1. Introduction Increased outbreaks of disease that were once better controlled , and infectious agents that can cause incurable diseases, such as HIV, HCV have become significant cause of illness and death in many parts of the world. Without the proper precautions, health care facility can actually cause the spread infections and diseases. So it is essential to prevent the transmission of infections at all times through standard procedures.

2. Each and every patients visit is of three fold importance. 1. To get right consultation for the ailment caused. 2. To get properly investigated and diagnosed within reasonable time frame. 3. To get treated with right knowledge and technology. 4. Right choice of antibiotics and controlled use. Among above, for the right, treatment, right investigation and proper diagnosis is compulsory. For investigations, the level of getting infected depends upon the type and nature of investigation. 3. HICC Members: The Director Chiefs of major clinical departments Microbiologist Chief nurse Pharmacists Head of maintenance and cleaning department CSSD Head of infection control team. 4. Cross infection and sterilization in dentistry Three sources of cross infections in dentistry Patients suffering from infectious illness Patient in prodromal phase if disease Carrier ( Convalescent, asymptomatic) Transmission of infection Direct contact of tissues with blood or saline Droplets containing infectious agents and Through use of contaminated instruments Routes of infection Transdermal Respiratory 5. Microorganisms commonly causing cross infection in dentistry Transmitted thr skin and blood Transmitted thr aerosols Bacteria Treponema pallidum Staphylococcus aureus Viruses Hepatitis B, C, d HIV Herpes simplex virus Fungi Dermaomycoses Candidiasis Bacteria Bordetella pertussis Mycobacterium tuberculosis Streptococcus pyogenes Viruses Influenza virus Rhinovirus Rubella Mumps Measles Epstein Barr virus 6. Prevention of cross infection Aseptic technique Protective clothing Immunization Prevention of infection from patient to patient by proper sterilization of equipments, Use of disposable material where ever possible Good environmental hygiene Proper disposal of waste etc 7. Standard Precautions 1. Wear personal protective equipment (PPE) 2. Personnel habits 3. Proper waste segregation 4. Immunization 8. MDROs Methicillin Resistant S. aureus (MRSA) Extended Spectrum Beta Lactamases (ESBL) Vancomycin Resistant Enterococci (VRE) Vancomycin Resistant S. aureus (VRSA) Pseudomonas and other nonfermenters 9. Waste management plan Sorting Handling Interim storage Sub disposal Final disposal 10. Option Waste category Treatment and disposal Category no.1 Human anatomical waste (Human tissues, organs, body parts) Incineration @deep burial* Category no.2 Animal waste (animal tissues, organ, body parts carcasses, bleeding parts, fluids, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal house) Incineration @deep burial* 11. Option Waste category Treatment and disposal Category no.3 Microbiology and biotechnology waste (wastes from laboratory cultures, stocks or microorganism live or vaccines, human and animal cells, culture used in research and infectious agents from research and individual laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures) Local autoclaving / microwaving / incineration @ Category no. 4 Waste sharps (needle, syringes, scalpels, blade, glass etc. that may cause puncture and cuts. this includes both used and unused sharps) Disinfection by chemical treatment @@@ / Autoclaving/ microwaving and mutilation. shredding ## 12. Option Waste category Treatment and disposal Category no. 5 Discarded medicines and cytotoxic drugs (waste comprising of outdated, contaminated and discarded medicines) Incineration @. destruction and drugs disposal in secured landfills Category no.6 Soiled wastes (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood) Incineration @ autoclaving / microwaving Category no. 7 Solid waste (disposable) (waste generated from disposable items other than the sharps such as tubing, IV sets etc) Disinfection by chemical treatment @@ / autoclaving / microwaving / shredding ## 13. Option Waste category Treatment and disposal Category no. 8 Liquid waste (waste generated from laboratory and washing, cleaning house keeping and disinfecting activities) Disinfection by chemical method @@ and discharge into drainage Category no. 9 Incinerator ash (ash form incineration of bio medical waste) Disposal in municipal landfills Category no. 10 Chemical waste (chemicals used in production of biologicals, chemicals used in disinfection , as insecticides etc) Chemical treatment @@ and discharge into drains for liquids and secured landfills for solids 14. INFUSION SETSNEEDLES USED BLADES BROKEN GLASS SLIDES P U N C T U R E P R O O F C O N T A I N E R BURN AND CUT THE NEEDLE BEFORE DISCARDING IN PUNCTURE PROOF CONTAINER CONTAINING 1% HYPOCHLORITE SOLUTION BROKEN AMPOULES LANCET 15. EXPIRED MEDICINES ALL HUMAN ANATOMICAL WASTE MICROBIOLOGICAL CULTURES Y E L L O W B A G USED SANITARY PADS PLASTER CASTS BLOOD STAINED COTTON, DRESSINGS CYTOTOXIC DRUGS SHOULD BE DISCARDED IN YELLOW BAG SEPERATELY BUT WITH LABEL AS CT 16. USED IV FLUID LINES AND CATHETERS USED SYRINGES (without needles & nozzles) R E D B A G CUT ALL THE IV LINES, SALINE BOTTLES,GLOVES & EMPTY BLOOD BAGS UROSAC BEFORE DISCARDING. EMPTY SALINE BOTTLES EMPTY BLOOD BAG GLOVES UROSAC 17. EMPTY BOTTLES WASTE FOOD FRUIT PEELINGS BOUQUET PACKAGING MATERIAL B L A C K B A GUSED PENS, ICE CREAM CUPS COCONUT SHELL 18. @@ Chemical treatment using 1% hypochlorite solution or any equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection. ## Mutilation / Shredding must be such so as to prevent unauthorized reuse. @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. * Deep burial shall be an option available only in towns with population less than five lakh and in rural areas. 19. WHAT TO DO IF EXPOSED TO THE BLOOD OF A PATIENT Do not put the pricked finger in the mouth reflexly Squeeze the finger and let blood flow. Needle stick cuts should be immediately washed with soap and water Apply antiseptics Splashes to the nose, mouth or skin, should be washed with plenty of water thoroughly Eyes should be thoroughly irrigated with clean water or saline Do not use sodium hypochlorite to clean wound as it is caustic to skin. 20. WHAT TO DO IF EXPOSED TO THE BLOOD OF A PATIENT Following any blood exposure one should: Report the exposure to the appropriate authority immediately. Contact ICU registrars during routine working and emergency hour. Treat the condition as an emergency Prompt reporting 21. Take home message Always wear personal protective equipments Get vaccinated for Hepatitis B Virus, Swine flu Follow aseptic precautions Strict adherence to HAND HYGIENE before and after touching the patient Cough etiquettes Waste segregation and proper disposal