Infection Control in the Dental Clinic: Protecting yourself, your family and your patients.

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1 Infection Control in the Dental Clinic: Protecting yourself, your family and your patients. This infection control audit tool contains background information and standards, which should be followed in order to protect you, your family and your patients from a range of infections which may be transmitted in the Dental Clinic. These include HIV and hepatitis viruses. It contains 6 sections and has been designed to be used as a check list to monitor improvements in adhering to the standards. A. Hand hygiene B. Personal protection C. Patient protection D. Decontamination of the environment E. Decontamination of instruments F. Preventing and managing inoculation (needle- stick) injuries 1

2 Infection Control Action Plan and Audit BACKGROUND A. Hand Hygiene Good hand hygiene protects your self and your family and also the patient. Bacteria and viruses that are present in blood saliva or that have contaminated the environment can survive on hands for long periods and be passed onto other people. STANDARDS 1. Hands must be washed between patients and after contact with bodily fluids such as saliva or blood 2. Washing Hands should be washed for at least 20 seconds using soap and water, ensuring all surfaces of the hands are washed. Alternatively, alcohol can be used. 3. Drying - Hands can be dried on clean paper towels, or if none is available a towel can be used solely for that purpose. The towel should be changed at the end of every clinical session (i.e. at the end of the morning and afternoon sessions). B. Personal protection - Staff Bacteria and viruses can be passed onto other people by splashing into eyes, noses and the mouth. - Gloves - Eye / face protection 4. Gloves - New gloves must be worn for every patient and when cleaning instruments. Once gloved hands are seen as dirty. Therefore do not touch anything else outside the patient area ie Cabinets / mobile phones etc. 5. Face masks and eye protection glasses - should be worn when treating patients Face and eye protection should be changed between patients or washed and disinfected between patients. 2

3 C. Patient protection - Eye protection For safety, patient s eyes should always be protected to prevent against any debris, materials etc falling in eyes during treatment. - Patient covering bibs Patient s clothes should be protected from blood, saliva, water, and liquids used. 6. Patients should be provided with eye protection glasses. Glasses should be cleaned with detergent and disinfectant prior to re- using. 7. Disposable paper covering is best, to protect patients clothing. Alternatively - Plastic bibs may be provided. Plastic bibs should be cleaned with detergent and disinfectant prior to re- using. Cloth bibs can be used but should be changed for every patient. 3

4 D. Decontamination of the environment Decontamination is a two- step procedure. Step one - cleaning with detergent Followed by: Step two disinfection using alcohol. Cleaning removes organic matter such as salivary and blood proteins which may prevent the effectiveness of the disinfectant. Splatter zone: Whilst small contaminated particles can travel throughout the clinic and settle on any surface, larger more infectious particles will fall within a 1 meter area from the patient s mouth. 8. The whole clinic environment and area where instruments are sterilised should be cleaned in 2 steps: Step 1. First washed with detergent. Step 2. Then disinfected with alcohol. This should be done at the beginning and end of each clinical session i.e. morning or afternoon session. 9. The 1meter splatter zone should be cleaned and disinfected in between every patient. This should include any areas of the unit that have been touched with a contaminated hand during treatment, e.g. light handle, chair control, drawer handles, instrument tray handle etc. 4

5 Step 1. Cleaning E. Decontamination of instruments Principle: distinguish between dirty and clean areas Flow Cycle: Sink dirty surface-box autoclave clean surface-box storage. Decontamination consists of a number of stages to ensure the instrument is safe to use on the next patient. Step 1. Cleaning - with detergent. This removes organic matter so that the steam from the autoclave can sterilize the instrument. 10. Dirty Box All dirty instruments, burs, trays must be transferred from the tray in surgery to the lock/seal container labeled Dirty Box. All instruments should be carried in the sealed box. The dirty box must be kept in the clean area. 11. Scrubbing Process - Dirty instruments etc should be transferred from the dirty box to the scrubbing sink. All instruments must be cleaned in detergent and water prior to sterilization in the autoclave. 12. Personal Protection - heavy duty domestic gloves, face and eye protection must be used during cleaning. 13. Instruments & burs should be scrubbed carefully with detergent, using a stiff brush - under water to reduce the risk of splashing of contaminated material in to the face. 14. Hand pieces should be cleaned first with alcohol and then oiled with KAVO SPRAY according to instructions. note the coupling should not be autoclaved 5

6 Step 2. Sterilisation Step 2. Sterilisation in Autoclave. 15. Autoclave procedure. Surgical instruments (forceps / elevators) should be put in pouches and sealed. Don t overload the autoclave. Instruments should be placed on a tray in the autoclave, with plenty of space between them, i,e. not over lapping. Hinged instruments should be processed with the hinge open if possible. Step 3. Storage Following sterilization instruments must be stored in a clean area to avoid recontamination from splatter or an unclean environment. Step 3. Storage 16. Once sterilized, using clean gloves, instruments should be put in Clean Box, and moved to storage. 17. Sterilised instruments should be stored on trays in a clean environment and be covered in cabinets. Surgical instruments should be stored in pouches. 18. Burs should be stored in bur stands. 19. Clean all work surfaces between loads with detergent and alcohol. 6

7 F. Prevention and management of inoculation An inoculation injury may be a needle- stick or similar sharp injury or may be the splashing of blood or saliva onto the face. Infection by HIV, hepatitis viruses and other pathogens can occur by both routes. 20. Care must be taken in handling all sharp instruments. 21. Needles and other disposable sharps should be disposed off in the appropriate sharps containers. 23. If a sharp instrument pierces the skin the wound should be washed gently and covered with a dressing. Do not scrub or suck the injury. If a splash occurs to the face, wash with lots of water. 24.In both cases, let your supervisor know and ensure to follow the local protocol to be assessed for the need for follow up treatment (e.g. PEP to prevent HIV). Authors: Dr Jim Edwards BDS London, LDS, RCS, MPhil Univerity of London; Dentist with Rotary Doctors Sweden. Dr Melanie Wilson BSc (HONS), BDS, FDS, PhD, FRCPath (Oral Microbiology) Infection Control Consultant, University Dental Hospital Cardiff Secretary of Association of Clinical Oral Microbiologist, UK. Honorary Consultant in Oral Microbiology, Cardiff and Vale, University Health Board, Wales, UK Senior Lecturer in Oral Microbiology, Cardiff University, Wales, UK 7

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