INFECTION CONTROL

1
INFECTION CONTROL

• Chapter 3
• Exposure Control

2
Clinical attire

• Gown or uniform
• Clean, pressed and maintained
• Solid, closed front
• No pockets
• Long garment to cover lap when seated for patient
  treatment

3
Hair and head covering

• Hair must be worn off the shoulders and fastened
  back away from face.
• Should not be touching the back of collar.
• Hair should be pulled back with a tie-back that
  is not overly evident. Hair color or white in
  color.

4
Uniforms

• Clinic uniforms and shoes are not be worn outside
  of the clinical setting.

5
The objectives of correct hand washing procedures

• Reduce the bacterial flora of the hands to an
  absolute minimum.
• Remove surface dirt and transient bacteria.
• Dissolve the normal greasy film on the skin
• Rinse and remove all loosened debris and
  microorganisms.
• Provide disinfection with a long-acting
  antiseptic.

6
Facilities

• Sink
• Soap
• Scrub brushes
• towels

7
Sink facilities

• A sink with a foot pedal or electronic control
  for water-flow control should be used to avoid
  contamination.
• If a sink does not have a foot pedal or
  electronic control- then turn on water at the
  beginning of procedure and leave on for entire
  procedure.
• Turn faucets off with the towel after drying
  hands.
• Clean around brim of sink with disinfectant.
  Contact with the inside of the wash basin should
  be avoided.
• Prevent contamination of clothing by not leaning
  against the sink.
• Use a separate area and sink reserved for
  instrument washing.

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Soap

• Use liquid surgical scrub containing an
  antimicrobial agent.
• Povidone-iodine (iodophore) broad spectrum
• Chlorhexidine preparation-provides rapid
  disinfectionhigh residual action
• Soap
• Never use bar soap---it may transmit bacteria and
  be a source of contamination
• Antimicrobial soapused in routine dental tx
• Germicidalused for surgical procedures

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Scrub brushes

• Scrub brushes should be used for under the finger
  nails to remove debris.
• Careful consideration while using a scrub brush
  should be observed. Too vigorous scrubbing may
  cause skin abrasion, leading to skin irritation
  and abrasion that can leave opeinings for
  additional cross-contamination..

10
Towels

• Only disposable towels should be used from a
  dispenser.
• No skin contact with dispenser while grabbing
  towel.
• Towel itself should be hung down form the
  container.
• Cloth towels ar not recommended.

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• Hand washing is considered the most important
  single procedure for the prevention of
  cross-contamination.

12
Hand-washing

• Before you glove
• after you remove gloves
• and before regloving after removing gloves that
  are turn, cut, or punctured.
• When hands are visibly soiled
• Before leaving the treatment room
• If there is a hole, tear, rip get rid of glove
• If you accidentally, while working, touch
  contaminated itemsremove glove, wash hands and
  re-glove

13
Minimize cross-contamination

• Sinks-should have hands-free faucets---activated
  electronically or by a foot pedals.
• No ringswedding rings
• Long finger nails
• Fake finger nails
• Fingernail polish
• These items can also puncture gloves---causing a
  route of infection to your hands or fingers.

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Routine hand wash

• Water and non-antimicrobial soap. (plain soap)
• To remove soil and transient microorganisms

15
Antiseptic Hand wash

• Alcohol-based hand rub (contains 60-95 ethanol
  or isopropanol)
• To remove or destroy transient microorganisms and
  reduce resident flora.

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Surgical AntisepsisSurgical scrub

• Water and antimicrobial liquid soap
• Chlorhexidine, iodine and iodophores,
  chloroxylenol or triclosan.
• To remove or destroy transient microorganisms and
  reduce resident flora with a persistent or
  prolonged effect that inhibits proliferation or
  survival or microorganisms.

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Antiseptic hand wash

• Remove watch and jewelry from hands
• Fasten hair back securely
• Don protective eyewear and mask before hand
  washing to prevent contamination of washed hands
  ready for gloving.
• Use cool water

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Procedure for hand washing

• Lather hands, wrists, and forearms quickly with
  liquid antimicrobial soap
• Rub all surfaces vigorously interlace fingers
  and rub back and forth with pressure.
• Rinse thoroughly, running the water from
  finger-tips down the hands. Keep water running.
• Repeat two more times. One lathering for 3
  minutes is less effective than are 3 short
  latherings and three rinses in 30 seconds.
• The latherings serve to loosen the debris and
  microorganisms and the rinsing wash them away.

19
Antiseptic hand rub procedural use

• Decontaminate hands with an alcohol-based hand
  rub
• Apply the product according to directions on the
  amount to be used.
• Rub hands vigorously, covering all surfaces of
  fingers and hands, until the hands are dry.

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Surgical antisepsis

• First scrub of day should be 10 minutes in
  length.
• Subsequent scrubs should be 3 5 minutes.
• Following treatment of a contagious or isolated
  patient, the procedure should take at least 5
  minutes.

21
Gloving

• Criteria for the selection of gloves
• Check for evidence of the manufacturers quality
  control standards.
• Impermeable to patients saliva, blood, and
  bacteria
• Strength and durability to resist tears and
  punctures
• Impervious to material routinely used during
  clinical procedures
• Nonirritating or harmful to skin.

22
Masks

• Are worn to protect nose, mouth from inhaling
  infectious organisms(air borne)
• Aerosal sprayHigh- speed hand piece, cavitron
• Accidental splatter
• ALL MASKS SHOULD HAVE A 95 FILTRATION
  EFFICIENCY.
• Filtration- measured in BFEbacterial filtration
  efficiency

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Masks

• Standard masks block filtration of particles as
  small as 3um with a filter efficiency greater
  than 95.
• Droplet nuclei of mycobacterium tuberculosis
  range from 0.5 to 1um and are a high risk to
  dental professional.

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Masks

• Two most common mask types
• Domed-shapedmolds to the face
• Flat types
• Should be changed after each procedure to
  eliminate cross-contamination---the mask becomes
  wet and lessens efficiency.

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Masks

• Fit- proper fit over face is vital to protect
  against inhaling droplet nuclei from aerosols
• Moisture absorption-
• Soak through- is an important factor. Mask must
  be changed for each patient and not worn longer
  than 1 hour.

26
Masks

• The most effective materials used for masks are
• Glass fiber
• Synthetic fiber mat

27
Use of a mask

• Steps to be used
• Place face mask
• Position eyewear
• Keep mask on after completing a procedure while
  still in the presence of aerosols.
• Removal of a mask in the treatment room
  immediately following the use of
  aerosol-producing procedures permits direct
  exposure to airborne organisms.

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Use of a mask

• Mask removal
• Grasp side elastic or tie strings to remove
• Never handle the outside of a contaminated mask
  with gloved or bare hands.
• NEVER place mask under the chin.

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Protective eyewear

• Protects your eyes from splatter
• Protect from chemical splashes
• OSHA requirements
• Front protection
• Side protection
• Sturdy plastic shatter-proof
• Light weight
• Easily disinfected
• Clear or lightly tinted lenses
• Prescription glassesmust have eye shields
• Face shields
• PATIENTS SHOULD WEAR GLASSES.

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Protective eyewear

• Types of eyewear
• Goggles
• Eyewear with side shields
• Eyewear with curved frames
• Postmydriatic spectacles
• Child sized glassessunglasses or childrens play
  spectacles.

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HAND CARE

• Portal of entry for microorganisms to enter
  dental professional by way of skin breaks or
  small cuts.
• Resident bacteria
• A stable bacteria that inhabit the surface
  epithelium or deeper areas in the ducts of skin
  glands or depths of hair follicles.
• Shed with exfoliated surface cells or by
  excretions of the skin glands

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HAND CARE

• Transient bacteria
• Reflects continuous contamination by routine
  contacts.
• They may be washed away or can cause an
  autogenous infection when there is a skin break.
• Most transients can be removed by soap and water
  and washing thoroughly.

33
HAND CARE

• Fingernails
• Clean, smooth trimmed, short fingernails with
  well-cared cuticles
• Make hand-washing more effective
• Prevents cuts from nails in disposable gloves
• Permits selection of a closer fit of glove
• Allow greater dexterity during instrumentation
• Decrease chance of patient discomfort

34
Wristwatch and jewelry

• Remove wrist watch and jewelry at the beginning
  of the day.
• Microorganisms can become lodged in crevices

35
Gloves

• MOST CRITICAL PPE
• Exam gloves- procedure
• usually not sterile
• Ambidextrousfits either hand
• Overglove-plastic
• food- handler glove
• Over- gloving putting it on over contaminated
  gloves
• to write or grab something out of a drawer

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Gloves

• 3. sterile surgical gloves
• Usually used in hospital setting
• Pre-packaged in specific sizes
• Are fitted for right or left hand
• 4. utility gloves
• Not used for direct patient care
• Usually for cleaning tx rooms, disinfection
• Cleaning contaminated instruments
• Surface cleaning
• They may be washed, disinfected or sterilized to
  be re-used
• 5. non-latex gloves
• When someone has a sensitivity to latex
• Either healthcare provider or patient
• Nitrile, vinyl---contents are of non-latex
  qualities

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Procedures for use of gloves

• Mask and eyewear placement
• Pre-gloving hand wash
• Glove placement
• Avoiding contamination
• Torn, cut, or punctured glove
• Removal of gloves.

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Considerations of proper glove use

• Length of time worn-
• Total time worn should be no longer than one hour
• When gloves develop a sticky surface, remove,
  wash hands and reglove

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Considerations of proper glove use

• Complexity of the procedure
• Certain procedure are more likely to promote
  perforations and must be changed frequently.

40
Considerations of proper glove use

• Packaging of the gloves
• Top gloves within a package can be tornone must
  be watchful when opening a new package.

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Considerations of proper glove use

• Size of glove
• When a glove is too large, the extra material at
  the fingertips can get caught, torn, or in the
  way during a procedure.

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Considerations of proper glove use

• Pressure of time
• Working too fast can increase the risk of glove
  damage

43
Considerations of proper glove use

• Storage of gloves
• Keep in a cool, dark place
• Exposure to heat, sun or fluorescent light
  increases potential for deterioration and
  perforations.

44
Considerations of proper glove use

• Agents used
• Certain chemicals react with the glove material
• Petroleum jelly
• Alcohol
• These products tend to break down the glove
  integrity.

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How to maintain infection control when gloved

• minimize cross-contamination
• Use over-gloves if available
• Try to have room set-up and everything out so
  that you dont have to go through drawers or
  cabinets during the procedure.
• Use cotton pliers to remove things from jars.
• NEVER OPEN DRAWERS, CABINETS OR USE COMPUTER KEY
  BOARD WITH CONTAMINATED GLOVESgt

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Latex Allergies

• How is latex sensitivity produced?
• Latex sensitivity is due to the protein
  allergens and to additives used when the
  commercial latex is prepared.
• Latex allergens occur in any equipment or product
  used that contains natural rubber latex.

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Latex hypersensitivity

• Methods of exposure
• Aeroallergen inhalation (from powdered gloves)
• Donning gloves
• Mucosal contact

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Latex hypersensitivity

• Type 1 Hypersensitivity
• Immediate reaction
• Urticaria-hives
• Dermatitis-rash, itching
• Nasal problems sneezing, itchy nose, runny nose
• Respiratory reaction breathing difficulty
• Eyes, watery-itchy
• Drop in blood pressure shock
• anaphylaxis

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Latex hypersensitivity

• Type IV hypersensitivity
• Delayed reaction
• Contact dermatitis develops within 6 to 72 hours
  after contact.

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Individuals at high risk of latex sensitivity

• Have had frequent exposure to latex products
• Health-care personnel
• Multiple medical treatments
• Example genitourinary anomalies, spina bifida

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Individuals at high risk of latex sensitivity

• Have other documented allergies
• Food allergies avocado, banana, kiwi fruit,
  chestnuts, papaya
• Workers in a rubber-manufacturing plant

52
Individuals at high risk of latex sensitivity

• Take medical history and document any changes
  carefully.
• Appoint early in the day before glove powder
  contaminates the air throughout the facility. Or
  that clinical attire becomes laden with airborne
  latex.
• Clean clinical areas with non-latex gloves
• Wipe all surfaces to remove allergen

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Individuals at high risk of latex sensitivity

• No latex in the treatment room
• Use all non-latex products for high-risk patients
• Prepare latex free cartsmaterials and gloves,
  for use when seeing high-risk patients in advance.

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Agencies

• OSHA
• Blood borne pathogens standard is the most
  important infection control law in dentistry.
• A. It protects employees from exposure from
  Hepatitis B (HBV), Hepatitis C (HCV), and HIV.
• B. Employers protect their employees by other
  potentially infectious material
• C. OSHA requires a copy of blood borne pathogens
  standard to be present in the dental office.
• D. Mandated training for employees

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Chapter 4 Infection control- clinical procedures

• Cleaning Step
• Ultrasonic processing
• Manual cleaning of instruments is a dangerous,
  difficult, and time-consuming procedure.
  Therefore ultrasonic equipment is used for the
  cleaning process.

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Advantages of Ultrasonic processing

• Able to obtain a high degree of cleanliness
• Reduce danger to clinician from direct contact
  with potentially pathogenic microorganisms
• Improved effectiveness for disinfection.
• Elimination of release of aerosols and droplets
  through the scrubbing process
• Clean areas of the instruments that bristles of a
  brush may not be able to contact
• Removal of rust.

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Procedure

• Do not overload devise
• Instruments must be completely immersed
• Dismantle instruments with detachable parts,
• Open jointed instruments
• Time accurately
• Drain, rinse and air dry

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Manual cleaning

• Only to be used if ultrasonic unable to be used.
• Wear heavy-duty gloves and mask
• Dismantle instruments with detachable parts,
• Use detergent and scrub with a ong-handled brush
  under running water
• Hold instrument low in the sink
• Brush with strokes away from body
• Use care not to splash and contaminate the
  surrounding area
• Rinse well
• Dry on paper towel.

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Care of brushes

• Color code
• Soak and wash and sterilize

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Exposure control plan

• A. Must have a written exposure control plan.
• B. This clearly describes how the office
  complies to blood borne pathogen.
• C. Must be updated annually

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Universal precautions

• treat everyone like they have an infectious
  diseaseyou cannot tell or identify someones
  health history.
• Universal precautions are procedure specific NOT
  PATIENT SPECIFIC.

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Categories of Employees

• A. BPSBlood borne pathogen standard
• Requires to categorize tasks that has an
  occupational exposure
• OSHA defines occupational exposure as, Any
  reasonable anticipated skin, eye, mucus membrane
  contact or percutaneous (through the skin) injury
  with blood or other infectious materials
• OPIM Other Potentially Infectious materials

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Post-exposure Incidents

• -Procedures to follow if an accident occurs
• a. The office must have a written plan
• b. Medical follow-up
• c. At no charge to employee
• d. Employer must have training for the
  employee on proper response to exposurekeep a
  record.

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Hepatitis B immunization

• A. OSHA requires dentist/employer to offer HBV
  to all employees must be offered within 10 days.
• B. Proof of vaccination must be kept on file
• C. If you refuse--you must sign informed
  refusal form
• D. If you happen change your mind, after
  refusing HBV, the Dr. must pay for vaccination.

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Post-vaccine testing

• TITRE-Between 6 weeks and 6 months after
  completion of series, an employee should see if
  immunity has been built- up against Hepatitis B.
• OSHA Does NOT require this.

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A need for a booster?

• CDC- doesnt require a routine booster dose or
  routine blood testing to monitor levels
• ALL RECORDS
• Must be kept confidental
• In a locked file
• Kept for 30 years.

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Other Agencies

• ADA- American Dental Association
• Helps to keep us informed through support
  services and journals

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Other Agencies

• CDC- Centers for Disease Control
• Made recommendations made by Federal, State and
  local agencies into regulations
• Issued standard precautions
• Universal precautions
• BSIBody Substance Isolation
• Require PPEto protect us when in contact with
  all body fluids whether or not blood is visible.

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Other Agencies

• FDA- Food and Drug Administration
• Regulates the manufacturing and labeling of
  medical devices and solutionsstandards be met
  prior to use by the public
• Ex. Sterilizers, chemical/biological indicators,
  cleaning solutions

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Other Agencies

• EPA Environmental Protection Agency
• Involved in the safety and effectiveness of
  disinfection and sterilizing solutions-
• Regulates disposal of hazardous waste after it
  leaves the office
• EPA must appear on the label of each solution

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Other Agencies

• OSAP- Organization for safety and asepsis
  procedures
• Has dental health professionals that have
  meetings that cover topics of
• Infection control
• Hazard communications

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Disinfection

• During dental treatment
• 1. dental equipment
• 2. treatment room surfaces
• Become contaminated by
• 1. saliva
• 2. aerosol-handpieces, ultrasonic, high-speed
  drill ect.
• Which can contain blood or saliva

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Cross-contamination

• The primary source of cross- contamination is
  when a member of a dental team touches surfaces
  with contaminated gloved hands.
• Cross-contamination- the spread of disease
  through contact items such as handles, food,
  instruments, or surfaces.

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Microorganisms survival rate

• Microorganisms may survive on surfaces for
  lengths of time
• Ie mycobacterium tuberculosis survives for weeks
• Hepatitis can live up to 6 months on a surface
• -HIV- dies in 70 degree environment
• -Herpes dies in a matter of minutes
• ALWAYS ASSUME and the SAFEST APPROACH TO TAKE
  within the dental care setting is that everything
  is contaminated with microorganismstreat each
  surface and pt. care items with this in mind.

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Surfaces within a dental tx room

• Are classified into two different areas
• 1. clinical contact surfaces
• 2. general housekeeping surfaces
• Clinical contact surfaces- those surfaces touched
  by contaminated hands, instruments, or items by
  splatter during tx.
• General housekeeping surfaces- all other surfaces
  ie walls or floors

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Clinical contact surfaces

• Three categories that the OSAP controls
• A. Touch (disinfected between pts, and barrier
  protected)
• B. Transfer(disinfected between pts, and
  barrier protected)
• C. Splash, splatter and droplet (cleaned
  daily)
• A. Touch surfaces- directly touched and
  contaminated during treatment. Ex dental light
  handles, unit control and chair switches
• B. Transfer surfaces- Not directly touched
  however, are touched by contaminated instruments.
  Ex instr. Tray or hand-pieces.
• C. Splash, splatter and droplet surfaces-do not
  actually contact the members of the dental team
  or contaminated instruments. Ex countertops

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Surface contamination

• Two methods
• 1. to prevent-from becoming contaminated by the
  use of a surface barriers.
• 2. pre-clean and disinfect the surfaces between
  patients.
• Achieve this method by using spray-wipe-spray
  technique

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Barriers

• Surface Barriers
• Define to prevent contamination on surfaces so
  it will not have to be pre-cleaned and
  disinfected between patients.
• They must be fluid resistant so that they prevent
  saliva, blood or microorganisms from soaking
  through to the hard surface below to
  cross-contaminate the item.

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Types of Barriers

• Plastic bags
• -special bags that are used for hoses, air
  water/syringe, pens, light handles
• -Sticky tape
• used on switches and x ray equipment
• -aluminum foil used because it is easily formed
  around equipment.

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Pre-cleaning

• Defined means to clean before disinfecting
• Reasons why pre-cleaning is done
• Saliva can decrease the effectiveness of the
  disinfection solution
• It reduces the number of microbes
• Removes blood, saliva and other body fluids

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Disinfectants

• Defined as chemicals that destroy most
  pathogenic (disease causing) organisms
• Disinfectants are categorized by their biocidal
  activity
• 1. high level
• 2. intermediate level
• 3. low level

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High level disinfectant

• Kills all forms of bacteria, fungi, and viruses
  same as sterilization

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Intermediate disinfectant

• Kills all forms bacteria, fungi and viruses but,
  does not kill sporeshas tuberculocidal activity
• Spores- a resistant bacteria encapsulated by a
  thick cell wall so it can survive in almost any
  environment.

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Low- level disinfectant

• Does not kill spores, bacteria or viruses or
  tuberculosis. usually used for general
  house-cleaning ie. walls or floors.

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Ideal surface disinfectant

• Should kill a broad spectrum or (range) of
  bacteria or (microbes)
• Minimal toxicity
• Does not damage surfaces
• Odorless
• Inexpensive
• Works on surfaces that kills blood, saliva
• Simple to use
• there is no such product on the market that has
  all these qualities therefore, we must weigh the
  advantages/disadvantages of each product.

87
Six types of disinfectants

• 1. alcohols
• 2. chlorines
• 3. iodophores
• 4. synthetic phenols
• 5. sodium hypochloride compounds
• Sodium bromide
• 6. gluteraldahydes

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1. Alcohol

• Low level disinfectant
• Two types
• 1. ethyl alcohol
• 2. isopropyl alcohol
• Used as
• skin antiseptic
• surface disinfectant
• NOT EFFECTIVE IN THE PRESENCE OF
• bio-burden (blood and saliva)
• it evaporates fast
• limits of anti-microbical action
• they damage plastics, vinyl which are used
  mostly in dentistry
• The ADA, CDC and OSAP DOES NOT Recommend this as
  an surface disinfectant

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2. Chlorine compounds

• Intermediate levelbroad spectrum
• Two types
• 1. sodium hypochlorite
• 2. chlorine dioxide
• rapid action (3 minutes)
• Chemical sterility (6 hours) and surface
  disinfectant
• -must be made fresh daily
• -cheapcost effective
• -has strong odor
• -corrosive

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3. Iodophores

• (intermediate level) Broad spectrum
• 1. Iodine- povidon-iodine
• Used for surgical scrub, soaps and surface
  antiseptics. Hospital disinfectantyellow or red
  in color stains easily
• They can discolor surfaces and clothes
• Must be activated by distilled water
• Inactivates in hard water
• Active to inactive state color changes from
  yellow/red to clear
• Usually effective within 5-10 minutes

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4. Synthetic phenols

• Intermediate level- broad spectrum
• Must be made daily
• Can have film build-up ruin equipment
• Has unique action keeps working long after
  initial application known as residual activity
• Can be used on glass, rubber and metal or plastic
• Can cause damage to plastic over time

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5. Sodium Bromide and Chlorine

• Supplied in tablet form
• Has a chlorine smell
• Hard surfaces only
• Used for pre-cleaning
• And ultrasonics

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6. Glutraldehydes

• High level disinfectant
• Used as a sterilant when heat sterilization
• isnt recommended for disposable items
• Toxic fumes, irritating to eyes
• Mixed by two components for activation
• Usually lasts for 28 days
• Cold soak10 hour sterile
• cidex

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Ultra-sonic cleaning

• Used to loosen and remove debris
• Wear PPE when using
• The sound waves can travel through metal, glass
  containerscavitation (bubbles in liquid)
• A jaccuzzi for instruments!
• These bubbles burst by implosion (bursting inward)

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Ultrasonic cleaning

• Bubbles chemicals actionremoves debris
• 5-10 minutes (depends upon actual unit within
  office)
• Instruments- this is the method of pre-cleaning
  instruments within the dental office-
• --DO NOT HAND SCRUB INSTRUMENTS
• Use manufacturers instructions for the specific
  solution used within the office
• The bottle of solution should be labeled
  biohazard and a chemical label

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Ultrasonic Cleaning

• This solution within the unit is
• HIGHLY CONTAMINATED
• The unit should be cleaned one time per day
• Rinsed
• Disinfected
• Rinsed again
• Dried
• Clinician must wear PPE during this process to
  eliminate contamination.

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Packaging materials

• These are FDA approved
• Only use sterilization bags
• Never substitute
• Types of packaging materials
• 1. cassettes
• 2. self-sealing
• 3. heat sealed
• 4. poly-bags or tubes
• 5. paper wraps / cloth wraps
• Use indicator tape to seal package

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Sterilizer Monitoring

• 1. physical monitoring
• Should be monitored daily when cycles are began
  and during cycle.
• involves looking at the gauges
• Recording temperature, time and pressure
• Keep a close watch on the sterilizer during the
  day---making sure that it is running correctly.

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Sterilizer Monitoring

• 2. chemical monitoring
• Three types
• 1. process indicators
• 2. process integrators
• 3. biologic monitoring or spore testing

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Sterilizer monitoring

• Process indicators
• These are on the outside of the bags or autoclave
  tape
• They change color when
• Temperature only
• Not duration or pressure
• Helpful to see what was sterile (or ran thru the
  sterilizer) or not

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Sterilizer monitoring

• Process integrators
• These are inside the instrument packages
• They respond to steam temperature and time
• Ie strips or tubes placed inside the sterilizing
  packages

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Sterilizer monitoring

• Biologic monitoring or spore testing
• BEST METHOD
• The CDC, OSAP and ADA recommends
• Weekly
• Monthly
• Or cycle- special intervals
• Ie test every 40 hours or every 30 days
  whichever comes first.
• Check the regulation within your state for more
  info.

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Biologic indicators or Spore test

• These contain harmless bacterial spores (spores
  that are resistant to heat)
• 1. place 3 biologic indicators
• 2 place within instrument packages
• 1 set aside as a control
• () reading sterilization has failed
• (-) reading sterilization was successful
• -you can do this through the mail
• Mail in monthly service
• In office culture is done
• make sure you use the strips that are compatible
  to your sterilizer

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Different types of strips used for biologic
indicators

• 1. steam sterilization- steam BI
• 2. chemical vapor - chv BI
• 3. dual- species contains spores of both
  organisms and can be used with all sterilizer
  types
• Clinician must be wearing full PPE when
  conducting testing of the sterilizer.

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Sterilization

• What is the reason sterilize equipment?
• Kill all spores
• Sterile- it is an absolute termthere is not such
  thing as partially or almost sterile

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Three forms of Sterilization

• 1. Steam
• 2. chemical vapor
• 3. dry heat

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1. Steam

• Involves heating water to generate
  steamproducing moist heat to kill the spores.
• - steam fills the chamber
• Cool air is pushed out of an escape valve
• Which closes and allows the pressure to increase
• Heat then kills the spores not pressure
• Without air steam creates a higher temp.
• Manufacturer sets their own sterilizer or
  autoclave
• Conditions that must be met usually 250 degrees
  or 121 celcius with 15-30 psi (pounds per square
  inch)
• This steam can corrode high carbon steel
  instruments

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Steam

• Distilled water can only be used due to tap
  water has too many minerals and impurities
  causes corrosion and pitting.

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Operation cycle of Steam Sterilization

• 4 cycles
• 1. heat up generates steam
• 2. sterilization cycle reaches the temp.
  needed to sterilize
• 3. depression cyclereleasing the pressure
• 4. Drying cycle dries instruments

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2. Flash Sterilization -flash

• It is done by heat transfer of steam and
  unsaturated chemical vapor
• Usually the instruments are unwrapped
• This compromises the sterility butthe
  instruments are sterile and the spores are
  killed.
• THEREFORElt it is always best to have instruments
  bagged when going thru the process of
  sterilization

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3. Chemical vapor

• Is similar to autoclaving but uses chemicals
• Alcohol-----keytone water
• Formaldehyde----acetone
• OSHA recommends a material safety data sheet
  (MSDS) on all chemicals because they are toxic.

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Chemical vapor contd

• Advantages of chemical vapor
• It doesnt dull, rust or corrode instruments
• Short cycle time
• It dries the instruments better than steam
• Disadvantages of chemical vapor
• Toxic chemicals
• You need adequate ventilation
• It smells

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Filtration and monitoring of chemical vapors

• New sterilizers have a filtration devicewhich
  reduces the chemical vapor
• You can also get a formaldehyde monitoring
  badge---it measures exposure to the vapor
• It the packaging is real thick in dimension it is
  required to run cycle longer because the
  chemicals will not penetrate
• 3 major factors
• 20 psi
• Temp. 270 degree or 131c
• Time 20-40 minutes

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Dry heat sterilization

• This heats up air and transfers the heat to the
  instruments
• Involves high temperatures
• 320 degrees 375 degrees (160-190c.)
• instruments will not rust if properly dried
  before use.
• Two types
• Static
• Forced air

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Static

• Similar to an oven
• It has coils and heat rises
• It takes 1-2 hours
• Forced air (also rapid heat transfer)
• This circulates hot air to chamber at a high
  velocityrapid heat to instruments reduced time
  for sterilization
• Your book states 6-12 minutes
• Statium 3.5 minutes unwrapped
• 10 minutes wrapped

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Hand piece sterilization

• Rotate- 400,000 revolution per minute (rpm)
  debris, blood etc may get inside these are very
  expensive and you must take care of them.
• Life expectancy---depends upon usage and how they
  are maintained.

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FYI

• Boiling water disinfection
• Minimum of 30 minutes at boiling 100 degrees
• Bactericidal kills is increased when an alkaline
  is added ie 2 sodium carbonate.
• Techniques and aids for infection control
• Pre-procedural mouth rinses
• HVE high volume evacuator
• Rubber dam
• Disposable items