1
Kolářová M., EPI Autumn 2016
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Guidelines for Infection Control
in Dental Health-Care Settings
CDC. MMWR 2003;52(No. RR-17)
http://www.cdc.gov/oralhealth/
infectioncontrol/guidelines/index.htm
Background
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 Personnel Health Elements
 Bloodborne Pathogens
 Hand Hygiene
 Personal Protective Equipment
 Latex Hypersensitivity/Contact Dermatitis
 Sterilization and Disinfection
 Environmental Infection Control
 Dental Unit Waterlines
 Special Considerations
 Program Evaluation
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 Both patients and dental health care personnel
(DHCP) can be exposed to pathogens
 Contact with blood, oral and respiratory
secretions, and contaminated equipment occurs
 Proper procedures can prevent transmission of
infections among patients and DHCP
Why Is Infection Control Important in Dentistry?
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Modes of Transmission
 Direct contact with blood or body fluids
 Indirect contact with a contaminated
instrument or surface
 Contact of mucosa of the eyes, nose, or
mouth with droplets or spatter
 Inhalation of airborne microorganisms
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Chain of Infection
Pathogen
Source
ModeEntry
Susceptible Host
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Chain of Infection
Causative agent - bacteria, viruses,
fungi, parasites, priony
Source of infection
The ende incubation period,, illness
carriers
Mode of transmission
-direct
-indirect
Susceptible
host Infection
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Chain of Infection in Hospital Conditions
Source
of Infection
The Transmission Susceptibility
pacient pacient
pacient Health worker
Health worker pacient
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EPIDEMIC PROCESS IN THE HOSPITAL ENVIRONMENT
SOURCES
OF INFECTION
MODE
OF TRANSMISSION
trough
biological material
of patients
or contaminated surfaces
or equipments
SUSCEPTIBLE
HOST
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Biological materials – their infectivity
1. Causative agens in blood, derivates from blood, plasma
VHB, VHC, VHA (short in the blood), HIV, CMV, rarely EBV,
virus of morbilli (viremie), kandidy-kandidémie,
malárie - (plasmodia can survive in fresh plasma 3 – 5oC - 14
days),
Toxoplasma gondii - (can survive in blood - 56 days)
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Concentration of HBV in Body Fluids
High Moderate Low/NotDetectable
Blood Semen Urine
Serum Vaginal Fluid Feces
Wound exudates Saliva Sweat
Tears
Breast Milk
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Source: Cleveland et al., JADA 1996;127:1385-90.
Personal communication ADA, Chakwan Siew, PhD, 2005.
PercentHBV Infection Among U.S. Dentists
Year
0
2
4
6
8
10
12
14
16
1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
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Transmission of HBV from Infected DHCP to Patients
 Nine clusters of transmission from dentists and oral
surgeons to patients, 1970–1987
 Eight dentists tested for HBeAg were positive
 Lack of documented transmissions since 1987 may
reflect increased use of gloves and vaccine
 One case of patient-to-patient transmission, 2003
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Occupational Risk of HCV Transmission among HCP
 Inefficiently transmitted by occupational
exposures
 Three reports of transmission from blood
splash to the eye
 Report of simultaneous transmission of HIV
and HCV after non-intact skin exposure
HCV Infection in Dental Health Care Settings
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 Prevalence of HCV infection among
dentists similar to that of general
population (~ 1%-2%)
 No reports of HCV transmission from
infected DHCP to patients or from
patient to patient
 Risk of HCV transmission appears very
low
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Transmission of HIV from Infected Dentists to Patients
 Only one documented case of HIV
transmission from an infected dentist to
patients
 No transmissions documented in the
investigation of 63 HIV-infected HCP
(including 33 dentists or dental students)
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Characteristics of Percutaneous Injuries Among DHCP
 Reported frequency among general dentists has
declined
 Caused by burs, syringe needles, other sharps
 Occur outside the patient’s mouth
 Involve small amounts of blood
 Among oral surgeons, occur more frequently during
fracture reductions and procedures involving wire
Hand Hygiene
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 Hands are the most common mode of
pathogen transmission
 Reduce spread of antimicrobial resistance
 Prevent health care-associated infections
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Hands Need to be Cleaned When
 Visibly dirty
 After touching contaminated
objects with bare hands
 Before and after patient treatment
(before glove placement and
after glove removal)
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Hand Hygiene Definitions
 Handwashing
Washing hands with plain soap and water
 Antiseptic handwash
Washing hands with water and soap or other
detergents containing an antiseptic agent
 Alcohol-based handrub
Rubbing hands with an alcohol-containing preparation
 Surgical antisepsis
Handwashing with an antiseptic soap or an alcoholbased
handrub before operations by surgical personnel
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Efficacy of Hand Hygiene Preparations
in Reduction of Bacteria
Good Better Best
Plain Soap Antimicrobial
soap
Alcohol-based
handrub
Source: http://www.cdc.gov/handhygiene/materials.htm
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Alcohol-based Preparations
Benefits Limitations
 Rapid and effective
antimicrobial action
 Improved skin
condition
 More accessible
than sinks
 Cannot be used if
hands are visibly
soiled
 Store away from
high temperatures or
flames
 Hand softeners and
glove powders may
“build-up”
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Special Hand Hygiene Considerations
 Use hand lotions to prevent skin dryness
 Consider compatibility of hand care products with
gloves (e.g., mineral oils and petroleum bases may
cause early glove failure)
 Keep fingernails short
 Avoid artificial nails
 Avoid hand jewelry that may tear gloves
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Personal Protective Equipment
Masks, Protective Eyewear, Face Shields
 Wear a surgical mask and either eye protection with
solid side shields or a face shield to protect mucous
membranes of the eyes, nose, and mouth
 Change masks between patients
 Clean reusable face protection between patients;
if visibly soiled, clean and disinfect
Sterilization and Disinfection of Patient Care Items
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Critical Instruments
 Penetrate mucous membranes or contact bone, the
bloodstream, or other normally sterile tissues (of
the mouth)
 Heat sterilize between uses or use sterile singleuse,
disposable devices
 Examples include surgical instruments, scalpel
blades, periodontal scalers, and surgical dental
burs
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Semi-critical Instruments
 Contact mucous membranes but do not
penetrate soft tissue
 Heat sterilize or high-level disinfect
 Examples: Dental mouth mirrors, amalgam
condensers, and dental handpieces
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Noncritical Instruments and Devices
 Contact intact skin
 Clean and disinfect using a low to
intermediate level disinfectant
 Examples: X-ray heads, facebows, pulse
oximeter, blood pressure cuff
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Instrument Processing Area
 Use a designated processing area to control
quality and ensure safety
 Divide processing area into work areas
 Receiving, cleaning, and decontamination
 Preparation and packaging
 Sterilization
 Storage
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Biological materials – their infectivity
2. Causative agens in droplets
Adenovirus, coronaviruses, enteroviruses, herpes virus,
myxovirus (influenzae), paramyxovirus, RSV, rhinovirus,
Stafylococcus, Streptococcus spp., Meningococcus spp.,
Haemophilus Influenzae, Neisseria meningitis, Bordetella
pertussis, Bordetella parapertussis, Mycoplasma pneumoniae,
Pneumocystis carinii, Kandidy….
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Biological materials – their infectivity
3. Causative agents in stool
Enteroviry (VHA, poliomyelitis), VHE, coxsackie viry,
Adenoviry,
Enterobactericeae (E.coli, Klebsiella pneumoniae,
Pseudomonas aeruginosa, Proteus spp., Citrobacter,
Enterobacter, Serratia apod)
Listeria monocytogenes, Clostridium perfringens, Clostridium
tetani, Pneumocystis carinii
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Biological materials – their infectivity
Causative agens in:
4. URINE
Virus of measles, parotitis, CMV, VHB, papovavirus, Listeria
monocytogenes, Candidae
5. LIQUOR
HIV, different causative agents of meningitid
6. Salive
VHB, HIV, CMV, EBV, herpes virus hominis typ 1,2, virus
of measles, rubellla
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Biological materials – their infectivity
7. TEARS, EYE - SECRET
VHB, HIV, adenoviruses, Enterovirus typ 70, Coxsackie A 24,
Staphylococcus aureus, hemophfilus, pneumokoky, moraxely,
chlamydie
8. VAGINA AND CERVIX - SECRET
HIV, VHB, rare VHC, herpes virus hominis typ 1,2,
Streptococcus agalactiae, Neisseria gonorrhoea, Haemophilus
Ducreyi, Treponema pallidum, Trichomonas vaginalis,
Chlamydia lymfogranulomatosis, Chlamydia trachomatis
9. EJACULAT
VHB, HIV, rare VHC, CMV,
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Chain of Infection in Hospital Conditions
SOURCE
OF INFECTION
MODE
OF TRANSMISSION
SUSCEPTIBLE
ORGANISM
HANDWASHING, DISINFECTION OF HANDS
LINEN WASING,
CLEANING
……..,
………
DISINFECTION
STERILIZATION
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PACIENT
LINEN WASHING,
………..,
DISINFECTION,
STERILIZATION
Wastes
A) Tools for one use
B) Reuseable tools
Standard Precautions
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Apply to all patients
Integrate and expand Universal
Precautions to include organisms spread
by blood and also
Body fluids, secretions, and excretions
except sweat, whether or not they contain
blood
Non-intact (broken) skin
Mucous membranes
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Elements of Standard Precautions
 Handwashing
 Use of gloves, masks, eye protection,
and gowns
 Patient care equipment
 Environmental surfaces
 Injury prevention
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Personnel Health Elements of an
Infection Control Program
 Education and training
 Immunizations
 Exposure prevention and postexposure
management
 Medical condition management and workrelated
illnesses and restrictions
 Health record maintenance