INFECTION CONTROL

PROCEDURES

Elements in infection control protocol

•patient evaluation•personal protection•instrument-cleaning, sterilization and storage•use of disposables•disinfection•laboratory asepsis•disposal of waste•staff training, including continuing education.

Patient evaluation• Complete medical history

should be taken prior to any treatment.• Update the medical history

if any prior to each visit.–Identify the infectious diseases. –Eliminates cross infection.–Relevant to the dental procedure to be undertaken.

Personal protection

• personal hygiene• clinic clothing• barrier protection (gloves, eye shield,

face masks, rubber dam isolation)• immunization procedures.

Personal hygieneNails • Nails should be cut short and

be clean• Nail varnish should be intact,

i.e. no chips or flakes. • Artificial nails are not

permitted• Artificial nails can be a

source of contamination Hair • Hair should be clean. • Long hair should be worn tied

up or tied back.

Jewellery • No rings, bracelets or

wristwatches should be worn during work.

• It is not possible to wash hands and/or lower arms if these are covered in jewellery

Eating, drinking and smoking

• In critical and semi-critical areas no eating, drinking or smoking is permitted.

Clothing • During the treatment of patients and

the handling of used instruments clothing with short sleeves should be worn in order to make good hand hygiene possible.

• This clothing should be changed daily and in the case of visible contamination immediately.

• During treatment clothing should not be touched with the hands (gloves).

Immunisation • All dentists and all the practice

employees should be vaccinated against hepatitis B

• because of the risk of exposure to blood and the possible risks it causes.

• A dedicated clean sink should be provided in the clinic for hand-washing, and the taps should be operated by elbow or foot controls or sensors (no-touch technique).

• Thoroughly wash the hands before and after treating each patient using a proprietary antimicrobial handwash (e.g. chlorhexidine gluconate) before putting on gloves.

• Hands should also be washed before leaving the surgery for any purpose, and upon return.

• A good hand-washing technique, should be developed by all staff so that all areas of the hands are washed consistently

• Any obvious cuts or abrasions must be covered with adhesive waterproof dressings.

• Liquid (not bar) soap should be used for routine handwashing, and antimicrobial liquids for hand-washing prior to surgical procedures.

• Hands should be dried thoroughly using disposable paper towels, and gloves should be worn as the last step before treatment commences.

• Moisturizing cream should be used as a routine at the end of each treatment session.

• Consider the compatibility of lotions and antiseptic products and the effect of petroleum or other oil emollients on the integrity of gloves during product selection and glove usage.

Barrier protection• gloves• eye shields• face masks• rubber dam isolation

Gloves• All dentists and close

support personnel should routinely wear disposable latex or vinyl gloves.

• to establish standards of hygiene in order to safeguard dental personnel and patient.

• gloves may perforate during surgical procedures - advisable to change gloves at least hourly during long procedures

• Gloves should be checked for visible defects immediately after wearing

them, and immediately changed when breaches occur

• never wash and reuse gloves.

• allergic reactions to gloves may develop in staff or patients.

• Skin creams, a spray-on microfilm on the skin or a cotton glove liner may help these individuals

• clean, high-quality, protective latex gloves

should be used whenever examining a patient's mouth or providing routine dental treatment when no blood-letting procedures are undertaken• sterile gloves should be used for surgical

procedures (blood-letting).wearing of two pairs of gloves leads to lower frequency of inner glove perforation and visible blood on the surgeon's hands

• heavy-duty utility gloves should be used for cleaning instruments or surfaces or handling chemicals.

Eye shields. • should be worn by dentists

and close support personnel

• to protect the conjunctivae from spatter and debris generated by high-speed handpieces, scaling (manual or ultrasonic), and polishing and cleaning of instruments.

• eyewear and face shields should be cleaned regularly

Face masks.

• clean mask should be worn for each patient.

• particularly during high-speed instrumentation, as it prevents inhalation of contaminated aerosols

• The filtration efficacy of such aerosols depends upon:

the material used for mask manufacture (paper masks are inferior to glass fibre and polypropylene types)

length of time the mask is wornthe useful life of a mask is about 30-60

min, particularly if the ! mask is wet.

• Always ensure that masks are well adapted so that the nose and mouth are completely covered.

• Masks with metal inserts are preferable as they can be tailored to fit the individual's profile.

• Masks should not be touched with gloves during treatment or worn outside the treatment zone; they should be worn beneath face shields as the latter provide only minimal protection from aerosols.

Rubber dam isolation• As far as possible rubber dam

should be used in operative procedures

Use of rubber dam during operative procedures:• provides a clear visual field as the

tissues are retracted

• minimizes instrument contact with the mucosa (thus minimizing tissue injury and subsequent bleeding)

• reduces aerosol formation, as saliva pooling does not occur on the rubber dam surface

• minimizes the retraction of contaminated oral fluids into the dental unit water systems as the rubber dam prevents pooling of oral fluids and the possibility of suck-back into the water lines.