Review article AODMR · Review article AODMR 19 Archives of Dental and Medical Research Vol 1 Issue 1 Infection Control in Dentistry: Need for A Better Practice Yogesh Garg, D.J

Review article

19 Archives of Dental and Medical Research Vol 1 Issue 1

AODMR

Infection Control in Dentistry: Need for A Better Practice

Yogesh Garg, D.J. Bhaskar, Chandan Agali R., Himanshu Punia, Kamal Garg1, Deepak

Ranjan Dalai, Santy Panchal2

Department of Public Health Dentistry, Teerthanker Mahaveer Dental College and Research

Centre, Moradabad, Uttar Pradesh, India, 1Department of Periodontics, Surendra Dental

College, Sri Gangnagar, Rajasthan, India, 2Department of Orthodontics and Dentofacial

Orthopaedics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar

Pradesh, India.

Address for Correspondence:

Dr. Yogesh Garg, Post graduate student, Department of Public Health Dentistry, Teerthanker

Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India. Email:

[email protected]

ABSTRACT: Guidelines for the control of infection in dental healthcare settings became necessary since

the eighties, following shocking events, such as the lethal outbreaks of hepatitis B among

dental patients and the episode of the Floridian dentist who infected five patients with HIV.

Infection control is one of the prime elements of a successful dental practice. There are many

infectious diseases that can be transmitted in a dental environment. Chlorhexidine (in wipes

or detergent) and liquid soap were effective disinfectant agents for photographic mirrors

decontamination, without harmful effect on its surface. Many respiratory disorders can

compromise routine dental care and require special treatment for the affected patients.

Chronic obstructive pulmonary disease (COPD) and asthma require special measures, such as

working with the patient in the vertical position, since some of these subjects do not tolerate

decubitus.

Keywords: Dental healthcare setting, Dental laboratories, Hepatitis, Human Immuno

Deficiency Virus, Infection control.

INTRODUCTION:

In dentistry, both patients and healthcare

professionals may be revealed to

pathogens through contact with blood, oral

and respiratory secretions. It confines the

area of cross infection control: personal

protection, routine procedures, clinical

waste and emerging infections.1

Infection control has become an essential

part of the practice to the extent that dental

health workers no longer question. While

treating patients, dental care professionals

are at an increased risk of cross infection.

Dental health care workers are increased

chance of hepatitis and human

immunodeficiency virus (HIV) infections.2

Guidelines became essential because it

was obvious that dental therapy revealed

patients and staff to the chance for

infectious diseases such as hepatitis B and

C, HIV infection, tuberculosis. The case of

the dentist in Florida, who was HIV

Garg et al: Infection Control in Dentistry


infected in 1986 and imparted this

infection to five patients and some of them

died of AIDS, was terrible for the public

and healthcare workers.3

Contusion with contaminated sharp objects

and burs, needle stick injuries, inadequate

protection of fresh wounds opposed to

contaminate blood or saliva due to neglect

to wear gloves on the skin or mucosa are

major occupational hazards.4

For occasion, high-speed dental

instruments can produce aerosols of water,

saliva, and potentially infectious droplets

through the air/water irrigation systems

which are required to prevent pulpal

overheating during dental preparation.5

The application of precautions such as

multiple aseptic procedures, latex gloves,

masks, protective eyewear, clinic coats,

automated instrument decontamination

devices, waste management procedures

and single-use disposable items have

produced a safer environment for dental

personnel and patients. The approach of

these and current practice involves a long

history of scientific and clinical

investigations and periodic publication of

upgraded guidance from professional

health care organizations.6,7

Infection control is one of the prime task

of dental health care personnel (DHCP).

The mouth’s natural flora contains a

number of microorganisms. During dental

procedures, the bacterial aerosols spread

through the entire dental room.8

In the Healthcare profession, teachers are

at the peak of their understanding and

capability to convey best practices in

future generations. Proper training of

infection control involving Hand Hygiene

is a key to prevent and transference of

infections.9,10

In dental surgeries, the use of procedures

to control infection and inhibit microbial

pollution and helped by organizations such

as the Centres for Disease Control and

Prevention, the American Dental

Association, schools of dentistry, and

many other health agencies and

professional associations.11

Dental photography is main part for

diagnostic and treatment planning and

registration of the patient’s condition

before and after treatment. So, good

quality photographs must be prioritized

and adequate mirrors must be used. They

should be disinfected by sterilization, but

some methods may harm their surface.12

Infections are created by pathogens,

involving bacteria, viruses and prions.

Pathogenic bacteria can create many

diseases involving tuberculosis,

pneumonia, diphtheria, cholera and

typhoid. Dental technicians are endangered

to microbial cross-contamination from the

impressions. When casts developed from

the impressions may also spread infectious

microorganisms throughout the laboratory

when the casts are trimmed.13

The transmissible, spongiform

encephalopathies (TSEs) contain a group

of neurodegenerative disorders created by

infection with prions. This diseases

involves sporadic, familial and iatrogenic

forms of Creutzfeldt Jakob Disease

(CJD).14,15

In prosthodontics, objects infected with

pathogenic microorganisms are moved

between dental laboratory and the dental

clinic. It has been stated that to avoid cross

contamination, specific disinfection

measures should be followed.16,17

We are not familiar of guidelines in

Nigeria, the Nigerian Medical Association

(NMA) and the Nigerian Dental

Association (NDA) has been drawn to

prepare guidelines for the management of

these patients. In Nigeria, medical and



dental practitioners acquire guidelines

from other countries for the treatment of

patients infected with blood borne

diseases.18

The dental procedures increase the chance

of prosthetic hip or knee infection has been

discussed for almost 3 decades. There have

been no well-designed, case control or

cohort studies that have associated any

type of dental procedure with an increased

chance of PJI.19

Dental treatment procedures cause

bleeding and show to infected blood,

saliva and aerosol is an infectious disease

transmission. To obstruct cross-infection

in the dentistry, the use of barrier

techniques (gloves, masks, and spectacles),

heat sterilization of dental instruments and

vaccination against hepatitis B are

known.20

The respiratory system is conduct for O2

and CO2 exchange between the blood and

the external environment. This gas

exchange takes place across partial

pressure gradients within the terminal

respiratory unit. Chronic obstructive

pulmonary disease (COPD) is an

irreversible and slowly progressing

disorder characterized by a limitation of

airway flow resulting from an abnormal

pulmonary inflammatory reaction to

harmful gases or particles – particularly

tobacco smoke.21,22

Human Immunodeficiency Virus (HIV)

and AIDS it is suppose that each and every

patient who is attending the health care

like oral care is infected with 'infective

carriers. The route of transmission of these

pathogenic microorganisms through;

a) Direct contact (e.g. blood)

b) Indirect contact (e.g. instruments)

c) Contact of oral mucosa with droplets

generated from an infected person (e.g. by

coughing, sneezing, or talking);

d) Inhalation23

Knowledge, attitude and practice behave

as three pillars, which make up the

dynamic system of life itself. Dental

students are working in the dental clinics

are higher chances of infections created by

various microorganisms. It is relevant to

always use eye/face protection and have

sufficient suction when using high-speed

rotary instruments.26

Dental patients and dental health care

workers are exposed to many infectious

disease agents during the treatment, such

as Mycobacterium tuberculosis,

Staphylococcus aureus, Streptococcus

pneumoniae, Streptococcus pyogenes,

Treponema pallidum and the viruses HIV,

Hepatitis B, Hepatitis C, Herpes simplex 1

and 2, Cytomegalovirus, Epstein-Barr

among others. The cross-contamination is

the passage of microorganisms from one

person or object to another. At the dental

office, infections may be transmitted by

direct contact (saliva, blood and other

secretions) or indirect contact (saliva drips

and contaminated aerosols).28,29

The recent scientific literature has various

studies to search the extent of public

knowledge of cross-infection control in

dentistry.30

HISTORY

Occupational Safety & Health

Administration (OSHA). In September of

1991, I started my collaboration with the

Arizona Dental Association to impart

knowledge to its members about the new

OSHA Blood borne Pathogen law that was

to take effect in June of 1992. The final

rule was not issued until December of

1991, but there was general among the

medical and dental communities.

BODEX and the CDC. After the basis of

the OSHA law were understood, the



importance of it appeared to greatly

decline. In 1994, changes occur when the

Arizona State Board of Dental Examiners

(BODEX) declared approval of the most

current State OSHA essential procedures

for worker protection and the most current

Centers for Disease Control approved

Infection Control Practices for Dentistry.9

During dental treatment, the universal

precautions concerning infection control is

predominant. The dental care is conveyed

to both patient and provider safety. Health

care professionals should be informed in

how to decrease exposure and

contamination chances to infectious

materials.25

In the broader health system, infection

control concern for government, health

professionals and the public, given

national public health issues, such as

severe acute respiratory syndrome

(SARS), pandemic influenza and global

problems with multi resistant bacteria,

such as Methicillin-resistant

Staphylococcus aureus (MRSA). Dental

hygiene clients and dental hygienists

impart detail for infection control

procedures and impart protocols to

minimize the chances of injury or

disease.26,27

Dentistry is predominately a surgical

discipline, involving exposure to blood

and other potentially infectious materials

and high standards of infection control and

safety (IC&S) practice are necessary in

improving patient safety and reducing

occupational exposures to bloodborne

diseases. Apart from bloodborne diseases

such as Hepatitis B and C and HIV

Infection, dental health care workers are at

risk of acquiring respiratory diseases.29

The preventive assessment of infection

transmission in dentistry makes possible

infection control measures in the three

stages of prophylaxis:

A. Primary:

a. Preventive assessment of environmental

parameters Detection of infection sources

b. Determination of patients and staff

susceptibility to infections

c. Compliance with the regulations for

decreasing the risk of infection exposure

d. Management of dental team activity

e. Immunization programs

B. Secondary:

a. Evaluation of aseptic techniques:

disinfection (decontamination),

sterilization

C. Tertiary:

a. Health care for the occupationally

exposed staff (OES)

SOURCES OF INFECTION IN

DENTAL PRACTICE

- physical exhaustion (posture, visual

effort, noise) and psychic stress

-contact with noxious materials and

substances (toxic, allergenic)

- exposure to infections - airborne:

bacterial, TB, staphylococcus,

pneumococcus viral: flu, other respiratory

viral diseases, measles, SARS

- digestive: enterobacteria, enteroviruses

- blood: HBV, HBC, HIV31

HIV AND AIDS

In 1973, it was usual that retroviral

isolation and purification must be built on

procedures. These procedures involve the

density gradient ultrafugation of the

specimen considered the retrovirus (e.g.,

HIV), the selective extraction from the

resulting solution of the band having a

density gradient of 1.16 gm/mL, and then

the electron microscopic examination and

photomicroscopy of this separate. The

electron photomicrographs issued by



Barré-Sinoussi and Gallo are of unpurified

cell cultures or stimulated cell cultures and

are not the contents of a band clearly

detailed the critical density gradient of

1.16 gm/mL.

HIV/AIDS — A PANDEMIC

Three important situations have avoided

Dr. Nutt and her colleagues. The first is the

level of health care in underdeveloped

countries such as sub-Saharan Africa. In

those locations, HIV/AIDS are found on

improper extrapolations from hospitalized

patients and clients of STD clinics. The

second is the most of the testing in Africa

is not done, not proved and lead in

dysfunctional laboratories using out-of-

date reagents. The third is the World

Health Organization’s clinical case

definition for AIDS allow the diagnosis to

be made based on the presence of weight

loss, chronic diarrhoea, prolonged fever

and persistent cough in Africa.

SCREENING FOR HUMAN

IMMUNODEFICIENCY VIRUS

DISEASE IN THE DENTAL SETTING

In 2004, a rapid HIV test using oral fluids

was confirmed. With its high sensitivity

and specificity, the test suggests results in

less than 20 minutes. The dental practice

residue an untapped venue for performing

HIV testing, since many of the previous

barriers, involving mandatory pretest and

posttest counselling have been

eliminated.21

CATEGORIES OF PATIENT CARE

ITEMS

In the mid-twentieth century, Dr. Earle H.

Spaulding divided patient care items into

three categories based on the risk of

infection involved in their use.

• Critical Items: It presents a high risk of

infection to the patient when items are

infected with any microorganism.

• Semi-critical Items. It presents object that

come in contact with mucous membranes.

We use both critical and semi-critical

objects in dental procedures and use

sterilized or single-use items that will be

placed in the mouth.

• Noncritical Items: It presents object that

come in contact with intact skin; cleaning

and intermediate or low-level disinfection

is required if bio burden is present.

• Environmental Surfaces: The Centres for

Disease Control and Prevention (CDC) has

divided noncritical surfaces into clinical

contact and housekeeping surfaces. The

environmental surfaces are assessed the

least risk of disease transmission because

they do not come into direct contact with

patients during care.9

ROUTE OF INFECTION:

a) Direct person to person infection-

Airborne infections, e.g., Tuberculosis,

b) Indirect infection route

i) Transfer of pathogens from

surface: e.g., MRSA or notovirus via hand

contact to patient.

ii) Transfer of pathogens from hand

or hand surfaces via instruments or

equipments causing infection through

mucosa or open wounds.

iii) Infection from incorrectly

processed instruments:

This could include prion transfer from

instruments not completely cleaned and

inadequately sterilized.13

INFECTION CONTROL

Infection control procedures involve

1. PATIENT SCREENING: Initial patient

screening is accomplished by the

Prosthodontist during the history taking



interactions before entering the operatory.

Dentist’s review of the patient’s medical

history is mandatory at the onset of every

clinical appointment.

2. PERSONAL HYGIENE: Dentist’s

personal hygiene is an absolute necessity.

As patients become more aware of the

potential danger to themselves from

materials and instruments that are not

disinfected or sterilized, their confidence

and acceptance of dental treatment

becomes directly proportional to the image

the clinician presents. Hair is cleared away

from the face.

3. PERSONAL PROTECTION: Residents

are required to have current immunizations

against communicable diseases, including

hepatitis B. Gloves are worn at all times

when treating patients. Masks are worn in

the patient treatment area and when the

dentist is manipulating the prostheses in

the laboratory. Glasses with solid side

protection for the patient, faculty member,

and resident are mandatory. The use of

disposable plastic face shields is highly

recommended.

4. INSTRUMENT PROCESSING:

-Presoaking and cleaning

-Packaging

-Sterilization

The following methods of sterilization are

most commonly used.

- Steam at 121 degree C for 20 to 30

mins or 134 degree C for 2 to 10

mins.

- Advantages – good penetration

Precautions – carbon steel corrodes,

damage to plastic and rubber items, packs

wet after the cycle, hard water spots

instruments.

5. SURFACE ASEPSIS: There are two

general approaches to surface asepsis.

- Clean and disinfect contaminated

surfaces.

- Prevent surface from becoming

contaminated by use of surface covers

A combination of both may also be used.24

INFECTION CONTROL

STRATEGIES WITHIN THE

OPERATING FIELD

The boundaries of the operating field need

to be clearly defined during dental

treatment and the spread of droplets and

aerosols contained within that field. This

can be achieved in part by the use of dental

dams, high volume evacuation and proper

patient positioning. Rubber dam minimizes

the spread of blood or saliva. When rubber

dam is not applied, high volume aspiration

becomes essential. All surfaces and items

within the operating field must be deemed

contaminated by the treatment in progress.

The surfaces must be cleaned and other

items removed, cleaned and sterilized

before the next patient is treated.

1. CLEAN AND CONTAMINATED

ZONES

Within the dental surgery, clean and

contaminated zones must be clearly

demarcated. Every person must understand

the zones, the requirements for each zone

and adhere to the outlined protocols.

Dental care providers and dental staff

should not bring Personal effects, changes

of clothing or bags into the clinical areas

where cross-contamination is likely to

occur. The operating field and areas where

contaminated instruments are placed are

regarded as contaminated zones whereas

clean Areas include those surfaces and

drawers where clean or sterilized

instruments are stored and which never

come in contact with contaminated

instruments or equipment. A system of

zoning aids and simplifies the

decontamination process.



2. WATERLINES AND WATER

QUALITY

Most dental unit waterlines contain

biofilm, which acts as a reservoir of

microbial contamination and while biofilm

in dental unit waterlines is an unknown

hazard it may be a source of known

pathogens (e.g., Legionella spp). All

waterlines and airlines must be fitted with

non-return (anti-retraction) valves to help

prevent retrograde contamination of the

lines. Routine maintenance of these valves

is necessary to ensure their effectiveness.

An independent water supply can help to

reduce the accumulation of biofilm. The

manufacturer's directions for appropriate

methods to maintain the recommended

quality of dental water and for monitoring

water quality should be followed. Biofilm

levels in dental equipment can be

minimized by using a range of measures,

including chemical dosing (e.g., hydrogen

peroxide, silver ions and peroxygen

compounds), flushing lines (e.g., triple

syringe and handpieces) after each patient

use, and flushing waterlines at the start of

the day to reduce overnight or weekend

biofilm accumulation.

3. SINGLE USE ITEMS

Dental items designated as single use by

the manufacturer must not be reprocessed

and reused on another patient, but must be

discarded after use.

Single ‘one patient’ use sterile instruments

should be used whenever indicated by the

clinical situation. These items include, but

are not limited to, local anaesthetic needles

and cartridges, scalpel blades and matrix

bands (not sterile when imported and must

be sterilized before use).

Injecting apparatus (including hypodermic

syringes, needles, dental local anaesthetic

solution and needles) must be sterile at

time of use and are single patient use only.

For example, incompletely used local

anaesthetic cartridges must be discarded

after each patient use. Similarly, suture

materials, suture needles and scalpels must

be used for one patient and then disposed

of.33

APPLICATIONS IN DENTISTRY

FIELD

The recognition of the potential for

transmission of numerous infectious

microorganisms during dental procedures

has led to an increased concern for

infection control in dental practice.

Approaches to the clinical use of

microwaves for preventing cross-infection

have shown relevant results. Devices and

instruments used in dental offices have

been identified as a source of cross-

contamination among patients and from

patients to dental personnel. In addition,

dental burs, which may become heavily

contaminated with necrotic tissues, saliva,

blood, and potential pathogens during use,

can also be sterilized by microwave

irradiation. In order to prevent cross-

infection, microwave energy can also be

used to the disinfection of finishing and

polishing instruments. As any another

device used in dental offices, finishing and

polishing instruments routinely come into

contact with patient’s saliva and blood and

may also act as a source of cross-

contamination. In accordance with the

studies of Tate et al., these dental devices

can be effectively sterilized by microwave

irradiation.34

BIOMEDICAL WASTE

SEGREGATION

Biomedical waste is defined as any waste

as the solid or liquid waste arising from



health care or health related facilities.

Categories biomedical waste includes:

a. Non- infectious

b. Infectious waste

Following is the method of choice of

disposal:

Yellow bag: In which all biodegradable

waste is disposed off (e.g. human

anatomical waste, cotton, expired medicine

without wrappers)

Red bag: Non- biodegradable waste such

as plastics (gloves, catheters, syringes etc)

White puncture proof container: The

container is filled with 1% Hypochlorite

solution and sharps are generally discarded

in these containers.

DENTAL RADIOLOGY

When taking radiographs for patients,

ensure that;

— Protective plastic covered I/0 films

(barrier pouches) are used

— Prevent contamination of the

processing equipment

— Gloves are used to position film, holder

and tube

— Tube head and surfaces are disinfected

—Biteblocks and holders are sterilisable.23

DECONTAMINATION OF

IMPRESSION AND PROSTHETIC

APPLIANCE:

All impression should be rinsed in running

water to remove all visible signs of

contamination and be disinfected with an

appropriate disinfecting agent before being

sent to dental laboratory. 5% phenol and

2% gluteraldehyde have proved to be

useful. Items like articulators, lathes

should be cleaned and sterilized.

Technician should wear gloves when

handling impressions and pouring models.

Transfer of oral microorganisms into and

onto impressions and dental casts has been

reported.

DENTURE DISINFECTION:

A 4% chlorhexidine scrub for 15 seconds

followed by a 3-minute contact time with a

chlorine dioxide solution was effective in

disinfecting contaminated dentures. There

are seven major active ingredients used for

disinfectants in dentistry.

1. Ethyl alcohol

2. Isopropyl alcohol

3. Chlorine

4. Iodophores and iodines

5. Glutaraldehyde

6. Phenolics

7. Quaternary ammonium compounds.13

2. INFECTIOUS DISEASES OF

CONCERN IN DENTISTRY

2.1 VIRAL INFECTIONS

Herpes Simplex Virus, one of the most

common types of Herpes Virus family.

Major signs of infection are fewer, malaise

lymphadenopathy and ulcerative

gingivostomatitis.

Epstein-Barr Virus causes infectious

mononucleosis and can persist in epithelial

tissues. It can be transmitted by skin

contact or blood and the virus is present in

saliva.

Hepatitis B Virus (HBV), A DNA virus

causative of acute hepatitis. Hepatitis B

surface antigen (HbsAg) is found by

serological tests as the main indicator of

active infection. HbeAg on the other hand

shows activity of the virus present in the

liver.

Hepatitis C Virus (HCV), is a RNA virus,

causative of non-A and non-B Hepatitis.

Following the primary infection, which is

usually asymptomatic, majority of the

infected individuals become persistent

carriers of the virus and there is a long-



term chance of chronic liver disease with

cirrhosis and hepatocellular carcinoma.14

HEPATITIS B AND C IN ORAL

CAVITY

HBV infection is the most important

infectious occupational hazard in the

dental profession.

A number of reports suggest:

• Higher incidence of HBV among dental

staff

• Higher rates of HBV especially oral

surgeons, periodontists and endodontists.

Vectors of infection with HBV in dental

practice are: blood, saliva and

nasopharyngeal secretions. In intraorally,

the greatest concentration of Hepatitis B

infection is the gingival sulcus. In

periodontal disease, severity of bleeding

and bad oral hygiene were related with the

chance of HBV.32

2.2 BACTERIAL INFECTIONS

Tuberculosis, caused by M. Tuberculosis

is transmitted by inhalation, ingestion and

inoculation. Cervical lymphadenitis and

pulmonary infections are encountered.

Immunization with BCG vaccine

adequately covers dental team members.

Gloves and masks on the side must be

used. M. Tuberculosis is highly resistant to

chemicals and heat and disinfection

protocols should be followed.

Legionellosis caused by Gram-negative

bacteria, which occupy in warm and

stagnant water reservoirs. During dental

procedures, the organism is water-borne, it

can easily be transmitted via aerosols

formed.

3.1 ROUTINE PROCEDURE

A proper medical and dental history should

be acquired for all patients at the first visit

and updated regularly.

3.2 IMMUNIZATION

Dentists and other dental team workers

must be vaccinated against Hepatitis B by

means of personal protection. Vaccination

must be started in ten days after onset of

practice and must be carried during

practice. Before the onset of their practice,

individuals must check their levels of

immunity sufficiency against Hepatitis B.

All dental health care personnel are

suggested to receive the following

vaccinations: influenza, measles (live-

virus), mumps (live-virus), rubella (live-

virus), and varicella-zoster (live-virus).

3.3 HAND HYGIENE

Providing and sustaining a level of hand

hygiene is of great importance in

protection techniques. All member of the

dental team adjust the habit of maintaining

providing hand hygiene. CDC published a

“how to” guideline for washing hands in

1975 and 1985 and according to these

publications hands must be washed with

antimicrobial soaps before and after

invasive procedures performed on patients.

At times, when washing hands is not an

option, application of water-free

antiseptics is suggested.

3.4 SINGLE USE (DISPOSABLE)

ITEMS

Equipment described by manufacturer as

“single use”, should be favoured and used.

“Single use” means that a device can be

used on a patient during one treatment and

then rejected. These items are local

anaesthetic needles and cartridges, scalpel

blades, suction tubes, matrix bands,

impression trays, surgery burs, patient

gown, working area covers.



3.5 BARRIER TECHNIQUES

Dental team members employ personal

protective equipment during applications

in order to protect themselves and avoid

cross infections. Guidelines for using these

products must be noted and updated under

data.

3.5.1 MASKS, EYEWEAR AND FACE

SHIELDS

If proper precautions are not taken, contact

of blood and saliva of patients with

dentists’ eyes and contamination with

aerosols during dental procedures is un-

preventable. A mask and a protective

eyewear must be used during all

applications.

3.5.2 GLOVES

Gloves were first used in medical

procedures by William Halstead a century

ago for avoiding nurses’ hands from harsh

antiseptics. In 1979, the Expert Group on

Hepatitis in Dentistry proposed the use of

non-sterile gloves for the first time, when

dealing with patients infected with

Hepatitis B and as HIV. During all kinds

of procedure in dentistry, it is impractical

to avoid contact of hands with blood and

saliva. This is why, all clinicians must

wear protective hand gloves before they

perform any kind of procedure on their

patients.14

TYPES OF GLOVES-

1. Sterile gloves

2. Medical examination gloves

3. General purpose gloves

4. Seamed gloves13

3.5.3 PROTECTIVE CLOTHING

Protective clothing should be used instead

of daily clothing. Whenever, the clinician

deal with patients with contagious

diseases, he/she should suggested long

sleeved protective clothing. This way,

contact of pathogens with skin can be

avoided.

3.5.4 POST-EXPOSURE PROTOCOL

In case, skin gets injured with

contaminated instruments or open wounds

come in contact with body fluids of the

patient, procedure should be immediately

stop and injured area should be washed

with ample amount of soap and water.

If an injury with infected materials used in

HIV, HBV or HCV contaminated patients

occurs, patient’s detailed medical history

should be questioned and tested if

required.14

STERILIZATION:

Sterilization is a process by which all

forms of microorganisms are destroyed,

including virus, bacteria, fungi, and spores.

Products that are capable of sterilization

are referred as sterilants.

DISINFECTION:

It eliminates virtually all recognized

pathogenic microorganisms but not

necessarily all microbial forms (bacterial

endospores), on inaminate objects.

Consequently, products that have the

ability to disinfect are referred to as

disinfectants.

LEVELS OF DISINFECTION:

Disinfection can be achieved in three

specific levels:

High.

Intermediate/Medium.

Low.16

Intravenous (IV) SOLUTIONS

1. Never use IV solution containers (e.g.,

bags, bottles) to acquire flush solutions.



2. Never use infusion supplies, such as

needles, syringes, or IV fluids, on more

than 1 patient.

3. Prepare IV solutions and medications as

close to administration as viable.

4. Disinfect IV ports and vial stoppers by

wiping and using friction with a sterile

70%isopropyl alcohol, ethyl/ethanol

alcohol, iodophor, or other approved

antiseptic swab.

SYRINGES

1. Remove the sterile needle/cannulas

and/or syringe from the package

immediately.

2. Never use a syringe for more than 1

patient.

3. Use a new syringe and a new needle for

each entry into a vial or IV bag.

4. Uses sharp safety devices whenever

possible.

VIALS

1. Use single-use or single-dose vials

whenever possible.

2. Always use a new sterile syringe and

new needle/ cannula when entering a vial.

3. Cleanse the access diaphragm of vials

using friction and a sterile 70% isopropyl

alcohol, ethyl alcohol, iodophor, or other

approved antiseptic swab.

4. Reject single-dose vials after use. Never

use them again for another patient.17

CONLUSION

In particular, this related to the

decontamination of surfaces and

instruments, the use of personal protection,

and training and education in cross

infection control. An absolute microbe free

environment is wanted to neglect the cycle

of infection and improve the overall health

status of the society. Prosthodontics and

their ancillary personnel may berevealed to

diseases found in adult patients such as

hepatitis-B and tuberculosis.

Administrators of medical facilities must

be familiar with safe injection practices

and secure that employees have the

knowledge, training, and equipment to

safely implement these procedures.

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How to cite this article: Garg Y, Bhaskar

DJ, Agali CR., Punia H, Garg K, Dalai

DR, Panchal S. Infection Control in

Dentistry: Need for a Better Practice. Arch

of Dent and Med Res 2015;1(1):19-31.

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Review article AODMR · Review article AODMR 19 Archives of Dental and Medical Research Vol 1 Issue 1 Infection Control in Dentistry: Need for A Better Practice Yogesh Garg, D.J