Infection Prevention

and Control Practices

PRE – CLINICAL DENTISTRY
BDS 312: RESTORATIVE DENTISTRY – PERIODONTOLOGY
DR. JESSIE MLOTHA - NAMARIKA
 What is prevention?
• Adequate oral hygiene such as daily toothbrushing and interdental
cleaning, is essential for prevention of periodontal disease
 Aseptic technique
• Aseptic technique means using practices and procedures to prevent contamination from pathogens.
• It involves applying the strictest rules to minimize the risk of infection
• Healthcare workers use aseptic technique in surgery rooms, clinics, outpatient care centers, and
other health care settings
• Sterilization and disinfection are the cornerstones of any surgical procedure
• Before performing a periodontal surgical procedure, the standard protocol to sterilize and disinfect
the instrument and equipment should be adhered strictly
• There are many items in a dental office that are used during dental surgical procedures
• Sterilization and disinfection of the instruments is a fundamental step for any surgical procedure
 Why aseptic technique?
• Bacteria are everywhere, and some are good for us while others are harmful
• Bacteria, viruses, and other microorganisms that cause disease are called
pathogens
• To protect patients from harmful bacteria and other pathogens during medical
procedures, healthcare providers use aseptic technique
• Helps prevent the spread of pathogens that cause infection
 When to use aseptic technique?
• handling surgery equipment
• helping with a baby’s birth by vaginal delivery
• handling dialysis catheters
• performing dialysis
• inserting a chest tube
• inserting a urinary catheter
• inserting central intravenous (IV) or arterial lines
• inserting other draining devices
• performing various surgical techniques
 Aseptic technique types
• There are four chief aspects of the aseptic technique: barriers, patient equipment and preparation,
environmental controls, and contact guidelines
• Each plays an important role in infection prevention during a medical procedure.
Barriers
• Protect the patient from the transfer of pathogens from a healthcare worker, from the environment, or
from both
• sterile gloves
• sterile gowns
• masks for the patient and healthcare provider
• sterile drapes
 Patient and equipment preparation
• Healthcare providers also use sterile equipment and sterile instruments
• To further protect the patient, they apply cleansing and bacteria-killing
preparations to the patient’s skin before a procedure
• Methylated spirit
• Iodine
• Savlon
• Chlorhexidine
 Environmental controls
• Maintaining a sterile environment requires keeping doors closed during an
operation
• Only necessary health personnel should be at the procedure
• The more people present, the more opportunities for harmful bacteria to
cause contamination
• Traffic control
 Contact guidelines
• Once healthcare providers have on sterile barriers, they should only touch other
sterile items
• They should avoid touching nonsterile items at all costs.
• A common procedure that carries a risk for infection is inserting a urinary catheter
• These catheters drain urine from the bladder and are associated with catheter-
associated urinary tract infections (CAUTIs)
• When healthcare providers insert a catheter, they demonstrate all four aseptic techniques in
action
 Catheter insertion
• They open sterile packaging that contains the sterile catheter. They
prepare the patient’s skin with a special solution
• Only one or two providers and the patient are in the room
• Healthcare providers take great care not to touch any nonsterile surface
with the hand that advances the catheter into the patient’s urethra
• If even one part of the aseptic technique is missed during catheter
insertion, the patient can easily get an infection
 Aseptic technique vs Cleanliness

Aseptic Cleanliness
• The goal is to eliminate germs • The goal is to reduce the number of
entirely germs whenever possible
• They prevent infections every day
• Decontamination vs sterilization
• Hand hygiene and wearing clean gloves
are examples
• Patients’ surroundings must be kept
clean
 When to use Clean technique:
Healthcare professionals commonly use clean techniques when they’re:
• giving an injection
• emptying a urinary catheter drainage bag
• giving a bed bath
• inserting a peripheral IV (an IV in a smaller vein)
• removing a peripheral IV
• removing a urinary catheter
 Implications of Aseptic technique
• Healthcare workers try to minimize several common kinds of healthcare-associated
infections (HAIs) by using aseptic techniques
• CAUTIs (pronounced caught-EASE)
• central line-associated bloodstream infections (CLABSIs, pronounced clab-SEES)
• surgical site infections
• Each of these infections represents a major healthcare concern in terms of costs.
• In most countries, medical/ health facilities are required to report their infection rates to
the federal government. If their rates are too high, the facility can face disciplinary
action
 Cost Implications of HAIs
• According to the 
Centers for Disease Control and Prevention (CDC) Trusted Source, an
estimated 37,000 CLABSIs happen each year in people who get dialysis
• Treating these infections costs an average of $23,000
• People who get dialysis often have multiple chronic conditions that can make it even
harder to get over an infection
• Preventing the infection in the first place saves lives and money
 Aseptic technique outcome
• Depends on whether all healthcare providers adheres to aseptic and clean techniques
• According to the Journal of American Medical Association (JAMA) Internal
Medicine, 50% get HAIs
• Reduced hospital length of stay
• Reduced cost incurred by the health facility and patients
• More lives are saved from potentially fatal infections
• Reduced harm to the patients
 Prevention of CAUTIs
• Clean around the catheter each day
• Clean the skin around the catheter each day
• Keep the drainage bag below your bladder
• Empty the drainage bag several times per day
• Keep the catheter tube from kinking
• Wash your hands before and after touching the catheter or drainage bag
• Change the catheter at least once per month
 Cross infection
• Is the transfer of harmful microorganisms, usually bacteria and viruses
• The spread of infections can occur between people, pieces of equipment,
or within the body
• These infections can cause many complications
• So, medical professionals work hard to ensure equipment safety and a clean
environment
 Symptoms of cross infection
• The symptoms of a cross infection depend on
• the source of the infection and
• the part of the body that is infected.
• One of the first symptoms of a cross infection is a fever
• This is the body’s first course of action to help get rid of an infection
 Types of cross infection
• A urinary tract infection (UTI) from an infection caused by a catheter
• A surgical wound infection that may cause redness, swelling, and pus
• An infection related to the presence of a peripheral or central venous
access line
 Causes of cross infection
• Cross infections can be caused by:
• bacteria
• fungi
• parasites
• viruses
• These microorganisms can be transmitted by:
• unsterilized medical equipment
• coughing and sneezing
• human contact
• touching contaminated objects
• dirty bedding
• prolonged use of catheters, tubes, or intravenous lines
• Media coverage has raised concerns over cross infection in hospitals by “superbugs” like Mycobacterium abscessus.
 Settings where cross infection occur
• Infections can be spread in any setting, including:
• schools
• banks
• stores
• government buildings
• homes
• The risk for infection is greater when undergoing a medical procedure
• Cross infection can happen within the body
• An infection in one part of the body can spread to another, like a respiratory infection spreading to the ears or eyes
 Diagnosis of cross infection
• Doctors may use a combination of ways to diagnose cross infection
• physical exams
• blood tests
• culture tests
• urine tests
• X-rays
• health history reviews
 Treatment of cross infection
• Treating a cross infection depends on the condition
• Antibiotics are used for bacterial, fungal, and parasitic infections, but not for most viral
infections
• Over time, bacteria can adapt and become resistant to medications. This leads to the evolution
of “superbugs”
• These are strains of bacteria immune to multiple antibiotics which makes them more difficult to kill, and can
increase complications
• Prescription anti-viral drugs are used to treat specific types of viruses Anti-fungal medications
in topical or oral form can be used to treat fungal infections, while parasites transferred
through cross infection may be treated with antibiotics and dietary changes
 Cross infection complications
Untreated infections can lead to:
• diarrhea
• sepsis
• pneumonia
• meningitis
• dehydration
• multisystem organ failure that could include the lungs, heart, liver, and kidneys
• death
• The risk for life-threatening complications during medical procedures increases when cross infection is present
 Cross infection prevention
• Cross infection is best treated at the source
• Medical professionals follow special procedures to help prevent infections
• Aseptic technique is a common process used to sterilize equipment so
harmful microorganisms can’t spread from patient to patient
• Hospitals and other healthcare settings all have procedures to prevent
infection
• Before undergoing a procedure, you can check the facility in advance and ask about
preventative measures
 Items for sterilization
• Critical items: Those instruments that penetrate soft tissues and bone
• They carry a higher risk of disease transmission therefore needs sterilization
• Semi-critical items: Instruments that come in contact with oral mucous membrane or bone, but do not penetrate
them.
• Mouth mirrors, restorative instruments
• Still need sterilization although their risk of disease transmission is intermediate
• Non-critical items: Items only in contact with intact skin and poses low risk of disease transmission
• Dental chair, surfaces on the shelf, dental light
• Need decontamination to reduce transmission of disease
• Chlorine products to be avoided
• Use wipers or cloth with detergent/ soapy water
 Universal/ Standard precautions
• To reduce blood-borne pathogens and other pathogens from known and unknown sources
• They are a must in periodontal treatment and surgical procedures
• Hand hygiene before gloving and after degloving/ gloves removal is a must
• Personal protective barriers to be worn during procedure
• Sterilization of reusable items with appropriate processing
• Aseptic non-touch techniques as necessary
• Respiratory hygiene and cough etiquette
• Linen and clinical gowns to be processed adequately in between procedures
• Environmental barriers such as plastic covers to be used in areas susceptible to contamination due to their difficulties to
maintain clean
• Contaminated waste to be disposed of as per guidelines
 References
• https://periobasics.com/principles-of-periodontal...
• https://www.healthline.com/health/aseptic-technique
• Saroch N (2020). Asepsis and disinfection. Periobasics: A Textbook
of Periodontics and Implantology. 2nd ED, Sushrut Publications