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Monday 9.00am to 8.00pm
Tuesday 9.00am to 6.00pm
Wednesday 9.00am to 6.00pm
Thursday 9.00am to 5.00pm
Friday 9.00am to 1.00pm (admin only)

Opening times may vary due to clinic variation, staff training & holiday

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Home Dental Practice Our Cross Infection Control Policy

Our Cross Infection Control Policy

Issue 2:   Policy Date: 04.01.16           

Review Date: 04.01.17

Practice Infection Control Policy

Infection control is of prime importance in this practice.  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 ask Leila Matthews your cross infection 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 sero convert or cannot be immunised, advice will be sought on the appropriate course of action. A 5 year booster must also be done and records kept in your personal files. 

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 Leila Matthews (Senior Dental Nurse)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, Derriford, Plymouth (01752 202082) and state that you have been exposed to a high risk needle stick injury. 

You may also call Occupational Health and Wellbeing Dept Derriford, Plymouth, 01752 437222 (they will only offer this service at a fee to the practice) but they are very helpful. 

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.  See separate protocols for ultrasonic 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. 

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. 

Staff will be appropriately trained to ensure they are competent to decontaminate existing and new reusable dental instruments. Records of this training are kept. See separate manual training protocol and care & maintenance of dental handpieces protocol for more information.

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 and footwear must be fully enclosed and in good order. 

Gloves

The disposable clinical gloves used in the practice are CE-marked and low in extractable proteins (<50 ?g/g), low in residual chemicals and powder-free. Anyone developing a reaction to protective gloves or a chemical must inform immediately. Non sterile and sterile latex gloves 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. 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 60oC with a suitable detergent is advised. 

Cleaning (correct PPE in use)

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. Once the instruments have been manually scrubbed they need to be placed in the ultrasonic bath, unless this is incompatible with the instrument(s) to be cleaned, following the manufacturer’s instructions for use. See separate protocols for ultrasonic cleaning and manual cleaning. 

When placing instruments in the ultrasonic cleaner:

  • Open instrument hinges and joints fully and disassemble where appropriate
  • Place instruments in the suspended basket and immerse fully in the cleaning solution (made up according to manufacturer’s instructions)
  • Avoid overloading basket or overlapping instruments.
  • Do not place instruments on the floor of the ultrasonic cleaner. 

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). 

Inspection

After rinsing, 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 hand and the instrument re-cleaned in the ultrasonic bath and re-inspected with magnifying/light device. 

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.

Non-Vacuum Type N Autoclave

When using this type of autoclave all instruments must be placed on perforated trays or racks provided and spaced not so not overlapping. Instruments must be handled with clean gloves once removed from the autoclave and dried with lint-free cloth and then either used that day or bagged and stamped with an expiry date of 12 months. 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. 

Work Surfaces and Equipment

A protective screen is in place in the scrubbing area to protect other members of staff from cross contamination during decontamination process when entering sterilization room. Our practice policy is that when a nurse is scrubbing and decontaminating at the sink, the room is out of action until the scrub nurse has completed their process, unless undergoing a medical emergency, where the medical kit is required (the kit is currently stored away from decontamination area, protected by the large screen). The nurses ensure that they have all necessary instruments and materials before treatment to avoid these circumstances. The plastic screen is wiped down at the end of each session am/pm or when visibly dirty. 

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. 

If however, the automatic hand gel dispenser is unavailable or not working, all staff have been provided a portable hand disinfectant rub, which attaches to staff uniform, in which this can be used as well or in the meantime of repairs. 

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. (Guidelines given by initial medical) – Practice details placed onto waste. 

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 central sterilisation 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 or in the locked outside compressor room and never left accessible to members of the public or patients.

Initial Medical Services 0870 8504045 – All clinical waste and other hazardous waste. 

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). 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. 

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 Mitesh Badiani.

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