Circuit 4, station 12

Disease control has emerged as a growing concern within the field of dentistry, primarily due to the heightened risk of acquiring or transmitting infectious diseases among dental patients. An equally significant issue is the occurrence of cross-contamination and disease transmission between patients. In order to tackle these challenges, it is crucial to address the measures that can be implemented to protect dentists and dental personnel from infection and the transmission of diseases to patients.

It has been observed that cross-contamination among patients, dentists, and auxiliary personnel often originates from commonly used items such as absorbent cotton swabs, air syringes, glass plates, and hand towels, which act as constant sources of contamination. The guidelines provided by the Centres for Disease Control and Prevention (CDC) highlight the significance of handling dental impressions appropriately to prevent infection among practitioners, patients, and the contamination of the environment, as these impressions pose a potential source of cross-contamination.

Based on thorough data verification and compliance with provincial regulations, it is imperative for dentists and their teams to adhere to established standards of dental infection control and occupational safety. This adherence is essential to ensure the well-being and safety of patients, as well as to uphold the overall quality of dental care.

Areas of concern

Transmission Routes of Infections in Dental Offices and the Presence of Pathogenic Microorganisms:

In a dental office, infections can be transmitted through various routes, including:

(1) direct contact with oral fluids, blood, and contaminated materials; (2) indirect contact with contaminated objects, such as instruments, environmental surfaces, and equipment; (3) contact of the conjunctival, nasal, or oral mucosa with microorganism-containing droplets or splashes expelled by an infected person while speaking, coughing, or sneezing; or (4) inhalation of suspended microorganisms in the air over extended periods.

It has been established a direct relationship between dental facilities and the presence of microorganisms. Analysis of dental impressions, dentures, crowns, and wax occlusion rims revealed the presence of various pathogenic microorganisms in 67% of the samples. Notable microorganisms identified in the study included Enterobacter cloacae, Escherichia coli, and Klebsiella oxytoca, among others. The findings underscore the significance of dental facilities as reservoirs for bacteria and contaminants, particularly in prosthodontic laboratories. Miller et al. further demonstrated that during abrasive procedures involving dental pumice, bacteria present on the pumice can aerosolise and disseminate throughout the dental room, potentially transmitting to both patients and personnel. While it has been previously recognised that the high bacterial load in contaminated pumice originates from the oral environment, studies by Wakefield and Williams et al. revealed the presence of non-oral microorganisms in used or finished pumice prostheses.

These diverse pathogenic microorganisms pose a significant hazard to dentists, patients, and general and prosthodontic laboratory personnel. A study that involved collecting pumice samples from four dental laboratories to quantify and identify bacterial colonies. The predominant bacteria identified were non-oral microorganisms belonging to genera such as Bacillus, Acinetobacter, Micrococcus, Pseudomonas, Moraxella, and Alcaligenes.

Clinical Significance

Infection Control Procedures in Healthcare Settings:

• Patient Screening In the context of dental practice – the dentist carries out a comprehensive medical history and initial examination of each patient before proceeding to the operative phase. This ongoing review serves several important purposes, including the establishment of baseline data from the patient’s clinical history, the monitoring and comparison of individual patient responses over an extended period, and the brief assessment of any prior occurrences of infectious diseases experienced by the patient.
• Personal Hygiene – the maintenance of optimal hygiene standards among dentists and personnel is of utmost importance within the dental profession. Over time, patients have become increasingly cognisant of the significance of sterilised materials and instruments for each treatment, with the appearance and hygiene practices within the dental office now assuming a pivotal role in instilling confidence in patients. To ensure comprehensive hygiene protocols, specific guidelines have been established, encompassing the following aspects:

1. Hair Management: Dentists should secure their hair in a manner that prevents it from contacting the patient or dental equipment. If the dentist’s hair is long and has the potential to come into contact with the patient or equipment, it must be secured at the back of the head and covered with a surgical cap. Additionally, facial hair should be adequately covered using a mask or face shield.
2. Removal of Jewellery and Objects: Prior to commencing patient treatment, all jewellery and objects on the hands, arms, or facial area of the dentist must be removed. This precautionary measure aims to minimise the risk of potential contamination during the treatment process. The phrase “bare below the elbow” is pertinent here.
3. Fingernail Care: Dentists are expected to maintain clean, unpolished, and short fingernails. This practice serves to prevent the accumulation of debris and minimise the likelihood of glove perforation, thus upholding hygiene standards.
4. Forearm Washing: Mandatory hand and forearm washing with soap and water before and after each patient’s treatment is a fundamental requirement. This practice ensures proper hand hygiene, mitigating the potential transmission of microorganisms and maintaining a clean environment.

By adhering to these specific hygiene rules, dental professionals actively contribute to the creation of a safe and reassuring environment for patients. The implementation of rigorous hygiene practices not only reinforces the importance of infection control measures but also fosters trust and confidence in the dental office as a whole.

• Personal Protection – in order to maintain a safe and hygienic environment in dental settings, it is imperative for all personnel to adhere to various infection control measures. These measures encompass the following guidelines:

1. Vaccination: All personnel working in dental settings should ensure that they are appropriately vaccinated against communicable diseases, including hepatitis B. This proactive step minimises the risk of disease transmission within the healthcare setting.
2. Glove Usage: It is crucial for personnel to consistently wear gloves when providing care to patients. This universal precaution helps prevent direct contact between healthcare workers and patients, reducing the potential transmission of infectious agents.
3. Mask Utilisation: Masks should be worn in the patient treatment area to provide an additional barrier of protection. Moreover, when dentures are being handled in the laboratory, the dentist should also wear a mask. This practice assists in minimising the spread of airborne particles and microorganisms.
4. Eye Protection: It is recommended that patients, teachers, and residents wear goggles with solid side shields. This protective eyewear shields the eyes from potential splashes, sprays, or debris that may occur during dental procedures.
5. Sharps Disposal: Proper guidelines for sharps disposal must be strictly followed. Emphasis should be placed on using haemostatic forceps when handling blades, ensuring safe and appropriate disposal to minimise the risk of accidental needlestick injuries.
6. External Aerosol Barriers: External aerosol barriers, such as protective gowns or coats, should be worn consistently when providing care to patients and when transitioning between different individuals. These barriers act as a shield against potential aerosolised particles and reduce the risk of cross-contamination.

By adhering to these infection control measures, dental personnel uphold the highest standards of safety and minimise the potential transmission of infectious diseases. Implementing these guidelines contributes to a safe environment for both patients and healthcare providers.

• Instrument Processing – instrument processing involves the cleaning, disinfection, and sterilisation of medical instruments and devices to prevent the transmission of infections. This procedure follows strict guidelines and protocols to ensure that instruments are thoroughly cleaned and free from contaminants. Proper handling, decontamination, and sterilisation techniques should be followed to maintain the safety and integrity of instruments used in patient care.
• Surface Asepsis – surface asepsis refers to the process of cleaning and disinfecting environmental surfaces within healthcare settings to minimise the risk of contamination and transmission of infectious agents. Regular cleaning and disinfection of surfaces, such as countertops, tables, chairs, and equipment, are essential infection control practices. This procedure helps reduce the potential for microbial colonisation and the spread of infections between patients and healthcare personnel.

Patient Treatment

To ensure optimal patient care and hygiene, the following steps should be meticulously followed:

• Preparing the Operating Room: Before attending to a patient, it is essential to clean the dental chair and the operating room using a disinfectant solution. The disinfectant should be sprayed and left to act for a minimum of 10 minutes prior to usage.
• Dental Chair Protection: The dental chair should be covered with a plastic protector. After treatment, the protective covers are removed, and the room and chair are sprayed and cleaned with a phenol solution. Subsequently, they should be allowed to dry.
• Patient Pre-Treatment Rinse: Prior to each treatment, all patients should rinse with a 0.12% chlorhexidine gluconate solution. This step aids in reducing the bacterial load in the oral cavity.
• Protective Goggles: Patients are provided with protective goggles to shield their eyes during dental procedures, safeguarding them from potential splashes or debris.
• Hand Disinfection: Prior to donning gloves, hands should be thoroughly disinfected using an antimicrobial cleaner. Once gloves are worn, only the patient and areas that have been cleaned or disinfected should be touched. The patient’s medical history should not be handled with contaminated gloves. If it is necessary to make notes in the history, gloves must be changed or a clean glove can be placed over the existing glove, which should be removed after completing the history. Alternatively, a suitable barrier can be placed on the pen and over the section of the history to be used.
• Proper Glove and Protective Garment Usage: The dentist should not leave the room without first removing gloves and protective outer garments.
• Disinfection of Non-Sterilisable Items: Large items used in the dental office, such as impression material guns, articulators, face bows, water baths, silicone spray bottles, dental lights, and mould guides, should be disinfected using a suitable disinfectant solution. This can be done through wiping, spraying, or immersing the objects.
• Disinfection of Items Used in Patient Care: All items used directly or indirectly in patient care should be removed from the office. If sterilisation is not possible, these items must be disinfected or placed in a sealed plastic bag with a phenol disinfectant solution before leaving the office. Latex gloves should always be worn during the disinfection process, and items in solution bags should remain submerged for a minimum of 10 minutes.
• Specific Disinfection Guidelines: Different dental materials require specific disinfection procedures. Metal impression trays should be hung and autoclaved before each use. Adhesives for impression trays should be used in single-dose quantities to prevent cross-contamination. Polyvinylsiloxane, polysulfide, impression compound, and zinc oxide eugenol (ZOE) impression materials should be thoroughly rinsed with water and immersed in a 5.25% sodium hypochlorite solution for 10 minutes. Alginate and polyether impressions should be rinsed with water, sprayed with a 5.25% sodium hypochlorite solution, and placed in a plastic bag for at least 10 minutes. Wax, ZOE, and resin-centric logs should be rinsed with water, sprayed with a 5.25% sodium hypochlorite solution, and placed in a plastic bag for 10 minutes. Stone casts requiring disinfection should be sprayed with a 5.25% sodium hypochlorite solution and allowed to stand for at least 10 minutes. Complete dentures and provisional restorations leaving the clinical room should be immersed in a 5.25% sodium hypochlorite solution for 10 minutes.
• Laboratory Disinfection: Laboratory disinfection procedures are crucial to maintaining a safe and hygienic environment in healthcare laboratories. Effective disinfection protocols should be established and followed to decontaminate laboratory surfaces, equipment, and materials. This helps mitigate the risk of cross-contamination and ensures the accuracy and reliability of laboratory results.

Post exposure prophylaxis

• Exposure Assessment: This step involves thoroughly describing the nature of the exposure, providing details on the injury site, performing appropriate local wound care, and documenting the personal protective equipment (PPE) worn by the healthcare worker at the time of the incident.
• Healthcare Worker Assessment: The second step focuses on assessing the healthcare worker involved in the exposure incident. This includes evaluating their immunisation history, previous exposures, and any underlying medical conditions that may impact the risk of infection.
• Source Case Information: Gathering information about the source case is crucial in understanding the potential infectious risks associated with the exposure. This step involves obtaining relevant details about the source individual, such as their medical history, known infections, and viral load, if applicable.
• Serological Testing: Serological testing plays a vital role in determining the immune status of the healthcare worker and identifying any potential infection following the exposure. This step involves conducting appropriate serological tests to assess the worker’s antibody response and confirm their susceptibility or immunity to the pathogen in question.