Infection Control in Dentistry

Introduction:

Infection control in a dental and medical healthcare setting or operatory is primarily dependent on,

• The hand hygiene of the operator.

• The usage of personal protective equipment (face shields, masks, gloves, and suit).

• Proper instrument sterilization.

• Disposal of wastes.

All these should not be thrown into the environment as such in order to maintain water safety guidelines to prevent air and water pollution from the clinic or hospital.

What Is Hand Hygiene?

Hand hygiene is an essential infection control practice to protect patients, healthcare personnel, and visitors. The significance of handwashing is highlighted by the medical and dental practitioners alike from the 19th century. The evidence that operator hand decontamination can reduce the risk of puerperal fever that increased maternal mortality was a primary purpose in signifying the importance of hand hygiene. Similarly, the germ theory of disease (that proved direct transmission of microbes from the operator can result in infectious transmission to the patient) in the 1950s was attributed to the prevention of the staphylococcus epidemic in newborn infants and young infants.

The two types of flora, the resident flora in the palms of the fingers and the transient microflora in the superficial skin surface, can be successfully eliminated by routine hand hygiene of the dental operator. Alcohols, Chlorhexidine, phenols, iodophors, and antiseptic compounds (used in different handwashes for dental operator hand hygiene) are effective but not completely against spores like bacillus anthracis.

In exposure to blood or bodily fluid contamination, the dental operator should scrub the hands with an antimicrobial soap and water (both before or after a procedure to maintain a sterile and aseptic environment). Primary disinfection protocols like applying a povidone-iodine 1% solution on the patient's cheek or jaw region (where the operator uses that area like a finger rest or support) are also effective for maintaining sterility through the procedure that reduces the chain of microbial transmission from the operator to patient.

What Is the Importance of Dental Instrument Classification?

The Spaulding classification mainly classifies instruments in the dental or medical office into 3 major categories based on their ability to infect the surroundings after usage on the patient, that is, dependent on the degree of the risk of spreading infection. So the priority is given for immediate disinfection before sterilization of high-risk items, while the low-risk items can be sequentially attended to for sterilization or disinfection.

Patient care items, that is, dental instruments, devices, and equipment, are categorized based on their risk of transmitting disease. They are,

Critical Items:

• Penetrate soft tissue or bone.

• The highest risk of transmitting infection

Semi Critical Items:

• Touch only the mucous membrane.

• Lower risk of transmission than critical items.

Non-Critical Items:

• Only contacts intact skin.

• Lowest risk of transmission.

Reprocess heat-sensitive critical and semi-critical instruments by using high-level disinfectants and follow the manufacturer's instructions for correct use.

What Is Instrument Processing?

Instrument processing should not take place in the operatory. A designated central processing area in the office should be used to control and ensure safety. The four main steps include:

1. Receiving, cleaning, and decontamination.

2. Preparation and packaging.

3. Sterilization.

4. Storage.

Train dental healthcare personnel to employ work practices that prevent contamination of clean areas and maintain a unidirectional flow of "dirty-to-clean" zones.

How to Handle and Transport Contaminated Patient Care Items?

Use appropriate covered puncture-resistant containers to transport instruments from the clinical area to the processing area. Use heavy-duty utility gloves in addition to other appropriate PPE while handling contaminated patient care items.

How Are the Instruments Sterilized and Liquid Wastes Managed?

1) The most commonly used method of sterilization of instruments in the dental or medical operatory is,

• The steam autoclave (121-134 degrees Celsius at a pressure of 115 kpa for 13-30 minutes-steam sterilization).
• The oven-type autoclave (160C/320 F temperature for 60-120 minutes that operates on the principle of dry heat sterilization).

2) The water used for the autoclave should be clean and as per safety standards (for both the dental chair and the instrument processing, drinking water would be preferred).

3) Water and air should be discharged from devices for 20-30 seconds after the patient leaves from the dental operatory, like from the scalers, handpieces, and three-way syringe as it would have been in contact directly or indirectly in proximity to the patient's mouth.

4) In order to help guard against post-surgical infections, sterile water or sterile saline only can be used during the patient's surgery as the sterility prevents microbial entry from either the dental operatory or the instrument into the patient's blood, bone tissue or skin surface.

5) Sodium hypochlorite should never be used to clean dental water lines.

6) If you suspect increasing bacterial count or contamination in the water quality after prolonged use of a dental chair unit and waterline using a self-contained test kit, water quality can be assessed by the dental operator. If not, the commercial water testing laboratories can be contacted for a quality check.

How Is Medical Waste Managed?

1) Any solid waste generated by a medical waste facility is defined as biomedical or biohazard medical waste. Though this waste disposal is the final step to adhere to by the dental operator in his operatory, it holds pivotal importance to minimize the risk of cross-infection to the environment and patients visiting the dental office.

2) Wear gloves or appropriate PPE while disposing of medical waste. The dental or medical personnel and staff should be instructed accordingly to maintain strict infection control by minimizing skin contact with disposable waste.

3) Color-coded containers should be used for sharps disposal. The sharps need to be disposed of in an appropriate medical container.

4) Medical and dental wastes need to be collected at the dental office and disposed of by regulated local waste management bodies.

Conclusion:

To conclude, the infection control that may potentially spread from the operator to the patient or vice versa in the healthcare setting or medical or dental practice can be not only well controlled by the dental or medical operator by following the safety guidelines and sterilization, disinfection protocols, hand washing, and disposal methods- but also be crucial in stopping the chain of infection or the microbial contamination spread.