Cross Infection Control

• Hand hygiene:

  • Hands should be washed with soap and a liquid detergent...
  • Before pt contact
  • Before every episode of dental treatment
  • After every episode of patient care
  • After contact with blood or saliva
  • After contact with contaminated dental equipment such as chairs, bracket table, light, materials such as cotton wool rolls, gauze, etc.
• Hand-washing technique:

  • There are 3 stages that should take 40-60 seconds (Ayliffe technique)
  • 1 - Preparation
  • 2 - Washing and rinsing
  • 3 - Drying water
• Hand-washing technique:

  • There are 3 stages that should take 40-60 seconds (Ayliffe technique)
  • 1 - Preparation
  • Bare below the elbows with the exception of a plain wedding band
  • Cuts and abrasions must be covered with waterproof dressing
  • Fingernails should be kept short, clean and free from nail polish or artificial nails
  • Wet hands under tepid running water before adding liquid soap
  • 2 - Washing and rinsing
  • 3 - Drying water
• Hand-washing technique:

  • There are 3 stages that should take 40-60 seconds (Ayliffe technique)
  • 1 - Preparation
  • 2 - Washing and rinsing
  • The hands must be rubbed together vigorously for a minimum of 20-30 seconds paying particular attention to the tips of the fingers, the thumbs, areas between the fingers and wrists
  • Rinse hands thoroughly under running water
  • 3 - Drying water
• Hand-washing technique:

  • There are 3 stages that should take 40-60 seconds (Ayliffe technique)
  • 1 - Preparation
  • 2 - Washing and rinsing
  • 3 - Drying water
  • Dry with paper towel - completely drying hands is a key factor in effective hand washing and maintaining skin integrity, as microorganisms can proliferate on damp hands and damage skin
• Alcohol gel/solution:

  • Alcohol hand rubs are an effective alternative to hand washing for clean hands as they reduce the bacterial and viral load quickly
  • Application:
  • dispense gel, rub hands vigorously together for 20-30 seconds as with handwashing technique paying particular attention to the tips of fingers, the thumbs, areas between the fingers and wrists
• Advantages and disadvantages of alcohol gel solution:

  • Advantages: can be performed at chairside, no need to dry and are less irritant than soap
  • Disadvantages: alcohol gel will not remove dirt or kill bacterial spores such as C. difficile. So hands that are visibly soiled or potentially contaminated with saliva need to be washed with a liquid soap
• Personal Protective Equipment (PPE) includes: clothing (scrubs), safety glasses, and disposable gloves and face masks and are worn as a barrier to prevent the transmission of microorganisms between patients and the dental team.
• Preventing scrubs from becoming a source of infection:

  • Dental handpieces, 3-in-1 syringes generate an aerosol spray which splatters clothing with potentially contaminated microorganisms therefore scrubs need to be
  • Changed daily
  • Washed separately from other clothes at 50 degrees C or above to kill bacteria
  • Scrubs should not be worn outside hospital grounds
  • If high risk of splattering with blood such as during minor oral surgery then surgical gowns are advised
• Safety glasses - protection against aerosol spray, foreign bodies such as tooth or amalgam fragments. To be worn:

  • During all types of dental treatment
  • Dispensing dental materials such as acid etch
  • Visors or face shields should be used to cover spectacles which do not provide sufficient eye protection

  Safety glasses should be cleaned using disinfectant wipes such as Clinell wipes before and after dental treatment.
• Gloves are worn to protect the wearer from contamination from a patient's blood or saliva and to reduce the risk of transmission of microbes from the dentist to the patient. For routine dentistry non-sterile latex free gloves are used. Sterile surgical gloves are worn for minor oral surgery, implant surgery, periodontal surgery.
• Safe use of gloves in dentistry:

  • Hands must be washed before putting on gloves. Gloves are not an alternative to hand washing!
  • Gloves must be worn when treating patients, handling contaminated dental instruments, materials or equipment
  • Gloves are disposable, single use never reuse
  • Always change your gloves between patients, preventing cross infection between patient, contamination of work surfaces
• Safe use of gloves in dentistry:

  • Never handle patient notes, x-rays, write up notes or touch your face with gloved hands
  • Remove gloves, wash hands after: treating patient, handling contaminated dental instruments, material, equipment
  • Change gloves during long procedures as up to 40% of gloves may leak or tear after prolonged use
  • Dispose of gloves in hazardous waste bins
• Face masks act as a physical barrier helping to protect from splashes of blood and saliva. Standard dental face masks provide no or only partial protection to the water from aerosol inhalation.
• Face masks:

  • Should be worn during all dental procedures
  • Should be tied using both strings
  • Should cover nose and mouth and chin
  • Are single use items and should be changed after every patient and never reused
  • Whilst wearing a mask the wearer should avoid touching the outer surface of the mask, which may be contaminated
  • Remove mask by breaking the straps dispose of as clinical waste
  • Washing hands after removing mask to prevent contamination of your face and the surgery environment
• PPE should be put on in the following order:

  1. Face mask
  2. Safety glasses
  3. Wash hands
  4. Put on gloves
• PPE should be removed in the following order:

  1. Gloves - wash hands
  2. Face mask - breaking ties at side of head, avoid touching the mask itself
  3. Safety glasses - disinfect with clinell wipes
  4. Wash hands
• Surgery set up before patient treatment - zoning:

  • The boundaries between clean and dirty areas should be clearly defined within the dental unit. Dental students and clinical staff should not bring any personal items, such as mobile phones into the clinical unit
• Clean zones:

  • Include those surfaces and drawers where clean and sterile instruments, equipment, patient notes are stored and should never come into contact with contaminated instruments or equipment
  • If it's necessary to move from contaminated area to clean, gloves must be removed, hands washed on returning to the contaminated area you will need to re-glove
• Dirty (contaminated) zones:

  • Defined as areas that will be contaminated by the patient's blood or saliva during dental treatment
  • This will normally include:
  • Chairs (including nurses and operators), switches, headrest, armrest, etc
  • Light and switches
  • Hand pieces & cables/connections
  • Bracket table
  • Aspirator cables
  • Spittoon
  • Protective glasses
  • Any instruments and equipment used during treatment
  • Materials such as cotton wool rolls
  • Work surfaces usually to the right of the bracket table
• Surgery/dental unit preparation involves collecting all instruments, materials and equipment required for the patient's treatment, from clean utility and trolleys.
• Hand hygiene practices include washing hands and putting on gloves.
• Using a separate disinfectant wipe for each surface, clean dental chairs and work tops, giving special attention to obviously contaminated surfaces such as handpiece connections, 3-in-1 syringes, light handles, and control switches on chairs, bracket table, etc.
• After cleaning, remove gloves, wash/gel hands, and dispose of paper towel in black domestic waste bin.
• Opening packaging without touching instruments, placing on bracket table, and disposing of uncontaminated packaging in black bin is a part of surgery/dental unit preparation.
• Set up and assemble hand pieces/peizons and check working correctly is a part of surgery/dental unit preparation.
• Laying out the instruments and equipment needed for treatment, including LA, is a part of surgery/dental unit preparation.
• Any radiographs are placed on viewer as part of surgery/dental unit preparation.
• If needed, light curing units require disposable cover and protective shield as part of surgery/dental unit preparation.
• During treatment:

  • All instruments and materials contaminated by the patient must be contained within the working areas (dirty zones)
  • Student/patient notes, bag, books and other non-clinical materials must NOT be placed in the dirty areas
  • Wherever possible, disposable or single use items should be used
  • Materials when required should be dispensed and mixed on a disposable or sterilisable container/pad or glass slab
• During treatment:

  •  When mixing/collecting amalgam from trollies held centrally on clinics, students/nurses must:
  • Remove gloves, wash hands or if visibly clean disinfect with alcohol gel before leaving dental unit
  • Mix amalgam
  • Return to unit, pass the unopened capsule to the operator, who will open and dispense into disposable dappens dish
  • Student/nurse assisting will wash hands and put on a clean pair of gloves
• During treatment:

  • Handpiece safety - burs must be removed from hand pieces whilst not in use or turned inwards to prevent needle stick injury
  • Patient's records or radiographs must not be handled during treatment except in exceptional circumstances. In such an occurrence gloves should be removed, hands washed or disinfected with alcohol gel before and after handling
  • Blood and spillages (must be reported to the nursing staff and cleaned up immediately - using 10,000ppm Acticolor solution)
• Set down after treatment:

  • Before anything else is done, sharps such as needles, cartridges, endodontic files, scalpel blades and matrix bands which must be removed from retainer using tweezers and placed in the sharps container, burs removed from hand pieces and other reusable sharps, such as carvitron tips should be removed from the unit using the safety guard provided and placed in their original trays and taken to the dirty utility
• Set down after treatment:

  • Waste disposal - any materials and single use equipment contaminated with the patients' blood or saliva must be disposed of in the orange plastic waste bags. These items include: gloves, masks, cotton wool rolls, tissues, cups, bibs, etc
  • Dirty instruments/equipment/handpieces and burs must be taken to the dirty utility on completion of treatment - before clean down and placed in the correct boxes, any instruments which don't have a designated box arrange neatly on the benches ready for collection
  • Correct disposal of amalgam and amalgam waste products
• Correct disposal of amalgam and amalgam waste products:

  • Small particles of amalgam are to be disposed of in the small amalgam containers found in each unit
  • Amalgam capsules and dappens dishes used to carry amalgam are to be taken to the 'dirty utility' and disposed of in the amalgam drums provided
• Surface disinfection:

  • Wash hands, put on clean gloves
  • Using a separate disinfectant, wipe down all potentially contaminated surfaces starting with least contaminated areas, these include:
  • Protective glasses
  • Defined work surfaces, clean and dirty
  • Chairs (including nurses and operators), switches, headrest, armrest, etc
  • Lights & switches
  • Hand piece cables/connections
  • Bracket table
  • Aspirator cables
  • Spittoon, check filters
  • Dispose of gloves as clinical waste, wash hands
• Disinfection of impressions:

  • All impressions/lab work must be disinfected before leaving the clinic
  • Rinse thoroughly under running water
  • Immerse fully in disinfectant
  • Leave for 3 minutes
  • Once disinfected rinse again under running water to wash away any residue left by the disinfectant solution
  • Place disinfected impressions in sealed polythene bag
  • Take to laboratory
• What to do in the event of a needlestick injury:

  • Report immediately
  • Do not allow patient to leave
  • Allow wound to bleed
  • Wash thoroughly in running water, cover with waterproof plaster
  • Consultant on call/or supervising clinical will council patient
  • Patient will be assessed as high or low risk
  • Patient's blood will be taken (if they agree)
  • You may have to ring Occupational Health and make arrangements to have your blood taken
  • Incident will be recorded