Infection Control

Introduction
The field of infection control is deeply seated within the discipline of microbiology. Infact, microbiology had its beginning as a science concerned with the control and identification of microorganisms in attempts to explain and prevent diseases. An understanding of the physical and chemical properties of the microorganisms, where microorganisms exist, how they grow, how they are influenced by the environment or special physical and chemical agents and how they cause specific diseases of concern form the basis for killing microbes and understanding and preventing them spread from person to person. Also, a general knowledge of immunology and body defensive mechanisms contributes to the understanding of disease prevention through immunization and through reliance on the bodys natural barriers against infection. History of microorganisms and infection control procedures iseases were recognized long before their causative agents. Italian physician !irolomo "racartouis in #$%& is given the credit for being first to recognize the existence of tiny living particles that cause 'catching( )contagens* diseases by being spread by direct contact with humans and animals and by indirect contact with ob+ects. Antony ,an -eeuwenhoek first observed what he called 'animal cules( )bacteria, yeast and protozoa* in #&&.. The microbes become visible when he observed tooth scrapings under a simple microscope.

The relationship of these animalecules to disease was not established until. 'The !olden age of /icrobiology( in the mid0to0late #122s by researchers such as -ouis 3asteur )"rance*, 4obert 5och )!ermany*, -ord 6oseph -ister )7ngland* and 8ilby /iller )9:A* who became known as the '"ather of ;ral /icrobiology(. The golden age of microbiology also brought about the basis for diseases prevention through use of infection control procedures. :emmelweiss in ,ienn and <olmes in 9:A first recognized the importance of hand washing in preventing the spread of disease agents. The use of heat to destroy vegetative bacteria and resistant bacterial spores has recognized by 3asteur and 6ohn Tyndall. They used boiling water to kill bacteria and the process known as pasteurization. -ord -ister as a surgeon became concerned about post operative infections and demonstrated that boiling instruments and washing his hands and surgical liners with phenol before surgery greatly reduced these complications. <e also prepared that infections of open wounds were caused by microbes in the air, so he sprayed the air around his patients with phenol before surgery. The activities of our bodys immune defense mechanisms were recognized about four centuries ago. 8hen it was known that some individuals who recovered from a sickness did not get that diseases a second time. 7dward 6enner is credited with recognizing the concept of immunization in #.=2s. 3asteur became the 'father of immunology( for his work in developing immunization techni>ue.

The development of infectious disease. There are several cause of disease in the body some are associated with microorganisms. An infectious diseases occurs when a microorganism in the body multiplies and causes damage to the tissues. The microorganisms that cause infectious diseases are called pathogens. There are two types of infections disease: Endogenous disease @ Aaused by microorganisms that are normally present on or in the body. 7xample of oral endogenous disease caused by normal oral flora are dental caries, pulpitis, periodontal diseases and cervicofacial actinomycetes. These are Bopportunistic pathogens. Exogenous disease @ caused by microorganisms that are not normally present on or in the body but contaminate the body from the outside. /ost infectious diseases are exogenous. 7.g. <epatitis C., AI :, /easles, some exogenous organisms cause toxigenic diseases by producing toxins or poisons. :teps in the development of diseaseD 0 0 0 0 0 0 :ource of the microbe. 7scape of the microbe from the source. :pread of the microbe to a new person. 7ntry of the microbe into the person. Infection )survival and growth of microbes*. amage to the body. The ma+or source of disease agents in the dental office are the mouths of the patients. Although can be present any where in the office )surfaces, dust,

water, air and dental team themselves*, of greatest concern are in the mouth of patients, it is not possible to accurately detect which patients may indeed be harboring these pathogens. Therefore infection control procedures must be applied during the care of all patients using the concept of 9niversal precautions. Cased on an understanding of asymptomatic carriers of disease agents. 3ersons who have disease agents but have no recognizable symptoms of the disease, they are the most important source for spread of disease agents, dental team will not be aware of the potentially infectious nature of patients because of no recognizable symptoms. :tages of an infectious diseaseD There are four stagesD #. Incubation. ?. 3rodromal. E. Acute and %. Aonvalescent.

Incubation stage @ period from the initial entrance of the infectious agents into the body to the time when the first symptoms of the disease appear, range from a few days to years. epending on the disease0producing potential of the microorganisms the number of microorganisms, resistance of the body. 0 0 0 "or hepatitis0C is usually several weeks. "or the rare 'slow virus( infections, it may be $2 or &2 years. 3erson infected with the human immunodeficiency virus )<I,0#* may be free of recognizable symptoms for #2 years or longer after the virus initially enter the body.

Prodromal stage D This stage involves the appearance of early symptoms first symptoms commonly called malaise )not feeding well* may include slight fever, headache and upset stomach. Acute stage D 8hen the symptoms of the diseases are maximal, potential to spread the disease, agents. Convalescent stage D is the recovery )stage* phase number of microorganisms may be decreasing infectious agents may be spread during this stage. :ome may never, fully recover from the disease. The symptoms may occur over a long period or may occur intermittently such as hepatitis C and tuberculosis. Escape from the source : /icroorganisms escape from the mouth during a variety of natural mechanisms, such as coughing, sneezing and talking. Anything that is removed from the patients mouth is contaminated )hands, instruments, hand pieces, x0ray film, cotton, precuts, needle etc. pread of microbes to another person /icroorganisms that have escaped from a patients mouth may be spread to others by three basic modes. 0 0 0 irect contact. Indirect contact. roplet infection.

!irect contact D Touching soft tissue or teeth in the patients mouth. !ives microorganism an opportunity to penetrate the body through small breaks or cuts in the skin and around the finger nails of ungloved hands.

Indirect Contact D Aan result from in+uries with contaminated sharps )e.g. needle sticks* and contact with contaminated instruments. These items and tissues can carry a variety of pathogens, usually because of presence of blood, saline as other contamination from a previous patient. !roplet infectionD :pread through aerosols and spatter, spatter generated may contact unprotected broken skin or mucous membrane of the eyes, noses and mouths of dental team, smaller aerosols particles spread through air providing potential for inhalation of the microorganisms. )Infection D Infection is the multiplication and survival of microorganisms on or in the body*. Entry into a new person 4outes of entry of microbes into the bodyD 0 0 Inhalation. Ingestion. 0 /ucous membranes. 0 Creaks in the skin.

Infection D An infection doesnt always indicate disease, but seldom results without infection. !amage to the body D Infecting microorganisms usually must multiply to a harmful level for disease to occur. Thus a harmful infection is the first step in development of an infectious disease. Host Defense Mechanism <ost defense against harmful infections are grouped into two categoriesD a. Innate and b. Ac>uired.

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Innate host defenses are D Physical barrier 0 :kin 0 /ucous membranes 0 Architecture of respiratory tree "echanical barriers 0 8ashing actions of secretion and incubation 0 :ticky nature of mucous, Ailiary excavator 0 es>uamation of skin and mucous membranes

0 Aoughing and sneezing, <air in the nose. Antimicrobial chemicals 0 <ydrochloric acid in stomach. 0 ;rganic acid on skin and vagina. 0 -ysozyme, 3hagocytic killing systems. 0 Interferan, Aomplement fragments. Cellular barrier # 3hagocytes Ac$uired Immunity - If a microbe invades the body, it usually activates a special host defense system directed specifically against that invading microbe. ;nce this system is activated, it attempts to prevent serious harm from that microbe and may provide protection against subse>uent invasion of the body by that same microbe. Artificial immunity D Artificial immunity involves being immunized or vaccinated against a specific disease.

Pathogens and other disease agents 3atients mouth is the most important source of potentially pathogenic microorganisms in the dental office. )3athogenic agents* may occur in the mouth as a result of four basic conditions. 0 0 0 0 Clood borne diseases. ;ral diseases. :ystemic disease with oral lesions and 4espiratory diseases. Clood or other body fluids like saliva, may contain the pathogens, the disease may be spread from the person to another by contact with the fluids. 7xamples D <epatitis0C, <I, infection and AI :, <erpes infection, :yphilis. Clood borne pathogens may enter the mouth during dental procedures that induce bleeding. Thus, contact with saline during such procedures may result in exposure to these pathogens if present. :aliva from all dental patients should be considered as potentially infectious. <epatitis0C usually transmitted by direct contact with infected body fluids. A millimeter of blood from an infected person may contain as many as #2 million virus particles. /eaning that only small amounts of blood or saline are necessary to transmit the disease to others. )The hepatitis C, vaccines of the <Cs, Ag that is synthesized in the laboratory by genetic engineering techni>ues*. <epatitis C virus has been shown to be killed or inactivated by commonly used methods of sterilization and disinfection including the steam autoclave and #2 minutes exposure to # D #22 diluted bleach #D#& diluted phenolic glutaraldehyde .$ parts per million iodophor and .2F isopropyl

alcohol. Thus <C, is relatively easy to kill when outside the body, provided the killing agent comes into direct contact with the virus one or more easily killed than mycobacterium tuberculosis and bacterial spores. The carrier state is being <CsAg0positive on at least two occasion when tested at least ? months apart or being <bsAg positive and Ig/ anti <Cc negative at a single test. Anyone who is positive for <CsAg has a potential to spread the disease to other. 9nvaccinated member of the dental team are at least two to five times more likely to become infected with <C, than the general population. The chances of any patient ac>uiring any disease in a dental office is extremely low, if the dentists routinely wear gloves. There is no successful medical treatment to cure this disease prevention is of paramount importance. HI% disease : Human Immunodeficiency virus disease involves destruction of the bodys immune system, making the individual to life threatening opportunistic infections. A person with antibodies to <I, is referred to as being '<I, positive(. Indicating that the person is infected with the virus. 3eople with asymptomatic <I, infection still can transmit the virus to others. <I, positive patient experience one or more of indicator opportunistic infections or a career, the symptoms experienced depend on the type of infection or career that occurs.

Transmitted from an infected person through intimate sexual contact exposure of blood, body fluids perinatal contact. Although <I,0# has been isolated from saliva so far no cases of transmission have been documented by the route in causual or household contact. The extremely low risk for transmission through salive may be attributable to the low concentration of the virus in the saliva of infected persons. Gevertheless ':aliva in dentistry( is still considered to be potentially infectious because of the intimate contact with the patients mouth during dental care and because of most dental procedures result in varying degrees of bleeding into mouth. ;ne half of infants who have <I, positive mothers are infected either before the birth through placent, at the time of birth by contact with mothers blood during delivery, or less commonly through breast milk. The rate of <I, disease transmission from dental patients to members of the dental team is extremely low there is some small potential for this to occur. The risk for a dental patient ac>uiring <I, disease in the office from a member of the dental team must be extremely low. A dentist <I, infected six of his patients being treated in his "lorida dental office during the year #=1.0 #==2. the investigation of this case demonstrated significant similarities in the viruses. Aenters for disease control and prevention suggested that direct spread from the dentist to the patients was most likely rather than spread from contaminated instruments ) irect contact*. It is important to maintain proper infection control during care for all patients. 3revention, abstinence or limiting sexual activities to one partner, who is not infected and not having any other sex partner. A lesser level of protection is

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offered by safer sex practices @ use of condoms to eliminate or minimize contact with body fluids that may contains <I,. In+ections 0 drug abusers must not use blood contaminated needles continued screening for <I, infectivity of blood for transfusion. All the dental team and health care workers must protect themselves from capsules to blood saliva and other potentially infectious body fluids. Aontaminated sharps must be handled and disposed of properly. !loves, mask and protective eyewear and clothing must be used during the care of all patients and in other instances to prevent direct or indirect contact with body fluids. &ral diseases Herpes infections D may cause infections of the mouth, skin, eyes and genital and those who have depressed immune systems may have a widespread infection. The herpes simplex infection experience the typical symptoms of oral herpes )primary herpetic gingivo stomatitis*. In this vesicle type lesions occur in the mouth. /ost herpes viruses )e.g. herpes simplex vericella zoster, ebstin bar virus* cause recurrent disease. An example is herpes labialis, sometime causes fever bleeding with lesions periodically appearing on the lips. The causative varicella zoster virus remain in the body for years later causing shingles. ,esicles during active herpes at any site of the body contain the virus which may be spread to others by direct contact with there lesions. Also herpes simplex virus may be present in saliva, in those with oral or lip lesions. In small cases, sprays or aerosols of the saliva may result in spread of the virus to

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infected eyes of the dental team. 7ntrance of the virus through break in the skin or unprotected hands and fingers can lead to vesicle development at these sites called 'herpetic whitelow(. ;ther important oral disease agents that may have some potential for spread to the dental team areD Trepanoma palladium and neisseria gonorrhea, Trepanoma palladium is the causative agent of syphilis about $0#2F of the cases of syphilis first occurs in the mouth in the form of a lesion called a primary chancre an open ulcer fre>uently occurs on the tongue or lips. These lesions do contain the live spirochetes and may be spread by direct contact. The possibility of the spirochetes entering small cuts or breaks in the skin of unprotected hands of the dental team exists and has been demonstrated in one instance causing syphilis of the finger. Geisseria0! a gram negative bacterium may be spread to the mouth during certain sex practices with an infected person, and the bacterium might cause an inflammation of the throat area. spread from a patient to dental team is never been documented there may be some potential for this to occur during generation of dental aerosols. G.!. can cause eye infections. Herpengina and hand foot mouth disease <epeangina appears as vesicles on the soft palate or elsewhere in the posterior part of the mouth that break down to ulcer that last for about a week. "ever, sore throat and headache fre>uently accompany the vesicular stage. The lesions are caused by coxsachievirus which also causes another vesicles type of disease in the mouth the hands and feat in this instance, the oral vesicles occur primarily on the cheek mucosa and tongue sometime on the hardpalate and any where else in the mouth.

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&ral candidiasis D Aandida albicans is a yeast that occur in the mouth asymptomatically in about one third of the adults. It is an opportunistic pathogen. It may result in oral disease called through or oral candidiasis might include conditions that disturb our body defense mechanisms such as the systemic disease of <I, infection, and leukemic long term broad spectrum antibacterial therapyH trauma to the mouth from poorly fitting dentures causing stomatitis. :pread of A.albicans from a patient mouth to the dental team is theoretically possible through direct contact with lesions or sprays or aerosols of infected saline. <owever unless the contaminated member of the dental team was lowered body defense the contamination will likely not lead to a harmful infection. Chic'en Pox @ the varicella0zoster enter the body by droplet infection invades the respiratory tract and is spread through the blood stream to the skin and other organs. After two weeks, vesicles fre>uently occur in the mouth, the disease is highly contagious through droplet infection and is usually mild in children can be more severe in teenager and adults. (espiratory disease treptococcal pharyngitis D streptococcus pyogens cause streptococcus pharyngitis is spread by droplet infections from mouth to mouth. Ahildren and adults carry :0pyogens in their noseIthroat area without having any symptoms and can spread the organism to others in respiratory droplets. Tuberculosis D is a lung infections caused by the bacteria mycobacterium tuberculosis. The risk for the dental team of ac>uiring this disease is likely low. Cecause prolonged exposure to an infectious environment is usually re>uired for infection to occur while direct contact appears to be of little risk. The

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disease is ac>uired by breathing in respiratory droplets from an infectious person and must be given concern by the dental team. treptococcal Pneumonia D /any bacterial and viral agents can cause pneumonia. Cut streptococcus pneumonia is of a particular importance it is spread by droplet inhalation of respiratory I oral droplets, a vaccine is available for the most common types of :.pneumonia and is recommended for elderly. ;ther respiratory diseases that spread by inhalation of infected respiratory I oral droplets include influenza, the common cold infection mononuclear measles, mumps and rubella.

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)aterborne disease: Gewer studies have shown that water inside dental units and hoses for water spray hand pieces and the airIwater syringes may be contaminated with bacteria. This has not yet been recognized as a ma+or proble in dentistry. Also retraction of oral bacteria back into the handpiece and airIwater syringes and their connecting water lines may occur when these instruments are turned off. ental units contain anti0 retraction valves to prevent this from occurring but these valves do fail periodically. Thus, dental unit water should not be used to irrigate surgical sites and the water lines should be flushed at the beginning of the day and between patients to reduce the numbers of oral microorganisms. Infection Control (ationale and (egulations (ationale : The basic logic for routinely preventing infection control is that the procedure involved interfere with the steps in development of diseases that may be spread in the office. Pathways for Cross#contamination A total office infection control to prevent or at least reduce the spread of disease agents fromD 0 0 0 0 3atient to dental team. ental team to patient. 3atient to patient. ental office to community, including the dental team facilities.

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Patient to dental team: There are numerous opportunities for spread of patient microbes to members of the dental team, this pathway is more difficult to control than other three pathways. irect contact )touching* with patients saliva or blood may lead to entrance of microbes through a nonintact skin resulting from cuts, abrasion.:prays, spatter, or aerosols from the patients mouth may lead to droplet infections though nonintact skin, mucosal surfaces of the eyes, nose and mouth or inhalation. Indirect contact involves transfer of microorganisms from the source to an item or surface and subse>uent contact with the contaminated item or surface. !ental team to patient : :pread of disease agents from the dental team to patient is indeed a rare event but could happen if proper procedures are not followed. If the hands of dental team members contain lesion or either nonintact skin, or if the hands are in+ured while in the patients mouth, blood borne pathogens or other microbes could be transferred by direct contact. The patient may have indirect contact with blood borne pathogens or other agents if a member of the dental team bleeds on instruments or other items that are then used in the patients mouth.

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Patient to patient :

isease agents might be transferred from patient to patient

by indirect contact through improperly prepared instruments, hand pieces and attachments operatory surfaces, and hands, transfer of the herpes simplex virus from a patient to the hands of a hygienist and then to the mouths of general patients has been documented. !ental office to community: This pathway may occur if microorganisms from the patient contaminate items that are sent out or are transported away from the office. 7xample, contaminated impressions or appliance or e>uipment needing service may in turn indirectly contaminate personnel or surfaces in dental laboratories and repair centers. ental lab technicians have been occupationally infectd with herpatitis C virus )<C,*. Also regulated waste that contains infections agents and is transported from the office may contaminate waste if it is not in proper containers. Immunity from herpatitis C vaccination protects the dental team from ac>uiring the diseases and passing it along to family members. *oal of infection control After microbes enter the body, there are three basic factors that determine if an infections disease will develop. 0 0 0 ,irulence )pathogenicity*. ose )number of microorganisms*. 4esistance )body defense*.

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<ealth is favored by low virulence, low dose, high resistance, disease is favoured by high virulence high dose, and low resistance, prevention of infectious disease involves influencing the determinants to favour health. %irulence D if microorganisms in active natural environment cannot be easily changed. Thus our body defenses must deal with whatever microbe that presents itself. 8e can enhance our resistance to infectious disease through specific immunization )7.g. hepatitis C. tetanus* but immunization are not available against all of the diseases. Thus the only disease determinant we can effectively manage is the dose and management of the dose is called infection control. Thus, the goal of infection control is to eliminate or reduce the dose of microorganisms that may be shared between individuals or between individuals and contaminated surfaces, the greater the dose is reduced the better the chance for preventing disease spread. 3rocedures that minimize spraying spattering of oral fluids )e.g. 4ubber dam, high volume evacuation, preprocedure mouth rinse* reduce the dose of microbes that escape from the source. <and washing and surface precleaning and disinfection reduce the number of microbes that may be transferred to surfaces by touching. Carrier such as marks gloves, and protective eyewear and clothing reduce the number of microbes that contaminate the body or other surfaces instrument precleaning and sterilization eliminate or reduce the number of microbes that may be spread from one patient to the next. 3roper management of infectious waste by using appropriate container for disposal eliminates or reduce the number of microbes that may contaminate people or inanimate

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ob+ects.

isease prevention is based on reducing the dose and increasing the

bodys resistance. (ecommendations and (egulations (ecommendations are made by individuals or groups that have no autotoxicity for enforcement. (egulations are made by groups that have the authority to enforce compliance, usually under the penalty of fives, imprisonment, or revocation of professional licensor. /ost infection control procedures practiced in dentistry are based on recommendations made by the Aenters for iseases Aontrol and 3revention. :ome state and local regulations exist in relation to medical waste management, instrument sterilization and sterilizer spore testing in dentistry. "ood and drug administration regulates the manufacturing and labeling of medical devices )such as sterilizer and biologic and chemical indicators, ultrasonic cleaners and cleaning solutions, gloves, masks surgical gowns, handpieces, li>uid sterilants, and disinfectants and age of antimicrobial hand washing agents and mouth rinses. The purpose is to assume the safety and effectiveness of medical devices.

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Immuni+ation:

ental personnel are exposed daily to a variety of

communicable diseases personnel protective barriers such as gloves, masks, gowns, and protective wear help prevent the ma+ority of cross infections. Immunization when available, however is the most effective method to reduce the chances of disease ac>uisition. Tetanus )lock+aw* is a disease with a high case fatality ratio. It can be an infectious complication of any cut and for puncture wound and is caused by the toxins of clostridium tetani. Tenanus endospores are continually present in the environment and because they are >uite resistant to disinfection procedures an overt effort must be made to control them spread. /eticulous handling of all wounds and the monitoring of immune status are essential. Absorbed tetanus toxoid when given in the complete primary form provides long lasting protection for at least ten years in properly vaccinated recipients. The hepatitis C virus is an infectious agent associated with acute and chronic hepatitis is a ma+or cause of necrotizing vaculitis, cirrhosis and primary hepatocellular carcinoma. 3ersonnel protective barrier can not eliminate all body fluid exposures, especially needlestic accidents. Therefore the best protection against <C, infection is immunization. Two vaccines 4ecombivax <C, and 7ngerix C are currently available. Coth are recombinent fungal products and can be used interchangeably. The most common vaccine regime consists of #2ml doses given at 2, # and & months. The need for a booster infection is still being debated.

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Protective barriers : Aontamination of the body with microorganisms should occur before disease can develop, it is always better to prevent contamination than to rely totally on our bodys resistance to fight off disease agents after contamination. 8hen exposure is likely, the best way to prevent contamination is to use protective barriers such as gloves, masks, protective eye wear and protective clothing. *loves D Got only protect dental team from direct contact, also protect patients from microorganisms on the hands of the dental team. Another advantage of wearing gloves is protection against contact with chemical that may irritate the skin such as cleansers disinfection, sterilants, x0 ray developing solutions and some dental materials. Types of gloves in dentistry Patient care gloves 0 0 0 0 0 :terile latex surgeon gloves and examination gloves. :terile venyle gloves. Gon0sterile letex and venyle examination gloves. 3owderless gloves, <ypoallergenic gloves. "lavoured gloves.

,tility gloves 0 0 0 <eavy latex gloves <eavy or thin nitrile gloves Thin copolymer gloves and thin plastic )food handler* gloves.

&ther gloves # <eat resistant gloves, ental gloves.

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isposable gloves should be worn during all patient care activities where there is a potential for direct hand contact when away from chairside, use inexpensive copolymer or plastic gloves or a sheet of plastic wrap over the patient care gloves )overhanging* to prevent spread of the patients microbes to surfaces that are touched. :terile latex or vinyl gloves are used during surgical procedures, it is important to use gloves that fit properly to ensure efficient handling of items and to prevent fatigue of the hands. Allergic reactions to gloves by dental team members and by patients can occur because of substances in the glove materials itself or in the dusting powder latex. ental gloves of thick cotton are sometimes recommended for use under other for those who have a glove allergy. 9se utility gloves nitrile or heavy latex when preparing and using chemicals, precleaning and disinfecting contaminated surfaces and when handling contaminated items during instrument processing. Although gloves provide a high level of protection against direct contact with infectious agents through touching they offer little protections against in+uries with sharp ob+ects such as instruments, needles, and scalpel blades. Hand washing : <and washing is an important type of personal hygiene and a primary disease prevention procedure. There are two types of microbial flora on the hands because of the resident and the transient skin flora. (esident flora 0 colonize the skin and never be totally removed even with a surgical scrub, they are less likely important in disease spread.

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Transient flora 0 do not usually colonize and serve as a source of disease spread because it can contain +ust about any pathogenic organism. "ortunately, the transient flora can be removed or greatly reduced by routine hand washing, hand washing reduces the number of microorganisms that may contaminate and subse>uently cause a harmful infection. Hand washing D step by step procedure Before surgery #. 4emove +ewellery and gently clean fingernails. ?. :crub nails, hands and forearms with an antimicrobial surgical scrub product and a soft sterile brush or sponge for $0. minutes using multiple scrub and mixed angles. E. 4inse hands and forearms with cool to luke warm water starting with the fingers and keeping your hands above the level of your elbows. -et the water drip from your elbow not your hands. %. ry with sterile towels.

$. 3ut on sterile gloves by inserting hands onto the gloves held around the wrist by an assistant wearing sterile gloves. &. Aheck the gloves for defects and do not touch contaminated items or surfaces before patient care. Although plain soap without antibacterial activity performs well in removing dirt and some transient microorganisms.

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:urgical scrub products contain the highest levels of antimicrobial agents. Aommon antibacterial agents in hand washing products include chlorhexidine gluconate, povidone iodine and triclosan. Ahlorhexidine binds to the skin to give prolonged release of antibacterial activity. Triclosan also have a prolonged effect. 3ovidone iodine does not exhibit prolonged activity. It is very important to wash hands every time before gloving and after removing gloves. The warm, moist environment under gloves can cause skin irritation, washing hands before gloving reduces the number of microbes to begin with and washing after removing gloves reduces the number of those that have increased. "as's : /asks were developed originally to reduce the chances of post operative infection in patients caused by microorganisms in the respiratory tracts of the surgeons. In recent years, a face mask has been viewed also as a means to protect the one who wears the mask from disease agents, that might be present in sprays, splashes or even some aerosol particles of body fluids on other potentially infectious materials. "ace masks should be worn by the dental team during patient care activities involving high speed or low speed handpieces, ultrasonic scalers, air I water syringes and grinding or splashing of items that may be contaminated with patient fluids. The mask should be changed with every patient because its outer surface is contaminated with droplets from the previous patient or from touching the mask with saliva0coated fingers. "ace masks serves to filter out =$F to ==.=F of ? to Em size particles that directly contact the mask.

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-imitations of face mas's : "ace masks do not provide a perfect seal around them edges, and enhanced and inhaled air that is not filtered does pass through these sites. 8hen a mask becomes wetted from moist inhaled air the resistance to airflow through the mask increases. Protective eye wear : isease agents may cause infection of the eyes or enter

the associated mucous membranes and cause systemic infections. ;ne example in the herpes simplex virus, which may be present in sprays or aerosols of oral fluids from a patient, hepatitis C virus may use the eye as a portal of entry into the body. Cesides protecting against infectious disease agents. 7ye wear also protects against physical damage to the eyes by propelled ob+ects such as broth fragments or small pieces of a restorative material. Impact damage to the eyes can occur from any polishing, grinding or buffing procedure be it performed in a patients mouth at chairside or in the dental laboratory. 3atient also should be offered eye protection during care. "ace shield should be chin length, provide top protection and be curved to provide side protection.

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Protective clothing : ;uter protective clothing can protect against contamination, which otherwise may lead to infection through non intact skin or at least to spread of the contamination from office to home or elsewhere to unprotected clothing. Although it seems reasonable to use protective clothing for both dental team and patient protection, little evidence is available on the interest to which this prevents disease spread. If this clothing becomes visibly soiled, it should be changed before caring for the next patient. 3rotective clothing should be removed when leaving clinical areas and should not be worn in lunch rooms or outside the office. 3rotective clothing include uniforms, clinic +ackets, laboratory coats, aprons and gowns. Instrument processing : Instrument processing is a collection of procedures that prepared contaminated instruments for reuse processing also must be performed correctly to keep instrument damage to a minimum. The overall steps consists of several steps. #. <olding )presoaking*. ?. 3recleaning.

E. Aorrosion control, drying, lubrication. %. 3ackaging. $. :terilization. &. :terilization monitoring .. <andling processed instruments. Cecause killing of microorganisms is the ultimate goal of instrument processing, it is important to first have a general understanding of microbial killing methods.

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terili+ation : :terilization is a process intended to kill all microorganisms and is the highest level of microbial kill that can be achieved. The bacterial endosphare has been selected as the standard challenge for sterilization because of its high resistance to killing by heat and chemicals. There are three types of sterilizatin processes used in dentistryD #. <eat sterilization. ?. !as sterilization. E. -i>uid chemical sterilization. <eat sterilization involving steam, dry heat and unsaturated chemical vapor is the most common type of sterilization. Ethylene oxide gas sterilizers that operate at .?J" to #%2J" can be used with bacterial endospores not commonly used in dental offices because of long exposure time li>uid chemical sterilant, glutaraldehyde can be shown to be sporicidal controlled laboratory testing. isinfection is a less lethal process than sterilization and is intended to kill disease producing microorganisms but not bacterial endospares. 7.g. synthetic phenolics phenol, iodophores, sodium hypochlorite, >uaternary ammonium compounds aerosols. Holding D if instrument can not be cleaned soon after use, place them in a holding solution to prevent drying of the saline and blood. 7xtended presoaking for more than a few hour is not recommended. 7.g. glutaraldehyde. The solution should be dissolved at least once a day.

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Precleaning D is an essential step before any sterilization reduces the number of microbes, removes blood saline and other material. ,ltrasonic cleaning D 4educes direct handling of the contaminated instruments and the chances for the cuts and punctures also in excellent cleaning mechanisms. The ultrasonic energy produces killings of any bubbles in the cleaning solution this dislodges the debris. :crubbing contaminated instruments by hand is a very effective method of removing the debris if performed properly. Instruments or portion of instruments and burs rust during steam sterilization rust inhibition like sodium nitrite can be sprayed. Instead thoroughly dry the instruments and are dry heat or unsaturated chemical vapor sterilization which do not cause rusting. 3ackaging involves organizing the instruments in functional sets and wrapping them or placing them in sterilization pouches, bags, trays, or cassette. Alosed containers such as trays or pans with solid tags or bottles, capped gloss nails or wrap such as aluminium foil should never be used to package items for sterilization to steam on unsaturated chemical vapor sterilizers. The steam or chemical vapor will not penetrate there containers or materials to reach the items inside.

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)rapping or bagging D of instruments can be placed on a small sterizable bag and the entire tray wrapped with sterilization wrap can also be placed in see through pouches. terili+ation D 3recleaned, packaged instruments are ready for processing through a heat sterilizers. Three most common types of sterilizers used in dental office areD 0 0 0 :team autoclave. 9nsaturated chemical vapor ry heat :team sterilization involves heating up water to generate steam in a closed chamber, producing a moist heat that rapidly kill microorganisms. It is the heat, not the pressure that actually kills the microorganisms. mall office sterili+er D The typical dental office steam sterilizer usually operates through four cycles. 0 0 the heat up cycle the depressurization cycle and 0 the sterilizing cycle 0 the drying cycle.

The temperature ranges from #?#JA0#E%JA with respective pressure of #$0E2 3ounds per s>uare inch. 9nsaturated chemical vapor sterilization involves heating up of special chemical solution in a closed chamber producing hot chemical vapors that kill microorganisms. The chemical solutions 2.?EF formaldehyde, .?F, E$F ethonol plus acetone ketane water and other aerosols. A positive feature is that corrosion of carbon steel instruments is eliminated or greatly reduced.

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!ry heat sterili+ation :

ry heat sterilization involves heating up air and ry heat sterilizer

transfer of heat energy from airs to the instruments. steel item do not corrode.

operate at approximately #&2JA to #=2JA main advantage is that carbon

Hand piece asepsis : <igh speed hand pieces reusable prophy angles contra angles and nose cones should be cleaned and sterilized by heat processing between patients, it is possible that contaminants may enter the internal positions of handpieces and their attachments during use. A li>uid germicide such as ?.2F to E.?F glutaraldehyde must be used for sterilization plastic items such as certain rubber dam frames, shade guides, rubbers and x0ray calliminating devices. :terilization in glutaraldehyde re>uires a #2 hour contact time and anything less than #2 hour is disinfection not sterilization. 7thylene oxide gas method re>uires % to #? hrs to sterilization has got potential toxicity. Clead sterilizers provide a form of dry heat processing tips of

instruments endodontic files and broaches are sterilized by inserting into the hot beads for ?$0E2 seconds temperature range from E.$0%?$J" uneven temperature occurs.

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urface and e$uipment asepsis D

uring patient care many operators and

other surfaces may become contaminated with patient materials two general approaches is to use a surface cover. 3reclean and disinfect the surface after contamination and before disease. 7xamples for surface cover clear plastic wrap, bags or tubes plastic backed pages, and aluminium foil. uring the precleaning process regular soap and water may be used, but it is best to use surface disinfectants that contain detergents @ of synthetic phenolic and iodophors, chlorine0alcohols some of surface disinfectants. Aseptic techni$ues D There are variety of infection control techni>ues that do not come under the ma+or infection control categories, collectively called aseptic techni>ues. Touch or flow surfaces are possible. o not rub your eyes, skinH nose or

touch your hair with contaminated, gloved hands. "inimi+e dental aerosols and spatter D ental aerosols and spatter are

generated during use of handpieces, ultrasonic sealers, and the air I water syringe. <igh volume evacuation during use of rotary e>uipment and the air I water syringe greatly reduces the escape of salivary aerosols and spatter from the patients mouth. The reduction in microorganisms escaping a patients mouth in aerosols or spatter can approach #22F with proper use of the rubber dam, depending on the type and site of the intraoral procedure. The application of antiseptic to skin or mucous membranes before surgery or infections to reduce the number of microorganisms on the surface to prevent their entry to underlying tissues that could cause bacterimia, septicemia

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or local harmful infection studies have shown that a mould rinse with a long lasting antimicrobial agent such as chlorhexidine gluconate can reduce the level of oral microorganisms for up to shows. ,se of disposables : A disposable item is manufactured for a single use on only one patient, such items are manufactured from plastics or less expensive metals that are usually not heat tolerant or are not designed to be ade>uately cleaned. Thus disposable must be properly disposed of after use and no attempt should be made to preclean and sterilize or disinfect it for reuse on another patient. It absolutely prevents the transfer of microorganisms from one patient to another. isadvantage may include less efficient operations than the reusable outer part, increased expense and adding non degradable materials to the environment. 7xample saliva operator tips, infection needles, air I water syringe tips, certain hand instruments gloves, masks. ental unit water is commonly contaminated with microorganisms some of the bacteria may attach to and accumulate on the inside of the lines, forming a biofilms. A reservoir for sterile water can be inserted into the water line or insert a small bacterial filtration unit in the water line that removes bacteria. A smooth surface floor rather than carpeting is more appropriate. ental impressions easily become contaminated with patient blood and saliva gloves protective eye wear and outerwear must be worn whenever handling orally soiled impressions. The best way to decontaminate is through chairside disinfection immediately after removal should be rinsed with tap water after removed and then shaken well. Alginates can be used Iodophors, sodium hypochlorite and not hydrocolloids.

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3olysulphide and silicones can be used with most of the disinfectants. "rench pumice and pan liners should be used for each individual appliances for polishing. 3roper infection control methods and materials for dental radiology differs little from those used for procedures. Aonsistant use of personal protective devices such as gloves, gowns and eyeglasses decreases the chances. 4emovable items such as film holding devices, mouth props and positioning devices must be rinsed cleaned and sterilized patients. )aste management : ;rally soiled disposable items, such as gloves, paper towels, or x0ray film covers are considered to be contaminated waste. Infections waste capable of causing an infectious disease like discarded waste blood components contaminated and discarded, unused sharps, pathologic wastes and teeth or other tissues I microbiological wastes I stocks I cultures*. 4esultant medical waste must be removed, neutralized and disposed of by an approved waste howler.

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C&.TE.T
Introduction <istory evelopment of Infectious isease

:teps in the evelopment :tages of an Infectious isease <ost efense /echanisms 3athogens and ;ther isease Agents Infection Aontrol 4ational and 4egulation 3athways for Aombination !oal of Infection Aontrol Immunization 3rotective Carriers Instrument 3rocessing Aseptic Techni>ues :ummary K Aonclusion

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