Dental Infection Control Guidelines

Health Regulation Department
Guidelines on Dental Infection

Prevention and Safety
2012
ACKNOWLEDGEMENT
The Dental Center is grateful to the following individuals
for their contributions
Revised on May 2011
Reviewers
Dr. Nadia Mohd Saleh
Ms. Nisreen Al Qasem
Ms. Joan Binas
Mr. Mathew Retty
Photos
Mr. Jade Melecio
From Clinical Settings & web sources
Contributors
Dr. Zuhair Z. Al Khatib

Consultant Endodontist
Dr. Mir Asad Ali

Consultant oral & Maxillofacial Surgeon
Dr. Khaled K. Al Gergawi

Senior Specialist Registrar Prosthodontist
Dr. Nadia M. Saleh

Specialist Registrar General Dentist
Dr. Faiqa M. Sharaf

Specialist Registrar General Dentist
Mrs. Brijeethamma T. Thekkemuri

Dental Nurse
Mrs. Nisreen M. Al Qaseim

Dental Hygienist
Mrs. Dana Al Khatib
Director- Dental Centre

Dr. Tariq Abdulkader khoory
DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 2 of 76

PREFACE
A number of diseases can be transmitted via routine dental care.
Fortunately, infection control and safety procedures when adhered to,
greatly reduce the risk to patients and dental workers.
Infection Control involves policies and procedures used to prevent

or reduce the potential for disease transmission
The GOAL of good infection control in dentistry is to treat every

patient as though he or she is infected with an incurable disease.
The method to implement this goal is to develop an infection control

protocol for use in the Dental Operatory that is simple and effective
for use with all patients.
If appropriate measures are taken, infection control will then occur

as a routine component of Dental Practice
Infection Control attempts to break one or more links in the CHAIN

OF INFECTION
The principles/ELEMENTS of Infection Control Which makes up the

basis in breaking the chain of infection will guide you by keeping
yourself and the patient safe.
I. Take action to stay healthy

II. Avoid Contacting blood and body fluids
III. Limit the spread of contamination
IV. Make objects safe for use.

TABLE OF CONTENTS
Chapter 1: Elements of a dental personnel health program

Chapter 2: Preventing transmission of blood borne pathogens
Chapter 3: Hand Hygiene
Chapter 4: Personal Protective Equipment
Chapter 5: Contact Dermatitis / Latex hypersensitivity
Chapter 6: Sterilization and Disinfection of Patient Care Items
Chapter 7: Environmental Infection Control
Chapter 8: Medical Waste Management
Chapter 9: Dental Unit Water-lines, Bio-film and water quality

Chapter 10: Dental hand-pieces and other devices attached to air
and water lines
Chapter 11: Dental radiology
Chapter 12: Other Recommendations
Chapter 13: Dental Laboratory

Chapter 14: Program Evaluation
Quick reference Guides
Glossary

Chapter I
ELEMENTS OF A DENTAL PERSONNEL HEALTH PROGRAM
General recommendations
• Health program for dental center personnel includes policies
procedures and guidelines for education and training;
immunizations; exposure prevention and post exposure
management; medical conditions, work-related illness and
associated work restrictions; contact dermatitis and latex
hypersensitivity and maintenance of records, data management
and confidentiality.
• Establish referral arrangement with qualified healthcare
professionals to ensure prompt and appropriate provision of
preventive services, occupationally related medical services and
post exposure management with medical follow-up. please refer
to Policy and procedure on incident reporting, sentinel even and
occupational exposure management
Education and training

• Provide dental healthcare personnel.(please refer to orientation
checklist)
a. On initial employment.
b. When new task or procedures affect the employee's occupational
exposure
c. Education and training regarding occupational exposure to
potentially infectious agents and infection control procedures.
• Provide educational information appropriate in content and
vocabulary to the educational level, literacy and language of
dental healthcare personnel.
Immunization programs
• Provide comprehensive immunization policies of dental
healthcare personnel, which include a list of all required and
recommended immunizations.
• Refer dental healthcare personnel to a prearranged qualified
healthcare professional or to their own healthcare professional to
receive all appropriate immunizations based on latest
recommendations as well as their medical history and risk for
occupational exposure.
Exposure Prevention and Post exposure management

Comprehensive post exposure management and medical follow-up
program.

• Includes policies and procedures for prompt reporting, evaluation
counseling, treatment and medical follow-up of occupational
exposures.
• Establish mechanisms for referral to a qualified healthcare
professional for medical evaluation and follow-up.
• Conduct a baseline two step test (TST) for all dental healthcare
personnel who might have contact with persons with suspected
or confirmed infectious TB, regardless of the risk classification.
Medical Conditions, Work-Related Illness, and Work

Restrictions
• Provide dental healthcare personnel comprehensive policies
regarding work restriction and exclusion that includes a
statement of authority defining who can implement the policy.
• Provide policy for work restriction and exclusion that encourage
dental healthcare personnel to seek appropriate preventive and
curative care and report their illnesses, medical conditions or
treatments that can render them more susceptible to
opportunistic infection or exposures.
• Provide procedures for evaluation, diagnosis, and management
of dental healthcare personnel with suspected or known
occupational contact dermatitis.
• Seek definitive diagnosis by a qualified healthcare professional
for any dental healthcare personnel with suspected latex allergy
to carefully determine its specific etiology and appropriate
treatment as well as work restrictions and accommodations.
Records Maintenance Data Management and Confidentiality

• Establish and maintain confidential medical records (e.g.,
immunization records and documentation of tests received as a
result of occupational exposure) for all dental healthcare
personnel.
• Ensure that the practice complies with all applicable local laws
regarding medical record keeping and confidentiality.

Chapter 2
PREVENTING TRANSMISSION OF BLOODBORNE PATHOGENS
Blood Borne pathogens are disease agents that exist in blood and certain
body fluids of infected individuals. The most effective ways to prevent
transmission of blood borne pathogens include
• Vaccination
• Standard Precautions
• Strategies to prevent injuries with sharp instrument
HBV Vaccination
• Offer HBV vaccination series to all dental healthcare personnel

with potential occupational exposure to blood or other
potentially infectious material.
• Always follow Public Health Service/CDC recommendations for
hepatitis B vaccination, serologic testing, follow-up and
booster dosing.
• Test dental healthcare personnel for anti-HBs 1-2 months
after completion of the 3-dose vaccination series.
• Dental healthcare personnel should complete a second 3-dose
vaccine series vaccine or to be evaluated to determine if they
are HBsAg- positive; if no antibody response occurs to
primary vaccine series.
• Retest for anti-HBs at the completion of the second vaccine
series. If no response to the second 3-dose vaccine occurs,
non-responders should be tested for HBsAg.
• Counsel non-responders to vaccination who are HBsAg-
negative regarding their susceptibility to HBV infection and
precautions to take.
• Provide employees appropriate education regarding the risks
of HBV transmission and the availability of the vaccine.
Employees who decline the vaccination should sign a
declination form to be kept on file with the employer.
• The following table summarizes the vaccination series for
occupational exposures.

Vaccine Dose Schedule Indications Major Special Consideration
Precautions/Contraindications
HEPATITIS B 3-dose schedule, IM in Workers at risk of exposure to History of anaphylactic No therapeutic or adverse effect
recombinant vaccine the deltoid blood and body fluids reaction to common baker's on HBV-infected persons.
2nd dose given 1 yeast. Pregnancy is not a Healthcare workers who have an
month after 1st dose contraindication ongoing contact with patients or
3rd dose given blood should be tested 1-2
4months months after completing the
vaccination series to determine
serologic response if vaccination
does not induce adequate
antibodies a second vaccine
series should be given
INFLUENZA vaccine Annual single-dose Workers who have contact with History of anaphylactic Recommended for women in the
(inactivated) vaccination, IM, with patients at high risk or working hypersensitivity to eggs or to 2nd or 3rd trimester of pregnancy
current vaccine in chronic-care facilities; other vaccine components during influenza season and
workers age 50 or over or who women in any stage of pregnancy
have high risk medical who have chronic medical
conditions conditions that are associated
with an increased risk of influenza
MEASLES live-virus 1 dose SC; 2nd dose at Workers born during or after Pregnancy; MMR (measles, mumps, rubella)
vaccine least 4weeks later. 1957 without documentation of immunocompromised state is the recommended vaccine if
(1)receipt of two doses of live (including HIV-infected recipients are also likely to be
vaccine on or after their first persons with severe susceptible to rubella or mumps;
birthday, (2)physician- immunosuppression); history persons vaccinated between1963
diagnosed measles or (3) of anaphylactic reaction after and 1967 with (1) a measles
laboratory evidence of receipt of neomycin. Or killed virus alone, (2) killed-virus
immunity. Vaccine should also recent receipt of antibody- vaccine followed by live virus, or
be considered for all workers, containing blood products. (3) a vaccine of unknown type
including those born before should be revaccinated with 2

1957, who have no proof of doses of live-virus measles
immunity. vaccine.
MUMPS live-virus 1 dose SC; no booster Workers believed to be Pregnancy; MMR is the recommended vaccine
vaccine susceptible can be vaccinated; immunocompromised state;
adults born before 1957 can be history of anaphylactic
considered immune. reaction after gelatin
ingestion or receipt of
neomycin.
RUBELLA live- virus 1dose SC; no booster Male female workers who lack Pregnancy; Women pregnant when
vaccine documentation of receipt of live immunocompromised state; vaccinated or who become
vaccine on or after their first history of anaphylactic pregnant within 4 weeks, of
birthday or who lack laboratory reaction after receipt of vaccination should be counseled
evidence of immunity. Adults neomycin. on the theoretic risks to the fetus,
born before 1957 can be however, the risk of rubella
considered immune, except vaccine-associated malformations
women of child bearing age. among these women is negligible.
MMR is the recommended vaccine
VARICELLA-ZOSTER Two 0.5mL doses SC; Workers without reliable Pregnancy; Serologic testing before
live-virus vaccine 4-8 wks if age 13 or history of varicella or immunocompromised state; vaccination may be cost effective.
older. laboratory evidence of varicella history of anaphylactic
immunity. reaction after receipt of
neomycin or gelatin; recent
receipt of antibody-containing
blood products; salicylate use
should be avoided for 6weeks
after vaccination.

Preventing Exposure to Blood and Other Infectious
materials
General recommendations
o Use standard precautions [Occupational Safety and Health
Administration (OSHA's blood borne pathogen standard
retains the term universal precautions)] for all patient
encounters.
o Consider sharp items (e.g., needles, scalers, burs, lab knives,
and wires) that are contaminated with patient blood and
saliva as potentially infective and establish engineering
controls and work practices to prevent injuries.
Engineering and work practice controls
o Identify, evaluate and select devices with engineered safety
features as they become available on the market (e.g., safer
anesthetic syringes, blunt suture needle, retractable scalpel or
needleless I.V systems).
o Place used disposable syringes and needles (without
attempting to separate the two), scalpel blades and other
sharp items in appropriate puncture- resistant containers
located as close as feasible to the area in which the items are
used.
o Do not recap used needle by using either hands or any other
technique that involves directing the point of a needle toward
any part of the body. Do not bend, break or remove needle
before disposal.
o Use either a one handed scoop technique or a mechanical
device designed for holding the needle cap when recapping
needles (e.g., between multiple injections and before
removing from a non disposable aspirating syringe).
Personal Protective Equipment (PPE)
Always wear adequate personal protective equipment whenever

exposure to patient body fluids is expected (Standard Precautions)
Post exposure management and prophylaxis

• An exposure is a medical emergency. In the event of an
exposure, Perform First Aid- Report injury to employer
(Incidence Report)- Report to designated Healthcare
professional for medical evaluation and follow-up care as
indicated
• Follow CDC recommendations after percutaneous, mucous

membrane, or nonintact skin exposure to blood or other
potentially infectious material (OPIM).

Chapter 3
HAND HYGIENE
Hand hygiene is considered the single most important way to reduce the
risk of disease transmission. To ensure you always use the proper
technique, consider the type and length of procedures you will be
performing, the degree of contamination you are likely to encounter, and
the persistence of anti-microbial activity you will need.
(Refer to Policy and procedure on hand hygiene- PHCSS)
• Perform hand hygiene with both a non-antimicrobial or
antimicrobial soap and water when hands are visibly dirty or
contaminated with blood or other potentially infectious
material. If hands are not visibly soiled, an alcohol-based
hand rub can also be used. Follow the manufactures
instructions.
• Indications for hand hygiene include:(Refer to Hand hygiene
audit tool on opportunity based procedure and the “five
moments for hand hygiene- WHO)
a. when hands are visibly soiled.
b. after barehanded touching of inanimate objects likely to be
contaminated by blood, saliva or respiratory secretions.
c. before and after treating each patient.
d. immediately after removing gloves.
The WHO five moments for hand hygiene are as follows:

1. Before touching the patient
2. before Clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings
• For oral surgical procedures, perform surgical hand antisepsis
before donning sterile gloves. Follow the manufacturer's
instructions either by using an anti microbial soap and water,
followed by drying hands and application of an alcohol-based
surgical hand scrub product with persistent activity.
• Store liquid hand-care products in either disposable closed
containers or closed containers that can be washed and dried
before refilling. Do not add soap or lotion to (i.e. top off) a
partially empty dispenser.
• Avoid using multiple use, hanging towels in health-care
settings. Disposable paper towels are more hygienic
• The Hand-Hygiene Process should include the six critical
steps which will ensure that all the areas of the hands are
covered. Posters that demonstrate and remind the health
care personnel and even the public for proper Hand hygiene

could be posted within and around the areas of an
organization.
Hand hygiene is an essential infection control practice to protect

patients, healthcare personnel, and visitors, and is required for both
Standard and Expanded Precautions. Hand hygiene should be
performed immediately after removing PPE, during PPE changes
(with removal if necessary), and between patient contacts. Wash
your hands thoroughly with soap and warm water or, if hands are
not visibly soiled, use an alcohol-based hand rub.
Alcohol based hand rubs: these agents provide persistent

antimicrobial activity on the skin and are particularly useful for a
quick asepsis and it can be done on the go. Critically placed hand-
rub dispensers will enable an easy access when a hand-wash is not
feasible. But these agents are NOT effective cleaners and should
NOT be used when hands are visibly soiled
Special Consideration for Hand Hygiene and Glove Use

• Use hand lotions to prevent skin dryness associated with
hand washing
• Consider the compatibility of lotion and antiseptitic products
and the effect of petroleum or other oil emollients on the
integrity of gloves during product selection and gloves use.
• Keep fingernails short with smooth, filed edges to allow
thorough cleaning and prevent glove tears.
• Do not wear artificial finger nail or extenders when having
direct contact with patients (especially those in high risk)
• Nail varnishes and paints are also not recommended
• Do not wear hand or nail jewelry if it makes donning gloves
more difficult or compromise the fit or integrity of the gloves.

AWARNESS POSTERS on HAND HYGIENE

Chapter 4
PPE (Personal Protective Equipment)

As a part of standard precautions, PPE should be worn by Dental Workers
which is effective in preventing exposure to Blood and other body fluids
by providing a physical barrier.

Personal Protective Equipment
All of the PPE prevent contact with the infectious agent, or body
fluid that may contain infectious agents, by creating a barrier
between the worker and the infectious material. Gloves protect the
hands, gowns or aprons protect the skin and/or clothing, masks
and respirators protect the mouth and nose, goggles protect the
eyes, and face shields protect the entire face. The respirator has
been designed to also protect the respiratory tract from airborne
transmission of infectious agents.
When you are selecting PPE, consider three key points:

1. Anticipated exposure
2. Durability and appropriateness of PPE
3. Fit
First, anticipated exposure can include personal touch, splashes or

sprays, or large volumes of blood or body fluids that could
penetrate the clothing. Selection of personal protection, or a
combination of PPE, also depends upon the patient’s category of
isolation precautions.
Second, and very much linked to the first, is the durability and
appropriateness of the PPE for the task.
Third, you must be concerned with proper fit. PPE must fit the
individual user.
Masks, Protective Eyewear and Face Shields

• Wear a surgical mask and eye protection with solid side
shields or a face shield to protect mucous membranes of the
eyes, nose and mouth during procedures likely to generate
splashing or splattering of blood or other body fluids.
• Ensure that the mask when worn, fit well over the nose and
mouth
• Change masks between patients or during treatment if the
mask becomes wet and after every patient
• Clean the re-usable eye wears with soap and water, or if
visibly soiled, clean and disinfect with an intermediate- level
disinfectant. (e.g., clinician and patient protective eyewear or
face shields) between patients.
Face mask with added eye shield

Protective Clothing
• Wear protective clothing (e.g., reusable or disposable gown,
laboratory coat, or uniform) that covers personal clothing and
skin (e.g., forearms) likely to be soiled with blood, saliva or
other potentially infectious materials (OPIM)
• Change protective clothing if visibly soiled: change
immediately or as soon as feasible or if penetrated with blood
or other potentially infectious fluid.
• Remove barrier protection, including gloves, mask, eyewear,
gown before departing the work area.
Gloves
Gloves are the most common type of PPE used in healthcare

settings. There are several things to consider when selecting the
right glove:
• Purpose: patient care, environmental services, other

• Glove material: vinyl, latex, nitrile, other
• Sterile or nonsterile
• One or two pairs
• Single-use or reusable
Most patient-care activities require the use of a single pair of

nonsterile gloves made of latex, nitrile, or vinyl. Because of allergy
concerns, some facilities have eliminated or limited latex products,
including gloves, and now use gloves made of nitrile or other
material. Vinyl gloves are frequently available and work well if there
is limited patient contact.
Some gloves do not fit the hand snugly, especially around the wrist,
and should not be used if extensive contact is likely. Gloves should
fit comfortably, neither too loose nor too tight. They should not tear
or damage easily. Gloves are sometimes worn for several hours,
and they need to stand up to the task.
Sterile surgical gloves are worn by surgeons and other healthcare

personnel who perform invasive patient procedures. Environmental
services personnel often wear reusable heavy-duty gloves made of
latex or nitrile to work with caustic disinfectants when cleaning
environmental surfaces.
Recommendations
• Wear medical gloves when a potential exists for contacting

blood saliva or potentially infectious material or mucous
membrane.

• Wear a new pair of medical gloves for each patient, remove
them promptly after use, and wash hands immediately to
avoid transfer of microorganisms to other patients or
environments.
• Remove gloves that are torn, cut or punctured as soon as
feasible and wash hand before regloving.
• Never Wash, Disinfect or sterilize surgical gloves before use.
Doing so may compromise the integrity of the glove material.
• Ensure that appropriate gloves in the correct size are readily
accessible.
• Use puncture and chemical-resistant utility gloves when
cleaning instrument and housekeeping tasks involving
contact with blood or other potentially infectious material.
• Use two pairs of gloves is not recommended as it does no
provide for any added benefit and the risk remains the same
Sterile Surgeons Gloves and Double Gloving During Oral

Surgical Procedures
• Wear sterile surgical gloves when performing oral surgical
procedures.
• Double gloving technique: no recommendation is offered
regarding the effectiveness of wearing two pair of gloves to
prevent disease transmission during oral surgical procedures.
The majority of studies among healthcare personnel have
demonstrated a lower frequency of inner glove perforation
and visible blood on the dental healthcare workers hands
when double gloves are worn. However, the effectiveness of
wearing two pairs of gloves in preventing disease transmission
has not been demonstrated.
WORK FROM CLEAN TO DIRTY
This is a basic principle of infection control. In this instance it refers

to touching clean body sites or surfaces before you touch dirty or
heavily contaminated areas. Limit opportunities for “touch
contamination” protect yourself, others, and environmental
surfaces.
"Dirty to Dirty-Clean to Clean",
That is, contaminated surfaces only touch other contaminated

surfaces: your bare hand, which is clean, touches only clean areas
e.g. inside the other glove.

Change Gloves as needed
If gloves become torn or heavily soiled and additional patient care

tasks must be performed, change gloves before starting the next
task. Always change gloves after each patient, discarding them in
the nearest appropriate receptacle. Patient-care gloves should never
be washed and used again.
Donning Techniques-Sterile Gloves

There are two techniques for donning sterile gloves, "Closed
Donning" and "Open Donning". Regardless of which one you use, it
is vital that all surface powder be removed from powdered gloves
after donning. This can be done with either sterile water from a
pour rinse, or a sterile wipe. Latest surgical gloves available in the
market do not require pre-washing or removal of powder of any
kind
Closed Donning
1. Peel open the outer pack from the corners. The inner pack is
sterile. Gripping it through your gown, open it to display the gloves.
(Image below)
2. With your gown covering your fingers, use your right hand to
remove the left glove. Hold your left hand palm up, fingers straight.
Lay the glove on your left wrist, and grip the cuff with your left
thumb.

3. Place your right thumb inside the top cuff edge. Make a fist with
your right hand and stretch the glove over your left fingertips.
4. Keeping your left fingers straight, pull down the glove.
5. Repeat the above procedure to don the other glove, that is: use
your gloved left hand to lay the right glove on your right wrist. Slide
your left thumb inside the top of the cuff, make a fist, and stretch
the cuff over your right fingertips. Pull down the sleeve and glove
together.

Open Donning
1. Pick up the cuff of the first glove with your left hand. Slide your
right hand into the glove until you have a snug fit over the thumb
joint and knuckles. Your bare left hand should only touch the folded
cuff - the rest of the glove remains sterile.
2. Slide your right fingertips into the folded cuff of the left glove.
Pull out the glove and fit your right hand into it.

3. Unfold the cuffs down over your gown sleeves. Make sure your
gloved fingertips do not touch your bare forearms or wrists.
Glove Removal
The key to removing both sterile and non-sterile gloves is
1. Take hold of the first glove at the wrist.

2. Fold it over and peel it back, turning it inside out as it goes. Once
the glove is off, hold it with your gloved hand.
3. To remove the other glove, place your bare fingers inside the
cuff without touching the glove exterior. Peel the glove off from the
inside, turning it inside out as it goes. Use it to envelope the other
glove.

Gowns
Isolation gowns are generally the preferred PPE to protect clothing,

but aprons occasionally are used where limited contamination is
anticipated. Gowns should fully cover the torso, fit comfortably over
the body, and have long sleeves that fit snuggly at the wrist.
1. Isolation gowns are made either of cotton or a spun-synthetic

material, which dictates whether they can be laundered and reused
or must be discarded.
2. Clean gowns are generally used for isolation. Sterile gowns are
only necessary for performing invasive procedures, such as
inserting a central line. In this case, a sterile gown would serve for
both patient and healthcare worker protection.
Face Protection
Several PPE types are available to protect all or parts of the face
from contact with potentially infectious material.
Masks should fully cover the nose and mouth and prevent fluid
penetration. Masks should fit snuggly over the nose and mouth.
Goggles provide barrier protection for the eyes; personal

prescription lenses do not provide optimal eye protection and should
not be used as a substitute for goggles. Goggles should fit snuggly
over and around the eyes or prescription lenses
Face shield is used when

skin protection is
needed or desired in
addition to mouth, nose,
and eye protection, the
face shield should cover
the forehead, extend
below the chin, and
wrap around the side of
the face.

Sequential Donning of PPE for a procedure
1. To don a gown, first select the appropriate type for the task
and the right size for you. The gown should open in the back;
secure the gown at the neck and waist. If the gown is too
small to fully cover your torso, use two gowns. Put on the first
gown with the opening in front and the second gown over the
first with the opening in the back.
2. Some masks are fastened with ties, others with elastic. If the
mask has ties, place the mask over your mouth, nose, and
chin. Fit the flexible nosepiece to the bridge of your nose; tie
the upper set at the back of your head and the lower set at
the base of your neck (Figure 2).
Mask worn well
If a mask has elastic head bands, separate the two bands and hold
the mask in one hand and the bands in the other. Place and hold
the mask over your nose, mouth, and chin, then stretch the bands

over your head and secure them comfortably as shown; one band
on the upper back of your head, the other below the ears at the
base of the neck. Adjust the mask to fit. Remember, you don’t want
to be touching it during use, so take the few seconds needed to
make sure it is secure on your head and fits snugly around your
face so there are no gaps.
If eye protection is needed, either goggles or a face shield should be

worn. Position either device over the face and/or eyes and secure to
head using the attached earpieces or headband. Adjust to fit
comfortably. Goggles should feel snug but not tight.
Position goggles over eyes and secure to the

head using the earpieces or headband.
Position face shield over face and secure on brow

with headband; adjust to fit comfortably.
The last item of PPE to be donned is a pair of gloves. Be sure to

select the type of glove needed for the task in the size that best fits
you. Insert each hand into the appropriate glove and adjust as
needed for comfort and dexterity. If you are wearing an isolation
gown, tuck the gown cuffs securely under each glove. This provides
a continuous barrier protection for your skin.

Donning of Gloves
Adjusting gown cuffs securely under the gloves. In addition to

wearing PPE, you should also use safe work practices. Avoid
contaminating yourself by keeping your hands away from your face
and not touching or adjusting PPE. Remove your gloves if they
become torn and perform hand hygiene before putting on a new
pair of gloves. Avoid spreading contamination by limiting surfaces
and items touched with contaminated gloves.
Removing PPE
To remove PPE safely, you must first be able to identify what sites
are considered “clean” and what are “contaminated. In general, the
outside front and sleeves of the isolation gown and outside front of
the goggles mask, face shield are considered “contaminated,”
regardless of whether there is visible soil. The outside of the gloves
are contaminated. The areas that are considered “clean” are the
parts that will be touched when removing PPE. These include the
insides of the gloves; the gown ties and the inside and back of the
gown; and the ties, elastics, or earpieces of the mask, goggles, and
face shield. The sequence for removing PPE is intended to limit
opportunities for self-contamination.
The gloves are considered the most contaminated pieces of PPE and
are therefore removed first. The face shield or goggles are removed
next
To remove gloves, using one gloved hand, grasp the outside of the
opposite glove near the wrist. Pull and peel the glove away from the
hand. The glove should now be turned inside-out, with the
contaminated side now on the inside. Hold the removed glove in the
opposite gloved hand. Slide one or two fingers of the ungloved hand
under the wrist of the remaining glove. Peel glove off from the
inside, creating a bag for both gloves. Discard in waste container.

Removing Gloves
To remove goggles, using ungloved hands, grasp the “clean” ear- or

headpieces and lift away from face. If goggle or face shield are
reusable, place them in a designated receptacle for reprocessing.
Otherwise, discard them in the waste receptacle.
Removing Eye/face wear
To remove your gown, unfasten the gown ties with the ungloved
hands. Slip your hands underneath the gown at the neck and
shoulder, and peel it away from the shoulders. Slip the fingers of
one hand under the cuff of the opposite arm. Pull the hand into the
sleeve, grasping the gown from inside. Reach across your body and
push the sleeve off the opposite arm. Fold the gown toward the
inside and roll into a bundle. (Only the “clean” part of the gown
should be visible.) Discard into a waste or linen container, as
appropriate.

The front of the mask is considered contaminated and should not be
touched. Remove your mask by handling only the ties or elastic
bands, starting with the bottom following with the top tie or band.
Lift the mask or respirator away from the face and discard it into
the designated waste receptacle.
Removing the Mask

Healthcare personnel are required to wear PPE beyond that recommended
for Standard Precautions. The three Expanded Precautions categories
(formerly called transmission-based precautions) where this applies are:
• Contact Precautions
• Droplet Precautions
• Airborne Infection Isolation
Contact Precautions requires gloves and gown for contact with the
patient and/or the environment of care; in some instances, use of this PPE
is recommended when entering the patient’s environment. Droplet
Precautions requires the use of a surgical mask within three feet of the
patient. Airborne Infection Isolation requires that a particulate
respirator be worn and use of a negative-pressure isolation room.

Chapter 5
CONTACT DERMATITIS LATEX HYPERSENSITIVITY

While the benefits of gloving and hand washing cannot be understated,
some adverse skin conditions can develop as a result of frequent and
repeated hand-washing, exposure to chemicals and glove use.
• Irritant Contact dermatitis (Physical irritation and non

allergic)
• Allergic Contact dermatitis (Allergic reactions type IV
delayed hypersensitivity to chemicals and rubber
manufacturing chemicals)
• Latex hypersensitivity (Allergic reaction to the proteins
in natural rubber latex)
• Educate dental healthcare personnel regarding the signs,
symptoms and diagnoses of skin reaction associated with
frequent hand hygiene and glove use.
• Screen all patients for latex allergy (e.g., take medical
history).
• Management of patient allergy to latex: provide for a latex
safe environment
Dermatitis

Chapter 6
Sterilization and Disinfection of Patient Care Items
Patient- Care- Items that is, Dental Instruments, Devices and

Equipments- are categorized based on their risk of transmitting disease:
- Critical Items – Penetrate Soft tissue or bone- Highest Risk of
Transmitting Infection
- Semi Critical Items- Touch only mucous membrane- Lower Risk of
Transmission than Critical items
- Non-Critical Items- Only contact Intact Skin- lowest risk of
transmission
This is also known as the SPAULDING Classification.
Instrument Processing require a number of steps to assure that

contaminated patient –care-items are rendered safe for reuse.
Maximum use of single-use disposable patient care items is always
recommended.
Recommendations
• Allow packages to dry in the sterilizer before they are handled
to avoid contamination. Each load or instrument pack must be
processed through the “full-cycle” which will also include the
drying process. Do not attempt to remove instruments prior
to completion
• Reprocess heat-sensitive critical and semi critical instruments
by using high level disinfectant and follow manufactures
instruction for correct use.
• Single use disposable instruments are acceptable and highly
recommended alternative if they are used only once and
disposed of correctly.

• Do not use high level disinfectants for environmental surface
disinfection or as holding solution.
• Ensure that noncritical patient- care items are barrier
protected or clean, or if visibly soiled, cleaned and disinfected
after each use with an EPA {Environmental Protection
Agency} registered disinfectant. If visibly contaminated with
blood use an EPA registered hospital disinfectant with a
tuberculocidal claim (i.e., intermediate level).
• Inform dental health care personnel of all OSHA guidelines for
exposure to chemical agents used for disinfection and
sterilization, using this report identifies areas and tasks that
have potential for exposure.
• Do not disinfect when you can sterilize
Instrument Processing Area

• Instrument processing shouldn’t take place in the operatory. A
Designated central processing area in the office should be

used to control and ensure safety. Divide the instrument
processing area physically or, at a minimum, spatially, into
distinct area for:
a. receiving, cleaning and decontamination.
b. preparation and packaging.
c. sterilization.
d. storage.
Do not store instruments in an area where contaminated
instruments are held or cleaned.
• Train dental healthcare personal to employ work practices
that prevent contamination of clean area and maintain a uni-
directional flow of “dirty-to-clean”
Handling and transporting contaminated patient care items:

• Use appropriate covered puncture resistant container to
transport instruments from clinical area to processing area.
• Use heavy duty utility gloves in addition to other appropriate
PPE whilst handling contaminated patient care items
• If instruments cannot be cleaned soon after use, place them
in a holding solution of detergent or an enzymatic cleaning
solution in order to prevent drying of the debris
Transport trolley with instrument boxes Puncture resistant instrument container
Receiving, Cleaning and Decontamination-Work Area

• Clean all visible blood and other contamination from dental
instruments and devices before sterilization or disinfection
procedures.
• Use automated cleaning equipment (e.g., ultrasonic cleaner or
washer-disinfector) to remove debris to improve cleaning

effectiveness and decrease exposure to potentially infectious
material.
• Use work-practice controls that minimize contact with sharp
instruments if manual cleaning is necessary (e.g., long-
handled brush and performing the cleaning in a deep sink
• Wear puncture- and chemical-resistant/heavy duty utility
gloves for instrument cleaning and decontamination
procedures.
• Wear appropriate PPE (e.g., mask, protective eyewear, and
gown).
• Prior to preparation for packaging instruments for sterilization,
the instruments should inspected for remaining debris and
damages and then dried thoroughly before transfer.
Washer disinfectors
Ultra Sonic Instrument Cleaner

Preparation and Packaging
• Before sterilization of critical and semi critical instruments
inspect for cleanliness, then wrap or place them in containers
designed to maintain sterility during storage (e.g., cassettes
and organizing trays).
• Hinged instruments such as hemostats, extraction forceps and
scissors should be processed open and unlocked to permit the
sterilizing agent to contact all surfaces.
• Use an internal chemical indicator in each package. If the
internal indicator cannot be seen from outside the package
also use an external indicator.
• Use a container system or wrapping material compatible with
the type of sterilization process used.
• Label each instrument pack with the date and the name of the
personnel responsible for cleaning, and packing of the
instruments.
Label the pack with the date, cycle load and initial of the sterilizer
attendant.
Sterilizers
There are three types of sterilization methods:

• In dental Settings, heat Tolerant instruments are sterilized by
steam under pressure (autoclaves), dry heat, or unsaturated
chemical vapor.
• Always follow manufacturer's instructions for proper use.
• Use only medical devices for the purpose of sterilization of
contaminated patient care items.

Heat Sterilization Methods
Method Temperature/ Exposure Advantages Precautions

Pressure Time (a)
Steam 121C (250F) 13-30 min - Good - Non stainless steel items
Autoclave (b) 115 kPa 3.5-12 min penetration corrode
- Non-toxic - May damage rubber &
134C (273F) - Time efficient plastics
216 kPa - Do not use closed
containers
- Unwrapped items quickly
contaminated after cycle
Dry heat (c) 160C (320F) 60-120 min - No corrosion - Long cycle time
(oven-type) - Non-toxic - May damage rubber &
- Items are dry plastics
after cycle - Door can be opened
- Can use during cycle
closed - Unwrapped items quickly
container (d) contaminated after cycle
Dry heat (c) 191C (375F) - 12 min: - No corrosion - May damage rubber &
(rapid heat wrapped - Non-toxic plastics
transfer) - 6 min: - Time efficient - Door can be opened
unwrapped - Items dry during cycle
quickly - Unwrapped items quickly
Unsaturated 134C (273F) 20 min - No corrosion - May damage rubber &

chemical 216 kPa - Time efficient plastics
vapor (b) - Items dry - Do not use closed
quickly containers
- Must use special solution
- Uses hazardous chemical
- Unwrapped items quickly

Sterilization Monitoring
• Use mechanical, chemical, and biological monitors according
to the manufacturer's instructions to ensure the effectiveness
of the sterilization process.
• Monitor each load with mechanical (e.g., time, temperature
and pressure) and chemical indicators.
• Place a multi-parameter chemical indicator on the inside of
each package. If the internal indicator is not visible from the
outside, also place an external chemical indicator ON the
package
• Place items and packages correctly and loosely into the
sterilizer so as not to impede penetration of the sterilant.
• Do not use instrument packs if mechanical and chemical
indicators indicate inadequate processing.
• Monitor sterilizers at least weekly using a biological indicator.
• Use a biological indicator for every sterilizer load that contains
an implantable device or instruments used for an invasive
procedure.
• Maintain Sterilization records (chemical, mechanical and
biological) in compliance with local regulations
(Refer to the OSAP and departmental polices for the latest guidelines
and protocol for a sterilization failure)
Biological indicators and incubator

Chemical Indicators
Storage Area for Sterilized Item and Clean Dental Supplies

• Packaged items should always be dried and cooled before
storage to maintain integrity of the pack and prevent
condensation.
• Store sterile items and dental supplies in covered or closed
cabinets if possible.(Not under areas such as sinks)
• Maintain stock rotation according to the principle "first-in first
out" so that older items are used first.
• The shelf life of sterilized instruments is the period during
which an item is considered safe for use. It depends on the
quality of the packaging material, storage conditions, and
conditions during transport and the amount of handling an
item has received.
• Implement practices on the basis of date or event related
shelf life for storage, wrapped sterilized instruments and
devices.
• Even for event related packaging, at a minimum, place the
date of sterilization and if multiple sterilizers are used in the
facility, the sterilizer used, on the outside of the packaging
material to facilitate the retrieval of processed items in event
of sterilization failure.
• Sterile supplies should be transported in a covered or
enclosed cart as and when required to the clinical areas. The
cart should be clean, and dried prior to use and frequently
• Examine wrapped packages of sterilized instruments before
opening them to ensure the barrier wrap has not been
compromised during storage.
• Re-clean, repack, and sterilize an instrument package that
has been compromised.

Sterilization of Unwrapped Instruments (flash sterilization)
The flash cycle on a stem sterilizer processes items to be
used immediately.
• Flash sterilization is not intended for routine instrument

processing
• Clean and dry instruments before the unwrapped sterilization
cycle.
• Use mechanical and chemical indicators for each unwrapped
sterilization cycle (i.e., place an internal chemical indicator
among the instruments or items to be sterilized).
• Allow unwrapped instruments to dry and cool in the sterilizer
before they are handled to avoid contamination and thermal
injury.
• Semi-critical instruments that will be use immediately or
within a short time can be sterilized unwrapped on a tray or in
a container system, provided that the instruments are
handled aseptically during removal from the sterilizer and
transport to the point of use.
• Critical instruments intended for immediate reuse can be
sterilized unwrapped if the instruments are maintained sterile
during removal from the sterilizer to the point of use.
• Do not sterilize implantable devices unwrapped.
• Do not store instruments un-wrapped.
• Unwrapped instruments have no shelf-life

Chapter 7
Environmental Infection Control
Environmental Surfaces are surfaces or equipments that does not contact

patient directly which can be become contaminated during patient care.
Certain surfaces especially once touched frequently for example: light
handles, drawer knobs, unit switches can act a s a reservoir for microbial
contamination.
General Recommendations
• Follow the manufacturers' instructions or correct use of
cleaning and EPA-registered hospital disinfecting products.
• Do not use high level disinfectants for disinfection of
• Use PPE as appropriate when cleaning and disinfecting
Clinical Contact Surfaces

• Use surface barriers to protect clinical contact surfaces
particularly those that are difficult to clean and change surface
barriers between patients.
• Clean and disinfect clinical contact surfaces that are not barrier-
protected, by using EPA-registered hospital disinfectant with a
low to intermediate level activity after each patient. Use an
intermediate level disinfectant if visibly contaminated with
blood.
Housekeeping Surfaces
• Clean housekeeping surfaces with a detergent and water or an
EPA-registered hospital disinfectant /detergent on a routine
basis depending on the nature of the surface and type and
degree of contamination and as appropriate, based on the
location in the facility, and when visibly soiled.
• Clean mops and cloths after use and allow drying before reuse
or using single use disposable mop heads or cloths.
• Prepare fresh cleaning or EPA-registered disinfectant solutions
daily and as instructed by the manufacturer.
• Clean walls blinds and window curtains in patients care areas
when they are visibly dusty or soiled.
Spills of Blood and Body Substances

Refer: Policy and Procedure on Spills
• Don gloves and other appropriate PPE. Visible organic material
should be removed with absorbent material (Disposable paper
towels) and discarded in a leak proof appropriately labeled
container (bio-hazard)

• Non-porous surfaces should be cleaned and then dis-infected
with either an EPA registered hospital disinfectant.
Carpet and Cloth Furnishings

Avoid using carpeting and cloth upholstered furnishings in dental
operatories, laboratories and instrument processing areas.

Chapter 8
Medical Waste Management
Medical waste can be defined as any solid waste generated

in a health care facility. Regulations regarding waste
management will vary from region to region and adherence
to local directives is a must
• Ensure that dental healthcare personnel who handle and
dispose of regulated medical waste are trained in appropriate
handling and disposal methods and informed of possible
health and safety hazards.
• Management of regulated medical waste in dental health care
facilities.
Installation of Sharp Disposal Container
a. use a color coded or labeled container that prevents leakage to

contain non sharp regulated medical waste.
b. place sharp items in an appropriate sharp container. Close
container immediately to prevent spillage or protrusion of contents
during handling storage, transport, and shipping.
c. Sharp Containers must have a temporary closure and permanent
lock.
d. must have a visible fill line
e. placed at a height that is slightly below eye level (0 – 15
degrees) for users (typically 52-56 inches of the floor when wall
mounted and 38-42 inches for a seated work station)
f. Installation heights vary depending on whether the installation is
designed to be a standing workstation or a seated workstation.
Maximum and minimum heights for both design situations can be
calculated by establishing the eye-level for each design, the
maximum thumb tip reach (MTTR) – of the target adult female
population and the drop in inches based on an angle of 15 degrees.
Basic formula: fixture height= (eye level height) – (tangent 15
degrees) (MTTR)
SHARPS DISPOSAL CONTAINER

Special Considerations
• Extracted teeth not containing amalgam must be considered

as bio-hazard waste and disposed off appropriately.
Recommendations are that the teeth be cleaned free of visible
blood and gross debris. Place the teeth in a well-constructed
container with a secure lid. Label the container as bio-hazard.
Before being used for educational purposes must be heat-
sterilized.
• Extracted teeth containing amalgam should NOT be placed in
a medical waste container intended for incineration for final
disposal. (Mercury is released into the environment on
extremely high temperatures). Recommendations state that
they be stored in 10% formalin for 14 days.
• Extracted teeth for EDUCATIONAL PURPOSES should be heat
sterilized to allow for safe handling. Store the tooth hydrated
with water or saline
• For disposal of chemical solutions such as expired fixer
solutions and other disinfectants, check with your local
municipal regulations.
• Lead foil from dental film packets are to be deposited in
containers labeled "Recyclable Lead Foil Only" which are
located at each film processing station. No other waste is to
be placed in these containers. (Local Municipal regulations
apply)
Lead X-ray foils are stored and disposed separately

Chapter 9
Dental Unit Waterlines, Bio-film and Water Quality
In most Dental practice settings water used for dental treatment

comes from the municipal water supply directly into the dental
UNIT thin plastic, tubing carries water from the dental unit to the
high-speed hand-piece, air water syringe, ultrasonic scaler, and
subsequently to the operating field in the patient mouth. The
inside surface of this dental water lines can become colonized with
variety of microorganisms, including bacteria fungi and protozoa
that live inside a slim layer that protects and feeds them. This
phenomenon, called a bio-film allows micro-organisms to survive
in the dental water lines, and raises concerns about possible
health effect of exposure to dental unit water.
Recommendations
• Use water that meets standards for drinking water.
• Consult with the dental unit manufacturer for appropriate
methods and equipment to maintain the recommended quality
of dental water.
• Discharge water and air for a minimum of 20-30 seconds after
each patient from any device connected to the dental water
system that enters the patient's mouth (e.g., hand pieces,
ultrasonic scalers, air/water syringes).
Maintaining and monitoring water quality

• Consult the Dental Manufacturing unit or other agencies for
appropriate methods and equipment to maintain the
recommended quality of Dental Water (< 200 Colony Forming
Units)
• Do not use Sodium hypochlorite to clean dental water lines.
• Monitor dental water quality using commercial self contained-
test kits or commercial water testing laboratories.
• If bacterial counts exceed 200 CFU/ml, re-evaluate the
technique, re-treat the dental unit water, and retest the
dental unit immediately before the next scheduled treatment
interval. Continue to monitor until acceptable water quality is
achieved.
Sterile Surgical irrigations

• To help guard against post-surgical infections use only sterile
water or sterile saline as a coolant/irrigate for surgical
procedures that present an increased opportunity for
microorganisms to gain entry into the bloodstream, bone or
tissue under the skin.

Dental Water-lines
Formation of bio-film in a unit water line

Chapter 10
Dental Hand pieces and other Devices Attached to

Air and Waterlines
Because they retract and retain patients materials, dental hand
pieces and other devices used in the mouth and connected to the
dental units air lines and water lines must be heat sterilize between
patients. Components of these devices are prone to contamination
from contact with gloves and droplet spatter should be protected
with a new surface barrier for each patient and cleaned and
disinfected when visibly contaminated.
• Clean and heat-sterilize hand pieces and other intraoral
instruments that can be removed from the air and waterlines
of dental units between patients.
• Follow the manufacturer's instructions for cleaning, lubrication
and sterilization of hand pieces and other intraoral
instruments that can be removed from the air and waterlines
of dental units.
• Do not advise patients to close their lips tightly around the tip
of the saliva ejector to evacuate oral fluids.
• Before removing the hand piece from the hose after
treatment, with the bur still in the chuck, briefly run the
water/air system to flush water lines and airlines.
• Remove the bur from the hand piece, wipe visible debris from
the outer surfaces of the hand piece, and disconnect the hand
piece from the hose.
• If the hand piece requires lubrication before heat-processing,
use a hand piece cleaner recommended by the manufacturer
that will both remove the initial debris and lubricate the hand
piece.
o If the hand piece does not require lubrication before
processing, use a cleaner that does not contain a
lubricant.
o Follow the manufacturer's instructions for each type of
hand piece used.
o Do not over lubricate hand pieces.
• Reattach the hand piece o a hose and operate the drive air
system to blow excess lubricant from the rotating parts.
Failure to perform this step before heat sterilization can lead
to excess lubricant accumulation in the working assembly and
gumming in the rotating assemblies during the heat cycle.

Chapter 11
Dental Radiology
BEFORE TAKING XRAYS

• Use heat-tolerant or disposable intraoral devices whenever
possible (e.g., film-holding, positioning devices). Clean and
heat-sterilize heat tolerant devices between patient.
• High level disinfection of semi critical heat- sensitive devices,
according to manufacturer's instructions.
• Protect radiographic equipment (such as x-ray tubehead and
control panel) with clean surface barriers.
• Prepare all necessary supplies, equipment and instruments
prior to patient seating. Unit-dose all necessary supplies such
as gloves paper towels, paper cups, film mount or paper
envelop as per requirement before seating the patient.
• Have the patient to rinse with a pre-procedural mouth rinse.
• Provide the patient with a lead apron with thyroid collar to
protect against any scatter radiation.
• Wash hands, dry thoroughly and put on exam gloves.
WHILE TAKING XRAYS
• Wear gloves when taking radiographs and handling

contaminated film packets. Use other PPE (e.g., protective
eyewear, mask, and gown) as appropriate if splattering of
blood or other body fluids is likely.
• Touch as few surfaces as possible.
• Stay behind the protective lead partition until after the
exposure.
• Following exposure of the radiograph, with gloves still in place
dry the film with disposable gauze or a paper towel to remove
blood or excess saliva.
• Drop the film packet into a container (such as paper or plastic
cup), be careful not to contaminate the outside of the
container.
AFTER TAKING THE XRAY
• Place reusable film holding devices in the designated area.

• If film barrier pouches have been used, carefully peel back the
barrier and allow each film packet to fall from its pouch into a
clean disposable container. Transport and handle radiographs
in an aseptic manner to prevent contamination of developing
equipment.
• Discard all contaminated disposable items.

• Carefully remove contaminated barriers from covered
surfaces.
• Remove gloves and wash hands.
• Remove lead apron and dismiss the patient.
• Disinfect all uncovered surfaces that were contaminated. If
barriers are not used, x-ray equipment that has come into
contact with gloved hands or contaminated film packets must
be cleaned and then disinfected after each patient. Use a low-
to intermediate-level disinfectant to disinfect the surfaces.
FOR DEVELOPING FILM

• With clean ungloved hands, transport the disposable container
of exposed film to the processing area.
• Take care to avoid contaminating the developing equipment.
Digital x-rays
• Clean and disinfect the digital x-ray sensors and place clean
barriers prior to patient exposure
use of barriers is essential

Chapter 12
Other Recommendations
Pre-procedural Mouth Rinses
No recommendation is offered regarding use of preprocedural
antimicrobial mouth rinses to prevent clinical infections among
dental healthcare personnel or patients. Although studies have
demonstrated that a preprocedural antimicrobial rinse (e.g.
chlorhexidine gluconate, essential oils, or povidone-iodine) can
reduce the level of microorganisms in aerosols and splatter
generated during routine dental procedures.
Oral Surgical Procedures

• Perform surgical hand antisepsis by using an antimicrobial
product (e.g. antimicrobial soap and water, or soap and water
followed by antimicrobial hand scrub) before donning sterile
surgeon's gloves.
• Use sterile surgeon's gloves.
• Use sterile saline or sterile water as a coolant/irrigant when
performing oral surgical procedures. Use devices specifically
designed for sterile irrigating fluids.
Handling Biopsy Specimens

• During transport place biopsy specimens in a sturdy leak proof
container labeled with a biohazard symbol.
• If a biopsy specimen container is visibly contaminated clean
and disinfect the outside of a container or place it in an
impervious bag labeled with a biohazard symbol.
Handling of Extracted Teeth

• Dispose of extracted teeth as regulated medical waste unless
returned to the patient.
• Do not dispose of extracted teeth containing amalgam in
regulated medical waste intended for incineration.
• Clean and place extracted teeth in a leak proof container,
labeled with biohazard symbol, and maintain hydration for
transport to educational institution ao dental laboratory.
• Heat-sterilize teeth that do not contain amalgam before they
are used for educational purposes.

Tuberculosis (TB) and the Dental Practice
TB is a contagious disease caused by the Mycobacterium tuberculosis

bacterium. This bacterium is carried in microscopic airborne particles
called droplet nuclei. Through a productive cough, these droplet nuclei
can be aerosolized from persons with TB and can stay suspended in the
air for several hours, where others breathe them into their lungs.
Although the risk of TB transmission in dentistry is low, your

practice setting should routinely perform risk assessments to
determine TB infection control policies. Such policies cover how
dental workers in your facility detect and defer patients who nay
have active TB, management of Dental emergencies in patients with
active TB, dental worker TB education, training, counseling and
screening.
Patient Management
• Routinely ask all patients whether they have a history of TB

disease or suggestive symptoms.
• Promptly refer for medical evaluation a patient with a medical
history or suggestive symptoms of undiagnosed, untreated
active TB
- While in the Dental Health-Care facility, any patients suspects
should be isolated as well as possible
- Ask the patient to wear a surgical mask when not being
evaluated
- Instruct the patient to cover his or her mouth and nose when
coughing or sneezing
• Defer elective dental treatment until the physician confirms that
the patient does not have infectious TB
• If urgent dental care is needed, provide treatment in a facility
that has TB isolation room and specific air-ventilation systems
- standard surgical face masks do not provide TB transmission
- Only fit-tested, disposable N-95 respirators guards against
airborne disease agents
- Standard Precautions must always be adhered to.

Dental Workers
• Get a base-lines two step tuberculin test at the beginning of
employment
• For a dental worker who has a persistent cough for at least 3
weeks:
- get evaluated immediately by a medical professional
- Do not return to the work-place until the diagnosis of TB has
been ruled out or medications initiated.

Chapter 13
Dental Laboratory
TO CONTAIN CONTAMINATION IN THE DENTAL SETTING
Clinical Disinfection of impressions:
Thoroughly clean and disinfect prostheses, impressions, orthodontic

appliances, and other prosthodontic materials (such as occlusal
rims, temporary prosthesis, bite registrations, and extracted teeth)
to remove blood and bioburden before sending them to the
laboratory.
• Impressions and dental prosthesis should be rinsed under
running tap water then immersed in a tuberculocidal hospital
disinfectant according to the manufacturers recommended
contact time.
• The impression should be gently scrubbed with a camel hair
brush and a liquid detergent to remove bioburden then soaked
with a hospital level disinfectant.
• The disinfected impression should be thoroughly rinsed under
tap water to remove any residual anti microbial chemicals.
• Reversible/irreversible hydrocolloid material, silicone or rubber
based impressions and polyether impression material, should
be handled carefully to prevent distortion.
• Alginate impression should be cleaned and soaked with a
hospital level disinfectant according to manufacturer's
instructions.
• Place a wet gauze or paper towel on the surface of the
impression to prevent distortion.
• The impressions should be transported to the dental lab in
sealed, disposable containers.
• Inform the lab in writing about the details of the patient and
disinfection procedure.
Wash and disinfect impressions before transport to the Lab

Sterilization of Other Materials or Instruments:
1. Heat-sterilize heat tolerant items used in the mouth such as
face bow forks, wax knives and carvers before using them for
other patients.
2. Heat-sterilize metal trays before using them on another
patient.
TO CONTAIN CONTAMINATION IN THE DENTAL LAB

• Establish a dedicated receiving and disinfecting area to reduce
contamination in the production area. The receiving area
technician should use all appropriate personal protective
equipment such as gown, face-shield, and facemask. All items
must be handled in an aseptic manner before transferring the
production area.
• Clean and disinfect the case before handling, unless written
directions states that it has already been done.
• If a previously undetected area of blood or bioburden
becomes apparent on the material or appliance, repeat
cleaning and disinfection procedures.
• Between cases, heat sterilize or high-level disinfect laboratory
items such as burs, polishing points, rag wheels, laboratory
knives that are used on contaminated or potentially
contaminated appliances, prostheses, or other material.
Disposable laboratory items are encouraged to be used.
• Between cases clean and disinfect pressure pots and water
baths.
• Barrier-protect the counters surfaces of the receiving area
with impervious paper and clean and disinfect on a regular
basis.
• Prosthesis, intertreatment prosthodontic materials (e.g.,
occlusal rims, interim prostheses, occlusal registrations, etc.),
and non- sterilizable equipment such as some facebow
components must be cleaned with soap and water and
disinfected with a hospital-level disinfectant if they become
contaminated.
• Discard waste such as disposable containers/trays, impression
material in medial waste bags meant for incineration.
• Articulators and other equipment that make no patient contact
should be cleaned and disinfected with a hospital level
disinfectant, rinsing drying and lubricating (for items with
moving parts).
• The polishing lathe should be cleaned and disinfected daily.

• On the polishing lathe the pumice should be made by
suspending the pumice in tincture of green soap or other
surfactant to prevent colonization of airborne organisms and
the pumice should be changed daily at a minimum. Unit doses
of pumice are recommended to be used. Use physical barriers
at the are of use to minimize splatter of dust that arises from
the pumice.
• Disinfection of the cast is not required as the impression has
been disinfected.
• Dispose of sharp items such as burs, disposable blades, and
orthodontic wires in puncture-resistant containers (Sharps
Box)
• Clean and disinfect countertops and lab benches when visibly
soiled and at the end of daily work activities.
Standard Precautions should be observed in the dental laboratory at

all times as; all patients are treated as though they are capable of
transmitting a blood borne disease. Employee safety precautions are a
must including the use of adequate eye and ear protection

Chapter 14
Program Evaluation
A successful infection control and employee protection program will
have valid means to measure its effectiveness. The following
methods can be used for this purpose
• Sterilization monitoring
• Scheduled and unscheduled inspections
• Waterline monitoring
• Health-care-associated infection monitoring
Evaluation of the infection control programs, including evaluation of

performance indicators will be conducted on a routine basis.

QUICK REFERENCES
QUICK REFERENCE CHART: MANAGING PATIENT-CARE ITEMS AND ENVIORNMENTAL SURFACES
PROCESS DEFINITION METHOD EXAMPLES USED FOR

High
temperature Steam (autoclave),dry heat,
Heat tolerant critical and
unsaturated
Heat
Destroys all Automated
semicritical
microorganisms Low Chemical vapor
Sterilization Heat-sensitive critical and
including temperature ethylene oxide gas, plasma sterilization
semicritical
bacterial spores
Chemical sterilant (e.g. gluteraldehyde,
gluteraldehyde with phenols, hydrogen Heat sensitive critical and
Liquid immersions
peroxide, hydrogen peroxide with semicritical
peracetic acid
Destroys all Heat automated Washer-disinfector

microorganisms
High-level but not Chemical sterilant/high-level
disinfectant (e.g. gluteraldehyde, Heat-sensitive semicritical
disinfection necessarily high Liquid immersions
numbers of orthophthaldehyde, hydrogen peroxide,
bacterial spores etc.)

Destroys
Clinical contact
vegetative
surfaces
bacteria, most Hospital disinfection with label claim of
Intermediat fungi, and most tuberculocidal activity (e.g. chlorine- Noncritical
Liquid contact or barrier
e-level viruses; containing products, quaternary with visible
protection Blood spills on
disinfection tuberculocidal; ammonium compounds with alcohol, blood
house keeping
not necessarily phenolics, iodophors,
surfaces
capable of killing
bacterial spores
Low-level Destroys most Liquid contact or barrier Hospital disinfection with HBV and HIV Noncritical Clinical contact
disinfection vegetative protection claims but no tuberculocidal activity without surfaces that
bacteria (quaternary ammonium compounds, visible blood are thoroughly
some phenolics, some iodophors) cleaned
Housekeeping
surfaces

SUGGESTED PPE FOR TASKS WITHIN THE DENTAL CENTER
Patient Care
Garmen
Comme
Protecti
Protecti
Gloves
Gloves
Utility
Other
None
Face
Eye
on
nt
t
Greeting the patient in the reception x
area
Taking a medical history 1* x
Performing an oral exam x 3* 3* 1*
Polishing Teeth x x x x x
Scaling (manual) x x x x
Scaling (ultrasonic) x x x x
Suctioning during a cavity preparation x x x x
In-operatory charting 1* 2 x
*
Taking an impression x 3* 3* 1*3 x
*
Answering the telephone during 2 x
treatment *
Instrument processing
Placing instruments in a holding x x x x
solution (to keep them moist until they
can be cleaned)
Loading the ultrasonic x x x x
cleaner/instrument washer
Hand scrubbing instruments x x x x
Wrapping instruments for sterilization 1* x
Loading the sterilizer 1* x
Removing instrument packs from the 4
sterilizer *
Distributing/storing wrapped, sterile x
instrument packets
Operatory clean-up
Transporting instruments from x 1*
operatory to the reprocessing area
Environmental surface disinfection (use x x x x
spray-wipe-spray technique)
Placing a clean surface barrier on an 1* x
uncontaminated surface
Maintenance/ quality control
Cleaning the ultrasonic chamber. x x x x
discarding and replacing solution
Recording result of sterilizer monitoring x

*Other/ Comments:
(1) Although might not be required it is acceptable to leave on
protective clothing that has been worn through out patient
treatment as long as it is not visibly soiled. Never wear PPE in coffee
rooms, break rooms or in reception areas.
(2) Alternative to removing gloves, vinyl overgloves (foodhandlers'
gloves) can be donned to limit the spread of contamination to
clinical contact surfaces during treatment interruptions.
(3) Optional; may provide additional protection against non-
bloodborne disease transmission.
(4) Heat-resistant gloves protect against burns from hot instrument
packs.

SUGGESTED WORK RESTRICTIONS FOR HEALTHCARE PERSONNEL
INFECTED WITH OR EXPOSED TO MAJOR INFECTIOUS DISEASES IN
THE DENTAL CENTER
(Regional/ local medical regulations apply)
Disease/Problem Work Restriction Duration

Conjunctivitis Restrict from patient Until discharge ceases
contact and contact with
patients environment
Cytomegalovirus infection No restriction
Diarrheal disease
Acute stage(diarrhea with other Restrict from patient
symptoms) contact, contact with
patients environment, Until symptoms resolve
and food handling
Convalescent stage, Salmonella Restrict from patient

sepsis care at high risk
Enteroviral infection Restrict from care of Until symptoms resolve
infants, neonates and
immunocompromised
patients and their
environments.
Hepatitis A Restrict from patient Until 7 days after onset of jaundice
contact, contact with
patient's environment
and food handling
Hepatitis B
Personnel with acute or chronic No restrictions, standard
hepatitis B surface antigenemia precautions to be
who do not perform exposure followed
prone procedures
Personnel with acute or chronic Until hepatitis B e antigen is negative

hepatitis B surface antigenemia Do not perform invasive
who perform exposure prone procedures until council
procedures from a review panel has
been sought; panel
should review and
recommend procedures
that personnel can
perform, taking into
account specific
procedures as well as
skill and technique.
Standard precautions
should also be observed
Hepatitis C No restrictions on
professional activity.
HCV-positive healthcare
personnel should follow
aseptic technique and
standard precautions

Herpes simplex
Genital No restrictions
Hands (herpetic Whitlow) Restrict from patient Until lesions heal

contact and contact with
patients environment.
Orofacial Evaluate need to restrict

from care of patients at
high risk
Human immunodeficiency virus; Do not perform invasive
personnel who perform procedures until council
exposure prone procedures. from a review panel has
been sought; panel
should review and
recommend procedures
that personnel can
perform, taking into
account specific
procedures as well as
skill and technique.
Standard precautions
should also be observed.
Measles
Active Exclude from duty Until 7 days after the rash appears.
Post exposure (susceptible Exclude from duty From 5 days after first exposure
personnel) through 21days after last exposure
or 4 days after rash appears
Mennigioccocal infection Exclude from duty Until 24hrs after start of effective
therapy.
Mumps
Active Exclude from duty Until 9 days after onset of parotitis
Post exposure (susceptible Exclude from duty From 12 day after first exposure
personnel) through 26th day after last exposure
or until 9 days after onset of parotitis
Pediculosis Restrict from patient Until treated and observed to free of

contact adult and immature lice
Pertussis
Active Exclude from duty From beginning of catarrhal stage
through third week after onset of
paroxysms, or until 5 days after start
of effective antibiotic therapy
Post exposure (asymptomatic No restriction,
personnel) prophylaxis
Post exposure (symptomatic recommended Until 5 days after start of effective
personnel) Exclude from duty antibiotic therapy

Rubella
Active Exclude from duty Until 5 days after rash appears.
Post exposure (susceptible Exclude from duty From 7 days after first exposure
personnel) through 21 day after last exposure
Staphylococcus aureus infection

Active, draining skin lesion Restrict from contact Until lesions after resolved
with patients and
patients environment or
food handling.
Carrier state No restriction unless
personnel are
epidemiologically linked
to transmission of the
organism.
Streptococcal infection, group A Restrict from patient Until 24 hours after adequate
care, contact with treatment started.
patients environment
and foodhandling
Tuberculosis
Active disease Exclude from duty Until proved non-infectious
PPD converter No restriction

Varicella (chicken pox)
Active Exclude from duty Until all lesions dry and crust.
Postexposure (susceptible Exclude from duty From 10th day after post exposure
personnel) through 21st day (28th day if
varicella zoster
immunoglobulin{VZIG}administered)
after last exposure
Zoster (Shingles)
Localized, in health person Cover lesions, restrict Until all lesions dry and crust.
from care of patients at
high risk.
Generalized or localized in Restrict from patient Until all lesions dry and crust.
immunosuppressed person. contact.
post exposure (susceptible Restrict from patient From 10th day after post exposure
personnel) contact. through 21st day (28th day if
varicella zoster
immunoglobulin{VZIG}administered)
after last exposure
Viral respiratory infection, acute Consider excluding from Until acute symptoms resolve.
febrile the care of patients at
high risk or contact with
such patients
environments during
community outbreak of
respiratory syncytial
virus and influenza

Glossary of Terms:
-A-
Aerosols – Particles of a size that can be inhaled (less than 10

microns) generated by both humans and environmental sources
that can survive and remain airborne for extended periods in the
indoor environment. Sources of aerosols in the dental setting
include the use of handpieces, ultrasonic scalers and air-water
syringes.
AIDS – Acquired Immune Deficiency Syndrome, which caused by

infection with the human immunodeficiency virus (HIV) and is
characterized by weakening of the immune system.
Airborne Transmission- A means of spreading infection in which

microscopic airborne particles (droplet nuclei) are inhaled by the
susceptible host.
Alcohol –based hand rub- An alcohol containing waterless antiseptic

preparation that is rubbed onto the hands without wetting or rinsing
to reduce the number of microorganisms on the skin.
Allergic Contact Dermatitis – A skin reaction resulting from a

contact with a chemical allergen (for example certain components of
patient-care gloves, some dental materials), generally confined to
the contact area and appearing slowly over 12-48 hours. Also
referred to as “type IV” or “delayed” hypersensitivity.
Anaphylaxis – A sudden, severe, potentially fatal systemic allergic

reaction with symptoms that can include hives, watery eyes and
difficulty in breathing. Also referred to as “type I” or “immediate”
hypersensitivity.
Antibody – A protein produced by the immune system in response

to the presence of a specific antigen (that is a foreign body / agent
such as a virus); it helps the body fight against infection.
Antimicrobial agent – A product that has the ability to kill or

otherwise irreversibly destroy microorganisms.
Antiseptic – A germicide used on skin or living tissue to inhibit or kill

microorganisms; examples include alcohols, chlorhexidine, chlorine,
hexachlorophene, iodine, chloroxylenol (PCMX), quarternary
ammonium compounds and triclosan.

Antiseptic Handwash – Washing hands with water and a soap /
detergent that contains antiseptic agent.
Antiseptic Handrub – Applying an alcohol-based hand rub products

to all surfaces of the hands to reduce the number of
microorganisms present.
Appliance – A fixed or removable corrected dental device that

replaces, holds or moves teeth, for example partial dental,
orthodontic retainer.
Asepsis – The absence of contamination.
Aseptic Technique – A manner of safe handling and use that

prevents or reduces the spread of microorganism from one site to
another.
-B-
Bacterial endocarditis – An infection of the heart’s inner lining

(endocardium) or the heart valves; occurs when bacteria in the
bloodstream lodge on abnormal heart valves or other damaged
heart tissue.
Barrier – An item that blocks the penetration of microorganisms,

particulates and fluids, thereby reducing the potential contamination
of the underlying surface. Also referred to as ‘’surface barrier”.
Bioburden (1) Organic material on a surface or object prior to

cleaning or sterilization; (2) the number of viable organisms in or
on the object or surface. Also known as “bioload”or “microbial load”.
Biological Indicator – Device that monitor the sterilization process

by using a standardized population of resistant bacterial spores;
verifies that all parameters necessary for sterilization were present.
Also called “spore test” or “BI”.
Biofilm – A complex colony of microorganisms, most notably

bacteria ,that forms on the surfaces that are bathed with water.
Biohazard – A biological agent (such as infectious microorganisms)

or a condition that poses a threat to humans.

Biohazard symbol – Universal indicator of an infectious hazard,
indicated by the symbol
Bloodborne Diseases – An illness that is transmitted by exposure to

pathogens in the blood.
Bloodborne Pathogen – A disease producing microorganism spread

by contact with blood or other body fluids contaminated with blood
from an ifected person; examples include hepatitis B virus, hepatitis
C virus and HIV.
-C-
Carrier – A person, immune or recovered from a disease, who still

harbors and can transmit the infectious agent to others.
CFU/ml – (Colony Forming Units per milliliter) The minimum

number, (that is tens of millions) of separable cells that give rise to
visible growth; may consists of pairs, chains and clusters as well as
single cells.
Chain of Infection – The set of five conditions --- all of which must
be present ---that allows disease transmission to occur; includes (1)
a pathogen in sufficient numbers to cause infection, (2) a place for
the pathogen to reside and multiply,
(3) a mode of transmission to transfer the pathogen to new host;
(4) a portal of entry into a new host (that is, an appropriate route
for the pathogen to enter the body); and (5) a host this is not
immune to the pathogen. Infection control efforts remove one or
more “links” in the chain of infection, thereby preventing disease
transmission.
Chemical Indicator – Device that monitor the sterilization process by

changing color or form with the exposure to one or more sterilizing
conditions (for example temperature, steam); intended to detect
potential sterilization failures due to incorrect packaging, incorrect
sterilizer loading or equipment malfunction.
Cleaning- Removal of visible contamination from a device or

surface, using either the physical action of scrubbing with a
surfactant / detergent and water or an energy-based process (such
as that used by an ultrasonic cleaner) with the appropriate chemical
agents.

Clinical Contact Surface – Surfaces that are touched by
contaminated hands, instruments, devices, or other items while
providing dental or medical care or while performing activities that
support dental or medical care.
Contact time – The exposure time for the disinfectant to accomplish

the desired antimicrobial effect, as defined by the disinfectant
manufacturer.
Contamination – The presence of microorganisms (usually those

capable of producing diseases or infection) on living or nonliving
surfaces.
Critical – The category of medical devices or instruments that cut or

otherwise penetrate bone or soft tissue, providing them with access
to the bloodstream or normally exposed tissues; so named because
of the substantial risk of acquiring infection if such an item is
contaminated.
Cross-contamination – Spreading of microorganisms between

persons and/or surfaces.
-D-
Decontamination – Process that makes a medical device, instrument

of environmental surface safe (that is, no longer capable of
transmitting a disease) to handle, use or discard.
Detergent – Compound with cleaning action but no antimicrobial

activity; also referred to as “soap”.
Direct Contact – Physical transfer of microorganisms between an

infected or colonized person and a susceptible host.
Disinfectant –Chemical agent used on inanimate (nonliving) objects

to destroy virtually all recognized pathogens, but not necessarily
bacterial endospores.
Disinfection – Destruction of pathogenic and other kinds of

microorganisms by physical or chemical means; less lethal than
sterilization, it destroys most recognized pathogens but does not
necessarily kill bacterial endospores.
Droplet Nuclei – Potentially infectious microscopic particles

(5microns or less in diameter) that can remain suspended in the air

for long periods of time; formed by the dehydration of airborne
droplets containing microorganisms. Also see airborne transmission.
Droplets / Spatter – Small particles of moisture expelled into the

air, as when a person coughs or sneezes or when water is converted
to a fine mist by an aerator or shower head. Larger than droplet
nuclei, these particles may contain infectious microorganism but
quickly settle on surfaces, usually limiting the risk of disease
transmission to persons near the source of the droplets.
-E-
Engineering Controls – Controls that isolate or remove the

bloodborne pathogens hazard from a workplace; examples may
include sharps disposal containers and safer medical devices (such
as self sheathing needles and needleless system).
Environmental Protection Agency (EPA) – Bureau of the United

States government charged with regulating the disinfectants used
on environmental surfaces (intermediate and low-level
disinfectants) and waste generated in healthcare facilities.
Environmental Surface – Surface within a dental or medical

treatment area that is not directly involved in patient care that may
or may not be contaminated during the course of treatment;
examples include countertops, drawer handles, floors, walls, and
instrument control panels.
Event-related Packaging – A storage practice that recognizes that a
package and its contents should remain sterile until some event
causes the items to be contaminated.
Exposure Incident – A specific eye, mouth, or other mucous

membrane, non –intact skin or parenteral contact with blood or
other potentially infectious materials that result from the
performance of a worker’s duties.
Exposure Management – Series of steps carried out in the event of

an accidental exposure; includes first aid; immediate reporting and
referral to a qualified healthcare professional for evaluation and
follow – up.
-F-
Flushing – The act of running water through waterlines and / or the

devices attached to them.

Food and Drug Administration (FDA) – Bureau of the United States
government that regulates medical devices such as sterilizers,
instrument cleaners, gloves, syringes, surgical masks and dental
alloys.
-G-
Germicide – An agent that destroys microorganisms, especially

pathogenic microorganisms. Other terms with the suffix “__cide”
(for example virucide, fungicide, bactericide, tuberculocide,
sporicide) use the prefix to indicate the type of microorganisms that
are inactivated (for example a virucide inactivates virus).
Antiseptics are germicides for living tissues; disinfectants are
germicides used on non-living items and surfaces.
-H-
Healthcare-Associated Infections – Any infection associated with a

medical or surgical intervention.
Heat Sterilization – A process that destroys all microbial life,

including bacterial endospores. Autoclaves, chemical vapor
sterilizers and dry-heat sterilizers are used in dentistry for heat
sterilization of patient-care items.
Hepatitis B Immune Globulin (HBIg) – A product prepared from

plasma containing high titers of hepatitis B antibodies that provides
short-term protection (3-6 mos.) against hepatitis B infection; may
be used in post exposure prophylaxis.
Hepatitis B Surface Antigen (HBsAg) – Serologic marker on the

surface of the HBV detected in high levels during acute or chronic
hepatitis.
Hepatitis B e antigen (HBeAg) – Secreted product of the

nucleocapsid gene of HBV found in serum during acute and chronic
HBV infection. Its presence indicates that the virus is replicating and
serves as a marker for increased infectivity.
Hepatitis B surface Antibody (anti-HBs) – Protective antibody

against HBsAg. Presence in the blood can indicate past infection
with and immunity to HBV or immune response from hepatitis
vaccine.

Hepatitis B Virus (HBV) – A highly transmittable bloodborne disease
agent that can cause a form of liver damage; a serious occupational
risk to unvaccinated dental workers.
Hepatitis C Virus (HCV) – A bloodborne disease agent that can

result in very serious liver disease.
High-level Disinfectant – U.S. Food and Drug Administration term

describing a liquid chemical sterilant used for a shorter contact
time; inactivates vegetative bacteria, mycobacteria, fungi, and
viruses but not necessarily high number of bacterial spores.
Hospital Disinfectant – A germicide registered by the U.S. EPA that
is effective against the test microorganisms Salmonella
Choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginosa
for use on nonliving objects in dental or medical facilities.
Host – Person or animal or plant on which or in which a foreign

microorganism lives.
Housekeeping surfaces – Environmental surface that is not involved

in the direct delivery of dental care (for example floors, walls).
-I-
Immunity – Protection against a disease, indicated by the presence

of antibodies in the blood, which usually can be identified with a
laboratory test.
Immunocompromised – Having an immune system that cannot

adequately respond to challenges.
Implantable Device – A device that is placed into a surgically or

naturally formed cavity of the human body where it is meant to
remain for at least 30 days.
Indirect Contact – Contact between a susceptible host and a

contaminated object that is not the original source of the
contamination (for example instruments, equipments or
environmental surface).
Intermediate Level Disinfectant – A chemical liquid germicide

registered with the U.S. EPA as a hospital disinfectant wit a
tuberculocidal activity.
-L-

Low-level disinfection – Process that inactivates most vegetative
bacteria, some fungi and some viruses but cannot be relied on to
inactivate resistant microorganisms.
-M-
Mechanical Indicator – Device (such as gauge, meter, display, or
printout) that displays an element of the sterilization process (for
example time, temperature and pressure).
Medical Waste – Waste generated through the provision of dental or

medical care; may be regulated or non – regulated.
Microorganism – An organism or microscopic or ultramicroscopic

size, includes bacteria, fungi and endospores, mycobacteria.
Mouthrinse – Also known as Preprocedural mouthrinse. A

preparation for cleansing the mouth and teeth, may contain
fluoride, antiseptic of odor inhibitors.
-N-
Noncritical – Instruments or surfaces that contact only intact skin.
Nosocomial Infection – An infection acquired in a hospital as a result

of medical care.
-O-
Occupational Exposure – see Exposure incident.
Occupational Illness – An infection or disease resulting form an

occupational exposure; for example, an on – the-job exposure to
hepatitis B virus (occupational exposure) can cause chronic hepatitis
B disease (an occupational illness) in unvaccinated dental worker.
Other Potentially Infectious Materials (OPIM) – an Occupational

Safety and Health Administration term that refers to body fluids or
tissues that may contain bloodborne pathogens or to body fluids
that are visibly contaminated with blood.
-P-
Parenteral – Means of piercing the mucous membranes or the skin

barrier through events such as a needlestick, human bite, cut or
abrasion.

Pathogen – Any microorganism that can cause disease in a host.
Percutaneous Injury – An injury that penetrates the skin, such as

needle stick or a cut with a sharp object.
Personal Protective Equipement (PPE) – Specialized clothing or

devices worn by workers for protection against a hazard; in
dentistry, includes gloves, mask, gown, and protective eyewear but
not general work clothes (such as uniforms, pants, shirts or
blouses) that are not intended to protect against a hazard.
Postexposure Management – The series of protocols recommended

to minimize the chance of disease transmission after an
occupational exposure; includes immediate reporting of an injury,
preparing an exposure incident report and referring the exposed
individual to a qualified healthcare professional for evaluation,
treatment, counseling and follow-up.
-Q-
Qualified Healthcare professional – A physician or other healthcare

professional who has the necessary and current training, expertise
and licensure to provide hepatitis B vaccination and postexposure
evaluation and follow – up, including postexposure prohylaxis and
counseling on risks and possible consequences of occupational
exposures.
-R-
Regulated Medical Waste – Waste generated through the delivery of

medical or dental services that requires special handling and
disposal because it can cause infection or physical harm (for
example blood-or-saliva-soaked cotton rolls, extracted teeth, sharp
items, surgically removed hard and soft tissue).
Retraction – The drawing in of oral fluids or other debris from the

mouth into dental waterlines or handpiece mechanisms, resulting in
contamination that may be introduced t subsequent patients if
equipment ins not properly maintained or processed, also referred
to as “suckback”.
-S-
Semicritical – Category of instruments or devices that contact but

do not cut or penetrate mucous membranes.

Seroconversion – The change of a serological test from negative to
positive, indicating the development of antibodies in response to
infection or immunizations.
Shelf life – Period of time a product or a solution may be stored

before use or activation without losing its effectiveness.
Standard Precaution – Practices and procedures that integrate and

expand the elements of universal precautions into a standard of
care designed to protect healthcare workers and patients from
pathogens that can be spread by blood or any body fluid, excretion
or secretion; applies to contact with blood; all body fluids,
secretions and excretions (except sweat), regardless of whether
they contain blood, nonintact skin; and mucous membrane.
Sterile – State of being free from all forms of living microorganisms.
Sterilization – The use of a physical (such as heat) or chemical

procedure to destroy all microorganisms; including large number of
resistant bacterial spores.
Surgical scrub – The technique used to aseptically scrub hands

before performing a surgical procedure.
Systemic – Affecting the whole body.
-T-
Transmission-based Precaution – Additional measures (that is,

outside of standard precaution) necessary to prevent the spread of
diseases that are transmitted through airborne, droplet or contact
transmission (for example wearing of N-95 respirator mask to
protect against tuberculosis transmission).
Tuberculosis – Diseases caused by Mycobacterium tuberculosis, a

bacterium that can infect various parts of the body but usually
involves the lungs.
-U-
Ultrasonic cleaner - Device that removes debris by a process called

cavitations, in which waves of acoustic energy are generated in a
solution to loosen and remove debris from objects.

Universal Precaution - a set of practices and procedures based on
the concept that all blood and all body fluids that might be
contaminated with blood should be treated as infectious.
-V-
Vaccine - A product administered through needle injections, by

mouth or by aerosols with the intent of producing immunity to
protect the body against a disease.
Visibly soiled – Showing evidence of blood, dirt, residual dental

materials or other debris.
-W-
Washer disinfector – An automatic device that uses a high

temperature cycle to clean and thermally disinfect instruments.
Waterline – The thin tubing that connects and caries treatment

water from the water source (either the municipal water supply or a
self-contained water system) to instruments used to treat patients.
Wicking – Absorption of liquid along a thread or through a material

(for example, penetration of liquids through undetected holes in the
glove)
Disclaimer:
The contents of Guidelines for Infection Control were gathered from

CDC, OSAP, ADA and OSHA. Care has been taken to confirm the
accuracy of the information present.
Our Resources and recommended reads
• www.cdc.gov
• www.osap.org
• www.ada.org
• www.osha.gov
• cottone's – practical Infection Control in Dentistry
• United States Air Force Medical Services

The Third Edition
The Dental Centre

Dubai Health Authority
[email protected]
Tel: 009714 508-1108/1086/1039

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Health Regulation Department

Guidelines on Dental Infection

Dr. Zuhair Z. Al Khatib

Dr. Mir Asad Ali

Dr. Khaled K. Al Gergawi

Dr. Nadia M. Saleh

Dr. Faiqa M. Sharaf

Mrs. Brijeethamma T. Thekkemuri

Mrs. Nisreen M. Al Qaseim

Mrs. Dana Al Khatib

Director- Dental Centre

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 2 of 76

Infection Control involves policies and procedures used to prevent

The GOAL of good infection control in dentistry is to treat every

The method to implement this goal is to develop an infection control

If appropriate measures are taken, infection control will then occur

Infection Control attempts to break one or more links in the CHAIN

The principles/ELEMENTS of Infection Control Which makes up the

I. Take action to stay healthy

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 3 of 76

Chapter 1: Elements of a dental personnel health program

Chapter 9: Dental Unit Water-lines, Bio-film and water quality

Chapter 13: Dental Laboratory

Quick reference Guides

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 4 of 76

ELEMENTS OF A DENTAL PERSONNEL HEALTH PROGRAM

Education and training

Exposure Prevention and Post exposure management

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 5 of 76

Medical Conditions, Work-Related Illness, and Work

Records Maintenance Data Management and Confidentiality

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 6 of 76

PREVENTING TRANSMISSION OF BLOODBORNE PATHOGENS

• Offer HBV vaccination series to all dental healthcare personnel

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 7 of 76

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 8 of 76

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 9 of 76

Personal Protective Equipment (PPE)

Always wear adequate personal protective equipment whenever

Post exposure management and prophylaxis

• Follow CDC recommendations after percutaneous, mucous

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 10 of 76

The WHO five moments for hand hygiene are as follows:

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 11 of 76

Hand hygiene is an essential infection control practice to protect

Alcohol based hand rubs: these agents provide persistent

Special Consideration for Hand Hygiene and Glove Use

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 12 of 76

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 13 of 76

PPE (Personal Protective Equipment)

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 15 of 76

When you are selecting PPE, consider three key points:

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 16 of 76

First, anticipated exposure can include personal touch, splashes or

Masks, Protective Eyewear and Face Shields

Face mask with added eye shield

DENTAL INFECTION CONTROL & OCCUPATIONAL SAFETY Page 17 of 76

Gloves are the most common type of PPE used in healthcare

• Purpose: patient care, environmental services, other

Most patient-care activities require the use of a single pair of