Reducing the risks

Aims & Objectives

  • To teach readers the risks of inadequate infection control procedures in a dental practice
  • To teach readers how infection can easily spread, especially via surface transmission, and pass infection to dental staff and patients, with potentially serious consequences
  • To teach readers about ways of managing the risk and ensuring a compliant and safe environment is maintained

Learning Outcomes

  • Readers will understand the risks of inadequate infection procedures in a dental practice
  • Readers will understand the ways in which infection can easily spread, especially via surface transmission, thus passing infection to dental staff and patients, with potentially serious consequences
  • Readers will have learnt about ways of managing the risk and of maintaining a compliant and safe environment

The majority of patients visiting a dental practice just want to have their treatment with the minimum of fuss in a clean and welcoming environment. What they generally don’t see is what goes on behind the scenes and the responsibility the dental team has, to ensure a compliant and safe environment covering health and safety legislation and infection control best practice.

Stringent infection control procedures have been an integral part of dentistry for well over a decade, and help to prevent the spread of infection between staff and patients, either directly or indirectly via equipment, instruments and surfaces. All practice owners now have a responsibility to ensure that any risk of infection is minimised.

What are the risks?

Any patient visiting a dental surgery could potentially be carrying an undiagnosed infection or be at risk of acquiring an infection if proper hygiene standards are not maintained. It can also be argued that practice staff are more at risk of infections due to the number of patients they see on a daily basis and their regular and extended exposure to bodily fluids such as blood and saliva.

The very nature of dental procedures means members of the dental team can come into direct contact with pathogens, especially those found in blood and saliva. Amongst the most serious of these are blood-borne viruses that cause HIV, hepatitis B and hepatitis C and can be readily transmitted from an infected patient to the dental worker via accidental punctures to the skin from blood-contaminated needles, scalpels or other sharps. This puts health care workers at particular risk, and although there is currently no vaccination against Hepatitis C, it is essential that all dental professionals should be vaccinated against hepatitis B as a first line of defence.

Surface transmission

Recent research in microbiology has shown that many micro-organisms can survive outside the body on a variety of surfaces, making the danger of disease transmission from contaminated surgery surfaces a serious concern. The biggest potential infection route within a practice is hand to surface/hand to patient contact. A patient attending with a cold, for example, can easily spread the virus by hand onto surfaces such as the reception desk or door handles, posing a potential infection risk to the next person who touches them.

Seasonal infections such as influenza and norovirus are easily spread within the dental practice environment. This winter has seen particularly high numbers of flu cases with around 5,000 people admitted to hospital with flu in the first week of January alone . Norovirus is highly contagious and can survive several days on surfaces or objects touched
by an infected person. Every year in the UK it’s estimated that between 600,000 and 1 million people catch norovirus which underlines the need for scrupulous hand hygiene and surface cleaning with appropriate cleaning agents.

Surfaces within the practice can easily become contaminated during patient treatment. This can occur as a result of spray and splatter of oral fluids from conventional high-speed handpieces and rotary instruments or when a member of the team touches the surface with contaminated gloves. These surfaces include headrests, X-ray equipment, light handles, control panels and reusable instruments such as handpieces and ultrasonic scaler heads. An effective way to protect contact surfaces such as these is to use dedicated plastic barrier products. Because barriers themselves can then become contaminated, they should be removed, discarded and replaced after each patient.

Clinical contact surfaces local to the dental chair that are not protected by a plastic barrier must be cleaned and disinfected between patients as specified in HTM 01-05 Section 6.62. These include:

  • local work surfaces
  • dental chairs
  • curing lamps
  • inspection lights and handles
  • hand controls including replacement of covers
  • trolley/delivery units
  • spittoons
  • aspirators
  • X-ray units

Areas and items of equipment that need to be cleaned after each session include taps, drainage points, splashbacks and sinks. In addition, cupboard doors, other exposed surfaces and floors, including those away from the dental chair, should be cleaned daily.

Much attention is given to the cleaning, packing and sterilisation of dental instruments. However, care must be taken after the sterilisation cycle is complete to ensure that sterile instruments are not re-contaminated from dirty surfaces or contaminated gloves.

Managing the risks

It is recommended that work surfaces should be cleaned with a wide spectrum, microbiocidal wipe or spray which has proven efficacy against mycobacteria, fungi, yeast and enveloped viruses such as HIV, HBV, HCV and TB. 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 and be HTM 01-05 compliant.

Staff exposed to any risk of cross-infection 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 prevent cross-infection within the practice.