Infection Control in Dental Radiology

Dr. Raghunath Puttaiah & Dr. Hui Liang

Introduction & Rationale

Most oral and maxillofacial radiology normally consists of non-invasive procedures Although exposure to blood is not common, contact with saliva does occur

What are the risks??

Common viruses seen in the oral cavity include
cytomegalovirus, herpes simplex viruses-1 & 2, hepatitis-B and D viruses, hepatitis-C virus, influenza viruses, Epstein-Barr virus (infectious mononucleosis), Rhinoviruses (common cold), and HIV

Common bacterial pathogens seen are

Pseudomonas, Flavobacterium, Staphylococci, Streptococci, Diplococci, Pneumococci, Mycobacterium, Chlamydia, and Spirochetes from human or inanimate sources

Candidiasis is also very common among dental patients

Rationale
Most of Oral and Maxillofacial radiology (OMR) procedures fall mainly in the semicritical and non-critical categories of Spaulding's Classification of inanimate surfaces BUT Many contagious diseases such as Infectious mononucleosis and hepatitis-B can possibly be spread by simple contact with saliva Therefore, it is necessary for aseptic techniques to reduce ambiguity within protocols The purpose of this module is to present the most recent information regarding aseptic techniques in OMR.

What PPE is needed

It is not usually necessary to wear PPE such as impervious gowns, long sleeves, masks and protective eyewear during routine OMR procedures when no aerosols, droplets or spatter are generated One may use gloves, gowns, masks and protective eyewear while treating patients with gagging problems While handling the processor and the chemicals, use full PPE Stay out of the Radiation Hazard area (behind a shield) Patients must be protected with a lead apron

Disinfectants and Barriers

Barriered films should be used when available Between patients, frequently touched areas must be

Barriered with plastic barriers OR -Disinfected with an Intermediate level, Hospital Disinfectant using a Spray-Wipe-Spray technique

If barriers are used between patients, disinfection is only needed at the beginning or end of the day

Steps in Infection Control

Unit Dose 1. Pre-procedural mouthrinse for patients Make them rinse for about 30 seconds to reduce the microbes in the mouth 2. PPEGloves Masks Eyewear Gown

Steps in Infection Control

Prepackaged films with plastic barriers

Unbarriered films

Barriered Films

Steps in Infection Control Steps in Infection Control

1. Unit dose supplies and sterile equipment on to a clean bib/work surface 2. Set up the films on to the positioning devices 3. Label cups as Exposed and Unexposed

Use of Disinfectants and Barriers

Disinfect surfaces at the beginning and end of each day, and between patients only if contaminated Avoid spraying electrical switches, wipe with disinfectant moistened paper towel Apply surface covers to the yoke, tube head, cone, control unit, head rest, arm rest, and any hand held switches

Aseptic Procedures
Place the sanitized lead apron and collar on the patient after seating the patient Set the required mA, kVp and exposure time on the control unit and reset as required Use Foot Controlled Trigger Switch if possible

Now Please expose the Radiograph

The whole purpose in dental radiology is to Get the radiograph

Inside a daylight loader

Place the cup with exposed films on one side and the Empty one on the other Place a clean bib or napkin as a barrier Dispense a pair of gloves

Daylight Loader with Films Inside

Be sure to close the lid before exposing the films

Donning Gloves inside the Loader

Various layers inside the polysoft film cover

Polysoft cover

Radio-opaque metal foil on the rear of the film Paper folder that secures the film

Film

Processing Barriered Films Barriered Films

Exposed film

Wear gloves Peel the outer cover and drop the film into the Exposed cup This should be done chairside

Step 1

Step 2

Step 3

Step 4

Bare hands with barriered film inside a daylight loader

Bare hands to be used to handle exposed and peeled film

Unbarriered Films

Step 1

Step 2

Step 3

Step 4

Now try this inside a daylight loader

Bare hands to be used to handle exposed and peeled film

Remove your gloves and then handle the film that has been taken out of the Polysoft cover

Clean up after loading films

Carefully hold the edge of the napkin or bib and fold it over the waste You need not wear gloves if you hold the non-contaminated corners

Disinfect the Daylight Loader once or twice daily if barriers are used

Panoramic Radiography
In panoramic radiography, infection control procedures are very simple Patient needs to have a lead apron No contact of film with saliva Only one barrier is needed

Panoramic Radiography
Bite block Barriered positioning device

Chin rest

Panoramic Radiography
Infection Control in Panoramic radiography is very simple All one needs is a barrier for the bite block Make sure the lead apron is on Film loaded on to the cassette Stay outside of the active radiation area

Panoramic Radiography

This film does not come in contact with saliva

Panoramic Radiography

Position the patient correctly

Panoramic Radiography

Make the patient remove the barrier on the bite block

Digital Radiography

Digital Radiography
Sensor being inserted into barrier Sensor

Sensor Barriered

Barrier or sleeve

Digital Radiography

1. Insert the barriered sensor in the film holder on the Rinn holder

Digital Radiography

Slide this door open

Digital Radiography

Peel open the barrier without touching the sensor

Digital Radiography

Slide the sensor into the chamber for the computer to read the image

Digital Radiography

Digital Radiography

Image appears on the screen within seconds