Cross Infection Policy

Practice Infection Control Policy

Infection control is of prime importance in this practice. Every member of staff will receive training in all aspects of infection control, including decontamination of dental instruments and equipment, as part of their induction programme and through regular yearly update training.

The following policy describes the routines for our practice, which must be followed at all times. If there is any aspect that is not clear, please ask our practice manager Maxine Raimbach. Remember, any of your patients might ask you about the policy, so make sure you understand it.

Minimising blood-borne virus transmission

All staff must be immunised against hepatitis B; records of hepatitis B seroconversion will be held securely by the practice owner to ensure confidentiality is maintained. For those who do not seroconvert or cannot be immunised, advice will be sought on the appropriate course of action.
Staff identified as at risk of exposure to blood borne viruses will be required to undergo an occupational health examination. This can be provided through your Medical Doctor. Records of these examinations will be held securely by the practice to ensure confidentiality is maintained. This applies to Dentists, Therapists and Hygienists.
In the event of an inoculation injury, the wound should be allowed to bleed, washed thoroughly under running water and covered with a waterproof dressing, in accordance with the practice policy. The practice policy for dealing with with inoculation is in your surgery folder and also in the practice manual. Record the incident in the accident book.
All inoculation injuries must be reported to David P Harris or Maxine Raimbach who will assess whether further action is needed (seeking advice as appropriate) and maintain confidential records of these injuries, as required under current health and safety legislation. Advice on post-exposure prophylaxis can be obtained from EMAS 01342 334200HSE0870 545500. Health Protection Agency 02082004400 Email [email protected]

Decontamination of instruments and equipment

Single use instruments and equipment must be identified and disposed of safely, never reused. All re-usable instruments must be decontaminated after use to ensure they are safe for reuse. Gloves and eye protection must be worn when handling and cleaning used instruments.
Before being used, all new dental instruments must be decontaminated fully according to the manufacturer’s instructions and within the limits of the facilities available at the practice. Those that require manual cleaning must be identified. Wherever possible, the practice will purchase instruments that can withstand automated cleaning processes using a washer-disinfector.
At the end of each patient treatment, instruments used in the surgery must be placed in the box provided. They must be kept moist using “Dentifoam”. The box will be collected by the Decontamination operative for processing in the decontamination area. The practice procedure for transferring used instruments and equipment is in your surgery folder and a copy is held in the practice manual in the office.
Staff will be appropriately trained to ensure they are competent to decontaminate existing and new reusable dental instruments. Records of this training are kept.

Cleaning (sterilization and decontamination)

A dedicated person is employed to carry out this process on a day to day basis in the Sterilization and Decontamination Area on the first floor. All nursing staff are also trained in this area should they need to stand in due to absence.

Where a washer-disinfector is used instruments must be cleaned using the washer-disinfector (unless this is incompatible with the instrument(s) to be cleaned), the manufacturer’s instructions for use must be followed when placing instruments in the washer-disinfector:
open instrument hinges and joints fully and disassemble where appropriate
avoid overloading instrument carriers or overlapping instruments
correctly attach instruments that require irrigation to the irrigation system, ensuring filters are in place if required.
Where instruments are cleaned manually, the practice policy for manual cleaning must be followed. The policy is posted up in the decontamination and sterilization area and in your surgery folder and practice manual. Hospec or Continu detergent must be used for manual cleaning.

Inspection

After cleaning, inspect instruments for residual debris and check for any wear or damage If present, residual debris should be removed by hand and the instrument re-cleaned
Where a vacuum (Type B) autoclave is used instruments are to be stored for use at a later date, they should be wrapped or put in pouches prior to being sterilised in the autoclave, following manufacturer’s instructions for use. Storage should not exceed 60 days, after this, instruments must be reprocessed. Instruments for same-day use do not require wrapping.

Sterilisation

Where a non-vacuum (Type N) and vacuum (Type S) autoclave is used Instruments should be loaded to allow steam to contact with all surfaces (avoid overloading) and follow manufacturer’s instructions for use. Where instruments are to be stored for use at a later date, they should be wrapped or put in pouches, which are then dated and labelled to allow easy identification. Storage should not exceed 45 days; after this, instruments must be reprocessed. Instruments for same-day use do not require wrapping, these are stored in the boxes provided. Mirrors/Probes/Tweezers Etc..

All instruments not bagged after the session must be returned for sterilisation and decontamination.
The patient treatment area should be cleaned after every session using a solution of HOSPEC detergent and then spraying with ‘Classic hard surface disinfectant detergent’. The use of alcohol wipes must be avoided. Non alcohol based wipes are provided for items that cannot be sprayed. All areas must be cleaned even if the area appears uncontaminated.

Work surfaces and equipment

Between patient treatments, the local working area and items of equipment must be cleaned using’ Classic hard surface disinfectant detergent’ spray. The use of alcohol wipes must be avoided. Non alcohol wipes are provided for areas/items that cannot be sprayed. This will include , dental chair, inspection light and handles, hand controls, delivery units and if used x-ray units and controls. Other equipment that may have become contaminated must also be cleaned.

In addition, cupboard doors, other exposed surfaces and floor surfaces within the surgery should be cleaned daily using a solution of HOSPEC and/or T.3. Germicidal Deodoriser detergent

Aspirators and spittoons must be disinfected once a day using the ‘OroCup’ system with the made ‘Orotol’ solution. The spittoons must be cleaned between patients using ‘Classic hard surface disinfectant’.

Impressions and laboratory work

Dental impressions must be rinsed until visibly clean and disinfected by spraying or dipping in anti-microbial impression disinfectant (‘Continu’) and labelled as ‘disinfected' before being sent to the laboratory. Technical work being returned to or received from the laboratory must also be disinfected and labelled.
Dentures, mouthguards etc must be disinfected with ‘Continu’ prior to placing in patients mouth.

Hand hygiene

The practice policy on hand hygiene must be followed routinely. The full policy is in your surgery folder and can be found in the practice manual, a summary is included here.
Nails must be short and clean and free of nail art, permanent or temporary enhancements (false nails) or nail varnish. Nails can be cleaned using a blunt “orange” stick.
Wash hands using liquid soap between each patient treatment and before donning and after removal of gloves. Follow the handwashing techniques displayed at each hand wash sink. Scrub or nail brushes must not be used; they can cause abrasion of the skin where microorganisms can reside. Ensure that paper towels and drying techniques do not damage the skin.
Antibacterial-based hand-rubs/gels can be used instead of hand-washing between patients during surgery sessions if the hands appear visibly clean. It should be applied using the same techniques as for handwashing. The product recommendations for the maximum number of applications should not be exceeded. If hands become “sticky”, they must be washed using liquid soap.
At the end of each session and following handwashing, apply the hand cream provided to counteract dryness. Do not use hand cream under gloves; it can encourage the growth of microorganisms.

Clinical waste disposal (Please refer to the waste disposal policy for more detailed information this is in your surgery folder and practice manual)

All clinical healthcare waste is classified as infectious hazardous waste’ (code 180103) and placed in orange bags awaiting collection.
Labelled ‘Clinical waste’ sacks must be no more than three-quarters full, have the air gently squeezed out to avoid bursting when handled by others and be secured with a plastic ‘tie’ at the neck and not knotted.
Sharps waste (mixed sharps waste and contaminated pharmaceutical LA cartridges) classified as hazardous infectious waste must be disposed of in UN type approved puncture-proof containers (to BS 7320), and labelled to indicate the type of waste. These bins have an yellow lid. Extracted teeth without amalgam must be placed in these bins. (Code 180103/180109) Sharps containers must be disposed of when no more than two-thirds full.
Clinical waste and sharps waste must be stored securely in the areas provided before collection for final disposal by the registered waste carrier appointed by the practice. The waste carrier holds a certificate of registration with the Environment Agency.
Dental amalgam and developer and fixer solutions must be disposed of as hazardous waste by the registered waste carrier appointed by the practice. (Codes 180110,090101,090104)
At each collection of waste, the waste carrier issues a consignment note, which is retained by the practice for 3 years. Consignment notes should be given to Maxine Raimbach prior to be filed in the office.
All staff involved in handling clinical waste are vaccinated against hepatitis B. All relevant staff will be trained in the handling, segregation, and storage of all healthcare waste generated in the practice.

Personal Protective Equipment

Training in the correct use of PPE is included in the staff induction programmes, All staff receive updates in its use and when new PPE is introduced into the practice.
PPE includes protective clothing, disposable clinical gloves, plastic disposable aprons, face masks, and eye protection. In addition, household gloves must be worn when handling and manually cleaning contaminated instruments Footwear must be fully enclosed and in good order.

Gloves

The disposable clinical gloves used in the practice are CE-marked and low in extractable proteins (<50 μg/g), low in residual chemicals and powder-free. Anyone developing a reaction to protective gloves or a chemical must inform Maxine Raimbach immediately. Latex free gloves are routinely worn. If latex gloves are worn a full risk assessment must be carried out on the patient prior to use.
Clinical gloves are single-use items and must be disposed of as clinical waste.
Long or false nails may damage clinical gloves, so nails should be kept short. Alcohol rubs/gels must not be used on gloved hands, nor should gloves be washed.
Domestic household gloves should be worn for all decontamination procedures (along plastic disposable aprons and protective eyewear) After each use, they should be washed with detergent and hot water to remove visible soil and left to dry. These gloves should be replaced monthly and more frequently if worn or torn or it becomes difficult to remove soil.

Plastic aprons

Plastic aprons should be worn during all decontamination processes. Aprons are single use and should be disposed of as clinical waste. Plastic aprons are removed by breaking the neck straps and gathering the apron together by touching the inside surfaces only.

Face and eye protection

Face and eye protection must be worn during all operative procedures. Face masks are removed by breaking the straps or lifting over the ears. They are single use items and must be disposed of as clinical waste.
A visor or face shield should be worn to protect the eyes; spectacles do not provide sufficient protection. Eye protection should be cleaned according to the manufacturer’s instructions when it becomes visibly dirty and/or at the end of each session. Disposable visors should be used wherever possible.

Protective clothing

Protective clothing worn in the surgery must not be worn outside the practice premises. Adequate changing and storage facilities are provided.
Protective clothing becomes contaminated during operative and decontamination procedures. Surgery clothing should be clean at all times and freshly laundered clothing worn every day. Machine washing at 60^oC with a suitable detergent is advised.

Blood spillage procedure

Large spillages of blood occur rarely in dentistry, although there might be occasions when a surface becomes contaminated with blood or blood/saliva splatter. In these situations the area should be saturated with 1% sodium hypochlorite with a yield of at least 1000 ppm free chlorine. Allow contact for a minimum of five minutes before using disposable cloths to clean the area. The cloths used for cleaning should be disposed of as clinical waste.
If blood is spilled – either from a container or as a result of an operative procedure – the spillage should be dealt with as soon as possible. The spilled blood should be completely covered either by disposable towels, which are then treated with sodium hypochlorite solution or sodium dichloroisocyanurate granules, both producing 10,000 ppm chlorine. Good ventilation is essential. At least 5 minutes must elapse before the towels etc are cleared and disposed of as clinical waste.
Appropriate protective clothing must be worn when dealing with a spillage of blood: household gloves, protective eyewear and a disposable apron. Care should be taken to avoid unnecessary contact with metal fittings, which can corrode in the presence of sodium hypochlorite. The use of alcohol in the same decontamination process should be avoided. Emergency Spillage Compound is located in the cupboard in the x-ray room

Needles and Sharps

All needles and sharps must be placed in the sharps box by the dentist in charge of the surgery. Nurses are not to handle needles and sharps accept prior to use on a patient when they can, only to stock the surgery. Where hygienists or therapists use needles or sharps they must only be handled by them. The use of needle guards is compulsory in this practice. Please refer to your surgery file for procedure following a needle or sharps stick injury.

Review

This policy and the policies referred to within it, will be reviewed at regular intervals to ensure its currency and amended as required by changes within the practice and legal and professional requirements.

Date of policy January 2010.

Review date November 2017

Needles and Sharps 17/11/2017 amended.

Amended 17/11/2017. Clinical Waste. Use of Hospec Continu and non alcohol wipes.

Reviewed no changes 17/11/2017. Reverse Osmosis unit fitted January 2013 for use in DUWL,s and Autoclves

Reviewed 17/11/2013 amendments to HTM01-05

Reviewed and changed use of Clinell Wipes instead of Classic July 2014 and MD555.