2. Presented to: Dr. Manzar Anwar Dr. Shakeel Anwar Dr. Shazia Makhdoom Presented By: Jawad Ullah Shah Class # 04 1

3. Infection Control In Dentistry 2

4. CONTENTS: Definition Aims Of Infection Control Cross Infection Chain of Infection Route of Transmission Centre of disease control (CDC) recommendations Decontamination Spaulding’s classification of instruments Prevention Barrier technique 3

5. What is Infection The entry and development or multiplication of an infectious agent in the body of the host i.e. humans or animals to produce disease. 4

6. Infection Control Primary Objective Elimination or reduction in spread from all types/forms of microorganisms. Factors involved in infection control Prevention and spread of microorganisms from their host (patient & clinician). Killing or removal of microorganisms from objects and surfaces. 5

7. Aims of Infection Control  To control/prevent iatrogenic infections from their hosts among patients and clinicians.  To Control/prevent Occupational Exposure.  To control/prevent Cross Infection. 6

8. Cross Infection Transmission of infectious agents among patients and staff within a clinical environment. 7

9. Pathways of cross infection  Patient to patient  Patient to practitioner  Practitioner to patient  Clinic to community  Clinic to practitioner’s family  Community to Patient 8

10. Common Transmissible Infectious Diseases in Dentistry HIV HBS HCV Mycobacterium Tuberculosis 9

11. Chain of Infection Pathogen Source ModeEntry Susceptible Host 10

12. Chain/Process of Infection. An adequate number of pathogens, or disease-causing organisms, to cause disease. A reservoir or source that allows the pathogen to survive and multiply (e.g., blood). A mode of transmission from the source to the host. An entrance through which the pathogen may enter the host. A susceptible host (i.e., one who is not immune). 11

13. Infection through any of these routes requires that all of the following conditions be present: An adequate number of pathogens, or disease-causing organisms, to cause disease. A reservoir or source that allows the pathogen to survive and multiply (e.g., blood). A mode of transmission from the source to the host. An entrance through which the pathogen may enter the host. A susceptible host (i.e., one who is not immune). The occurrence of all these events is considered the “chain” of infection. Effective infection control strategies prevent disease transmission by interrupting one or more links in the chain of infection. 12

14. Routes of transmission  Direct contact of tissues with infective biological fluids. 13

15. Routes of transmission  Indirect contact with contaminated instruments 14

16. Routes of transmission  Inhalation of infective droplets / particles 15

17. Routes of transmission  Direct inoculation into cuts/abrasions via contaminated instruments 16

18. Centre of Disease Control (CDC) recommends: “Consider each and every patient to be operated as potentially infectious and routinely take standard/universal precautions for each, to protect ourselves and to prevent cross infection”. 17

19. Decontamination Sanitization—first level Disinfection—second level Sterilization—third level 18

20. Decontamination Sanitization Reduction of viable microorganism to safe levels. Sterilization It is the process by which all forms of microorganism are destroyed. Disinfection/Antisepsis It is the process by which chemicals are used to prevent the multiplication of microorganism capable of causing infection. 19

21. Decontamination Antiseptic For living tissues (animate). Disinfectants For Non living things (Inanimate). 20

22. Methods of Sterilization in Dentistry Autoclave Chemiclave Dry Heat Other Methods Ethylene Gas Boiling water Ionizing Radiation 21

23. Methods of Sterilization in Dentistry Autoclave: It is an efficient and reliable method by which instruments are sterilized, using steam under pressure which acts by inactivating essential cellular proteins or enzymes of microorganisms. It is ideal form of sterilization. (spore strip) Dry heat sterilizer: These sterilizers use hot air to kill microorganisms by oxidation. They do not cause corrosion. 22

24. Methods of Sterilization in Dentistry Chemical vapor sterilizer: Alcohols, Formaldehyde, ketone, water and acetone are heated under pressure produces a gas that is effective for sterilization by permeation of the heated formaldehyde and alcohol. Time 120 min. Temp. 120º C to 132º C with 20-40 lbs pressure. Gaseous Sterilization: Ethylene oxide gas when mixed with CO2 or N2. At 50ºC, time 3 hours it kills all microorganism including spores. 23

25. Dry-Heat TemperatureDuration of Treatment 120º C (250º F)6-12 hours 140º C (285º F)3 hours 160º C (320º F)2 hours 170º C (340º F)1 hours 24

26. Steam Sterilization Temperature Duration of Treatment 116º C (240º F)60 minutes 118º C (245º F)36 minutes 121º C (250º F)24 min 125º C (257º F) 16 min 132º C (270º F) 4 min 138º C (280º F) 1-1/2 min 25

27. Spaulding’s classification of instruments 1- Critical 2- Semi critical 3- Non critical 4- Environmental 26

28. Critical Items that are used in various specialties of dentistry which pierce soft and hard tissues. Burs, chisels, forceps. DISEASE RISK High METHOD Sterilization EXAMPLES Surgical instruments 27

29. Semi Critical Items which do not pierce soft and hard Tissues but cross vermillion border into the oral cavity. Mouth mirrors, condensers DISEASE RISK High METHOD Sterilization or Disinfection EXAMPLES Hand piece, syringes, Impression trays. 28

30. Non Critical Items that are used in various specialties of dentistry which do not cross vermillion border or penetrate soft and hard tissues. X-ray heads DISEASE RISKModerate METHOD Surface disinfection, Sanitization & barrier EXAMPLES Dental unit & accessories 29

31. Environmental Items not directly in contact with skin or mucous membrane DISEASE RISKLow METHODCleansing EXAMPLESTables,counters Floor surfaces & door handles 30

32. How to prevent cross infection ? 31

33. From infected patient to other patients How to prevent cross infection? 32

34. 1. Use of disposable materials 33

35. 2. Disinfecting surfaces with Halogens compounds Aldehydes 34

36. 3. Sterilize reusable instruments (Autoclave) 35

37. DISINFECTION AND STERILIZATION METHODREDUCTION Cleaning90% Disinfection99.9% Sterilization99.9999% 36

38. From infected patient to dental staff How to prevent cross infection? 37

39. 1- To recognize carriers history of  Hepatitis/Jaundice  Venereal disease  Intravenous drug use  Hereditary bleeding disorders 38

40. 2- To recognize groups of people having high risk of exposure.  Hemodialysis patients and technician  Hemophiliacs and blood bank workers  Dental Surgeons  General surgeons 39

41. 3- Use of barrier technique during  Surgery  Handling of contaminated objects  Clean up 40

42. 4- Prompt disposal of sharp objects into a well-labeled protective container. 5- Use of an instrument to place a scalpel blade on or taking one of a blade handle. 41

43. 6- Disposal of needles immediately after use rather than resheathing. 7-Vaccine 42

44. Refrences S S Hremeth Wikipedia http://www.cdc.gov/oralHealth/InfectionControl/ https://www.osha.gov/SLTC/dentistry/index.html 43

45. “He That Has accquired learning and nor practised what he has learnt,is like a man who ploughs but sows no seed”. By Sheikh Saadi 44

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