Cross Infection Control
All patients should be treated as potentially infective (many people carry infectious diseases without knowing). Dentists have an obligation to treat HIV and Hepatitis infected patients. (Remember such information is strictly confidential must not be discussed with anyone other than health care professionals who are directly involved with the
patient's care).
Only patients with transmissible spongiform encephalopathies should be considered of a greater cross-infection risk and should be treated in the hospital service.
All staff should be trained in cross-infection control and fully understand the theory behind the procedures.
Instruments:
Instruments should be cleaned (either manually by a nurse wearing thick gloves, with detergent, a brush and hot water) or with an ultrasonic bath (containing detergent) or an enzyme cleaner.
The instruments should then be inspected, and if debris is visible they should be cleaned again.
The instruments should then be sterilized in an autoclave.
Work surfaces should be designated as 'clean' or 'dirty' areas and used instruments should not be placed on
'clean' surfaces.
All 'dirty' i.e. possibly contaminated surfaces should be thoroughly washed down (with detergent) and then cleaned again, with a chemical disinfectant, between each patient.
Handpieces should be:
Washed with detergent and warm water (with the burr in place to prevent contamination of the handpiece bearing.
- The burr should then be removed.
- The handpiece should be lubricated with pressurised oil until clean oil emerges from the chuck
- Excess oil should then be cleaned off and the handpiece sterilised in an autoclave. (Autoclaves with a
pre-sterilisation vacuum phase are recommended for handpieces or for instruments with lumens and all instruments in pouches. (Many practices
don't have vacuum autoclaves yet. If you don't have one it is better to autoclave the instruments without pouches).
Disinfection of impressions and prosthetic and orthodontic appliances
The dentist is responsible for ensuring impressions and appliances are disinfected before they are sent to the laboratory.
Once the impression/appliance is removed from the mouth, it must be immediately rinsed under running water and then visually inspected to ensure all traces of blood and saliva have been washed off. The impression/appliance must then be placed in a bath of disinfectant (check
manufacture's instructions for suitability) for the required period of time. It should then be rinsed again before packaging.
Clinical waste
Clinical waste must be disposed of in the correct container. Sharps must be kept in a sharps box, which must be emptied when 2/3 full.
Partly discharged local anesthetic cartridges are classified as special waste and should be stored separately from empty cartages and other sharps.
Waste amalgam and fluids from the radiograph developer also require specialized disposal.
Protective clothing
Gloves, eye protection and masks must be worn by all clinical staff when working with a patient or cleaning contaminated equipment.
Staff uniforms should be worn (they should not be worn outside of the practice). Uniforms should be washed at 65 degrees centigrade.
Patients must wear eye protection and disposable bibs.
Recording inoculation injuries
If someone is injured with a contaminated instrument or infected material
contacts the eyes, the incident must be recorded.
If there is a reason to suspect the blood on the instrument carries Hep B, Hep C
or HIV the local Primary Health Care Trust should be contacted.
The usual procedure for an injury with a contaminated injury is:
- Encourage the injury to bleed
- Wash the injured area with running water but do not scrub.
- Record the incident, noting the date, the name of the person who was
injured, the type of injury and the name of the patient whose blood
contaminated the instrument. Every practice should have an 'accident' book
for this purpose.
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