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Infection Control
Aim: To provide highest level of infection control possible
and practical that will ensure a safe environment for both
patient and clinician.
Objectives:
Elimination of cross contamination by breaking the chain
of infection.
Reduction of available pathogenic microorganism to a
level at which normal resistance mechanisms of the body
may prevent infection.
Application of universal precautions by treating each
patient as if all human blood and body fluids are known
to be infectious for HIV,HBV and other blood born
pathogens.
Guideline for Infection Control
ADA and Center for disease control and prevention have
developed guidelines for infection control.
All guidelines are based on concept of standard
precautions, previously called universal precautions.
A parallel approach presented in 1987 called body
substance isolation which focuses on reducing
transmission of infection from any most body substance of
the patent to the health care work.
The universal precautions emphasize on barrier
procedures, routine autoclaving of instruments and means
of handling potentially infectious material.
In 2003 CDC guidelines combined body substance
isolation and universal precautions called Standard
infection control procedures.
OSHA and Dental Practice
In USA OSHA(occupational safety and health
administration) is responsible for establishing standard for
safe and healthy working in almost all industries
Blood-born pathogen standard came into effect in 1992.
BP standard covers instrument sterilization and storage
handling of contaminated equipment, disposal of medical
waste. HBV vaccination to staff reporting needle stick
injuries, level of washing and storing laundry.
The BP standard is a formidable document.
Barriers for Patient and Clinician
Protection
Immunization
Management programs:
a) Recommended tests
Serologic test for herpes simplex virus I (HSV I)
antibodies to determine susceptibility to primary
HSV.
Annual tuberculin test
b) Written records: keep written records of
immunization, reimmunization and booster plan for
regular follow up.
Clinical Attire:
The wearing apparel of clinicians and their assistants is
vulnerable to contamination from splash, aerosol and
patient contact.
Gown, scrub suit with solid closed fronts with out
pockets.
Hair or head cover
Face mask
Face shields
Proper syringe capping Techniques
HIV / AIDS
Acquired immunodeficiency syndrome is the end point of HIV
infection.
Aids virus is a retrovirus.
Aids is the final progressive process of immunological deficit
mediated by the virus.
Pnuemocystis carinii pnuemonia is the most common
opportunistic infection.
In severe HIV infection the CD 4+ T- cell count of 200/uL or
less.
Modes of Transmission:
Sexual transmission
Infected mother to infant
Transfusion of infected blood
Intravenous drug use
Investigations in adults
Detection of HIV antibody: enzyme-linked
immunosorbent assay (ELISA), Western blot.
Assessment of viral load: detection of virus or viral antigen:
HIV RNA or branched DNA (bDNA) assay.
FBC: anaemia, thrombocytopenia, lymphocytopenia with
reduced CD4 cell count.
Raised ESR.
Assessment of other infections: eg tuberculosis, hepatitis
B, cytomegalovirus (CMV), toxoplasma, syphilis, varicella.
Screening for co-existing sexually transmitted diseases
(STDs).
Baseline CXR and cervical smear.
It may be appropriate to screen for glucose-6-phosphate
dehydrogenase (G6PD) deficiency in appropriate racial
groups.
Diagnosis
Is based on detecting anti-HIV antibodies in serum.
Acute infection may be detected by the presence of P24
antigen or HIV RNA by polymerase chain reaction (PCR)
and precedes the appearance of IgM and IgG.
A combination test checking for the presence of HIV
antibody and p24 antigen (the so-called 'fourth generation
test') is provided by hospital and is very accurate. It takes
about four weeks to get the result back.
Investigation in children
Standard anti-HIV IgG antibody tests cannot be used
before 18 months of age, as maternal antibodies may
be detected.
PCR and virus culture are the best investigations in
children born to infected mothers.
38% of infected infants can be detected within the first
48 hours after birth, rising to 96% at four weeks .
Oral manifestations of HIV
Principal signs of HIV
Oral candidiasis
Hairy leukoplakia
Kaposi sarcoma
Chronic Herpes Simplex
Oral Candidiasis
Fungal infection.
Usually present as a white plaque on the palate.
Plaque can be sore and very common among HIV
infected individuals.
Candidiasis
Oral Hairy Leukoplakia
Lesion commonly appear on lateral surface of tongue.
Wide variation in size, severity and characteristics of
lesion.
Condition is highly predictive of future development
of aids.
It is caused by Epstein-Barr virus (EBV)
Kaposi Sarcoma
Diagnostic for aids.
Found in 28%-34% of aids patients.
Palate is the most common intraoral site.
Dry Heat
Action of dry heat is oxidation.
Temp 160 C (320 F).
Time: 2 hours or 1 hour for 170 C
Advantage:
No corrosion
Well suited for sharp instruments.
Use full for material that cannot stand stem under
pressure.
Disadvantage:
High temperature is critical for plastic materials.
Autoclave
Chemical Vapor Sterilization
A combination of alcohols, formaldehyde, ketone,
water and acetone heated under pressure produces a
gas that is effective as strigling agents.
Time / Temp: 20 min 127 o C -132 o C
Pressure: 20-40 pounds
Advantage:
Rust free operation for carbon steel instruments.
Less time consuming
Sterilization for Heat sensitive Instruments
Cold sterilization (Liquid chemicals The use of
chemicals classified as "sterilants)
10 hour of exposure to chemical liquid agent.
This sterilization is followed by aseptic rinsing with
sterile water, drying and if the instrument is not used
immediately, place in a sterile container.
Physical Methods
Filtration
Used on fluids and on air supplies
Gamma-Irradiation
Used on disposable plastics, e.g. in sealed packs
Only in specialised centres
Mercury Safety
Dental amalgam contains elemental mercury. It
releases low levels of mercury vapor that can be
inhaled. High levels of mercury vapor exposure are
associated with adverse effects in the brain and the
kidneys.
Based on this evidence, FDA considers dental
amalgam fillings safe for adults and children ages 6
and above.
Research has not shown any health effects from
amalgam fillings in pregnant women. However,
mercury can cross the placenta. Women should not get
amalgam fillings during pregnancy. Dentists can
suggest other materials for any pregnant woman who
needs a cavity filled.
Occupational exposure is completely preventable with
the implementation of proper mercury hygiene
practices.
There is no evidence in the scientific literature that the
minute amounts of mercury vapor that may be
released from amalgam restorations pose a health
threat. Allergic reactions to mercury and other
constituents of amalgam have been documented, but
are exceedingly rare.
Some individuals have an allergy or sensitivity to
mercury or the other components of dental amalgam
(such as silver, copper, or tin). Dental amalgam might
cause these individuals to develop oral lesions or other
contact reactions.
Alternative to Amalgam
Composite resin filling
Glass ionomer filling
Gold fillings
Mercury Hygiene Guidelines