Cross-Infection Control Protocol Continued

DAILY ROUTINE

At The Beginning of Each Day

Fill a fresh purified water bottle and attach to dental unit
Flush handpiece line and 3-in-1 line for 2-3 minutes.
Make up fresh ultrasonic cleaning solution as per manufacturer's instructions.
Make up fresh solution of Milton as per manufacturer's instructions.
If impressions, try-ins etc. are to be taken during the session make up fresh solution of impression disinfectant as per manufacturer's instructions.

N.B.Always wear gloves/masks/eye protection when making up these solutions. Ensure adequate ventilation. Label containers properly.

Before the Procedure

Prepare the zoned area -
Disinfect the zoned area with Virkon
Cover control panels, light switch, light handle, head rest, light cure unit, with sticky back plastic wrap or cling film.
NB Should the layout of the surgery be such that the keyboard is located adjacent to the dental chair, then the keyboard should be covered with cling film only during operative procedures that might be considered to create aerosols.
Place sterile instrument/burs/cotton rolls on a water-proof sheet on the bracket table. (Place topical anaesthetic on one cotton roll if required).
Collect and seat patient and place protective glasses and bib on patient.
Adjust chair position and light.
Operator dons protective glasses and mask.
Operator washes and dries hands and dons a pair of gloves.

The Procedure

After delivering Local Anaesthetic, resheath needle using 'Single Handed' technique.
Dentist removes and disposes of needle and cartridge in Sharps Waste bin.
Carry out procedure. Operator should not touch any surface or item outside zoned area.
Should the operator need to leave the chairside, e.g. to answer telephone, he/she should remove and dispose of gloves in Contaminated Waste bin and wash hands; on returning to chairside the operator washes and dries hands and dons fresh pair of gloves.

Note: cavity lining, composite materials, etc. should be presented to the chairside on a disposable paper pad and not on a glass slab. Certain materials require to be mixed on a glass slab. After mixing transfer to a paper pad and present on bracket table/tray

After the Procedure

Flush handpiece for 30 seconds with bur in place.
Flush suction with water
Flush spittoon
Remove covers on controls etc. and dispose of them in Contaminated Waste bin.
Remove gloves and dispose of them in Contaminated Waste bin.
Don fresh pair of gloves and clean/disinfect the zoned area with disinfectant solution as per manufacturer's instructions.
Remove gloves and dispose of them, together with wipes, in Contaminated Waste bin.
Wash and dry hands.
Set up for next patient.

End of the Day

Run solution of Orotol through suction as per manufacturer's instructions.
Remove and empty purified water bottle from unit.
Any waste amalgam found in filter should be placed in an 'Amalgam Safe' container and the filter then rinsed with water and soaked in Milton overnight.
Remove filter from suction unit and soak in solution of Milton overnight.
Empty, disinfect and dry ultrasonic bath as per manufacturer's instructions.
Disinfect all work surfaces and dental unit, base of chair and pedals.
Disinfect heavy duty gloves with Virkon and store in a labelled plastic bag.

Pre-sterilization handling of instruments
N.B. Always wear heavy duty gloves, eye protection and face mask when handling contaminated instruments. Handling of contaminated instruments should be reduced to a minimum to reduce the risk of percutaneous injury.

Ultrasonic Cleaning

Ensure bath is 3/4 full as per manufacturer's instructions.
Ensure lid is well fitting to avoid creating aerosols.
Instruments should always be placed in a basket within the bath to ensure that they are kept a proper distance from the bottom of the bath. Burs should be placed in the beakers provided.
Never overload the basket. Overloading the basket with instruments causes 'wave shadows' - inactive zones within the bath.
Choose cycles as per manufacturer's instructions. Currently the counter top ultrasonic baths in use operate at <40 C. At this temperature a cycle of 15 minutes is recommended. Alkazyme is currently considered an appropriate solution to use in this manner. (If the throughput is very large and instruments are heavily contaminated it is currently recommended to change the solution twice daily after the a.m. and p.m. sessions respectively).
On removal of instruments rinse thoroughly (in basket) under running water, inspect for any residual cement etc., dry and pack.

Notes

Ultrasonic units should be tested on a regular basis. Place a piece of tinfoil in the solution and run the unit. If the foil shows uniform pitting after 5 minutes this indicates that the submerged items received adequate ultrasonic cleaning during the cycle. No holes or an uneven pattern may indicate that the machine is not functioning properly.
Every new solution must be 'degassed' by running the ultrasonic bath free of instruments for 15 minutes.
Ultrasonic cleaning is not suitable for handpieces.
Amalgam carriers should not be placed in the ultrasonic bath
Ultrasonic cleaning has no effect on elastic instruments e.g. made from rubber or plastic materials.

Sterilization of Instruments (AUTOCLAVE)

Instructions will vary depending on make of autoclave and manufacturer's instructions.

Little Sister SES 2000

Place instruments in bags and leave open until cycle complete. Seal bags immediately.
Autoclaves with vacuum cycle - seal bags before cycle.
Ensure bags are placed in racks with the clear sides facing each other.

Autoclave testing

Vacuum autoclaves have digital displays showing temperature and pressure/time and provide data output for storage. This data should be stored for each batch of instruments. A chemical indicator strip (e.g. SteriGage) should also be used with each load. A biological indicator (e.g. ATTEST spore strips) should be used with each autoclave at least once a week. Records from all autoclaves should be maintained for 11 years.

Surface disinfection

Virkon
In practice cleaning wipes should be fully wet with disinfectant instead of just being damp, and the surface should be visibly wet following cleaning. This will evaporate within five minutes.

Steel Burs:- Single use. Dispose of these in Sharps bin

Diamond Burs

Clean with bur brush.
Place in ultrasonic bath.
Dry, bag and autoclave.

Bur Stands and Cotton Wool Roll Holders

The use of these is to be discontinued

Endodontic Instruments

Reamers/Files - single use - dispose of them in sharps container

Non-autoclavable Items

Any non-autoclavable items, e.g. suction tip adaptors, needle guards, filters, etc. should be placed in a solution of Milton in a covered container and left overnight. A fresh solution of Milton should be made up each day as per manufacturer's instructions.

Amalgam Waste

Waste amalgam should be placed in 'Amalgam Safe' containers

Always ensure lid is replaced after use
Do not expose container to strong light
Once the 'Amalgam Safe' container is put in use the effectiveness lasts for 12 months only. Note the date of commissioning and/or the effective expiry date.

Staff with latex allergy

When handling contaminated instruments either use 'double glove' technique with vinyl gloves or preferably use vinyl glove within the heavy duty gloves

Correct Lubrication Procedure for Handpieces

Remove bur from head
Remove handpiece from tubing
Remove head from shank, and shank from motor
Shake oil can to ensure contents are well mixed
Place can on a horizontal surface in a supported vertical position
Bring individual item to can and locate in correct nozzle
Wrap tissue around item to absorb excess spray
Fully depress spray button
Release spray button but keep holding handpiece on nozzle until all residual can pressure has been dissipated.
Unwrap tissue and check for debris
Continue cleaning/lubricating until tissue shows clean uncontaminated oil
Wipe excess external oil and place handpiece on either a handpiece stand or in a glass to drain excess internal oil
When sterilizing item in an autoclave, oil before each and every cycle. Do not re-lubricate after sterilization
For high-speed handpieces, check that O-rings on multiflex coupling are clean and in good condition

N.B. Disinfection is not an acceptable level of infection control for dental handpieces