Aims & Objectives
- Readers will learn about the risk of the spread of infections in practice
- Readers will learn about maintaining a safe working environment
- Readers will learn about effective cleaning processes
- Readers will understand the risk of the spread of infections in practice
- Readers will understand how to maintain a safe working environment
- Readers will understand practice cleaning processes
The majority of patients visiting a dental practice are blissfully unaware of the rigorous infection control and decontamination measures taking place behind the scenes to ensure their safe treatment. Visiting the dentist is rarely high on the list of ‘favourite days out’ and they just want to be seen with the minimum of fuss in a clean and welcoming environment.
Stringent infection control procedures are now an integral part of dentistry thanks in the main to the introduction of HTM 01-05 and other local infection control regulations. They are designed to help prevent the spread of infection between staff and patients, either directly or indirectly via instruments, surgery equipment and surfaces. All practice owners now have a duty of care to ensure any risk of infection is kept to an absolute minimum.
Risk of infection is real
Anyone visiting or working in a dental practice can potentially be carrying an undiagnosed infection or be at risk of acquiring an infection if hygiene standards are not met. In many ways the dental team are at more risk of exposure to pathogens due to the number of patients they see on a daily basis and their regular exposure to bodily fluids such as blood and saliva on contaminated dental instruments.
Surfaces within the practice can easily become contaminated during routine patient treatment. This can occur as a result of the spray of oral fluids generated by conventional high-speed handpieces and air-water syringes or when surfaces are touched with contaminated surgical gloves. Another major cause of contamination is hand to surface/hand to patient contact, whereby patients attending with a cold, for example, can easily pass on the virus by hands touching surfaces such as the reception desk or door handles, posing a potential infection risk to the next person who touches them.
Hand hygiene is one of the simplest but most effective measure for reducing the risk of infection transmission during patient care and is an essential part of a practice’s infection control policy. All staff should be provided with and encouraged to use compliant and high-quality hand hygiene products that reach British and European standards to provide both staff and patients with the best possible protection from potential infection risk.
Within the dental practice both cleaning and disinfection processes are required to maintain a safe working environment. Cleaning involves the physical removal of soiling matter from surfaces whilst disinfection refers to the inactivation of pathogens. It is important that cleaning takes place before disinfection to ensure bacteria, proteins and other contaminants are removed from surfaces. This is particularly important where the disinfecting agent is alcohol, a substance that is known to ‘fix’ protein and biofilm.
HTM 01-05 underlines this problem in Section 6.75: “The use of disinfectant or detergent will reduce contamination on surfaces. If there is obvious blood contamination the presence of protein will compromise the efficacy of alcohol-based wipes. Note: Alcohol has been shown to bind blood and protein to stainless steel. The use of alcohol with dental instruments should therefore be avoided.”
(A demonstration of how alcohol-based products may fix protein and biofilm to surfaces can be viewed here)
Maintaining a safe environment
Clinical contact surfaces that surround the dental chair must be cleaned and disinfected between patients as specified in HTM 01-05 Section 6.62 including:
• local work surfaces
• dental chairs
• curing lamps
• inspection lights and handles
• hand controls including replacement of covers
• trolley/delivery units
• X-ray units
Areas and items of equipment that should be cleaned after every session include taps, drainage points, splashbacks and sinks while other exposed surfaces and floors, including those away from the dental chair, should be cleaned daily.
It is recommended that work surfaces should be cleaned with a wide spectrum, microbiocidal wipe or spray which meets all the needs of the practice in a single product:
• Removes soiling and disinfects in a single process
• Alcohol free
• Effective against mycobacteria, fungi, yeast and enveloped viruses such as HIV, HBV, HCV and TB
• Compatible with a broad range of surgery materials
• HTM 01-05 compliant
For use on medical device surfaces, these cleaning and disinfection products should also conform to the requirements of the Medical Device Directive 93/42/EEC.
Infection control procedures must be effective on a number of levels including their cleaning and disinfection properties, material compatibility and cost-effectiveness. Staff must also receive comprehensive training in every aspect of infection prevention in dental practices, undergoing regular training updates when new guidance or revised procedures are introduced.
As the risk of surgery-acquired infections remains, all members of the dental team must be aware of the procedures required to prevent transmission of infection and employers have a duty of care to both staff and patients to take the necessary steps to maintain a safe and effective working environment.