12: Appendix

Chapter 12

Appendix

Table 12.1 Daily infection control clinical pathway

At start of the day

  • Remove watch and rings (except wedding rings). Work bare below the elbows; wash hands with plain or medicated soap
  • Fill the steriliser reservoir with reverse osmosis (RO) or sterile water
  • Confirm the steriliser is working correctly by completing an automatic control test (for all types of sterilisers) and steam penetration test (for vacuum sterilisers)
  • Store printout or record the cycle sterilisation parameters (temperature, pressure and holding time) in sterilizer logbook; record if passed or failed tests
  • Check sufficient sterile instruments are available for the session. Run steriliser as required; record cycle number in patient’s notes
  • Don heavy duty gloves, apron and goggles for cleaning surfaces with disinfectant and preparing fresh solutions of detergents and disinfectants
  • Fill dental unit waterlines reservoir with RO, distilled or sterile water. Flush lines for 2 minutes. Replenish biocide in waterlines
  • Prepare fresh solution of detergent for ultrasonic bath, fill with solution and run bath empty for 2 minutes to degas bath; function test regularly
  • Check all clinical surfaces are clean and free of clutter. Wipe all surfaces with a hard surface cleaner. Clean chair and headrest
  • Switch on air conditioning or open windows to ensure good ventilation
In preparation for patient treatment

  • Cover chair, light switches, handles, suction and air and waterlines with disposable coverings. Items can be passed into ‘dirty zones’ but contaminated items should not be passed out into ‘clean zones’
  • Place sterile instrument set on the bracket table and lay out all materials to be used in the clean zone. Storage containers of dental materials should not be placed in the ‘dirty zone’
During patient treatment

  • Recheck patient’s medical history. Patient’s notes, radiographs and computers should remain in the clean zone and not be touched with gloved hands
  • Observe standard precautions; treat all patients as potentially infectious
  • Place goggles and bib on the patient
  • Clean hands with alcohol hand rub before and after removing gloves at the end of procedure
  • Don personal protective equipment (PPE) (gloves, masks, protective eyewear and clothing). Change between patients and dispose of as clinical waste (yellow or orange waste sack)
  • Reduce aerosols contamination by the use of high-volume suction and rubber dam (if appropriate)
  • Work sharp safe: use resheathing device or safety syringes or single-handed technique to dispose of needles
  • Clinician should dispose of single-use sharps (needles, sutures, scalpels, steel burs) and fully discharged Local Anaesthetic cartridges into clinical (hazardous) waste ‘sharps bin’ immediately after use. Only fill to three-fourths full
  • Segregate medicines waste, e.g. partially discharged LA cartridges and needles from other sharps waste (yellow-lidded sharps bin for incineration)
  • Dispose of amalgam waste in a special white-lidded mercury waste receptacle
  • Remove disposable coverings at the end of treatment and dispose of as clinical waste
After treatment (wear appropriate PPE, remove before leaving treatment or decontamination area; clean hands before and after removing gloves)

  • In treatment room: Clean and disinfect all contaminated work surfaces in the dirty zone
  • Rinse and disinfect impressions and other dental appliances before sending to laboratory
  • Prepare surgery for next patient; flush waterlines for 30 seconds between patients
  • Instrument decontamination: Transport instruments to decontamination room/area in clean container with secure lid. Deposit in dirty zone
  • Strictly segregate dirty from clean instruments
  • Clean hands and don fresh PPE, e.g. apron, heavy duty gloves (protective eyewear and mask if manually cleaning instruments)
  • Pre-soak instruments if cannot be cleaned immediately
  • Whenever possible keep instruments together in their trays, for instrument tracking
  • Clean instruments in ultrasonic bath (metal instruments only) or preferably use washer disinfector fitted with connectors for handpieces, dry and inspect to ensure visibly clean. Wrap instruments if using a vacuum sterilizer
  • Disinfect and lubricate handpieces (preferably in an automated handpiece cleaner)
  • Sterilize instruments at 134°C for 3 minutes; keep cycle printout
  • Store dry instruments in covered trays or instrument packs in clean dry environment; use stock control
  • Remove PPE and clean hands with alcohol hand rub or soap and water on exiting the room
At the end of each session, clean hands before and after removing gloves

  • Clean and disinfect all work surfaces thoroughly in both dirty and clean zones
  • Wipe down the dental chair, bracket table, tubing and spittoon
  • Drain off water in sterilizer and replace with freshly prepared or bottled water
  • Do not eat or store food or drink in the treatment or decontamination room
At the end of the day, clean hands before and after removing gloves

  • Dispose of all clinical waste sacks from treatment room and store in secure area
  • Disinfect the aspirator, its tubing and the spittoon, and clean trap
  • Drain down dental unit waterline and disinfect (if not using a continuous dosing systems). Empty and disinfect reservoir bottle. Store dry and inverted
  • Drain down and clean ultrasonic bath, and leave dry
  • Clean steriliser chamber and inspect seals
  • Empty and drain sterilizer water reservoir; clean and leave dry
  • Dispose of any partially used bottles of water as they will be contaminated
  • Change out of tunic/uniform and launder daily

Note: This is an outline only; read best practice guides for more detailed protocols.

Table 12.2 Decontamination methods for specific instruments and items of dental equipment

Item Decontamination requirements
Airways and endotracheal tubes Single-use items. Any reusable items should be steam sterilized
Bracket table and handle Cover with cling film during use; then disinfect with surface disinfectant, e.g. alcohol wipe
Brushes (for cleaning equipment) Discard, />

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Jan 3, 2015 | Posted by in General Dentistry | Comments Off on 12: Appendix
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