DENT 1103 Unit 3

Bioburden

Blood, saliva, bodily fluid

Contamination

Objects, barriers, or surfaces that have come into contact with microorganisms either directly or indrectly

Biofilm

Bacterial cells and other microbes that adhere to surfaces and form a protective slime layer

- A type of "plaque" that forms and is distributed in DUWL and causes infection of water delivery system

- Difficult to remove

- Slime layer on teeth

How are items/ equipment in the dental office classified as

Based on the potential risk for infection associated with their intended use and minimal type of post-treatment processing

- Can be critical, semi-critical, and non-critical

Critical insturmnets

Pose the greatest risk of transmission used to penetrate soft tissues or contact bone (SUBgingival, not enamel)

ex. forceps, scalpel, burs, blades - these should be sterilized

Semi-critical instruments

Lower risk of transmission: touch mucous membranes or non-intact skin

ex. HVE and A/W tips, mouth mirror, amalgam carriers - should be sterilized if not used high-level disinfectant

Non-critical instrumnets

Pose the least risk of transmission of infection contacting only intact skin - no exposure to blood, blood contaminated saliva or tissue

ex. lead apron, blood pressure cuff, x-ray tube head - should be clean and processed with intermediate or low-level disinfectant after each use

Sanitation

Cleaning - removes visible debris, blood and saliva from instrument or surface 

- Reducing number of microorganisms (with wipe)

Disinfection

Destruction of some but not all microorganisms - kills disease-causing microorganisms that remain 

SPORES ARE NOT KILLED

Sterilization

Destruction of all life forms including spores, viruses, bacteria, and fungi - cannot occur through adherent debris or blood

- A definite state, there is no partial or extra sterilizing

Approved methods of sanitation & disinfectants

- Products that must be registered as "hospital disinfectants" by Environmental Protection Agency

- Effectiveness is only assured if appropriate concentrations and exposure times are used

Precleaning

Clean before disinfecting even when there is no visible blood on surface - removes bioburden

High level disinfection

Kills some not all bacterial endospores and inactive TB (a high form of life)

- used to disinfect semi-critical items that cannot tolerate heat sterilization

Intermediate level disinfection

Destroys less resistant organisms (HEP B and HIV), inactivates TB

- Disinfects operator surfaces, non-critical items that have been contaminated with blood or saliva

Low level disinfection

Ineffective against TB and should only be used in dental office as general housekeeping - surfaces not contaminated with blood

Qualities of an ideal surface disinfectant

- Must kill TB and be virucidal (virus)

- Be registered with EPA and have a DIN

- Rapidly kill board spectrum of bacteria

- Have residual activity

Idophoros

Intermediate-level surface disinfectant

- EPA registered

- Surfaces that have been soiled with infectious material

- Effective within 5-10 minutes

Limitations of idophoros

- Inactivated by hard water: mixed with soft/distilled water

- Iodine combined with surfactant, may corrode/discolour surfaces and irritate tissues

Synthetic phenol compounds

Intermediate level disinfectant 

- EPA registered

- Broad spectrum surface disinfectant 

Limitation of synthetic phenol compounds

Prepared and diluted daily

Sodium hypochlorite

Intermediate level disinfectant 

- Not EPA approved

- Fast-acting and cheap for broad spectrum disinfectant (root canal disinfecting)

- BLEACH (main ingredient in household bleach)

Limitations of sodium hypochlorite

- BLEACH (main ingredient in household bleach)

- Unstable and daily preparation, strong odour and corrosive to some metals, irritating to skin and eyes

Limtiation of Alcohol

- Not effective in presence of bioburden 

- Rapid rate of evaporation limits antimicrobial activity of alcohol

- Not recommended to use as a surface disinfectant

Quaternary ammonia

low toxicity disinfectant 

 ex. lysol wipes

- Contains detergent for cleaning 

- Effective within 6-10minutes

Limitation of quanternary ammonia

Readily inactivated by anionic detergents and organic matter (what we're trying to destroy)

Chlorine dioxide

High level disinfectant/ sterilant

- Effective, rapid acting environment surface disinfectant (3mintes)

- Chemical sterilant (6 hours)

Limitation of chlorine dioxide

- Do not readily penetrate organic debris, they must be cleaned first

- Must be prepared fresh daily, use with good ventilation 

- Corrosive to aluminum

Limitations of Glutaraldehyde

High level disinfectant/ sterilant

- Not approved for sterilization 

- Used as liquid sterilant when immersion time increased

- Very toxic - items must be thoroughly rinsed before using

- Can cause discoloration and corrosion of instrument surface

Accelerated hydrogen peroxide

Intermediate level of disinfectant

- Optim 33 TB surface disinfectant 

- Effective in 1 minute 

Clinical contact surfaces

a) touch surfaces 

b) transfer surface

c) splash, splatter, and droplet surfaces

Touch surface

Clinical contact surface - directly touched

- barrier protected or C&D between clients

ex. dental light handles, dental unit controls, containers for dental materials, drawer handles

Transfer surface 

Touched by contaminated instruments - clinical contact surfaces

- Barrier protected or C&D between clients 

ex. trays, handpieces holders

Splash, splatter, and droplet surfaces

Do not contact staff or contaminated instruments - clinical contact surfaces

- Cleaned at least once daily 

ex. counter top

Pre-cleaning and disinfection armamentarium 

Gloves, glasses, masks

Pre-cleaning and disinfection process

- assess for gross debris and remove if any - C&D may need to change gloves

- wipe must be open not crumpled

- do not pick up fallen wipes from floor 

- semi critical/high contact surfaces/items must be wiped twice (clean and disinfected)

Surface barriers

To prevent contamination

- Discard and remove barriers between clients while gloves

- can be clear plastic wrap, bags, plastic tape

- placed with clean and dry hands

C&D before putting barriers on