Under many codes (Box 6.1.1), clinical staff must tie back long hair, but not with ribbons or combs. Jewellery is limited to simple earrings and one ring, and any clothing that exposes the midriff or cleavage is banned. Nose studs should be covered with a fresh plaster each day. Some codes also cover above-the-knee skirts and high heels. Shoes that are low-heeled, soft-soled, supportive and closed are generally agreed to be best for work. Shoes with holes in the top or side may carry a risk of injury from falling scalpels and needles, or the risk of catching an infection from blood or fluids dropping through the holes.

BOX 6.1.1 Dress Codes in Practice

Dress codes can be controversial. At least one hospital banned nurses from wearing Croc shoes, suggesting they might be dangerous. But some surgeons use Crocs in the operating theatre, believing they are easier to clean. Even NHS rules can vary. In England and Wales for example, bare-below-the-elbows dress code for clinicians is recommended since it ‘helps to support effective hand-washing and may reduce the risk of patients catching infections’. Other codes have caused considerable controversy and even made newspaper headlines. See the Daily Mail archive for example, for the article ‘Don’t forget to wear socks and make sure your shoelaces match’ (31 December 2007).

The Scottish code (published on the Scottish Government website, www.scotland.gov.uk/Publications/2008/08/interimdresscode) is reproduced below:

• ‘Staff should dress in a manner which is likely to inspire public confidence:

For example: in clean uniform (where uniform is a requirement), with hair tied back off the collar, with nails kept short and clean.

Wear clear identifiers, (e.g. badges, epaulets etc).

Where changing facilities are available, staff should change into and out of uniform at work. In any case, staff should avoid undertaking activities in public, such as shopping, whilst wearing their uniform, except where such activities form an integral part of their duties.

• Appropriate steps should be taken to minimise the risks of infections and cross contamination for patients and the public:

For example: staff should wear short-sleeved shirts/blouses and avoid wearing white coats or neck ties when providing patient care.

Staff should not wear false nails or hand or wrist jewellery (other than a plain wedding ring or one other plain band) when providing patient care.

• All appropriate health and safety requirements for staff should be met:

For example: Staff should not wear excessive jewellery, such as necklaces, visible piercings and multiple earrings.

Staff should wear soft-soled, closed toe shoes.

Staff should not carry pens or scissors in outside breast pockets.

• Be sensitive to the social, cultural and diversity and equality needs of staff and patients:

For example: tattoos which could be deemed offensive should be covered where this does not compromise good clinical practice.’

Whatever is the prescribed code in your workplace, as a healthcare worker, your clothing should clearly conform to health and safety standards. In some organisations, breaching the code could lead to disciplinary action.

Cleanliness and Hygiene

Conduct

• Do not interrupt the clinician when they are talking to the patient.

• Ensure any conversation with the clinician includes the patient.

• Do not take personal mobile phone messages in the clinical area.

• Do not discuss other patients or people.

• Do not discuss patients’ details outside the surgery as they are confidential.

• Do not eat or drink in a clinical area but rather in another separate designated area for infection control and health and safety reasons.

• Do not chew gum in the workplace.

• Do not wear an iPod or other such device

• Do not carry out personal hygiene measures such as combing hair or blowing your nose in a clinical area.

Good Practice Points: Patient Care

• Know your patient.

• Act professionally at all times.

• Follow the prescribed dress code.

• Ensure personal hygiene.

• Keep the environment user friendly.

• Minimise hazards in the dental surgery.

The dental appointment

Aims of Healthcare

Healthcare aims to improve the health of patients but can itself carry risks.

Hazards of Healthcare

Dentistry is essentially very safe in healthy patients. Thus morbidity and mortality following dental procedures are even less excusable than when they follow, for example, more invasive surgery.

Terms to Learn

Morbidity: the state of being unwell or having a disease. Here, it means developing a condition or ill health becoming worse after a dental or medical procedure.

Mortality: a term that pertains to death. Here it means a patient dying as a result of a dental procedure.

Drugs, particularly those that act on the central nervous system (CNS; e.g. sedatives and anaesthetic agents) are potentially dangerous and must be carefully administered. Most dental procedures can be carried out under local anaesthesia (LA, sometimes called local analgesia) with minimal morbidity. Conscious sedation (CS) is not as safe as LA alone. CS must be carried out:

• In appropriate facilities

• By adequately trained personnel

• With due consideration of the possible risks.

General anaesthesia (GA) with intravenous or inhalational agents is only permitted in a hospital with appropriate resuscitation facilities. It is not often needed for dental treatment, and then only in a hospital setting: because of its potential dangers it must be carried out by a qualified anaesthetist. CS is considerably safer, and is thus preferred.

Surgical procedures are generally the most hazardous. In the dental environment, operative procedures that involve use of LA and CS, and operative interventions such as drilling teeth and cutting tissues and bone are the main ones that can be hazardous.

Risks mainly happen when staff are overambitious in terms of their skill or knowledge, the patient is not healthy, inadequate time is taken and/or the procedure is invasive (tissues are disrupted).

Thus there is always a need for doing risk assessments and careful peri-operative care.

Term to Learn

Peri-operative: the term that covers the period of time starting from preparation for surgery up to the time the procedure is completed and the patient can go home safely.

Patient Care during Diagnosis

Risk assessment

An adequate risk assessment endeavours to anticipate and to prevent trouble. This topic was covered in the context of a medical emergency in Chapter 2. This chapter explains its relevance in day-to-day practice.

At the start of a patient’s visit it is essential to:

1. Assess patient’s needs

2. Obtain a careful medical, dental, family, social, (and sometimes developmental) history and make a risk assessment

3. Obtain patient’s consent to any investigations required

4. Obtain patient’s consent to agreed treatment plan.

A patient’s ‘fitness’ for a procedure depends on several factors (see Chapter 2, Box 2.1 and Table 2.1). Many patients with life-threatening diseases now survive as a result of advances in surgical and medical care. Such diseases can significantly affect the dental management of the patient. A patient attending for dental treatment and apparently ‘fit’ may actually have a serious systemic disease. Or they may be taking drugs (including recreational drugs). Both of these might influence the healthcare that can be delivered to the patient.

Term to Learn

Systemic: a condition that affects a system or the whole body as opposed to a distinct local site.

The risk is greatest when surgery is needed, and when GA or sedation is given. In addition, problems may be compounded if medical support is not at hand.

Key Point

No interventional procedure is entirely free from risk but care can be improved by making an adequate assessment based on history, clinical signs and, where appropriate, investigations, and minimising trauma and stress to the patient.