Infection Control in Dental Radiology

Infection Control in Dental RadiologyDr. Raghunath Puttaiah& Dr. Hui Liang

Introduction & RationaleMost oral and maxillofacial radiology normally consists of non-invasive proceduresAlthough exposure to blood is not common, contact with saliva does occur

What are the risks??Common viruses seen in the oral cavity includecytomegalovirus, herpes simplex viruses-1 & 2, hepatitis-B and D viruses, hepatitis-C virus, influenza viruses, Epstein-Barr virus (infectious mononucleosis), Rhinoviruses (common cold), and HIVCommon bacterial pathogens seen arePseudomonas, Flavobacterium, Staphylococci, Streptococci, Diplococci, Pneumococci, Mycobacterium, Chlamydia, and Spirochetes from human or inanimate sourcesCandidiasis is also very common among dental patients

RationaleMost of Oral and Maxillofacial radiology (OMR) procedures fall mainly in the semicritical and non-critical categories of Spaulding's Classification of inanimate surfacesBUTMany contagious diseases such asInfectious mononucleosis and hepatitis-B can possibly be spread by simple contact with salivaTherefore, it is necessary for aseptic techniques to reduce ambiguity within protocolsThe purpose of this module is to present the most recent information regarding aseptic techniques in OMR.

What PPE is neededIt is not usually necessary to wear PPE such as impervious gowns, long sleeves, masks and protective eyewear during routine OMR procedures when no aerosols, droplets or spatter are generatedOne may use gloves, gowns, masks and protective eyewear while treating patients with gagging problemsWhile handling the processor and the chemicals, use full PPEStay out of the Radiation Hazard area (behind a shield)Patients must be protected with a lead apron

Disinfectants and BarriersBarriered films should be used when availableBetween patients, frequently touched areas must beBarriered with plastic barriers OR-Disinfected with an Intermediate level, Hospital Disinfectant using a Spray-Wipe-Spray technique

If barriers are used between patients, disinfection is only needed at the beginning or end of the day

Steps in Infection Control

Unit Dose

1. Pre-procedural mouthrinsefor patientsMake them rinse forabout 30 seconds toreduce the microbesin the mouth2. PPE-GlovesMasksEyewearGown

Steps in Infection Control

Prepackaged films with plastic barriers

Unbarriered films

Barriered Films

Steps in Infection Control

Unit dose supplies and sterile equipment on to a clean bib/work surface2. Set up the films on to the positioning devices3. Label cups as Exposed and Unexposed

Use of Disinfectants and BarriersDisinfect surfaces at the beginning and end of each day, and between patients only if contaminatedAvoid spraying electrical switches, wipe with disinfectant moistened paper towelApply surface covers to the yoke, tube head, cone, control unit, head rest, arm rest, and any hand held switches

Aseptic ProceduresPlace the sanitized lead apron and collar on the patient after seating the patientSet the required mA, kVp and exposure time on the control unit and reset as requiredUse Foot Controlled Trigger Switch if possible

Now Please expose the Radiograph

The whole purpose in dental radiology is toGet the radiograph

Inside a daylight loader

Place the cup with exposed films on one side and theEmpty one on the otherPlace a clean bib or napkin as a barrierDispense a pair of gloves

Daylight Loader with Films Inside

Be sure to close the lid before exposing the films

Donning Gloves inside the Loader

Various layers inside the polysoft film cover

Polysoft coverRadio-opaque metal foilon the rear of the filmPaper folder that securesthe filmFilm

Processing Barriered Films

Exposed filmWear glovesPeel the outer cover and dropthe film into the Exposed cupThis should be done chairside

Step 1Step 2Step 4Step 3Bare hands with barriered filminside a daylight loader

Bare hands to be used to handle exposed and peeled film

Unbarriered Films

Step 1Step 2Step 4Step 3Now try this inside a daylight loader

Bare hands to be used to handle exposed and peeled film

Remove your gloves and then handle the film that has been taken out of the Polysoft cover

Clean up after loading films

Carefully hold the edge of the napkin or bib and fold it over the wasteYou need not wear gloves if you hold the non-contaminated corners

Disinfect the Daylight Loaderonce or twice daily if barriers are used

Barriers limit the use of disinfectants

Panoramic Radiography

In panoramic radiography, infection control procedures are very simple

Patient needs to have a lead apron

No contact of film with saliva

Only one barrier is needed

Panoramic Radiography

Chin restBite blockBarriered positioning device

Panoramic Radiography

Infection Control in Panoramicradiography is very simpleAll one needs is a barrier forthe bite blockMake sure the lead apron is onFilm loaded on to the cassetteStay outside of the activeradiation area

Panoramic Radiography

This film does not come in contact with saliva

Panoramic Radiography

Position the patient correctly

Panoramic Radiography

Make the patient remove the barrier on the bite block

Digital Radiography

Digital Radiography

SensorBarrier or sleeveSensor being inserted into barrierSensor Barriered

Digital Radiography

Insert the barriered sensor in the film holder on the Rinn holder

Digital Radiography

Slide this dooropen

Digital Radiography

Peel open the barrier withouttouching the sensor

Digital Radiography

Slide the sensor into thechamber for the computerto read the image

Digital Radiography

Digital Radiography

Image appears on the screen within seconds