1. GUIDE TO INFECTION
PREVENTION FOR DENTAL
HEALTH CARE SETTINGS

2. Why Is Infection Control ImportantWhy Is Infection Control Important
in Dentistryin Dentistry??
 Both patients and dental health care personnelBoth patients and dental health care personnel
(DHCP) can be exposed to pathogens(DHCP) can be exposed to pathogens
 Contact with blood, oral and respiratory secretions,Contact with blood, oral and respiratory secretions,
and contaminated equipment occursand contaminated equipment occurs
 Proper procedures can prevent transmission ofProper procedures can prevent transmission of
infections among patients and DHCPinfections among patients and DHCP

3. Infection prevention and
occupational health program
 A. Education and training of faculty staff,
interns and students.
 B. Immunization Programs
 C. Illness and work restriction
 D. Exposure & Infection prevention
procedures (Standard Precautions)

4. B. Immunization Programs
 Hepatitis B vaccination : Three-dose schedule administered
intramuscularly (IM) in the deltoid; second dose administered
1 month after first dose; third dose administered 4 months
after second.
 Testing for anti- HBs 1–2 months after completion of the 3-
dose vaccination
 If anti-HBs <10 mIU/mL) → complete a second 3-dose
vaccine series or be evaluated to determine if they are HBsAg-
positive.
 If no antibody response occurs after the second series, testing
for HBsAg should be performed.
 Non-responders to vaccination who are HBsAg-negative
should be considered susceptible to HBV infection.

5. D. Exposure & Infection prevention
procedures (Standard Precautions(
The Foundation of the Exposure Control Plan is the
use of Standard Precautions to prevent the
transmission of bloodborne and other diseases
from healthcare workers to patients and vice versa.
Medical histories and examinations cannot reliably
identify all infected patients. Therefore all body
fluids (with the exception of sweat) of all patients
should be considered infectious.

6. Standard Precautions
basic safety measures that must be used for all
patients. They include the use of appropriate
barriers such as gloves, masks, and eye
glasses to prevent skin and mucous
membrane exposure when contact with
blood, saliva or OPIM (other possibly
infectious material) is anticipated.

7. Objectives ofObjectives of Standard Precautions
[a} Reduce the number of pathogens so that
normal resistance can prevent infections
[b] Break the cycle of infection and eliminate
cross-contamination,
[c] Protect all patients and personnel from
infection

8. Modes of Transmission
 Direct contact with blood or body fluidsDirect contact with blood or body fluids
 Indirect contact with a contaminatedIndirect contact with a contaminated
instrument or surfaceinstrument or surface
 Contact of mucosa of the eyes, nose, orContact of mucosa of the eyes, nose, or
mouth with droplets or spattermouth with droplets or spatter
 Inhalation of airborne microorganismsInhalation of airborne microorganisms

9. Exposure Determination
Anyone who participates in any of the following tasks, even on a sporadic basis,
should follow standard precautions, receive training, and receive the HBV
vaccine.
 Performing clinical or laboratory dental procedures
 Assisting in a dental procedure
 Cleaning and/or sterilizing contaminated equipment
 Handling potentially contaminated laundry
 Scrubbing contaminated counter tops and other
environmental surfaces
 Disinfecting impressions
 Exposing radiographs
 Flushing water lines in the dental unit

10. Hand hygiene & Hand careHand hygiene & Hand care
You MUST:
 Put on mask and glasses before washing
hands.
 Remove all jewelry (including watches)
from hands and wrists. All fingernails must
be kept short and never put false nails.

11. Hand WashingHand Washing
3. Initial Wash: Wet hands and
forearms under running water
and lather them with anti-
microbial soap and water for 15-
20 seconds, paying particular
attention to nails, fingertips, and
interdigital spaces.
a. Rinse thoroughly with cool water.
b. Use paper towels to blot and dry
hands.
4. Subsequent washes: Wash hands
for 15 seconds after removing
gloves, between patients, and
before leaving the operatory area.

12. Hand WashingHand Washing
 When performing oral surgical procedures
perform surgical hand antisepsis by using
an antimicrobial product (e.g.,
antimicrobial soap and water, or soap and
water followed by alcohol-based hand
 A body area that contacts blood, saliva, or
OPIM must be washed immediately after
contact.
 Any cuts or open wounds need to be
covered with a waterproof dressing.

13. Hand WashingHand Washing
 Clean sinks fitted with non-touch taps (or carried out
using a non-touch technique). If touch taps are used the
taps may be turned on and off with a paper towel.
 Alcohol (ethanol or isopropanol) -based hand rubs
(ABHR, 70-95%) is the preferred method for hand
hygiene in all clinical situations except when hands are
visibly soiled (e.g., blood, body fluids).
 A compatible moisturiser should be applied up to four
times per day or use an emollient-containing ABHR.
 ABHR must only be used on dry skin.
 Position ABHR dispensers close to the clinical working
area (but away from contamination by splash and
aerosols)

14. Personal protection
 Personal protective
equipment (PPE) includes
gloves, eyeglasses, masks,
and clinic attire.
 Always remove PPE before
leaving the clinic area.
PPE is not allowed in the
hallways.

15. GlovesGloves
General categories of gloves are:
Non-sterile latex: examination and restorative
procedures.
Sterile latex: surgical procedures
Overgloves: They should be put on when doing tasks
that would contaminate items during dental
procedures. Examples: answering the phone,
writing in a patient’s chart, or leaving the dental
chair for any reason.
Non-sterile vinyl
Utility gloves: Made of sterilizable polynitrile and
appropriate for cleaning instruments, handling
laundry, and other housekeeping tasks. They
provide superior protection and can be
decontaminated for reuse.

16. GlovesGloves
 Wearing gloves does not replace the need for hand
hygiene.
 Gloves should be put on immediately before
treatment.
 Gloves must be changed as soon as they are cut, torn
or punctured.
 Gloves must be removed or overgloves worn before
touching any environmental surface without a barrier
or before accessing clean areas.
 Gloves must be removed as soon as clinical treatment
is complete and hand hygiene undertaken
immediately.
 The use of powder-free gloves for patient care is
recommended strongly

17. When removing contaminated gloves, grasp
them around the wrist and pull them off so
that they end up inside out. This will keep
the contaminated areas away from your skin.
Dispose immediately in a red bag or a
biohazard trash

18. Masks and Protective Eyewear
A disposable mask and eyewear must be worn
when spray, spatter, or droplets of blood,
saliva, or OPIM will be generated. Goggles
or glasses with non-perforated side shields
are required. Face shields also provide good
protection; they may be used in place of
safety glasses.

19. Masks and Protective Eyewear
 Contaminated eyewear should be washed with a
disinfectant soap whenever visibly contaminated.
 Masks must be changed if they become soaked with
moisture or visibly splattered (and always between
patients).
 Remove mask using ungloved hands. When removing a
mask, handle it only by the elastic or cloth tie strings; the
mask itself should not be touched.
 Treat all masks and glasses as contaminated.
 Eyewear must be disinfected at the end of each patient
appointment with a surface disinfectant

20. Clinic Attire
Long sleeve- Gowns must be worn
routinely for the following
procedures:
[1] Oral or periodontal surgery;
[2] Periodontal/hygiene procedures;
[3] Restorative procedures where an
aerosol will be generated;
[4] Cleaning instruments, biohazard
trash cans, evacuation hoses, and
lab equipment;
[5] Loading the clothes washing
machine.
If there is no risk of exposure to blood
or saliva, short-sleeve attire (scrub
top) is acceptable. Such procedures
would include patient
screening/workup, oral radiology,
dispensing sterile instruments or
clean dental supplies, and folding
clean laundry

21. Laundry Protocol
 Contaminated laundry (clinic/lab coats or gowns,
towels, etc.) should be handled as little as possible and
placed in appropriately labeled biohazard containers or
red laundry bags located in each clinic.
 Laundry bags are contaminated and therefore
considered biohazardous.
 Contaminated laundry will not be sorted or rinsed in
the area where it has been used; it will be transported to
the laundry room in laundry bags or designated
containers.
 All sorting and rinsing will be done in the designated
laundry area located on the first floor.

22. Exposure incidentsExposure incidents
 Immediate first aid.
 referral to a qualified health care provider for
exposure follow-up.
 The source patient must be asked to submit to
testing for hepatitis B, HIV, and hepatitis C.
In spite of the use of protective attire, the risk of accidental
exposure to BBF continues to exist in the dental
setting. An exposure incident is a specific occupational incident involving the eye, mouth,
other mucous membranes, non-intact skin, or parenteral contact with blood, saliva, or
OPIM. Minor occupational injuries such as paper cuts or injuries from sterile
instruments are not considered exposure incidents.

23. Exposure incidentsExposure incidents
 Post-exposure prophylaxis has been
associated with a decrease of approximately
79% in the risk for HIV seroconversion after
percutaneous exposure to HIV-infected
blood.
 Prophylactic administration is most effective
within 1-2 hours following exposure. Early
administration affords the most benefit.

24. Equipment Sterilization
 Sterilization of instruments
between uses is a
fundamental aspect of
good infection control
practices. Numerous
guidelines exist that aid
the DHCW in the
appropriate method for a
given type or classification
of instrument.

25. Instrument Classification
Dental instruments are classified according to their intended
use. These classifications assist the practitioner in determining
the appropriate method of reprocessing instruments between
uses:
Critical instruments: those instruments intended to penetrate soft tissue
or bone. These instruments should be sterilized between use or must be disposable
Semicritical instruments: not intended to penetrate tissue, but do
contact oral tissues. These instruments also require sterilization between uses. If heat
sterilization is not feasible, immersion in a high-level sterilant/disinfectant is
accepted.
Noncritical instruments: contact only intact skin. These items may be
processed using an appropriate intermediate or low-level disinfection.

26. STERILIZATION/DISINFECTION
 Heat-tolerant critical and semicritical items →
Sterilization (Steam autoclave, dry heat)
 Heat-sensitive critical and semicritical → Sterilization
(Glutaraldehyde, glutaraldehydes with phenol, hydrogen
peroxide)
 Noncritical with visible blood → Intermediate level
disinfection → (e.g., chlorine containing products,
quaternary ammonium compounds with alcohol,
phenolics, iodophors)
 Noncritical without visible blood → Low-level
disinfection (e.g., quaternary ammonium compounds,
some phenolics, some iodophors)

27.  Heat sterilization method:Heat sterilization method:
 Autoclave: 15-20 min.Autoclave: 15-20 min.
 Dry heat: 160c 2 hr. Or 170c 1 hr.Dry heat: 160c 2 hr. Or 170c 1 hr.
 Chemiclave: 131c 20-40 min.Chemiclave: 131c 20-40 min.

28.  Chlorine-based product, a fresh solution of sodium
hypochlorite (e.g., household bleach) :
( approximately ¼ cup of 5.25% bleach to 1 gallon
of water) Dental practices should follow the product
manufacturer’s directions regarding concentrations
and exposure time for disinfectant activity relative to
the surface to be disinfected.

29. 5.Work practice control
1. Discard or sterilize any instrument or other item
dropped on the floor.
2. Do not touch glasses, mask, hair, or clinic attire
during patient treatment.
3. Do not keep pens or pencils in the pockets of
clinic gowns during patient treatment if there is
the potential for splash or splatter of blood or
OPIM

30. 4. If the patient record must be consulted, remove
gloves and wash hands before and after
handling. If already gloved, you may don
overgloves and discard after use.
5. Place all contaminated instruments in
appropriate cassettes, metal containers or plastic
tubs in which they were initially dispensed.

31. Environmental Infection Control
1. clinical contact
surfaces
2. Housekeeping
surfaces

32. Dental unit disinfectionDental unit disinfection

33. Dental unit disinfectionDental unit disinfection
For surface disinfection, use a modified spray-wipe-
spray technique:
1. Spray/pour surface disinfectant on clean gauze or
a disposable towel and clean the working surfaces
from clean surfaces to most contaminated..
2. With another clean gauze or towel, again spray or
saturate with disinfectant and apply to the
surfaces.
3. Allow the disinfectant to stay in contact with the
surface for the manufacturers recommended
time(10 minutes).

34. Disposal of biomedical waste
Biomedical waste must be:
 • Stored in colour-coded containers that are
marked with the universal biohazard
symbol.
 • Released to an approved biomedical waste
carrier for disposal.

35. Dental unit waterlines
 All waterlines : flushing them thoroughly
with water for at least two to three minutes.
 Handpieces: using water coolant should be
run for 20 to 30 seconds after patient care

36. Special Considerations
 A. Dental Handpieces and Other Devices
Attached to Air and Waterlines
 B. Dental Radiology
 C. Handling of Extracted Teeth
 D. Dental Laboratory

37. Asepsis Prior to Treatment
 Prior to seating the patient, use the modified spray-wipe-spray
technique to disinfect the following:
1. Chair arms, seat, and headrest
2. Light handles, evacuation system, and bracket table.
NOTE: The foot control should be left on the floor; it does not require
disinfection. Do not spray the back of the light or wipe it with
disinfectant since this will damage the reflective paint. Light backs
should be considered contaminated and should not be touched during
treatment.
3. control levers, seats, and backs;
4. Counter tops and amalgamators.

38. Asepsis Prior to Treatment
 Place a sterile tip on the air/water syringe and
flush the syringe and hand-piece hoses to dispel
stagnant water.
 Place disposable plastic tips on high-speed
evacuator and saliva ejector.
 Place headrest cover over chair back, plastic wrap
on air/water syringe handle, patient napkins on
operator and assistant carts, and plastic adhesive
 cover on light handles and touch pads.

39.  Obtain instruments from dispensary and
lay out armamentarium for the procedure.
 Place patient chart in chart holder. If there
is no specific holder, keep chart away from
immediate operating area to avoid
contamination.

40. Asepsis During Treatment
Attention to aseptic technique during patient treatment
includes the following:
1. Consider having patient rinse and expectorate with
mouthrinse. Rinsing with an approved mouthwash
reduces number of microorganisms present on the
surface of the oral cavity.
2. Do NOT touch any areas outside immediate
operating field during treatment
( hair, face, glasses, mask, patient chart, and/or
radiographs).
3. Use over gloves to consult chart or radiographs.
4. DO NOT ask patient to close lips around the saliva
ejector tip.

41. Asepsis Following Treatment
After completing the procedure, proper asepsis is accomplished as follows:
1. Remove patient's napkin. Remove gloves, wash hands before
completing necessary paperwork and replacing radiographs in chart.
2. Dismiss patient.
3. Put on gloves to place all sharps in sharps container and all instruments
in cassettes and/or plastic tub.
4. Flush evacuation system with water for 20 -30 seconds. Flush air/water
syringe for 20 - 30 seconds.
5. Place all contaminated items (gauze, cotton rolls, gloves) and all
disposableitems (saliva ejectors, evacuation tips) in red plastic
biohazard bag attached to operator or assistant cart. Place this bag in
the biohazard-labeled trash container in the clinic.

42.  Disinfect/clean chair and all contaminated surfaces using the modified
spraywipe- spray technique.
 Flush handpiece for 20 -30 seconds. Remove handpiece, clean,
disinfect, lubricate then reattach to hose and run handpiece to remove
excess lubricant.
 Remove handpiece and package it for sterilization. following
themanufacturer's directions).
 Place contaminated instrument tub on designated transport cart
 Remove contaminated gown and place in contaminated laundry bag.
 Do not leave clinic area in your gown.
 Remove overgloves, wash hands, and return unit to original storage
position.

43. CLASSIFICATION/DECONTAMINATION OF EQUIPMENT,
INSTRUMENTS, AND MATERIALS: SUMMARY
Air-water syringes Dispose After each patient
Angle attachments Sterilize After each patient
Dental materials, individual Disinfect containers After
each patient
Floors, clinic Wash Each morning
Handpieces Sterilize After each patient
Impression trays Sterilize After each patient
Inhalation bags (nitrous/oxygen) Dispose After each
patient
Instruments, dental Sterilize After each patient
Instruments, surgical Sterilize After each patient
Light-curing units Disinfect After each patient
Mouth probs Sterilize After each patient

44.  Napkin (alligator) clips Disinfect After each patient
 Operatory lights Disinfect/Use barrier After each patient
 Operatory chairs Wash/ barrier After each patient
 Operatory carts Disinfect At end of clinic session
 Scalers, ultrasonic Disinfect/Sterilize tips After each
patient
 Suction hoses Disinfect/outer surface After each patient
 Suction hoses Flush hose with water After each patient
 Telephones, clinic Disinfect Weekly

45. RESPONSIBILITIES TO PATIENTS WITH
INFECTIOUS DISEASES
Obligation to Treat: You may not refuse to treat a patient solely
because the patient has an infectious disease. However,
departments/clinics may choose to defer non-emergency
procedures on patients with airborne infectious diseases until
such time as the patient is non-infectious.
Records: All patient dental/medical records must be kept
confidential.
Patient Assignment: Patients with active infectious diseases will be
assigned to the appropriate clinic or program based on the
patient's medical condition, the experience level of the dentist,
and the need for or availability of dental allied personnel.

46. THANK YOUTHANK YOU