INFECTION CONTROL IN DENTISTRY DR ZIA UR REHMAN KHALIL ASSISTANT PROFESSOR COMMUNITY AND PREVENTIVE DENTISTRY
CONTENTS Introduction Mode of Transmission Mode of Infection control Objective of Infection control Operatory Asepsis Personal Protection Barrier Sterilization Disinfection Laboratory Infection Control 2 Clinical Waste Disposal.
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. The Occupational Safety and Health Administration (OSHA) 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
MODES OF DISEASES TRANSMISSION Direct contact with blood or body fluids Indirect contact with a contaminated instrument or surface.eg dental assistant or sweeper Contact of mucosa of the eyes, nose, or mouth with droplets or spatter 10 Inhalation of airborne microorganisms
MODES OF TRANSMISSION: Infectious agent Susceptible Reservoirs host Chain of infection Portal of Portal of entry exit Means of transmission 11 Six links in chain of transmission of infection
The Chain of Infection Components Infectious Agent-any potential pathogen (bacteria, virus, fungi, etc.) Reservoir-where the pathogen lives (a person, on equipment, surfaces, instruments, etc) Portal of exit- how the infectious agent leaves its reservoir and reach a new host. Transmission-direct, indirect, airborne, droplet Portal of entry- how the infectious agent gets into the new host (bloodstream, mucous membrane, etc.) Susceptible host-someone who is not immune
MODES OF TRANSMISSION: Infectious agent eg Hep B Susceptible host Reservoirs Unvaccinated bloodstream Dental worker Chain of infection Portal of entry Portal of exit Puncture wound Bleeding wound Means of transmission Direct via 13 needle stick Six links in chain of transmission of infection
OBJECTIVES OF INFECTION CONTROL Reduce Protect Implement Simplify 14
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 . 15
• Who is responsible for infection control in the dental office ? – Each member of the dental team must follow the recommended guidelines . 16
• What should be done to prevent the transmission of disease in the dental office ? 17
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 18
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 19
• To prevent such infections, following is a list of all those procedures and precautions that together constitute infection control. 20
• 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 Precautions". 21
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 22
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 5Disposable patient treatment gloves 6- Heavy-duty utility gloves 23
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 . 24
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 . 25
• 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. 26
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. 28
• 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. 29
• Transfer of microorganisms from contaminated environmental surfaces to patients occurs primarily through personnel hand contact 30
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. 31
• 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. 32
1. REMOVE UNNECESSARY ITEMS FROM THE DENTAL PROCEDURE AREA The dental procedure area should be arranged to facilitate a thorough cleaning following each patient.
2. PRE PLAN 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 gloves cabinets and drawers once have become contaminated. 34
3. Utilize disposable items whenever possible: The use of disposable items saves time during cleanup and decontamination and solves the problem of proper reprocessing. 35
• 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. 36
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. 37
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. 38
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. 39
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