Cross-Infection Control Protocol

INTRODUCTION

The dental team spend their time at work in an environment where there exists a real danger not only of the team themselves contracting infections but also the potential for spread of infections to others. The Safety, Health and Welfare at Work Act, 1989, states that “members of the dental team have a duty to ensure that all necessary steps are taken to prevent cross infection in order to protect their patients, themselves, their families and others.”

Standard Precautions is a philosophy that considers all patients to be infected with pathogenic organisms hence certain basic infection control procedures must be used during the care of all patients. Body fluids and tissues may be contaminated with a variety of different pathogens. Most carriers of infection including blood borne viruses are unaware of their condition and therefore it is important that the same cross-infection routine is adopted for all patients. Routine cross-infection control procedures (standard precautions) not only safeguard patients but also protect the dental team.

Every dental procedure results in contamination of the dental work environment. Limitation of contamination to designated areas within the surgery is the principle of Zoning. This means identifying areas that may be contaminated during treatment and ten cleaning and disinfecting these areas only between patients. The principle of zoning is an effective and efficient means of controlling cross-infection. All unnecessary equipment should be placed/stored in presses/cabinets off the worktop to reduce the number of items that require disinfection between patients.

Every member of the dental team has a duty to ensure that all necessary precautions are taken to prevent cross-infection to both patients and themselves. The only safe approach is to assume that every patient is a carrier.

Due to the limitations of individual dental surgery design/lay-out it must be accepted that it is impossible to work in a completely sterile environment. However our aim should and must be to strike a balance between the ideal and a reasonable approach as near as possible to ideal which is above all practical and which will minimize hazards to a point where they present negligible risks.

The following recommendations for procedures in routine dental practice are made in the light of current knowledge and best practice, and are subject to alteration and updating as further information becomes available.

Barrier Methods for Staff/Patient Protection

• Gloves
• Face Masks
• Eye Protection
• Protective Clothing
• Surface Covers
• High Volume Suction
• Rubber Dam

GLOVES

Gloves should always be worn if there is a risk of exposure to:

• Blood/body fluids
• Non-intact skin
• Mucous membranes
• Hazardous substances
• Handling contaminated items or surfaces

• Gloves should be worn for all dental procedures and when handling items or surfaces contaminated with body fluids.
  REMEMBER: If you leave the chairside remove gloves and dispose of them immediately in the Contaminated Waste bin. Do not re-use gloves. Don a fresh pair on return to the chairside. Always remove gloves when using the telephone or computer keyboard or mouse. Never handle charts when gloved.
  On no account should gloves or masks be worn outside the clinical area.
• · Hands and lower arm/wrist area should be washed in liquid soap and fully dried before gloving and after gloves are removed. Wearing gloves is not intended as a replacement for hand washing. Disposable towels should be used for drying hands. It is important that hands are thoroughly dried before gloving.
• · Jewellery should not be worn. Nails should be short. False nails should not be worn. Nail polish should not be worn.
• Cuts and abrasions on hands should be protected with waterproof dressings.
• Heavy duty gloves should be worn by the dental nurse when handling contaminated instruments to reduce the risk of percutaneous injury.

Face Masks

• Masks protect both dentist and dental nurse from splashes/sprays/aerosols. Masks should be worn by both dentist and dental nurse during all operative procedures
• Do not handle face mask by filter (tie back mask).
• Ensure mask is well fitting.
• Change mask frequently/between patients. (A damp mask no longer provides adequate protection)
• Dispose of mask in the Contaminated Waste bin.

Protective Eye Wear

• To be worn by dentist, dental nurse, and patient during all operative procedures.
• To be worn by dental nurse when cleaning contaminated instruments.
• Decontaminate protective eye wear between patients
• Each member of staff should have his/her own protective eye-wear.

Protective Clothing/Tunics/Uniforms

• Change if visibly contaminated. Always wear a plastic apron if contamination with blood/body fluids is likely.
• Ideally change daily.
• Change clothes at work.
• Avoid contamination to home/tea-room.
• · Flat or low-heeled shoes that cover the toes, heels and sides of the feet must be worn.
• Wear gloves when handling contaminated clothes.
• Place in separate bag when transporting.
• Wash in separate cycle – white cycle preferably, or fast coloureds.
• Disposable bibs should be used for every patients. If patients leaves surgery for e.g. x-ray, the bib should be removed and left on dental chair.
• Appropriate Personal Protective Equipment must be used for all procedures and not worn outside the clinical area.

Tips for Removal of Personal Barriers

1. Remove gloves and avoid touching skin
2. Wash and dry hands
3. Remove protective eye wear by catching ear pieces
4. Remove mask by the ties at the back of head. Never catch mask by the filter Always dispose of in contaminated waste receptacle.

HAND HYGIENE

Hand hygiene is the responsibility of all individuals in the provision of healthcare. It is the single most important intervention to prevent transmission of infection.

Preparation:

Nails should be kept short and cut smoothly
Nail varnish and/or false nails should not be worn
All wrist and hand jewelry (except plain wedding bands) should be removed
Shirts should have short or turned back sleeves

Types of Handwash

There are three types of handwash:

1. Social hand hygiene: this involves the use of plain soap and water to render hands socially clean
2. Antiseptic hand hygiene: This involves the use of an antiseptic approved detergent and water, or an alcohol hand rub on visibly clean hands, for example:
   • Prior to invasive procedures as part of an aseptic technique
   • After contact with a patient with a known transmissible infection
3. Surgical hand hygiene: This involves the use of an antiseptic scrub and a sterile, single use/autoclavable nail cleaner prior to surgical procedures
   • Hands should be washed after every patient treatment or examination
   • Frequent hand washing significantly reduces the numbers of bacteria on hands and reduces the chance of carrying potentially pathogenic organisms
   • Antibacterial hand washes reduce bacterial counts lower than those obtained with soap
   • Poorly washed areas of hands include finger webs, the thumbs and around the finger nails