East Street Dental Practice.

Infection Control Guidelines

Infection control is of prime importance in this practice. It is essential to the safety of our patients, our families and us. Every member of staff will receive training in all aspects of infection control, including decontamination of dental instruments and equipment, and the following policy must be adhered to at all times. If there is any aspect that is not clear, please ask Mr Jones You might not be the only person who is unclear and it is useful to discuss the policy frequently to ensure that we all understand its implications. Remember, any of our patients might ask you about the policy, so make sure you understand it.

Main Points
A thorough medical history should be taken for each patient, updated at every check-up. All patients are accepted for treatment despite health status. There are some rare exceptions (e.g. CJD) Gloves are always worn for treatment after washing the hands with disinfectant liquid soap. Alcohol (gel/solution) hand rubs are used when hands are visibly "clean."  Visibly soiled hands are washed with liquid soap. New gloves are worn for each patient. We use Nitrile gloves that are Latex free. Thick gloves are available for cleaning instruments. Protective eyewear are always worn by treating staff; the patient always wears protective glasses A disposable bib is always worn by the patient; disposable towels are used for hand drying. High volume evacuation is used to reduce aerosol and splatter Sharps are handled carefully and kept in sharps containers after use, needles are re-sheathed using a re-sheathing device The treatment room is divided into zones, clean and dirty areas. Areas that are touched during treatment are disinfected between patients. Care is taken not to touch record cards, telephones, radiographs etc. with contaminated gloves Contaminated surfaces are cleaned then disinfected with suitable disinfectants Impressions are disinfected following the practice written procedure. Clinical Waste is stored in orange bags and collected appropriately.

Comments
1 All instruments that are capable of sterilisation are sterilised in an autoclave which is regularly tested, they are then stored dry in trays
2 Instruments that are not capable of being sterilised are cleaned then disinfected by immersion in a suitable disinfection solution for at least 10 hours.
3 X-Ray Film sleeves are handled with gloves, care is taken not to touch the actual film with the gloved hand
4 Treatment rooms are adequately ventilated
5 The clinical staff should always wear protective clothing. Outdoor clothing is not worn in the treatment room.
6 Disposable cups, 3 in 1 tips and saliva ejectors are used
7 Sterile water is used for surgical procedures
8 Biopsies sent in the post are dealt with according to current guidelines.
9 Clinical staff who have an infections disease will take medical advice regarding their treatment of patients

Infection Control Procedures
All patients are accepted for treatment regardless of health status. Although a thorough medial history is always taken, patients who are HIV +ive may not know or may be unwilling to disclose the information. We therefore take ‘Universal Precautions’ for every patient. If a patient has full-blown AIDS it may be appropriate to refer them for specialist advice and treatment. Although there is no evidence of transmission of CJD from dental procedures, it may be appropriate to refer at-risk patients to a hospital for treatment where disposable equipment is available and instruments can be incinerated according to guidelines. The use of a non-allergenic hand cream is recommended to protect the hands. Patients currently suffering from a cold sore should have their appointment rescheduled.

The Patient 
Upon seating the patient in the chair dispense a fresh mouthwash. If the patient has a denture, offer a paper tissue to put it upon. Protect the patient's clothes with a paper towel and eyes with goggles.

Hand Care
Hands should be washed with soap before donning gloves and after touching a contaminated area in the treatment room. Hypo allergenic "Nitrile" gloves are worn, they should never be used for more than one patient, they must not be worn outside of the treatment room and they must be disposed of in the clinical waste bin. The use of a non-allergenic hand cream is recommended to protect the hands.

Protective Eye shields
Clinical staff,  should wear chin-length protective eye shields & Patients should wear protective eyewear.

Protective Clothing
Protective clothing should always be worn in the treatment room and it must be changed when soiled. Clothing can be washed normally with a hot wash. Outdoor clothes must not be worn whilst treating patients and likewise clinical wear should not be worn outside the practice.

Zoning
Identify dirty areas and clean ones that will be contaminated during treatment procedures. These areas are the only ones that will need protecting with cling film and/or disinfecting between patients. Follow the surface disinfection guidelines below. Non-contaminated areas only need to be disinfected at the beginning and end of each session.

Sterilisation Guidelines
Heavy-duty rubber gloves and protective glasses are worn whilst cleaning dirty instruments. Instruments are washed in water using a long-handled brush to remove debris. Burs are cleaned with a "Bur brush" then placed in a small metal container. Instruments excluding hand pieces can be washed in the washer/disinfector rather than being hand cleaned. Handpieces are flushed through with the can of cleaning oil. Instruments are placed in the autoclave without a paper bag.

Disinfection Guidelines
Between clinical sessions, all surfaces should be disinfected. Between patients, disinfect surfaces that may have become contaminated by the treatment. Cling-film is a good barrier for handles and computer keyboards etc. Don’t forget to disinfect the X-Ray head if contaminated gloves have touched it. There are two stages to disinfecting surfaces, first cleaning with a detergent solution then secondly disinfecting with an agent. Floors and walls etc. do not need to be disinfected but should be kept clean.

Ventilation
Our treatment rooms must be adequately ventilated; An open window will suffice or a mechanical ventilation system can refresh the air in the surgery.

Disinfection of instruments
If an instrument is non-sterilisable and is not used surgically it can be disinfected by immersion in a glutaraldehyde-free disinfectant solution following the manufacturer's guidelines. Disinfected instruments should be dried with sterile towels before packing.

Impressions
Impressions should be rinsed under running water to remove blood and debris they should then be soaked in an impression disinfectant for 10 minutes. After soaking, rinse off the impression and wrap it ready for sending to the laboratory. If sent by post impressions should be sent first class or by data post.

Repairing Equipment
Sterilisable equipment must be autoclaved before sending for repair. Non-sterilisable equipment should be disinfected. The equipment should be appropriately labelled as disinfected or sterilised.

Sharps Injuries
Staff are to read our policy document.

Dealing with Spilt, Potentially Infective Materials.
If there is a spill of blood or of saliva you should take the following actions:
1 Put on a visor and gloves
2 Put absorbent tissues or kitchen-roll onto the spill until it is completely absorbed
3 Pour an aqueous solution of household bleach 1:10 onto the tissues and soak them completely
4 Leave for 10 minutes
5 Put some more tissues on to absorb the bleach
6 Collect the tissues with two pieces of card such as two record cards and place in a sealed bag in the clinical waste bin
7 Wipe the area with the 1:10 solution of bleach

Latex Allergy
Nitrile gloves are always used, as they are non latex, Latex free rubber dam should always be used.

Mercury Management
All staff regularly exposed to mercury metal and its vapours should undergo regular monitoring, the occupational health service arranges for testing.

Waste Management
Please read our waste policy document.

Water Regulations and Handpieces
We ensure that infective agents are not ‘sucked back’ into the water supply. This is why we must have an air gap between mains water and any water delivery equipment that comes into contact with blood or saliva. Equipment that could potentially infect the water supply includes: Handpieces with a water spray, wet-line aspiration motors, ultrasonic scalers, 3 in 1 syringes and spittoons where the outlet is near the bowl etc.

There are two main issues; the first being that there should be an air gap, (Type A air gap) in the supply line to the equipment and the second is that instruments should not be able to aspirate fluids back into them. This is seen mainly in air turbine handpieces, which may aspirate some liquid immediately after the foot control is released. The aspiration is due to the turbine causing a brief vacuum when it is initially deprived of the compressed air supply. Dental equipment is supplied with a bottle that holds the water that to be used for treatment. The problem with this system is that the water can easily become contaminated and can be difficult to clean. The equipment manufacturers will have guidelines on how to disinfect the water system and these should be followed carefully. There have been cases of legionalla contamination of bottled water systems. The fine pipes in the delivery units are prone to microbial colonisation. All surgeries are equipped with a bottled water system, which enables us to do something about this problem. Over lunchtime a dilute bleach (Not “Milton”) solution can be run through the tubes. After lunch the system should be run through with fresh water to dispel any chemical (Danger! This will bleach patient’s clothes!) Overnight the bottle of water should be emptied and the tubes blown through with air. Algae cannot thrive in a dry environment.

Posting Pathological Specimens
Staff should initially phone Royal Mail Customer Service to obtain permission on 08457 7740740, and to be told about the special requirements which are as follows. The specimen should be placed in a watertight container no larger than 50ml. This must be wrapped in enough absorbent material e.g. cotton wool, to absorb all of the liquid. This all has to be placed in a secondary container which is either metal or thick cardboard with polystyrene reinforcements, two pieces on either side. The bundle should all be wrapped up with adhesive tape so that none of the constituents can move around and then placed in a ‘Jiffy Bag’. Label the package in bold “Pathological Specimen, Fragile with Care” and with the practice name and address. The specimen should ideally be sent Special Delivery, it cannot be sent by second-class post.

Autoclaves
Autoclaves must be tested daily; When the machine is turned on the indicator light should be illuminated. The first cycle should be monitored and should have completed properly. Test strips should be used; the colour change should be successful. Water should be drained from the autoclave reservoir each day and the tank flushed out with fresh deionised water.

Additional weekly tests - The seal should be inspected to ensure it is free of tears and is supple. The seal and sealing surfaces should be wiped clean with a damp cloth. The door should be checked during a cycle to ensure that it cannot be opened inadvertently.