2. Infection Control in Dental Radiology Dr. Raghunath Puttaiah & Dr. Hui Liang

3. Introduction & Rationale Most oral and maxillofacial radiology normally consists of non-invasive procedures Although exposure to blood is not common, contact with saliva does occur

4. What are the risks?? Common viruses seen in the oral cavity include— – cytomegalovirus, herpes simplex viruses-1 & 2, hepatitis-B and D viruses, hepatitis-C virus, influenza viruses, Epstein-Barr virus (infectious mononucleosis), Rhinoviruses (common cold), and HIV Common bacterial pathogens seen are— – Pseudomonas, Flavobacterium, Staphylococci, Streptococci, Diplococci, Pneumococci, Mycobacterium, Chlamydia, and Spirochetes from human or inanimate sources Candidiasis is also very common among dental patients

5. Rationale Most of Oral and Maxillofacial radiology (OMR) procedures fall mainly in the semicritical and non-critical categories of Spaulding's Classification of inanimate surfaces BUT Many contagious diseases such as— – Infectious mononucleosis and hepatitis-B can possibly be spread by simple contact with saliva Therefore, it is necessary for aseptic techniques to reduce ambiguity within protocols The purpose of this module is to present the most recent information regarding aseptic techniques in OMR.

6. What PPE is needed It is not usually necessary to wear PPE such as impervious gowns, long sleeves, masks and protective eyewear during routine OMR procedures when no aerosols, droplets or spatter are generated One may use gloves, gowns, masks and protective eyewear while treating patients with gagging problems While handling the processor and the chemicals, use full PPE Stay out of the Radiation Hazard area (behind a shield) Patients must be protected with a lead apron

7. Disinfectants and Barriers Barriered films should be used when available Between patients, frequently touched areas must be— – Barriered with plastic barriers OR -Disinfected with an Intermediate level, Hospital Disinfectant using a Spray-Wipe-Spray technique If barriers are used between patients, disinfection is only needed at the beginning or end of the day

8. Steps in Infection Control Unit Dose— 1. Pre-procedural mouthrinse for patients Make them rinse for about 30 seconds to reduce the microbes in the mouth 2. PPE- Gloves Masks Eyewear Gown

9. Steps in Infection Control Prepackaged films with plastic barriers

10. Unbarriered films

11. Barriered Films

12. Steps in Infection Control 1.Unit dose supplies and sterile equipment on to a clean bib/work surface 2. Set up the films on to the positioning devices 3. Label cups as Exposed and Unexposed

13. Use of Disinfectants and Barriers Disinfect surfaces at the beginning and end of each day, and between patients only if contaminated Avoid spraying electrical switches, wipe with disinfectant moistened paper towel Apply surface covers to the yoke, tube head, cone, control unit, head rest, arm rest, and any hand held switches

14. Aseptic Procedures Place the sanitized lead apron and collar on the patient after seating the patient Set the required mA, kVp and exposure time on the control unit and reset as required Use Foot Controlled Trigger Switch if possible

15. Now Please expose the Radiograph The whole purpose in dental radiology is to Get the radiograph

16. Inside a daylight loader Place the cup with exposed films on one side and the Empty one on the other Place a clean bib or napkin as a barrier Dispense a pair of gloves

17. Daylight Loader with Films Inside Be sure to close the lid before exposing the films

18. Donning Gloves inside the Loader

19. Various layers inside the polysoft film cover Polysoft cover Radio-opaque metal foil on the rear of the film Paper folder that secures the film Film

20. Processing Barriered Films Exposed film Wear gloves Peel the outer cover and drop the film into the “Exposed” cup This should be done chairside

21. Step 1 Step 2 Step 4 Step 3

22. Bare hands with barriered film inside a daylight loader

23. Bare hands to be used to handle exposed and peeled film

24. Unbarriered Films Step 1 Step 2 Step 4Step 3

25. Now try this inside a daylight loader

26. Bare hands to be used to handle exposed and peeled film Remove your gloves and then handle the film that has been taken out of the Polysoft cover

27. Clean up after loading films Carefully hold the edge of the napkin or bib and fold it over the waste You need not wear gloves if you hold the non-contaminated corners

28. Disinfect the Daylight Loader once or twice daily if barriers are used Barriers limit the use of disinfectants

29. Panoramic Radiography In panoramic radiography, infection control procedures are very simple Patient needs to have a lead apron No contact of film with saliva Only one barrier is needed

30. Panoramic Radiography Chin rest Bite block Barriered positioning device

31. Panoramic Radiography Infection Control in Panoramic radiography is very simple All one needs is a barrier for the bite block Make sure the lead apron is on Film loaded on to the cassette Stay outside of the active radiation area

32. Panoramic Radiography This film does not come in contact with saliva

33. Panoramic Radiography Position the patient correctly

34. Panoramic Radiography Make the patient remove the barrier on the bite block

35. Digital Radiography

36. Sensor Barrier or sleeve Sensor being inserted into barrier Sensor Barriered

37. Digital Radiography 1.Insert the barriered sensor in the film holder on the Rinn holder

38. Digital Radiography Slide this door open

39. Digital Radiography Peel open the barrier without touching the sensor

40. Digital Radiography Slide the sensor into the chamber for the computer to read the image

41. Digital Radiography

42. Image appears on the screen within seconds