1. Registered Dental Assistant: Infection Control Techniques
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By Janice Lewis

2. Routes of Infection Transmission
Direct
Contact with lesion or microorganism
Blood or saliva
Open lesion
Indirect
Cross contamination
Countertops, equipment
Pens, charts
Inhalation
Microorganisms inhaled
Handpieces
Ultrasonic cleaner

3. Infection Control Techniques
The dental assistant must maintain his or her health and should make sure all immunizations are current. This will keep the immune system working to fight infection.
At each appointment the dental assistant should discuss the patient’s medical history to be sure the information on the patient is up to date and accurate. This will allow any current problems or risks to be identified and procedures can be put in place to prevent any further spread of infectious agents.
Handwashing is the most important method to maintaining infection control and preventing the spread of disease. The hands should be thoroughly washed at the beginning of the day, before and after every patient care, donning and removing gloves, breaks, and at the end of each day.

4. PPE - Eyewear Personal protective equipment – eyewear
Protects mucous membranes from spatter of blood and saliva
Hepatitis, Herpes simplex, and pink eye
Metals and enamel may injury eye.
Over glasses designed to be worn over eyeglasses
Side shield may be placed on personal eyewear. Difficult to see in slide.
Goggles with side shields

5. PPE - Gloves Personal protective equipment – gloves
Latex allergies are common
Petroleum-based lotion prior could break down gloves
Change gloves after each patient
Polynitrile autoclavable gloves
Overgloves
Utility gloves

6. PPE – Masks and Clothing
Face shield to be worn in addition to mask
Goggles rest on top of side shields
Protective Clothing
Only to be worn in the dental offices, not to lunch or home
Must close tightly at neck and around cuff area
During a high-risk procedure, must bbe knee length
Must be laundered in office or sent to laundry service

7. Chemical Disinfectants
Physically remove all debris
Cleaned:
Microorganisms still exist
Sanitized
Some microorganisms destroyed
Disinfected
All microorganisms destroyed
Sterilized
Various disinfectants are used in the dental office. Some provide high level disinfection and some low or moderate level disinfection
Chlorine Dioxide
Glutaraldehyde
Sodium hypochlorite
Iodophor
Phenolics
Alcohol

8. Ultrasonic Cleaner Holding bath Three to ten minute cleaning cycles
Sound waves used
Loosens hardened debris from instruments prior to sterilizing by submerging instruments.
Cavitation process is where bubbles implode.

9. Sterilization Methods
All forms of microorganisms are destroyed in the process of sterilization.
Dental assistant most often is the person who ensures that all items used in intraoral procedures are sterile.
Many types of machines and tools used to sterilize.
Liquid chemical disinfectant
Ethylene oxide
Hot glass bead or salt
Dry heat
Chemical vapor
Steam under pressure
Steam Autoclave

10. Sterilization Monitoring
Biological monitors are often the most accurate way to assess that sterilization has occurred.
Process indicators are normally heat-sensitive tapes or inks printed on packaging materials.
Dosage indicators are dyes placed in the sterilization packaging and change color when exposed to dry heat, chemical vapor, or steam.
Monitors for liquid disinfectants/sterilizers do not exist; however, by using several strips to test concentration and following EPA directions, this ensures the product is working.

11. Infection Control Techniques
The use of a preprocedure mouth rinse is a recommendation. This reduces the number of microorganisms in the patient’s mouth before treatment.
The high volume evacuator will effectively reduce spray coming from handpiece and air-water syringe. This reduces the risk of inhalation exposures and releasing pathogens into the air.
The dental dam provides a barrier to the fluids in the oral cavity during procedures.
Equipment that can be disposed of after one use eliminates the possibilities of transferring microorganism by cross contamination.

12. Clinical Asepsis Asepsis Environment free of pathogens
Housekeeping standards
Government guidelines
Creating an environment free of pathogens is key. A dental office should always be not only meeting government standards, but striving to keep things as clean as possible.

13. Treatment Room Preparation
After chart has been reviewed, it can be placed under a plastic envelope barrier or under a surface barrier.
New barriers could be placed on dental chair, hoses, counter, light switches and controls, etc.
Instrument tray should include packaged sterile instruments with patient’s napkin and protective eyewear.
PPE should be last, including eyewear, mask, gloves, and over gloves.

14. Completion of Dental Treatment
Move tools back to the treatment tray
Gloves should be kept on until all potentially infected materials have been removed and disposed of correctly.
A final washing of the hands is also imperative.

15. Final Cleaning Put on utility gloves
Spray-wipe-spray-wipe technique
Set routine
By following a routine procedure that meets all regulatory standards as well as each individual office, the dental assistant completes this practice.

16. References
Dental Assisting: A Comprehensive Approach (3rd. Ed.) by Phinney and Halstead. Thomson /Delmar Learning, 2008