Chapter 16: Aseptic Techniques

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Aseptic Techniques
Chapter 16
1

Learning Objectives
Lesson 16.1: Aseptic Techniques
1. Describe how to limit the spread of disease
agents from the hands to environmental
surfaces and from dental aerosols and
spatter.
2. Describe the importance of the high-volume
evacuator in infection control and how to
change a high-volume evacuator trap safely.
3. Describe the proper use of the saliva ejector
and rubber dam.
2

4. Describe the use of preprocedure mouth
rinses.
5. Describe the proper use of disposable items.
6. Describe proper housekeeping and cleaning
considerations, as well as other aseptic
techniques.
3
Learning Objectives
Lesson 16.1: Aseptic Techniques (Cont.)

Limited Touching of Surfaces
 Gloves used for patient care are contaminated
 Touch as few surfaces as possible with saliva-
or blood-coated fingers
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 Surfaces that may be touched should be protected
with surface covers or precleaned and disinfected.
 Dispense all items needed at chairside before
patient care begins.
 This task reduces the need for leaving chairside
with contaminated gloves, mask, and protective
clothing, which may spread contamination to other
parts of the office.
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 Removal of contaminated gloves or use of an
overglove before leaving chairside during patient
care is the best practice.
 Put on gloves or carefully remove and discard
overgloves when returning to chairside.
 Another alternative is to have an uninvolved person
retrieve items needed unexpectedly during patient
care, which is particularly important during some
types of surgery (e.g., implant surgery).
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Minimizing Dental Aerosols and Spatter
 Dental aerosols and spatter are generated
during use of high- and low-speed
handpieces, ultrasonic scalers, and the
air/water syringe
7

Minimizing Dental Aerosols and
Spatter
 What are dental aerosols?
 Dental aerosols and spatter are small, invisible
particles of saliva that may contain a few
microorganisms and may be inhaled or remain
airborne for extended periods.
 Aerosol particles are less than 50 µm in
diameter, and the smallest ones of 5 µm in
diameter can be inhaled to the depths of the
lungs (air sacs or alveoli).
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Minimizing Dental Aerosols and
Spatter
 Spatter consists of particles larger than 50
µm.
 When these particles are propelled from the
patient’s mouth, they settle rapidly or land on
nearby operatory surfaces or the face, neck,
chest, and arms of the dental team member
providing care to the patient.
 Minimizing the generation of dental aerosols
and spatter by use of high-volume evacuation
and the rubber dam and by proper positioning
of the patient’s head reduces the spread of
microbes from the patient’s mouth.
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High-Volume Evacuation
 When rotary equipment and the air/water
syringe are used, HVE greatly reduces the
escape of salivary aerosols and spatter from
the patient’s mouth
10

 The HVE system should be cleaned at the end of
the day by evacuating a detergent or water-based
detergent-disinfectant through the system, but not
bleach (sodium hypochlorite) because this chemical
can destroy metal parts in the system.
 After flushing, remove and clean the trap in the system
periodically.
 A safer approach, however, is to use a disposable trap.
 These traps may contain scrap amalgam that should be
disposed of properly.
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 The dental team member must wear gloves,
masks, protective eyewear, and protective
clothing when cleaning or replacing these
traps to avoid contact with patient materials in
the lines from splashing and direct contact.
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Proper Use of Saliva Ejector
 Previously suctioned fluids might be retracted
into the patient’s mouth when a seal around
the saliva ejector is created
 Do not tell patients to close their lips around the
ejector and “spit” into the tip
 Never position the vacuum line above the patient’s
head for this could allow flow of materials in the
line toward the tip
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 The seal can cause a type of “suck back” or reverse
flow in the vacuum line that might allow the contents
of the line to reach the patient’s mouth.
 Although disease spread, if this occurs, has not been
demonstrated, reverse flow should not be allowed to
happen.
 Thus one should not tell patients to close their lips around
the ejector and “spit” into the tip.
 Alternatively, some disposable saliva ejector tips
now have a small hole in the side that relieves the
pressure when the tip is closed off, preventing
reverse flow.
 Others have a closable valve that prevents backflow.
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Use of the Rubber Dam
 Reduction in microorganisms escaping a
patient’s mouth in aerosols or spatter can
approach 100% with proper use of the rubber
dam
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 What is a rubber dam?
 A thin square of latex rubber
 Simultaneous use of HVE and the rubber dam
provides the best approach to minimize dental
aerosols and spatter.
 A sealant is also available for placement at the
rubber dam–tooth interface to reduce further the
leakage of saliva into the operative site.
 Because the rubber dam reduces the amount of -
saliva present at the operative site, less saliva is
available for retraction into water spray handpieces
or air/water syringes if antiretraction valves in the
dental unit fail.
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Preprocedure Mouth Rinses
 The application of antiseptics to skin or
mucous membranes before surgery or
injections has been practiced for many years
 The use of an antimicrobial mouth rinse is
based on a similar principle:
 It reduces the number of oral microorganisms
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 This reduction also lowers the number of
microorganisms that may escape a patient’s mouth
during dental care through aerosols, spatter, or
direct contact.
 Although studies have not yet shown that the
aseptic technique of preprocedure mouth rinsing
actually prevents diseases in dental team members,
studies have shown that a mouth rinse with a long-
lasting antimicrobial agent can reduce the level of
oral microorganisms for up to 5 hours.
 Use of nonantimicrobial mouth rinses allows the oral
microorganisms to return to their original levels
before most dental procedures are completed, thus
having little infection control value.
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Use of Disposables
 A disposable item is manufactured for a
single use or for use on only one patient
 Not heat tolerant
 Not to be cleaned
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Use of Disposables
 These items are manufactured from plastics or
less expensive metals.
 Thus, an item that is labeled as disposable must
be disposed of properly after use, and should not
be precleaned and sterilized or disinfected for
reuse on another patient.
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Use of Disposables
 A single-use device (SUD) is a device originally
cleared by the Food and Drug Administration
(FDA) for a single use on one patient.
 If one wishes to reprocess an SUD, the FDA now
requires one to meet the same good manufacturing
standards used by the original manufacturer.
 Determination of cost-effectiveness of disposables
or reusables must include the cost of the items and
also the labor dollars required to decontaminate
the reusable items.
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Disposable Items
22

Disposable Items (Cont.)
23

Disposable Items (Cont.)
24

Housekeeping and Cleaning
 Dusting of surfaces or sweeping of floors in
patient-care areas can distribute
microorganism-laden dust particles to other
surfaces unless performed with a wet cloth or
wet mop
25

 Properly clean mops and cloths after use and
allow them to dry before reuse, or use single-
use, disposable mop heads or cloths.
 Mop water should contain a low-level
disinfectant to keep microorganisms from
building up in the water and being painted
onto the floor.
 The filters in air vents and furnaces require
frequent changing to avoid dust buildup.
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 A smooth-surface floor rather than carpeting
is more appropriate for patient-care areas
because of its cleanability and lesser
likelihood of accumulating dust and dirt.
 Avoid using carpeting and cloth-upholstered
furnishings in the dental operatory,
laboratory, or instrument-processing areas.
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Other Aseptic Techniques
 There are many other things to consider in
dentistry concerning aseptic techniques
 Aseptic techniques with regard to instrument
processing
 Unit dosing and sterile retrieval system
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Other Aseptic Techniques
 High-speed handpiece processing involves
the spraying of cleaner/lubricant into the drive
air line and flushing excess lubricant out by
connecting the dental unit air system on an
air line installed in the sterilizing room.
 Flush the air system so that the aerosol is not
released into the air environment by flushing
directly into the vacuum system or into a sink
with water or a container with absorbent
material that will catch the spray.
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Chapter 16: Aseptic Techniques

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Chapter 16: Aseptic Techniques