.
Aseptic veterinary surgery began to be practiced in the 1940s.
The use of surgical gowns, caps, masks, and gloves became
routine in the 1960s.
In the late 1860s, Louis Pasteur, a French chemist, proved that
bacteria were the cause of disease in humans and animals.
He also developed the process of pasteurization which uses heat
to kill microorganisms in milk.
His theories led Joseph Lister, an English surgeon, to develop
“antiseptic technique” for performing surgery.
Aseptic veterinary surgery began to be practiced in the 1940s.
The use of surgical gowns, caps, masks, and gloves became
routine in the 1960s.
The rationale for infection control is
to “control” iatrogenic, nosocomial infections among patients, and potential occupational
exposure of care providers to disease causing microbes during provision of care,
to “control” iatrogenic, nosocomial infections among patients, and potential occupational
exposure of care providers to disease causing microbes during provision of care,
VIRULENCE
The virulence of an organism refers to the degree of
pathogenicity,or the strength of that organism in its
ability to produce disease.
NUMBER OF MICROORGANISMS
To cause disease, a high enough number of
pathogenic microorganisms must be present to
overwhelm the body's defenses. The number of
pathogens may be directly related to the amount of
bioburden present
SUSCEPTIBLE HOST
least on part must be cemoved to break: the cla of A susceptible host is a person who is unable to resist
infection infection by a particular pathogen
FIG, 19-1 A
PORTAL OF ENTRY
TT. paies lafastina mathanane mich haus à aa at
The virulence of an organism refers to the degree of
pathogenicity,or the strength of that organism in its
ability to produce disease.
NUMBER OF MICROORGANISMS
To cause disease, a high enough number of
pathogenic microorganisms must be present to
overwhelm the body's defenses. The number of
pathogens may be directly related to the amount of
bioburden present
SUSCEPTIBLE HOST
least on part must be cemoved to break: the cla of A susceptible host is a person who is unable to resist
infection infection by a particular pathogen
FIG, 19-1 A
PORTAL OF ENTRY
TT. paies lafastina mathanane mich haus à aa at
, when adequate precautions are not followed Common modes of disease
transmission in the order of severity are-
Percutaneous (high risk)
+ Inoculation of microbes from blood and saliva transmitted through needles and sharps
Contact (high risk)
* Touching or exposing non-intact skin to infective oral lesions, infected tissue surfaces or
infected fluids, splash and spatter of infected fluids
Inhalation of Aerosols or droplets (moderate risk)
+ Breathing bioaerosols suspended in the clinics ambient air laden with infective material
while using handpi
transmission in the order of severity are-
Percutaneous (high risk)
+ Inoculation of microbes from blood and saliva transmitted through needles and sharps
Contact (high risk)
* Touching or exposing non-intact skin to infective oral lesions, infected tissue surfaces or
infected fluids, splash and spatter of infected fluids
Inhalation of Aerosols or droplets (moderate risk)
+ Breathing bioaerosols suspended in the clinics ambient air laden with infective material
while using handpi
ye
y
IDC
(DE
CENTERS FOR DISEASE"
CONTROL AND PREVENTION
®
federal agencies that play very important
roles in infection control for dentistry
OSHA's a regulatory ag
Its role is to issue spectic
ndards i
ete tees
y
IDC
(DE
CENTERS FOR DISEASE"
CONTROL AND PREVENTION
®
federal agencies that play very important
roles in infection control for dentistry
OSHA's a regulatory ag
Its role is to issue spectic
ndards i
ete tees
@isintection
The destruction or
removal of all pathogenic
organisms, or organisms
capable of giving rise to
infection.
@ Sterilization
The process by which an article,
surface or medium is freed of all
living microorganisms either in
the vegetative or spore state.
8 Asepsis
Term used to indicate
the prevention of
infection, usually by
inhibiting the growth
of bacteria in wounds
or tissues.
0 Decontamination
The process of
rendering an article
or area free of
danger from
contaminants,
Including microbial,
chemical radioactive
The destruction or
removal of all pathogenic
organisms, or organisms
capable of giving rise to
infection.
@ Sterilization
The process by which an article,
surface or medium is freed of all
living microorganisms either in
the vegetative or spore state.
8 Asepsis
Term used to indicate
the prevention of
infection, usually by
inhibiting the growth
of bacteria in wounds
or tissues.
0 Decontamination
The process of
rendering an article
or area free of
danger from
contaminants,
Including microbial,
chemical radioactive
Decontamination & Spaulding's Classification
The fir Brunn ” ,
decontamination PRS
is called .
nitization
+ a process that kills all vegetative
microorganisms, fungi and some
viruses but not necessarily bacterial
ing chemical
endospore
jermicides, radiation, ultraviolet
* a process that kills all bacteria,
fungi, viruses, and bacterial
endospores using chemical
methods such as liquids and
gases, chemical methods in
combination with heat and
e, physical methods
The fir Brunn ” ,
decontamination PRS
is called .
nitization
+ a process that kills all vegetative
microorganisms, fungi and some
viruses but not necessarily bacterial
ing chemical
endospore
jermicides, radiation, ultraviolet
* a process that kills all bacteria,
fungi, viruses, and bacterial
endospores using chemical
methods such as liquids and
gases, chemical methods in
combination with heat and
e, physical methods
Instrument and operatory surfaces
1 2 3 4
Critical Semi-critical Non-critical Environmental
Items that pierce the Non-sharp items Items that do not surfaces
skin or mucosa thatenter the oral enterthe oral cavity Walls, floors and
cavity such as bracket table non=high touch or
and other intimate non-intimate
work surfaces surfaces
1 2 3 4
Critical Semi-critical Non-critical Environmental
Items that pierce the Non-sharp items Items that do not surfaces
skin or mucosa thatenter the oral enterthe oral cavity Walls, floors and
cavity such as bracket table non=high touch or
and other intimate non-intimate
work surfaces surfaces
STERILIZATION PROTOCOL
Pre-soaking:
+ Keeps the instruments wet until a thorough cleaning can occur.
+ Prevents blood and saliva from drying on the instruments, facilitating
actual cleaning
Pre-soaking:
+ Keeps the instruments wet until a thorough cleaning can occur.
+ Prevents blood and saliva from drying on the instruments, facilitating
actual cleaning
« Sunlight
* Drying
+ Dry heat-
Flaming,Inceneration,Hot air.
+ Moist heat-
Pasteurisation boiling,steam
under normal pressure, steam
under high pressure,
+ Filtration- candles, asbestos
pads membranes
+ Radiation
+ Alcohol-Ethyl, isopropyl,
trichlorobutanol
+ Aldehydes-Formaldehyde,
glutaraldehyde
* Dyes
+ Halogens
+ Phenols
* Surface active agents
+ Metallic salts
» Gases: Ethylene oxide,
formaldehyde, beta
propiolactone hydrogen
peroxide
* Drying
+ Dry heat-
Flaming,Inceneration,Hot air.
+ Moist heat-
Pasteurisation boiling,steam
under normal pressure, steam
under high pressure,
+ Filtration- candles, asbestos
pads membranes
+ Radiation
+ Alcohol-Ethyl, isopropyl,
trichlorobutanol
+ Aldehydes-Formaldehyde,
glutaraldehyde
* Dyes
+ Halogens
+ Phenols
* Surface active agents
+ Metallic salts
» Gases: Ethylene oxide,
formaldehyde, beta
propiolactone hydrogen
peroxide
HEAT
Most reliable method of sterilization and should be the method of choice.
MECHANISM OF ACTION:
Dry heat-protein denaturation,
oxidative damage and toxic Moist heat: due to denaturation
effect of elevated level of and coagulation of protein
electrolytes.
Most reliable method of sterilization and should be the method of choice.
MECHANISM OF ACTION:
Dry heat-protein denaturation,
oxidative damage and toxic Moist heat: due to denaturation
effect of elevated level of and coagulation of protein
electrolytes.
DRY HEAT
1. FLAMING: Instruments are held over Bunsen flame until red hot.
Items: Tips of Forceps, Spatulas, Inoculating loops and wires
2, INCINERATION; It is a process that involves the combustion of organic
substances contained in waste materials.
Items: contaminated cloth, animal carcasses and pathological material.
|
3. HOT AIR OVEN: Hot air ovens are electrical devices that uses dry heat to (
sterilize articles. |
Generally, they can be operated from 160-180°C. Holding period: 2 hours | de
1. FLAMING: Instruments are held over Bunsen flame until red hot.
Items: Tips of Forceps, Spatulas, Inoculating loops and wires
2, INCINERATION; It is a process that involves the combustion of organic
substances contained in waste materials.
Items: contaminated cloth, animal carcasses and pathological material.
|
3. HOT AIR OVEN: Hot air ovens are electrical devices that uses dry heat to (
sterilize articles. |
Generally, they can be operated from 160-180°C. Holding period: 2 hours | de
MOIST HEAT
Categorized into 3 groups:
Temperature below 100° C
Temperature at 100° C
Temperature above 100° C
1.Temperature below 100° C
Pasteurisation of milk Fen
Milk is heated at 63°C for 30 minutes (holder method);
or id
72°C, 15-20 seconds(flash method)
followed by cooling quickly to 13°C or lower.
Heating Coding
sector section
A Y a eR AA RS A A E A A | O A | A
Categorized into 3 groups:
Temperature below 100° C
Temperature at 100° C
Temperature above 100° C
1.Temperature below 100° C
Pasteurisation of milk Fen
Milk is heated at 63°C for 30 minutes (holder method);
or id
72°C, 15-20 seconds(flash method)
followed by cooling quickly to 13°C or lower.
Heating Coding
sector section
A Y a eR AA RS A A E A A | O A | A
2.Temperature at 100° C
Boiling-
+ Vegetative bacteria are killed almost immediately at 90-100°C,
+ Not recommended for sterilising but used for disinfection.
+ Sterilization may be promoted by addition of 2% sodium
bicarbonate to the water. Holding period: 10-30 minutes,
Steam at atmospheric pressure (100°C)
+ Used to sterilize culture media.
* Koch or Arnold steamer is used,
* Holding period: 100° C, 20 minutes on three successive days
(intermittent sterilization or tyndallisation).
Boiling-
+ Vegetative bacteria are killed almost immediately at 90-100°C,
+ Not recommended for sterilising but used for disinfection.
+ Sterilization may be promoted by addition of 2% sodium
bicarbonate to the water. Holding period: 10-30 minutes,
Steam at atmospheric pressure (100°C)
+ Used to sterilize culture media.
* Koch or Arnold steamer is used,
* Holding period: 100° C, 20 minutes on three successive days
(intermittent sterilization or tyndallisation).
3.Temperature above 100° C
Sterilization by steam under regal is carried out at temperatures between 108°C
and MT by an o sterilizer.
15 mins | 121 E i 15 lbs lbs
10 mins 126€ 20lbs
3 mins 134 30lbs ln — |
Sterilization by steam under regal is carried out at temperatures between 108°C
and MT by an o sterilizer.
15 mins | 121 E i 15 lbs lbs
10 mins 126€ 20lbs
3 mins 134 30lbs ln — |
Principle:
+ Water boils when its vapour pressure equals that of
the surrounding atmosphere.
+ Thus, when pressure inside a closed vessel
increases, the temperature at which water boils also
increases.
+ Saturated steam has penetrating power.
+ When steam comes in contact with a cooler surface
it condenses to water and gives up latent heat to
that surface,
+ The large reduction in volume sucks in more steam
to the area and the process continues till the
temperature of that surface is raised to that of
+ Water boils when its vapour pressure equals that of
the surrounding atmosphere.
+ Thus, when pressure inside a closed vessel
increases, the temperature at which water boils also
increases.
+ Saturated steam has penetrating power.
+ When steam comes in contact with a cooler surface
it condenses to water and gives up latent heat to
that surface,
+ The large reduction in volume sucks in more steam
to the area and the process continues till the
temperature of that surface is raised to that of
Advantages of Autoclaves
1. Autoclaving is the most rapid and
effective method for sterilizing cloth
surgical packs and towel packs.
2. Is dependable and economical
3. Sterilization is verifiable.
Disadvantages of Autoclaves
1. Items sensitive to the elevated
temperature cannot be autoclaved.
2. Autoclaving tends to rust carbon
steel instruments and burs,
3. Instruments must be air dried at
completion of cycle
1. Autoclaving is the most rapid and
effective method for sterilizing cloth
surgical packs and towel packs.
2. Is dependable and economical
3. Sterilization is verifiable.
Disadvantages of Autoclaves
1. Items sensitive to the elevated
temperature cannot be autoclaved.
2. Autoclaving tends to rust carbon
steel instruments and burs,
3. Instruments must be air dried at
completion of cycle
MONITORS OF STERILIZATION
There are 3
methods of
monitoring
Mechanical techniques Chemical indicators Biological indicators
Browne's tube contains red Spores of Bacillus
Thermocouple solution which turns stearothemophilus are killed
P green,when exposed to in T2minutes at 121°C.
temperature of 121°C for 15
minutes in autoclave,
Paper strip impregnated with
10 spores is placed inside
autoclave -
There are 3
methods of
monitoring
Mechanical techniques Chemical indicators Biological indicators
Browne's tube contains red Spores of Bacillus
Thermocouple solution which turns stearothemophilus are killed
P green,when exposed to in T2minutes at 121°C.
temperature of 121°C for 15
minutes in autoclave,
Paper strip impregnated with
10 spores is placed inside
autoclave -
RADIATION
Non-ionising radiation | DANKEN
1. Infrared radiations are used for rapid mass sterilization of pre-packed items such as
syringe,catheters.
2. Ultraviolet radiations are used for disinfecting enclosed area such as entryways,
operation theatres and labs.
Gamma rays, X rays and cosmic rays are highly lethal to DNA and have a very high
penetrating power,
Since there is no appreciable increase in temperature,this method is referred to as cold
sterilization,
DEG Ss as ls il "eae ds a
.
Non-ionising radiation | DANKEN
1. Infrared radiations are used for rapid mass sterilization of pre-packed items such as
syringe,catheters.
2. Ultraviolet radiations are used for disinfecting enclosed area such as entryways,
operation theatres and labs.
Gamma rays, X rays and cosmic rays are highly lethal to DNA and have a very high
penetrating power,
Since there is no appreciable increase in temperature,this method is referred to as cold
sterilization,
DEG Ss as ls il "eae ds a
.
CHEMICAL
AGENTS
AGENTS
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
The ideal disinfectant has the following properties:
Broad spectrum of activity
Acts rapidly
Non corrosive
Enviranmant friendly
SES
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
The ideal disinfectant has the following properties:
Broad spectrum of activity
Acts rapidly
Non corrosive
Enviranmant friendly
SES
LEVELS OF DISINFECTION
High-level disinfection: Disinfection process that inactivates vegetative bacteria,
mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores.
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.
Low-level disinfectant: Can kill most bacteria,some viruses and some fungi,
Liquid chemical germicide.
High-level disinfection: Disinfection process that inactivates vegetative bacteria,
mycobacteria, fungi, and viruses but not necessarily high numbers of bacterial spores.
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.
Low-level disinfectant: Can kill most bacteria,some viruses and some fungi,
Liquid chemical germicide.
+ Frequently used are Ethyl alcohol Isopropyl alcohol
+ These must be used at concentration 60-90%,
> Isopropyl alcohol used in disinfection of clinical thermometer.
> Methyl alcohol is effective against fungal spores, treating cabinets and incubators.
+ Methyl alcohol is also toxic and inflammable.
ETC
+ These must be used at concentration 60-90%,
> Isopropyl alcohol used in disinfection of clinical thermometer.
> Methyl alcohol is effective against fungal spores, treating cabinets and incubators.
+ Methyl alcohol is also toxic and inflammable.
ETC
2.Aldehydes
Formaldehyde:
> It is bactericidal and sporicidal and also has a lethal effect on viruses.
+ Used to preserve anatomical specimens,to destroy anthrax spores on hair and wool,
+ 10% formalin containing sodium tetraborate is used to clean metal instruments.
+ Formaldehyde gas is used for sterilizing heat sensitive catheters and for fumigating wards and laboratories.
Glutaraldehyde:
+ Effective against tubercle bacilli, fungi, viruses.
» Less toxic and irritant to eyes, skin =
5 Lead ta trast anaacthatic rubber fare mace alactic andatrachaal hilise matal inetnimente and nolvthana tubina
Formaldehyde:
> It is bactericidal and sporicidal and also has a lethal effect on viruses.
+ Used to preserve anatomical specimens,to destroy anthrax spores on hair and wool,
+ 10% formalin containing sodium tetraborate is used to clean metal instruments.
+ Formaldehyde gas is used for sterilizing heat sensitive catheters and for fumigating wards and laboratories.
Glutaraldehyde:
+ Effective against tubercle bacilli, fungi, viruses.
» Less toxic and irritant to eyes, skin =
5 Lead ta trast anaacthatic rubber fare mace alactic andatrachaal hilise matal inetnimente and nolvthana tubina
2 groups of dyes:
1. Aniline dye
2. Acridine dye
Both are bacteriostatic in high dilution but are of low bactericidal activity. Fo Y,
> Aniline dye 2
+ Brilliant green,malachite green and crystal violet. ur on
* More active against gram +ve than gram-ve organisms. =
+ Their lethal effects on bacteria are believed to be due to their reaction with the acid groups in the cell,
+ Acridine dyes
+ Proflavine Acriflavine, Euflavine, Aminacrine
1. Aniline dye
2. Acridine dye
Both are bacteriostatic in high dilution but are of low bactericidal activity. Fo Y,
> Aniline dye 2
+ Brilliant green,malachite green and crystal violet. ur on
* More active against gram +ve than gram-ve organisms. =
+ Their lethal effects on bacteria are believed to be due to their reaction with the acid groups in the cell,
+ Acridine dyes
+ Proflavine Acriflavine, Euflavine, Aminacrine
4.Halogens
lodine
» Used as Skin disinfectant
+ Active bactericidal activity & moderate action on spores.
» Active against the tubercle bacteria and viruses.
Chlorine
+ Used to disinfect water supplies, swimming pools and food and dairy industries.
+ Chlorine and hypochlorites are bactericidal.
+ Also act on viruses. v
DE
> The organic chloramines are used as antiseptics for dressing wounds.
lodine
» Used as Skin disinfectant
+ Active bactericidal activity & moderate action on spores.
» Active against the tubercle bacteria and viruses.
Chlorine
+ Used to disinfect water supplies, swimming pools and food and dairy industries.
+ Chlorine and hypochlorites are bactericidal.
+ Also act on viruses. v
DE
> The organic chloramines are used as antiseptics for dressing wounds.
These are obtained from distillation of coal tar between 170° and 270° C.
Lethal effects are due to their capacity to cause cell membrane damage,
releasing cell contents and causing lysis.
Low concentration will precipitate proteins.
Cresols (Lysol) are active against a wide range of organisms.
Sterilization of glass ware,cleaning floors.
.
Chlorhexidine is a non toxic skin antiseptic which is most active against gram
positive organisms
Lethal effects are due to their capacity to cause cell membrane damage,
releasing cell contents and causing lysis.
Low concentration will precipitate proteins.
Cresols (Lysol) are active against a wide range of organisms.
Sterilization of glass ware,cleaning floors.
.
Chlorhexidine is a non toxic skin antiseptic which is most active against gram
positive organisms
TYPES OF GASES USED FOR STERILIZATION
Ethylene oxide Formaldehyde gas Beta propiolactone (BPL)
Action is due to its alkylating Fumigation of OT and wards Condensation product of
the amino, carboxyl, hydroxyl ketane and formaldehyde
and sulphydryl groups in
protein molecules.
It also reacts with DNA and
RNA.
Formaldehyde is generated by
adding 150g to 280ml
of formalin for every 1000cu.ft of
room volume, after closing the
windows and other outlets and
left unopened for 48hrs,
KM
(boiling point of 163 C).
Has rapid bactericidal
activity,but it is carcinogenic.
Ethylene oxide Formaldehyde gas Beta propiolactone (BPL)
Action is due to its alkylating Fumigation of OT and wards Condensation product of
the amino, carboxyl, hydroxyl ketane and formaldehyde
and sulphydryl groups in
protein molecules.
It also reacts with DNA and
RNA.
Formaldehyde is generated by
adding 150g to 280ml
of formalin for every 1000cu.ft of
room volume, after closing the
windows and other outlets and
left unopened for 48hrs,
KM
(boiling point of 163 C).
Has rapid bactericidal
activity,but it is carcinogenic.
RECOMMENDED CONCENTRATION
OF DISINFECTANTS
DISINFECTANT CONCENTRATION
Gluteraldehyde 2%
Phenol 5%
Sodium hypochlorite 05-5%
Chlorhexidine 1-4%
Povidine lodine 10%
Alcohol 70-80%
OF DISINFECTANTS
DISINFECTANT CONCENTRATION
Gluteraldehyde 2%
Phenol 5%
Sodium hypochlorite 05-5%
Chlorhexidine 1-4%
Povidine lodine 10%
Alcohol 70-80%
CHEMICLAVING
Chemiclaves use a combination of liquid chemicals (with <15% water) that are
introduced into the chamber, heat and pressure for a sterilization cycle.
The parameters for sterilization are temperature of 131°C (270°F), 20 psi and
sterilization time of 30 minutes.
Chemiclaves use a combination of liquid chemicals (with <15% water) that are
introduced into the chamber, heat and pressure for a sterilization cycle.
The parameters for sterilization are temperature of 131°C (270°F), 20 psi and
sterilization time of 30 minutes.
NEW METHOD
STERILIZAT
ON
PEROXIDE VAPOR STERILIZATION - an
aqueous hydrogen peroxide salution 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
ULTRAVIOLET LIGHT + exposes the
contaminants with a lethal dose of energy in the form
of light. The UV light will alter the DNA of the
pathogens. Not effective against RNA viruses like HIV
OZONE + Ozone sterilization is the newest low-
temperature sterilization method recently introduced
and is suitable for many heat and moisture sensitive
devices
+ Ozone sterilization is compatible with stainless steel
STERILIZAT
ON
PEROXIDE VAPOR STERILIZATION - an
aqueous hydrogen peroxide salution 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
ULTRAVIOLET LIGHT + exposes the
contaminants with a lethal dose of energy in the form
of light. The UV light will alter the DNA of the
pathogens. Not effective against RNA viruses like HIV
OZONE + Ozone sterilization is the newest low-
temperature sterilization method recently introduced
and is suitable for many heat and moisture sensitive
devices
+ Ozone sterilization is compatible with stainless steel
4
PLASMA STERILIZATION
For sterilization, radiofrequency energy is
applied to create an electromagnetic field,
Into this hydrogen peroxide vapours are
introduced which generates a state of plasma
containing free radicals of hydrogen and
oxygen.
This state has a sterilizing action on the articles,
ho
PLASMA STERILIZATION
For sterilization, radiofrequency energy is
applied to create an electromagnetic field,
Into this hydrogen peroxide vapours are
introduced which generates a state of plasma
containing free radicals of hydrogen and
oxygen.
This state has a sterilizing action on the articles,
ho
Mores that are used In surgery which pierce soft and hard Besue—
‘Scalpel blades, burs, extraction forceps, elevators, needies, thes, bone.
fongert, pentodontal intiramenta used in prophytams, surgical drains:
(or abscetses, and any other intirumer used in Surgery, dental
‘explorers, periodontal proben, EGP punch, EURGEAI GRR.
hora that do not Aecesearty pene tale LON ond hard Setues But wich
‘rots the vermion border (lp) into the oral cavity—
Moderate ‘Surtace Disinfection with intermediate level hems uted in denbstry which do not cross the vermilon border or
Dim hospital disiniectants: Deneirate the cof cues. char ight handles, mirument Paye, high
“Hrérogen peroxide based touch work rurtaces, Bracket bles. chair contott Animator yenes.
Prenol hases and dental chars
sodophort
Auray Arena Corse
LA
Drepocabie Samer:
Lon Disinfecios with Intermediate to low level Floors, wats and door handies fat are not considered high touch
disinfectants. suecos. General hounekeerang ie apple lo ete curlaces
‘Scalpel blades, burs, extraction forceps, elevators, needies, thes, bone.
fongert, pentodontal intiramenta used in prophytams, surgical drains:
(or abscetses, and any other intirumer used in Surgery, dental
‘explorers, periodontal proben, EGP punch, EURGEAI GRR.
hora that do not Aecesearty pene tale LON ond hard Setues But wich
‘rots the vermion border (lp) into the oral cavity—
Moderate ‘Surtace Disinfection with intermediate level hems uted in denbstry which do not cross the vermilon border or
Dim hospital disiniectants: Deneirate the cof cues. char ight handles, mirument Paye, high
“Hrérogen peroxide based touch work rurtaces, Bracket bles. chair contott Animator yenes.
Prenol hases and dental chars
sodophort
Auray Arena Corse
LA
Drepocabie Samer:
Lon Disinfecios with Intermediate to low level Floors, wats and door handies fat are not considered high touch
disinfectants. suecos. General hounekeerang ie apple lo ete curlaces
* High-speed handpieces should be cleaned and lubricated as per manufacturer's
recommendation and sterilized using either a Chemiclave, autoclave or dry-heat,
+ Slow-speed handpieces should be single-use-disposable such as the contra-angle
handpieces that are used for polishing during oral prophylaxis.
* Other slow-speed handpieces must be cleaned, lubricated and sterilized
+ Handpieces and inserts for scaling teeth must be cleaned and sterilized between
patients.
recommendation and sterilized using either a Chemiclave, autoclave or dry-heat,
+ Slow-speed handpieces should be single-use-disposable such as the contra-angle
handpieces that are used for polishing during oral prophylaxis.
* Other slow-speed handpieces must be cleaned, lubricated and sterilized
+ Handpieces and inserts for scaling teeth must be cleaned and sterilized between
patients.
Sterilization of UltraSonic Scaler Inserts
Ultrasonic scaler inserts should be sterilized after each use,
Soak inserts immediately after use in a container of 70% Isopropyl Alcohol
Rinse cleaned inserts thoroughly in warm water to remove all chemicals.
Dry inserts completely with air syringe.
Water should be completely removed from inside the insert before autoclaving.
Ultrasonic scaler inserts should be sterilized after each use,
Soak inserts immediately after use in a container of 70% Isopropyl Alcohol
Rinse cleaned inserts thoroughly in warm water to remove all chemicals.
Dry inserts completely with air syringe.
Water should be completely removed from inside the insert before autoclaving.
@
INFECTION $
CONTROL *
0
INFECTION $
CONTROL *
0
Under universal precautions, blood and certain body fluids of all patients are
considered to be potentially infectious for human immunodeficiency virus (HIV),
hepatitis B virus (HBV), hepatitis c virus (HCV) and other blood-borne pathogens.
The rationale for treating all patients as po! é is due to
the fact that most patients are unaware of their infectious disease
status.
considered to be potentially infectious for human immunodeficiency virus (HIV),
hepatitis B virus (HBV), hepatitis c virus (HCV) and other blood-borne pathogens.
The rationale for treating all patients as po! é is due to
the fact that most patients are unaware of their infectious disease
status.
Comtech exudate, salva, sexual contact. blood
Contactleción exudate, calva, blood
Contactleción exudate, calva, blood
dental care settings
Standard precautions should be followed with all patients, whether or not they have been diagnosed with HIV
Dental personnel should w
After a needlestick exposure to HIV-infected the average risk of HIV transmission is approxim
recommends high-level disinfection for HBV-, HCV-, HIV- or TE-contaminated d
In the case of exposure to material knawn or ted to be infected with HIV the incident should be
applicable) and the exposed individı uld consult with a doctor immediately.
x (if
Standard precautions should be followed with all patients, whether or not they have been diagnosed with HIV
Dental personnel should w
After a needlestick exposure to HIV-infected the average risk of HIV transmission is approxim
recommends high-level disinfection for HBV-, HCV-, HIV- or TE-contaminated d
In the case of exposure to material knawn or ted to be infected with HIV the incident should be
applicable) and the exposed individı uld consult with a doctor immediately.
x (if
Bi
DENTAL PATIENT MANAGEMENT
A comprehensive intraoral soft tissue, periodontal and hard tissue examination should be
conducted at an HIV-positive patient's initial assessment
If any oral manifestations of HIV are present, the first priority is to relieve pain and treat infections
To help prevent further disease, dentists can provide counselling about modifiable risk factors,
such as use of tobacco, alcohol, or other drugs that may increase risk of oral abnormalities or
complications
Implement oral hygiene regimens.
Dentists should continuously monitor dental and oral health for disease progression
DENTAL PATIENT MANAGEMENT
A comprehensive intraoral soft tissue, periodontal and hard tissue examination should be
conducted at an HIV-positive patient's initial assessment
If any oral manifestations of HIV are present, the first priority is to relieve pain and treat infections
To help prevent further disease, dentists can provide counselling about modifiable risk factors,
such as use of tobacco, alcohol, or other drugs that may increase risk of oral abnormalities or
complications
Implement oral hygiene regimens.
Dentists should continuously monitor dental and oral health for disease progression
DENTAL PATIENT MANAGEMENT.
All dental practioners should be able to bl routine dental care for adult or pediatric HIV-
positive patients.
Nearly all patients with HIV are able to tolerate routine dental care and procedures, including oral
surgery.
Still, dental treatment planning must be done on an individual basis, in conjunction with
consultations with the patient and their physician as appropriate
HIV and antiretroviral therapies may be associated with abnormal bleeding, glucose intolerance, or
hyperlipidemia.
Other conditions that may require modification of dental treatment are reduced platelet count
<60,000 cells/ml, which may affect clotting, or white-blood-cell neutrophil counts <500 cells/ml,
which may require antibiotic prophylaxis.
Preoperative scaling may be performed before oral surgical procedures to help reduce the risk of
All dental practioners should be able to bl routine dental care for adult or pediatric HIV-
positive patients.
Nearly all patients with HIV are able to tolerate routine dental care and procedures, including oral
surgery.
Still, dental treatment planning must be done on an individual basis, in conjunction with
consultations with the patient and their physician as appropriate
HIV and antiretroviral therapies may be associated with abnormal bleeding, glucose intolerance, or
hyperlipidemia.
Other conditions that may require modification of dental treatment are reduced platelet count
<60,000 cells/ml, which may affect clotting, or white-blood-cell neutrophil counts <500 cells/ml,
which may require antibiotic prophylaxis.
Preoperative scaling may be performed before oral surgical procedures to help reduce the risk of
BD DENTAL HYGIENE CARE FOR THE HIV INFE
aerosol
IV patients is
Cave Documentation
aerosol
IV patients is
Cave Documentation
HIV POST EXPOSURE
Source pt has AIDS Exposed worker should be Exposed worker testing -ve initially
OR counseled about risk of infection. should be retested 6 weeks, 12 weeks
Source pt is HIV+ve Should be test
OR immediately
ted for HIV infection & 6 months after exposure
Source Pt refuses to be tested Should be asked to seek medical
advice for any febrile illness
within? weeks
Refrain from blood donation &
take appropriate precautions
Source pt is tested «e found -ve Baseline testing of the exposed worker
With follow up testing 12 weeks later
Source cannot be identified Serological testing must be done &
decisions must be individualized
Source pt has AIDS Exposed worker should be Exposed worker testing -ve initially
OR counseled about risk of infection. should be retested 6 weeks, 12 weeks
Source pt is HIV+ve Should be test
OR immediately
ted for HIV infection & 6 months after exposure
Source Pt refuses to be tested Should be asked to seek medical
advice for any febrile illness
within? weeks
Refrain from blood donation &
take appropriate precautions
Source pt is tested «e found -ve Baseline testing of the exposed worker
With follow up testing 12 weeks later
Source cannot be identified Serological testing must be done &
decisions must be individualized
Table 5: When can an infected clinician return to work?
‚After 7 days from the appearance of rash
ps After 9 day from start of parotibs
Amoebasıs After starting effective antmacrobial therapy and symptoms resolve.
Enteroviral Infections After symptoms resolve
apatites ‚After 7 day from the onset of Jaundice
‚After 7 days from the appearance of rash
ps After 9 day from start of parotibs
Amoebasıs After starting effective antmacrobial therapy and symptoms resolve.
Enteroviral Infections After symptoms resolve
apatites ‚After 7 day from the onset of Jaundice
MEDICAL HISTORY AND DENTAL SAFETY
While taking medical history the clinician should not discriminate an infectious
disease patient with reference to the potential of spreading the disease in the clinic.
The reason one should look out for patients with infectious diseases is to protect
them from other acquiring other infectious disease conditions, as they usually are
medically compromised,
While speaking to patients with infectious diseases one must maintain a high level of
professionalism and confidentiality in acquiring the patient's trust and confidence.
While taking medical history the clinician should not discriminate an infectious
disease patient with reference to the potential of spreading the disease in the clinic.
The reason one should look out for patients with infectious diseases is to protect
them from other acquiring other infectious disease conditions, as they usually are
medically compromised,
While speaking to patients with infectious diseases one must maintain a high level of
professionalism and confidentiality in acquiring the patient's trust and confidence.
IMMUNIZATION OF PERSONNEL
INVOLVED IN DENTAL CARE [14
We as health care workers are at a high risk of preventable infectious diseases and
therefore must adopt this first line of defense.
Other than the common vaccinations (childhood vaccines), the clinicians should also
INVOLVED IN DENTAL CARE [14
We as health care workers are at a high risk of preventable infectious diseases and
therefore must adopt this first line of defense.
Other than the common vaccinations (childhood vaccines), the clinicians should also
Proposed protocol for HBV vaccine for Dental Undergraduate &
Postgraduate students and "m Teaching Faculty in India
It is mandatory for every dental student undergraduate and postgraduate and dental
teaching faculty to be vaccinated against Hepatitis B with a three dose regimen and a
booster.
All non teaching faculty which include dental assistants, dental hygienists, dental
mechanics and all those who come directly in contact with patient care, cleaning and
sterilization of instruments and all those who are in the clinical area or the pre clinical
area of the dental teaching institution must to be vaccinated against Hepatitis B.
It is also mandatory for the institution managements including government owned
institutions to provide free Hepatitis B vaccine to all its students both undergraduate
and postgraduate, teaching and non teaching faculty.
Postgraduate students and "m Teaching Faculty in India
It is mandatory for every dental student undergraduate and postgraduate and dental
teaching faculty to be vaccinated against Hepatitis B with a three dose regimen and a
booster.
All non teaching faculty which include dental assistants, dental hygienists, dental
mechanics and all those who come directly in contact with patient care, cleaning and
sterilization of instruments and all those who are in the clinical area or the pre clinical
area of the dental teaching institution must to be vaccinated against Hepatitis B.
It is also mandatory for the institution managements including government owned
institutions to provide free Hepatitis B vaccine to all its students both undergraduate
and postgraduate, teaching and non teaching faculty.
If a health care worker who is immunized against polio is exposed to the oral secretions of a
patient with active polio, Oral polio vaccine (live attenuated virus) or Inactivated Polio virus
vaccine boosters are needed.
If a person is not immunized against HBV and is exposed to an infected patient's body fluids,
a combination of Hepatitis B vaccine and an immunoglobulin (HBIg) must be administered
immediately.
If the exposed person does not want to take the vaccine, two doses of the HBlg
immunoglobulin must be given (in most cases, dose 1 within 24 hours and dose 2 given 25
to 30 days after exposure).
patient with active polio, Oral polio vaccine (live attenuated virus) or Inactivated Polio virus
vaccine boosters are needed.
If a person is not immunized against HBV and is exposed to an infected patient's body fluids,
a combination of Hepatitis B vaccine and an immunoglobulin (HBIg) must be administered
immediately.
If the exposed person does not want to take the vaccine, two doses of the HBlg
immunoglobulin must be given (in most cases, dose 1 within 24 hours and dose 2 given 25
to 30 days after exposure).
Source pt is +ve for HBsAG Exposed worker not x ld receiv ine series
should receive single dose of HB
immunoglobulin within 7 days.
Exposed worker has been vaccinated Should be tested for anti-HBs & given
I dose of vaccine & | dose of HBIG
101U
Source pt is --ve for HBsAG Exposed worker not vaccinated Worker should be encouraged to
receive hepatitis B vaccine.
Exposed worker has been vaccinated No further action is needed
Source pt refuses testing or not Exposed worker not vaccinated Should receive HB series
identified. HBIG should be considered
Exposed worker has been vaccinated Management should be
individualized
should receive single dose of HB
immunoglobulin within 7 days.
Exposed worker has been vaccinated Should be tested for anti-HBs & given
I dose of vaccine & | dose of HBIG
101U
Source pt is --ve for HBsAG Exposed worker not vaccinated Worker should be encouraged to
receive hepatitis B vaccine.
Exposed worker has been vaccinated No further action is needed
Source pt refuses testing or not Exposed worker not vaccinated Should receive HB series
identified. HBIG should be considered
Exposed worker has been vaccinated Management should be
individualized
0
o
: Infection Control
. Practices
0
0
o
: Infection Control
. Practices
0
0
Hand Hygiene
Handwashing Guidelines
SURGICAL
HANDWASHING
* Thorough cleaning/scrubbing
of the hands immediately
prior to surgery with a
surgical scrub level soap
(Chlorhexidine Gluconate 4%,
or other lodine based
+ Serubbing hands all the way
up to the elbow for about 2
to 6 minutes using a single-
use disposable sponge or a
soft scrub brush removes the
dead cells along with the
FAR ER ONE EE D SRE ET
Handwashing Guidelines
SURGICAL
HANDWASHING
* Thorough cleaning/scrubbing
of the hands immediately
prior to surgery with a
surgical scrub level soap
(Chlorhexidine Gluconate 4%,
or other lodine based
+ Serubbing hands all the way
up to the elbow for about 2
to 6 minutes using a single-
use disposable sponge or a
soft scrub brush removes the
dead cells along with the
FAR ER ONE EE D SRE ET
What af one use?
Chlorhexidine Gluconate (CHG) at 0.75% to 4% concentration that may be dispensed
as liquid soap or foam, Parachlorometaxylenol (PCMX) liquid, lodine liquid or
Triclosan liquid, gel or foam.
CHG at 4% is marketed for surgical scrub as opposed to routine handwashing and
the latter may show residual effect or substantivity (remains on the skin as a
protectant) on the skin after 4-5 repeated washes,
Chlorhexidine Gluconate (CHG) at 0.75% to 4% concentration that may be dispensed
as liquid soap or foam, Parachlorometaxylenol (PCMX) liquid, lodine liquid or
Triclosan liquid, gel or foam.
CHG at 4% is marketed for surgical scrub as opposed to routine handwashing and
the latter may show residual effect or substantivity (remains on the skin as a
protectant) on the skin after 4-5 repeated washes,
Alcohol-Based Hand Rubs
Applying Alcohol-Based Hand Rubs Applying Alcohol ased Hand Rubs
a a ms pu ep a a Be par
e a
Pa tt ae
1 Aha und a]
Cas pa ta ew a ay mm
ee ee
Serer ee pat ne ug ere m den i
Po Hy
pet rs a a Pa
ns open var
À nt ec rd SP Ps a
—
CORTE
na manne eee ae
its ay arma
Because rings and long fingernails can harbor pathogens, nalts
should be kept short and well manicured, Rings, long nalls, and
artificial nails are likely to puncture examination gloves and
may poke a patlent during an examination, In addition, micro:
organisms thrive around tough cuticles and can enter the body
Applying Alcohol-Based Hand Rubs Applying Alcohol ased Hand Rubs
a a ms pu ep a a Be par
e a
Pa tt ae
1 Aha und a]
Cas pa ta ew a ay mm
ee ee
Serer ee pat ne ug ere m den i
Po Hy
pet rs a a Pa
ns open var
À nt ec rd SP Ps a
—
CORTE
na manne eee ae
its ay arma
Because rings and long fingernails can harbor pathogens, nalts
should be kept short and well manicured, Rings, long nalls, and
artificial nails are likely to puncture examination gloves and
may poke a patlent during an examination, In addition, micro:
organisms thrive around tough cuticles and can enter the body
OSHA's BBP Standard requires the employer to provide
employees with appropriate personal protective equipment
(PPE) without charge to the employee.
Examples of PPE include-
* Protective clothing,
* surgical masks, face shields,
* protective eyewear,
+ disposable patient treatment gloves, and
+ heavy-duty utility gloves
employees with appropriate personal protective equipment
(PPE) without charge to the employee.
Examples of PPE include-
* Protective clothing,
* surgical masks, face shields,
* protective eyewear,
+ disposable patient treatment gloves, and
+ heavy-duty utility gloves
utting on Personal Protective Equipment
Removing PPE
ul
Protective clothing should be made of fluid-resistant
material, Cotton, cotton/polyester, or disposable jackets
or gowns usually are satisfactory for routine dental
procedures,
«Tom skin, clothing
» During high-risk procedures, protective clothing must
cover dental personnel at least to the knees when seated.
Protective clothing should be made of fluid-resistant
material, Cotton, cotton/polyester, or disposable jackets
or gowns usually are satisfactory for routine dental
procedures,
«Tom skin, clothing
» During high-risk procedures, protective clothing must
cover dental personnel at least to the knees when seated.
Guidelines for the Use of
Protective Clothing
Because protective clothing can spread contamination, it
is not worn out of the office for any reason, including
avel to and from the office,
Protective clothing should be changed at least daily and
more often if visibly soiled.
If a protective garment becomes visibly soiled or
Saturated with chemicals or body fluids, it should be
changed immediately.
« Protective clothing must not be worn in staff lounge
areas or when workers are eating or consuming
beverage
Protective Clothing
Because protective clothing can spread contamination, it
is not worn out of the office for any reason, including
avel to and from the office,
Protective clothing should be changed at least daily and
more often if visibly soiled.
If a protective garment becomes visibly soiled or
Saturated with chemicals or body fluids, it should be
changed immediately.
« Protective clothing must not be worn in staff lounge
areas or when workers are eating or consuming
beverage
Protective Masks ide
A mask is 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 and by
accidental splashes.
A mask with at least 95 percent filtration efficiency for particles 3 to 5 micrometers (1m) in
diameter should be worn.
Dental aerosols that are generated during patient care are usually smaller than 5 microns in
diameter (these are usually considered to be aerosols (<50 microns in diameter).
Larger particulate liquid matter (50-100 microns) tends to settle down due to gravitational
forces.
A mask is 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 and by
accidental splashes.
A mask with at least 95 percent filtration efficiency for particles 3 to 5 micrometers (1m) in
diameter should be worn.
Dental aerosols that are generated during patient care are usually smaller than 5 microns in
diameter (these are usually considered to be aerosols (<50 microns in diameter).
Larger particulate liquid matter (50-100 microns) tends to settle down due to gravitational
forces.
\ The passing of the liquids from the outer layer of the mask on to the inner surface is called
À “strike-through” and this should be avoided by using masks that are impervious for liquid passage.
\ The surgical mask may have three layers— the outer (esthetic layer), the middle (fluid shield
| layer), and the inner layer (that is soft and compatible with the skin of the face),
\ y : ;
| Whenever one uses a mask, a work practice must be to dispose the mask after treating one patient
| Ifthe procedure extends beyond 25-30 minutes, one may need to replace the mask with a new one.
À “strike-through” and this should be avoided by using masks that are impervious for liquid passage.
\ The surgical mask may have three layers— the outer (esthetic layer), the middle (fluid shield
| layer), and the inner layer (that is soft and compatible with the skin of the face),
\ y : ;
| Whenever one uses a mask, a work practice must be to dispose the mask after treating one patient
| Ifthe procedure extends beyond 25-30 minutes, one may need to replace the mask with a new one.
The two m
masks are the:
domeshaped and flat types.
tively tl
nd creates an air sp
n the mask and the
wearer
masks are the:
domeshaped and flat types.
tively tl
nd creates an air sp
n the mask and the
wearer
Protective Eyewear
+ Eyewear is worn to protect the eyes against damage from aerosolized pathogens
such as herpes simplex viruses and Staphylococcus and from flying debris such as
scrap amalgam and tooth fragments.
« Protective eyewear also prevents injury from splattered solutions and caustic
chemicals.
« Such damage may be irreparable and may lead to permanent visual impairment or
LAS RE RS
+ Eyewear is worn to protect the eyes against damage from aerosolized pathogens
such as herpes simplex viruses and Staphylococcus and from flying debris such as
scrap amalgam and tooth fragments.
« Protective eyewear also prevents injury from splattered solutions and caustic
chemicals.
« Such damage may be irreparable and may lead to permanent visual impairment or
LAS RE RS
+ If you wear prescription glasses, you must add protective side
and bottom shields.
+ Protective eyewear that can be worn over prescription glasses
is also available,
+ Ifyou wear contact lenses, you must also wear protective
eyewear with side shields or a face shield.
The CDC Guidelines recommend that you clean your
eyewear with soap and water, or, if visibly soiled, you can
and bottom shields.
+ Protective eyewear that can be worn over prescription glasses
is also available,
+ Ifyou wear contact lenses, you must also wear protective
eyewear with side shields or a face shield.
The CDC Guidelines recommend that you clean your
eyewear with soap and water, or, if visibly soiled, you can
Patients should be provided with protective eyewear
because they also may be subject to eye damage from:
(1) handpiece spatter,
(2) spilled or splashed dental materials such as caustic
chemical agents, and
(3) airborne bits of acrylic or tooth fragments
When certain laser treatments are performed, patients
must be supplied with special filtered-lens glasses.
because they also may be subject to eye damage from:
(1) handpiece spatter,
(2) spilled or splashed dental materials such as caustic
chemical agents, and
(3) airborne bits of acrylic or tooth fragments
When certain laser treatments are performed, patients
must be supplied with special filtered-lens glasses.
ed on the t
Non-Latex-
Containing Gloves
Utility Gloves
Sterile Surgical person who is
* notused for direct
‘Giana Gloves tier sensitive to latex can
verre a ening patient care substitute with gloves
A 73 + used in hospital A A de ny
og: + also known as “food let al 1) when the made from vinyl
Examination Gloves handler gl are old Re poli treatment roomis nitrile, and other non-
latex or vinyl made of lightweight pee ne cleaned and latex containing
« often are referred inexpensive, clear hiba q disinfected material
to as ‘exam plastic involving the between patients,
gloves” oF « These may be worn cutting of bone or + (2)while
procedure over contaminated significant contaminated
gloves: treatment gloves amounts of blood instruments are
+ These gloves are (overgloving) to or sal Va Such as being cleaned or
most frequently prevent the oral surgery handled, and
ntal
nination of periodo
worn by dental
Non-Latex-
Containing Gloves
Utility Gloves
Sterile Surgical person who is
* notused for direct
‘Giana Gloves tier sensitive to latex can
verre a ening patient care substitute with gloves
A 73 + used in hospital A A de ny
og: + also known as “food let al 1) when the made from vinyl
Examination Gloves handler gl are old Re poli treatment roomis nitrile, and other non-
latex or vinyl made of lightweight pee ne cleaned and latex containing
« often are referred inexpensive, clear hiba q disinfected material
to as ‘exam plastic involving the between patients,
gloves” oF « These may be worn cutting of bone or + (2)while
procedure over contaminated significant contaminated
gloves: treatment gloves amounts of blood instruments are
+ These gloves are (overgloving) to or sal Va Such as being cleaned or
most frequently prevent the oral surgery handled, and
ntal
nination of periodo
worn by dental
OPENING CONTAINERS cé
During the procedure, it may become necessary to open containers of
materials or supplies.
When opening a container, use overgloves, a paper towel, or a sterile gauze
sponge to remove the lid or cap.
While doing this, take care not to touch any surface of the container. A
Use sterile cotton pliers to remove an item from the container.
a. 20 O E A E MA A A A A
During the procedure, it may become necessary to open containers of
materials or supplies.
When opening a container, use overgloves, a paper towel, or a sterile gauze
sponge to remove the lid or cap.
While doing this, take care not to touch any surface of the container. A
Use sterile cotton pliers to remove an item from the container.
a. 20 O E A E MA A A A A
Latex Allergies
Three common types of allergic reactions to latex have been identified.
Irritant dermatitis involves only a surface irritation.
Type | and type IV allergies involve an immune reaction
Irritant Dermatitis
* Frequent handwashing with
+ nonimmunologic process soaps or antimicrobial agents
caused by contact
«Irritation caused by the
comstarch powder in gloves
+ The skin becomes reddened,
dry, irritated, and, in severe
cases, cracked
+ Excessive perspiration on the
hands while wearing gloves
+ Failure to dry hands thoroughly
after rinsing
Three common types of allergic reactions to latex have been identified.
Irritant dermatitis involves only a surface irritation.
Type | and type IV allergies involve an immune reaction
Irritant Dermatitis
* Frequent handwashing with
+ nonimmunologic process soaps or antimicrobial agents
caused by contact
«Irritation caused by the
comstarch powder in gloves
+ The skin becomes reddened,
dry, irritated, and, in severe
cases, cracked
+ Excessive perspiration on the
hands while wearing gloves
+ Failure to dry hands thoroughly
after rinsing
+ Most common type of latex allergy, ls a
delayed contact reaction that involves
the immune system
+ It may take 48 to 72 hours for the red,
itchy rash to appear,
+ Reactions are limited to the areas of
contact
«The chemicals used to process the latex
in these gloves cause an immune
response;
+ Most serious type of latex allergy and can
result in death,
+ This reaction occurs in response to the
latex proteins in the glove
+A severe immunologic response occurs,
usually 2-3minutes after latex allergens
contact the skin or mucous membranes
+ coughing, wheezing, runny eyes and
nose shortness of breath, and respiratory
distress
+ The primary cause of death associated
with latex allergies is anaphylaxis.
Anaphylaxis is the most severe form of
immediate allergic reaction. Death results
from closure of the airway caused by
swelling
delayed contact reaction that involves
the immune system
+ It may take 48 to 72 hours for the red,
itchy rash to appear,
+ Reactions are limited to the areas of
contact
«The chemicals used to process the latex
in these gloves cause an immune
response;
+ Most serious type of latex allergy and can
result in death,
+ This reaction occurs in response to the
latex proteins in the glove
+A severe immunologic response occurs,
usually 2-3minutes after latex allergens
contact the skin or mucous membranes
+ coughing, wheezing, runny eyes and
nose shortness of breath, and respiratory
distress
+ The primary cause of death associated
with latex allergies is anaphylaxis.
Anaphylaxis is the most severe form of
immediate allergic reaction. Death results
from closure of the airway caused by
swelling
Treatment
+ No specific cure has been identified for latex
allergy.
+ The only options are prevention, avoidance of
latex-containing products, and treatment of the
symptoms.
Care of Patients with Latex Allergies
Keep the use of latex containing products in the dental
office to a minimum. There is no practical way to create
a latex-free" dental office.
‘Allow no direct contact by the patient with latex (latex
gloves or latex rubber dam material).
Avoid handling instruments with latex gloves, including
wearing latex gloves when packaging instruments for
sterilization, if those instruments are to be used on a
latex-allergie patient,
Use nonlatex substitutes for patient care: prophy cups,
latex-free instruments, nonlatex tourniquets, and
nonlatex stoppers in medicine droppers used for dental
materials.
Use non-latex-containing blood pressure cuffs.
The latex-allergic patient should be scheduled as the first
patient of the day to minimize the quantity of latex
proteins in the air.
No latex should be present in the treatment room.
The treatment room that is to be used for latex-allergic
patients should be located near an outside entrance (to
prevent the patient from traveling through a large dental
suite, where latex from other activities may be present).
Ensure that no one who has worn latex that day enters the
treatment room when a latexallergic patient is being
+ No specific cure has been identified for latex
allergy.
+ The only options are prevention, avoidance of
latex-containing products, and treatment of the
symptoms.
Care of Patients with Latex Allergies
Keep the use of latex containing products in the dental
office to a minimum. There is no practical way to create
a latex-free" dental office.
‘Allow no direct contact by the patient with latex (latex
gloves or latex rubber dam material).
Avoid handling instruments with latex gloves, including
wearing latex gloves when packaging instruments for
sterilization, if those instruments are to be used on a
latex-allergie patient,
Use nonlatex substitutes for patient care: prophy cups,
latex-free instruments, nonlatex tourniquets, and
nonlatex stoppers in medicine droppers used for dental
materials.
Use non-latex-containing blood pressure cuffs.
The latex-allergic patient should be scheduled as the first
patient of the day to minimize the quantity of latex
proteins in the air.
No latex should be present in the treatment room.
The treatment room that is to be used for latex-allergic
patients should be located near an outside entrance (to
prevent the patient from traveling through a large dental
suite, where latex from other activities may be present).
Ensure that no one who has worn latex that day enters the
treatment room when a latexallergic patient is being
Surface barriers are a practical and an easy way to contain cross-contamination. Barriers can be
sterile or non-sterile depending on whether they are used for a surgical or a non-surgical
routine dental care
The turn around time for an operatory if a disinfectant is used (8-15 minutes) is
longer than the time taken for removal of barriers, placing new surface barriers,
disposal of the waste, return of the used instrument to the instrument
reprocessing area (3-5 minutes)
sterile or non-sterile depending on whether they are used for a surgical or a non-surgical
routine dental care
The turn around time for an operatory if a disinfectant is used (8-15 minutes) is
longer than the time taken for removal of barriers, placing new surface barriers,
disposal of the waste, return of the used instrument to the instrument
reprocessing area (3-5 minutes)
Light handles and light switches need to be barriered during patient use and
discarded after each patient. Thin plastic bags, wraps or aluminum foil may be used
nn
discarded after each patient. Thin plastic bags, wraps or aluminum foil may be used
nn
Cleaning and disinfection strategies for blood spills
» Visible organic material should be removed with absorbent material (e.g., disposable paper
towels discarded in a leak-proof, appropriately labelled container).
+ Nonporous surfaces should be cleaned and then decontaminated with either an hospital
disinfectant effective against HBV and HIV or an disinfectant with a tuberculocidal claim (i.e,,
intermediate-level disinfectant).
+ However, if such products are unavailable, a 1:100 dilution of sodium hypochlorite (e.g.,
approximately 4 cup of 5.25% household chlorine bleach to 1 gallon of water) is an inexpensive
and effective disinfecting agent.
» Visible organic material should be removed with absorbent material (e.g., disposable paper
towels discarded in a leak-proof, appropriately labelled container).
+ Nonporous surfaces should be cleaned and then decontaminated with either an hospital
disinfectant effective against HBV and HIV or an disinfectant with a tuberculocidal claim (i.e,,
intermediate-level disinfectant).
+ However, if such products are unavailable, a 1:100 dilution of sodium hypochlorite (e.g.,
approximately 4 cup of 5.25% household chlorine bleach to 1 gallon of water) is an inexpensive
and effective disinfecting agent.
Waste Management
in the Dental Office
Because of the high probability that blood may be carried in saliva during dental
procedures, CDC Guidelines and OSHA BBP Standard regulations consider saliva in
dentistry to be a potentially infectious body fluid.
Saliva-coated items should be treated as potentially infectious waste and
disposed of as contaminated waste.
in the Dental Office
Because of the high probability that blood may be carried in saliva during dental
procedures, CDC Guidelines and OSHA BBP Standard regulations consider saliva in
dentistry to be a potentially infectious body fluid.
Saliva-coated items should be treated as potentially infectious waste and
disposed of as contaminated waste.
Classification of Waste
Example: Handling Require
Example: Handling Require
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.
Contaminated needles and other disposable sharps, such as
scalpel blades, orthodontic wires, and broken glass, must be
placed into a sharps container.
SEGREGATION OF HOSPITAL WASTE IN COLOR CODED BAGS
YELLOW RED BLUE BLACK bal
IHuman Anatomical Solid disinfected Waste Sharps 1. Discarded (ES
porros wastes- (disinfected)- medicines
Plastics,rubber ' ’
, : Needles Syringes 2. Chemical
2. Cell cultures, a
deheaintedions ‘lie ‚scalpels,blades,g wastes(solid)
agents lass,etc
3.Soiled wastes-
blood contaminated
materials like
sets, tubings,etc
YELLOW RED BLUE BLACK bal
IHuman Anatomical Solid disinfected Waste Sharps 1. Discarded (ES
porros wastes- (disinfected)- medicines
Plastics,rubber ' ’
, : Needles Syringes 2. Chemical
2. Cell cultures, a
deheaintedions ‘lie ‚scalpels,blades,g wastes(solid)
agents lass,etc
3.Soiled wastes-
blood contaminated
materials like
sets, tubings,etc
CDC Guidelines: Special
Considerations
al fluids, (Il)
Preprocedural Mouth Rinses
* reduces the number of microorganisms released in the form of aerosol or spatter
* can decrease the number of microorganisms introduced into the patient's bloodstream
during invasive dental procedures
Considerations
al fluids, (Il)
Preprocedural Mouth Rinses
* reduces the number of microorganisms released in the form of aerosol or spatter
* can decrease the number of microorganisms introduced into the patient's bloodstream
during invasive dental procedures
C Guidelines for
bacterium tuberculosis|
M. tuberculosis is a bacterium that is spread by airborne infective particles when
the patient sneezes, coughs, or even speaks.
The small particles can remain airborne for hours.
Infection occurs when a susceptible person inhales the bacteria, which then travel
to the lungs. TB bacteria can remain alive in the lungs for years, a condition called
latent TB Infection,
CDC recommends that elective dental treatment be delayed until the patient
is noninfectious.
t dental care, the CDC 1
ecommends referring the
ring controls and i
Y For patients wh
pati ory pre
a facility
bacterium tuberculosis|
M. tuberculosis is a bacterium that is spread by airborne infective particles when
the patient sneezes, coughs, or even speaks.
The small particles can remain airborne for hours.
Infection occurs when a susceptible person inhales the bacteria, which then travel
to the lungs. TB bacteria can remain alive in the lungs for years, a condition called
latent TB Infection,
CDC recommends that elective dental treatment be delayed until the patient
is noninfectious.
t dental care, the CDC 1
ecommends referring the
ring controls and i
Y For patients wh
pati ory pre
a facility
These gases/smoke/plumes could contain hydrogen cyanide, benzene and
formaldehyde, affecting both the dental care providers and the patients.
With respect to disease risks, these gases/smoke and plumes may also contain
tissue debris, microbes and viruses.
The methods of controlling risks from electrosurgical and LASER plumes is to wear
full PPE
To control release of the gases/smoke/plumes into the ambient air, a high volume
evacuation system as close as possible to the site generating the
gases/smoke/plumes must be used,
Methods of improving air circulation in the clinic should also be used
formaldehyde, affecting both the dental care providers and the patients.
With respect to disease risks, these gases/smoke and plumes may also contain
tissue debris, microbes and viruses.
The methods of controlling risks from electrosurgical and LASER plumes is to wear
full PPE
To control release of the gases/smoke/plumes into the ambient air, a high volume
evacuation system as close as possible to the site generating the
gases/smoke/plumes must be used,
Methods of improving air circulation in the clinic should also be used
Written Exposure Control Plan
Required by OSHA
General policy of implementing Centers for Disease Control
and Prevention guidelines and American Dental Association
infection control recommendations:
Use of Universal Precautions
Required use of personal protective equipment
Standardized housekeeping
Laundering of contaminated protective clothing
Standardized policy on cleaning and disinfection
Policy on general waste disposal
Labeling procedure (secondary labeling)
Policy on sterilization (including monitoring) and
disinfection
Use of sharps containers and disposal system
Standardized handwashing protocol
Hepatitis B virus (HBV) vaccination
Postexposure evaluation and medical follow-up
OSHA, Occupational Safety and Health Administration.
Required by OSHA
General policy of implementing Centers for Disease Control
and Prevention guidelines and American Dental Association
infection control recommendations:
Use of Universal Precautions
Required use of personal protective equipment
Standardized housekeeping
Laundering of contaminated protective clothing
Standardized policy on cleaning and disinfection
Policy on general waste disposal
Labeling procedure (secondary labeling)
Policy on sterilization (including monitoring) and
disinfection
Use of sharps containers and disposal system
Standardized handwashing protocol
Hepatitis B virus (HBV) vaccination
Postexposure evaluation and medical follow-up
OSHA, Occupational Safety and Health Administration.
@
U}
CONCLUSION §
0
0
U}
CONCLUSION §
0
0
REFERENCES
CDC, guidelines for disinfection & sterilization in health care facilities
Dental Infection Control & Occupational Safety Dental Infection Control & Occupational
Safety For Oral Health Professionals,Dental Council of India, Anil kohli & Raghunath
puttaiah
Operative dentistry, infection control, 4th edition, Sturdevent
Textbook of microbiology, sterilization and disinfection, 9th edition, Ananthanarayan
Dental Hygiene theory and practice, Darby and Walsh,3 edition
Essentials of Public Health Dentistry 5th Edition, Soben Peter
Sterilization and disinfection of dental instruments by ADA
Modern Dental Assisting 11th Edition, Doni Bird Debbie Robinson
CDC, guidelines for disinfection & sterilization in health care facilities
Dental Infection Control & Occupational Safety Dental Infection Control & Occupational
Safety For Oral Health Professionals,Dental Council of India, Anil kohli & Raghunath
puttaiah
Operative dentistry, infection control, 4th edition, Sturdevent
Textbook of microbiology, sterilization and disinfection, 9th edition, Ananthanarayan
Dental Hygiene theory and practice, Darby and Walsh,3 edition
Essentials of Public Health Dentistry 5th Edition, Soben Peter
Sterilization and disinfection of dental instruments by ADA
Modern Dental Assisting 11th Edition, Doni Bird Debbie Robinson
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