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

Transcription

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

21 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 SORAGE OF SERILE DENAL INSRUMENS All dental instruments must be cleaned and sterilised after use as detailed in able Specific Items A-Z. hey should be stored dry and protected from dust, splash or aerosol contamination in closed or covered trays or in sealed pouches then placed in closed cupboards or drawers o avoid inadvertent contamination, storage drawers or cupboards must be kept closed during procedures. ABLE SPECIFIC IEMS ANAESHEIC CARRIDGES APPLIANCES PROSHEIC/ ORHODONIC ASPIRAORS/UBING BURS BRACKE ABLES CHAIR: HAND CONROLS Single patient use only. Discard into sharps container. reat as for impressions. If gross contamination an ultrasonic bath containing a general purpose neutral detergent and water solution should be used for cleaning prior to rinsing and disinfection. Clean regularly according to manufacturer s instructions and flush through daily with their recommended non-foaming disinfecting agent. Steel burs and debonding burs: Disposable, clinician to discard into sharps container after single use. ungsten Carbide, Diamond burs, Finishing burs and Stones: Preclean then sterilise in an autoclave after each patient use. Wash daily and between each patient using the appropriate detergent wipe. In the event of contamination, clean with appropriate detergent wipe and then wipe over with 70% isopropyl alcohol impregnated wipe. Clean daily and between each patient, before use, using an appropriate detergent wipe. Protect during procedures with disposable impervious cover - discard after each patient and wipe over with appropriate detergent wipe. 2

22 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 22 of 5 Replaces Jan 200 CAVIRON HANDPIECES Wipe over between use with appropriate detergent wipe and 70% isopropyl alcohol impregnated wipe. CAVIRON HEADS CURING LIGH DRAINAGE SYSEM HANDPIECES A sterile Cavitron head must be used for each patient. Pre-clean and autoclave after each use, or discard into sharps container if disposable. Cover tip when in use with a transparent impervious polythene cover. Wipe over after use with appropriate detergent wipe. Clean after every session, using cleaner recommended by manufacture, e.g., Orotol or MC 000. A sterilised hand piece must be used for each patient: remove bur during cleaning to prevent contamination of hand piece bearing clean outside of hand piece with appropriate detergent wipe - DO NO IMMERSE; DO NO USE ALCOHOL WIPES lubricate hand piece with pressurised oil, as recommended by the manufacturer, until clean oil appears out of the chuck clean off excess oil place flat in WD for cleaning sterilise in autoclave lubricate hand piece after sterilisation, if recommended by manufacturer run hand piece briefly before use to clear excess lubricant Each morning run for 2 minutes before use to clear the water line. If the unit has been out of operation for more than a few days, increase time to 5 minutes. 22

23 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 23 of 5 Replaces Jan 200 HEADRESS IMPRESSIONS MARIX BANDS MOUHWASH CUPS NEEDLES Use disposable cover and discard after each patient. Wipe over between patients with the appropriate detergent wipe. (See also I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) Impressions must be decontaminated before leaving the surgery. Immediately on removal from the mouth, rinse under running water until visibly clean to remove saliva, blood and debris - avoid splashing. After cleaning as above (except for hydrocolloid or polyether impressions): disinfect by immersion in chlorine releasing agent 0,000 ppm available chlorine for 0 minutes (See I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) rinse well again under running water Hydrocolloid or polyether impressions: dip the rinsed impression in chlorine releasing agent 0,000 ppm available chlorine rinse under running water dip again in the chlorine releasing agent cover with gauze dampened in above disinfectant solution, for 0 minutes rinse well under running water store for transport as per manufacturers instructions Disposable - discard into sharps box after single patient use. Disposable - discard after single patient use. Disposable clinician to discard into sharps containers after single patient use. 23

24 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 24 of 5 Replaces Jan 200 OPERAING LIGH SALIVA EJECORS SPIOON SINKS SYRINGE 3-IN-ONE Clean daily before use and after each patient with the appropriate detergent wipe. Protect handles during procedures with disposable impervious cover, discarded after each patient and wiped down with appropriate detergent wipe. Use disposable or autoclave between patients. Clean using appropriate detergent wipe as often as required. Clean using appropriate detergent wipe, once a day or as often as required. Use disposable tips for each patient. Use disposable cover and discard after each patient. Each morning run for 2 minutes before use to clear the water line. If the unit has been out of operation for more than a few days, increase time to 5 minutes. WORK SURFACES Wipe over with appropriate detergent wipe. (See also I: Policy for Cleaning, Disinfection and Sterilisation - Spillages) 7. DECONAMINAION OF EQUIPMEN PRIOR O INSPECION, SERVICE OR REPAIR Equipment and articles which have been contaminated by contact with blood or other body fluids must be rendered safe, and a statement confirming this completed, prior to examination by third parties (see I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) 8. SPILLAGES Spillages of blood or body fluids must be cleaned up as soon as possible (see I: Decontamination of Equipment and the Environment (including the use of single-use and singlepatient use items) In all surgeries items required to deal with spillages must be easily accessible, either as individual items or in the form of a spill pack. 24

25 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 25 of 5 Replaces Jan WASE DISPOSAL he producers of waste are responsible for it until final disposal and must comply with the Duty of Care obligations in terms of the Environmental Protection Act 990. All waste must be segregated into clinical and domestic waste (see K: Guidelines for the Management of Healthcare Waste, Control of Infection Manual) 20. ACCIDENAL EXPOSURE O BLOOD OR BODY FLUIDS If any member of staff sustains a significant injury* or contamination** involving exposure to blood or body fluids, first aid treatment should be carried out immediately (see below) and medical help sought - see G: Blood borne Virus Infection: Prevention, Control of Infection Manual he rapid management of the exposed person can make the difference between them becoming ill or remaining well First Aid Action: Encourage wounds to bleed by gentle squeezing. DO NO suck the area. Wash thoroughly with soap and warm running water, - DO NO SCRUB the area Irrigate eye or mouth splashes thoroughly with water. Do not swallow mouth rinsing water Remove contact lenses, if worn, before irrigating eyes Contact SALUS for further advice or during the Out of Hours period, contact nearest A&E Dept * A significant injury is penetration of the skin by a needle or other sharp object that is, or is suspected to be, contaminated with another person s blood or body fluid, or when a human bite breaks the skin. ** A significant contamination is contact of broken skin, mucous membrane or eyes with another person s blood or body fluid 25

26 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 26 of 5 Replaces Jan SANDARD OPERAING PROCEDURES (SOPs) he SOPs should be adhered to by all dental staff working in either the dental surgery or decontamination room SANDARD OPERAING PROCEDURE - SURGERY SE UP Power up the surgery Switch on the following items Dental compressor Computer, monitor al all peripheral PC equipment SWICH ON Suction motor Dental chair Dental operating light Amalgamator Curing light X-ray developer Any other electrical equipment that is used regularly in the surgery Clean the surgery CLEAN Wash hands in accordance with the Hand Hygiene Policy and put on fresh PPE Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for Dental Surgeries Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Fill water bottle on dental cart with sterile water Run through all lines on dental cart (do not attached hand pieces or 3 in tips during this flushing process) Remove PPE and wash hands in accordance with the Hand Hygiene Policy 26

27 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 27 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Set up for patient Put on fresh PPE Cover operating light handles with disposable impervious covering COVER & CHECK Cover headrest with disposable impervious covering Cover curing light tip when in use with a transparent impervious polythene sheath Check surgery has a sufficient supply of stock (materials, sundries and disposables) before session starts Check integrity and location of Emergency Equipment ( Emergency Drugs box, Emergency Oxygen Cylinder and Resuscitation Equipment Check that ceiling lights are working normally Check surgery floor is clean and dry and no trip risks are present Remove PPE and wash hands in accordance with the Hand Hygiene Guidelines Once patient has been shown into the surgery Dental staff should perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on PPE Instruments can be removed from bags and put onto trays SE OU Hand pieces can be removed from bags and put onto couplings or motors Disposable single use items can be laid out or set up e.g. 3 in tip, aspirator tip, mouthwash cup, patient bibs, etc Local anaesthetic syringe can be set up and loaded Materials and instruments expected to be required should be looked out 27

28 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 28 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 SANDARD OPERAING PROCEDURE - SURGERY CLEANING BEWEEN PAIENS Dispose of all waste and sharps in the appropriate bags or containers in the surgery REMOVE Remove all items from the dental cart e.g. tray, instruments, hand pieces, 3 in tip, cotton wool rolls, gauze squares, etc Remove all materials and disposables including tray liner from the instrument tray. Remove, empty and dispose of mouthwash cup in the clinical waste orange bag Remove any disposable protective covers from items of equipment e.g. head rest covers, curing light covers, digital sensors and operating light handle covers and dispose of in clinical waste orange bag Dispose of any nursing roll or patient protective bib in the clinical waste orange bag Remove and dispose of 3 in tips in clinical waste orange bag Remove and dispose of aspirator tips in clinical waste orange bags Place instruments and items to be decontaminated into an appropriate container used for transportation of 'dirty' instruments to the decontamination area/room Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines ake instruments in a container to the decontamination area/room Return to surgery Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Wipe clean and dry the following areas using a neutral detergent wipe followed by 70% isopropyl alcohol impregnated wipe All work surface including handles or controls touched by gloved hands or obviously contaminated during the procedure Delivery unit surface (bracket table and handle) Wipe clean and dry the following areas using a neutral detergent wipe Delivery unit controls Couplings and motors Hand piece tubing Hand operated chair controls including those on nurse side of unit if present Spittoon and surfaces of aspirator unit Aspirator tubing Operating light handle (even if disposable cover used) Operating light lens cover Mouse Keyboard WIPE 28

29 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 29 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Amalgamator controls if used Curing light controls if used Cavitron controls if used Safe Air or gas burner controls if used Sink on Nurse side and taps if used X-ray head and X-ray control panel if used Eye protection for patients Eye protection for staff All dental chair upholstery including headrest (even if disposable cover used) and chair arms Upholstery on Dentist and Dental Nurses stools Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines Set up for next patient Put on fresh PPE Cover operating light handles with disposable impervious covering Cover headrest with disposable impervious covering Cover curing light tip when in use with a transparent impervious polythene sheath COVER Remove PPE, dispose of in clinical waste orange bag and wash hands in accordance with the Hand Hygiene Guidelines Once patient has been shown into the surgery Dental staff should perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on PPE Instruments can be removed from bags and put onto trays Hand pieces can be removed from bags and put onto couplings or motors Disposable single use items can be laid out or set up e.g. 3 in tip, aspirator tip, mouthwash cup, patient bibs, etc Local anaesthetic syringe can be set up and loaded Materials and instruments expected to be required should be looked out SE OU 29

30 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 30 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 SANDARD OPERAING PROCEDURE - SURGERY SHU DOWN Dispose of all waste and sharps in the appropriate bags or containers in the surgery REMOVE Remove all items from the dental cart e.g. tray, instruments, hand pieces, 3 in tip, cotton wool rolls, gauze squares, etc Remove all materials and disposables including tray liner from the instrument tray. Remove, empty and dispose of mouthwash cup in the clinical waste orange bag Remove any disposable protective covers from items of equipment e.g. head rest covers, curing light covers, digital sensors and operating light handle covers and dispose of in clinical waste orange bag Dispose of any nursing roll or patient protective bib in the clinical waste orange bag Remove and dispose of 3 in tips in clinical waste orange bag Remove and dispose of aspirator tips in clinical waste orange bags Place instruments and items to be decontaminated into an appropriate container used for transportation of 'dirty' instruments to the decontamination area/room Put sharps bin, boxes of gloves and other items sitting on the work surface away into cupboards Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines ake instruments in a container to the decontamination area/room Clean the surgery perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Clean and disinfect the suction system by aspirating litre of non-corrosive, non-foaming disinfectant into each aspirating tube Clean and disinfect the suction trap Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for Dental Surgeries Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove water bottle on dental cart w, empty and leave overnight to dry Remove PPE, dispose of in clinical waste orange bag and wash hands in accordance with the Hand Hygiene Guidelines Seal clinical waste bags in accordance with the Guidelines for the Management of Health Care Waste. Store clinical waste bags in the locally agreed designated area for collection and disposal CLEAN 30

31 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 3 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Power down the surgery Switch off the following items Dental compressor Computer, monitor al all peripheral PC equipment - follow log off procedure Suction motor Dental chair but before switching off raise the chair Dental operating light Amalgamator Curing light X-ray developer Any other electrical equipment that is used regularly in the surgery SWICH OFF Surgery security and safety Place all paperwork containing patient identifiable information in a locked file or cupboard Ensure no materials or products are stored on the surgery floor Final check of work surface and equipment Ensure store cupboards, filing cabinets, compressor room, other rooms used by dental department, etc are locked Switch off surgery light Lock surgery SECURE 3

32 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 32 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 SANDARD OPERAING PROCEDURE - DECONAMINAION ROOM SE UP Power up the decontamination room Switch on the following items Lights Air exchange system Ultrasonic Bath Autoclave Washer disinfector SWICH ON Clean the decontamination room perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Clean and dry 'dirty' boxes used for transportation of contaminated dental instruments Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for decontamination rooms Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines CLEAN esting and monitoring Put on fresh PPE Fill Ultrasonic leaner using approved detergent and fill with water to the maximum level Run the 'empty' test cycle for the Ultrasonic bath. Fill autoclave with sterile or Reverse Osmosis water to the maximum level as marked n the reservoir Carry out the daily safety check for autoclaves as described in the Autoclave Logbook Run the 'empty' test cycle for the autoclave and record the outcome in the Autoclave Log book Complete the Autoclave Logbook to record the outcome of the test cycle and the daily safety checks Ensure decontamination room is well stocked with required materials and supplies e.g. gloves, hand washing materials, wipes, sterilisation pouches, tray liners etc. Check decontamination room floor is clean and dry and no trip risks are present Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines CHECK 32

33 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 33 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 SANDARD OPERAING PROCEDURE - DECONAMINAION ROOM SHU DOWN Clean the decontamination room perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for decontamination rooms Remove all instruments from the ultrasonic cleaner Drain the ultrasonic cleaner Remove all instruments from the autoclave Drain all water from the autoclave Complete daily log record for autoclave and ultrasonic bath Clean containers used fro transporting 'dirty' instruments. If trolleys wipe with neutral detergent wipes. If plastic boxes fill with water and dissolve a chlorine releasing tablet. Leave over night. Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag CLEAN Seal clinical waste bags in accordance with guidance contained within the Policy for the Management of Health Care Waste. Store clinical waste bags in the locally agreed designated area for collection and disposal Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines Power down the decontamination room Switch off the following items: Washer disinfector Air exchange system Ultrasonic Bath Autoclave Lights Lock decontamination room door and return key to safe storage SWICH OFF 33

34 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 34 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 SANDARD OPERAING PROCEDURE - DECONAMINAION OF INSRUMENS On arrival in decontamination room with contaminated dental instruments Place the box clearly identified for the transportation of contaminated instruments on the worktop in the contaminated area of the room adjacent to the dirty sink perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE but note heavy duty gloves should be worn Fill dirty sink with hot water (no more than 2/3rds full) and add the appropriate measure of approved detergent, the one currently in use is Hospec. FIRS VISI Open box containing the instruments and gently place the instruments into the sink. Fully submerge the instruments to be cleaned in the detergents solution. he instruments can be placed in a basket e.g. basket from Ultrasonic Bath before being submerged in the detergent solution. Using a long handled brush with soft plastic bristles agitate the submerged dental instruments. he gentle scrubbing action that this creates will help remove debris from the instruments. o minimise aerosol risk do not carry out precleaning of instruments under running water. Following precleaning, drain the water and avoiding splashing If the water is heavily soiled repeat the precleaning process Rinse the instruments by refilling the sink with fresh water but do not add detergent. Repeat this several times if required to remove residual soil and detergents Once rinsing is complete remove the instruments from the sink and if they are not already in one, place them in an Ultrasonic Basket. Place the basket of instruments in an Ultrasonic Bath pre-filled filled to the maximum level with a detergent solution as recommended by the manufacturer Set the timer to the correct setting, close the lid and do not open until the cycle is completed Wash the long handled brushes with detergent and hot water after use to remove visible soil and store dry with the brush head up Clean the 'dirty' box used for transportation of contaminated dental instruments using a fresh detergent solution then dry the box Once the Ultrasonic Bath cycle is complete remove the basket from the Ultrasonic Bath Rinse the basket of instruments thoroughly to remove residual soil and debris by immersing the basket of instruments in a sink full of clean 34 tap water in a basin or sink dedicated for

35 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 35 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 rinsing instruments Once rinsed immediately empty the basket of instruments onto disposable non-linting paper towels and dry. Do not allow the instruments to air dry. Before loading the instruments into the Washer Disinfector check that they are clear to the naked eye of all visible debris Load instruments into the Washer Disinfector in the correct manner to ensure effective cleaning Oil hand pieces using the oil spray can clearly identified for use before Washer Disinfector (No.). Lay hand pieces flat in the Washer Disinfector Check that the Washer Disinfector has sufficient detergent in the reservoir and that the cycle selected is suitable for the load. All NHS Lanarkshire's Washer Disinfectors have been set up so that only one cycle can be selected Switch on the Washer Disinfector Remove the heavy duty gloves and wash them using detergent and hot water to remove visible soil. Leave them to dry Remove all PPE and dispose of masks and aprons in the orange clinical waste bag. Clean eye protection if not single use. Perform hand hygiene in accordance with the Hand Hygiene Guidelines ake the empty but cleaned box used for the transportation of contaminated instruments back to the dental surgery On return to the decontamination room after the Washer Disinfector has completed its cycle SECOND VISI Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Open up the Washer Disinfector Remove all the dental instruments and hand pieces. Subject all instruments to naked eye inspection to ensure that they are clean, functional and in good condition. If available an illuminated magnifier should be used If there are signs of any visible soiling such as blood or lining materials reject the instrument and put it though another cycle in the Washer Disinfector Any hand instruments found not to be in good working order should de disposed off in the sharps box 35

36 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 36 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Load clean instruments into the autoclave correctly and avoid overloading. Steam must be able to freely circulated round all surfaces of each instruments Oil hand pieces using the oil spray can clearly identified for use before sterilisation (No.2) and place the hand pieces into the autoclave Close the autoclave door and switch on the machine Remove PPE, dispose of in clinical waste orange bag, clean eye protection if not single use and perform hand hygiene in accordance with the Hand Hygiene Guidelines On return to the decontamination room after the autoclave has completed its cycle HIRD VISI Perform hand hygiene in accordance with the Hand Hygiene and put on fresh PPE Open the autoclave door Remove all dental instruments and hand pieces Check all instruments are functional and in good condition. Oil hand pieces using the oil spray can clearly labelled for use after decontamination (No.3) Place all instruments and hand pieces on trays or in bags Place trays and bagged instruments into the box clearly labelled for transportation of decontaminated instruments Remove PPE, dispose of in clinical waste orange bag, clean eye protection if not single use and wash hands in accordance with the Hand Hygiene Policy ake the box with clean instruments back to the surgery 36

37 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 37 of 5 in the Dental Surgery and Decontamination Room Replaces Jan CLEANING SCHEDULES hese cleaning schedules must be followed by all dental staff working in a dental surgery or decontamination room Method of Decontamination Codes Clean surfaces with warm water and neutral detergent (e.g. Hospec) or use neutral detergent wipes (e.g. Cutan or uffie wipes). Dry thoroughly. 2 Clean surfaces with warm water and neutral detergent (e.g.hospec) or use neutral detergent wipes (e.g.cutan or uffie wipes) followed by a 70% isopropyl alcohol impregnated wipe (e.g. Azo wipes) NOE If any surface, piece of equipment or item is obviously contaminated then it should be cleaned as soon as possible with warm water and neutral detergent (Hospec) or use neutral detergent wipes (e.g.cutan or uffie wipes) followed by a 70% isopropyl alcohol impregnated wipe (e.g. wipes) Summary Cleaning Schedules - Dental Surgery and Decontamination Rooms CLEANING SCHEDULES FOR SALARIED PRIMARY CARE DENAL SERVICE FREQUENCY IEM CODE BEWEEN WEEKL DAILY PAIENS Y MONHLY All work surfaces All sinks Dental chair upholstery Dental Chair controls Dental delivery unit ( cart or bracket table) surfaces 2 37 COMMENS

38 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 38 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Dental delivery unit arm Dental delivery unit tubing Operating light head Operating light arm X ray unit head Only if used X-ray unit extension arm X-ray control panel Only if used X-ray digital sensors Only if used Aspirator unit surfaces Aspirator unit tubing Curing light surfaces Only if used Amalgamator surfaces Only if used Cavitron surfaces Only if used Pulse oximeter surfaces Only if used Blood Pressure monitor surfaces Only if used Glucose meters Keyboard Mouse Operator stool upholstery 38

39 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 39 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Dental Nurse stool upholstery elephones Parent/Carer Seat Computer stool upholstery Wall cupboard fronts Base cabinet fronts Dental Chair base Monitor surfaces and cables PC unit surfaces and cables Printer surfaces and cables Scanner surfaces and cables Portable drill Only if used X-ray viewer Safe air Only if used Hoist Only if used Waiting room oys Only if used 39

40 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 40 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Base unit shelves Wall cupboard shelves Drawers Bins Portable fans Radios Ultrasonic cleaner surfaces Washer disinfector surfaces Autoclave surfaces RO hand gun rolleys or boxes transporting dirty instruments Eye protection patient Eye Protection staff 40

41 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 4 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Daily Cleaning Schedule - Dental Surgery - to be carried out at the start and at the end of the day his tool should be completed on a daily basis and signed off weekly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Surgery work surfaces Sinks surgery Code Carried out by - Enter date and signature (or initials) for each day. Carry out cleaning schedule at the start of the day and again at the end of the day. If a different dental nurse carries out the end of day clean then both dental nurses must sign or initial the form Monitored weekly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments Dental chair upholstery Dental Chair controls Dental delivery unit surfaces and arm Dental delivery unit tubing 2 4

42 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 42 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Operating light head Operating light arm X ray unit head X-ray unit extension arm X-ray control panel X-ray digital sensors Aspirator unit surfaces Aspirator unit tubing Curing light surfaces Amalgamator surfaces Autoclave surfaces Ultrasonic cleaner surface 42

43 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 43 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Cavitron surfaces Pulse oximeter surfaces Blood Pressure monitor surfaces Glucose meters Keyboard surface and cable Mouse surface and cable Operator stool Dental Nurse stool elephones Parent/Carer Seat Computer stool 43

44 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 44 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Weekly Cleaning Schedule - Dental Surgery his tool should be completed on a weekly basis and signed off monthly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Wall cupboard fronts Base cabinet fronts Dental Chair base Code Carried out by - Enter date and signature each time item or area is cleaned Monitored monthly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments Monitor surfaces and cables PC unit surfaces and cables Printer surfaces and cables Scanner surfaces and cables 44

45 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 45 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Portable drill X-ray viewer Safe air Hoist Waiting room oys 45

46 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 46 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Monthly Cleaning Schedule - Dental Surgery his tool should be completed on a daily basis and signed off weekly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Base unit shelves Code Carried out by - Enter date and signature each time item or area is cleaned Monitored monthly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments Wall cupboard shelves Drawers Bins Portable fans Radios 46

47 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 47 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Daily Cleaning Schedule - Decontamination Room - to be carried out at the start and at the end of the day his tool should be completed on a daily basis and signed off weekly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Work surfaces Code Carried out by - Enter date and signature (or initials) for each day. Carry out cleaning schedule at the start of the day and again at the end of the day. If a different dental nurse carries out the end of day clean then both dental nurses must sign or initial the form Monitored weekly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments All sinks Ultrasonic cleaner surfaces Washer disinfector surfaces Autoclave surfaces RO hand gun Keyboard. 47

48 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 48 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 surface and cable Mouse surface and cable Operator stool elephone rolleys or boxes transporting dirty instruments 48

49 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 49 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Weekly Cleaning Schedule - Decontamination Room his tool should be completed on a weekly basis and signed off monthly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Base cabinet fronts Code Carried out by - Enter date and signature each time item or area is cleaned Monitored monthly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments 49

50 Area Control of Communicable Disease Effective From May 202 Committee/Infection Control Committee Review date May 205 SECION Guidelines for the Control of Infection Pages 50 of 5 in the Dental Surgery and Decontamination Room Replaces Jan 200 Monthly Cleaning Schedule - Decontamination Room his tool should be completed on a daily basis and signed off weekly by the Senior Dental Nurse and kept as evidence for audit purposes. his list is not exhaustive, items relevant to your area should be added and delete those not applicable. Refer to the Control of Infection Manual, I Decontamination of Equipment and the Environment, for further advice. IEM (enter tick in box if applicable to your area) Base unit shelves Code Carried out by - Enter date and signature each time item or area is cleaned Monitored monthly by Senior Dental Nurse Date / Signature (Following visual inspection) Comments Bins Portable fans 50

51 Area Control of Communicable Disease Effective From Jan 202 Committee/Infection Control Committee Review date Jan 205 SECION POLICY FOR HE CONROL OF Pages 5 of 5 INFECION IN HE DENAL SURGERY AND DECONAMINAION ROOM Replaces Jan 200 Please note: any required changes to this guideline before the review date will be posted on First Port NHS Lanarkshire intranet 23. REFERENCE DOCUMENS NHS Scotland (200), he Glennie Framework: Sterile Services Provision Review Group, ( st Report). Accessible via Scottish Dental Clinical Effectiveness Programme (SDCEP) (March 2007). Cleaning of Dental Instruments: Dental Clinical Guidance. Scottish Dental Clinical Effectiveness Programme, (March 2007). Decontamination into Practice: Dental Clinical Guidance Scottish Dental Clinical Effectiveness Programme (March 2007). Decontamination into Practice: Appendices and References Scottish Government Health Department (202). National Infection Prevention and Control Manual for NHSScotland. Chapter : Standard Infection Control Precautions (SICPs) Policy accessible via