INTRODUCTION: Centers for Disease Control as critical,
INTRODUCTION:Nosocomial infectionsor hospital acquired infections are one of the most commonlyaffecting the patients. According to the Harvard Medical Practice Study II a single type of nosocomial infection issurgical-wound infection which constituted the second-largest category of all.Many sterilization techniques have been developed withingeneratios to free the instruments from pathogenic organisms after everyuse. Diseases can be transmittedby indirect contact when dental instruments contaminated by one patient arereused for another patient without adequate disinfection or sterilizationbetween uses. Using an infected instrument does not only affect patients but alsodentist anddental staff by producing cross infection like hepatitis B1 and C2,tuberculosis3, HIV, infective endocarditis etc. Especially when theinstrument involves blood contact like extraction forceps, elevators,endodontic files, burs etc. It is important to sterilize instruments properlyto avoid cross contamination and infection spread.
Depending on the possible risk for infectionin link with their use, dental instruments, devices, and equipment arecategorized by the Centers for Disease Control as critical, semi critical, ornoncritical:Critical items are used to penetrate softtissue or bone including surgical instruments, periodontal scalers, scalpelblades, dental burs, dental probes. They have the greatest risk of transmittinginfection and should be sterilized properly. Semicritical items touch mucous membranes ornonintact skin and have a lower risk of transmission; because the majority ofsemicritical items in dentistry including dental mouth mirror, amalgamcondenser, reusable dental impression trays, dental handpieces). If asemicritical item is heat-sensitive, it should, at a minimum, be processed withhigh-level disinfection. Noncritical patient-care items pose the least risk oftransmission of infection, contacting only intact skin, which can serve as aneffective barrier to microorganisms including radiograph head/cone, bloodpressure cuff, facebow, pulse oximeter. Cleaning followed by disinfection withan EPA-registered hospital disinfectant is adequate.
When the item is visibly contaminatedwith blood or OPIM, an EPA-registered hospital disinfectant with atuberculocidal claim usually intermediate-level disinfectant should be used.Cleaning or disinfection of certain noncritical patient-care items can bedifficult or damage the surfaces; therefore, use of disposable barrierprotection of these surfaces might be a preferred alternative. STERILISATION:Sterilization refers to any process that eliminates, removes, kills, ordeactivates all forms of life including spores and vegetativeform present in an article, surface, ormedium. Many types of sterilization techniques are available. They areclassified into physical and chemical agents. Some are incineration, hot airoven, steam under pressure, radiations, ultrasonic and sonic vibrations,sunlight etc. Most commonly used method of sterilization for steam underpressure or autoclave. AUTOCLAVE:The principleof the autoclave or steam sterilizer is that the water boils when its vaporpressure equals that of the surrounding atmosphere.
When the pressure inside aclosed vessel increases, the temperature at which the water boils alsoincreases. Saturated steam has penetrative power. When steam comes in contactwith a cooler surface it condenses to water and releases latent heat to thatsurface which in turn ensures killing the microbes present. Most frequentlyused at 121 degree Celsius at 15 minutes of holding time pressure ???.Infectioncontrol and maintaining high standard sterilization protocol is highly stressedin current practice of dentistry.
4 Improper sterilization practicecan lead to transmission of various fatal diseases. It may lead to crosscontamination.5 Transmission of infection can occur in possibleways:1. Patient to dental worker.2. Dental worker to patient3. Patient/ dental workers to community4. Patient/dental workers to familymembers.
Infectionsspread through many things including aerosol, droplets, saliva, blood, plasmaetc. Aerosol can cause acute respiratory syndrome or SARS6,Pneumonia7 and pulmonary diseases8. Blood can causeHepatitis B9,10, HIV11,Hepatitis C etc.
DISINFECTION:Destruction of pathogenic microorganisms or their toxins or vectors by direct exposure to chemical or physical agents.Commonly used disinfectants in dentistry are glutaraldehyde, glutaraldehyde with phenol, hydrogenperoxide, hydrogen peroxide with peracetic acid, ortho-phthalalhyde (OPA), alcohols (ethyl, isopropyl), quaternary ammonium chloride, oxidizers (bleach), formaldehyde and phenolics.The aim of the study is to evaluate the microbial count on extractionforceps prior to dental extraction. MATERIALS ANDMETHOD:SAMPLECOLLECTION: 20 sample size werecollected from Saveetha Dental College. Swab sample is taken immediately prior to extraction from theautoclaved extraction forceps. Sampling are selected near the beaks of theforceps.
Seal wasbroken round the tube and the swab was rolled firmly against the area severaltimes across the area. Return the swab into the tube and label the sample. Sendthe sample to the laboratory for analysis.
MICROBIOLOGICAL ANALYSIS:The samples obtained wereinoculated in culture plates of nutrient agar. The plates were incubation for24 hours followed by analyzing the colonies count.DATA ANALYSIS:The data is collected andstatistically analysed. Data is collected in form of colony forming unit. Thetotal sample collected was taken average of the colony formed.RESULTS:The average colony count of6.1 CFU is seen in total 20 samples taken. The colony count is quite lowsuggestive of good sterilization protocol followed by the institution.
FIGURE-1FIGURE -2FIGURE-3DISCUSSION: Manyresearchers have proved that dental environment is one of the major cause ofmicrobial contamination which can be either pathological or nonpathological. Ifthey are pathological, can lead to many infection and disease. Williams et al,199812 conducted a study where he compared bacterialcontamination of same dental institution from 1976 to 1998. They found slightdifference in bacterial count in 1998 with lesser colonization from headlights, light handle covers and clinic jacket cuffs. Hence proved that evenafter years of having advanced sterilization protocol there was still bacterialcontamination seen even if it showed statistical difference. The epidermologystudy done in 1989, in this study they proved the presence of bacteria inmultiple dose vial of local anaesthesia and heparin.
They concluded that thebacterial contamination was due to the vacuum in the vial removed cells and bacteria from thesyringe that had entered the tip because of a back pressure in thesyringe during use.13 Swaminathan et al in201314 concluded in their review that aerosolplays an important role in contaminating environment which can producehazardous effect on patient and the dentist. Amad et al in 201715collected swab from headscarves during performing restorative dentistry with orwithout rubberdam. They found bacterial colony forming unit from theheadscarves. This in turn prove the contamination level in dental office bycontaminating the headscarves.
Nejatidanesh et al in 201316in their study showed different levels of bacterial colony forming units indifferent part of face like nose, eyes, zygoma etc. Dental practice presents opportunities forcross-contamination. The dentist’s face is at high-risk of infectiontransmission. Which can in turn cause cross infection from dentist to patientand vice versa. Many researches have been done to bring out various methods andtechnology in field of sterilization and improve maintaining asepsisenvironment. Molinari et al. 200017 suggested applicationof precautions such as multiple aseptic procedures, latex gloves18,19, masks20, protective eyewear, clinic coats,automated instrument decontamination devices, time-efficient heat sterilizationmodalities, chemical disinfectants, waste management procedures and single-usedisposable items have created a safer environment for dental workers andpatients.
Lockhart et al 200821 compared the incidence, duration, nature, andmagnitude of endocarditis-related bacteremia from single-tooth extraction andtooth brushing and to determine the impact of amoxicillin prophylaxis onsingle-tooth extraction. He mentioned that extraction is one of the cause ofendocarditis. But tooth brushing may be a greater threat for individuals atrisk for infective endocarditis. Peter et al in 199622 concluded inhis study that single-tooth extraction should beexpected to cause a bacteremia regardless of the status of the dentition orperiodontium.
Brian et al23 concluded in his study that Dentaltreatment does not seem to be a risk factor for infective endocarditis, even inpatients with valvular abnormalities, but cardiac valvular abnormalities arestrong risk factors. Few cases of infective endocarditis would be preventablewith antibiotic prophylaxis, even with 100% effectiveness assumed. Okell et al24made blood cultures before and ten minutes after the removal of teeth undergeneral anaesthesia. They obtained over 60% positive blood cultures afterextraction under nitrous oxide. No serious systemic manifestation is recordedin spite of the high incidence of transient bacteremias. They isolatedstreptococci totally nine times.
Okabe et al25 examined the factorsthat affect the occurrence of bacteremia associated with tooth extraction andthe kind of bacteria causing this bacteremia. Anaerobes wereisolated from 104 (78.8%) of the 132 cases of bacteremia. Of the 187 isolatesobtained, three (1.6%) were aerobes, 51 (27.
3%) were facultative anaerobes(including microaerophils), and 133 (71.1%) were anaerobes. Among facultativeanaerobes and microaerophils, the most frequently isolated bacterial generawere Lactobacillus (n=15), Streptococcus (n=13), and Staphylococcus (n=12); and amonganaerobes, Eubacterium (n=40), Peptostreptococcus (n=40), and Propionibacterium (n=20).
CONCLUSION:Although there was minimal number of colony forming unit inthe extraction forceps. There is high chance that the organism can bepathogenic and can create many postoperative complications like infectiveendocarditis, abscess, dry socket etc. As said prevention is better than cure.It is better to maintain a good sterilization protocol which will reduce therisk of cross contamination and maintain good asepsis.