Sas 7 Infection Control

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- basic level of infection control. - “To treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other blood borne pathogens”

- It also includes having all doctors and staff who come in contact with such secretions wear barriers devices like face mask, head cap, eye protection googles and gloves.

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UNIVERSAL PRECAUTION

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What barriers should a clinician or dentists wear for them to be protected from exposure of HBV, HIV and other bloodborne pathogens?

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• head cap

• face mask

• eye protective goggles

• containgloves

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contains microorganisms usually present in saliva and on the surfaces of the oral tissues in HEALTHY, IMMUNOCOMPETENT INDIVIDUALS who have not been exposed to agents that alter the composition of oral organisms

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NORMAL ORAL FLORA

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NORMAL ORAL FLORA:

Bacteria present in Oral Cavity

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• Aerobic, gram-positive organisms : Streptococcus spp and Actinomyces spp

• Anaerobic, gram positive organisms: Candida spp

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NORMAL ORAL FLORA:

Bacteria present in Nasal Cavity

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Aerobic, gram-positive organisms:

• Streptococcus spp

• Haemophilus influenza (in children)

• Staphylococcus aureus ( in adults)

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- Viral organisms pose most difficulty in dentistry are:

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• Hepatitis B and C virus

• Human Immunodeficiency virus(HIV)

• SARS-Cov-2

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spread by contact with feces of infected individuals

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HEPATITIS A

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may also spread through contaminated feces or by contaminated blood

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HEPATITIS C

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spread by direct contact with any human secretion(fluids)

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HEPATITIS B AND D

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• most serious risk of TRANSMISSION in the dental setting

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HEPATITIS B (HBV)

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can be transferred when a patient’s saliva or blood ENTERS the body of another individual through ANY MOIST mucosal surface or epithelial wound

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HBV

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HBV is exceptionally resistant to:

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dessication and chemical disinfectants (phenols, alcohols, and quarternary ammonium compounds)

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HBV can be inactivated by:

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• halogen-containing disinfectants (iodophor and hypochlorite)

• formaldehyde

• ethylene oxide gas

• heat sterilization

• irradiation

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TRUE OR FALSE:

Dental staff should not receive HBV vaccinations as this effectively reduce an individual’s susceptibility to hepatitis B infection.

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FALSE: Dental staff should receive HBV vaccinations as this effectively reduce an individual’s susceptibility to hepatitis B infection.

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- Causative agent of Acquired Immunodeficiency Syndrome (AIDS)

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Human Immunodeficiency Virus (HIV)

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- Transmitted via direct contact between VIRUS-LAIDEN BLOOD or SECRETIONS from the infected individual and mucosal surface or epithelial wound of the potential host.

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HIV

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- LOSE their infectivity when they are desiccated

- Universal precautions should be followed with proper PPE and barriers for both the patient and dental staff.

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HIV

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- the only mycobacterium of significance to dentists.

• Transmission: primarily through exhaled aerosols from infected patients during breathing, coughing, sneezing and speaking.

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Mycobacterium tuberculosis

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- highly RESISTANT to desiccation and to most chemical disinfectants -

- SENSITIVE to heat, ethylene oxide and irradiation

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Mycobacterium Tuberculosis

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What to wear to prevent transmission of mycobacterium tuberculosis?

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N95 respirator masks

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breakdown of living tissue by the action of microorganism and is usually accompanied by inflammation

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SEPSIS

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ATTEMPT to keep patients, health care staff and objects as free as possible of agents that cause infection

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MEDICAL ASEPSIS

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ATTEMPT to prevent microbes from gaining access to surgically created wounds

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SURGICAL ASEPSIS

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substances that are applied to a living tissue to prevent MULTIPLICATION of organisms

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ANTISEPTIC

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substances that are applied to inanimate objects to prevent multiplication of organisms

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DISINFECTANT

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- freedom from viable forms of microorganisms.

- represents an ABSOLUTE STATE as there is no degree of sterility

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STERILITY

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reduction of the number of viable microorganisms to LEVELS judged safe by public health standards

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SANITIZATION

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similar to sanitization except that it is not connected with public health standards

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DECONTAMINATION

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microorganisms MOST RESISTANT to elimination both by physical or chemical means

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BACTERIAL ENDOSPORES

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Means of reducing the number of viable organisms from a surface:

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PHYSICAL AND CHEMICAL

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Means of reducing the number of viable organisms from a surface:

PHYSICAL

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heat, mechanical dislodgement, radiation

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Means of reducing the number of viable organisms from a surface:

CHEMICAL

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antiseptics, disinfectant, ethylene oxide gas

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TECHNIQUES OF INSTRUMENT STERILIZATION

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• STERILIZATION WITH HEAT: Dry Heat and Moist Heat

• STERILIZATION WITH GAS: Ethylene oxide gas

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• The spore of the bacterium that is extremely resistant to heat

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Bacillus stearothermophilus

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Sterile instruments, if properly placed in a sealed pouch, can be stored for:

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6-12 months

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• Most commonly used to sterile glassware and bulky items

• can withstand heat but are susceptible to rust

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Dry Heat

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Needs longer time at a HIGH TEMPERATURE to eliminate bacterial spores

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DRY HEAT

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ADVANTAGES OF DRY HEAT

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• ease of use

• unlikelihood of DAMAGING heat-resistant instruments

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DISADVANTAGES OF DRY HEAT

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• length of time necessary (longer time needed at high temp)

• potential damage to heat-sensitive instruments

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- more efficient than dry heat for sterilization because it is effective at much lower temperatures and requires less time.

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Moist Heat

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EXAMPLE OF MOIST HEAT STERILIZATION

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AUTOCLAVE

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container usually used for providing steam under pressure

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AUTOCLAVE

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ADVANTAGES OF MOIST HEAT STERILIZATION

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- effectiveness

- speed

- relative availability of office- proportioned autoclaving equipment

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DISADVANTAGES OF MOIST HEAT STERILIZATION

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• dulls and rusts instruments

• autoclave are costly

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Commonly used in Sterilization with gas

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ETHYLENE OXIDE GAS

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Highly flammable gas, mixed with carbon dioxide or nitrogen to make it safer to use.

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ETHYLENE OXIDE GAS

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What can be mixed with ethylene oxide gas for it to be safer to use?

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Carbon dioxide or Nitrogen

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Killing time and temp of microorganisms and spores by using ethylene oxide gas?

- It effectively kill all microorganisms

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50°C for 3 hours

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Must be aerated for how many hours and days at what temp and why?

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8-12 hours @ 50°C to 60°C or at ambient temperatures for 4-7 days because it is highly toxic to animal tissue

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ADVANTAGES OF ETHYLENE OXIDE GAS

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• effectivity against porous material

• large equipment and materials sensitive to heat and moisture

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DISADVANTAGES OF ETHYLENE OXIDE GAS

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• need for special equipment

• length of sterilization

• necessary aeration time

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TECHNIQUES OF INSTRUMENT DISINFECTION

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CHEMICAL DISINFECTION

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ALTERNATIVE CHOICEif instruments cannot withstand the temperatures needed for heat sterilization

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CHEMICAL DISINFECTION

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Substances acceptable in dentistry for Chemical Disinfection:

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Glutaraldehyde, Iodophors, Chlorine compounds, Formaldehyde

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Most commonly used in Chemical disinfection

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Glutaraldehyde-containing compounds

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NOT RECOMMENDED for dentistry because they are ineffective against Hepatitis B virus

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Quarternary ammonium compounds

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TRUE OR FALSE:

Instruments free of blood and other body fluids are soaked in the solution for a recommended period and rinsed thoroughly free of chemicals after disinfection

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TRUE

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GOAL: prevent any organisms from the surgical staff or other patients from entering the patient’s wound

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SURGICAL FIELD MAINTENANCE

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A Platform should be used as a tray to hold the sterile instruments needed for surgery

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MAYO STAND COVERED WITH TWO STERILE TOWELS

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TRUE OR FALSE:

Anything placed in the Mayo table must be sterilized or disinfected and the assistant must not allow excessive moisture get in the towel to prevent CONTAMINATION .

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TRUE

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ANY SURFACE that a patient or patient’s secretions contact is a potential carrier of infectious organisms.

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OPERATORY DISINFECTION

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Disinfection of the operatory can be done by:

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wiping all surfaces with a hospital-grade disinfectant solution and to cover surfaces with protective shields that are changed between each patient

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Chemical disinfectant solutions used to prevent transfer of Hepatitis virus

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0.2% Chlorine and 2% Glutaraldehyde

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Common antiseptic solution used in dentistry:

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• iodophors

• chlorhexidine

• hexachlorphene

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• have the broadest spectrum of ANTISEPTIC ACTION in which it is effective against gram-positive and gram-negative bacteria, most viruses, M. tuberculosis, spores and fungi.

• They are usually formulated in a 1% iodine solution

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Iodophor solution (Povidone-Iodine)

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- Designed to protect the dental staff and other patients from a particular patient as it is to protect the patient from pathogens that the dental staff may harbor

- Used in any dental procedure that does not incise a tissue

- Clinician may wear scrub suits or dental uniforms covered by a long-sleeved surgical gown. Eye protection googles, face mask and head cap must always be worn during the performance of the surgery and sterile gloves must be used when rendering surgery to the patient.

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CLEAN TECHNIQUE

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SURGICAL STAFF PREPARATION CAN EITHER BE:

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CLEAN OR STERILE TECHNIQUE

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-Used for office-based surgery when skin incisions are made or when surgery is performed in an operating room

-PURPOSE is to minimize the number of organisms that enter the wounds created by the surgeon

- Surgical hand and arm scrub must be performed by the surgical team.

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STERILE TECHNIQUE

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(STERILE TECHNIQUE)

Hands and forearms are scrubbed using an:

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ANTISEPTIC solution up to approximately 5cm above the elbow

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(STERILE TECHNIQUE)

Sterile gloves must also be properly donned:

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ONLY the sterile hand touches the sterile part and unsterile hand only touches the unsterile part

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PATIENT PREPARATION:

Perioral skin or tissues may be decontaminated using:

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iodophor solutions

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PATIENT PREPARATION:

Oral Cavity may be prepared by having the patient rinse:

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0.12% Chlorhexidine gluconate (Orahex) mouthwash

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PATIENT PREPARATION:

should be the only solutions used to irrigate the surgical field.

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Sterile saline or water

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most common risk for transmission of disease from infected patients to the staff by:

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accidental needle sticks or scalpel lacerations

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Sharp instruments should be disposed:

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a rigid, well-marked receptacles and must be turned over to a reputable hazardous waste management company

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Transmission occurs primarily between close contact with one another through respiratory droplets produced when an infected person coughs, sneezes or talks

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SARS Cov-2 virus

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TRUE OR FALSE:

Risk of SARS Cov-2:

most of the dental practice performed use rotary instruments that generates aerosol that can contain particle droplets of water, saliva, blood, and microorganisms.

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TRUE

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dental clinic must equip the office with:

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- proper ventilation system

- special protective barriers (acrylic glasses)

- HEPA filters

- hands-free alcohol dispensers

- must ensure that high-volume suction machines are used

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Principal antimicrobial effect of Dry Heat

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Oxidizes cell proteins

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Principal antimicrobial effect of Moist Heat

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Denatures cell proteins

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Time necessary to achieve sterilization for Dry heat

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Long

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Time necessary to achieve sterilization for Moist Heat

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Short

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Equipment complexity and cost for dry heat

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Low

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Equipment complexity and cost for Moist Heat

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High

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Tendency to dull or rust instruments for Dry heat

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Low

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Tendency to dull or rust instruments for Moist Heat

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High

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Availability of equipment sized for office use for Dry heat and Moist Heat

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GOOD

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Microorganism extremely resistant to heat and is used to check effectiveness of sterilization

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Bacillus stearothermophilus

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Most common disinfectant used in dentistry

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Glutaraldehyde-containing compounds

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It is the solution used to reduce the number of microorganisms in an inanimate object.

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DISINFECTANT

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How long are well-packed sterile instruments be stored?

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6-12months

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If an instrument is prone to rust what technique of sterilization is recommended?

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Dry heat or Sterilization using ethylene oxide gas

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CAN I STERILIZE SURGICAL MASKS FOR REUSE?

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- surgical masks are not intended to be used more than once

- If mask is damaged or soiled, or if breathing through the mask becomes difficult, mask should be removed, safely discarded and replaced with a new one.

- Surgical face masks are recommended to be replaced every patient.

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CAN I GIVE PATIENTS THEIR TEETH AFTER THEY HAVE BEEN EXTRACTED?

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Yes, patient can have their extracted upon request. Once an extracted tooth is returned to the patient, it is no longer considered a potential risk to dental health care personnel and is no longer subject to the provisions of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard.

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MEANING OF OSHA

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Occupational Safety and Health Administration