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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:
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
20 Archives of Dental and Medical Research Vol 1 Issue 1
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
Garg et al: Infection Control in Dentistry
21 Archives of Dental and Medical Research Vol 1 Issue 1
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
Garg et al: Infection Control in Dentistry
22 Archives of Dental and Medical Research Vol 1 Issue 1
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
Garg et al: Infection Control in Dentistry
23 Archives of Dental and Medical Research Vol 1 Issue 1
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
Garg et al: Infection Control in Dentistry
24 Archives of Dental and Medical Research Vol 1 Issue 1
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.
Garg et al: Infection Control in Dentistry
25 Archives of Dental and Medical Research Vol 1 Issue 1
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
Garg et al: Infection Control in Dentistry
26 Archives of Dental and Medical Research Vol 1 Issue 1
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-
Garg et al: Infection Control in Dentistry
27 Archives of Dental and Medical Research Vol 1 Issue 1
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.
Garg et al: Infection Control in Dentistry
28 Archives of Dental and Medical Research Vol 1 Issue 1
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.
Garg et al: Infection Control in Dentistry
29 Archives of Dental and Medical Research Vol 1 Issue 1
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.