Infection Control Measures in Dental Office 1- Immunization:
Vaccination against: Hepatitis B, Influenza, MMR, Varicella (chickenpox), Tetanus and diphtheria. 2- Patient Screening: Complete medical history from the patient, and should be updated and stamp dated during recall visits. \ 3- Hand Hygiene: * Hand washing, hand antisepsis, or surgical hand antisepsis, substantially reduces potential pathogens on the hands and is considered the single most critical measure for reducing the risk of transmitting organisms. * For routine dental examinations and nonsurgical procedures, hand washing and hand antisepsis is achieved by using either a plain or antimicrobial soap + water (15 sec.). If the hands are not visibly soiled, an alcohol-based hand rub is adequate (until it dries~15 sec). It should be done:

* Before glove placement and after glove removal. * After barehanded touching of infected objects. * Before leaving the dental office. * When visibly soiled. * After removing gloves that are torn, cut, or punctured.

* For surgical procedures, surgical hand antisepsis with an antimicrobial soap (2-6 min.) or alcohol hand rub with persistent activity should be used. * Antimicrobical soap include: (chlorhexidine, iodine and iodophors and triclosan) * Fingernails should be unpolished, short enough to allow DHCP to thoroughly clean underneath them and prevent glove tears.

* All hand jewelry should be removed, except for plain wedding ring. 4- Personal Protective Equipments * Worn in the order: Protective clothing, Mask, Eye glasses and finally the Gloves. c) Gloves * Their selection should be based on the type of procedure to be performed : * Patient examination gloves (latex, vinyl or nitrile), non sterile, used in non surgical procedures and patient examination. * Sterile surgeon’s gloves (latex or Nitrile), Sterile and single-use disposable and are designated left and right hands.

* Over gloves are used only when supplies are retrieved to/from the operatory or during charting. * Utility gloves are used for Housekeeping procedures.
b) Masks

* Regular masks which filter particles 5-μm and larger. * The mask should be changed between patients or even during patient treatment if it becomes contaminated with infectious droplets or from touching the mask with contaminated fingers or wetted from exhaled moist air. * When a mask becomes wet from exhaled moist air, the resistance to airflow through the mask increases, causing more airflow to pass around edges of the mask. * When airborne infection isolation precautions are required, Particulate Filter Respirators e.g. N95 (filter 1-μm particles with a filter efficiency of >95%), N99 and N100, should be used. a) Protective Clothing * Requires sleeves to be long, should be changed when it becomes visibly soiled. * All disposable protective clothing should be damped before leaving the work area, while reusable clothes should be laundered at high temp 60-70 0C

Masks, a: regular masks, b: N95 Particulate Filter Respirators a c a b b Protective clothing a: (gown, white coat and scrub), b: protective footwear and c: protective head cover.

Sterile surgeon’s gloves

d) Protective Eye Wear

5- Environmental Surface Asepsis * There are 2 types of dental environmental surfaces: * Clinical contact surfaces are touched frequently with gloved hands during patient care, or may become contaminated with blood, saliva. * Housekeeping surfaces (e.g, floors, walls, and sinks) do not come in contact with hands or devices used in dental procedures.

* Using utility glove, Spray-wipe as pre-cleaning step “sanitization”, then second spray-wipe for disinfection. Surfaces are kept moist for usually 5 to 10 min. Chemical Category | Definition | Examples | Uses | (1) High-level disinfection | Can destroy all microorganisms, save high numbers of bacterial | Glutaraldehyde, hydrogenperoxide, | Heat-sensitive items; immersion only
Not appropriate for environmental surface disinfection | (2) Intermediate-level disinfection | Can destroy vegetative bacteria, most fungi and viruses | Agents with tuberculocidal activity as daily fresh prepared Chlorine-based products (1:100 dilution of sodium hypochlorite (e.g.,approximately ¼ cup of 5.25% household chlorine bleach to1 gallon of water), phenolics, iodophors | Clinical contact surfaces and | (3) Low-level disinfection | Can destroy vegetative bacteria, some fungi and viruses | Quaternary ammonium compunds | Housekeeping surfaces | * Barrier protection of environmental surfaces with plastic wraps is carried afterward to protect against infections. 6- Needle and Sharp Instrument Safety: * One-hand needle recapping (scoop technique) or not using fingers for cheek retraction while using sharp instruments or suturing. * Used needles shouldn’t be bent or broken prior to disposal into sharps container. * Maintain sharp ends of any instruments angled away when passing or receiving them. 7- Sterilization and Disinfection of Patient-Care Items: * Classified into: * Critical items used to penetrate soft tissue or bone, should be sterilized by heat. (e.g. Surgical instruments, periodontal scalers) * Semicritical items touch mucous membranes or non-intact skin; if heat-tolerant then should be sterilized. If heat-sensitive, it should be processed with high-level disinfection (e.g. Dental mouth mirror, amalgam condenser)

* Noncritical items contacting only intact skin, cleaning followed by disinfection (e.g. Radiograph head/cone, face-bow). * Reusable instruments, supplies, and equipment should be cleaned for the removal of debris by scrubbing with a detergent and water, and then dried. If visible debris is not removed, it will compromise the disinfection or sterilization process. * Cleaned instruments packaged for sterilization. Hinged instruments should be processed open and unlocked. There are several choices in methods to maintain sterility of surgical instruments, including, peel-open pouches and sterilization wraps (woven and nonwoven).

* Heat-tolerant dental instruments usually are sterilized by 1) steam under pressure (autoclaving) or 2) dry heat. Packs should not be touched until they are cool and dry.

* Monitoring the sterilization procedure should be monitored routinely by using a combination of mechanical, chemical, and biological indicators.

* Mechanical monitors for ETO include time, temperature, and pressure recorders * Chemical indicators are heat sensitive inks that change color. Should be placed on the outside and the inside of each pack to verify steam penetration. * Biological indicators (i.e., spore tests) they assess it directly by killing resistant microorganisms and should be verified at least weekly.

8- Dental Units Connected to Water Lines: * Use water that meets nationally recognized standards for drinking water for routine dental treatment output water. * All dental instruments that use water should be run to discharge water for 20-30 seconds after each patient and for several minutes before the start of each clinic day.

* Sterile water should be used in dental units either through:

* Self-contained water system, a reservoir (bottle) that attaches to the dental unit waterline, which isolates it from the municipal water supply. Water (tap, distilled, sterile etc.) must be added manually. The simple task of regularly adding cleaning agents to the bottle make this a convenient system. * A point-of-use filter between the dental unit and the waterline tubing.

9- Intra oral Barrier techniques: * The use of rubber dam, high volume evacuation and pre-procedural mouth rinses can reduce the bacterial load in aerosol.

10- Reduce microorganisms transferred to patients: * Remind patients not to close their lips around the saliva ejector. * Instruments are n*o longer sterile if dropped on the floor.