sterilization of dental instruments

1. Presented By:
Sushant Kumar Swatantra

2. Contents:
 Definitions
 Classification of instruments
 Decontamination cycle
 Sterilization and its methods
 Principles of sterilization
 Disinfection and its methods
 Agents used for disinfection
 Personal barrier protection
 Conclusion
 References

3.  Infection
It is the process of invasion of the tissue by organisms
characterized by their multiplication in the body of the
host to produce disease.
 Infection control:
In medical care, institutional procedures and policies
for monitoring and attempting to control the
transmission of communicable diseases.
 This includes establishing mandatory sanitation,
sterilization, hand hygiene, and isolation procedures.
3

4. Why Is Infection Control Important
in Dentistry?
 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

5. 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

6. Standard Precautions
 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

7. Universal precaution Vs Standard precaution
 According to Centers for Disease Control, STANDARD
PRECAUTION is the outgrowth of UNIVERSAL
PRECAUTION (UP). Universal Precaution was first
introduced on 1987 to prevent the spread or the
transmission of blood borne pathogens to the health care
providers. However, on 1996 the concept of standard
precaution was established to expand the course of
universal precaution .
 STANDARD PRECAUTION now constitutes the primary
strategy to prevent the transmission of infectious agents
not only to the health care personnel but also to patients
and hospital visitors.

8.  Cleaning
A process which removes visible contamination, but
does not necessarily destroy microorganisms.
 Asepsis
The methods which prevent contamination of wounds
and other sites, by ensuring that only sterile objects
and fluids come into contact with them, and that the
risks of air-borne contamination is minimized.
 Antisepsis
The prevention of infection, usually by inhibiting the
growth of bacteria in wounds or tissues.

9.  Antiseptics
Chemical disinfectants which can be safely applied to
skin or mucous membrane and are used to prevent
infection by inhibiting the growth of bacteria.
 Decontamination
The process of rendering an article or area free of
danger from contaminant, including microbial,
chemical, radioactive and other hazards.

10.  Disinfection
Process which reduces the number of microorganisms
present, but may not inactivate some viruses and
bacterial spores.
 Sterilization
Process that destroys, eliminates or inactivates (kills)
all forms of microbial life including bacterial
endospores.

11. Depending on the risk of transmitting infection
instruments are classified as:
A. Critical :-(high risk)
 Instrument that come in contact with Critical
surfaces such as Sterile tissue, body cavity,
bloodstream
 instruments that penetrate soft tissue or bone
 Enter sterile body cavity such as endodontic
microsurgical procedures
 Should be sterilized
 Eg. chisel, scalpel, forceps, burs, periodontal scalers

12. B. Semi critical :(medium risk)
 Instruments that come in contact with semi critical
surfaces such as Intact oral mucosa, non-intact skin
contact with the oral tissue/body fluids such as
gingiva, teeth
if sterilization not possible than high level disinfection
Eg.- mouth mirror, explorer and amalgam condensers ,
air water syringe, dental handpieces

13. C. Non Critical :(low risk)
 Instruments or medical devices that comes in contact
with the non critical surfaces such as intact skin.
 Intermediate level or low level disinfection or
detergent and water washing
 E.g. external components of x-ray head, chairs,
supporting equipment of dental unit, stethoscope

14. USE
CLEANING
DISINFECTION
INSPECTIONPACKAGING
STERILISATION
STORAGE
DECONTAMINATION CYCLE
proper
sterilisation relies
on a combination
of processes
which together
form an infection
control system

15. Sterilization and its methods
3 most commonly used methods of sterilization are:
 Steam autoclave
 Dry heat oven (dryclave)
 Unsaturated chemical vapour sterilizer(Chemiclave)
Other methods are:
 Exposure to ethylene oxide gas
 Boiling water
 Ionizing radiation

16. Principles of sterilization
 All instruments should be thoroughly cleaned

17.  Essential is that sterilizing agent should be in contact
with every surface of each item to be sterilized for
specified period of time at the specified temperature.
 All sterilizing equipment should be regularly maintained.
 Manufacturer’s instruction should be strictly adhered
to.

18. Moist/ steam heat sterilization
(Autoclave)
PRINCIPLE:
 Water boils when its vapor pressure equals that of the
surrounding atmosphere
 Hence when pressure inside a closed vessel increases ,
the temperature at which it boils also increases.
 Saturated steam has penetrative power
 When steam comes into contact with a cooler surface, it
condenses into water and gives up its latent heat to that
surface.

19. 1600ml of steam
at 100°C and 1
atmospheric
pressure
1 ml of water at
100°c
Releases 518
calories of heat
• This large reduction in volume sucks in more steam to
the area & the process continues till the temperature of
that surface is raised to that of the steam
• The condensed water ensures moist conditions for
killing the microbes present

20.  Types of autoclave:
1) Downward (gravitation)
displacement sterilizer
2) Steam sterilizer with pre and
post vacuum processes

21. Phases of Sterilization :
1. Pre-treatment phase/heat up cycle: All air is expelled
by a number of pulses(at least 3) of vacuum and
introduction of steam.
2. Sterilizing phase/Sterilization cycle: Temperature is
increased sufficiently at which sterilization is to take
place.
 Actual sterilizing period is called Holding/plateau time,
starts when the temperature in all parts of the
autoclave chamber and its content has reached the
sterilizing temperature.

22. 3. Post treatment phase / depressurisation cycle and
drying cycle: Steam or revaporized condensed
water is removed by vacuum to ensure that the goods
are dried rapidly.
 Time,temperature and pressure for autoclaving are :
Pressure (Psi) Temperature (°C) Time(mins.)
15 121 15
20 126 10
30 134 3

23. Packaging and marking of packs
 Done before sterilizing to prevent instruments from being
contaminated after sterilization till it is opened and used.
 Autoclave packaging should be porous to permit steam to
penetrate and reach the instruments. Eg. Fabric, paper,
muslin cloth pouches, nylon bags etc.
 Packs should have some external indication, showing the
packs have been processed in form of marking.
 Each pack must be labeled with content, date of
sterilization, autoclave number, load number.

24. ADVANTAGES
 Most rapid and effective method of sterilization.
 Provides excellent penetration.
DISADVANTAGES
 Corrosion of carbon steel instruments.
 May damage plastic and rubber items.
 Unprotected cutting edges may become dull.

25. Dry heat sterilization (Dryclave)
It effectively sterilizes instruments at high
temperature above 160°C.
Basic action involves dehydration and oxidation of
microorganism.

26. Achieved by 2 methods:
1) Dry heat oven type sterilizer(static air):
-160 °C for 60-120 mins
2) Dry heat-rapid heat transfer(forced air):
- 6 mins for unwrapped instruments at 190 °C.
-12 mins for wrapped instruments at 190 °C.

27. Advantages:
 Rapid cycles are possible at high temperature.
 Burs &carbon steel instruments do not rust if they
are well dried before sterilization.
 Large load can be placed.
 Low cost of equipment.

28. Disadvantages:
 Heat sensitive items like rubber or plastics may be
damaged.
 At lower temperature ,sterilization cycles are
prolonged.
 Sterilization is ineffective if there is heavy
instrument load and crowding.

29. Unsaturated chemical vapour
sterilizer (Chemiclave)
 This sterilizer is same as autoclave
unlike it uses special chemical
solution containing formaldehyde
and alcohol.
 The chemical vapour kills
microorganisms by destroying vital
protein systems.
STERLIZATION CYCLE FOR CHEMICLAVE:
Temperature (°C) Pressure(Ibs) Time(minutes)
132 20 20

30. Advantages:
 It does not corrode metals.
 Load comes out dry.
Disadvantages
 High cost of equipment.
 Vapour odor may be offensive and requires increased
ventilation.
 The solution supplied by manufacture has to be used.
 Handpieces cannot be sterilized by this method.

31. ETHYLENE OXIDE STERILIZATION
 It is an excellent sterilizer of heat sensitive items as
well as ideal for electric equipment ,flexible fiber
endoscopes and photographic equipment.
 This method uses automatic devices filled with
ethylene oxide gas at temperature below 100˚c to
sterilize complex and delicate materials.
 Ethylene oxide destroys microorganisms by chemically
reacting with nucleic acid.

32. Advantages :
 Most gentle for sensitive equipment like hand pieces.
 Operate effectively at low temperature.
Disadvantages:
 High cost.
 Prolonged time.
 Best for hospitals not practical for dental clinics
 Ethylene oxide gas is potentially mutagenic and
carcinogenic.

33. BOILING WATER
 Boiling water produces temperature of 100̊c at normal
atmospheric pressure which requires 10 mins exposure
to kill bacteria and some viruses.
 When the water starts boiling instruments should be
kept in it and should be fully immersed in it for 20-30
minutes.
 Cutting instruments should not be sterilized by boiling
as they loose their sharpness.

34. IONIZING RADIATION
 It is effective for heat labile items .
 It is commonly used by industry to sterilize disposable
materials such as needles, syringes, swabs, catheters,
suture material, cannulas.
 High energy gamma rays from cobalt 60 are used to
sterilize such article.

35. If autoclave is not available???
 Place all instruments in water immediately after use.
 Remove all debris from the instruments by scrubbing with
brush in soapy water.
 Prepare fire with fuel available.
 Put clean instruments in a pressure cooker and add clean water
in it.
 Place the pressure cooker on the stove and bring it to boil.
 Continue heating the pressure cooker on low heat for a
minimum of 15 minutes.

36.  Ensure that steam continues to be released from pressure
cooker during this time
 Remove pressure cooker from stove after 15 minutes and
leave it to cool.
 Release pressure first before opening the pressure cooker.
 Take instruments out of pressure cooker with instrument
forceps and dry in clean towel.
 Store in a covered box(metal box).

37. DISINFECTION
 Disinfection is a process by which microbes
are removed from an object or surface. This
does not include bacterial endospores. This
process is used to treat articles which do not
penetrate the mucous membrane or skin.

38. Classification of disinfectants
1. Based on consistency
a. Liquid (E.g.Alcohols, Phenols)
b. Gaseous (Formaldehyde vapor, Ethylene oxide)
2. Based on spectrum of activity
a. High level
b. Intermediate level
c. Low level

39. 3. Based on mechanism of action
a) Action on membrane (E.g.Alcohol, detergent)
b) Denaturation of cellular proteins (E.g.Alcohol, Phenol)
c) Oxidation of essential sulphydryl groups of enzymes (E.g.
H2O2, Halogens)
d) Alkylation of amino-, carboxyl- and hydroxyl group
(E.g.Ethylene Oxide, Formaldehyde)
e) Damage to nucleic acids (Ethylene Oxide, Formaldehyde)

40.  The two methods of achieving disinfection are:
thermal and chemical disinfection.
1. Thermal disinfection (pasteurization)
 By using heat and water at temperatures that destroy
pathogenic, vegetative agents
 Level of disinfection depends on the water temperature
and the duration the instrument is exposed to that
temperature

42. 2. Chemical Disinfection
The performance of chemical disinfectants is dependent
on a number of factors including: temperature, contact
time, concentration, pH, presence of organic or inorganic
matter and the numbers and resistance of the initial
bioburden on a surface.
Chemical agents used are:
 Aldehyde (formaldehyde, glutaraldehyde)
 Biguanides (chlorhexidine)
 Halogens (sodium hypochlorite solution)

43. 2% Glutaraldehyde
 Is generally the most appropriate high level
chemical disinfectant.
 Active against most vegetative
bacteria(including M. tuberculosis) and some
viruses including HIV ,fungi and bacterial
spores.
 Can be safely used on metal instruments
(< 24 hrs ), rubber, plastics and porcelain.
 An immersion time of
≥20 min - disinfection
6-10 hours - sterilization
 Must be used under very strict controlled
conditions and in a safe working
environment.

44. Biguanides (Chlorhexidine)
 It is active against bacteria but
not spores, fungi and viruses.
 0.5% chlorhexidine in 70%alcohol
is used

45. Halogens (sodium hypochlorite solution)
 Active against
bacteria,spores,fungi and
viruses including hepatitis
viruses.
 1:10 freshly prepared sodium
hypochlorite solution is an
effective surface
disinfectant.

46. Alcohols
 Antibacterial activity against some Gram -ve, some
Gram +ve bacteria (especially against M. tuberculosis),
not effective against spores, viruses
 It acts by denaturing proteins
 70% alcohol is most effective than high concentration
 Don’t function as disinfectant when simply wiped
(must have minimum of 10 minutes contact)

47. STERILIZATION OF HANDPIECES
 While using hand pieces in patient’s mouth, blood, saliva, tooth
cutting debris and restorative materials may be drawn into its
working portion. Hence it should be properly sterilized between
patient exposure to prevent cross infection.
PROTOCOL FOR STERILIZING HANDPIECES
 Clean the handpiece by wiping visible debris using suitable
disinfectant such as alcohol.
 Run it for minimum of 30 seconds to discharge residual
water and air.

48.  Clean it thoroughly with soap and detergent solution.
 Reattach handpiece to the unit and run dry.
 Lubrication of handpiece should be done before
sterilization using lubricant.
 Finally place the instruments in paper pack and seal it.
 Now handpiece can be sterilized by autoclaving.

49. INSTRUMENT PROCESSING

50. DISINFECTION OF DENTAL CHAIR
It is necessary to disinfect the dental chair between
appointments to prevent cross contamination.
The chair is prepared as follows:
 Pull a large clear plastic cover over dental control unit
from front and tuck excess up under the unit.
 Pull another bag down over the chair back which also
cover chair arm.
 Install suction and air/water syringe tips.Place a slender
bag over each tip pushing the tip through the end of bag
and then sliding the bag to cover all the handle.For
suction tip wrap autoclave tape at tip/bag junction to
secure the bag against creeping and to prevent
contamination of handle area.

51.  Install sterilized handpiece .A plastic sleeve may be
used to cover the motor end of handpiece.
 After completing one appointment remove all the
plastic cover and area where previously not covered
should be wiped with towel wetted with disinfectant.
 Wash the sink with water and disinfectant spray.

52. DISINFECTION OF ENVIROMENTAL
SURFACE OF DENTAL CLINIC
 Environmental surfaces such as floors, doors carry a
lower risk of disease transmission than the
instruments and devices that come into direct contact
with patients.
 The surfaces should be sprayed, or they should be
wiped with disinfectant-soaked towel to remove
debris.

53. Categories of Environmental Surfaces
1.Clinical contact surfaces
 High potential for direct contamination from spray or
spatter or by contact with DHCP’s gloved hand
 Risk of transmitting infections greater
 Surface barriers can be used and changed between
patients
 Clean then disinfect using an EPA-registered low-
(HIV/HBV claim) to intermediate-level (tuberculocidal
claim) hospital disinfectant

54. Clinical Contact Surfaces

55. 2. Housekeeping surfaces
• Do not come into contact with patients or devices.
• Limited risk of disease transmission.
• Routinely clean with soap and water or an EPA-registered
detergent/hospital disinfectant.
• Clean mops and cloths and allow to dry thoroughly before
re-using.
• Prepare fresh cleaning and disinfecting solutions daily
and per manufacturer recommendations.

56. Housekeeping Surfaces

57. DISINFECTION OF RADIOGRAPHIC
SECTION IN DENTAL CLINIC
 The tube head of X-ray machine, X-ray buttons should
be covered with plastic bags.
 The operator hand should be gloved before taking the
radiograph.
 Before processing the exposed film it should be
washed under running water to remove saliva or blood.
 Disinfect the lead apron with disinfectant spray.

58. WATER BIOFLIM
 The interior of small-diameter tubing in dental unit
waterlines are sites of biofilm formation.
 Water becomes stagnant when the units are not in use.
 Flush water lines at the beginning of the day for 30
seconds.
 Flushing for several minutes between patients for 20-30
second however, may be valuable in removing contaminants
that can enter the water system during patient
treatment.

59.  In general, disinfectants are allowed to remain in the
lines overnight, and are then flushed from the lines the
next morning. If bleach is used, it should be left in the
tubing for a short time only, and the system should then
be rinsed with copious amounts of water and left to dry
overnight.
Disinfectant for dental unit waterlines include hydrogen
peroxide, chlorhexidine gluconate, and iodophors.

60. DISINFECTION OF IMPRESSION
 Alginate-immersion in iodophors or 0.5%hypochlorite.
 Poly sulfide-immersion in gluteraldehyde, iodophor,
0.5%hypochlorite or phenolic solution.
 Silicone-immersion in any disinfectant.
 Polyether-sprays and wrap in iodophors ,0.5%hypochlorite.
 Hydrocolloid-immerse in iodophor ,0.5%hypoochlorite.
 Impression compound-immerse in iodophor, 0.5%
hypochlorite.

61. Categories of task in relation to risk
Category I
 Tasks involving exposure to blood, body fluids and
tissues
 Most tasks performed by the dentist, dental
hygienist, dental assistant and laboratory technician
falls in this category

62. Category II
 Tasks that do not involve routine exposure to blood,
body fluids or tissues
 Clerical or non-professional workers who may help to
clean up the office, handle instruments or impression
materials or send dental instruments to laboratory
fall in this category

63. Category III
 Tasks that involve no exposure to blood, body fluids or
tissues
 Front office receptionist, book-keeper or insurance clerk
who doesn’t handle dental instruments and materials
 The American Dental Association(ADA) and
Occupational Safety and Health Act(OSHA)
guidelines advise that all dental office staff in
category I and II be trained in infection control
to protect themselves and their patients.

64. OSHA regulation
 Occupational safety and health administration(OSHA) is
federal agency that establishes regulation to protect
employees from unsafe working condition.
They are:
 Employers must provide HBV immunization to employees
without charge within 10 days of employment.
 Employers must require that standard precaution to be
observed to prevent contact with blood and other
potentially infectious materials.

65.  Employers must implement engineering controls to
reduce production of contaminated spatter, mists and
aerosols.
 Employers must implement work practice control
precautions to mimimize splashing, spatter, or contact
of bare hands with contaminated surfaces.
 Employers must provide facilities and instruction for
washing hands after removing gloves.
 Employers must prescribe safe handling of needle or
other sharp items.

66.  Employers must prescribe disposal of single use needles,
wires, carpules and sharps as close to the place of use as
possible, as soon as feasible, in hard walled, leak-proof
containers that are closable, from which needles cannot be
easily spilled.
 Contaminated reusable sharp instruments must not be
stored or processed in manner that requires employees to
reach hands into containers to retrieve them.
 Employers must prohibit eating, drinking, handling contact
lenses and application of facial cosmetics in contaminated
environments, such as operatories and clean up areas.

67.  Blood and contaminated specimens to be shipped,
transported or stored should be placed in suitable closed
containers that prevent leakage.
 Employers must provide a written schedule for cleaning
and decontaminating equipment, work surfaces and
contaminated floors.
 Place reusable contaminated sharp instruments into a
basket in hard walled container for transportation to
clean up areas.
 Employers must provide laundering of protective
garments used for universal precautions at no cost to
employers.

68. Personnel Health Elements of an Infection
Control Program
 Education and training
 Immunizations
 Exposure prevention and post-exposure management
 Medical condition management and work-related
illnesses and restrictions
 Health record maintenance

69. Personal barrier protection in the community
Gloves
 Medical gloves(latex or vinyl)
must always be worn when there
is potential for contacting blood,
blood contaminated saliva or
mucous membrane
 Nonsterile gloves for examination
and nonsurgical procedures and
sterile gloves for surgical
purposes

70.  Must not be washed or used for more than one patient
 Washing of gloves may cause wicking effect
 Disinfecting agents, oils, certain oil-based lotions and heat
treatment may cause deterioration of gloves
 While cleaning and sorting used instruments, puncture
resistant utility gloves should be worn which can be washed
inside out, disinfected or steam autoclaved as needed

71.  In 1997, the National Institute for Occupational Safety
and Health(NIOSH) issued an alert on preventing
allergic reactions to natural rubber latex in the
workplace.
 NIOSH recommends the selection of products and work
practices that reduces risk for allergies.
 FDA has issued latex labeling requirements for all items
made from or containing natural rubber latex.

72.  While the Center for Disease Control recommends using
a new pair of gloves in the medical field for every use,
some situations such as a shortage of gloves or an
emergency may require multiple uses of gloves.
 In this case, it is imperative that gloves are
appropriately disinfected using a specific procedure to
avoid passing along germs, pathogens, infections or even
diseases.

73. Instructions:
 Grab the cuff of one of the gloves to turn inside out
and pull halfway off of the hand. Pull the other glove at
the cuff to turn inside out and pull halfway off the
hand.
 When both gloves are halfway off the hands, pull both
gloves off from the inside at the same time. Never
touch the outer portion of the gloves with your skin.
 Soak the gloves in 0.5 percent chlorine solution for at
least 10 minutes.

74.  Wash gloves in soapy water inside and out and rinse fully.
Test for holes or tears by placing the gloves under water.
If any air bubbles appear, throw the gloves away
immediately. If no air bubbles appear, let the gloves air
dry.
 Turn the cuffs of the gloves inside out a few inches and
place five to fifteen pairs of gloves onto each steamer pan
and cover with the lid.
 Steam the gloves for 20 minutes at a rolling boil.
 Air dry the gloves in the steamer pan for four to six hours
before use and remove with forceps into a disinfected
container with a lid.

75. Instructions for handwashing
 At the beginning of a routine treatment
period, remove watches, jewelry and rings
then wash hands with suitable cleanser
 Hands should be lathered for at least 10
seconds rubbing all surfaces and rinsed
 Washing should be repeated at least once
to remove all soil

76.  Even good quality surgical gloves develop minor pinholes or
leaks during vigorous use.
 Washing minimizes infection risks secondary to leakage.
 Hand cleansers containing mild antiseptic like 3%
parachlorometaxylenol (PCMX) or chlorhexidine are
preferred to control transient pathogens and to suppress
overgrowth of skin bacteria.
 Alcohol rubs are also effective against pathogens with less
drying effect.

77.  CDC recommends the Dental Health Care
Worker(DHCW) who have exudative lesions or weeping
dermatitis particularly on the hands, should refrain
from all direct patient care and from handling dental
patient care equipment until the condition resolves.

78. 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)

80.  When water and soap are not available,
 Using hand sanitizer is a good substitute, but it's best
when you really know how to use it properly.
Composition of hand sanitizer
Active ingredient:
Isopropanol, ethanol, n-propanol or
Povidone iodine.
Inactive ingredient:
Poly-acrylic acid as thikening agent
Humectants like glycerin or propylene
glycol
Essential oil of plants

81.  Here are some easy steps to follow to make sure that
you do it correctly:
Step 1
 Squirt the hand sanitizer into the palm of your hand.

82. Step 2
 Start rubbing your hands
together gently. Be sure to get
every spot and not miss any
part. Get in between fingers,
under rings and under jewelry.
Rub hand sanitizer thoroughly
on hands and about two inches
up your wrist. Hold hands
downward to avoid
contamination on the upper
part of your arms.

83. Step 3
 Finish. Don't dry your hands on a towel; it will be better
to let them air dry.

84. How to make your own hand sanitizer?
 2/3 cup 99% rubbing alcohol (isopropyl alcohol) or ethanol
 1/3 cup aloe vera gel
 8-10 drops essential oil, optional (such as lavendar,
vanilla, peppermint, grapefruit)
 bowl and spoon
 funnel
 recycled liquid soap or hand sanitizer bottle
Simply mix the ingredients together and then use the
funnel to pour them into the bottle. Screw the pump back
onto the bottle and it can be used.

85. Protective eyewear, masks and hair
protection
 Protective eyewear consists of
goggles or glasses with solid
side-shields
 Put eyewear with clean hands
before gloving and remove with
clean hands after gloves are
removed
 Mask should be worn to protect
against aerosols

86.  Grasp the mask only by the string or band at the sides or
back of the head to remove it
 Mask should be changed between every patient or
whenever it becomes moist or visibly soiled
 Should be discarded when patient is dismissed after
treatment instead of wearing it around the neck
 Hair should be kept back out of the treatment field
 Hair can trap heavy contamination which if not washed
away can cause cross contamination

87. Protective overgarments
 Protective clothing such as reusable
or disposable gowns, laboratory coats
or uniforms worn when clothing is
likely to be soiled with blood and
other body fluids
 Reusable protective clothing washed
using a normal laundry cycle
according to instructions of
manufacturer and detergent

88. CONCLUSION
 Pervasive increases in serious transmissible diseases over the
last few decades have created global concern and impacted
the treatment mode of all dental health care workers.
 The aim of sterilization and infection control is to control
iatrogenic, nosocomial infections among patients and potential
occupational exposure of care providers to microbes causing
disease during provision of care.
 To prevent occupational exposure and cross-infection dental
health care provider must be knowledgable about the
diseases commonly encountered and follow high standards of
infection control for the safety of patients and dental health
care workers.

89. REFRENCES
 Essentials of Preventive and Community Dentistry,
5th edition, Soben Peter
 Sturdevant’s art and science of Operative Dentistry
,5th edition, Theodore M. Roberson, Harald O. Heymann,
Edward J. Swift
 Textbook of Oral and Maxillofacial Surgery 2nd
edition, Neelima Anil Malik
 Preventive and Social Medicine ,20th Edition, Park.K
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 http://www.cdc.gov/oralhealth/infectioncontrol/
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