Cross Infection Control

Dentist have a duty to treat all patients as potentially infective as many people carry infectious diseases without knowing, Dentist are obliged to treat HIV and Hepatitis infected patients and respect their confidentiality.
It is advised patients with transmissible spongiform encephalopathy's should be considered of a greater infection risk and treated by the hospital service.
 

All staff should be trained in cross-infection control and fully understand the theory behind the procedures. 

Patients must wear eye protection and disposable bibs.

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. 

Hand pieces should be:
Washed with detergent and warm water (with the burr in place to prevent contamination of the hand piece bearing. 

  • The burr should then be removed.
  • The headpiece should be lubricated with pressurised oil until clean oil emerges from the chuck 
  • Excess oil should then be cleaned off and the hand piece sterilised in an autoclave. (Autoclaves with a pre-sterilisation vacuum phase are recommended for hand pieces 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 aesthetic 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.

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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