Infection control protocols are of critical importance at any dental clinic. Laser + Holistic Dental provides a safe and healthy environment patients and staff alike by cleaning, disinfecting and sterilising equipment and the surgery settings. Continuous auditing is conducted throughout the clinic by our staff in order to ensure standards of infection control are being met.
Clinical waste with the potential to cause sharps injuries, infection or offence are packaged and disposed of appropriately. This includes the following types of waste:
- Sharps such as needles
- Human tissue (excluding hair, teeth and nails)
- Visibly blood stained body fluids and visibly blood stained disposable material and equipment
- Bulk body fluids and blood
- Laboratory specimens and cultures
Treating patients with blood-borne viral infections such as hepatitis B, C or HIV are treated using standard precautions and the same cleaning and sterilisation techniques as for other patients. This ensures a consistently high standard of infection control across all patients.
All the surgery zones are designated as clean, grey and dirty and are to be identified in the clinical area. Clean zones are where no contaminated items enter. The grey zone is focused on the patient’s mouth and includes the clinician and assistant work surfaces. Dirty zones are where contaminated instruments are placed to start the cleaning and/or disinfection and/or sterilising process. Dirty zones are not in the actual clinical surgery.1
Personal protective equipment
Dental practitioners and clinical support staff will wear gloves whenever there is risk of exposure to blood, saliva or other body secretions or hands will come in contact with mucous membranes. Wearing gloves does not replace the need for hand hygiene largely due to the potential for damage during use.
Non-sterile examination gloves may be worn for non-surgical general dental procedures. Sterile gloves are worn when a sterile field is necessary for procedures such as oral, periodontal or endodontic surgery.
In the dental surgery environment, the most common causes of airborne aerosols are the high-speed air rotor handpiece, the ultrasonic scaler and the triplex syringe. The aerosols produced may be contaminated with bacteria and fungi from the oral cavity as well as viruses from the patient’s blood. Therefore, masks are worn at all times when treating patients or prevent contamination of the working area with the operator’s respiratory or nasal secretions.
Eye protection is worn to prevent penetrating injury or exposure to aerosols, splattering or spraying with blood, saliva or body substances.1
Placement of equipment:
The primary work surface or grey zone is usually on top of the assistant’s cart and on the bracket table, where instruments and equipment of direct relevance to the appointment are be placed. When using equipment that cannot be directly sterilised such as curing lights – appropriate barriers and disinfection are carried out after each patient.
All other items that are not involved in the procedure such as the clinical records, patient notes, radiographs, computer keyboard and mouse remains in the clean zone. To access these items in the clean zone gloves are removed and hand hygiene performed.
If other items, equipment or consumables are required during the procedure they are retrieved by the assistant by using transfer forceps that are cleaned and disinfected between patients, or are single use only, and stored in the clean zone, or by removing gloves and performing hand hygiene before and after retrieving equipment.
Exemptions may occur depending on the design of the dental unit as some equipment may be attached to the unit, such as the curing light and would therefore remain in the grey zone. This equipment is covered with a barrier film to minimise bacterial/microbial load. Decontamination of this equipment is carried out as per the manufacturer’s instructions.1 2
Management of sharps:
Sharp instruments such as scalpels and scalers are never to be passed by hand between dental staff members and are placed in a puncture-resistant tray or bowl after each use.
Needles are not re-sheathed unless using an approved recapping device or single-handed technique.
Dental assistants are trained to check that sharps such as burs or orthodontic wires have been removed by the operator before commencing the changeover procedure.1
All instruments are set up and materials dispensed prior to treatment commencing and remain in their sterile pack until the patient is seated in the dental chair. This reduces the need to enter drawers or cupboards during an appointment.
We follow these guidelines:
- All materials are pre-dispensed where appropriate. Some volatile materials deteriorate quickly in air, so may be prepared for dispensing, but not dispensed.
- Hand hygiene is performed immediately prior to the procedure commencing and after finishing, and appropriate personal protective equipment shall be used.
- Materials that require hand mixing are mixed on a single sheet of non-porous clean paper, and a bib, tray or paper towel will be used to define the work surface. Pre-set/pre-dispensed items are to be placed on the primary work surface.2
The patient light is pre-set at the commencement of treatment. Only handles of the overhead light are touched, and these are covered with barrier film where light sensor controls are not in place. The barrier film is changed between patients and the light and handles are wiped clean with detergent and water at the conclusion of the appointment.
Hand washing is undertaken in dedicated (clean) sinks preferably fitted with non-touch taps (or done with a non-touch technique) and not in the (contaminated) sinks used for instrument cleaning. If touch taps are used the taps may be turned on and off with a paper towel’.1 4
Hands are not washed in a sink which is used for processes such as:
- instrument cleaning
- disposal of blood, body substances or chemicals
- cleaning of impressions and impression bowls
- flushing of lines
- where bleach or other antiseptic solutions are disposed
Cleaning of impressions/prosthesis:
When taking an impression either single use trays or sterilized metal trays are used. All impressions are rinsed clean with neutral detergent and running water to remove all debris. A neutral detergent is used according to the manufacturer’s instructions for the cleaning of impressions and dental prostheses.
This process occurs prior to transportation from the clinical area. If a designated sink is not available in the clinical area an alternative location will be provided. DOHA states “Although the efficacy of disinfection of dental materials is still undetermined, standard precautions must be applied whenever people handle dental material. The most important step is the thorough cleaning of material that has contacted oral tissue (e.g. impressions).
Thorough rinsing with tepid running water, followed by the application of a neutral detergent and further rinsing, should continue until all visible contamination is removed”.3
Between patients the head of the x-ray tube is wiped down with neutral detergent and water after each use. Single use barriers are used on parts that come into contact with non-intact skin or mucous membrane. All parts including lead aprons are thoroughly cleaned with neutral detergent and water after each use and stored dry. Radiographic films are covered by single use barrier envelopes or be single use films, which are wiped over with neutral detergent prior to processing.2
Single use barriers are used for extra-oral radiological equipment such as bite piece for CBCT scan, chin rests, head frames, cephalostat earpieces and extra-oral cassettes and are to be thoroughly cleaned with neutral detergent and water after each use. Single use barrier films designed to protect the equipment are disposed of between patients.