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Chapter 6
Infection Control:
Clinical Procedures
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Overview
• Objectives
• Basic considerations for safe practice
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Treatment Room Features
• Dental unit
• Floor
• Dental chair
• Sink
• Light
• Supplies
• Clinician’s chair
• Waste
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Instrument Processing Center
• For instrument:
– Care & cleaning
– Packaging
– Sterilizing
– Storing
• Located apart from treatment rooms
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Cleaning Procedures
• Instrument washer/thermal disinfector
• Ultrasonic processing
• Manual cleaning
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Packaging Step
•Purposes
•Instrument arrangement
•Preparation
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sterilization
• Approved methods
• Selection of method
• Tests for sterilization
– External chemical indicator
– Internal chemical indicator
– Biologic monitor
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Moist Heat:
Steam Under Pressure
• Autoclave types
– Gravity displacement
– High-speed prevacuum
• Use
• Principles of action
• Evaluation
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Review
Which of the following is an autoclave?
A) It is a chemical vapor sterilizer
B) It is sterilization achieved by steam
under pressure
C) It is a dry heat sterilizer
D) It is an ethylene oxide sterilizer
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
B) It is sterilization achieved by steam
under pressure is the correct answer.
By definition, an autoclave is a sterilizer
that sterilizes using steam under
pressure. The other sterilizers do
sterilize, but by other methods and
chemicals.
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Dry Heat
• Use
• Principles of action
• Operation
• Evaluation
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Chemical Vapor Sterilizer
• Use
• Principles of action
• Operation
• Care of sterilizer
• Evaluation
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Care of Sterile Instruments
• Storage
• Shelf life
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Chemical Disinfectants
•Categories
•Uses
•Principles of action
•Criteria for agent selection
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Review
A. High-level disinfectants inactivate spores and all
forms of bacteria, fungi, and viruses. B.
Intermediate-level disinfectants inactivate all forms
of microorganisms but do not destroy spores.
A) Statement A is correct and statement B is correct
B) Statement A is correct and statement B is incorrect
C) Statement A is incorrect and statement B is correct
D) Statement A is incorrect and statement B is
incorrect
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
A) Statement A is correct and statement
B is correct.
High-level disinfectants inactivate spores
and all forms of bacteria, fungi, and
viruses. Intermediate-level
disinfectants inactivate all forms of
microorganisms but do not destroy
spores.
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Preparation of the Treatment
Room
• Objectives
• Preliminary planning
– Hand contacts
– Sterilizable items
– Disposable items
– Items that may be covered
– Items that require chemical disinfection
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Preparation of the Treatment
Room (cont’d)
• Clean and disinfect environmental
surfaces
– Agent
– Procedure
• Unit water lines
– Procedure for clinical use
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Patient Preparation
• Preprocedural oral hygiene measures
– Toothbrushing
– Rinsing
• Application of surface antiseptic
– Before injection of anesthetic
– Before scaling and other dental hygiene
instrumentation
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Review
A. Preprocedural rinsing and other oral hygiene
measures help to prevent the spread of
communicable diseases. B. Preprocedural rinsing
and other oral hygiene measures decrease the
number of microorganisms in the oral cavity.
A) Statement A is correct and statement B is correct
B) Statement A is correct and statement B is incorrect
C) Statement A is incorrect and statement B is correct
D) Statement A is incorrect and statement B is
incorrect
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
A) Statement A is correct and statement
B is correct.
The use of preprocedural rinsing and
toothbrushing has been shown to lower
the numbers of oral bacteria and,
therefore, to lower the numbers of
infected aerosols created during
instrumentation.
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Summary of Standard
Procedures
• Patient factors
• Clinic preparation
• Factors for the dental team
• Treatment factors
• Posttreatment
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Patient Factors
• Comprehensive patient history
– Assessment of history
– Medical consultation or referral
• Preprocedural mouthrinse
• Protective eyewear
• Patient with communicable condition
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Clinic Preparation
• Waterline cleaning
• Environmental surface disinfection
• Instrument sterilization
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Factors for the
Dental Team
• DHCP medical status
• PPE use
• Meticulous hand hygiene
• Aseptic technique
• http://www.osha.gov/
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Treatment Factors
• Hypodermic needles
• Removable oral prostheses
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Posttreatment
• Use heavy, puncture-resistant gloves
to handle instruments
• Disinfect, clean, & prepare instruments
• Secure contaminated waste in bags
• Disinfect safety eyewear
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Occupational Post-Exposure
Management
• Significant exposures
• Procedure following exposure
– First aid procedures
– Documentation
• Follow-up
• http://www.cdc.gov/
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Disposal of Waste
•Regulations
•Guidelines
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Supplemental
Recommendations
• Cleaning the face
• Smoking and eating
• Reception area
• Sterilization monitoring
• Office policy manual
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Documentation: Needlestick
• Patient name, record #, address,
phone #, email
• Medical history of HBV, HCV, HIV
• For HIV+ source patient:
– Current medications & effectiveness
– Viral load & current CD4, if known
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Factors to Teach
the Patient
• Standard precautions
• Medical, dental, and social histories
• Sterilization and biologic monitoring
• Normal oral flora and disease etiology
• Personal oral infection control methods
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