This document discusses infection control in dental clinics. It begins with terminology related to infection control, including definitions of infection, sterilization, disinfection, asepsis, antiseptics, and more. It then covers the history of infection control practices dating back to Joseph Lister's pioneering work in the late 19th century. The objectives, modes of transmission in dental clinics, and guidelines for infection control are outlined. Methods of sterilization like heat, chemicals, and newer technologies are described. Factors that impact the efficacy of sterilization processes are also summarized.

2. HAVE A NICE DAY

3. INFECTION CONTROL
Presented by
DR.VAISHNAVI SHAH

4. CONTENTS
• TERMINOLOGY
• HISTORY
• INTRODUCTION
• OBJECTIVES
• MODE OF TRANSMISSION IN DENTAL CLINIC
• GUIDELINES
• GENERAL PRINCIPLE OF INFECTION CONTROL
• METHODS OF STERILIZATION
• VARIOUS METHODS AND STERILIZATION TECHNIQUE
• STERILIZATION CONTROL
• CLINICAL ASPECT
• CONCLUSION
• BIBLIOGRAPHY

5. • INFECTION :
The entry and development or multiplication
of an infectious agent in the body of man or
animals.
(Essential of preventive and community dentistry 4th edition soben peter.)
• STERILISATION :
It is defined as a process by means of which
an article, surface or medium is made free
from all living micro-organisms including
spores.
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH
EDITION ,UNIVERSITY PRESS,HYDRABAD 2008
TERMINOLOGY

6.  DISINFECTION:
It is a process of destruction of
vegetative forms of pathogenic
organisms which are capable of
producing infection but not necessarily
resistant to spores.
 ASEPSIS:
Technique that is employed in preventing
infections from gaining access to an
uninfected tissue.
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH
EDITION ,UNIVERSITY PRESS,HYDRABAD 2008
6

7.  ANTISEPTICS:
Substances which either kill micro-organisms
or inhibit their growth.
 BACTEROSTATIC AGENTS:
Chemical agents that inhibit bacterial growth.
 BACTERIOCIDAL AGENTS:
Substances that are able to kill bacteria.
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH EDITION
,UNIVERSITY PRESS,HYDRABAD 2008 7

8. Lets
walk
back in
time…

9. HISTORY
• Principle were accepted after
JOSEPH LISTER’S studies on
prevention of wound infection
from 1865 to 1891.
• The concept of asepsis and it’s role in the prevention of
infection control was put forward nearly two century
ago.
• Louis Pasteur :
The Father of Sterilisation.
Introduced use of heat to
destroy vegetative bacteria and
resistant bacterial spores.

11. • Elimination or reduction in all types of microorganisms.
• Breaking the cycle of infection and eliminating cross
contamination.
• For the protection of the dentist , patients and for all
the members of the dental team.
• Ensuring and showing confidence to patients that they
are well protected from risk of infectious
disease.
SOBEN PETER,ESSENTIAL OF PREVENTIVE AND COMMUNITY DENTISTRY,3RD
EDITION,ARYA PUBLISGER,NEW DELHI,2014
11
OBJECTIVES

12. MODE OF TRANSMISSION
• Area of colonization – Human body, Human
secretion, dental chair – Light handle, 3 way syringe,
aeroter, suction tip handle, enamel tray. Mobile,
atmosphere.
• Contact – cross infection, saliva.
• Immuno-compromised patients – HIV
TB
HSV
CHICKEN POX

13. Modes of disease transmission
The Dentist and the
operatory
Equipment/ instrument
The Patient
CONTACT
DROPLET
INFECTION
PERCUTANEOUS
INJURY

14. Cross Infection
• Cross-infection is defined as the transmission of
infectious agents among patients and staff
(clinical and non-clinical staff) within a clinical
environment.
14
patient practitioner
patient

15. Pathogen
Source
ModeEntry
Susceptible
Host
15
(sufficient virulence
& adequate numbers)
(allows pathogen to
survive & multiply)
(transmission
from source to
host)
(the
pathogen can
enter the host)
(Who is not immune)

16. 16

17. • The instruments are classified as, (according to the degree of
risk for involved in the use of the items)
1. Critical
2. Semi critical
3. Non critical
28/08/2015 17

18. 1. Establish an exposure control plan.
2. Employers must update the plan annually.
3. Implement the use of universal precautions.
4. Identify and use engineering controls.
5. Identify and ensure the use of work practice
controls.
18
Regulations by OSHA to be followed to
prevent infection.

19. 6. Provide personal protective equipment (PPE) such as
gloves, gowns, eye protection.
7. Hepatitis B vaccinations to all.
8. post-exposure evaluation and follow-up to any
occupationally exposed worker.
9. Use labels and signs to communicate hazards.
10. Maintain worker medical and training records.
SOBEN PETER,ESSENTIAL OF PREVENTIVE AND COMMUNITY DENTISTRY,3RD
EDITION,ARYA PUBLISGER,NEW DELHI,2014
19

20. • Understanding the disease and their root of
transmission that has high susceptibility.
• Screening of every new patient has be done
by taking proper medical history and oral
examination.
• Continuing to update patient’s medical
history.
20
Identifying high risk patients and
source of infection

21. Universal protection:
• All infected patients cannot be identified on the
basis of medical history, physical examination
and laboratory examination.
• Hence, it is considered as all patients are
infected with pathogenic organisms.
• it recommended that certain basis infection
control procedure must be followed routinely for
all patients, referred to as Universal Protection.
21

22. Universal protections for dental team,
include:
• Routine hand washing
• Protective barrier technique
• Immunization
22

23. 23
SEQUENCE FOR DONNING PROTECTIVE
AIDS
GOWN
MASK
GOGGLES OR
FACE SHIELD
GLOVES
23
HEAD CAP

24. GOWN :
• Reusable or disposable
gown.
• Material may be natural
or man made.
• Clean or starile.
24

25. MASK :
 The provide protection to nose
and mouth from likely splashes and
sprays of blood or body fluids.
 Place over nose , mouth and
chin .
 Fit flexible nose piece over
nose bridge
 Secure on head with ties or
elastic
 Adjust to fit.

26.  SWINE FLU (H1N1 VIRUS)
• N95 RESPIRATOR MASK IS USED
MASK N95 RESPIRATORS
 Loose fitting. Very close facial fit
 creates physical Efficient filtration of
barrier between nose airborne particles.
& mouth of the wearer.
 Filters large droplets. Filters 95% small parti-
cle and aerosolized
droplets.

27. N95 Respiratory
3M 8670F

28. Hand washing is the key to
Control of Infection
28

29. • It help to reduce the risk of
disease transmission.
• Transient micro-organisms can come to rest
on the hands following direct contact with
patients or contaminated environmental
surfaces.
• These micro-organisms, which colonize the
top layers of the skin, are most frequently
associated with healthcare-acquired
infections. 29
ROUTINE HAND WASHING

30. 30
HANDWASHING IS MOST IMPORTANT MEASURE FOR
PREVENTING INFECTION.
Less frequently missed
Least frequently missed
Most frequently missed30

31. 28/08/2015 3131

32. 32
Gloves:
Patient examination gloves
Surgical gloves
Non medical gloves

33. Based on the material used:
• LATEX
• VINYL
• NITRILE
LATEX GLOVES:
• Fit like a second skin.
• Have a high level of touch sensitivity.
• Good for wearing for an extended amount of time
• cost-effective.
• lightly powdered, making it easier to put on
• very elastic 33

34. NITRILE GLOVES:
• Latex-free.
• Are most puncture resistant.
• Mold to your hand for a great fit.
• Work well for high-risk situations involving
infectious material.
• Resist many chemicals.
• Have a long shelf life.
VINYL GLOVES :
• Latex-free.
• looser fit.
• Good for short-term, low-risk tasks.
• Most economic.
• Best for use with non-hazardous materials.
• lightly powdered to make it easier to put on.

35. 35

36. Recent Advances
UV operated system

37. 37
REMOVAL OF HAND GLOVES, GLASSES, GOWN,
MASK

38. STERILIZATION

39. • First, formaldehyde-alcohol has been deleted as a
recommended chemical sterilant or high-level
disinfectant.
• Second, several new chemical sterilants have been
added, including hydrogen peroxide, peracetic acid,
peracetic acid and hydrogen peroxide in combination.
• Third, 3% phenolics and iodophors have been deleted
as high-level disinfectants.
39
Changes in Disinfection and
Sterilization Since 1981

40. • Fourth, isopropyl alcohol and ethyl alcohol
have been excluded as high-level
disinfectants.
• Fifth, 2.0% glutaraldehyde, 7.05% phenol ,
1.20% sodium phenate has been deleted as a
high-level disinfectant.
• Sixth, the exposure time required to achieve
high-level disinfection has been changed from
10-30 minutes to 12 minutes or more .
40
Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
William A. Rutala, .1,2,

41. • All used instrument should thoroughly cleaned.
• The modes of sterilization should be in contact
with every surface of each instrument.
• All sterilizing equipment must be regularly
serviced and maintained.
• Follow the manufacturer’s instruction.
41
PRINCIPLES OF STERILIZATION
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF
MICROBIOLOGY,7TH EDITION,2005,UNIVERSITY PRESS2005

43. STERILISATION OF PRIONS
Dry heat
3600C for one hour
Moist heat
134-1380C for 18 min
Chemicals
25% sodium hypochlorite for one hour
Sensitive to household bleach, phenol (90%) and iodine
disinfectants
43

44. Factors that affect the efficacy of
disinfection and sterilization
• Types of organisms (spore forming organisms)
• Number of organisms
• Concentration of disinfecting agent
• Presence of organic material (e.g., serum,
blood)
• Nature (composition) of surface to be
disinfected
• Contact time
• Temperature
• pH
44

45. Number of micro-organisms = higher numbers of
organisms require longer exposure.
Concentration of disinfecting agent = a proper
concentration of disinfecting agents ensure the
activation of target organisms. (povidone-iodine)
Presence of organic material = affects killing
activity.

46. • Nature (composition) of surface to be
disinfected = endoscopic instruments
• Contact time = the amount of time a disinfectant
or sterilant is in contact with the object.
• pH = an increase in pH improves the
antimicrobial activity of dis-infectant.
(gluteraldehyde). Decrease antimicrobial activity
of phenols, hypochlorite, iodine.

47. Method of
Sterilization
47
Physical method
Chemical method

48. PHYSICAL METHODS
SUN LIGHT
DRYINGFILTRATION
HEAT
MOISTDRY
RADIATION
UTRASONIC
& SONIC

49. HEAT
Dry
heat Flaming
Red heat
Incineration
Hot air oven

50. Materials are held in the flame of a bunsen
burner till they become red hot.
USES :
 Inoculating wires or loops
 Tips of forceps
 Surface of searing spatulae
 Needles
50
RED HEAT

51. FlAMING
Materials are passed
through the flame of a
bunsen burner without
allowing them to become
red hot.
USES :
» Glass slides
» scalpels
» Mouths of culture tubes
and bottles
51

52. HOT AIR OVEN
 Most widely used method of sterilisation by dry
heat.
 It is used to process materials which can withstand
high temperatures, but which are likely to be
affected by contact with steam.
 Hot air oven is electrically heated and is fitted
with a thermostat that maintains the chamber air at
a chosen temperature.
 Fitted with a fan that distributes hot air in the
chamber. 52

53. Holding temperature &
time
Temperature & time:
1600C for 2 hour
1700C for 1 hour
Rapid Heat Transmission =
375⁰ F – 12 min for wrapped items
375⁰ F – 6 min for unwrapped items
P CHAKRABORTY ,TEXT BOOK OF MICROBIOLOGY,3RD EDITION,NEW CENTRAL BOOK
AGENCY(P)LIMITED,,LONDON,2013 53

54. Sterilisation of ,
 Glassware like glass syringes, swabs, petri
dishes, pipettes and test tubes.
 Surgical instruments like scalpels, scissors,
forceps etc.
 Chemicals like liquid paraffin, fats and grease
etc.
Uses of Hot Air Oven
54

55. • It involves heating water to generate steam in closed chamber.
• Known for destruction of all forms of microorganism because
high penetrating capacity and give up a large amount of latent heat.
Advantages:
• The results are consistently good, and reliable
• The instrument can be wrapped prior to sterilization
• Time efficient
• Good penetration
Disadvantages:
• Blunting and corrosion of sharp instrument
• Damage to certain rubber goods 55
MOIST HEAT STERILIZATION :

56. Moist Heat
Below 100⁰ C At 100⁰ C Above100⁰ C
Pasteurization Boiling Autoclave
Vaccine bath
Tyndallization ( Steam under
Water bath pressure)

57.  Pasteurization
Milk is sterilised by this method.
Two methods are there.
1. Holder method (630C for 30 min followed by rapid
cooling to 130C or lower)
2. Flash method (720C for 15-20 seconds followed by rapid
cooling to 130C or lower)
All nonsporing pathogens such as Mycobacteria are destroyed by
these processes.
57
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH EDITION
,UNIVERSITY PRESS,HYDRABAD 2008

58. VACCINE BATH
Bacterial Vaccines prepared at 600C for 1 hour as most
vegetative bacteria are killed.
WATER BATH
Serum or body fluids containing coagulable proteins can be
sterilized by heating for 1 hour at 560C.
ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH
EDITION ,UNIVERSITY PRESS,HYDRABAD 2008 58

59. BOILING AT 1000C
 Boiling at 1000C for 10-30 min kills all vegetative bacteria and
some bacterial spores.
 Sporing bacteria required prolonged periods of boiling.
 Therefore, it is not recommended for sterilization of surgical
instruments.
 Addition of 2% sodium bicarbonate may promote sterilization.
Uses
 For the disinfection of medical and surgical equipment – when
sterility is not essential in emergency or under field conditions.
59

60. TYNDALLISATION
An exposure of steam 1000C for 30 min on three consecutive
days is known as Tyndallization or intermittent sterilization.
Principle:
First exposure kills all the vegetative forms, and in the intervals
between the heatings the remaining spores germinate into
vegetative forms which are killed on subsequent heating.
Uses:
For sterilisation of egg, serum or sugar containing media.
60

61. • It is double walled or jacket chamber made up of stainless steel
or gunmetal with a supporting frame.
• The steam circulates within the jacket and is supplied under high
pressure to the closed inner chamber where goods are kept for
sterilization.
• Known for destruction of all forms of microorganism because
high penetrating capacity and give up a large amount of latent
heat.
• Basically, 3 types:
• simple iron jacket
• low pressure low temprature
• high pressure high vaccume
61
AUTOCLAVE

62. Large reduction in volume sucks in more steam to the area
This process continues till the temperature of
that surface is raised to that of steam
Steam (Condensed water) under pressure
ensures killling of microbes present
Temperature at which water boils also increases
Saturated steam comes in contact with
cooler surface
Condenses to water and gives up latent
heat to that surface
When water boils, it becomes vapor, pressure is equal to surrounding atmosphere
Pressure inside closed vessel increases
62
Principle of Autoclave
P CHAKRABORTY ,TEXT BOOK OF MICROBIOLOGY,3RD EDITION,NEW CENTRAL BOOK
AGENCY(P)LIMITED,,LONDON,2013

63. • Temp =
121⁰c
• Pressure =
15 psi
• Time =
15-20 min

64. 64

66. 66
Uses :
 To sterilize culture media,
rubber material, gowns,
dressings, gloves,
instruments.
 For all materials that are
water containing,
permeable or wettable.
 Useful for materials which
cannot withstand the high
temperature of hot air
oven.

67. Precautions
1. All the air must be removed from the autoclave chamber.
 The admixture of air with steam results in low temperature
being achieved.
 The air being denser forms a cooler layer in the lower part of
the autoclave.
2. Materials should be arranged in such a manner which ensures
free circulation of steam inside the chamber.
3. Lid should not open until inside pressure reaches to the
atmospheric pressure.
67
P CHAKRABORTY ,TEXT BOOK OF MICROBIOLOGY,3RD EDITION,NEW CENTRAL BOOK
AGENCY(P)LIMITED,,LONDON,2013

68. GLASS BEAD STERILIZATION
• Advised for sterilization of small
instrument like root canal
instruments .
• Temperature is 2180 C to 246 0 C.
• Broaches, files & reamers are
sterilized for 5 seconds.
• Absorbent points and cotton
pellets are sterilized in 10 seconds.

69. Ultrasonic and sonic
vibrations-
 It has been shown to be
effective in removing dried
blood and saliva.
 instruments should be
placed in cleaning basket
supplied with the unit.

70. IONIZATING RADIATION:
• Include x-ray, gamma rays, and high speed electron.
• It is effective for heat labile instruments.
• The lethal action is due to effect on the DNA of nucleus
and on the other vital cell compound.
• Commonly Used For Plastic disposable syringes ,
catheters, All glass materials, Animal feeds, Clothes, Oils,
Grease, Rubber material.
70
RADIATION
P CHAKRABORTY ,TEXT BOOK OF MICROBIOLOGY,3RD EDITION,NEW CENTRAL BOOK
AGENCY(P)LIMITED,,LONDON,2013

71. NON- IONIZING RADIATION
Ultraviolet Radiation (UV)
• The wavelength of UV radiation ranges
from 328 nm to 210 nm. Its maximum
bactericidal effect occurs at 240–280
nm.
• Inactivation of microorganisms results
from destruction of nucleic acid
through induction of thymine dimers.
• Use: operating rooms, isolation
rooms, Hospital wards and biologic
safety cabinets in laboratory.
71

74. STERILIZATION CONTROL
• To ensure that potentially infectious agents are
destroyed by adequate sterilization.
• Three levels =
• physical: measuring device control (temp.,
time, pressure)
• chemical: substances that undergo a colour
change or have melting points within the
sterilizing range.
-Browne's tubes, Bowie Dick tape
- give an immediate indication of a successful or
non- successful sterilization.
74

75. Biological control
Autoclave
Bacillus
stearothermophilus
Hot air
oven
Clostridium tetani
Ethylene
oxide
Bacillus globigii

76. 76
• Browne's tubes are glass tubes that contain heat
sensitive dyes. These change colour after sufficient
time at the desired temperature.
• Before heat exposure, the contents of the tube appear
red.
• As heating progresses, the colour changes to green.
• Only when the tube is green, sterilization conditions
can be considered adequate.
www.surgicalnote.co.uk/node/210

77. Bowie Dick tape
 Before heat exposure, the tape is uniformly buff in
colour.
After adequate heating, the tape develops dark brown
stripes.
The pack on the left has been properly sterilized; that
on the right has not.
77

78. Tests for sterility
Special ink
30.1% Lead thiosulfate
0.6% Magnesium
carbonte
20.8% Neocryl
22.7% Ethyl acetate
1% Ethanol
49% Ink solids

80. 23/02/2017 80

81. 23/02/2017 81

82. • Disadvantages for Dry heat
sterilization
• Time consuming method because of slow rate
of heat penetration and microbial killing.
• High temperatures are not suitable for most
materials.

83. Disadvantages of Glass bead
sterilization
• This method is considered to be only an auxillary
method of sterilization.
• The glass beads which are less than 1mm in
diameter sometimes get stuck in the instruments
like files.
• Larger beads are not so effective in transferring
heat to endodontic instruments, because of the
large air spaces between the beads that reduces
the efficiency of the sterilizer.

84. • FORMALDEHYDE = hazaduous, irritant to eye,
skin, respiratory tract. 18-20 hours of contact
is necessary for cidal activity.
• CHLORINE DIOXIDE = Causes oxidation of
metals, mucous membrane sensitivity,
difficulty in breathing.
• IDOPHOR = There is corrosiveness, staining,
irritation of tissues.

85. • PHENOL = Toxic to skin & bone marrow.
• ETHYLENE OXIDE = Causes human mutagenicity
& carcinogenicity.

86. CONTENTS
• Chemical methods of sterilization
• Clinical Aspects
• Conclusion
• Bibliography

87. CHEMICAL
AGENT
LIQUID GAS

88. CHEMICAL AGENT
ALDEHYDE
ALCOHOL
HALOGEN
SURFACE
ACTIVE AGENT
QUATERNARY
AMMONIUM
COMPOUND
PHENOLIC
COMPOUND
SALTS OF HEAVY
METALSDYES
GAS VAPOUR
STERILIZATION

89. Ethanol Cresol
• Alcohol Phenol
isopropyl Carbolic acid
Formaldehyde
Aldehyde
Gluteraldehyde
Iodine Acridine
Halogen Dyes
Chlorine Aniline

90. Silver
Metalic salts
Mercury
Ethelene oxide
Gases Formaldehyde
Betapropiolactone

91.  Ethyl- & Isopropyl alcohol commonly used.
 MOA ; denaturing microbial proteins.
 Not effective against spores & viruses.
 Effective conc. 50% to 70%
 Must have a 10 min contact with organisms.
 Evaporate quickly.
 Corrosive to carbon steel.
 Rubber articles absorb alcohol.
 Plastics may harden or swell in their presence.
ALCOHOL
91

92. ALDEHYDES
 Formaldehydes & Gluteraldehyde :
- MOA : kills microbes by denaturing proteins & nucleic
acids.
- Broad spectrum disinfectant.
- Formaldehyde is not preferred due to its smell and
because of 18 to 30 hours of contact is necessary for cidal
action.
- 2% conc. Of Gluteraldehyde ---- disinfection – 20 min.
sterilization – 6-10 hrs.
- Used as high level sterilant/disinfectant for heat sensitive
materials.
- Allergic to skin and mucous membrane on repeated
contact.
92

93. Trade name for gluteraldehyde =
MetriCide28
93

94. HALOGENS ( chlorine, iodine )
 CHLORINE
 Used as disinfectant for many years to disinfect
drinking water, swimming pool water etc.
 these agents are intermediate level disinfectants,
kill a wide variety of micro-organisms.
 sodium hypochlorite has rapid action.
 1:10 dilution will provide a disinfectant solution
containing 0.5% or 5000 ppm NaOCl.
• 0.5% sodium hypochlorite is used in serology and
virology.
• 5.2% is used as an endodontic irrigant. 94

96. IODOPHOR
 Used for surgical scrub and surface
antisepsis.
 Usually effective within 5-10
minutes.
 Undesirable properties are
corrosiveness, staining, irritation of
tissues, and allergic.
 Concentrated solutions have less
free iodine.
 broad-spectrum antimicrobial
activity
 Povidone-iodine is much more
stable.
96

97. PHENOLS
 Also known as carbolic acid.
 Obtained by distillation of tar
between 170 0– 270 °C.
 MOA – bacterial cell membrane
damage.
 Toxic to skin & bone marrow.
 Synthetic combination(phenolics) are
used as surface disinfectant. {walls,
floors, furniture}
97

98. CHLOROXYLENOL
 It is a broad spectrum antimicrobial chemical compound used to
control bacteria, fungi and viruses.
 Non-corrosive, non irritant.
 4.8% choroxylenol + 9% terpinol + 13% alcohol DETTOL
98

99. ETHYLENE OXIDE
 Colorless liquid with a boiling point above 108 °C.
 Highly penetrating, noncorrosive, sweet smell.
 Cidal action against bacteria, spores & viruses.
 Destroys microbes by denatures nucleic acid.
 Highly toxic, irritant.
 Reacts with DNA & RNA.
 Causes human carcinogenicity
 Mainly used for presterilising single-use devices.
 It is specially used for sterilizing heart-lung
machines, respirators, sutures, dental
equipment, books and clothing.
 Used to sterile Glass, metal, paper surfaces,
plastics & tobacco.
99

100. FORMALDEHYDE GAS
• Widely employed for fumigation of operating & other rooms.
• PROCEDURE
• Seal the windows & other outlets
• Gas is generated by adding 150g of KMnO4 to 280ml of
formalin for every 1000cu.ft
• Considerable heat and vapours generated
• Doors kept close for 48 hours.
100

101. BETAPROPIOLACTONE (BPL)
• Condensation product of ketone & formaldehyde
• Boiling point – 1630C
• Low penetrating power but more efficient than
formaldehyde gas
• Rapid bacteriocidal action
• Carcinogenic activity
• 0.2% conc. used
• Kills all microbes
• Active against viruses
101

102. CATEGORY DEFINATION USE EXAMPLES
STERILANT Destroys all
microorganisms,
Including high
numbers of
bacterial spores
Heat-sensitive
reusable items:
Glutaraldehyde ,
Glutaraldehyde
phenol,
Hydrogen peroxide,
Hydrogen peroxide
with peracetic acid,
peracetic acid
HIGH LEVEL
DIS-
INFECTANT
Destroys all
microorganisms,
but not
necessarily high
numbers of
bacterial spores
Heat-sensitive
reusable items:
Glutaralaldehyde ,
Glutarlaldehyde
phenol,
Hydrogen peroxide,
Hydrogen peroxide
with paracetic acid,
paractic acid.
102

103. INTER-
MEDIATE
LEVEL DIS-
INFECTANT
Destroys
vegetative
bacteria, most
fungi, and
most viruses,
inactivates
myco-
bacterium
Clinical
contact
surfaces,
noncritical
surfaces with
visible blood
Gluteraldehyde,
Gluteraldehyde with
phenol,Hydrogen
peroxide, Hydrogen
peroxide with peracetic
acid.
LOW LEVEL
DIS-
INFECTANT
Destroys
vegetative
bacteria,
some fungi,
and some
viruses; does
not inactivate
myco-
bacterium.
Housekeeping
surfaces(floors
,walls)
Noncritical
surfaces
without visible
blood clinical
contact
surfaces.
EPA-registered hospital
disinfectant with label
claim of tuberculocidal
activity .
(e.g, chlorine containig
products, phenolics,
iodophors, quaternary
ammonium
compounds ) 103

104. 104
New methods in disinfection and sterilization
Regulatory agency actionAgentProcess
FDA cleared, October 1999Ortho-phthalaldehyde (Cidex
OPA)
Disinfection
Not FDA/EPA clearedAntimicrobial coating (Surfacine)
Not FDA/EPA clearedSuperoxidized water (Sterilox)
Not FDA clearedLiquid sterilization process
(Endoclens)
Sterilization
Not FDA clearedEthylene oxide biological
indicator (Attest)
FDA cleared, January 1999New plasma sterilizer (Sterrad 50)

105. Comparison of Glutaralaldehyde and
OPA
 Needs activator
 14 day use life
 2 year shelf life
 Strong odour
• No activator
needed
• 14 day use life
• 2 year shelf life
• Weak odour
> 2.0% Glutaralaldehyde 0.55% Ortho-phthalaldehyde
105

106. Low-temperature plasma
106
• Technique for decontaminating thermo labile
products without the severe drawbacks of gas
sterilization methods.
• Advantages:
– Alternative to steam sterilization for sterilizing easily
corroding products or electronic instruments.
– Takes less time.
.

107. CLINICAL ASPECT

108. • All sharp instrument should be disposed in
proper containers.
• Uncaped needles should not remain on the
instrument tray or in operating area.
• Used needle should never be recapped
utilizing both hand.
• An uncapped needle or syringe should not
be passed from assistant to surgeon.
108
USE OF SHARP INSTRUMENTS AND
NEEDLES
 NEELIMA ANIL MALIK.,TEXTBOOK OF ORAL AND MAXILLOFACIAL SURGERY ,SECOND EDITION,J P
BROTHERS,2010

109. Plastics are used to cover the chair
and unit.
• Changes the bag after each
patient.
109
CLINICAL OPERATING AREA

110. Surface disinfection
110
• Used for mechanical removal of
organic debris.
• Spray – Wipe – Spray Technique
• Use 4 x 4 Gauze to wipe the surfaces
in overlapping strokes.
• Recommended surface disinfectants
are
A. Sodium hypochlorite
B. Iodophors
C. Phenol

111. 111
PROSTHODONTICS
• Dentist or dental assistant
prepares a potentially infectious
impression for by rinsing the
impression and placing it in a plastic
bag without contaminating the
bag’s outer surface.

112. • ADA Recommendations for disinfecting
Impressions are:
• Chlorine compound
• Iodophors
• Combination with phenolics
• Gluteraldehyde 2%
112

113. Title Knowledge and attitude of general dentists of Ahwaz about disinfection of dental
impressions
Author Raju, T. B. V. G.1 Garapati, Satish2Agrawal, Rupika3Reddy, Sridhara4Razdan, Ankur5
Kumar, S. Kishore6
journal Journal of International Oral Health. Nov/Dec2013, Vol. 5 Issue 6, p108-112. 5p. 4
Color Photographs, 1 Chart, 1 Graph.
aim Aim of the study was to compare 4 different methods of sterilizing endodontic files in
dental practice.
Methods and
material
The present study was performed on 100 K-files, 21 mm long and of size 25. Of these,
20 files were taken as control group, and the remaining 80 files were divided into 4
groups of 20 files each and they were tested for the efficacy of sterilization with
different methods: Autoclave, glass bead, glutaraldehyde and CO2 laser
Results The study showed that the files sterilized by autoclave and lasers were completely
sterile. Those sterilized by glass bead were 90% sterile and those with glutaraldehyde
were 80% sterile
conclusion The study concluded that autoclave or laser could be used as a method of sterilization
in clinical practice and in advanced clinics; laser can be used also as a chair side
method of sterilization
113

114. • The staff working in radiology department usually, is
not aware of the medical history . Hence ,it is
essential to take certain precaution.
114
Dental radiograph

115. 115
Other precautions
• Use of antimicrobial
mouth rinse.
• Rubber dam
isolation.
• Minimizing dental
aerosols.

116. • Sterilium
• SANITISERS are agents
including detergents used to
maintain microbial levels at
safe acceptable levels.
• Propanol - 45g
• Ethyl sulphate - 0.2g

117. • Hand piece – clean and sterilize/ disinfect after
each patients with bur. (by disinfect or lubricant)
- Discharge air & water for 20-30 sec.
- flush 20-30 sec. air/water lines in
hose before attaching.
• Casts – clorine compond or iodophor.
• Alginate – clorine compond or iodophor, 2%
gluteraldehyde.
• Impression compound – clorine compound or
iodophor. Also phenolic spray.

118. • Removable appliances – chlorine compound or
iodophor.
• S.S.Crown – HCL , Avoid corrosion of metal can
also be sterilized by exposure to Ethylene oxide
gas.
• Burs – Dry heat sterilization or use disinfectant.
• Radiograph – film holder, bite block can be used.
Plastic cover for sensor.
• Canal – 1.5 % sodium hypochlorite followed by 2%
chlorhexidine.
• G.P.Point – 2.5 % aqueous sodium hypoclorite
solution .

119. • Paper point – Gamma radiation [ cobalt 60 ].
• Files – Autoclave or lasers [co2 ].
• Excess Amalgam – fixer.
• Rubber mouth props – Steam autoclave,
chemiclaved upto 127⁰ c.
• Patient drap – Dry sterilization.
• Prepration before surgical procedure – used
Mouth wash , paint the patient’s extra oral
surface with betadine.
• Chair – Head rest should have plastic cover and
change after each patient, and should clean with
disinfect agents.

120. • Sutures - Autoclave, Ethylene oxide.
• Swabs - Autoclave (Gamma radiation, hot air
oven)
• Implants - UV radiation (Journal Oral Maxillofac Surg 1996)
• Dental cements – Dry heat sterilization
• Curing light – Dis-infectant
• Dental clinic – fumigation/ gamma radiation

121. DECONTAMINATION CYCLE

122. 122
• Cleaning
• Disinfection
manual
ultrasonic

123. b
• Packing
• Sterilization
• Storage
• Use
123

124. 124

125. • This method is used for
destruction of infective
material.
• Soiled dressings
• Animal carcasses
• Pathological material
Incineration:
125

126. • Relation of temperature and time.
126
⁰C f TIME (MINUTE)
170 340 60
160 320 120
150 300 150
140 280 180
Journal of American Dental Association Vol 122, December 1991

127. CONCLUSION
127
• In summary:
– However, it is an essential in all health care
facilities to avoid spread of diseases.
– It depends on the ethics of the instrument users.
– Users should keep in mind that contaminated
instrument present risk to patient as well as the
user himself.

128.  ANANTHANARAYAN AND PANIKER’S TEXT BOOK OF MICROBIOLOGY,7TH
EDITION,2005,UNIVERSITY PRESS 2005.
 NEELIMA ANIL MALIK.,TEXTBOOK OF ORAL AND MAXILLOFACIAL
SURGERY ,SECOND EDITION,J P BROTHERS,2010
 MCDONALD,AVERY DEAN,DENTISTRY FOR THE CHILD AND
ADOLESCENT,8TH EDITION,ELISVIER,NEW DELHI,2004
 SOBEN PETER.,ESSENTIAL OF PREVENTIVE AND COMMUNITY DENTISTRY
,4TH EDITION,ARYA(MEDI)PUBLISHING HOUSE,NEW DELHI,JULY2008.
 RAJESH BHATIA, RL ICHHPUJANI. MICROBIOLODY FOR DENTAL
STUDENTS. JAYPEE BROTHERS, 3RD EDITION, 2003.
 WILLIAM A. RUTALA, GUIDELINE FOR DISINFECTION AND STERILIZATION
IN HEALTHCARE FACILITIES, 2008 128
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129.  SHARON K. DICKINSON, RICHARD D. BEBERMEYER. GUIDELINES
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130. 23/02/2017 130