{ Infection Control Infection Control Disease Transmission and Sterilization Tiffany Baggs, RDH, BASDH Joy Davis, RDH, BASDH

 Objectives for DHCP  Responsibility of entire dental team  Work practices prevent cross- contamination

An approach to infection control in which all human blood and certain human body fluids are treated as if known to be infectious. Universal Precautions

Protects the DHCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion  Blood  All body fluids (except sweat)  Non-intact skin  Mucous membranes Standards of care -Level of clinical performance expected for the safe, effective and ethical practice of dental hygiene. (CODA) Standard Precautions

P.P.E.  Clinical attire  Hair  Face mask  Protective eyewear  Gloves  CDC recommendations Personal Protective Equipment

Introduction of microorganisms, blood or infectious material onto a surface or into tissue Cross-contamination  Person to person  Person to inanimate object  Inanimate object to another person  Brainstorm – Consider a dental appointment what all might occur that would cause cross contamination to happen? Contamination

Disease Transmission

 Number of organisms, duration of exposure  Virulence of the organism  Immune status of host  Host general physical health and nutritional status Factors Influencing the Development of Infection

 Abnormal physical conditions  Systemic diseases  Drug therapy  Prostheses and transplants Factors That Alter Normal Defense

 Dust-borne organisms  Aerosol production  Aerosols: biologic contaminants, solid or liquid, invisible, remains suspended in air for long periods of time  Spatter : larger than aerosols, may be visible  Origin: breathing, speaking, coughing, sneezing  Contents: microorganisms,  Cavity preparation, ultrasonic scaling Air-borne Infection

 Pre-procedural oral hygiene measures  Tooth brushing and flossing  Antiseptic mouth rinse WHY? (chlorhexidine, Listerine)  Interruption of transmission  Rubber dam, high volume evacuation, manual scaling  Clean water  Run waterlines 2-3 minutes before first patient, 30 seconds between patients  Protection of the clinician: PPE  Protection of the patient: protective eyewear. WHY? Prevention of Transmission

 Use waterlines that meet EPA regulatory standards for drinking  Biofilms form in tubing and waterlines that lead to hand-pieces, air-water syringes, & ultrasonic  Human pathogens including Pseudomonas, Legionella, Non-TB, & Mycobacterium species  Source of infections immuno-compromised patient Waterlines

 Use enclosed water systems  Flush lines  Avoid heating units  Educate  DUWL

 Free from contamination of microorganisms  Chain of asepsis: a procedure that avoids transfer of infection  Includes sterile conditions  Elimination of infection is the key to Asepsis not necessarily Sterile.

Sterilization  Process by which all forms of life, including bacterial spores, are destroyed by physical or chemical means Disinfection  An agent (chemical, x-ray, ultraviolet light)  Destroys microorganisms but may not kill bacterial spores  Substance applied to inanimate objects Sanitation The process by which organisms on inanimate objects is reduced to a safe level, cleaning process

Cleaning procedures Instrument washer or thermal disinfectors (Miele) Ultrasonic processing- Used in most dental offices, Prior to sterilization Manual cleaning- Wet 2X2 (Nitrile gloves) Instrument Cleaning Miele

 To prevent contamination of sterilized instruments as soon as they are removed from sterilizer.  Provide a means of storing instruments to have them available for patient appointment use  WHY? Purpose of Packaging

 Process by which all forms of life, including bacterial spores, are destroyed by physical or chemical means  Approved methods  moist heat- steam under pressure; dry heat- oxidation, chemical vapor  Method selection  All items can not be sterilized by certain methods. IMPORTANT CONCEPT  Tests for sterilization  External chemical indicator  Internal chemical indicator  Both  Biologic monitor- Spore testing Sterilization

MethodTimeTemperaturePressure Moist Heat- Steam Under Pressure min 20 min 250 F 121 C PSI Dry heat oven 120 min320 F 160 C No pressure Unsaturated Chemical Vapor 20 min270 F 132 C PSI Methods of sterilization

 Glutaraldehydes- (High) Alkaline, acidic, and neutral (Cold sterile soak)  Chlorines - dentures, water purification  Iodophors- broad spectrum, surface disinfectant  Phenolics- Synthetic (water or alcohol based) Chemical Disinfecting Agents

Surface Disinfection UseMode of ActionPreparation IodophorBroad spectrum w/residual biocidal activity Iodine released slowly from compound to create disinfecting action. 1 part Iodophor concentrate to 213 parts water Phenols (water, or alcohol based) Broad spectrum w/residual biocidal activity Destroys cell wall & precipitate protein. Chlorine CompoundsDisinfection; clean water lines, and dentures Microorganisms destroyed primarily by oxidation of microbial enzymes and cell wall components. Mixed Daily GlutaraldehydeHigh level disinfectants Kill microorganisms by damaging their proteins and nucleic acids. Two solutions activate when mixed together. 28 day life.

Instrument Cleaning and Processing

Steps for labeling packaged Instruments….

Surface Category DefinitionSterilization/ Disinfection Examples CriticalPenetrate soft tissue or bone Sterilize or disposeNeedles Curets Explorers Probes Semi-CriticalTouch intact mucous membrane, oral fluids Does not penetrate Sterilize or High level Xray bite block Ultrasonic handpiece Mouth mirror Non-CriticalDoes not touch mucous membrane Cleaning and TB Intermediate level disinfectant Light handles Xray parts Safety goggles EnvironmentalNo contact with patient Cleaning and intermediate to low disinfection Counter tops Equip. surfaces Housekeeping surfaces Inanimate Objects

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