When taking dental radiographs, there is significant potential for cross-contamination of equipment and environmental surfaces with blood and/or saliva if proper aseptic techniques are not practiced. Dental healthcare personnel (DHCP) also can be at risk. Research indicates that oral micro-organisms can remain viable on inert radiographic equipment for up to 48 hours. Similar microbes have been shown to survive in x-ray developer/fixer for periods as long as 2 weeks.1-4
USING INTRAORAL FILMS HELD WITHIN BARRIER POUCHES
|Table 1. Prior to taking x-rays (modified from references 2 to 5).|
|Table 2. While taking x-rays (modified from references 1 to 8).|
|Table 3. After taking x-rays (modified from references 1 to 8).|
Preparing to Take Dental Radiographs
It is important to prepare the area prior to seating the patient. Advanced preparation increases the chances of success. Whenever possible, items used in the mouth should either be single-use, disposable, or sterilized by heat (Table 1).
Taking Dental Radiographs
Gloves should always be worn when taking radiographs and handling contaminated film packets. Other PPE should be used when the spattering of patient body fluids is likely. Ideally, only heat-tolerant intraoral x-ray accessories (eg, film holders and positioning devices) should be used. Some items such as mouth props can either be sterilized or be single-use and disposable (Table 2).
After Taking Dental Radiographs
Care must be taken when peeling or pulling open the protective barriers covering the x-ray films. Patient fluids must not reach either the films or the transport cups. Unsoiled films are the desired goal. Handling such items without gloves makes processing much easier in the darkroom and daylight loader1-4 (Table 3).
Developing Dental Radiographs
Once in the developing area, open film packets with clean, ungloved hands. Holding the tab, films can go into clean plastic cups or onto paper towels. Holding films by their edges, insert them into the processor. Just to be safe, it is best either to cover or to clean and disinfect the surfaces of developing equipment regularly1-4 (Table 4).
|Table 4. Processing x-rays (modified from references 1 to 8).|
|Table 5. Processing unprotected x-rays (modified from references 1 to 8).|
|Table 6. Extraoral radiographs (modified from references 1 to 8).|
USING INTRAORAL FILMS NOT HELD WITHIN BARRIER POUCHES
It is important when handling and processing films not held in protective barriers that they be well wiped off chairside after removal. It is very important either to cover or clean and disinfect any surface that may become contaminated2,3 (Table 5).
PANORAMIC/ CEPHALOMETRIC X-RAYS
Fewer intraoral pieces of equipment are used when taking extraoral radiographs such as panoramic and cephalometric films. The chances of contamination with patient blood or saliva are greatly reduced. Bite guides should be sterilized or be single-use disposable types. The use of covers over the bite guide is less desirable2,3 (Table 6).
Daylight loaders commonly have cloth or rubber sleeves, cuffs, or flaps. These are used to allow for the passage of materials in and out of the daylight loader without allowing light to enter. This means that the equipment is difficult or impossible to clean or disinfect. Therefore, it is imperative that an effective yet efficient protocol for aseptic use be established and rigorously maintained. After reviewing the following steps, it should be obvious how useful barrier protected films are2-6 (Table 7).
DIGITAL X-RAYS AND OTHER TECHNOLOGIES
|Table 7. Using daylight loaders (modified from references 1 to 8).|
Digital radiographic sensors and other high-technology instruments such as intraoral cameras, electronic periodontal probes, colossal analyzers, and lasers come into contact with mucous membranes. Such devices are considered to be semi-critical items. Ideally, they should be cleaned and heat-sterilized or high-level disinfected between patients. However, many cannot be heat-sterilized or undergo high-level disinfection.
Infection control for dental radiography employs the same materials, processes, and techniques used in the operatory, yet unless proper procedures are established and followed, there is a definite potential for cross-contamination to clinical area surfaces and DHCP. In general, the aseptic practices used are relatively simple and inexpensive, yet they require complete application in every situation.
- Kohn WG, Collins AS, Cleveland JL, et al; Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
- Organization for Safety & Asepsis Procedures. From Policy to Practice: OSAP’s Guide to the Guidelines. Annapolis, Md: Organization for Safety & Asepsis Procedures; 2004:91-97.
- USAF Dental Investigation Service. Infection control practices for dental radiology. Available at: http://www.brooks.af.mil/dis/DOWNLOAD/radiologyinfcontrol.pdf. Accessed April 2004.
- Organization for Safety & Asepsis Procedures. Infection control and dental radiography. Infection Control In Practice. 2003;2(November):1-8.
- Miller CH, Palenik CJ. Sterilization, disinfection, and asepsis in dentistry. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1049-1068.
- Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 2nd ed. St Louis, Mo: Mosby; 1998:217-221.
- Haring JI, Jansen L. Infection control and the dental radiographer. In: Haring JI, Jansen L. Dental Radiography: Principles and Techniques. 2nd ed. Philadelphia, Pa: WB Saunders; 2000:194-204.
- Glass BJ, Terezhalmy GT. Infection control in dental radiology. In: Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control in Dentistry. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996:229-238.
Dr. Palenik has held over the last 25 years a number of academic and administrative positions at Indiana University School of Dentistry. These include professor of oral microbiology, director of human health and safety, director of central sterilization services, and chairman of infection control and hazardous materials management committees. Currently he is director of infection control research and services. Dr. Palenik has published 125 articles, more than 290 monographs, 3 books, and 7 book chapters, the majority of which involve infection control and human safety and health. Also, he has provided more than 100 continuing education courses throughout the United States and 8 foreign countries. All questions should be directed to OSAP at email@example.com.