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Infection Control Sterilization Protocol and Operating Room Protocol

Today is the age of modern technology coupled with medical challenges. Pervasive increase in serious transmissible disease over last few decades has created global concerns. The challenge of microbial infections that includes the ever prevalent tetanus, typhoid, measles to the modern day pandemics that of AIDS and hepatitis is omnipresent and ever threatening. Into this scenario comes the dental professional who is not only at risk themselves but also pose a pathway of transmission of infection to the numerous patients. Thus it becomes a religion of every dentist to implement all those practices and procedures that will result in minimising the microbial challenge.

To begin with we shall be discussing in brief about its historical perspective, few of the important terminologies used in relation to infection control and the need behind infection control protocol.Cleaning, sterilization and transport of instruments to the sterilization Process that meets ADA (American Dental Association) and CDC (Centre for Disease Control) guidelines is vital to an effective infection control program. Streamlining of this process requires an understanding of proper methods, materials, and devices.Use of a complete system that encompasses and fulfils all elements that are critical maximizes efficiency and minimizes risks.

Historical perspective....
Concern about transmission of disease has been expressed for thousand of years.Written guidelines for “disease control” are found in Bible specially in books of Leveticus and Numbers. Italian physician Girolamo Fracastorious is generally credited as the first to recognise it in 1546, the existence of tiny living particles that cause 'catching' or contagious disease.Micro organisms existence was established with discovery of simple microscope by Antony Van Leeuwenhoek in 1667, relationship of these little animals as he called "animalcules"(bacteria, yeast, protozoa.), to disease was not established until " The Golden Age of Microbiology" in mid to late 1800.Semmelweis in Veinna and Holmes in US first recognised importance of hand washing to prevent spread of disease agents.

Pasteur and Tyndall recognised use of heat to destroy vegetative bacteria and resistant bacterial spores. Lord J. Lister demonstrated that boiling the instruments and washing the hands and surgical lining with phenol before surgery greatly reduces the complications.The modern infection control recommendations and sterilization guidelines were stated by the CDC in 1973. Comprehensive guidelines for infection control came into effect in Dec 1991 and are continually being upgraded to include the advances in field of sterilization.After reading this you must have realised the importance of sterilization and infection control in our day to day practice. So before we discuss in detail let me give you a brief recall of some important terms....Sterilization: It is defined as freeing the object or substance from all life of any kind.It is defined alternatively as the process by which an article, surface or medium is freed of all micro-organisms either in the vegetative or spore state.Disinfection: It means the killing, removal or destruction of organisms capable of causing infection namely pathogens.Disinfectant: It is an agent accomplishing disinfection. It is applicable to inanimate objects.

Antiseptic: Closely linked to disinfection, it inhibits or destroys pathogens and is applicable to living tissuesBactericide means killing of bacteria while Bacteriostatic means reversible inhibition of bacterial growth without killing them.

Asepsis: It is the prevention from contamination from micro-organisms includes sterile condition in tissues, on materials and in rooms, as obtained by excluding,removing or killing micro-organisms.Cross Infection or Cross Contamination: It is the passage of micro-organisms from one person to another via any route direct or indirect.

Rationale for infection control
The answer lies in the fact that many infectious diseases may be transmitted during dental care. Source of potential infection that exists in dental office include hands,saliva, nasal secretion, blood, clothing & hair as well as dental instrument and equipment.Infectious microbial agents can spread by direct contact, indirect contact via a contaminated surface or material, spattering of secretions and aerolisation.Hence goal of infection control is to reduce the dose of micro-organisms that may be shared between individuals and contaminated surfaces.

Infection control can be achieved by following two protocols:

1. Sterilization protocol

2. Operatory protocol

Hence the chapter will be dealing with infection control under the above said headings.

Now let us discuss the sterilization protocol under which we will be covering the steps involved starting from transportation, cleaning, packaging and also the various modalities available for sterilization.

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