A Confidentiality Notice

This document and the information contained therein is the property of The Dentist.

This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from The Dentist.

B Document Details

Title	Infection Control Policy
Classification	For all clinical and non-clinical staff
Author and Role	Erika Howell, Consultant
Document Number	15
Current Version Number	1.2
Date last reviewed	June 2021
Authorised by	Michael Goldstone & James Taylor
Date of next review	June 2022
Document available on Practice Intranet	Yes

Introduction

Infection control is of prime importance at The Dentist. 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 update training, at least annually.  

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 discuss with your cross infection control lead. 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 sero conversion will be held securely by the practice manager 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. A 5 year booster must also be completed and records kept in your personal files, if advised by your GP.

Staff identified as at risk of exposure to blood borne viruses will be required to undergo an occupational health examination. This will be provided by your registered GP. Records of these examinations will be held securely by the practice to ensure confidentiality is maintained. 

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. Record in the practice accident book and report to the Practice Manager and obtain as much information regarding the patient and make the patient aware of the situation and ask them to complete an up to date medical history. Please see the practice policy for dealing with inoculation injuries.  

Advice on post-exposure prophylaxis can be obtained from your own GP and if high risk contamination then contact the A&E department at Leeds General Infirmary, 0113 243 2799 and state that you have been exposed to a needle stick injury. 

You may also call Occupational Health and Wellbeing Dept (they will only offer this service at a fee to the practice) but they are able to advise and provide further information if required.  

Decontamination of Instruments and Equipment 

Single use instruments and equipment must be identified and disposed of safely, never reused. A full list of all single use items is available in protocols folder. 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 an ultrasonic cleaner or washer disinfector See separate protocols for ultrasonic/washer disinfector testing and validation. 

The practice policy for new instruments is to remove all packaging and sterilise in a sterilisation pouch on a full vacuum cycle, making sure an expiry date of sterilisation is logged on the bag before storing correctly, along with the initials of the member of staff carrying out the decontamination process.

At the end of each patient treatment, instruments should be transferred to the decontamination area for reprocessing by placing all contaminated instruments and equipment into the lockable containers provided and labelled DIRTY. Instruments should be decontaminated as soon as practically possible. Those than cannot be reprocessed straight away must be kept moist until decontamination to avoid the risk of contaminants drying on the instrument surface, making them difficult to remove.

Clinical staff will be appropriately trained to ensure they are competent to decontaminate existing and new reusable dental instruments. Records of this training are kept.

Personal Protective

Equipment     

Information on the correct use of PPE is available in the central sterilisation room. All staff receive updates in the use and when new PPE is introduced into the practice. See separate protocol for full information on personal protective equipment and hand & eye protection. 

PPE includes protective clothing, disposable clinical gloves, plastic disposable aprons, disposable face masks, and eye protection. In addition, heavy duty 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 nitrile-based, low in residual chemicals and powder-free. Anyone developing a reaction to protective gloves or a chemical must inform immediately. Non sterile nitrile and sterile latex gloves (Biogel) are available. 

All gloves are not to be worn out of the clinical treatment or decontamination area. 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 and free of any enhancements such as acrylic, nail varnish and shellac.  Alcohol rubs/gels must not be used on gloved hands, nor should gloves be washed. 

Heavy duty gloves should be worn for all decontamination procedures (along with a 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 weekly 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 and any treatments which are likely to create splatter or visible contamination. 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. Aprons are not to be worn out of the clinical treatment or decontamination area. 

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 and not worn out of the clinical treatment or decontamination area. 

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 and not worn out of the clinical treatment or decontamination area. 

Protective Clothing

Protective clothing worn in the surgery must not be worn outside the practice premises or during lunch breaks. Adequate male and female changing facilities have been provided with individual lockers. 

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. 

Washer Disinfector

Contaminated instruments should be transported to the decontamination room via a sealed, lidded container. Any deposits of cement etc should ideally be removed with a tissue or wipe during at chairside, during treatment, to avoid setting on the instruments which makes it difficult to remove.

Whilst wearing PPE, instruments should be carefully loaded into the baskets of the washer disinfector, taking care to ensure they are not overloaded or touching, as this will lead to an ineffective decontamination process.

Please bear in mind the washer disinfector cycle can take approximately 1 hour so ensure the machine if sufficiently full before starting the cycle.

Once the machine is full, close the hatch and start the cycle.

When the cycle is complete, wearing clean PPE, carefully remove the instruments and follow the rest of the process. Please take care immediately after the cycle is finished as instruments may be hot.

Inspection

Inspect all instruments for residual debris and check for any wear or damage using task lighting and a magnifying device provided. If present, residual debris should be removed by being re-cleaned in the washer disinfector

After inspection all instruments need to be dried using a lint free cloth 1 per load of instruments before being placed and sealed into the correct sized sterilisation pouch. When placed instruments into the pouch, ensure the manufacturers guidelines are followed and the pouch must be folded on the perforated line to ensure they are sealed correctly. 

Sterilisation

Vaccum Type B Autoclave

Where 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 12 months and this will be checked and rotated on a quarterly basis, after this, instruments must be reprocessed. Instruments for same-day use do not require wrapping. See separate protocol for autoclaves and sterilisation of dental instruments. 

Back Up Process

Manual Process (If Automated Process Not In Use)

Should the automated decontamination process fail or be out of use, the below steps should be taken to manually cleaning the instruments prior to sterilisation. Further details can be found in the manual cleaning protocol.

Contaminated instruments must be manually cleaned using a long handled scrubbing brush and heavy duty gloves in the scrubbing sink, using a suitable manual cleaning solution and the water must not exceed 45 degrees.

Rinsing

Once instruments have been scrubbed they then need to be rinsed in the rinse bowl in normal tap water, as we are in a low PH water level +area (as informed by professional hygiene). 

Once the instruments have been manually scrubbed and rinsed. they need to be inspected under the magnification light for residual debris.

When thoroughly clean, they can then pass to the sterilisation phase.

Work surfaces and equipment 

The patient treatment area should be wiped down after every patient using disposable alcohol free disinfectant wipes. The treatment area is to include all items of equipment, work surfaces, cupboard doors, all parts of the dental chair, inspection light and handles, hand controls, delivery units, spittoons, aspirators, if used, x-ray units and controls any item within a 2m radius of dental chair, any other item or equipment that may have become contaminated must also be cleaned. 

In addition, floor surfaces need to be inspected regularly and should be cleaned daily or when visibly decontaminated. 

At the end of each session am/pm the decontamination room should be cleaned using disposable alcohol free disinfectant wipes followed by house hold disinfectant spray on a clean paper towel, ensuring the system is disinfected from clean area to dirty area (not dirty area to clean area) even if the area appears uncontaminated. Equally this procedure should be carried out more regularly if it becomes visually contaminated. 

All units in dirty zone (i.e. – Ultrasonic unit, Hand-piece oil bottles, taps, sinks and cross infection screens) are to be cleaned using same protocol as above and the end of each decom cycle.

Impressions and Laboratory Work 

Dental impressions must be rinsed until visibly clean and then disinfected by immersing in a disinfection impression solution for a period of 10 minutes – timed using a timer (as recommended by the manufacturer) and labelled as ‘disinfected’ before being sent to the laboratory. Technical work being returned to or received from the laboratory must also be disinfected in a disinfection impression solution and labelled (using the correct labelled boxes lab work in and lab work out). See separate protocol for decontamination of impressions and labwork. 

Hand Hygiene 

The practice policy on hand hygiene must be followed routinely. The full policy is on display in the central sterilisation room, 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. Jewellery must not be worn this includes rings, bracelets and watches. 

Wash hands using antibacterial liquid soap between each patient treatment and before 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 in the staff area to counteract dryness. Do not use hand cream under gloves; it can encourage the growth of microorganisms.

Clinical Waste Disposal 

All clinical healthcare waste is classified as ‘hazardous’ waste and placed in orange sacks for collection. 

Clinical waste sacks must be no more than three-quarters full, have the air gently squeezed out to avoid bursting when handled by others, labelled according to the type of waste and tied into a knot twice (in the style of a cross) with a zip tie placed around the knot to avoid it opening. Practice details placed onto waste bags using adhesive label.

Sharps waste (needles and scalpel blades etc) must be disposed of in UN type approved puncture-proof containers (to BS 7320), and labelled to indicate the type of waste. Sharps containers must be disposed of when no more than two-thirds full – practice details written on the label. 

Used and contaminated local anaesthetic cartridges must be disposed of in the correct blue lidded UN approved puncture proof container. Any out of date pharmaceutical drugs are to be disposed of in the correct blue lidded UN approved container (found in locked storage cupboard outside) 

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 extracted teeth must be disposed of also in the correct containers. 

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 a dental nurse and filed in the correct folder and stored in the correct folder located within the administration room.

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. 

All clinical waste waiting for collection must be stored in the lockable bin store and never left accessible to members of the public or patients.

Blood Spillage Procedure

Spillages of blood occur rarely in dentistry, although there might be occasions when a surface becomes grossly contamination with blood or blood/saliva. In these situations the area should be saturated with 1% sodium hypochlorite with a yield of at least 1000 ppm free chlorine (household bleach). Ideally, using a ‘Clinell SpilPack’ which can be ordered from a dental supplier. Allow contact for a minimum of five minutes before using disposable cloths to clean the area. The cloths used for cleaning should be despised 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 heavy duty 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. See separate protocol for spillages procedure. 

Environmental Cleaning

The non-clinical areas of the practice are cleaned in line with the practice policy which is kept in reception protocol folder and cleaners cupboard. 

Cleaning equipment is stored outside patient care areas in individual sterilisation rooms. 

Records of cleaning protocols and audits/checks on its efficacy are retained and kept in the allocated cleaning cupboard. 

Summary

The Dentist is currently working to ’best practice’ in regards to cross infection control. We will continue to audit and review our standards to ensure that best practice is always met, making amendments and improvements as necessary.

Review 

This policy and the protocols and 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. This policy relates to the latest addition of the HTM 01-05 ‘Revision 2013’ and must be followed in accordance with criteria set by our clinical lead Dr Michael Goldstone.