FACULTY OF DENTISTRY

DOCTOR OF DENTAL SURGERY

DENTAL RADIOLOGY-DDS3:1304
By: Prof Dr Phrabhakaran ([email protected])
Control of Infection in Radiology
The goal of an infection control program in radiology is to
avoid cross-contamination among patients and between
patients to dental staff in the course of imaging.

LEARNING OUTCOMES:
•Recognize infection control procedures for operator,
radiology staff and patient protection.
•Precautions during imaging and processing of x-ray films
or PSP scanning.
CONTROL OF INFECTION
Health care workers or HCWs have a legal duty to ensure that
all necessary steps are taken to prevent cross-contamination
(infection) to protect themselves, their colleagues and the
patients.

Effective infection control measures are therefore required in

dental radiography even though most investigations are
regarded as non-invasive or non-exposure prone procedures-
because they do not involve breaches of the mucosa or skin. The
main risk of cross-infection is from one patient to another and
from salivary contamination of work areas and equipment.

Saliva borne; air borne; water borne; blood borne

 Routes of Disease Transmission
• Direct contact – including skin-to-skin and blood-to-mucous
membrane contact. Pathogens such as herpes simplex virus
and hepatitis B may be transmitted in this way.

• Indirect contact – requires an intermediate object such as

personal protective equipment (PPE) or the surgery/hospital
environment for transfer. Bacteria such as methicillin-resistant
Staphylococcus aureus and Clostridium difficile may be transmitted by this
route.

• Droplet and airborne routes – examples of pathogens transmitted

by these routes include the influenza viruses(COVID-19) and
Mycobacterium tuberculosis, respectively. Transmission may occur during a
range of activities including talking, sneezing and interventions such as
aerosol generation and cardiopulmonary resuscitation.
 Universal Precautions
• Standard precautions(universal
precautions) are the infection control
practices.
• Respiratory hygiene
• Cough etiquette
• Hand hygiene
• Use of PPE when contact with blood or body fluids is anticipated.

• Standard precautions are supplemented by additional transmission based

precautions (contact, droplet and airborne) to prevent the transmission of particular
micro-organisms associated with significant morbidity and mortality.
Main infections of concern
• Infective hepatitis caused by hepatitis strains A through E.
Two billion people have been infected with HBV, more
than 350 million have chronic (lifelong) infections. Many
are asymptomatic. The transmission of blood borne viruses
such as HIV and hepatitis B and C during radiography is
rare (HIV and hepatitis C- saliva is not regarded as a likely source of
transmission of infection). Hepatitis B is highly infectious and can be
transmitted by a small amount of blood present in saliva.
•Tuberculosis-multidrug resistance is increasing.

•Cold sores caused by herpes simplex virus (HSV)-HCWs

are at risk of getting herpetic whitlow, a painful finger
infection. It is reduced due to glove wearing practices.
•Rubella

•Syphilis
HCW PATIENTS
•Diphtheria PATIENTS HCW
PATIENT PATIENT

•Mumps

•Influenza

•Transmissible spongiform encephalopathies (TSEs),

e.g. Creutzfeldt-Jakob disease (CJD).

Any other viral and bacterial infections

Infection Control Measures
Radiography/Imaging the main concerns arise from
salivary contamination of work areas and equipment.
Suitable precautions include:

•Training of all staff in infection control procedures and

monitoring their compliance (they must be implementing
procedures responsibly).

•Vaccinated against hepatitis B, have their response to this

vaccine checked and maintain this vaccination.

•Open wounds on the hands should be covered with

waterproof dressings.
 •Protective sterile, non-powdered medical gloves (e.g.
latex or nitrile) should be worn for all
radiographic/imaging procedures and changed after every
patient.

•Eye protection - either safety glasses or visors (face

shield) should be worn and masks for
radiography/imaging procedures (Personal Protection
Equipment).
•All required image receptors and holders should be
placed on disposable trays to avoid contamination of work
surfaces.

Film/receptor holders ready for

Plastic safety glasses and Vista-Tec visor (Polydentia SA)
clinical use on a disposable tray.
suitable for eye protection during dental radiography
•Digital radiography sensors must also be placed inside
appropriate barrier envelopes.

•If barrier envelopes are not used, saliva should be wiped from
exposed film packets with disinfectant before handling and
processing. The disinfectant should be tuberculoidal-an effective
killer of tuberculosis and preventing other diseases, including
Hepatitis B and HIV.

Disinfectants-iodophers,
chlorines and synthetic
phenolic compounds.
 INFECTION CONTROL IN
RADIOLOGY
• INTRAORAL RADIOGRAPHY/IMAGING FOR
UNIDENTIFIED OR NON-SPECIFIED CASES

• Use autoclavable film holders; must be first washed,

cleaned in ultrasonic cleaner, and sterilized.
OR
• Used non-autoclavable film holders must be washed and
soaked in disinfectant.
PROCEDURE
•Use clean sterile image receptor-holder for each patient. Digital receptors
must also be placed inside appropriate plastic barrier envelopes.
•Position the holder in patient’s mouth. Never insert fingers into patient’s
mouth to position the holder.
•After the imaging procedure, remove the digital receptor from the barrier
envelope and discard the envelope into the yellow clinical waste plastic
bag. Wash and clean the holder.
•Subsequently remove your gloves or wash your gloves?? before
processing the receptor.

•If you have used a film packet (without barrier envelope) , then it should be
washed in the holder under running water.
•Remove the film packet with forceps. Dip the film packet in disinfectant
solution and dry the packet with paper towel before sending for processing.
•Soak the receptor-holder in disinfectant solution for 15 mins before using
for the next patient.
• Gloves and other items of PPE should be discarded as clinical
waste or decontaminated according to manufacturer’s
guidelines, e.g. glasses and visors.

• Image receptor holders should be disposed of into clinical

waste (single use) or, if reusable, decontaminated according to
the manufacturer’s instructions.

• X-ray equipment, including the tubehead, control panel, timer switch

and cassettes, that has been touched during the radiographic
procedure should be thoroughly cleaned and disinfected with a
suitable surface combination detergent/disinfectant.
RECEPTOR WITH BARRIER ENVELOPE
INTRAORAL RADIOGRAPHY/IMAGING
FOR IDENTIFIED HIGH RISK PATIENT
• Apply plastic cover (cling plastic/film) to the yoke, tube head
cone, control panel, headrest and any hand-held switches.
• The operator should wear double pair of gloves, mask, visor and
disposable apron.
• Intraoral film/sensor is inserted into barrier plastic envelope to
guard against contamination.
• The receptor is inserted into a receptor holder.
• Disposable apron is placed over the lead apron to be worn by the
patient.
• After radiograph is taken, dispose receptor holder and apron into
a clinical waste bin.

Rinn disposable polystyrene bite blocks for

both paralleling and bisected angle
technique .
Good surface disinfectants include iodophors, chlorines and sythetic phenolic
compounds.
• Wipe off the saliva on the plastic covering the film packet
with disinfectant wipes.
• Open the plastic barrier envelope and drop the receptor
into the cup/clean paper.
• Dispose off contaminated barrier plastic into a clinical
waste bin.
• Dispose off outer pair of gloves.
• Pass receptor for processing.
• Remove plastic covers and wipe chair and x-ray tube
with disinfectant and leave for 10 minutes.
• Dispose inner pair of gloves into a clinical waste bin, and
wash.
•Daylight-loading automatic processors -the risk of salivary
contamination of the soft flexible arm sleeves.

•Film packets must only be introduced into daylight-loading

processors using clean hands (or washed gloves). Powdered
gloves may cause artifacts on the films.
Important Points To Note

•When X-raying known or suspected TSE patients, extraoral

radiographic techniques that avoid salivary contamination,
should be chosen whenever possible (preferably using a
technique that does not involve any form of intraoral
positioning device) and films/sensors should be processed
immediately and not left on work surfaces.

Infection control measures are of particular importance

during sialography when the wearing of an eye protective
visor and a mask are recommended.

FOOTNOTE
All health care workers should remember that they have a
duty of care to do no harm to their patients.
 Lead Apron
• Lead aprons should be cleaned, disinfected and covered between
patients because it is frequently contaminated with saliva as a result
of handling during radiographic procedures.
 DIGITAL SENSORS
• Digital sensors, including PSP plates
(despite placing in plastic barriers)
should preferably be disinfected
between patients using a method
recommended by the manufacturer!!

• PSP plates may be gas sterilized with ethylene

oxide.
 Disposable bite blocks/
plastic envelope covers
the bite blocks

PANORMIC
RADIOGRPAHY