THE NEW IMAGES OF

INFECTION CONTROL
AND
STERILIZATION GUIDELINES

By: Dr.Habbaba Al Mazeedi

Quality and Infection Control
Coordinator

Certified CS professionals
 INTRODUCTION

• Infection Prevention and Control is an important part of safe

patient care. Concerns about the possible spread of blood-
borne diseases, and the impact of emerging, highly
contagious respiratory and other illnesses, require
practitioners to establish, evaluate, continually update, and
monitor their infection prevention and control strategies and
protocols.
 PRINCIPLES OF INFECTION PREVENTION AND
CONTROL
• Include:
• Patient assessment
• Following routine practices
• Using barrier techniques to protect both patients and staff
• Applying the principles of cleaning, disinfection, sterilization, and storage of dental
instruments
• Environmental cleaning
• Care of the overall office setting
• Safe handling and disposal of wastes
 PATIENT SAFETY
• Three main elements are required to spread infection:
1) Susceptible Host
2) Causative Agent
3) Model of Transmission
By removing any one of these elements, an infection cannot
occur. This principle forms the foundation of an acceptable
infection prevention and control strategy.
 TRANSMISSION OF MICRO-ORGANISMS

• Understanding the modes of transmission of infection is necessary for designing and implementing effective
infection prevention and control strategies. Dental patients and OHCWs can be exposed to pathogenic micro-
organisms, including viruses (e.g. HBV, HIV, human herpes group of viruses, human papilloma virus), bacteria
(e.g. Mycobacterium tuberculosis, staphylococci, streptococci) and other microbes that colonize or infect the
oral cavity and respiratory tract.
• In the dental office, the three main modes of transmission of micro-organisms are:
 Direct Transmission: direct physical contact with blood, oral fluids, or other materials
 Indirect Transmission: contact with an intermediate contaminated object, such as a dental instrument,
equipment, or an environmental surface
 Droplet Transmission: contact of oral, nasal, or conjunctival mucosa with droplets, spatter, or spray
containing micro-organisms generated from an infected person, such as by coughing, sneezing, or talking
 ROUTINE PRACTICES

1. Hand Hygiene
2. Use of Personal Protective Equipment
3. Safe handling and disposable of sharps
4. Environmental Surfaces
5. Sterilization Process
6. X-Ray Rooms
 UPDATED ROUTINE PRACTICES

• In school oral health programs:

1.THE STAFF ADHERENCE TO PPE
- ALL STAFF SHOULD WEAR PPE IN THE CLINIC (HEAD CAP WITH COLLECTED HAIR , FACE SHIELD ,
MASK , NO BIG FEMALE ACCESSORIES(EARRINGS ,RINGS, NECKLACE), CLEAN LAB COAT , COLOR
CODED GOWN , NO LONG NAILS, ACRYLIC AND COLOR NAILS , SUITABLE COVERED FOOTWEAR .

- HOW AND WHEN TO PUT ON AND TAKE OF PPE :

A. PUT ON :(CLEANERS BEFORE CLEANING , DENTAL ASSISTANTS IN THE BEGINNING OF DAY BEFORE
CLEANING THE CLINIC , CSD STAFF BEFORE ENTERING THE CSD , DENTISTS BEFORE TREATING
PATIENTS )

B. TAKE OFF: ONES GO OUT OF THE WORKING ROOM AND NEVER GO WITH PPE IN CORRIDORS ,
BREAK ROOMS , PATIENTS WAITING HALL , AND TAKE OFF THE PPE IN THE SPECIFIC PLACES (WASTE
BINS WITH YELLOW TRASH BAGS)

C. SHOULD CHANGE THE PPE ITEMS(HEAD CAP, MASK ,SHIELD , GOWN , LAB COAT) ONES THAT ARE
CONTAMINATED WITH BLOOD , OR FLUID.
2. HAND HYGIENE
-ALL STAFF WORKING (DENTISTS , ASSISTANTS ,
CLEANERS ) MUST ADHERE TO HAND HYGIENE BEFORE AND
AFTER PROCEDURES

- EDUCATE ALL STAFF WORKERS WITH POSTERS AND

BROCHOURES ON THE CORRECT WAY OF HAND HYGIENE.

- SPREAD THE HAND HYGIENE POSTERS NEAR EVERY

WASHING SINK (CLINICS) AND IN PATIENTS WAITING HALLS.
POSTERS
 WHAT IS HAND HYGIENE ?
A GENERAL TERM REFERRING TO ANY ACTION OF HAND CLEANSING *WHAT ARE INDICATIONS FOR HAND HYGINE.TO REDUCE
PATHOGENS AND CONSIDERED THE PRIMARY MEASURE OF OR REDUCING THE RISK OF TRANSMITTING ORGANISMS TO PATIENT
AND HEALTH CARE PERSONNEL , HOSPITAL BASED STUDIES HAVE SHOWN AND SPECIALLY DENTAL CLINICS THAT NON
COMPLIANCE WITH HAND HYGIENE PRACTICES IS ASSOCIATED WITH HEALTH CARE AND ASSOCIATED INFECTIONS , THE SPREAD
OF MULTI –RESISTANCE ORGANISMS , AND HAS BEEN A MAJOR CONTRIBUTOR TO OUTBREAKS .-STUDIES ALSO HAVE SHOWN THAT
THE PREVELANCE OF HEALTH CARE –ASSOCIATED INFECTIONS DECREASED AS HAND HYGIENE MEASURE IMPROVED .
 -BEFORE AND AFTER TREATING THE PATIENT
( BEFORE GLOVE PLACEMENT AND AFTER GLOVE REMOVAL ) .
BEFORE LEAVING DENTAL OPERATORY .
WHEN HANDS ARE VISIBLY SOILED .
CONCERN ABOUT THE HEALTH CARE AREA AND PATIENT ZONE AND HEALTH CARE FACILITY
ENVIRONMENTS .
3.ENVIROMENTAL SURFACES
A. CLEANING ALL WORKING SURFACES IN THE BEGINNING OF DAY WORK AND BEFORE PATIENTS
PROCEDURE .

B. CLEANING SURFACES CHECK LIST FOR ALL SURFACES PER TIME INCLUDING( CLINICS , CSD ,
PATIENTS WAITING HALLS , STAFF OFFICES , RECEPTION AREA .

C. CLEANING FLOORS CHECK LIST PER TIME (CLINICS, CORRIDORS ,WAITING HALLS , OFFICES ,
RECEPTION AREA AND HOW TO DEAL WITH WIPING FLOORING AFTER CLEANING

D. EDUCATE CLEANERS AND ASSISTANTS ON HOW TO DEAL WITH SPILLS.

E. EDUCATE ALL STAFF OF THE CUSTOM EXITS IN CASE OF FIRE , BUILDING FALL , EMERGENCY…

F. COLOR THE TRASH BAGS ACCORDING TO THEIR USAGE (RED FOR BIOHAZARD WASTES, BLOOD , AND
HUMAN WASTES … BLUE FOR INDUSTRIAL PRODUCTS LIKE PAPERS AND BOTTLES … YELLOW FOR
MEDICAL WASTES (GOUZE , PPE ….ETC)
FIRE DRILL
 4.STERILIZATION PROCESS

 Central Sterile Services Department:

The CSSD, also called Sterile Processing Department, Sterile
Processing, Central Supply Department, or Central Supply, is an
integrated place in hospitals and other health care facilities that
performs sterilization and other actions on medical devices,
equipment and consumables; for subsequent use by health workers
in the operating rooms of the hospitals and dental offices.
 CLEANING START FROM THE CLINIC !!

• With wet gauze.

NEW UPDATING OF CSD
- CS DEPARTMENT DIVIDED INTO 3 IMPORTANT SECTIONS:
A. DIRTY AREA : FOR SORTING THE INSTRUMENTS IN A GOOD WAY FOR CLEANING AND ISOLATE THE
DAMAGED ONE.
- CLEANING INSTRUMENTS IN 3 WAYS:
MANUAL : PUT BRUSHES BESIDE THE STERILIZATION SINK IN A DISINFECTION SOLUTION
ULTRASONIC : IS ELECTRICAL DEVICES THAT REMOVE IMPURITIES FROM SURFACE OF HARD
OBJECTS BY MEANS OF CAVITATION. VALIDATION FOR MOST DENTAL ITEMS INSTEAD OF
HANDPIECES.
INSTRUMENT WASHERS: ARE A WIDE RANGE OF WASHERS FOR HOSPITALS AND CLINICS. ITS
EVOLUTION OF A FLEXIBLE FULL SYSTEM FOR WASHING , DISINFECTION , AND DRYING FOR MOST
OF MEDICAL INSTRUMENTS INSTEAD OF HANDPIECES
B. ASSEMBLY AND PACKAGING AREA; A CLEAN AREA OF THE CENTRAL SERVICE DEPARTMENT (CS)
WHERE INSTRUMENT INSPECTION, ASSEMBLY AND PACKAGING ARE PERFORMED
C. STORAGE AREA; WHERE THE INSTRUMENTS ARE STORED AS INTERNATIONAL STANDARDS
ACCORDING TO QUALITY ORGANIZATION AND INFECTION PREVENTION
- TAKE THE CLINICAL FUNDED INSTRUMENTS BY CLEAN TROLLEY EVERY SCHEDULE TIME TO THE
STORAGE ROOM
5. DAILY , WEEKLY DEVICES TEST
- THERE ARE DIFFERENT KINDS OF TESTS TO OBSERVE THE QUALITY AND VALIDITY OF
THE DEVICES IN CSD .
Area name Daily
Dirty room
Assembly and Bowie-dick it’s a pack consists
of a series of air removal and
packaging steam penetration barriers . A
chemical indicator is located in
the central of each pack . Placed
directly into an otherwise empty
steam sterilizer chamber.
Weekly Monthly
washers (2 strips for every washers ( to check validity
washer for validity of of removing blood from
removing blood ,materials instrument's)
…)
Ultrasonic ( foil strips all
around the device to check
validity of cavitation
Biological test (a physical
monitoring process in autoclave's
to if they reaches the physical
parameters such as time ,
temperature and pressure
according to each cycle )

Storage room Check and inspect the

validity of instruments packaging
such as (pouches damage ,
instruments wrapping box’s , wet
instruments ,blood or dirt in
instruments after sterilization
ULTRASONIC CLEANERS ARE USED FOR FINE CLEANING NOT FOR
STERILIZATION .THEY USED TO REMOVE SOIL FROM JOINT OF
INSTRUMENTS MECHANISM OF WORKING IS NAMED AS
CAVITATION IN WHICH THE VIBRATIONS ARE TRANSMITTED
THROUGH THE DETERGENT BATH AND CREATE CAVITATION .ALL
INSTRUMENTS MUST BE COMPLETELY SUBMERGED IN THE
SOLUTION , SO THEY ARE EXPOSED TO THE CAVITATION
PROCESS .ONLY DETERGENT FOR ULTRASONIC CLEANERS
SPECIALLY FORMULATED SHOULD BE USED .
DIRTY ROOM TESTS
1. ULTRASONIC
2. WASHER DISINFECTOR :
WASHERS HAVE BEEN USED FOR MANY YEARS IN CS DEPARTMENT AROUND THE WORLD . AND THEY
ARE EFFECTIVE TO CLEAN INSTRUMENTATION . WASHERS WORK ON THE PRINCIPLE OF
IMPINGEMENT WHICH IS THE SPRAY FORCE ACTION OF PRESSURIZED WATER AGAINST
INSTRUMENTS BEING PROCEEDED TO PHYSICALLY REMOVE BIO BURDEN .-HINGED INSTRUMENTS
SHOULD BE OPENED TO PERMIT DIRECT CONTACT OF THE WATER AND DETERGENT .
ASSEMBLY AND PACKAGING
1. AUTOCLAVES(DAILY )BOWIE-DICK

2. Biological test
ALL RESULTS OF DAILY ,WEEKLY
, MONTHLY ASKED TO BE
REPORTED AND SAVED IN
PRIVATE FOLDERS AND
INSPECTED BY STERILIZATION
ADMINISTRATOR
6. INSTRUMENTS TRANPORTATION
- TRANSPORTING CLEAN INSTRUMENTS TO CLINICS IN THE EARLY MORNING AND ALL DAY BY
CLEAN TROLLEYS CLOSED OR OPENED MARKED WITH COLOR TO BE JUST FOR CLEAN
INSTRUMENTS.

- CONTAMINATED INSTRUMENTS ARE TRANSFERRED FROM CLINICS TO THE DIRTY AREA OF CSD
BY CLOSED TROLLEYS MARKED AS A CONTAMINATED INSTRUMENT ONE AND CONTAINS RIGID ,
EASY TO CLEAN , AND LEAK PROOF BOXES FOR THE INSTRUMENTS INSIDE .

- TRANSPORTATION TROLLEYS SHOULD BE MADE OF STAINLESS STEEL , HAVE GOOD QUALITY ,

AND EASY TO CLEAN ,
-TRANSPORTATION TROLLEY SHOULD BE ACCORDING TO INTERNATIONAL STANDARDS, QUALITY
ORGANIZATION, AND PREVENTING INFECTION .

-CONTAMINATED INSTRUMENTS SHOULD BE CHECKED FROM CLINICS BY CSD ASSISTANT IN

SCHEDULE TIME AS THE CENTER OR CLINIC NEEDS,

-WHILE COLLECTING FROM CLINICS, IF POSSIBLE, CHECK FOR REMAINS OF BLOOD OR DAMAGE
ON ALL DENTAL MATERIALS

-CSD ASSISTANT SHOULD WEAR FULL PPE DURING TRANSPORTATION OF CLEAN OR

CONTAMINATED INSTRUMENTS.
-
CLEAN INSTRUMENTS TROLLEYS
CONTAMINATED INSTRUMENTS
TROLLEYS
7. X-RAY
-DISINFECT PATIENT X-RAY AND CHAIR X-RAY TUBE DEVICE AFTER EVERY PROCEDURE .

- ALL PATIENTS SHOULD WEAR X-RAY LEAD APRON –RADIATION , AND X-RAY PHYSICIAN'S .

- X-RAY PHYSICIANS SHOULD WEAR GLOVES , MASK ,PROTECTIVE SHIELD , T.L.D

(THERMOLUMINESCENT DOSOMETER), LAB COAT , HAIR CAP , GOWN , AND CLOSED
FOOTWEAR ,

-ALL FILMS ARE ADJUSTED IN PATIENTS MOUTH WITH DISPOSABLE HOLDERS AND NEVER
WITH PHYSICIAN HANDS .

- SHOULD UNDERSTAND THE IMPORTANCE OF X-RAY FOR THEM AND PATIENTS, AND HOW
TO EXECUTE THE INFECTION CONTROL AND PROTECTION CONTROL TO PROTECT FROM
CROSS INFECTION AND RAYS SIDE EFFECTS
 EXAMPLES

Veena Fatimah

Shibi

Shakeela
GENERAL NOTES
. IMMUNIZATION &MEDICAL FILE FOR EACH STAFF MEMBER.
.
EXPIRATION DATES FOR STERILIZED PACKAGES (EVENT RELATED)
.
WRITING ON POUCHES BY APPROVED PERMANENT MARKERS FROM THE PLASTIC SIDE OF THE POUCH .
.
EVERY THING IS CLEAN AND STERILIZED ACCORDING TO MANUFACTURER INSTRUCTIONS.
.
TRAINING COURSES FOR NEW STAFF AND UPDATING INFORMATION'S AND LECTURES FOR OLD STAFF .
.
INCIDENT REPORT APPLIES ACCORDING TO THE MOH REGULATION
(EXP.NEEDLE INJURIES )
. EMERGENCY PLAN WITH MINISTRY OF INTERIOR IN KUWAIT .
.
ETHICS BETWEEN ALL STAFF MEMBERS AND BETWEEN CSD STAFF AND ALL DEPARTMENTS.
THANK YOU!