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Cross infection control in Dentistry - Best Practice

Jan 30 2018, 14:56 PM

Infection control in dentistry is important, in order to reduce the possibility of infectious diseases. The prevention of infection is the responsibility of everyone working within a dental surgery and certain policies and procedures should be implemented with the aim of reducing Healthcare Associated Infections (HCAI’s).

With new guidance and legislation rules regularly coming into play, keeping up to date with these is one of the key roles a dental nurse will play, as part of infection control and prevention process within the general surgery and main examination areas.

The General Dental Council (GDC) states that dentists and dental care professionals must complete a total of five hours of training in decontamination and disinfection over a five year cycle. Infection control responsibilities are put in place for the protection of dental workers and patients, as they are all at risk of infection. Failure to provide appropriate precautions in decontamination, disinfection and sterilisation could lead to professional misconduct.

In addition to this staff members need to protect themselves by ensuring that they have up to date immunisation against hepatitis b and other infectious diseases such as tuberculosis, poliomyelitis, rubella, tetanus, diphtheria and varicella zoster. It is the responsibility of the dentist and their employer to ensure all members of staff are fully aware of the standards of infection control that are required within the workplace.

Cross infection in dentistry
There are three main sources of infection which include:

There are also three main ways in which an infection can spread:
In order to prevent the spread of infection you should treat every patient as if they could be carrying an infectious disease. This means protecting yourself and the environment from anything that could be considered a contaminant.

A variety of microorganisms are present in the saliva, body fluids, vomit and blood of patients. During dental treatment an infection can be transmitted through direct contact, trauma, biting or by contaminated instruments. 

People who are carrying infections, including blood borne viruses, may be unaware of their condition - meaning that it is important that you continue to have the same control of infection practice for all patients.

How to prevent cross infection in dentistry
All patients should be treated as potentially infectious and so their medical records should be checked and updated on every visit. Each patient needs to be treated and provided with clean personal protective equipment (PPE) such as eye protection and a bib while examinations and treatments are being carried out.

A rubber dam may also need to be used when appropriate to ensure a clean and well ventilated surgery, with a high volume suction that reduces the bacterial load that is generated in an aerosol. PPE aims to protect individuals from pathogens entering or exiting a body. Dental workers should also have their own clean personal protective equipment which consists of a uniform, disposable gloves, eye protection, plastic disposable aprons, face masks and appropriate footwear. None of this should be worn outside of the dental premises. 

Hand hygiene:
Hand hygiene is one of the main causes of cross-infection, therefore a hand hygiene protocol should be put into place. This procedure should be applied before and after treatment with a patient, when using personal equipment and buying a decontamination process. It should also be applied when coming into contact with sterilised equipment. Hand hygiene includes washing and using disinfectant gels.

For further instructions, refer to our step-by-step hand washing guide, so you can ensure you are washing you and those you work with are washing your hands correctly.

Cleaning:
Under the Health and Social Care Act 2008, dental practices need to have suitable cleaning protocols in place. This is due to the high risk of infection in clinical areas. The equipment that is used to clean should be kept away from other cleaning equipment and the cleaning area should also be isolated. A colour coding system should be put in place to assist with the help of controlling infection. The following codes should be used:

Download your colour coded cleaning equipment poster here

Cleaning all the equipment and instruments is the process of removing all the visible debris from the surfaces. There are a number of products that you should be using in your surgery to keep equipment clean and germ-free. These include:
Washer Disinfectors
A washer disinfector in your dental practice will help to maintain best practice requirements. They clean instruments and also include a disinfectant cycle that will allow for the safe handling and inspection of all instruments before sterilisation - this is the most effective way of cleaning. A washer-disinfector has five stages of cleaning which include:

Flush - removing all the difficult and contamination bacteria including blood, tissue debris, bone fragments and other fluids and solid debris.
Wash - this removes any mechanical and chemical elements that have loosened and broken up, causing contamination. Detergents that should be used for this must be ones advised by the manufacturer because they will be the ones that are suitable for usage in a washer disinfector.
Rinse - this stage removes all of the detergents that you have used during your cleaning process.
Thermal disinfection - this is the temperature of the load and what it is held at for a pre-set disinfection temperature - for example 80 degrees for 10 minutes and 90 degrees for 1 minute.
Drying - using heated air, this stage removes all the residual moisture from the instruments.

All instruments that have been cleaned must then be checked and fully inspected afterwards for any visible debris. This can be done using a magnifying glass tool that can be illuminated to help aid visibility. Should the equipment still be dirty when inspected it will need to go back in to be cleaned again. When cleaning equipment it is important that you abide by the Health Technical Memorandum (HTM 01-05) guidelines for decontamination of instruments.

Disinfection:
Disinfection is the process of reducing the number of pathogens (a bacteria, virus another other microorganism that can cause disease) on equipment or surfaces to a harmless level. Disinfectant should be used when equipment cannot be disposed of or hasn’t been sterilised. It is also used in the process of washer disinfectors, as previously mentioned.

Sterilisation:

Sterilisation is performed using pressurised steam and is considered to be the best option to use in a dental environment. The process is carried out using an autoclave.

Autoclaves come in ‘N’, ‘B’, and ‘S’ types, these refer to the sterilisation process whereby the instruments are not wrapped before going into the autoclave.

Steam will pour downwards on the instruments using ‘N’ type, whereas for ‘B’ and ‘S’ a vacuum approach will be used. ‘B’ type autoclaves are the most common as well as ‘S’ because they are designed for specific loads. Each type available should have a temperature of 134-137 degrees celsius, plus a minimum time of three minutes at a pressure of two bars.

Finally, check that the following guidelines are in place to help ensure that your dental practice is clean and decontaminated:
Infection prevention and control is a very important practice for all healthcare professionals.

Professional dental associations and provincial licensing authorities within the UK have said that universal precautions must be applied to all patients as infectivity may not be known. All members of staff should stick to the recommended infection control procedures that are in place to minimise the risk of cross infection in all dental practices.


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