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INTRODUCTION

Infectious diseases can be transmitted from one person to another. Dentist & dental staff can be exposed to serious infectious disease on daily basis. The dentist has the responsibility to thoroughly understand disease transmission & prevent cross infection.

SOURCES OF INFECTION

Hands Saliva Nasal secretions Blood Instruments & Equipments etc.

Sterilization is a physical or chemical process that completely destroys or remove microorganisms and all their forms (spores)
OBJECTIVES OF STERILIZATION:To provide the highest standard of care. To minimize the risk of infections. To provide a supportive, informal, relaxed & non-threating operatory environment to the pt.

STERILIZATION

METHODS OF STERILIZATION
PHYSICAL
Dry Heat Radiation Filtration Moist Antiseptics Disinfectants Ethylene oxide gas

CHEMICAL

Heat sterilization
DRY HEAT

Prolonged dry heat

Intense dry heat

PROLONGED DRY HEAT:

It kills microorganism by an oxidation process of cell proteins, a process requiring very high temperature.
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PROLONGED DRY HEAT (CONT.) It is very slow to penetrate instrument loads A margin of safety requires instruments to be sterilized at 160C for 2hrs.
GUIDE-LINES FOR DRY HEAT:-

Temperature 121C 140C 150C 160C 170C

Duration of exposure 6-12hrs 3hrs 2-1/2hrs 2hr 1hr

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PROLONGED DRY HEAT: (CONT) Instrument cases must not be upon one another. The hot air must be allowed to circulate freely within the sterilizer. Ovens are manufactured for dental & medical use. ADVANTAGES: Large volume capacity. Low cost equipment. No rusting or dulling of instruments. Sterilization is verifiable.

DISADVANTAGES: Slow instrument turn around because of poor heat exchange. Potential damage to heat-sensitive instruments. INTENSE DRY HEAT: (GLASS BEAD STERILIZATION): Chair side sterilization of endo files can be accomplished by using this type of sterilization. This device is a metal crucible that heats a transfer medium of glass beads.

GLASS BEAD STERILIZATION(CONT): Process: Clean endo instruments of small mass are kept in transfer medium at temperature of 220C for 15secs. Transfer medium heats the endo instruments through heat convection & kills any adherent microorganism. ADVANTAGES: Small size & convenience of sterilizer.

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Serves as emergency back up to other methods of sterilization. DISADVANTAGES: Only instrument of small size can be sterilized. Only a few instruments can be sterilized at a time. It is non-verifiable.

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MOIST HEAT

It kills microorganism denaturation of protein, RNA or DNA breakdown. It is more efficient than dry heat because it is effective at much lower temperatures & requires less time as water is better than air at transferring heat. The method could be used at different temperatures Temperature below 100iC Temperature at 100iC Temperature above 100iC

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TEMPERATURE BELOW 100C

Pasteurization: Pasteur used heat to reduce the no. of pathogens in liquid for preservation. For e.g. Milk is pasteurized by being held in water at 63C for 30 mins and cooled suddenly. Tyndallization: heating at 56C for 60 mins for three successive days is known as tyndallyzation.

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TEMPERATURE AT 100C Boiling: at 100C for 5 mins Steam at 100C: this is done in a steamer
TEMPERATURE ABOVE 100C

Autoclave sterilization:
In this, sterilization takes place by the use of steam under pressure.

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AUTOCLAVE STERILIZATION

When steam comes in contact with an object, it condenses & almost instantly releases that stored heat energy, which quickly denatures vital cell proteins. It takes place in 15-30min at 121C at the pressure of 15lbs/sq.i Saturated steam is much more efficient than either dry heat or boil water.

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GUIDE-LINES FOR DRY HEAT:Duration of exposure 60min 36min 24min 16min 4min 1-1/2min

Temperature 116C 118C 121C 125C 132C 138C

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Time required depend on type of load placed & its permeability. Instruments placed in autoclave must be properly arranged. Non stainless steel metal may oxidize unless protected by a reducing agent prior to packaging or autoclaving. 1-2% sodium nitrite is an effective rust inhibitor.

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ADVANTAGES: Relatively quick turnaround time . Excellent penetration of packages Will not destroy cotton or cloth product. Verifiable. DISADVANTAGES: Material must be air dried at completion of cycle. Corrosion or dulling of certain material as carbon steel. Cost.

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RADIATION Ultra violet rays inhibits DNA replication Used for disinfecting surfaces, sterilization of atmospheric air e.g. operation theatres. Ionizing radiations: X-Rays, Particle radiations. These produces free radicals, which break the covalent bond of DNA and thus kill organisms.

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FILTRATION

This is used for sterilizing solutions that contains sera or amino acids that would be denatured by heating and water Types of filters are cellulose membrane, earthenware candles, asbestos, sintered glass

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CHEMICAL METHOD

Disinfection

Ethylene oxide gas

Antiseptic

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DISINFECTION

A process of destroying pathogenic organisms or rendering them inert.

Less lethal than sterilization as it does not necessarily kill all microbial forms, hence lacks the margin of safety. Is reserved for large environmental surfaces that cannot be sterilized. Or where instruments cant withstand heat.

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DISINFECTANTS: Glutaraldehyde 2% Isopropyl Alcohol 70% Formaldehyde 3% Sodium Hypochlorite Iodophores 1% Iodine O-phenylphenol 9% & O-benzyl-p-chlorophenol 1% Quartenary ammonium compounds.

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GLUTERALDEHYDE:Most commonly used. Action: Kills microorganism by altering protein components. Useful as immersion sol. for instruments like contaminated with blood, saliva etc Can be used in small containers specifically designed to hold dental instruments. Sol. Should be discarded once a week.

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USES: Used for wiping down of large surfaces such as dental unit etc Heat sensitive plastics, rubbers, fibre optics, hand piece can be safely sterilized. Available in 3 forms:
GLUTERALDEHYDE 2% ACIDIC GLUTERALDEHYDE 2% ALKALINE

GLUTERALDEHYDE 2% NEUTRAL

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GLUTERALDEHYDE 2% ACIDIC Brand name: sterall, wavicide Exposure time: 10min Temperature: 25C Disinfectant level: high, intermediate Less effective sporocide. corrosive. Irritating to eyes, nose & skin.

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GLUTERALDEHYDE 2% ALKALINE: Brand name: Cidex, Omnicide Exposure time: 10min Temperature: room temp Disinfectant level: high Irritating to nose & skin. GLUTERALDEHYDE 2% NEUTRAL: Brand name: Glutarex Exposure time: 10min Temperature: room temp Disinfectant level: high Irritating to eyes, nose & skin.
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ADVANTAGES: Can sterile heat sensitive equipments. Is relatively non-corrosive & non toxic. DISADVANTAGES: Has some odor. Non-verifiable Irritating to mucous membrane.

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IODOPHORES-1% iodine: Is a combination of iodine & solubilizing agent. Releases small amount of iodine when diluted with water. Used to wipe off surfaces, plastics, hand piece, other instruments like mirror,etc Brand name: isodine, betadine Exposure time: 10min Temperature: room temp Disinfectant level: intermediate to high
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ADVANTAGES: Effective & less irritating. Less corrosive to metal. DISADVANTAGES: Inactivated by heat. Contraindicated in iodine sensitive pt. Stains plastics.

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SODIUM HYPOCHLORITE: Brand name: House hold bleach Exposure time: 10-30min Disinfectant level: high, intermediate Action: The free chlorine in sol. Inactivate enzymes & nucleic acid & denatures protein. Uses: In a dilute solution can be used to wipe down large environmental surfaces, instruments. Also used to disinfect GP points in 5.25% conc. for 1min.
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DISADVANTAGES: Corrosive to metal. Irritable to eyes, skin. Has strong odor. ISOPROPYL ALCOHOL: Although it is a good cleaning agent, it is not suitable as it evaporates too rapidly. However can be used to disinfect L.A cartridges. QUARTENARY AMMONIUM COMPOUND:

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ETHYLENE OXIDE GAS ( GASEOUS STERILIZATION) : Most gentle method for sterilizing complex instrument & delicate material. Highly flammable mixed with CO2 or N2. Readily diffusable through porous material such as plastic & rubber. Kills microorganism by chemically reacting with nucleic acid. Temperature: 50C Time: kill all including spores within 3 hrs.

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ADVANTAGES: Effective at low temperature. Excellent penetration. Can be used for heat sensitive instruments like hand piece. DISADVANTAGES: More time required to complete each cycle. Requires aeration for 24 hrs or more before it is safe to use. Cost.

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ANTISEPTICS

Agent that prevent the growth or action of microorganism on living tissue.

Applied to the surface of body, open wounds or abraded tissue surfaces or mucous membrane. Used to prep the hands before gloves are donned EXAMPLES Volatile: alcohol, chloroform Phenols: Lysol, dettol Metallic salts: mercuric chloride Detergents: soap Iodophores , chlorhexidine etc
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THE HANDS: Major route of transmission of oral microorganism Nails should be kept short All rings & bracelets be removed prior to pt contact Hands should be cleaned with anti-septic soap. Gloves must be worn. Poly ethylene over gloves should also be be used when talking on phone or

PRACTICAL ASEPSIS

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FACIAL PROTECTION: It includes Protective eye wear Face mask HAIR CLOTHING

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MERCURY TOXICITY It can produce a toxic effect if sufficient amount is absorbed through lungs, skin or GIT.
PREVENTIVE MEASURES REQUIRED IN DENTAL OFFICE:

It should be kept in unbreakable tightly sealed container. Spills & leaks should be cleaned immediately Wear mask as aerosol produced durind cutting procedure involving Hg contains Hg vapours Apply rubber dam to reduce

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OPERATORY ASEPSIS

It can be achieved in two ways: First is to wipe off floors, flat surfaces. Second to cover surfaces with protective shields. COVERINGS: Most useful & simple are paper, plastic & foil A new cover is used for each patient.

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APPLICATION OF COVERINGS

Head rest, high velocity vaccum: plastic bag Switches, controls: plastic or small pieces of foil Triplex syringe: narrow plastic bag or use disposable one Light handles of unit: sterile plastic sleeves Light switch: short length of soda straw Light cure device: plastic wrapper around the tip, handle & control trigger X-ray cone & head: plastic wrap or paper secured with tape.
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