INFECTION CONTROL AND OFFICE SAFETY INTRODUCTION: Pervasive increase in serious transmissible disease over the last few

decades has created global concern and has made health care personnel to comply with rigid infection control procedures to prevent cross infection. The emphasis of infection control in dentistry that occurred in 1980s has now resulted in impressive approaches to prevention of disease spread in the office. These approaches are directed towards patient protection and protection of all numbers of dental team, so that dentistry has never been safe than it is today for patient and staff alike. lthough there is a common goal of infection control i.e. to eliminate or reduce the number of microbes shared between people there are several approaches that may be used to achieve its desired end result. These approaches vary from one office to the ne!t depending on the type of dental procedures performed, the number and training of employees, office design, the pattern of patient flow through the office, and the type of dental e"uipment used. #ost infection, control procedures have been validated for effectiveness when used currently, when they are misused, increased chances for disease spread can occur. This is one of the reasons why infection control procedures fre"uently have safety factors built in to help ensure success under a variety of unpredictable conditions. Thus one must be careful while using these infection control procedures. OVERVIEW: THE CHAIN OF INFECTION: The life and growth of pathogens $disease causing organisms% is a cycle as a chain. &reak the chain and you break the infections process. The chain of infection consists of four parts. 1% 'irulence (% )umber of microorganisms

*% +usceptible host ,% Portal of entry VIRULENCE: 'irulence of an organism refers to the degree of pathogenecity or strength of that organism in its ability to produce disease. Number of microorgani m : -n addition of being virulent, pathogenic microorganisms must be present in large enough members to overwhelm the body.s defense. The number of pathogens is directly related to the amount of bioburde present, the organic materials such as blood and saliva. /se of dental dam and high volume evacuation helps to minimi0e bioburden on surfaces and reduce the number of microorganisms in the aerosol. Su ce!"ib#e $o ": susceptible host is a person who is unable to resist infection by the pathogen. %or"a# or en"r&: To cause infection microorganisms must have a portal of entry as means of entering the body. The portals of entry for air1born pathogens are through mouth and nose. &lood born pathogens must have access to the blood supply as means of entry into the body. This can occur through a break in the skin caused by needle stick, a cut as even a human bite. TY%ES OF INFECTION: Acu"e Infec"ion: -t is of short duration. -n acute infection symptoms are often severe and usually open soon after the initial infection occurs. C$ronic infec"ion: 2hronic infections are those in which microorganisms is present for a long duration. La"en" infec"ion: latent infection is a persistent infection in which the symptoms come and go. The virus enters the body cause the infection. -t then lies dormant, away from the surface, in a nerve cell until certain

conditions $+uch as fever% cause the virus to leave the nerve cell and attack the surface again. 3.g. 4erpes 0oster. O!!or"uni "ic infec"ion: They occur in individuals where resistance is decreased or compromised. 3.g. individual recovering from influen0a may develop pneumonia. 'ETHODS OF DISEASE TRANS'ISSION: () DIRECT TRANS'ISSION: Pathogens can be transferred by coming into direct contact with infectious lesion as infected body fluids, including blood, saliva, semen and vaginal secretions. #any viruses and pathogenic bacteria are transmitted directly and cause hepatitis, herpes infection, 4-' and tuberculosis. *) INDIRECT TRANS'ISSION: The indirect transfer of organisms to a susceptible person can occur by handling contaminated instruments as touching contaminated surfaces and then touching the face, eyes as mouth. -t important to wash the hands fre"uently to avoid indirect transmission of microorganisms. S!#a $ or !#a""er : &lood, saliva or nasopharyngeal secretions can be sprayed as spattered during many dental procedures. 5isease can be transmitted during a dental procedure by splashing the mucosa as non intact skin with blood or blood contaminated saliva. )on intact skin in which there is a cut, scrape or needle stick in6ury provides an entrance for pathogens into the body. AIR +ORNE TRANS'ISSION: lso known as droplet infection as a spread of disease through droplets of moisture containing bacteria or viruses. #ost of the contagious respiratory diseases are caused by pathogens carried in droplets of moisture. +ome of these pathogens are carried long distances through the air and ventilation systems.

high speed hand piece is capable of creating air borne contaminants from bacterial residents in dental unit water spray system and from microbial contaminants from saliva, tissues, blood, pla"ue and fine debris cut from carious teeth. 7ith suspect to si0e, these air born contaminates e!ist in the form of splatter, mist and aerosol. Aero o#: -nvisible particles ranging from 80m to appro!imately 8m that can remain suspended in air and breath from hours. )o scientific evidence indicates that fine aerosols have transmitted the blood borne infection caused by hepatitis & virus. 'i " : 2onsist of droplets estimated to approach 80 m visible in a beam of light. They tend to settle down from air after 8118 minutes. e.g. Tuberculosis, hepatitis and other viral disease. S!a""er: Particles larger than 80m and even visible splashes. The have distinct tra6ectory frilling with in * feet as patients mouth thus can result in coating of face and outer garments of attending personnel, in potential route of spread. 2onsists of large droplet particles contaminated with blood, saliva, and other debris. +patter is created during all restorative and hygiene procedures involving rotary and ultrasonic dental instruments use by air water syringe may also produce spatter. %ARENTERAL TRANS'ISSION: Through the skin, as with cuts or punctures parenteral transmission of blood born pathogens can occur through needle stick in6uries, human bites, cuts, abrasions or break in the skin. +LOOD +ORNE TRANS'ISSION: 2ertain pathogens known as blood borne are carried in the blood and body fluids of infected individuals and can be transmitted to others. &lood borne transmission occurs through direct or indirect contact with blood and other body fluids. +aliva is of great concern during dental treatment because

it is fre"uently contaminated with blood. saliva but it may be present.

lthough blood is not visible in

ll blood borne diseases are transmitted by

improperly sterili0ed instruments and e"uipments. -ndividuals sharing needle while using illegal drugs easily transmitted these diseases to each other. /nprotected se! is another common method of transmission of blood borne disease. 2ommon blood borne disease includes hepatitis 2 ,42', 4&' and 4-'. FOOD AND WATER TRANS'ISSION: #any diseases are transmitted by contaminated food that has not been cooked as refrigerated properly and water has been contaminated with human or animal fecal material. 3.g. Tuberculosis, botulism and staphylococcal and streptococcal infections. FECAL , ORAL TRANS'ISSION: 9ccurs most often among health care and day care workers $who fre"uently change diapers% and by careless food handlers. -OALS FOR DENTAL OFFICE INFECTION CONTROL: The most important step is to depine and set general goals for infection control in the office. 5 recommended , general goals that form the bases of the :golden rules; for infection control. -. To ensure each patient that he < she will not receive any residual blood, saliva, or microorganisms from other patients treated in the office $)o patient to patient contamination%. --. To ensure each patient that all office personnel will use appropriate universal precautions to minimi0e possible body fluid transfer between office personnel and the patient. $)o health care workers to patient body fluid transfer%.

---.

To ensure each patient that the level of general office cleanliness and sanitation will be maintained within the professional standards of care in dentistry and community public health e!pectations in general.

-'.

To ensure each patient that office will use only the mast effective infection control materials and methods available without compromising their use for reasons of office convenience, efficiency or cost $use the best even if last a little more and follow the directions%.

O+.ECTIVES: 1% (% *% infection. ,% Protect patient and personnel from infection 1% Patient to dental team (% 5ental team to patient *% Patient to patient ,% 5ental office to community $including dental team.s family% 8% 2ommunity to dental office to patient. %a"ien" "o /en"a# "eam: #icroorganisms from the patient.s mouth can be passed to the dental team through the following three routes. a% 5irect contact b% 5roplet infection c% -ndirect contact -nfection control measures that help prevent disease transmission from the patient to the dental team member include 1% =loves (% hand wash *% masks ,% rubber dams 8% patient mouth rinses. DISEASE TRANS'ISSION IN DENTAL OFFICE 5ecrease the number of pathogenic microorganisms to level where normal body can prevent infection. &reak cycle of infection between dentist to patient. Treat all patients and instrument as though they could transmit

patient may be a carrier of disease.

carrier is one individual who

harbors the specific organisms of a disease in the body without obvious symptoms and is capable of transmitting the disease to others. Den"a# "eam "o !a"ien": The spread as disease from a member of the dental team to a patient is very unlikely to occur. -f proper procedures are not fallowed them disease transmission can occur. -f the hands of the dental team member contained lesions as if the hands were cut while in the patients mouth transferring microorganisms. 5roplet infection of patient occur if the dental team member had cold. Den"a# office "o communi"&: #icroorganisms can have dental office and enter the community in a variety of ways. 3.g. contaminated impressions may be sent to the dental laboratory, as contaminated e"uipment may be sent out for repair. 9ffice to community transmission can also occur if members of the dental team transport microorganisms out of the office on their clothing as in their hair. RECO''ENDATIONS AND RE-ULATIONS FOR INFECTION CONTROL IN THE DENTAL OFFICE: +ome government agencies and professional organi0ations have a direct influence on dentistry, infection control and other health care safety issues. +ome have regulatory rules and some have advisory. >ecommendations are made by individual or group that are advisors and have no authority for enforcement. >egulations are made by groups that have the authority to enforce compliance with the regulations. 3nforcement may include penalty fines imprisonment or revocation of professional licenses. ASSOCIATIONS AND OR-ANI0ATIONS:

Professional organi0ations are a valuable resource for infection control and other professional information. () American /en"a# a ocia"ion: The 5 is the professional organi0ation for dentists. The 5 5 periodically updates its infection control recommendations as new scientific information becomes available. also publishes reports or emerging issues of interest to the dental community. *) Organi1a"ion for afe"& an/ a e! i !roce/ure : The organi0ation is compared of dentists, hygienists, dental assistants, government representatives, dental manufacturers, university professors, researchers and dental consultants. 9+ P is e!cellent resource for information on infection control, in6ury presentations and occupational health issues. 9+ P publishes its official infection control recommendations actually to keep pace with new information and distributes information monthly on the form of news letter, reports, position papers and press releases. -OVERN'ENT A-ENCIES: () Cen"er for /i ea e con"ro# an/ !re2en"ion: #ost infection control procedures practiced in dentistry are based on recommendations made by 252. 252 does not have the authority to make laws but many local, static and federal agencies use 252 recommendation to formulate laws. *) Foo/ an/ /rug a/mini "ra"ion: -s a part of /+ department of health and human services. -n addition to infection control ?5 gloves, masks, surgical regulates the manufacturing and leveling of gowns, handpieces, li"uid sterilants and medical devices $such as sterili0ers and biologic and cleaning solutions, disinfectants and of antimicrobial hand washing agents and mouth washes%.

The purpose of ?5+ is to assure the safety and effectiveness of medical devices by re"uiring :good manufacturing practices; and reviewing the devices with associated labeling. 3) En2ironmen"a# !ro"ec"ion agenc&: -s associated with infection control by attempting to ensure the safety and effectiveness of li"uid sterilants and disinfectants. They also are involved in regulating medical work after it leaves the dental office. 3P registration number will be given to the product only if the product is scientifically proved to be safe. 4) Occu!a"iona# afe"& an/ $ea#"$ a/mini "ra"ion: -t is a regulatory agency that is a division of the /+ department of labor. 9+4 .s responsibility is to protect the /.+. workers from physical, chemical or infections ha0ards in the workplace. 9+4 offering technical assistance and consultation programs. Cer"ain "ermino#ogie u e/ b& OSHA: 3!posure is defined as :specific eye, month, other mucous membrane, non intact skin or parenteral contact with blood or other potentially infections material that results from performance of employees duties;. contamination risks. 3.g. careful handling of sharp instruments, use of high volume suction. Personal protective e"uipment @ term used for batters such as gloves, gowns and masks. 7ork practice control and engineering controls @ are term describe precaution and use of device to reduce accomplishes its mission by establishing protective standards, enforcing those standards and

4ousekeeping @ term that relates to clean up of treatment soiled respiratory e"uipment, instruments. 2ounters and floors as well as to management of used gowns and waste.

?ollowing is the summary of current 9+4 re"uired of employer.

regulations specifying what

employees must furnish, directions employers must proved and compliance 1% Provide 4epatitis & immuni0ation to employees without charge within 10 days of employment. (% >e"uire that universal precautions be observed to prevent contact with blood and other potentially infections materials. +aliva is considered to be a blood contaminated body fluid in relation to dental treatment. *% -mplement engineering controls to reduce production of contaminated splatter, mists and aerosols. 3.g. rubber dam, high volume suction scaling instruments instead of control for respiratory infection. ,% -mplement work pta practice control precautions to minimi0e splashing spatter as contact of base hands with contaminated surfaces. 3.g. when using a brush to scrub instruments, hold instruments will down in the sink, place the bristles on upper surface of instrument and brush away from you. )ever contact telephones, switches, pens, down handles with soiled gloves. 8% Provides facilities and instructions for washing hand after removing gloves and for washing other skin immediately or as soon as feasible after contact with blood or other potentially infections material. A% Prescribe safe handling of needles and other sharp items. B% Prescribe disposable of single use needles, wires, carpules and sharps as close to the place of use as possible, as soon as feasible is head

walled leak proof containers labeled that are closable from which needle cannot be easily spilled. 8% 2ontaminated reusable sharp instrument must not be stored < processed in a manner that re"uires employees to reach hand into containers to retrieve them from soaking pens. /se bioha0ard labeled as red pens that are leak proof and puncture resistant. 9% Prohibit eating, drinking, handling contact lenses and application of facial cosmetics in contaminated environment such as separatories or clean up areas. &ase storage of food and drinks in refrigerators or other spaces where blood or infectious material are stored. 10%Place blood and contaminated specimens e.g. teeth, biopsy specimen, culture specimen in a suitable closed containers. +urface of all containers must be cleaned enclosed in another clean red or bioha0ard labeled container. 11% t no cast to employees, provide them with necessary personal protective e"uipment and clear directions for use e.g. gloves, masks etc. 1(%3nsure that employees correctly use and discard personnel protective e"uipment $PP3% or prepare it for reuse. Provide ade"uate facility to discard gowns or laundry in location where they are used. 1*% s soon as feasible after treatment attend to house keeping re"uirements $operating asepsis% that are sub6ected to contamination. 1,%Provide a written schedule for cleaning and then decontaminating procedures. 18%2ontaminated re"uirement that re"uire service must first be decontaminated or a bioha0ard label must be used to indicate contaminated parts.

1A%2ontaminated sharps are regulated waste, discarded in hard walled containers. 2ontainers contaminated outside must be placed in a secondary container. 1B%Place reusable contaminated sharp instrument into a basket in a hard walled container for transportation to the clean up area. Personnel must not reach hands into containers of contaminated sharps. 18%Provide laundering of protective garments used for universal precautions at no cast to employees. OSHA 'ANDATED TRAININ- FOR DENTAL E'%LOYEES: The following must be available to all dental employees. copy of blood borne pathogens standard and specific information regarding the meaning of standard. -nformation about blood borne pathogens, both the epidemiology and symptoms of the diseases. -nformation about the cross contamination pathways of blood borne pathogens. written copy as means for employees to obtain the employer.s written e!posure control plan. -nformation on the tasks, category placement of employee classification and how each is identified in relation to blood borne pathogens and other potentially infectious materials. vaccine. -nformation about e!posure reductions, including PP3, work practices, standard precautions, including universal precautions and engineering practices. -nformation regarding the hepatitis &

 material arises. communication standard.

-nformation about the selection, placement, use, removal, disinfection, sterili0ation and disposal of PP3. -nformation about what to do and whom to contact if an emergency involving blood as potentially infectious -nformation about the past e!posure

evaluation and follow up the employer provides. copy of the 9+4 hacast

#aterial safety data sheets $#+5s% and information about labeling and ha0ardous waste. 9pportunity to the employees to ask "uestions of the individual giving the information.

CATE-ORIES OF E'%LOYEES: () Ca"egor& I: >outinely e!posed to blood, saliva or both. 3.g. 5entist, dental hygienist, dental assistant, sterili0ation assistant, dental laboratory technician. *) Ca"egor& II : #ay on occasion e!posed to blood, saliva or both. 3.g. receptionist or office manager who may occasionally clean a treatment room or handle instruments or impressions. 3) Ca"egor& III: )ever e!posed to blood, saliva or both. 3.g. ?inancial manager, insurance clerk, or computer operator. I'%ORTANT INFECTIOUS DISEASE TRANS'ISSI+LE +Y THE ORAL CAVITY: () AIDS:

-5+ is a severe condition caused by infection with the human immunodeficiency virus $4-'11%. -5+ was reported as a new clinical disease in the summer f year 1981 and 252 now estimates that appro!imately ,0 million people have been infected with 4-' world wide. 2ausative organism 1 4-' is a member of a group of >) retrovirus. Type - @ #ost common world wide cause of 4-' Type -- @ in 7estern frica ROUTES OF TRANS'ISSION: A) Se5ua# con"ac" 6$e"ero e5ua# or $omo e5ua#) The virus from an infected person.s blood, seminar vaginal secretions enter the blood circulation through tiny breaks in the rectum, vagina or penis. +) +#oo/ an/ b#oo/ !ro/uc" : 1% -n6ection drug usersC contaminated, shared needles carry the infection. (% Transfusion and use of blood products by patients with blood disorders. *% 9ccupational accidental in6uriesC low risk of infection. C) %erina"a#: 1% PlacentaC virus can be transmitted across placenta. (% 5uring deliveryC e!posure during passage through infected genital tract. *% Postnatal C through breast feeding. INDIVIDUALS AT HI-H RIS7 OF INFECTION: a% b% +e!ually active homose!ual or bise!ual man having multiple partners without practicing safe se!. /sers of intravenous drugs particularly when sharing contaminated needles. viruses called

c% d% e% f% g% h%

>ecipients of blood transfusions or blood products. #ale and female prostitutes who do not practice safe se!. >ecipients of 4-'11 infected organ transplants. ?emales artificially inseminated with 4-'11 infected semen. -nfants born to 4-'11 infected mothers. -nfants fed breast milk from 4-'11 infected mothers. 4-'11 is a retrovirus having >) as care genetic material. 3n0yme

LIFE CYCLE OF THE HIV8(: reverse transcriptase is essential for replication. II9 E "ab#i $men" of infec"ion: A9 +in/ing "o a "arge" : $o " ce##: 1% 4-'11 enters the body and passes by way of the blood to a target cell surface where it binds to a specific cellular receptor 25,D. (% Target cells that have 25,D receptors include T1helper lymphocytes, monocytes, macrophages and certain neurons and gilial cells of the brain tissue. +9 En"r& "$roug$ ;a## of "$e "arge" : $o " ce## : ?usion occurs between virion and the target cell membrane and the virus becomes uncoated. 9nly the viral >) and en0ymes enter the cell. C9 Re2er e "ran cri!"ion : 1% 'iral >) is changed into single1stranded 5) by the en0yme reverse transcriptase. +ingle stranded 5) is these translated to

double stranded 5) which is called the provirus. (% The provirus migrates to the nucleus of host cell, enter the nucleus and becomes permanently integrated with the host 5) . D9 Infec"ion i e "ab#i $e/ E9 La"enc& !erio/ The integrated proviral 5) remains latent for long period, but they induce the production of new viruses pentacle within the lymphocytes.

'irus that can infect and destroy more lymphocytes leading to depletion in T, cells which leads to variety of infections and neoplasm due to immunocompromised state $below (00mm*%. This end stage of 4-' infection is called -5+. -n patients with advanced 4-' disease, as many as 109 new virions are produces each day and as many as (!109 25, cells turn over per day. 9ccupational e!posure to 4-' many occur, percutaneous e!posure involves needles carrying 4-' infected blood. >isk of ac"uiring 4-' via a percutaneous e!posure is 0.*E whereas after a mucocutaneous e!posure, risk is about 0.09E. E!i/emio#og& : -5+ appears to have originated in frica, where serologic evidence suggests that it has been present for atleast ( decades. n estimated ,( million people world wide have been infected with 4-' since the onset of the pandemic. )o end is in sight for the 4-' pandemic because here is no presently available drug that will inactivate the virus in vivo. &ecause there is no effective vaccine, we must depend upon education and behavioural change to control the disease, uni"ueness of this infection is based upon the fact that 4-' attacks cells of the immune system. Thus event eventually leads to a progressive and irreversible immunosuppression by production of more virus and further killing of T, helper lymphocytes, the cells that moderate immune system. The subse"uent immunodeficiency leads to a opportunistic infections, malignancies and autoimmune disease which then lead to death. %rogre ion of HIV8AIDS : 7indow
period c"uiring 4-' infection cute illness $fever, rash, 6oint and muscle pain, sore throat% Pre1 -5+ -5+ +ymptomatic 5eath

symptomatic

CLASSIFICATION OF HIV INFECTION AND AIDS : 252 gave the classification for 4-' infection in 199*
A CD4 coun" F 800<mm* (001,99mm* G (00<mm* < =>> ce## :mm3 cute primary infection 1 Persistent generali0ed lymphadenopathy 1 >ecurrent vaginal candidiasis 1 1 perpura >opharyngeal candidiasis ? (>> ce## : mm3 1 1 1 )on hodgkins lymphoma 2erebral to!oplasmosis 4-' associated dementia ?=> ce## :mm3 1 1 2#' retinitis &urkitt.s lymphoma 1 A &m!"oma"ic /i ea e
1 ( *

+ 'inima##& &m!"oma"ic 6no" A or C ca"egor&) &1 &( &* *>>8=>> ce## :mm3 4erpes 0oster Pulmonary T& 9ral leukoplakia -diopathic 1 thrombocytopenic 1 hairy 1

C AIDS in/ica"or con/i"ion 21 2( 2* ? *>> ce##:mm3 Pneumocystitis carinii pneumonia #ucocutaneous herpes simple! 9esophageal candidiasis 4-' Peripheral neuropathy associated wasting disease

Co8re#a"ion be";een CD4 coun" an/ HIV a ocia"e/ /i ea e :

1 1 1 1 1

C#inica# cour e of HIV8( infec"ion : detectable antibody level usually can be detected within 1 to * months after e!posure to 4-'11 virus. infection. ntibody presence indicates

I9 Incuba"ion !erio/ : >anges from the tissue of infection until the time when symptoms of -5+ are evident which may by 18 years or longer. A9 Ini"ia# infec"ion : fter e!posure, one half of these infected will have flue like symptoms within ( to A weeks. They are often unsuspected as associated with 4-'11 infection. 1% +ymptoms @ fever, lymphadenopathy, pharyngitis, fatigue, muscle pain and a skin rash. (% 'iremia @ within ( to , weeks after the initial infection high levels of virus occur related to dissemination and development of antibody. +9 Ear#& HIV8( infec"ion : 1% 25, F 800 cell<mm* (% +ymptoms C no symptoms usually but if any lymphadenopathy and dermatologic lesions. *% 9ral lesion C #ore common in later stage herpes simple! labialis, apthous ulcers. 4airy leukoplakia @ indicator of 4-'11 infection. C9 In"erme/ia"e "age : 1% 25, count C (001800 cells < mm* (% +ymptoms C skin and oral lesions become more common. >ecurrent herpes simple!, varicella 0oster, fever, weight loss, candidiasis, myalgia, headache, fatigue. *% 9ral lesions C #ore common candidiasis is considered to be indicator of pneumocystis carinii pneumonia. D9 La"e "age /i ea e : -5+ 1% 25, count 1 (001800 cells < mm* (% +ymptoms C -5+ indicator condition 9pportunistic infections

2onstitutional disease C 4-'11 wasting syndrome, long term fever, sever weight loss, anemia, chronic diarrhoea, chronic weakness are all effects of loss of immune response. 3) Ence!$a#o!a"$& : organic mental disorders 5isabling cognitive or motor dysfunction may develop with symptoms of apathy, inability to concentrate, poor memory and depression. 4) Neo!#a m : Hapsoi sarcoma, non1hodgkin.s lymphoma. Ora# manife "a"ion : patches over tongue. recurrent Sero#og& for HIV infec"ion : 4-' infection is detected by blood tests 1% 3I-+ (% 7estern blot test *% ?loroscent antibody tests These tests detect the bs formed against the virus. Test for anti 4-' antibody are often positive within * months after infection, most are positive by A months. second positive test is necessary to confirm the serologies. O"$er me"$o/ : 5irect P2> @ polymerase chain reaction HIV ri @ for c#inica# !er onne# : typical periodontitis associated with 4-' 2helitis at angles of the lips. Painful herpes stomatitis Haposis sarcoma @ sarcoma of capillaries @ often seen over palate as red brownish to purple blotches. =ingivitis and periodontitis which is Persistent oral candidiasis white curd like

9f all

merican health care workers in6ured by needles and sharp

instruments used to treat 4-' infected persons only 0.*E as less have been infected with 4-'. 4-' infection has been developed in a nurse and technician spattered with 4-' infected blood. Therefore personnel are re"uired to protect eyes, mucosa, skin and hands from spatter and direct contact with blood and blood contaminated body fluids during dental treatment of all patients. Precautions also must be made to minimi0e risk of in6uries with sharp instrumentation. Patients with patients. HIV ri @ for /en"a# !a"ien" : 7ith proper use of infection control measures in dental practice, the risk of dental patients of contracting 4-' from office personnel is low. 9nly one uni"ue circumstance has come to light, where a group of A patients was found to be infected with the same strain of 4-' that infected the florida dentist who treated them. HIV /a"a re#a"e/ "o infec"ion con"ro# : 1% /nlike 4& virus, 4-' usually has been found in very low levels is blood of infected persons. This is especially there of asymptomatic persons who are the most difficult to recogni0e and would be most likely to be treated in private office. (% 4-' was detected in only (8 of 80 samples of blood from infected persons. -n saliva from infected persons, 4-' was detectable in only 1 of 8* samples. *% -n dried infected blood, 99E of 4-' has been found by 252 investigators to be inactive in appro!imately 90 minutes. 4owever when wet virus may survive for ( or more days. -5+ may harbor transmissible respiratory infection such as T& and 2#' which are generally atypical in these

,%

4-' is killed by all methods of sterili0ation. 7hen used properly, all disinfectants e!cept some "uaternary ammonium compounds are said to inactivate 4-' in less than ( min.

8%

4-' has been transmitted by blood contaminated fluids that have been heavily splattered or splashed. 4owever aerosols produced during dental treatments, have not been found to transmit 4-' infection.

A%

&arriers have proven successful protecting dental personnel to hospital dentistry.

VIRAL HE%ATITIS : -nfective inflammation of the liver termed as hepatitis viruses cause a variety of types of hepatitis. 1 4epatitis 1 4epatitis & 1 4epatitis 2 1 4epatitis 5 $% 1 4epatitis 3 )ew viruses have been found
-n post transfusing or in6ection )on patients &253 during users

4='

Fea"ure of $e!a"i"i 2iru :

Viru grou! )ucleic acid -ncubation week +P>3 5 ?acies &lood +aliva +e!ual He! V en"ero + $e!ane"e C F#a2i2iru D incom!#i"ic RNA

E!i/emio#og& :

-n the 8 years after

-5+ was recogni0ed *8,000 persons developed

the disease. 5uring the same period an estimated *8,,00 died from 4epatitis &, related cirrhoses or liver carcinoma. He!a"i"i + : 5escribed in 19A8, caused by hepatitis & virus. -t is a 5) virus. The virus is composed of an outer compartment of 4&s g and an inner compartment of 4&c g @ inside the core particle is a single molecule of circular, partially double stranded 5) blood in great numbers. for long term immunity. nti 4&s antibody to care antigen develops in all patients with 4&' infection to persists indefinitely. The replication and high infectivity. S&m!"om an/ c#inica# fin/ing : )ausea, vomiting, chronic fatigue, mental depression, fever, 6oint aches, 6aundice, possible rash or diarrhoea. 9nly ( to 10 patients infected with hepatitis & show symptoms, the remaining 8 persons are usually unaware of their infection. ?or this reason, it is impossible to detect most hepatitis & infected person from medical history. 7hether infected prson are asymptomatic or not they can transmit hepatitis & virus. 2hronic carrier state is seen. 'o/e of "ran mi ion : 1% Percutaneous C dental treatment involves use of small sharp instruments. ccidents with sharp needles. 4&e g correlates with 4&' nti 4&s antibody to 4bs g is responsible endogenous 5) polymerase and 4&e g. +pherial and tubular particles of 4&s g circulates in infected

(% *% ,% 8% O"$er "&!e : *) He!a"i"i A :

)on percutaneous C transfer of infections body secretions, saliva, blood and crevicular fluid. Perinatal e!posure +e!ual e!posure -nfection from blood transfusion and blood products.

4ighly infections includes preicterus phase and icteric phase. 'o/e of "ran mi ion : ?arco1oral route seen generally in overcrowding and poor sanitation. 2hronic carrier state analogus to hepatitis & is not there. 3) He!a"i"i C : $)on 'o/e of "ran mi ion : &lood, saliva, direct percutaneous e!posure, perinatal transmission possible, intravenous drug abuse. 4) He!a"i"i D : -t is a >) defective virus which has no independent e!istence. -t can infect individual simultaneous with 4&' or it can super infect those who are already chronic carrier of 4&'. 'o/e of "ran mi ion : Parental, -' drug abuse, similar to hepatitis &. =) He!a"i"i E : 3pidemic non , non & ?ecal oralmode of transmission 2linical course and distribution are like those of hepatitis . %REVENTION AND CONTROL : He!a"i"i A : 1% +anitation and personal hygiene < )on &% 9ccurs without 6aundice

&ecause principle means of transmission is by feces, prevention an that level is indicated. a% Public health control of food handlers and of water contamination. b% Personal hygiene control through proper hand washer by patient as well as health care personnel involved in patient care. (% pplication in dental setting -nstrument sterili0ation, use of disposable materials, and all related precautions for persons and ob6ects contacted by the patient. He!a"i"i + : 4epatitis is a critical occupational ha0ard for dental personnel because of their close association with the potentially infected body fluids of patients. 3very health care personnel should be immuni0ed so that the possibilities of disease ac"uisition and transmission can be minimi0ed. I9 CO'%REHENSIVE %REVENTIVE %RO-RA' : A9 E#imina"e "ran mi ion /uring infanc& an/ c$i#/$oo/9 1% Prenatal testing of all pregnant women for 4&s g. (% /niversal immuni0ation of infants and childrens to be accomplished during routine health care visits when vaccinations are usually administered. *% -mmuni0ation of uninfected children. ,% -mmuni0ation of adolescents and adults, particularly those at high risk. +9 Enforce b#oo/ ban@ con"ro# mea ure : 1% +creening of donors, re6ection of individuals who have a history of viral hepatitis. (% +trict testing for all donated blood. 2. 3nforce sterili0ation or use of disposable syringes and needles. II9 ACTIVE I''UNI0ATION : the vaccines

Ac"i2e immuni"& : occurs by stimulation of an individuals own immune response. Protection is provided only after a latent period. 4owever long term immunity is provided. 3g. of active immuni0ation are actual ac"uisition of the disease and vaccination. %a i2e immuni"& : 9ccurs by transferring performed antibodies from an actively immuni0ed host. Protection provided is transitory and onset is immediate. 3g. infection of immunoglobulin -g or 4&-=. 4epatitis & vaccine are administered in three doses, the first at the onset these at 1 and A months. The vaccine is given in deltoid muscle for adults and childrens and in the anterolateral thigh muscle for infants and neonates. A) %#a ma @ derived 4& vaccine 3g. 4eptava!1&. prepared by using purified 4&s g from plasma of chronic 4&s g carriers +) Recombinan" : 5) 4& vaccine >ecombinant 5) technology has been used to synthesi0e 4&s g in culture of saccharomyes arevisiae a yeast. %OST EA%OSURE %RO%HYLAAIS : A) In/ica"ion for !ro!$&#a5i : 1% )ewborn of 4&s g @ positive mother (% +ignificant hepatitis & e!posure to 4&s g positive blood. +) He!a"i"i + immune g#obu#in : C) %roce/ure for ne;born of H+ Ag @ positive mother. 4&-= and 4&' vaccine intramuscularly within 1( hours of birth subse"uently as recommended for a specific vaccine. 3) HER%ES VIRUS DISEASE

4erpes virus produce disease with latent, recurrent and sometimes malignant tendencies. Abbre2ia"ion Name of "$e 2iru 'J' 'aricella10oster 3&' 42#' 4+'11 4+'1( 3pastin1&arr 4uman cytomegalovirus 4erpes simple! virus Types 1 and ( Infec"ion 'aricella $chickenpo!% 4erpes 0oster $shingles% 3&' mononucleosis 2ytomegalovirus disease ?etal infection 4erpes labialis 4erpetic gingivostomatitis 4erpetic keratocon6unctivitis 4erpetic whitlow 3ncephalitis 44'1A 44'1B 44'18 H+4' 4uman herpes virus A 4uman herpes virus B Haposis +arcoma herpes virus )eonatal herpes #ononucleosis like rash ?ebrile illness Haposis sarcoma

VIRAL LATENCY : The herpes virus have the ability to travel along sensory nerve pathways to specific ganglia. The specific ganglia are usually the following % ganglion. &% 2% 4erpes simple! type ( $4+'1(% travels to the thoracic, lumbar and sacral dorsal root ganglia. 'arcella10oster virus $'J'% goes to the sensory ganglia of the vagal, spinal and cranial nerves. SEBUENCE OF EVENTS : %RI'ARY INFECTION 1% 3!posure of person to the virus at the mucosal surface or abraded skin. (% >eplication begins in the cells of dermis and epidermis 4erpes simple! type 1 $4+'11% travels to the trigeminal nerve

*% -nfection of sensory and autonomic nerve endings. ,% 'irus travel along the nerve to ganglion. 8% fter primary disease resolves, the virus becomes latent in the ganglion. A% >eactivation at later date is precipitated by a stimulus, such as sunlight, immunosuppression, infection or stress. B% 'irus transfers along the nerve to the body surface where replication takesplace and a lesion forms. RES%IRATORY VIRUSES : Transmission is by way of small particle, aerosols, droplets and large particles and by direct contact or famites. 2ommon cold caused by variety of viruses is primary a nuisance but can result in loss of work time. 2ommon cold most readily transmitted by fomites or autoinnoculation. These viruses may cause pharyngitis. denovirus C common cause of respiratory illness. 2on6unctivitis may accompany the respiratory symptoms or occur as primary symptoms. 3nterovirus C characteri0ed by rashes and upper respiratory tract infection. '&cobac"erium "ubercu#o i : Transmission is by way of inhalational of tubercle bacilli ladese aerosoliced droplets with lungs becoming the initial site of infection. recent concern of the immunocompromised patients as well as for dental personnel is transmission of multidrug resistant mycobacterium tuberculosis. INFECTION CONTROL : Uni2er a# !recau"ion : +ince not all the patients with infectious diseases can be identified by medical history, physical e!amination or readily available laboratory tests routinely in dental practice. The 252 has introduced the concept of universal precautions i.e, treating of all body fluid from all patients as

though infected with blood borne disease agents and this has been incorporated as a rule into the blood borne pathogens standard by the occupational safety and health administration $9+4 %. The basis for this approach to infection control lies in the fact that many infectious diseases, including the blood borne diseases like 4-', hepatitis &, 2, and 5 are commonly asymptomatic. Thus because it is impossible to identify all those who may be carrying such infectious disease agents, the same infection control procedures must be used for everyone to maintain protection for both the patients and the dental team. Uni2er a# !recau"ion are a fo##o; : 1% #edical history (% &arrier techni"ue *% Iimiting contamination ,% 7ashing and care of hands 8% 4andling of sharp instruments and needles A% +terili0ation and disinfection < instrument processing B% +urface asepsis 8% septic techni"ue 9% 5isposal of waste materials 'e/ica# $i "or& : -n dentistry it has been recommended routinely that a comprehensive medical history be taken for each patient and to be reviewed and updated at subse"uent appointments. -t serve several purposes 1% To detect any unrecogni0ed illness that re"uire medical diagnosis and care. (% To identify any infection or high risk that may be important to a clinical person e!posed during e!amination treatment, or clean up procedures.

*% To assist in managing and caring for infected patient. ,% To reinforce use of ade"uate infection control procedures bearing in mind that general history taking is not capable of detecting all infections persons. II9 %ROTECTIN- +ARRIER TECHNIBUE : 5ental assistant has constant e!posure to saliva and blood during intraoral < invasive dental procedures. &arriers such as protective eyewear, face masks, disposable gloves and appropriate uniforms should be used routinely to minimi0e e!posure. -#o2e : =loves are used as a barrier to microorganisms. =loves must be worn by dentist, dentist, dental assistant and dental hygienist during all treatments that may involve contact with the patients blood, saliva or mucous membranes or with contaminated items or surfaces. fter contact with each patient, gloves must be removed, hands must be washed and these regloved before treating another patient. >epeated use of single gloves by disinfecting them is not acceptable. 3!posure to disinfectants or other chemical often causes defects in gloves thereby diminishing their values as effective barriers. CRITERIA FOR SELECTION OF TREAT'ENT : EAA'INATION -LOVES : A9 Safe"& fac"or : 1% 3ffective barriers (% -mpermeable to patients saliva, blood and bacteria *% +trength and durability to resist tears and punctures ,% -mpervious to materials routinely used during clinical procedures. 8% )onirritating or harmful to skin, use nonlate! gloves when patient or clinician is allergic. +9 Comfor" fac"or :

1% ?it hand well, no interference with motion, glove cuff e!tends to provide coverage over cuff of long sleeve. (% Tactile sense minimally decreased. *% Taste and odour not unpleasant for patient. TY%ES OF -LOVES : A9 'a"eria# : 1% Iate! (% )on late! C neoprene, block copolymer, vinyl, )1nitrile. +9 For !a"ien" care : 1% )onsterile single @ use e!amination < treatment late!, nonlate! (% Presterili0ed single @ use surgical, late!, nonlate! *% 4ypoallergic gloves ,% Powderless gloves 8% ?lavoured gloves C) U"i#i"& g#o2e : 1% 4eavy duty, late!, nonlate! @ heavy nitrile gloves $puncture resistant% (% Plastic @ food handler.s glove to wear as overglove D) Derma# un/erg#o2e : to reduce irritation from late! or nonlate!. E) Hea" re i "an" g#o2e () S"eri#e urgica# g#o2e : The best fitting and generally the most e!pensive disposable gloves. /sed when ma!imum protection is indicated. *) La"e5 g#o2e : These are most commonly used in dentistry. n occasional hypersensitivity to the late! has been reported. -nade"uate changing of hand prior to gloving has proven to be another cause of dermatitis. -f the hypersensitivity e!ists the practiouer can opt for a glove without cornstarch, use a vinyl or neoprene gloves or use cotton glove liners under the late! gloves.

Pinholes are present under all types of gloves and late! gloves are no e!ception. The danger in pinholes is that microorganisms can penetrate through minute openings in the late! and multiply. 3) OVERCILOVES : =loves are placed over the late! as vinyl gloves during a procedure to prevent cross contamination. They are big loose gloves that do not have the tactile touch that the late! and vinyl gloves have but they "uickly fit over the gloves to obtain something in sterile area. They are not used as a e!amination gloves. They should be discarded after every use. NON DIS%OSA+LE -LOVES : 4eavy utility gloves used during handling contaminated instruments or supplies when using chemical sealant and during cleaning of treatment area. /tility gloves can be purchased that can be washed, sterili0ed, disinfected and used and that are puncture resistant. %ROCEDURE FOR USE OF -LOVES : % #ask and eyewear placement prior to hand washing and glaring to prevent the need for manipulating the mask around the face and hair after washing the hands. &% 2% Pregloving hand wash C 4ands must be dried throughly to control moisture inside gloves and thus discourage growth of bacteria. =love placement C appointment. 5% voiding contamination. Heep gloved hands away from face, hair, clothing, telephone, patient records. 2linical stool and all other e"uipments that have not been pre disinfected. 3% ?% Torn, cut or punctured gloves @ >emove immediately wash hands thoroughly and wear new gloves. >emoval of gloves. lways glove and deglove in front of the patient. patient may need assurance that gloves are new and used only for that

FACTORS AFFECTIN- -LOVE INTE-RITY A) Leng"$ of "ime : 1% )ew pair for each patient (% Total time should be no longer than 1 hour. *% 7hen glove develops sticky surface @ reglove. +) Com!#e5i"& of !roce/ure 2ertain procedures more likely to promote perforations, especially when sharp instruments are used. C) Si1e of g#o2e 7hen too long, e!tra material at the finger tips can get turn or in the way picking up of small ob6ect is difficult especially sharp instruments. D) S"orage of g#o2e 1 Heep in cool, dark place 1 3!posure to heat, sun increases the potential for deterioration and perforations. E) Ha1ar/ from $an/ , #i@e ring F) %re ure of "i ue +ires, was ring too fast increases the risk of grove damage. -) Agen" u e/ : 2ertain chemicals react with the grove material, eg petroleum fully, alcohol and products made with alcohol tend to break down the from integrity. La"er $&!er en i"i2i"& : Iate! sensitivity is to protein allergens and additives used when commercial late! is prepared. 3"uipment that may contain late!. 1 =roves 1 #asks 1 >ubber dun 1 Iead apron cover 1 >ubber polishing cup 1 &ike blocks.

Harmfu# reac"ion "o #a"e5 gro2e an/ o"$er #a"er !ro/uc" :

S&m!"om Con/i"ion 1% 4ands become dry, red itchy -rritant contact dermatitis and sometimes cracked (% >edness, initial itching, Type -' hypersensitivity $delayed

vesicles appear in areas of contact hypersensitivity% within (, to ,8 hours followed by dry skin with fissures and sores *% >unny nose, snee0ing, itchy Type - hypersensitivity $-mmediate eyes, scratchy throat, asthma and type hypersensitivity% in rare case anaphyla!is

LI'ITATION OF -LOVES : 9ffers with protection against in6uries with sharp ob6ects instruments needles and scalpel blades. 5o not reuse utility gloves of they are peeling, cracking, discolored, tarn, punctured. OVER-AR'ENTS: +) %ROTECTIVE CLOTHIN-: The purpose of protective clothing is to protect the skin and under clothing from e!posure to saliva, blood, aerosol and other contaminated materials. Protective clothing includes uniforms, laboratory coats, gowns and clinic 6ackets. -ui/e#ine for u e of !ro"ec"i2e c#o"$ing: &ecause protective clothing can spread contamination, it is not warn out of the office for any reason. Protective clothing should be changed at least daily and more often is visibly soiled.

-f a protective garment becomes visibly soiled or saturated with chemicals or body fluids, it should be changed immediately Protective clothing must be warn the staff lounge areas as when workers are eating or consuming beverages.

%ro"ec"i2e c#o"$ing reCuiremen" : Protective clothing should be made of fluid resistant material. 2otton or disposable 6ackets or gluons are satisfactory for routine dental procedures. To minimi0e the amount of uncovered skin, clothing should have long sleeves and high neck line. The design of sleeve should allow the cuff to be tucked inside the band of glove. 5uring high @ risk procedures, clothing must cover dental personnel at hest to the knees when seated. &uttons, trim, 0ippers should be kept to minimum as they can harbor pathogens. )o pockets. Pockets are too readily available for placing contaminated ob6ects. =loved hands should not be used for touching contaminated ob6ects placed in pockets. Han/#ing con"amina"e/ #aun/r&: 2ontaminated laundry must be labeled with the universal bioha0ard label. #ust be laundered in the office or sent to laundry service. II) Han/ an/ Hair Co2ering: % 4air must be warn off the shoulder and fastened back away from the face. 7hen longer it should be held within the head cover. &% ?acial hair must be covered with face mask as a face shield. +ARRIERS:

ny area that can be covered where contamination is possible during dental treatment should be covered. &arriers have been made specially for areas that have been hard to disinfect or sterili0e in past. -n the operatory, the patient dental chair, the light handless and operating switdes, hand piece, air wakes syringe, high volume evaluator, saliva e6ector and tubing are covered with barriers. Plastic dry cleaning bags are non1e!pensive and can be used to cover the dental chair. FACE 'AS7: mask is warn over the nose and mouth to protect the person from inhaling infectious organisms spread by aerosol spray of the hand piece or air water syringe and by accidental splashes. 'a @ efficienc& : 1% ?iltration standard mask blocks filtration of particles as small as * m with a filter efficiency greater them 98E. (% Proper fit over the face is a must to protect against inhaling aerosols. C$arac"eri "ic b& i/ea# ma @: )o contact with the wearers nostril or lips 4as high bacterial filtration efficiency rate. ?its smugly around the entire edges of the mask, convenient to put and remove. 5oes not collapse during wear as when wit )o fogging of eyewear. #ade of materials that does not irritate skin or induce reaction.

'a"eria# u e/ for ma @: 1% (% *% 'a"eria# Effec"i2ene Paper, 2loth, ?oam Iess effective =lass, synthetic fibers &etter Plastic face shield D face mask ?or total effectiveness

U e of ma @: 1% d6ust the mask and position eye wear before a scrub or hand wash. (% /se face mask for each patient more fre"uently when it becomes wit. *% Heep the mask on after completing a procedure while still in the presence of aerosols. Particles smaller than 8 m remain suspended longer than do larger particles and can be inhaled directly. ,% #ask removal @ grasp sick elastic or tic strings to remove. 1 )ever handle the outside of a contaminated mask with gloved as bane hands. 8% #ask should be disposed off after each use and not left hanging around the neck. %ROTECTIVE EYE WEAR: -mportant to prevent physical in6uries and infection to the eye contamination can be induced from saliva, pla"ue, carious material, aerosol, spatter etc. dvisable to use protective eye wear by all involved dental team member and patient. -enera# frac"ure of acce!"ab#e e&e ;ear: 1 7ide coverage with side shields 1 +hatter proof, made of strong sturdy plastic 1 3asily disinfected 1 +urface area smooth 1 ?rames and less should not be distasted by disinfectants used. T&!e of e&e ;ear: 1% =ogglesC 3specially necessary for protecting during laboratory work. (% 3ye wear with side shields. *% 3ye wear with covered frames < ?ace shields.

3ye wear should provide front, top and side protection. 3ye wear is also used to protect eyes from high intensity lights used for curing dental materials. These glasses are colored arrange for protection.

RU++ER DA': >ubber dam isolation has shown to significantly reduce infectious particles in aerosols. /sed in combination with a pre1operative rinse of chlorhe!idine gluconate. The contamination can be further reduced. dditionally rubber dam use reduces the e!tent of contact of the operator hands with the patient.s mucosa. Thus when used be con6ugation with other barriers dam usage minimi0ed transmission of blood barn pathogens from patients mouth. LI'ITIN- CONTA'INATION: Three principles of limiting contamination by droplet and spatter are the use of high volume evacuation, proper patient positioning and rubber dam. utiseptic mouth rinse $0.1(E chlarhe!idine gluconate% helps in reducing the total number of microorganisms. Hig$ 2o#ume e2acua"ion : -t is an effective way to minimi0e the spray coming from the high speed rotary hand piece and the air water syringe. 3vacuation system use tips that are sterili0able or dispasable. >unning water and speciali0ed detergent deodari0ers through high volume evacuation at the end of each day aids in reducing the microorganism in hoses and the trap. WASHIN- AND CARE OF HANDS: The hands may as a means of transmission of blood saliva and bacterial pla"ue from patient. &y caring properly for the hands, using effective washing procedures and following basic rules for glaring, primary crass contamination can be controlled.

A)

Finger nai# : #aintain clean, smoothly trimmed short finger nails with week cared

for cuticle to prevent breaks where microorganisms can enter. 1 1 +) 3ffect of short nail makes hand washing more effective because microorganisms that harbor under nail are removed. Prevents cuts from nails in disposable gloves. Wri " ;a"c$ an/ De;e#r& : 7atch and 6ewelry at the beginning of the day. Han/ ;a $ing !rinci!#e : Ra"iona#e: 3ffective and fre"uent hand washing can reduce the overall bacterial flora of the skin and prevent the organism ac"uired from a patient from becoming skin resident. %ur!o e: 1 1 1 Faci#i"ie : A) 1% (% Sin@ : /se sink with a foot pedal or electronic control for water flow to avoid contamination from faucet handles. ?or regular sink, turn on water of the beginning and leave and through the entire scrub procedure. Turn faucets off with the towel after drying hands. *% sink. +) Soa! : Prevent contamination of clothing by not leaning against the >emove surface dirt and transient bacteria 5issolve normal greasy film on the skin Provide disinfection with long acting antiseptic

1%

/se a li"uid surgical scrub containing an antimicrobial agent poridone iodine has a broad spectrum of action chlarhe!idine preparation can also be used.

(% To;e# :

pply from a foot activated or electronic controlled dispensce to avoid contamination.

1% 9btain disposable towel dispenses that re"uires no contact e!cept with the towel itself. (% 2loth towels are not recommended. 'e"$o/ of $an/ ;a $ing: * methods 1% +hort scrub (% +hort standard hand wash *% +urgical scrub. () S$or" crub : 4and washing is recommended for the beginning of the day prior to the first gloving, and 6ust prior to the first gloving of any series of appointment. A) 1 1 1 sterile soft brush as nail brush may be used, but hard brushing is avoided as breaks in skin could result. %re#iminar& "e! : 7ear protective eye wear and mask. 7ash hands and wrist briefly using li"uid antimicrobial surgical scrub soap. Ieave water running at moderate speed. 2lean under finger nails with arrange wood stick rinse from finger tips towards wrists. Heep hands higher than elbow during entire procedure. +) C) La"$er $an/ : Fir " $an/ : 1% &rush back and forth across nails and finger tips five times.

(% &egin with the thumb, use small circular strokes on each side of thumb and each finger, then plan and back of hand. 3!tend fingers to gain access to each crevice and line. *% +crub wrist on both sides and more to forearm. ,% 7hen completed, rinse will from fingertips on up over the wrist. D) Secon/ $an/ : 1% >epent entire procedure (% >inse the hand and arm generously and thoroughly to wash away all transient microorganisms. *% 5ry hands thoroughly use separate paper towel for each and. E) *) Wear g#o2e : S$or" "an/ar/ $an/ ;a $ : -t is a general procedure for all times eg. before each patient whenever gloves are donned, after gloves are removed and before leaving the treatment area. % &% 2% 5% 3% ?% 3) 7ear protective eyewear and mask. Tie hair securely at back. >emove watch and all 6ewllery. /se cool water and li"uid antimicrobial surgical scrub soap. Iather hands, wrists and forearm "uickly, rubbing all surface rigorously. >inse thoroughly from finger tips across hands and wrists. >epeat two more times. The lathering serves to loosen the debris and microorganisms and the rinsing wash them away. /se proper towels for drying. Take care not to recontaminate. Surgica# crub : -n each has petal or oral surgery clinic, a surgical scrub is performed as the initial scrub of a day for 10 minutes and subse"uent scrubs may be for *18 minutes, fallowing treatment of a contagious or isolated patient. A) %re#iminar& "e! :

1% 7ear mask and eye wear. (% 7ash hands and arms using surgical li"uid antimicrobial soap to remove gross surface dirt. *% >inse thoroughly from finger tips across hands and wrists. ,% /se arrange wood stick to clean nails and rinse. Fir " $an/ : 1% Iather the hands and arms and leave the lather on during the scrub to increase e!posure time to the antimicrobial in gradient. (% pply surgical li"uid soap and begin bush procedure. +crub in an orderly se"uence without areas previously scrubbed. *% &rush back and forth across nails and finger tips, passing the brush under the nails. ,% ?ingers and hand use small circular strokes on all sides of the thumb and each finger. 8% 2ontinue to wrist. pply more soap to obtain a good lather. A% 7hen arm is completed leave lather on. Secon/ $an/ : 1% >epeat on the other arm. (% t one half of scrub time, rinse hands and arms thoroughly first one and then the other starting at the fingertips and letting water pass down over he arm. *% Iather and repeat. ,% 4ard hand up and collapsed together, proceeds to dressing room area for gowning and gloving. OVERVIEW OF ASE%TIC TECHNIBUE: 2oncept of asepses is to prevent crass contamination during each appointment. 1% >emember whatever touched is contaminated (% 5irectly touch only whatever has to be touched

*% /se the following to control contamination a% b% 2lean and sterili0e instruments Protect surfaces and e"uipments that are hat sterili0ed with disposable single use covens. 5iscard them after every appointment. /se covers on portable items eg curing lamp handless, amalgam mi!ers and plastic air water syringe. c% d% /se a paper towel, tongs or plastic bags over gloves to open cabinets and drawers to get things not anticipated during set up. +crub and disinfect noncritical surface as will as possible operatory asepsis.

%re!ara"ion of o!era"or& urface : 1 9peratory surfaces that will be repeatedly touched as soiled are best protected with disposable covers that can be discarded after each treatment. 1 2hanging covers eliminate cleaning and disinfecting the surface, saves time and effort and e!panse and can be more protective. 1 fter each appointment discard and replace bags and cover without cleaning and disinfecting covered e"uipment items. %re!ara"ion of emicro"ica# i"em an/ noncri"ica# i"em :
Ca"egor& 2ritical Func"ion an/ eg 2ontact cut tissues In"ra ora# Ri @ of /i ea e %roce/ure ue as Kes "ran mi ion 'ery high +terili0ation

penetrate soft tissues eg )eedle, scalpel, +urgical instruments, mirrors, dental e!plorer, periodontal probes, scalers, burs, bone &emicritical chisels. Touch mucous membrane Kes #oderate +terili0ation

but will not touch bone or penetrate soft tissue eg #outh mirror, condensers, )oncritical amalgam handpiece, -ntermediate to low level or disinfection

or level

high

disinfection

impression trays. 2ontact only with intact )o skin eg counter tops, height handle, switch, !1ray head tubing far handpiece, instrument tray

basic cleaning.

S"e! b& "e! !re!ara"ion of "$e /en"a# c$airE /en"a# uni" an/ in "rumen" be";een a!!oin"men" : 1% 7ith hand still groved after the last treatment, remove and invert chair back cover, discard cotton rolls and other disposable materials. >emove and discard groves aseptically. (% 7ash hands with antiseptic hand soap and drug. Put on nitrile late! utility groves *% 7ith the used suction tip, clean saliva and debris, discard disposable suction tip. ,% >emove from anesthetic syringe the resheated needle. 5iscard it with all other sharp disposable items in a sharp container. 8% &efore handling disinfectant disinfecting bottles, wash utility groves with antiseptic scrub, rinse and dry. A% +pray any used bottles containers, tube and unused burs with disinfectant and wipe with a paper towel. B% -nvert, remove and discard plastic drapes from the control unit. >emove and discard covers from lamp handles and surface covering from side table. 8% ?or any controls and switches not covered, wet a paper towel with disinfectant spray and wipe lamp switch and controls that were

contaminated and side arms as dental chair, contaminated drawer handles, radiographic view bo! switch. 9% /se a second towel wet with disinfectant to rewet these items and leave wet. 10% +pray any contaminated fances handles, sink counter top and trash disposal opening with disinfectant and wipe dry with paper towel. 11% 7ash the utility groves with strong antiseptic hand scrub as disinfectant chances, >inse thoroughly and dry them with paper towels. >emove utility groves and rehang them in the operatory. 7ash hands. Uni" for ne5" !a"ien" i !re!are/ a fa##o; : 1% Pull a large clear plastic bag cover over be dental control unit. (% Pull another bag down over the chair back and also chair arms. *% -nstall suction and air<water syringe tips. Place a slander bag over each tip. 7rap autoclave tape at the tip. ,% -nstall sterili0ed handpieces. 8% +et out materials and instrument pucks, open packs carefully not to touch the sterili0ed instruments with bone hands. A% +eat the patient and put on a clean mask, eye wear and gloves. Protection of comple! device against contamination like cancer as, light curing units, intra oral cameral etc. must be covered with clear plastic bags @ as effective +ingh use protective barrier. NEEDLE STIC7 IN.URY : This is most common in6ury occurring in the dental clinic during handling sharp instruments. -n the event you do puncture the skin with sharp contaminated instrument do not panic. ?ollowing steps should be followed following e!posure. a% >emove the instrument gently.

b% c% d% e%

7ash with running water, do not scrub. bleed freely for 8 months under tap water.

llow the hand to

-f necessary induce bleeding, suck blood as in shake bit and spit s"uee0e blood. 5isinfect the wound with chlorhe!idine gluconate and rinse. 2over with dressing before continuing treatment.

%OST EA%OSURE %RO%HYLAAIS :

3!posure incident occurs 3mployee reports it to employer 3mployer directs employee to 42P $4ealth 2are Personnel% sends to 42P. 2opy of standard 6ob description of employer. -ncident report $route etc%. +ource patient identify and 4&'<4-' status. 3mployer.s 4&' status and other relevant medical information.

42P evaluates e!posure incident. rrange for testing as e!posed employer and source patient )otifies employer of results of all testing. Provides counseling. Provides pest e!posure prophyla!is of indicated. 3valuates reported illness.

+ends the 42PLs written openion to employer

>eceives 42P.s written openion Provides copy of 42P.s written openion to employer

DISINFECTANTS: &ecause many operatory surfaces routinely became coated with saliva, blood, e!udate and other debris and because each surface re"uires cleaning and disinfection when it is not feasible to use disposable covers, chemical disinfectants serve as a very useful purpose in infection control.

-nfection control needs in dental treatment facilities re"uire the use of disinfectants in several forms. 1% +urface disinfectants. (% -mmersion sterilants. *% -mmersion disinfectants. ,% 4and antimicrobials. Surface /i infec"ion : -t is the treatment of environmental surface such as cabinets, brackets, tables, chairs, units, heights, !1ray and similar surfaces where items are too large too sensitive to be immersed in disinfecting chemicals. /sually accomplished by spraying or wiping the solution on the surface and allowing it to remain moist and undisturbed for the manufacturer.s directed time. Immer ion /i infec"ion : +ometimes called instrument disinfection an incorrectly also called cold sterili0ation is the immersion of instruments, plastics and other smaller items in a li"uid disinfectant contained in a disinfecting tray, historically called cold sterili0ing tray. Immer ion "eri#i1a"ion : -s the use of an 3P registered agent that has the capability of killing the liming micro1organisms and infection agents usually in A110 hours, immersed in solution. Han/ an"imicrobia# : Treatment is the specific art of washing or otherwise treating hands with a chemical soap or lotion with resulting reduction in number of hand microbes. -t is important to recogni0e that the effectiveness of both immersion and surface disinfectants is dependent on a member of factors. 1% 2oncentration and type of micro1organisms.

(% 2oncentration of chemical. *% Iength of e!posure time. ,% mount of accumulated debris. +paulding in 199( proposed a classification of chemical disinfectants. A) Hig$ #e2e# : 4igh level disinfectants inactivate spands and all forms of bacteria, funci and viruses. pplied at different time schedules. 4igh level chemical is either a disinfectant an sterilant. 3g C 3thyl o!ide gas. -mmersion gluteraldehyde solution. +) In"erme/ia"e #e2e# : -nactivate all forms of micro1organisms but do not destroy spares. 3g C formaldehyde, chlorine compounds, idophar, alcohol, chlorine compounds. C) Lo; #e2e# : -nactivate vegetative bacteria and certain lipid @ type viruses but do not destroy spares, tubercle bacilli or nonlipid viruses. %RO%ERTIES OF IDEAL DISINFECTANT : () *) +roa/ !ec"rum : +hould always have widest possible antimicrobia spectrum. Fa " ac"ing : +hould always have rapidly lethal action on all vegetative forms and spares of bacteria, fungi, proto0oa and virus 3) feces. +hould be compatible with soaps, detergents and other chemicals encountered in use. No" affec"e/ b& !$& ica# fac"or : ctive in presence of organic matter, such as blood, sputum and CLASSIFICATION OR DISINFECTANTS:

4) =) F) G) H) I) 1% (% *% ,% ()

Non "o5ic Surface com!a"ibi#i"&9 +hould not carrode instruments and other metallic surfaces. Re i/ua# effec" on "rea"e/ urface Ea & "o u e O/or#e Economica# 5isinfection as achieved by coagulation, precipitation or o!idation as protein of microbial alls or dematuration of en0ymes of the cells. 5isinfection depends on contact of the solution at the known effective concentration for the optimum period of time. -tems must be thoroughly cleaned and dried because action of the agent is altered by foreign matter and dilution. solution has specific shelf like, use life and sense life. A#co$o# : 3ffective skin antiseptics and valuable disinfectants for medical

%rinci!#e of ac"ion :

instruments. 1 3thylalcohol and isopropylalcohol are most commonly used. 1 -sopropylalcohol is preferred over ethylatcohol as it is a better fat solvent, more bactericidal and less volatile. 1 -t is active against vegetative bacterial cells including the tubercle bacillus. 1 -t denatures proteins and lipids and leads to cell membrane disintegration. 1 -t is used to disinfect skin prior to cutaneous in6ections. 1 -t is active against gram Dve, gram @ve and acid fast organism at a concentration of 80 @ B0E.

1 -sopropyl alcohol have high bactericidal activity at a concentration of 99E. 1 7ater solution work best. 1% lcohols work best at A0 to 98E solution with water. by coagulating proteins and water is needed for coagulation reaction. Di a/2an"age : 1 >elatively ineffective in presence of blood and saliva. 1 Iacks sparicidal activity. 1 2ause corrosion of metals. ALOEHYDES : FOR'ALDENYDE : 1 ctive against amino group in the protein molecule. 1 /sed to preserve anatomical specimen. 1 10E formalin containing 0.8E sodium tetrabarate as used to sterili0e clean metal instrument. 1 -n a"ueous solution it is markedly bactericidal and sparicidal and also has a lethal effect on nerves. Forma#/e$&/e ga : 1 /sed for sterili0ing instrument and heat sensitive catheters. 1 /sed for fumigating wards and laboratories. 1 =as is resistant and to!ic when inhaled. 1 7idely employed for fumigation of operation theaters. 1 fter sealing windows and other outlets, formaldehyde gas is generated by adding 180 gm of $H# n9n% potassium magnesium o!ide to (80 ml of formalin. Ci#u"era#/e$&/e : lso B0E alcohol1water mi!ture penetrates more deeply than pure alcohol into most materials. (% +ome water must e present for alcohol to disinfect because they act

Three types of gluteuraldehyde preparation are there alkaline, acidic and neutral preparations. Ac"ion : They are high level of disinfectant and act to kill microorganism by damaging their protein and nucleic acid by acting in aminogroup in protein molecules. +pecially effective against tubercle bacilli, fungi and viruses. 1 /sed to sterili0e rubber anesthesia tubes, face mask, plastic, metal instruments, some impressions. LI'ITATIONS : 1% 2austic to skin. (% -rritating to eyes. *% 2orrosion to some metal instruments . ,% -tems must be rinsed in sterile water after removal from immersion bath. IODO%HORS : Ac"ion : -odine is released slowly from the iodophas and bring a disinfecting action as a broad spectrum antimicrobial with enhancement of bactericidal activity. Povidine @ iodine preparation are widely used in the farms of surgical scrub, li"uid soaps, mouth and surface antiseptics prior to hypodermic in6ection. 1 -t was found that free iodine $- (% contributes to the bactericidal activity of iodophares and dilutions of iodophars demonstrate more rapid bactericidal action than does povidon @ iodine solution. %HENOLS AND THEIR DERIVATIVES 6CAR+OLIC ACID) : 1 ?ollowing its introduction in 18A8 by listes as a surgical antiseptic, phenol was widely used as a disinfectant. 1 +ince mast phenolic compounds have low solubility in water, they are formulated with emulsifying agents duck as soap which increase their antimicrobial action.

Ac"ion : 1 They are cytoplasmic parsons by penetrating and disrupting all wall thereby backing to dematuration of intracellular proteins. 1 Phenol disinfectant are active against gram Dve bacteria. 1 &acterial at 1E and fungicidal at 1.*E. LI'ITATIONS : 1 ctivity reduced in presence of organic matter. 1 2austic to skin. 1 3!pensive. D&e : Two groups of dyes. % niline dyes &% cridine dyes. 1 3!tensively sued as skin and wound antiseptic. 1 &oth are bacteriastatic in dilution but have low bactericidal activity. AWLINE DYES : 1 ctive against gram Dve than gram @ve. Ac"ion : Iethal effect on bacteria are believed to be due to their reaction with acid groups in the cells. ACRIDINE DYES : 1 ctive against gram Dve than gram @ve. -t is impregnated in gauge, they are slowly released in moist environment and hence there advantages and use in clinical medicine. Ac"ion : They impair 5) HALO-ENS : 1% -odine is apparent and has been used as a skin disinfectant active bactericidal agent with moderate activity against spars. against tubercle bacilli and number of viruses. lso active comple! of organisms and thus kill or destroy the reproduction capacity of cell. A/2an"age :

(%

2hlorine compounds

Ac"ion : #icroorganisms are destroyed primarily by o!idation of microsomal en0ymes and all membrane components. a) C$#orine /io5i/e : 1 /se life is only 1 day. 1 Preparation is economical and generally nonto!ic. 1 2orrosive to metals. 1 >e"uires proper ventilation. 1 -rritating to eyes and skin. b) So/ium $&/roc$#ori"e : 1 5aily fresh solution is needed s sodium hypochlorite tends to be unstable. 1 /se distilled water for mi!ing to improve the stability. 1 3conomical. Di a/2an"age : 1 2an harm eye, skin and clothing. 1 2an corrode instruments. 1 +kin odor may be offensive. Common#& u e/ an"i e!"ic an/ /i infec"an" : () +e"a/ine : 1 Povidine iodine microbicidal solution. $0.8E w<v available iodine% 1 5egerming of skin pre and post operatively for surgical procedures. 1 >apid and prolonged germicidal action against a wide spectrum of pathogenic organism. 1 lso active against bacterial spares. persist as long as the color remains. *) Snrgi crub : 1 -n presence of blood, serum, purulent and nectrotic tissue. -ts activity

2hlorhe!idene gluconate (0E w<v. 3) S"eri##ium 4and disinfectant. lcohol preparation. 4) +aci##o85 *= : 1 +urface disinfectant. 1 lcohol preparation. 1 3ffective against bacteria veins and fungi.

STERILI0ATION : 1 5efined as a process by which an article surface or medium is freed from all microorganisms both in vegetative and spare forms $ nanathnaryan% 1 Process by which all forms of life including bacterial spars are destroyed by physical and chemical means $7ilkins%. FLOWCHART SNOWINTHE STE%S INVOLVED IN INSTRU'ENT STERILI0ATION :

-nstrument cleaning $thermal disinfection or ultrasonic% >inse and dry Package +eal 2linical use

+terili0e

+tare packages

%RE%ARATION FOR STERILI0ATION : -nstruments and e"uipments intended for sterili0ation < disinfection procedure must be carefully prepared. The basic steps in recirculation of instruments from the time an appointment procedure is completed until the instruments are sterili0ed and ready for use in the ne!t clinical appointments canes under following tuacheins. 1% 4olding < pre soaking step. (% 2leaning step. *% Packing step. HOLDIN- : %RE SOA7IN- STE% : 2leaning is more difficult when saliva and blood are left on instrument for a period of time after use. -f a cleaning process can not be accomplished immediately, a container with a holding solution of mild disinfectant or detergent should be available in which to place the used instruments. The instruments can be placed directly into the basket for later submergence into the ultrasonic cleanser. The basket can be placed in the soaking solution. CLEANIN- STE% : -deally the instruments are contained within a cassette so that little or no handling is re"uired when instruments are not in a cassette, transfer forcep are used for transferring contaminated instruments. ?or all cleaning processes heavy duty, puncture resistant gloves must be used and a face mask and protective eye wear must be warm. Two methods for cleaning instruments are C

1% /ltrasonic cleaning. (% #anual cleaning. 'ANUAL CLEANIN- : /ltrasonic processing is a method of choice but when manual cleaning is the only alternative, precautions must be taken to prevent contamination. %ROCEDURE : 1% 7ear heavy duty gloves and mask. (% 5ismantle instruments with detachable parts, open 6oint instruments. *% /se detergents and scrub with a long handled brush under running water. 4old the instrument low in the sink. ,% &rush with strokes away from the body. 2are should be taken not to splash and contaminate the surrounding area. 8% >inse thoroughly. A% 5ry on paper towels. ULTRASONIC CLEANIN- : /ltrasonic cleaning prior to sterili0ation is safer than manual cleaning. #anual cleaning of instruments is dangerous, difficult and time1 consuming procedure ultrasonic processing is not a substitute for sterili0ation. it is only a cleaning process. ADVANTA-ES : 1% -ncreased efficiency in obtaining high degree of cleanliness. (% >educed danger to clinician from direct contact with potentially pathogenic microorganisms. *% -mproved effectiveness for disinfection. ,% 3limination of possible dissemination of microorganisms through release of aerosols and droplets which can occur during scrubbing process.

8% Penetration into areas of instruments where the bristles of brush may be unable to contact. A% >emoval of tarnish. %RINCI%LE OF WOR7IN- : The ultrasonic cleaning device works by producing sound waves beyond the range of human hearing. These sound waves which can travel through metal and glass containers cause cavitation $formation of bubbles in li"uid%. The bubbles which are too small to be seen, burst by implosion $bursting inward%. The mechanical cleaning action of the bursting bubbles combined with the chemical action of the ultrasonic solution removes the debris from the instruments. %ROCEDURE : 1% =uard against overloading. The solution must contact all surfaces. -nstruments must be completely immersed. (% 5ismantle instruments. 9pen 6ointed instruments. *% Time accurated by manufacturer.s guide. /sually 8 to 18 min. ,% 5rain, rinse sense and air dry. %AC7A-IN- STE% : I) %UR%OSES : 1% To prevent contamination of newly sterili0ed instruments as soon as they are removed from the sterili0er. (% To provide a means of staring instruments to keep then in sets for individual appointment use and sterili0ed and ready for immediate use on opening. II) INSTRU'ENT ARRAN-E'ENT : 1% Preset cassettes, trays or packages can be preplanned to contain all the items usually needed for particular appointment. (% 3ach package or tray should be dated and marked for identification of contents.

*% 2lear packages with self seal permit instrument identification without special labeling. III) %RE%ARATION : 3ach method of sterili0ation has specific re"uirements and manufacturer s recommendations must be reviewed. 7rapping is necessary to prevent punctures or tears that break the chain of asepsis and re"uire the repeat of the process. The wrap must permit the steam or chemical vapour to pass through the content. 'ETHOD OF STERILI0ATION : 1 1 Physical method 2hemical method 1% +unlight (% 5rying *% 4eat ,% ?iltration 8% >adiation A% /ltrasonic and sonic vibration. () HEAT : A) Dr& $ea" : 1% ?lamming. (% >ed heat *% -ncineration ,% 4ot air oven +) 'oi " $ea" : 1% &elow 10002 @ pasteuri0ation. (% *% t 10002 @ boiling. bove 10002 @ utoclave.

%$& ica# me"$o/ :

*) FILTERATION A) Can/#e fi#"$ : a% b% c% filters. 2hamber land and doulton filter @ made of ungla0ed ceramic which after use can be cleaned with sodium hypochlorite. 5iatomous earth filter eg @ berkefold and mandler filters. sbestos filters @ disposable, single use eg C +eit0 and sterimat

+) Sin"ere/ g#a

fi#"er : verage pare diameter is

2% #embrane filters @ #ade of cellulose ester.

0.(( m. #ost widely used for sterili0ation. /sed in water purification. 3) RADIATION : 1% -onising. (% )onionising () SUNLI-HT : 1 Processes appreciable bactericidal activity. 1 ction is mainly due to content of ultraviolet rays most of which are screened out by glass and the presence of o0one in the outer regions of atmosphere. 1 )atural method of sterili0ation. 1 +emple and 2irieg showed that typhoid bacilli e!posed to sun were killed in two hours whereas controls kept to dark were still alive for si! days. Dr&ing : #oisture is essential for growth of bacteria. ,<8 th of the weight of bacterial cells is water. 5rying in air has therefore deleterious effect on many bacteria.

Hea" : #oist heat is mast reliable method of sterili0ation and should be the method of choice unless contraindicated. #aterials damageable by heat can be sterili0ed at lower temperature for longer period by repeated cycles. Fac"or inf#uencing "eri#i1a"ion b& $ea" are : 1% )ature of heat whether dry heat or moist heat. (% Temperature and time. *% )umber of microorganisms present. ,% 2haracter of the organism such as species, strain and sparing capacity. 8% Type of material from which the microorganism have to be eradicated. DRY HEAT : Ac"ion : ction or dry heat is by o!idation. 5ue to o!idative damage there will be protein dematuration and to!ic effect of elevated levels of electrolytes. Ue : 1% Primarily for materials that cannot be safely sterili0ed with steam under pressure. (% ?or oils and powders when they are thermostabli0e at the re"uired temperature. *% +mall metal instruments that might be corroded or rusted by moisture. 'ETHOD USED IN DRY HEAT : () F#amming : -noculating loops or wires, tip of forceps and scaring spatulas are held in bunsen till they become red hot. -f the loop contains infected protainaceons materials they should be first dipped in chemical disinfectant before flamming to prevent spattering. +calpels, needles, glass shies can be sterili0ed by this method.

*) Incinera"ion : 3!cellent 3) Ho" air o2en : Con2en"iona# /r& $ea" o2en : 1 #ast widely used method of sterili0ation by dry heat. 1 4olding period of 1A002 for 1 hour. 1 Timing must start after the desired temperature has been reached. 1 /sed to sterili0e glass ware, forceps, scissors, scalpel, all glass syringes and petridishes. 'ec$ani m : 1 9ven is usually heated by electricity with heating elements in the walls of the chamber. -t must be fitted with a fan to ensure distribution of air and elimination of air pockets. The material should be arranged in a manner which allows free circulation of air between the ob6ects. fter sterili0ation the oven must be allowed to cool slowly for about ( hours before the door is opened. +ince glassware may get baked by sudden or uneven cooling. Con"ro# : Paper strips of nonro!igenic strain of clostridium ketani are used. fter sterili0ation they are cultured in a suitable media and checked. &acillus subtitles strips can also be used. SHORT CYCLE , HI-H TE'%ERATURE DRY HEAT OVEN : rapid high temperature process that reduces total sterili0ation time to A minutes for unwrapped and 1( minutes for wrapped instruments. They operate at 180 @ 19002. Time and temperature recommended by medical research council. 1A002 @ ,8 min 1B002 @ 18 min 18002 @ B.8 min method for safely destroying materials such as contaminated cloth, and pathological materials.

19002 @ 1.8 min A/2an"age : 1 2arbon steel instruments and burs do not rust. 1 7hen maintained at correct temperature. -t is well suited for sharp instruments. Di a/2an"age : 1 4igh temperature many damage heat sensitive items such as rubber, plastic.

In"en e /r& $ea" : 2hair side sterili0ation of endo files can be accomplished by using glass bead or hot salt sterili0er. HOT SALT STERILI0ER : -t consist essentially of a metal cup in which table salt is kept at a temperature between ,(80? and ,B80?. >oot canal instruments such as broaches, files, reamers sterili0ed in 8 seconds. bsorbent points and cotton pellets in 10 seconds. A/2an"age : 1 /se of ordinary table salt. 1 +alt is readily available and contains 1E sodium aluminate, magnesium carbonate and sodium carbonate that class not fuse under heat. 1 Pure salt should never be used. 1 +alt carried to root canal can be irrigated. 4ot salt sterili0er has superceded the molten metal and glass bead sterili0er becomes the metal or small glass beads can clung to a wet instrument which gets clogged in the root canal.

-LASS +EAD : 1 &ead less than 1 mm in diameter. Iarger beads are not effective in transferring heat. 1 Iarge air space between the beads reduce the efficiency of sterili0er. 1 4ottest part in salt sterili0er is along the outer rim starting at the bottom layer. Temperature is lowest in the center of surface layer. 1 -mmerse instrument properly "uarter inch below the salt surface and in peripheral area.

'OIST HEAT : 1 Iethal effect of moist heat is due to dematuration and coagulation of proteins. 1 Temperature below 10002. 3gC Pasteuri0ation of milk Temperature employed @ A*02 for *0 minutes @ holder method B(02 for 181(0 seconds @ ?lash method followed by coaling "uickly to 1*02 or lower. Tem!era"ure a" (>>>C : +oi#ing : 'egetative bacteria are killed almost immediately at 9002 to 10002. 1 &oiling is not recommended for sterili0ation of instruments used for surgical procedures and regarded only as a means of disinfection. 1 )othing short of autoclaving at high pressure can destroy spores and ensures sterili0ation. 1 4ard water should not be used. +terili0ation can be promoted by addition of (E sodium bicarbonate to water.

1 -n case where boiling is considered, ade"uate material should be immersed in water and boiled for 101*0 min. 1 The sterili0er should not be open during this period. AUTOCLAVE 6STEA' %RESSURE STERILI0ATION) : The principle of autoclave is that water boils when its vapour pressure e"uals that of surrounding atmosphere. 4ence when pressure inside a closed vessel increases, the temperature at which water boils also increases. +aturated steam has high penetrating power. 7hen steam comes in contact with a cooler surface, it condenses to water and fives up its latent heat to that surface. The condensed water ensure moist conditions for killing the microbes present. 4ence sterili0ation is achieved by action of heat and moisture serves only to attain high temperature. Time, temperature and pressure recommendation C 1 1(102 for 18min at 18 lbs pressure. 1 1*,02 for B min and *0 lbs pressure for wrapped instruments. STERILI0ATION OF +URS IN AUTOCLAVE : ?or autoclave sterili0ation, burs can be protected by keeping them submerged in a small amount of (E sodium nitrate solution $(0 gm of sodium nitrile in 1 litre of distilled water%. Then burs are placed in glass beaker with perforated lid and fill the breaker with sufficient nitrite solution appro!imately 1 cm above the burs. Place container of burs and fluid into sterili0e and operate a normal sterili0ation cycle. A/2an"age : 1 #ast rapid and effective method for sterili0ing cloth surgical packs an towel packs. 1 5oes not destroy cooton and cloth products. 1 3!cellent penetration of packages. 1 +terili0ation verifiable.

Di a/2an"age : 1 /nsuitable for oils or powders that are impreviors to heal. 1 -tems sensitive to the elevated temperature can not be autoclave. 1 utoclaving tends to rust carbon steel instruments and burs. diamond instruments and carbide burs. +terili0ation control species of bacillus sterother @mophilus killed in 1( minutes at 8802 @ A002 and spare at 1(102. Care of au"oc#a2e : 1% 5aily @ #aintain proper level of distilled water. (% 7eekly @ flush the chamber with appropriate cleaning solution such as hot trisodium phosphate. %RINCI%LES OF ACTION : . &. 1% +terili0ation is achieved by action of heat and moisture, pressure serves only to obtain high temperature. +terili0ation depends on penetrating ability of steam. ir must be e!cluded, otherwise steam penetration and heat transfer are prevented. (% +pace between the ob6ect is essential to ensure access for the steam. *% #aterials must be thoroughly cleaned and air dried, material can provide a barriers to the steam. O%ERATION : A) %ac@ing au"oc#a2e : Pack loosely to permit steam to reach all instruments in all packages. &% Temperature must remain at 1(102 at 18 pounds for 18 minutes. /se *0 minutes for heavy leads to ensure penetration. C) Coo#ing : 1% Dr& ma"eria# : >elease steam pressure, turn operating valve, and open the door. >e"uired time for drying is about 18 minutes. dherent 1 +team appears to corrode the steel neck < shank portions of the

(%

LiCui/ : >educe chamber slowly at an even rate over 10 to 1( minutes to prevent boiling as escape of fluids into the chamber. -t is preferable to turn off the autoclave and let the pressure fall before opening door.

CHE'ICLAVE 6CHE'ICAL VA%OUR STERILI0ER) : 4allen &ack and 4arvey in 19,0 culminated in development of an unsaturated chemical vapour sterili0ation system called :4 >'3K 243#-2I '3;.

%RINCI%LE : 2hemical vapour sterili0ation kill micro1organism by destroying vital protein systems. #icrobial and viral destruction results from the permeation of the heated formaldehyde and alcohol. 4eavy tightly wrapped, or scaled packages would not permit the penetration of the vapours. combination of alcohols, formaldehyde, ketone water and acetone heated under pressure produces a gas that is effective as a sterili0ing agent. USE : 2hemical vapour sterili0ation can not be used for materials or ob6ects that can be altered by the chemicals that make the vapour as that cannot withstand the high temperature. 3gC low melting plastics, li"uids, heat sensitive handpiece. TE'%ERATURE : ?rom 1(B02 to 1*(02 with (0 to ,0 pounds pressure in accord with manufacturer.s direction. Time : #inimum of (0 minutes after correct temperature and pressure have been attained.

Coo#ing a" "$e com!#e"ion of c&c#e : -nstruments are dry instruments need a short period for cooling. Care of "eri#i1er : 5epending on the amount of use, refilling is needed by at least every *0 cycles. A/2an"age : 1 2orrosion and rust free instruments for carbon steel instruments. 1 bility to sterili0e in a relatively short total cycle. 1 3ase of operation and care of e"uipment. Di a/2an"age : 1 de"uate ventilation is needed, cannot use in small room. 1 +light odor which is rarely ob6ectionable. Con"ro# : &acillus sterothermophilus strips. ETHYLENE OAIDE : =aseous sterili0ation using ethyl o!ide is not commonly found in private dental office or clinic. USE : ll materials, whether metal, plastic, rubber or cloth can be sterili0ed on ethylene o!ide with little on no damage to the material. %rinci!#e of ac"ion : 3thylene o!ide vapour is affective against all types and farms of microorganisms provided sufficient @ time is allowed. O!era"ion : 1 9peration is well ventilated room is necessary. 1 9vernight processing is usually mast practical. Time an/ "em!era"ure : 'ary from 10 to 1A hours, depending on both the temperature and the concentration of ethylene o!ide used. Aera"ion af"er com!#e"ion of "$e c&c#e :

Plastic and rubber products need to be aerated for atleast (, hours. #etal instruments are ready for immediate use. A/2an"age : 1 #any types of materials can be sterili0ed with minimum or no damage to the material itself. $including plastic and rubber items% 1 Iow temperature for operation. 5isadvantages C 1 4igh cast of the e"uipment. 1 Problems of dispersement of gaseous e!haust. 1 -ncreased time of operation. 1 =as absorption re"uires airing of plastic, rubber, and cloth goods for several hours. S"eri#i1a"ion con"ro# : &acillus subtitles strips. 'ICROWAVE : 1 #icrowave have wavelength longer than /.' light. 1 -n microwave oven, waves are absorbed by water molecules. 1 The molecules are set into high speed motion and the heat of friction is transmitted to food which become hot rapidly. LASER : 1 dam stop 4ot0 in 199* showed the bactericidal effect due to laser radiation in ,18 seconds. 1 4ooks et al found that infected instruments for * seconds to laser beam is sufficient to destroy micro1organism including spares. FREE0IN- : 1 ?ree0ing can both kill and pressure depending on various factors. 1 >epeated free0ing and thawing are much more destructive to bacteria there prolonged storage at free0ing temperature.

1 -f bacteria are rapidly sub6ected to temperature below @ *8 02, ice crystals that form within the cell produce a lethal effect during free0ing. RADIATION : Two types of radiations used )on ioni0ing @ infra red and ultraviolet rays. -oni0ing @ gamma rays and high energy systems. Non8ioni1ing ra/ia"ion : 1% -nfra red radiations is used for rapid mass sterili0ation of syringes. (% /ltraviolet radiation @ used for disinfecting enclosed areas such as hospital wards, operation theaters, small virus inoculation rooms and virus laboratory. Ioni1ing ra/ia"ion : M1ray, gamma rays and cosmic rays are highly lethal to 5) other vital all instrument as they have very high penetration power. =amma radiation is used for sterili0ation of mast plastic, syringes, swab, catheters. NEW DISINFECTION AND STERILI0ATION 'ETHODS : Di infec"ion : S"eri#i1a"ion : ntimicrobial coating $+urfacine% +uper o!idi0ed water $+terilo!%. Ii"uid sterili0ation @ endodonts. )ew plasma sterili0er @ +terrad 80. STERILI0ATION OF CONSERVATIVE INSTRU'ENTS :
S"eam au"oc#a2e 1% &urs 1 2arbon steel. 1 +teel 1 Tungsten carticle (% 2ondensers *% 5apen dishes 1 D D DD DD DD DD DD DD D Dr& $ea" C$emica# 2a!or DD DD DD DD D E"$&#ene o5i/e DD DD DD DD DD C$emica# /i infec"ion 1 D D D D

and

,% =lass slab 8% 4and instruments 1 2arbon steel 1 +tainless steel A% #orrars B% 9rthodontic

DD 1 DD 1 DD

DD DD DD DD DD DD DD DD 1 DD DD 1

DD DD DD DD DDD DD DD DD 1 DD DD 1

DD DD DD DD DD DD DD DD DD DD DD DD

D D 1 D D D 1 D D D D 1

phichs 8% Pluggers DD 9% >ubber dam 3"uipment 1 2arbon steel 1 clamps 1 #etal frances 1 Plastic frances 1 Punches 1 +tainless steel 10% >ubber items prophyla!is cups DD 1 1 DD 1

S"eri#i1a"ion of en/o/on"ic in "rumen" : 1% &roaches, files, reamers, absorber points not salt < glass bead sterili0er. (% =utta1percha screw copped vials containing alcohol. 1 8.(E )a92l @ 1min rinse with water. *% +ilver cones @ &unsen flam @ *., min slowly 4ot salt sterili0er @ 8 seconds Im!re ion ma"eria# :
Au"oc#a2e Dr& $ea" 1% -mpression trays 1 luminum metal 1 Plastic C$emica# 2a!or DD 1 D 1 DD 1 E"$&#ene o5i/e DD DD C$emica# /i infec"ion 1 D

Sa#i2a eDec"or : 4igh melting plastic @ utoclave, ethylene o!ide. /ltrasonic scaling tips @ 3thylene o!ide. Im!re ion :

1%

lginate @ chlorine compounds. compound.

(% Polysulfide rubber base @ =lutaraldehyde, iodophar, chlorine *% +ilicone @ =lutaraldehyde, iodophar, chlorine compound. ,% Polyethylene @ 9nly chlorine compound. 8% Jn93 pass @ =lutaraldehyde, -odopharesis. Prosthesis @ =lutaraldehyde. HAND %IECE STERILI0ATION : 1 4andpiece should be flushed for *0 seconds at the beginning of dry and between every appointment. 1 +team sterili0ation of handpieces. o utoclave sterili0ation of hanpieces is are of the most rapid methods. O"$er me"$o/ : 1% 2hemical vapour pressure sterili0ation @ indicated for handpieces with ceramic bearing. (% 3thylene o!ide gas is gentle method of handpiece sterili0ation. *% 5ry heat sterili0ation of handpiece is hot recommended. A8ra& uni" a e! i : 1 Placing barriers on the portions of the one and tube head handled during positioning and an e!posure switch. 1 &ite blocks used for film placement should also be sterili0ed between patient. DENTAL WATER LINE CONTA'INATION : 5ental handpiece, water syringes, sonic < ultrasonic handpiece can be contaminated after sterili0ation but before patient use by biofilm contaminated dental unit water lines. /sual source is contaminated commercial water supply entering dental office. The result of biofilm contamination it that the water emitted

from handpieces, syringes etc. may contain elevated concentration of pseudomonas, mycobacterial, legionella. ADA recommen/a"ion "o im!ro2e /en"a# uni" ;a"er Cua#i"& : 1% 5ischarge water lines without hanpieces attached for several minutes at beginning of each dry. (% 4andpieces should run to discharge water and air for a minimum of (01*0 seconds after each patient. *% /se filters. ,% /se sterile saliva < water as coolants. 3gC povidone @ iodine 10E coupled. WASTE DIS%OSAL 'ANA-E'ENT :
T&!e 1% =eneral waste E5am!#e Han/#ing reCuiremen" Paper towels, paper mi!ing 5iscard in covered pads, empty food container containers made of durable materials such as plastic or (% 4a0ardons waste metal 7aste presenting a danger ?ollow you specific static to humans as the and local regulations $to!ic environment *% 2ontaminate waste

chemicals% 7aste that has contact with -n mast states, disposed of blood as other body fluids with the general waste $used barriers, patient

napkins% ,% -nfections or regulated 7aste that is capable of ?ollow your specific state waste $bioha0ard% transmitting an infections and local regulations disease a% &lood and blood soaked &lood or saliva that can be 2ontainers for all three materials s"uee0ed out, as dried types of infections materials blood that many flake off must be labeled with the b% Pathologic waste c% +harps on items bioha0ard label. +oft tissue and e!tracted teeth 2ontaminated needles, 2losable leak proas

scalpel blades, orthodontic puncture wires, files% endodontic containers.

resistant 2ontainers

instruments $reamers and should be color code red and marked with bioha0ard symbol.