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Disease Transmission

            &
    Infection Control
Disease Transmission

    Microorganisms
Microbiology
• Microbiology is the study of microorganisms
• micro means microscopically small
• bio means living organisms
• The existence of microorganisms is not
  usually noticed unless they cause illness
• Most microorganisms do not produce human
  illness
• Beneficial microorganisms are used in the
  production of cheese and yogurt
Disease Transmission
•    Five major groups of microorganisms
2.   Bacteria
3.   Rickettsiae
4.   Viruses
5.   Protozoa
6.   Fungi
Bacteria
• One celled microorganisms
• Humans host a variety of bacteria at all
  times
• The skin, respiratory tract and
  gastrointestinal tract are inhabited by
  harmless bacteria
Diseases Caused by Bacteria
•   Dental Decay
•   Periodontal Disease
•   Pneumonia
•   Rheumatic Fever
•   Syphilis
•   Tuberculosis
Rickettsiae
• Transmitted to humans by bite of an
  infected insect ( lice , fleas, ticks, and
  mosquitoes)
• Rocky Mountain spotted fever
• Typhus
• Not of concern in dentistry
Protozoa
• Found in freshwater and marine
  habitats and in moist soil
• May be responsible for intestinal
  infections in humans
• Not of concern in dentistry
Viruses
• Require an electron microscope to see them
• Much smaller than bacteria
• Parasitic – live and multiply only inside an
  appropriate host cell
• Not affected by antibiotics
• Diseases caused by viruses include: AIDS,
  Hepatitis, Herpes, Polio, West Nile, SARS
Fungi
• Plants such as mushrooms, yeasts and
  moulds that lack chlorophyll
• Fungi are not green
• Two divisions: yeasts and moulds
• Oral Candidiasis is a common yeast
  found in the oral cavity of about ½ the
  patient population
The Chain of Infection
• Virulence – refers to the degree of strength of
  that organism in its ability to produce disease
• Numbers – there must be a high enough
  number of microorganisms present to
  overwhelm the body’s defenses
• Susceptible host – is a person who is unable
  to resist infection
• Portal of Entry – means of entering the body
  such as a needlestick
Universal Precautions
• The basis of Universal Precautions is
  acceptance that blood and certain body
  fluids of all patients are considered
  potentially infectious for HIV, Hepatitis B
  and all other Bloodborne pathogens.
• Not all patients with infectious diseases
  can be identified by obtaining a medical
  history.
Routes of Transmission
Airborne transmission
• Aerosol spray – dental handpiece
• Mists – ultrasonic scaler
• Spatter – from saliva
Cross Contamination
• Food Transmission
• Many diseases are transmitted by
  contaminated food that has not been cooked
  or refrigerated properly
• Water may have been contaminated with
  human or animal fecal material
• TB, botulism and staphylococcal and
  streptococcal infections are spread this way
Fecal –Oral
• Occurs most often among healthcare
  workers , day care workers, and by
  careless food handlers
• Prevented by proper handwashing after
  using the toilet
• May be transmitted by touching another
  person or contact with contaminated
  surfaces or food
Dental Office
• Improperly sterilized instruments and
  equipment can transfer all bloodborne
  diseases
• Dental treatment often involves contact
  with blood and always with saliva,
  bloodborne diseases are of major
  concern
• HCV, HBC, HIV
Tuberculosis
• Bacteria
• No immunization




• Requires high level of sterilization &
  disinfection
HAV
•   Acute Infective Hepatitis A
•   Liver disease
•   Found in stool
•   No carrier state
•   Transmission is fecal/oral route
•   Prevented by good personal hygiene
•   Instrument sterilization
•   Vaccination
HBV
• Hepatitis B
• Serious liver disease
• May have a chronic carrier state
• Transmission by contact of infectious body
  fluids
• Requires Percutaneous or permucosal
• Prevented by universal precautions, barriers,
  PPE, aseptic techniques, obtaining
  immunizations
HCV
• Hepatitis C
• Transmitted through blood, blood
  products or IV drug use
  ( Percutaneous)
• No vaccine
• Treatments to control the effects of the
  disease
HSV Type I
• Viral infection
• Causes recurrent sores on lips
• Highly contagious first appearance in
  very young children ages 1-3
• Transmission through direct contact
  with lesions or with infectious saliva
HSV Type II
• Genital Herpes
• Most common STD in the U.S.
• Transmitted only during occurrences of
  the lesions
HIV
• Human Immunodeficiency Virus
• Bloodborne viral disease
• Spread by sexual contact with an
  infected person
• Needle sharing
Preventing Disease Transmission

• Immunization – Hepatitis B, MMR &
  influenza
• Handwashing Protocols
• Office Hygiene
• Pre cleaning – remove bioburden that
  could inactivate disinfectant
Infection Control
• Sterilization: process that kills all
  microorganisms
• If a surface is not clean, it cannot be
  disinfected.
• If a surface cannot be easily &
  thoroughly cleaned & disinfected it
  should have barrier protection
Infection Control
Sterilization Techniques
• Asepsis = the product of sterilization
• Sterilization destroys all microbial forms
  including bacterial spores
• All reusable items must be heat
  sterilized
Terminology
• Sterilize: process where all forms of life
  are COMPLETELY destroyed
• Disinfect: process where some forms of
  life are destroyed
• Sanitize: process that few forms of life
  are destroyed
Sterilization
1.    Steam Autoclave
2.   Chemical Vapor Sterilization
3.   Dry Heat Oven
4.   Chemical Immersion
Steam Autoclave Sterilization
• Sterilizes dental instruments by means
  of steam under pressure
• Rapidly kills all microorganisms
• Disadvantage is that the moisture may
  cause corrosion on some high carbon
  steel instruments
Chemical Vapor Sterilization
• Similar to autoclaving except a
  combination of chemicals is used
  instead of water
• Does not rust, dull, or corrode
  instruments if absolutely dry
• Chemical vapors can be irritating
Dry Heat Sterilization
• Operate by heating up air and
  transferring that heat from the air to the
  instruments
• Requires higher temperatures than
  steam or chemical vapor sterilization
• Instruments will not rust
• Static air and forced air
• Toaster oven is NOT adequate
Chemical Liquid Sterilization
• For items that will be damaged by heat
• Requires a 10 hour contact time
• Post sterilization procedures are
  essential
• Must be used full strength
• Replace solutions as recommended by
  the manufacturer
Disinfection
• Process that kills disease causing
  microorganisms, but not necessarily all
  microbial life
• Disinfectant: chemical used to reduce
  or lower the number of microorganisms
  on inanimate objects
• Applied to countertops and dental chair
Disinfectant Solutions
• Glutaraldehydes          • Iodophors
• High level               • Intermediate level
  disinfectant/sterilant     disinfectant
• Times for disinfection   • Effective within 5 – 10
  range from 10 – 90         minutes
  minutes                  • Contain iodine
• Generally used as an     • May discolor clothing or
  immersion disinfectant     other surfaces
Disinfectants
• Synthetic Phenol          • Sodium Hypochlorite
• Broad spectrum activity   • Intermediate level
• Surfaces must be            disinfectant
  cleaned first             • Main ingredient in
• Can be used on metal        bleach
  glass rubber or plastic   • Not EPA registered so
                              is NO longer a
                              recommended product
                              for use as a disinfectant
                              in a dental setting
Performing Treatment Room
       Cleaning & Disinfection
1. Personal Protective Equipment
2. Preclean with the appropriate product
3. Spray the paper towel or gauze
4. Vigorously wipe the surface to be cleaned
5. Spray a fresh paper towel or gauze and this
   time let the surface remain moist for the
   recommended time for tuberculocidal action
6. Usually 10 minutes
Barriers
• Useful to cover equipment and
  surfaces that are difficult to clean and
  disinfect
• Should be resistant to fluids
• Prevents contamination when properly
  placed
• Changed for each patient ( mask,
  gloves)
Instrument Processing
• Protective clothing, mask, eyewear and
  utility gloves
• Soiled instruments are processed in a
  single loop or workflow pattern
• From dirty to clean to sterile to storage
  without ever doubling back
Infection control powerpoint 1
Ultrasonic Cleaning
• Used to loosen and remove debris from instruments
• Reduces hand injuries from cuts and punctures
• Produces sound waves which can travel through
  metal & glass
• Causes cavitation ( formation of bubbles in liquid)
• Implosion = mechanical cleaning action of bursting
  bubbles
• Combined with chemical action of the solution
  removes the debris from the instruments
• 16 times more effective than scrubbing by hand
Biologic Monitoring
• Spore testing
• Only way to determine if sterilization has
  occurred
• Strips of paper contain harmless bacterial
  spores ( heat resistant)
• Placed inside instrument packs during normal
  operation
• Sent to UBC for culturing and a report is sent
  back
Maintaining Infection Control
          While Gloved
• During dental procedures it may be
  necessary to touch surfaces or objects
• Use a barrier or cotton forceps to
  minimize the possibility of cross-
  contamination
• Limit operatory contamination by being
  prepared for treatment
Mini - paper
Break into pairs and choose one topic
• Explain Universal Precautions
• Explain Biologic monitoring
• Explain Ultrasonic cleaning
• Explain Disinfection
Conclusion
• Discuss your mini – paper with the
  class

How much could you recall?
Was the PowerPoint helpful for recalling
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Infection control powerpoint 1

  • 1. Disease Transmission & Infection Control
  • 2. Disease Transmission Microorganisms
  • 3. Microbiology • Microbiology is the study of microorganisms • micro means microscopically small • bio means living organisms • The existence of microorganisms is not usually noticed unless they cause illness • Most microorganisms do not produce human illness • Beneficial microorganisms are used in the production of cheese and yogurt
  • 4. Disease Transmission • Five major groups of microorganisms 2. Bacteria 3. Rickettsiae 4. Viruses 5. Protozoa 6. Fungi
  • 5. Bacteria • One celled microorganisms • Humans host a variety of bacteria at all times • The skin, respiratory tract and gastrointestinal tract are inhabited by harmless bacteria
  • 6. Diseases Caused by Bacteria • Dental Decay • Periodontal Disease • Pneumonia • Rheumatic Fever • Syphilis • Tuberculosis
  • 7. Rickettsiae • Transmitted to humans by bite of an infected insect ( lice , fleas, ticks, and mosquitoes) • Rocky Mountain spotted fever • Typhus • Not of concern in dentistry
  • 8. Protozoa • Found in freshwater and marine habitats and in moist soil • May be responsible for intestinal infections in humans • Not of concern in dentistry
  • 9. Viruses • Require an electron microscope to see them • Much smaller than bacteria • Parasitic – live and multiply only inside an appropriate host cell • Not affected by antibiotics • Diseases caused by viruses include: AIDS, Hepatitis, Herpes, Polio, West Nile, SARS
  • 10. Fungi • Plants such as mushrooms, yeasts and moulds that lack chlorophyll • Fungi are not green • Two divisions: yeasts and moulds • Oral Candidiasis is a common yeast found in the oral cavity of about ½ the patient population
  • 11. The Chain of Infection • Virulence – refers to the degree of strength of that organism in its ability to produce disease • Numbers – there must be a high enough number of microorganisms present to overwhelm the body’s defenses • Susceptible host – is a person who is unable to resist infection • Portal of Entry – means of entering the body such as a needlestick
  • 12. Universal Precautions • The basis of Universal Precautions is acceptance that blood and certain body fluids of all patients are considered potentially infectious for HIV, Hepatitis B and all other Bloodborne pathogens. • Not all patients with infectious diseases can be identified by obtaining a medical history.
  • 14. Airborne transmission • Aerosol spray – dental handpiece • Mists – ultrasonic scaler • Spatter – from saliva
  • 15. Cross Contamination • Food Transmission • Many diseases are transmitted by contaminated food that has not been cooked or refrigerated properly • Water may have been contaminated with human or animal fecal material • TB, botulism and staphylococcal and streptococcal infections are spread this way
  • 16. Fecal –Oral • Occurs most often among healthcare workers , day care workers, and by careless food handlers • Prevented by proper handwashing after using the toilet • May be transmitted by touching another person or contact with contaminated surfaces or food
  • 17. Dental Office • Improperly sterilized instruments and equipment can transfer all bloodborne diseases • Dental treatment often involves contact with blood and always with saliva, bloodborne diseases are of major concern • HCV, HBC, HIV
  • 18. Tuberculosis • Bacteria • No immunization • Requires high level of sterilization & disinfection
  • 19. HAV • Acute Infective Hepatitis A • Liver disease • Found in stool • No carrier state • Transmission is fecal/oral route • Prevented by good personal hygiene • Instrument sterilization • Vaccination
  • 20. HBV • Hepatitis B • Serious liver disease • May have a chronic carrier state • Transmission by contact of infectious body fluids • Requires Percutaneous or permucosal • Prevented by universal precautions, barriers, PPE, aseptic techniques, obtaining immunizations
  • 21. HCV • Hepatitis C • Transmitted through blood, blood products or IV drug use ( Percutaneous) • No vaccine • Treatments to control the effects of the disease
  • 22. HSV Type I • Viral infection • Causes recurrent sores on lips • Highly contagious first appearance in very young children ages 1-3 • Transmission through direct contact with lesions or with infectious saliva
  • 23. HSV Type II • Genital Herpes • Most common STD in the U.S. • Transmitted only during occurrences of the lesions
  • 24. HIV • Human Immunodeficiency Virus • Bloodborne viral disease • Spread by sexual contact with an infected person • Needle sharing
  • 25. Preventing Disease Transmission • Immunization – Hepatitis B, MMR & influenza • Handwashing Protocols • Office Hygiene • Pre cleaning – remove bioburden that could inactivate disinfectant
  • 26. Infection Control • Sterilization: process that kills all microorganisms • If a surface is not clean, it cannot be disinfected. • If a surface cannot be easily & thoroughly cleaned & disinfected it should have barrier protection
  • 28. Sterilization Techniques • Asepsis = the product of sterilization • Sterilization destroys all microbial forms including bacterial spores • All reusable items must be heat sterilized
  • 29. Terminology • Sterilize: process where all forms of life are COMPLETELY destroyed • Disinfect: process where some forms of life are destroyed • Sanitize: process that few forms of life are destroyed
  • 30. Sterilization 1. Steam Autoclave 2. Chemical Vapor Sterilization 3. Dry Heat Oven 4. Chemical Immersion
  • 31. Steam Autoclave Sterilization • Sterilizes dental instruments by means of steam under pressure • Rapidly kills all microorganisms • Disadvantage is that the moisture may cause corrosion on some high carbon steel instruments
  • 32. Chemical Vapor Sterilization • Similar to autoclaving except a combination of chemicals is used instead of water • Does not rust, dull, or corrode instruments if absolutely dry • Chemical vapors can be irritating
  • 33. Dry Heat Sterilization • Operate by heating up air and transferring that heat from the air to the instruments • Requires higher temperatures than steam or chemical vapor sterilization • Instruments will not rust • Static air and forced air • Toaster oven is NOT adequate
  • 34. Chemical Liquid Sterilization • For items that will be damaged by heat • Requires a 10 hour contact time • Post sterilization procedures are essential • Must be used full strength • Replace solutions as recommended by the manufacturer
  • 35. Disinfection • Process that kills disease causing microorganisms, but not necessarily all microbial life • Disinfectant: chemical used to reduce or lower the number of microorganisms on inanimate objects • Applied to countertops and dental chair
  • 36. Disinfectant Solutions • Glutaraldehydes • Iodophors • High level • Intermediate level disinfectant/sterilant disinfectant • Times for disinfection • Effective within 5 – 10 range from 10 – 90 minutes minutes • Contain iodine • Generally used as an • May discolor clothing or immersion disinfectant other surfaces
  • 37. Disinfectants • Synthetic Phenol • Sodium Hypochlorite • Broad spectrum activity • Intermediate level • Surfaces must be disinfectant cleaned first • Main ingredient in • Can be used on metal bleach glass rubber or plastic • Not EPA registered so is NO longer a recommended product for use as a disinfectant in a dental setting
  • 38. Performing Treatment Room Cleaning & Disinfection 1. Personal Protective Equipment 2. Preclean with the appropriate product 3. Spray the paper towel or gauze 4. Vigorously wipe the surface to be cleaned 5. Spray a fresh paper towel or gauze and this time let the surface remain moist for the recommended time for tuberculocidal action 6. Usually 10 minutes
  • 39. Barriers • Useful to cover equipment and surfaces that are difficult to clean and disinfect • Should be resistant to fluids • Prevents contamination when properly placed • Changed for each patient ( mask, gloves)
  • 40. Instrument Processing • Protective clothing, mask, eyewear and utility gloves • Soiled instruments are processed in a single loop or workflow pattern • From dirty to clean to sterile to storage without ever doubling back
  • 42. Ultrasonic Cleaning • Used to loosen and remove debris from instruments • Reduces hand injuries from cuts and punctures • Produces sound waves which can travel through metal & glass • Causes cavitation ( formation of bubbles in liquid) • Implosion = mechanical cleaning action of bursting bubbles • Combined with chemical action of the solution removes the debris from the instruments • 16 times more effective than scrubbing by hand
  • 43. Biologic Monitoring • Spore testing • Only way to determine if sterilization has occurred • Strips of paper contain harmless bacterial spores ( heat resistant) • Placed inside instrument packs during normal operation • Sent to UBC for culturing and a report is sent back
  • 44. Maintaining Infection Control While Gloved • During dental procedures it may be necessary to touch surfaces or objects • Use a barrier or cotton forceps to minimize the possibility of cross- contamination • Limit operatory contamination by being prepared for treatment
  • 45. Mini - paper Break into pairs and choose one topic • Explain Universal Precautions • Explain Biologic monitoring • Explain Ultrasonic cleaning • Explain Disinfection
  • 46. Conclusion • Discuss your mini – paper with the class How much could you recall? Was the PowerPoint helpful for recalling the information? Would you like this type of format again?

Notas del editor

  1. Can live outside the body for months depending on the environmental conditions
  2. Hep D needs HepB to occur – higher risk of death with combination Hep E fecal oral transmission contaminated food and water- mostly in developing countries
  3. Students will each receive a spore test to perform as an assignment. Must be complete by October 6 th . Process indicators simply identify packages that have been exposed to a certain temperature, they do not measure duration or the pressure. Useful in determining paks that have been processes and those that were not.