NHS Lanarkshire. Committee/Infection Control Committee Review date July 2015

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1 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection Pages of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Guideline Objective his guideline aims to ensure that systems are in place to prevent and control infection and communicable disease within the dental surgery environment by underpinning national polices. It outlines the criteria, responsibilities and systems required within dental services to manage specific conditions/infections. he goal of this guideline is to protect patients, staff and the public by effective prevention and control of infection and communicable disease. Compliance with this guideline is best practice. If you have any concerns please discuss with your line manager who will consult the local Infection Control/Health Protection eam for advice

2 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 2 of 5 Replaces Jan 200 SECION CONENS GUIDELINES FOR HE CONROL OF INFECION IN HE DENAL SURGERY AND DECONAMINAION ROOM Page Nos. 50 INRODUCION 4 2 SAFE WORKING PRACICE 4 2. HAND PROECION EYE PROECION AND FACE MASKS 5 `2.3 AEROSOL AND SALIVA BLOOD SPAER 5 3 ZONING IN HE DENAL SURGERY AND DECONAMINAION ROOM 4 SURFACE CLEANING AND DISINFECION 6 5 SINGLE-USE IEMS, SINGLE-PAIEN-USE AND 6-7 WRAPPED IEMS 6 INSRUMEN DECONAMINAION/ 8 7 DEFINIIONS 9 8 PRE-CLEANING OF DENAL INSRUMENS 0-9 CLEANING DENAL INSRUMENS INSPECION OF DENAL INSRUMENS 5 LUBRICAION OF DENAL INSRUMENS SORAGE OF CONAMINAED INSRUMENS SERILISAION (UNWRAPPED INSRUMENS) DECONAMINAION PROCESS WHEN REAMEN IS CARRIED OU OUWIH HE DENAL SURGERY 5 CLEANING PROCEDURE FOR REVERSE OSMOSIS WAER UNI

3 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 3 of 5 Replaces Jan SORAGE OF SERILE DENAL INSRUMENS DECONAMIBAION OF EQUIPMEN PRIOR O INSPECION, SERVICE OR REPAIR 24 8 SPILLAGES 24 9 WASE DISPOSAL ACCIDENAL EXPOSURE O BLOOD OR BODY FLUIDS 2 SANDARD OPERAING PROCEDURES SURGERY SE UP SURGERY CLEANING BEWEEN PAIENS SURGERY SHU DOWN DECONAMINAION ROOM SE UP DECONAMINAION ROOM SHU DOWN DECONAMINAION OF INSRUMENS 2 CLEANING SCHEDULES OVERALL CLEANING SCHEDULE DAILY CLEANING SCHEDULE DENAL SURGERY WEEKLY CLEANING SCHEDULE DENAL SURGERY MONHLY CLEANING SCHEDULE DENAL SURGERY DAILY CLEANUING SCHEDULE DECONAMINAION ROOM WEEKLY CLEANING SCHEDULE DECONAMINAION ROOM MONHLY CLEANING SCHEDULE DECONAMINAION ROOM REFERENCES

4 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 4 of 5 Replaces Jan 200. INRODUCION Infection control is an important aspect of clinical practice for all health care workers and the guidance contained in the other sections of this manual applies equally to dentistry. It is recognised, however, that additional guidance is required to cover specific dentistry related issues. his section, therefore, deals with these and refers the reader to generic guidance where appropriate. All staff (including new staff) should be aware of infection control procedures and understand why they are necessary, be appropriately qualified and able to demonstrate competency before working in the surgery. In any case where competency cannot be proven appropriate training must be provided. In addition, all staff carrying out decontamination processes should have a formally documented training needs assessment and a record of training received as part of the Glennie report (200) 2. SAFE WORKING PRACICE A wide variety of micro-organisms may be present in the saliva, body fluids, vomit and blood of patients. During dental treatment infection may be transmitted through direct contact, trauma, bites, droplets, aerosols or inoculation by contaminated instruments. Most carriers of infection, including, blood borne viruses (BBV), are unaware of their condition and therefore it is important that the same control of infection practice is adopted for all patients. Standard Infection Control Precautions must be observed at all times as this ensures a safe approach for all. Refer to Chapter : Standard Infection Control Precautions of the Control of Infection Manual. 2. Hand Protection Cover all cuts and abrasions with a waterproof plaster Non-sterile Nitrile/vinyl gloves should be worn by all clinical staff during all clinical procedures (invasive and non invasive) Gloves should be worn for as short a time as possible and a new set of gloves after every patient. Gloves must be removed before leaving clinical area Used gloves should be disposed of as clinical waste (see K: Guidelines for the Management of Healthcare Waste, Control of Infection Manual) Perform hand hygiene before and after removing gloves Alcohol hand rubs may be used (on hands that are not contaminated with blood or saliva) where handwashing facilities are not readily available 4

5 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 5 of 5 Replaces Jan 200 Moisturising hand creams (should) can be used to counteract dryness Refer to H: Hand Hygiene Guidelines, Control of Infection Manual. 2.2 Eye Protection and Face Masks Eye protection must always be provided for patients. All clinical staff must use eye protection and disposable masks during all operative procedures. Eye protection and masks must be removed before leaving clinical area. 2.3 Aerosol and Saliva Blood Spatter Many common infectious diseases are readily spread via aerosols e.g., chickenpox and influenza. here is no evidence that blood-borne viruses can be spread by aerosols but they may be spread by blood spatter. he risk of transmission of infection by these routes will be reduced if: here is good surgery ventilation and efficient high speed aspirators which exhaust externally from the premises Aspirators and tubing are regularly cleaned and disinfected in accordance with the manufacturer s instructions and flushed through daily with their recommended nonfoaming disinfecting agent Rubber dam isolation is used whenever practicable Appropriate personal protective equipment (PPE) is used. 3. ZONING IN HE DENAL SURGERY AND DECONAMINAION ROOM o facilitate cleaning, the design and layout of the dental surgery and decontamination room should be kept simple and in general the environment should be kept uncluttered. All surfaces should be smooth, impervious, washable and able to withstand chemical disinfectants. A zoning system should be utilised with clean and dirty areas clearly defined and clean-to-dirty work flow maintained. In general decontamination of dental instruments should not be carried out in the dental surgery However, where physical segregation of patient areas from the decontamination area is not possible, clinical activity and decontamination must not take place simultaneously. Decontamination of dental instruments can take place in the surgery in the absence of patients (emporal Separation). However this option expires in Jan

6 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 6 of 5 Replaces Jan SURFACE CLEANING AND DISINFECION IN HE DENAL SURGERY he areas which may be contaminated during operative procedures should be cleaned between patients. he light and chair controls should be protected with disposable impervious coverings which are changed between patients. All work surfaces, including those apparently uncontaminated, aspirators, drains and spittoons should be thoroughly cleaned after each patient (See paragraph 6.4 and I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) 5. SINGLE-USE IEMS, SINGLE-PAIEN-USE AND WRAPPED IEMS 5. Single-Use items and Single-Patient-Use Items Items designated as single use must never be re-used his symbol indicates Single-Use here is no symbol for Single-Patient Use instructions for this are given on the packaging. 6

7 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 7 of 5 Replaces Jan Wrapped Items Before using any equipment check the manufacturer s instructions regarding reprocessing Ensure your hands are clean before opening or using any medical equipment. Check the wrapper and identify the markings on the medical device. Check the expiry date has not passed, if the date has passed, DO NO USE Check the wrapping is intact, if not intact, DO NO USE. Check there is no staining on the wrapper or indication that it has been wet after. sterilisation, if staining is present, DO NO USE Prior to use, packaging must be checked for single-use markings and decontamination instructions. Items marked Single-Use must only be used once on one patient and discarded as clinical waste. Items marked Single-Patient-Use may be decontaminated and reused on the same patient provided the manufacturer s instructions on the decontamination and reuse are followed. Local anaesthetic needles must always be disposed of safely by clinician. See G Blood Borne Virus Infection: Prevention, Control of Infection Manual Part-used local anaesthetic cartridges must be disposed of after each patient, they must never be used on a second patient Use disposable items including: burs, scalpels, aspirator tips, 3 in tips, saliva ejectors, matrix bands, impression trays and beakers, whenever possible. Dispose safely in accordance with guidance. See G Blood Borne Virus Infection: Prevention, Control of Infection Manual 7

8 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 8 of 5 Replaces Jan INSRUMEN DECONAMINAION 6. General Local Decontamination Units Decontamination of dental instruments where practicable should be carried out in a Local Decontamination Unit (LDU), he LDU should be a dedicated room designed and equipped for the purpose and be located close to the dental surgery. Contaminated dental instrument must be placed in an approved, clean, rigid, leak-proof labelled and secure transit container with a tight fitting lid. his container should be stored safely until taken to the LDU. Ideally, clean these containers in a washer-disinfector (WD). If this is not possible, clean containers with a fresh detergent solution, rinse and dry. Do not use bleach or hypochlorite solution because residues might damage the instruments. he LDUs are designed to facilitate a dirty-to clean one way workflow throughout the decontamination process 6.2 General- Decontamination in the Dental Surgery In exceptional circumstances decontamination of dental instruments can take place in the surgery in the absence of patients (emporal Separation). emporal separation means using the same area for two separate activities at different times. If, through lack of space, a work surface is used for both dirty and clean instruments, ensure that the surface is thoroughly cleaned, and if necessary disinfected, between the two activities to avoid recontamination of cleaned instruments. emporal separation is a temporary arrangement and plans are in place to ensure space for a decontamination area to enable physical segregation of decontamination activities in all our sites.however this option expires in Jan General Central Decontamination Providers If decontamination of dental instruments is carried out by a Central Sterilisation Service Provider then contaminated dental instrument must be placed in an approved, clean, rigid, leak-proof labelled and secure transit container with a tight fitting lid. his container should be stored safely until collection. 8

9 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 9 of 5 Replaces Jan DEFINIIONS Decontamination: the combination of processes, including cleaning, disinfection and/or sterilisation, used to render a reusable item safe for further use. Cleaning: Physically removes contaminants including dust, soil, large numbers of micro-organisms and the organic matter that protects them. Disinfection: Reduces the number of micro-organisms to a safe (or relatively) safe level. Bacterial spores are not usually destroyed Sterilisation: Removes or destroys all known micro-organisms including bacterial spores 9

10 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 0 of 5 Replaces Jan PRE-CLEANING he first and most important stage of the decontamination process is pre-cleaning. Prior to sterilisation of instruments it is essential to remove all physical contamination such as blood, tissue or saliva. Residual blood or other adherent material, if not removed, may become fixed and shield micro-organisms which could then survive the decontamination process. Pre-cleaning must be carried out in the dirty area. For more details on pre-cleaning Procedures please refer to section 3 in the Scottish Dental Clinical Effectiveness Programme (SDCEP) document Cleaning of Dental Instruments, Dental Clinical Governance (March 2007) If pre-cleaning of dental instruments is required it must be carried out wearing appropriate Personal Protective Equipment (PPE) e.g. disposable aprons, heavy duty gloves, face mask and eye protection). Heavy duty gloves must be washed with detergent and hot water to remove visible soil and dried after each use. Prior to cleaning segregate re-usable instruments to be cleaned from items for disposal according to their category Some instruments will require dismantling, according to their manufacturer s instructions for cleaning 8. Manual Pre-Cleaning 8.. Removal of cements and hard setting materials from instruments Cement should be removed at chair side by the dental nurse before it has fully set using either of the following options: Wiping the head of the instrument as it is held out and held steady by the dentist aking the instrument from the dentist and wiping it Set cement can be removed in either the surgery once the patient has left or in the decontamination room. Set cement should be removed by holding the instrument under water (not running water) in a designated dirty sink and using a spatula to scrape away the cement Full PPE must be worn 0

11 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages of 5 Replaces Jan o Pre-Clean Dental Instruments Place the instruments in a basket (ultrasonic basket) Place the basket in the dirty sink. Agitate the instruments under water (detergent is not required) using a long handled brush (do not pre-clean instruments under running water) while wearing full PPE e.g. heavy duty gloves, plastic apron and eye protection. Rinse instruments thoroughly with clean water and check instruments are free from visible residual debris. If debris is still visible on instruments repeat bullet points 2-.4

12 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 2 of 5 Replaces Jan CLEANING DENAL INSRUMENS 9. Ultrasonic Cleaning Ultrasonic cleaning in a fully functioning machine enhances removal of debris, thereby reducing the need for scrubbing instruments. hus, although a WD is preferred an ultrasonic cleaner can be used as a cleaning method, particularly for instruments with hinges and/or intricate parts. Do not use ultrasonic cleaners to clean dental hand pieces. 9.2 Ultrasonic Cleaning Procedure Always use detergents specified by the manufacturer as suitable for the intended use. For manual and ultrasonic cleaning, use low-foaming neutral detergents dispensed in a measured dose in a measured volume of water. A neutral detergent is regarded as one that has a ph within the approximate range of ph 5 9 when diluted in accordance with the manufacturer s in-use specification. Run the ultrasonic cleaner while filled with the water detergent solution but without a load for the manufacturer s specified time to de-gas the solution on start up and on subsequent re-fillings; If instruments are particularly heavily soiled, briefly immerse them in cold water in the washing sink to remove some of the blood and other visible soil before ultrasonic cleaning. Follow the manufacturer s recommendations for the safe operating procedure of your ultrasonic cleaner Ensure that instruments with joints or hinges are opened fully and instruments that need taking apart are fully disassembled before they are immersed in the solution. Place instruments in a suspended basket and fully immerse in the cleaning solution ensuring that all surfaces are in contact with the solution. Do not overload the basket or overlap instruments because this results in poor cleaning and can cause wear to the instruments. Set the timer to the correct setting as per the ultrasonic cleaner manufacturer s instructions. Close the lid and do not open until the cycle is complete. After the cycle is complete, drain the basket of instruments before rinsing. 2

13 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 3 of 5 Replaces Jan 200 Change the solution when it becomes visibly contaminated or otherwise every 4 hours because the build-up of debris will reduce the effectiveness of cleaning. Drain, clean with a neutral detergent solution, rinse and dry the cleaner when not in use (e.g. overnight). After ultrasonic cleaning, rinse instruments thoroughly to remove residual soil and detergents by immersing clean instruments in clean water in a separate sink or basin dedicated for rinsing clean instruments. It is acceptable to use freshly drawn soft tap water for rinsing instruments. Instruments must not be allowed to air dry as inadequate drying might enable moisture to be trapped, promoting corrosion and/or microbial growth. Use disposable, non-linting towels to dry instruments immediately after rinsing Inspect instruments for cleanliness 9.3 Manual Pre-Cleaning and Ultrasonic Cleaning Always use detergents specified by the manufacturer as suitable for the intended use. For manual and ultrasonic cleaning, use low-foaming neutral detergents dispensed in a measured dose in a measured volume of water. A neutral detergent is regarded as one that has a ph within the approximate range of ph 5 9 when diluted in accordance with the manufacturer s in-use specification. 9.4 Washer Disinfectors Using a washer-disinfector (WD) is the preferred method for cleaning dental instruments because it offers the best option for the control and reproducibility of cleaning, and the cleaning process can be validated. WDs are used to carry out the processes of cleaning and disinfection consecutively. A typical WD cycle for instruments has five stages Five Stages of the WD. Flush Removes difficult gross contamination, including blood, tissue debris, bone fragments and other fluid and solid debris. Latest standards indicate that a water temperature of <45 C is used to prevent protein coagulation and fixing of soil to the instrument. 2. Wash Removes any remaining soil. Mechanical and chemical processes loosen and break up contamination adhering to the instrument surface. Use only approved detergents 3. Rinse Removes detergent used during the cleaning process. his stage can contain 3

14 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 4 of 5 Replaces Jan 200 several sub stages. 4. hermal disinfection he temperature of the load is raised and held at the pre-set disinfection temperature for the required disinfection holding time: for example, 80 C for 0 minutes, or 90 C for minute 5. Drying Purges the load and chamber with heated air to remove residual moisture What instruments go through the WD Clean all instruments that are able to be immersed in water in a WD if available, except where stated otherwise in the manufacturers instructions For details of all operational aspects of using a WD follow the manufacturer s instructions. Clean all instruments that are able to be immersed in water in a WD except where stated otherwise in the manufacturers instructions How to load a WD Dental instruments must not be placed into the automated WD unless they are clear to the naked eye of all visible debris. It is crucial to load a WD correctly because incorrectly loaded instruments will not be cleaned effectively. herefore, follow these principles when loading a WD: Do not overload instrument trays or overlap instruments Open instrument hinges and joints fully; Do not attach hand pieces to the irrigation system - simply lay hand pieces flat on the tray All the parts of an instrument that requires dismantling, according to their manufacturer s instructions, for cleaning should be placed separately in the WD After cleaning in a WD inspect instruments for cleanliness and check functionality e.g. smooth opening of hinges 4

15 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 5 of 5 Replaces Jan INSPECION OF DENAL INSRUMEN 0. Inspection and Care of Instruments before Sterilizing Inspect all instruments that have been through any cleaning procedure, including processing by a WD to ensure they are clean, functional and in good condition. An illuminated magnifier is while not essential is recommended because it makes it much easier to see residual contamination, debris or damage 0.2 Inspection for Cleanliness Inspect instruments for any visible soiling such as blood or lining materials. It is especially important to check joints, hinges or the serrated surfaces of jaws, which are difficult to clean. If there is any residual contamination, reject the instrument and ensure it undergoes another cycle of the cleaning process. 0.3 Functional Inspection Check all instruments that have been through any cleaning procedure, including processing by a WD, to ensure that they are in good working order. Dispose of instruments that are blunt, bent or damaged or show any signs of pitting or other corrosion.. LUBRICAION OF DENAL INSRUMENS. Lubrication Lubricate the joints and hinges of instruments before sterilizing to prevent seizing and corrosion. he lubricant used for this purpose must be permeable to steam, water soluble and suitable for sterilisation. Follow manufacturers recommendations..2 Hand piece Care Lubricate hand pieces according to the manufacturer s instructions. hose that have been processed in a WD might have had the lubricant removed and require lubrication again before going into the sterilizer. 5

16 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 6 of 5 Replaces Jan 200 Use a separate canister of lubricant for cleaned instruments. Label the lubricant canisters so that it is clear which canister is used for unclean instruments, and which is used for instruments that have been cleaned in a WD. Another canister for use with hand pieces after sterilization might be required if the manufacturer recommends it. Inadequate lubrication can lead to unnecessary damage to the internal mechanism of hand pieces. he cleaning process is now complete and the dry instruments are ready for sterilisation 2. SORAGE OF CONAMINAED INSRUMENS Preferably, fully decontaminate instruments as soon as possible after use. However, if a patient is seen late or out of normal working hours, clean and dry instruments at the end of the treatment session. 2. Storage of instrument during the working day until able to take them to the decontamination room for processing Contaminated dental instrument must be placed in an approved, clean, rigid, leak-proof labelled and secure transit container with a tight fitting lid. his container should be stored safely in an appropriate container clearly marked as containing contaminated instruments. 2.2 Storage of contaminated instruments overnight (Monday to hursday) On the few occasions when the dental staff members do not have time to complete the full decontamination of instruments at the end of a working day the following procedure should be followed: Pre-clean if necessary Place instruments in the ultrasonic bath, run the cycle, remove instruments, rinse and dry then place in red box and clearly mark as containing contaminated instruments Or Place instruments in washer/disinfector switch on, run the cycle & leave overnight Continue the reprocessing of the dental instruments the next working day by reprocessing these instruments through the complete decontamination process starting with cleaning because micro-organisms can accumulate during storage. 6

17 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 7 of 5 Replaces Jan Storage of contaminated instruments over weekends or on Public Holidays On the few occasions when the dental staff members do not have time to complete the full decontamination of instruments at the end of a working week the following procedure should be followed: Pre-clean and dry instruments at end of clinical session. Place in red box and clearly mark contaminated instruments Continue the reprocessing of the dental instruments the next working day by reprocessing these instruments through the complete decontamination process starting with cleaning because micro-organisms can accumulate during storage 3. SERILISAION (UNWRAPPED INSRUMENS) 3. Autoclaves basic working principles and loading Before being sterilised, all used instruments must be thoroughly cleaned. Steam under pressure in an autoclave is the method of choice for the sterilisation of all dental instruments. Steam sterilisation is dependant on direct contact between the load material and saturated steam under pressure, in the absence of air. he highest temperature of 34 o C with a minimum holding time 3 minutes is recommended wherever possible. he majority of bench top autoclaves currently in use achieve the above conditions by heating sterile water within the chamber to produce steam at the required pressure and temperature. Air is passively displaced from the chamber by the steam. his type of autoclave is for sterilising unwrapped instruments only, and no wrapping material or pouches should be used. hey are also unsuitable for the sterilisation of narrow lumen instruments. All instruments should be placed in the autoclave so that there is free circulation of steam. Items such as bowls, which may retain air and condensate, should be supported within the autoclave chamber in a manner that will facilitate complete air removal and drainage of condensate. 7

18 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 8 of 5 Replaces Jan 200 Autoclaves must not be overloaded and manufacturers loading instructions should be followed at all times. Ensure that instruments with joints or hinges are opened fully and instruments that need taking apart are fully disassembled before they are placed in the autoclave esting of Autoclaves o ensure adequate performance, equipment must be maintained and tested regularly. A logbook must be kept for each autoclave. he logbook must contain results of routine monitoring, examinations, tests, faults, repairs user name etc, (see I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items) Sterilisation emperature Bands, Holding imes and Pressure for Sterilisation with High emperature Steam SERILISAION EMPERAURE RANGE ( O C) Minimum Normal Maximum APPROX. PRESSURE (bar) MINIMUM HOLD IME (min) DECONAMINAION PROCESS WHEN REAMEN IS CARRIED OU OUWIH HE DENAL SURGERY Domiciliary Visits and National Dental Inspection Programme Clean instruments may be transported to the place of care in either sealed sterilisation pouches or in a clean, sturdy transit container with a tight fitting lid. his container should be clearly marked as containing clean instruments Fluoride Varnish Application visits to Nursery and Primary Schools Disposable instruments should be transported to the place of care in their original packaging. Following use they must be placed in the appropriate clinical waste containers i.e. yellow bags or sharps containers and returned to base clinic or nearest Health Centre for disposal. Following treatment contaminated instruments must always be transported back to the Clinic in a sturdy, leak-proof, labelled transit container with a tight fitting lid for decontaminated in the appropriate manner. 8

19 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 9 of 5 Replaces Jan 200 All waste must be segregated into clinical and domestic waste (see K: Guideline for the Management of Healthcare Waste) and taken back to the Clinic or Health Centre for disposal ooth brushing Programme in Nursery and Primary Schools no instruments used. All clinical waste i.e. gloves and old toothbrushes are disposed of on site in the appropriate waste bags which are provided and disposed of by each establishment visited. 5. REVERSE OSMOSIS WAER UNIS 5. Purified soft water of good quality (i.e. free from humic and fulvic acids) freshly drawn drinking water might be allowed for rinsing. In hard water areas, or where the water is discoloured use purified water (e.g. freshly produced reverse osmosis (RO), water freshly produced distilled water or Sterile Water for Irrigation BP) Softening of water is not sufficient on its own because this does not reduce the level of total dissolved solids, which can be left on the instruments as a residue. RO water units require proper installation, testing and routine maintenance to consistently produce good quality water. RO water quality can deteriorate at a rate that is dependant on the temperature and other local factors. Use RO water within 24 hrs of production, and preferably within 4 hrs. 9

20 Area Control of Communicable Disease Effective From July 202 Committee/Infection Control Committee Review date July 205 SECION Guidelines for the Control of Infection in the Dental Surgery and Decontamination Room Pages 20 of 5 Replaces Jan he Reverse Osmosis Unit system must be maintained and cleaned on a monthly basis by carrying out the following process:. Ensure reservoir is less than 70% full (gauge is on the front of the unit) 2. Press the process button (on front of the unit to the right of the display screen) 3. urn off electrical supply 4. Wait a few minutes to relieve residual pressure in the system 5. Unscrew the blue cap (on top left of the unit) 6. Insert one CI cleaning tablet 7. Replace the blue cap 8. Close valve No 9. Open valve No 2 0. Valves are clearly marked No is on the right and No 2 on the left. Switch on the power 2. Press the process button to start the cycle 3. Allow the cycle to continue for at least 30 minutes 4. Press the process button to end the cycle 5. urn electrical supply off 6. Open valve No 7. Close valve No 2 8. urn on power 9. Press process button to start normal operation 20. Check the unit for any leak 20

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