Policy for the Control of Infection in the Dental Surgery and Decontamination Room

Transcription

1 Policy for the Control of Infection in the Dental Surgery and Decontamination Room Author: Responsible Lead Executive Director: Endorsing Body: Governance or Assurance Committee Infection Prevention & Control Team Irene Barkby - Executive Director of NMAHPs LICC Implementation Date: December 205 Version Number: V3.2 Review Date: December 207 Responsible Person Healthcare Quality & Assurance Committee Emer Shepherd Head of Infection Prevention & Control/Mike Devine, Director of Public Dental Services Version No.3.2 December 205 Page of 48

2 CONTENTS i) Consultation and Distribution Record ii) Change Record. INTRODUCTION 2. AIM, PURPOSE AND OUTCOMES 3. SCOPE 3. Who is the Policy Intended to Benefit or Affect 3.2 Who are the Stakeholders 4. PRINCIPLE CONTENT 4. Safe working Place 4.2 Hand Protection 4.3 Eye Protection, Face Masks and Aprons 4.4 Aerosol and Saliva Blood Spatter 4.5 Zoning in the dental surgery and decontamination room 4.6 Surface cleaning and disinfection in the dental surgery 4.7 Single-use items, single-patient-use and wrapped items 4.7. Single-Use items and Single-Patient-Use Items Wrapped Items 4.8 Instrument decontamination 4.8. General Local Decontamination Units General- Decontamination in the Dental Surgery General Central Decontamination Providers 4.9 Definitions 4.0 Pre-cleaning 4.0. Manual Pre-Cleaning To Pre-Clean Dental Instruments 4.Cleaning dental instruments 4.. Ultrasonic Cleaning 4..2 Ultrasonic Cleaning Procedure 4..3 Manual Pre-Cleaning and Ultrasonic Cleaning 4.2 Washer Disinfectors 4.2. Five Stages of the WD What instruments go through the WD How to load a WD 4.3 Inspection of dental instrument 4.3. Inspection and Care of Instruments before Sterilizing Version No.3.2 December 205 Page 2 of 48

3 4.3.2 Inspection for Cleanliness Functional Inspection 4.4 lubrication of dental instruments 4.4. Lubrication Hand piece Care 4.5 Storage of contaminated instruments 4.5. Storage of used/contaminated instrument during the working day until they are able to be taken to the decontamination room for processing 4.6 Storage of contaminated instruments overnight (Monday to Thursday) 4.6. Storage of contaminated instruments over weekends, Public Holidays or days when the clinic is not operational the next working day 4.7 Protocol for leaving contaminated instruments unprocessed overnight 4.7. Monday to Thursday if clinic operational next day Over the weekend or if the clinic is not operational the next day 4.8 Sterilisation (unwrapped instruments) 4.8. Autoclaves basic working principles and loading Testing of Autoclaves 4.9 Decontamination process when treatment is carried out, out with the dental surgery 4.20 Storage of sterile dental instruments 4.2 Decontamination of equipment prior to inspection, service or repair 4.22 Spillage 4.23 Waste disposal 4.24 Accidental exposure to blood or body fluids 5 APPENDIX STANDARD OPERATING PROCEDURES 6 APPENDIX 2 CLEANING SCHEDULES 7. RESOURCE IMPLICATIONS 8. COMMUNICATION PLAN 9. QUALITY IMPROVEMENT MONITORING AND REVIEW 0. EQUALITY AND DIVERSITY IMPACT ASSESSMENT. EVIDENCE BASE 2. ABBREVIATIONS Version No.3.2 December 205 Page 3 of 48

4 CONSULTATION AND DISTRIBUTION RECORD Contributing Author / Authors Consultation Process / Stakeholders: Infection Prevention and Control Team Infection Prevention and Control Team Health Protection Team Director of Public Dental Services Microbiologists Infection Control Doctor Lead Antimicrobial Pharmacist Chief Nurses Chief Medics Distribution: Available to NHS Lanarkshire staff via Firstport CHANGE RECORD Date Author Change Version No. 0/06/205 Infection Prevention and Control Team Revision of Policy for the Control of Infection in the Dental Surgery and Decontamination Room V3. 03/2/205 Infection Prevention and Control Team Revision of Policy for the Control of Infection in the Dental Surgery and Decontamination Room V3.2 Version No.3.2 December 205 Page 4 of 48

5 . INTRODUCTION Infection control is an important aspect of clinical practice for all health care workers and the guidance contained in the other sections of this manual applies equally to dentistry. It is recognised, however, that additional guidance is required to cover specific dentistry related issues. This section, therefore, deals with these and refers the reader to generic guidance where appropriate. All staff (including new staff) should be aware of infection control procedures and understand why they are necessary, be appropriately qualified and able to demonstrate competency before working in the surgery. In any case where competency cannot be proven appropriate training must be provided. In addition, all staff carrying out decontamination processes should have a formally documented training needs assessment and a record of training received as part of the Glennie report (200) 2. AIM, PURPOSE AND OUTCOMES The Purpose of this policy is to ensure that systems are in place to prevent and control infection and communicable disease within the dental surgery environment by underpinning national polices. It outlines the criteria, responsibilities and systems required within dental services to manage specific conditions/infections. The policy aims to: Protect patients, staff and the public by effective prevention and control of infection and communicable disease. The outcome will be a consistent approach across Dental surgery environments to ensure safe and supportive practice to prevent the spread of infection. 3. SCOPE 3. Who is the Policy Intended to Benefit or Affect This policy will be of benefit to: Patients-by effective prevention and control of infection and communicable disease Carers and Relatives - by having a level of reassurance that interventions will be employed as appropriate to reduce the risk of harm to patients in receipt of dental care and treatment Staff - by having clear guidance and direction through a standardised policy Organisation - by having clear guidance and direction through a standardised policy 3.2. Who are the Stakeholders Patients, Carers and relatives and all staff involved in the treatment of those in the dental surgery and those responsible for the decontamination of equipment within the decontamination rooms. Version No.3.2 December 205 Page 5 of 48

6 4. PRINCIPLE CONTENT 4. Safe working Place A wide variety of micro-organisms may be present in the saliva, body fluids, vomit and blood of patients. During dental treatment infection may be transmitted through direct contact, trauma, bites, droplets, aerosols or inoculation by contaminated instruments. Most carriers of infection, including, blood borne viruses (BBV), are unaware of their condition and therefore it is important that the same control of infection practice is adopted for all patients. Standard Infection Control Precautions must be observed at all times as this ensures a safe approach for all. Refer to Chapter and 2: Standard Infection Control Precautions of the Control of Infection Manual. 4.2 Hand Protection Cover all cuts and abrasions with a waterproof plaster Non-sterile Nitrile gloves should be worn by all clinical staff during all clinical procedures (invasive and non invasive) Gloves should be worn for as short a time as possible and a new set of gloves after every patient. Gloves must be removed before leaving clinical area Used gloves should be disposed of as clinical waste. Perform hand hygiene before and after removing gloves Alcohol hand rubs may be used (on hands that are not contaminated with blood or saliva) where hand washing facilities are not readily available Moisturising hand creams (should) can be used to counteract dryness 4.3 Eye Protection, Face Masks and Aprons Eye protection must always be provided for patients. All clinical staff must use eye protection, disposable masks and eye protection during all operative procedures. Eye protection, masks, aprons and gloves must be removed before leaving the surgery or decontamination room. 4.4 Aerosol and Saliva Blood Spatter Many common infectious diseases are readily spread via aerosols e.g., chickenpox and influenza. There is no evidence that blood-borne viruses can be spread by aerosols but they may be spread by blood spatter. The risk of transmission of infection by these routes will be reduced if: There is good surgery ventilation and efficient high speed aspirators which exhaust externally from the premises Aspirators and tubing are regularly cleaned and disinfected in accordance with the manufacturer s instructions and flushed through daily with their recommended non-foaming disinfecting agent. Rubber dam isolation is used whenever practicable. Version No.3.2 December 205 Page 6 of 48

7 Appropriate personal protective equipment (PPE) is used Flushing hand pieces with water before use to clear water lines 4.5 Zoning in the dental surgery and decontamination room To facilitate cleaning, the design and layout of the dental surgery and decontamination room should be kept simple and in general the environment should be kept uncluttered. All surfaces should be smooth, impervious, washable and able to withstand chemical disinfectants. A zoning system should be utilised with clean and dirty areas clearly defined and clean-to-dirty work flow maintained. 4.6 Surface cleaning and disinfection in the dental surgery The areas which may be contaminated during operative procedures should be cleaned between patient using detergent wipes as well as alcohol wipes and or Chlorine releasing solution. All work surfaces, including those apparently uncontaminated, aspirators, drains and spittoons should be thoroughly cleaned after each patient. 4.7 Single-use items, single-patient-use and wrapped items 4.7. Single-Use items and Single-Patient-Use Items Items designated as single use must never be re-used This symbol indicates Single-Use There is no symbol for Single-Patient Use instructions for this are given on the packaging Wrapped Items Before using any equipment check the manufacturer s instructions regarding reprocessing Ensure your hands are clean before opening or using any medical equipment. Check the wrapper and identify the markings on the medical device. Check the expiry date has not passed, if the date has passed, DO NOT USE Version No.3.2 December 205 Page 7 of 48

8 Check the wrapping is intact, if not intact, DO NOT USE. Check there is no staining on the wrapper or indication that it has been wet after sterilisation, if staining is present, DO NOT USE Prior to use, packaging must be checked for single-use markings and decontamination instructions. Items marked Single-Use must only be used once on one patient and discarded as clinical waste. Local anaesthetic needles must always be disposed of or made safe for disposal by the clinician. Refer to Management of Occupational and Non-Occupational Exposures to Blood borne Viruses including needle stick injuries and sexual exposures Policy. Part-used local anaesthetic cartridges must be disposed of after each patient, they must never be used on a second patient Use disposable items including: burs, scalpels, aspirator tips, 3 in tips, saliva ejectors, matrix bands, impression trays and beakers, whenever possible. Dispose safely in accordance with guidance. Refer to Management of Occupational and Non-Occupational Exposures to Blood borne Viruses including needle stick injuries and sexual exposures Policy. 4.8 Instrument decontamination 4.8. General Local Decontamination Units Decontamination of dental instruments where practicable should be carried out in a Local Decontamination Unit (LDU), The LDU should be a dedicated room designed and equipped for the purpose and be located close to the dental surgery. Contaminated dental instrument must be placed in an approved, clean, rigid, leakproof labelled and secure transit container with a tight fitting lid. This container should be stored safely until taken to the LDU. Ideally, clean these containers in a washer-disinfector (WD). If this is not possible, clean containers with a fresh detergent solution, rinse and dry. Do not use bleach or hypochlorite solution because residues might damage the instruments. The LDUs are designed to facilitate a dirty-to clean one way workflow throughout the decontamination process General- Decontamination in the Dental Surgery In exceptional circumstances decontamination of dental instruments can take place in the surgery in the absence of patients (Temporal Separation). Temporal separation means using the same area for two separate activities at different times. If, through lack of space, a work surface is used for both dirty Version No.3.2 December 205 Page 8 of 48

9 and clean instruments, ensure that the surface is thoroughly cleaned, and if necessary disinfected, between the two activities to avoid recontamination of cleaned instruments General Central Decontamination Providers If decontamination of dental instruments is carried out by a Central Sterilisation Service Provider then contaminated dental instrument must be placed in an approved, clean, rigid, leak-proof, appropriately labelled and secure transit container with a tight fitting lid. This container should be stored safely until collection. 4.9 Definitions Decontamination The combination of processes, including cleaning, disinfection and/or sterilisation, used to render a reusable item safe for further use. Cleaning Physically removes contaminants including dust, soil, large numbers of microorganisms and the organic matter that protects them. Disinfection Reduces the number of micro-organisms to a safe (or relatively) safe level. Bacterial spores are not usually destroyed Sterilisation Removes or destroys all known micro-organisms including bacterial spores 4.0 Pre-cleaning The first and most important stage of the decontamination process is pre-cleaning. Prior to sterilisation of instruments it is essential to remove all physical contamination such as blood, tissue or saliva. Residual blood or other adherent material, if not removed, may become fixed and shield micro-organisms which could then survive the decontamination process. Pre-cleaning must be carried out in the dirty area. For more details on pre-cleaning Procedures please refer to section 3 in the Scottish Dental Clinical Effectiveness Programme (SDCEP) document Cleaning of Dental Instruments, Dental Clinical Guidance (October 204) - see page 48. If pre-cleaning of dental instruments is required it must be carried out wearing appropriate Personal Protective Equipment (PPE) e.g. disposable aprons, heavy duty gloves, face mask and eye protection). Heavy duty gloves must be washed with detergent and hot water to remove visible soil and dried after each use. Prior to cleaning segregate re-usable instruments to be cleaned from items for disposal according to their category Some instruments will require dismantling, according to their manufacturer s instructions for cleaning 4.0. Manual Pre-Cleaning Removal of cements and hard setting materials from instruments Version No.3.2 December 205 Page 9 of 48

10 Cement should be removed at chair side by the dental nurse before it has fully set using either of the following options: Wiping the head of the instrument as it is held out and held steady by the dentist Taking the instrument from the dentist and wiping it Set cement can be removed in either the surgery once the patient has left or in the decontamination room. Set cement can be removed by holding the instrument under water (not running water) in a designated dirty sink and using a spatula to scrape away the cement Full PPE must be worn (e.g. heavy duty gloves, plastic apron and eye protection) To Pre-Clean Dental Instruments Place the instruments in a basket (ultrasonic basket) Place the basket in the dirty sink. Agitate the instruments under water (detergent is not required) using a long handled brush (do not pre-clean instruments under running water). Rinse instruments thoroughly with clean water and check instruments are free from visible residual debris. If debris is still visible on instruments repeat bullet points Cleaning dental instruments 4.. Ultrasonic Cleaning Ultrasonic cleaning in a fully functioning machine enhances removal of debris, thereby reducing the need for scrubbing instruments. Thus, although a WD is preferred an ultrasonic cleaner can be used as a cleaning method, particularly for instruments with hinges and/or intricate parts. Do not use ultrasonic cleaners to clean dental hand pieces Ultrasonic Cleaning Procedure Always use detergents specified by the manufacturer as suitable for the intended use. For manual and ultrasonic cleaning, use low-foaming neutral detergents dispensed in a measured dose in a measured volume of water. A neutral detergent is regarded as one that has a ph within the approximate range of ph 5 9 when diluted in accordance with the manufacturer s in-use specification. Version No.3.2 December 205 Page 0 of 48

11 Run the ultrasonic cleaner while filled with the water detergent solution but without a load for the manufacturer s specified time to de-gas the solution on start up and on subsequent re-fillings; If instruments are particularly heavily soiled, briefly immerse them in cold water in the washing sink to remove some of the blood and other visible soil before ultrasonic cleaning. Follow the manufacturer s recommendations for the safe operating procedure of your ultrasonic cleaner Ensure that instruments with joints or hinges are opened fully and instruments that need taking apart are fully disassembled before they are immersed in the solution. Place instruments in a suspended basket and fully immerse in the cleaning solution ensuring that all surfaces are in contact with the solution. Do not overload the basket or overlap instruments because this results in poor cleaning and can cause wear to the instruments. Set the timer to the correct setting as per the ultrasonic cleaner manufacturer s instructions. Close the lid and do not open until the cycle is complete. After the cycle is complete, drain the basket of instruments before rinsing. Change the solution when it becomes visibly contaminated or otherwise every 4 hours because the build-up of debris will reduce the effectiveness of cleaning. Drain, clean with a neutral detergent solution, rinse and dry the cleaner when not in use (e.g. overnight). After ultrasonic cleaning, rinse instruments thoroughly to remove residual soil and detergents by immersing clean instruments in clean water in a separate sink or basin dedicated for rinsing clean instruments. It is acceptable to use freshly drawn soft tap water for rinsing instruments. Instruments must not be allowed to air dry as inadequate drying might enable moisture to be trapped, promoting corrosion and/or microbial growth. Use disposable, non-linting towels to dry instruments immediately after rinsing Inspect instruments for cleanliness 4..3 Manual Pre-Cleaning and Ultrasonic Cleaning Always use detergents specified by the manufacturer as suitable for the intended use. For manual and ultrasonic cleaning, use low-foaming neutral detergents dispensed in a measured dose in a measured volume of water. A neutral detergent Version No.3.2 December 205 Page of 48

12 is regarded as one that has a ph within the approximate range of ph 5 9 when diluted in accordance with the manufacturer s in-use specification. 4.2 Washer Disinfectors Using a washer-disinfector (WD) is the preferred method for cleaning dental instruments because it offers the best option for the control and reproducibility of cleaning, and the cleaning process can be validated. WDs are used to carry out the processes of cleaning and disinfection consecutively. A typical WD cycle for instruments has five stages Five Stages of the WD. Flush Removes difficult gross contamination, including blood, tissue debris, bone fragments and other fluid and solid debris. Latest standards indicate that a water temperature of <45 C is used to prevent protein coagulation and fixing of soil to the instrument. 2. Wash Removes any remaining soil. Mechanical and chemical processes loosen and break up contamination adhering to the instrument surface. Use only approved detergents. 3. Rinse Removes detergent used during the cleaning process. This stage can contain several sub stages. 4. Thermal disinfection The temperature of the load is raised and held at the pre-set disinfection temperature for the required disinfection holding time: for example, 80 C for 0 minutes, or 90 C for minute 5. Drying Purges the load and chamber with heated air to remove residual moisture What instruments go through the WD Clean all instruments that are able to be immersed in water in a WD if available, except where stated otherwise in the manufacturers instructions For details of all operational aspects of using a WD follow the manufacturer s instructions. Clean all instruments that are able to be immersed in water in a WD except where stated otherwise in the manufacturers instructions How to load a WD Dental instruments must not be placed into the automated WD unless they are clear to the naked eye of all visible debris. It is crucial to load a WD correctly because incorrectly loaded instruments will not be cleaned effectively. Therefore, follow these principles when loading a WD: Do not overload instrument trays or overlap instruments Version No.3.2 December 205 Page 2 of 48

13 Open instrument hinges and joints fully; Do not attach hand pieces to the irrigation system - simply lay hand pieces flat on the tray All the parts of an instrument that requires dismantling, according to their manufacturer s instructions, for cleaning should be placed separately in the WD After cleaning in a WD inspect instruments for cleanliness and check functionality e.g. smooth opening of hinges 4.3 Inspection of dental instrument 4.3. Inspection and Care of Instruments before Sterilizing Inspect all instruments that have been through any cleaning procedure, including processing by a WD to ensure they are clean, functional and in good condition. An illuminated magnifier while not essential is recommended because it makes it much easier to see residual contamination, debris or damage Inspection for Cleanliness Inspect instruments for any visible soiling such as blood or lining materials. It is especially important to check joints, hinges or the serrated surfaces of jaws, which are difficult to clean. If there is any residual contamination, reject the instrument and ensure it undergoes another cycle of the cleaning process Functional Inspection Check all instruments that have been through any cleaning procedure, including processing by a WD, to ensure that they are in good working order. Dispose of instruments that are blunt, bent or damaged or show any signs of pitting or other forms of corrosion. 4.4 Lubrication of dental instruments 4.4. Lubrication Lubricate the joints and hinges of instruments before sterilizing to prevent seizing and corrosion. The lubricant used for this purpose must be permeable to steam, water soluble and suitable for sterilisation. Follow manufacturers recommendations Hand piece Care Lubricate hand pieces according to the manufacturer s instructions. Version No.3.2 December 205 Page 3 of 48

14 Those that have been processed in a WD might have had the lubricant removed and require lubrication again, using Canister, before going into the sterilizer. Note another canister, (canister 2), for use with hand pieces after sterilization might be required if the manufacturer recommends it. Inadequate lubrication of hand pieces can lead to unnecessary damage of the internal mechanism of hand pieces. The cleaning process is now complete and the dry instruments are ready for sterilisation 4.5 Storage of contaminated instruments Preferably, fully decontaminate instruments as soon as possible after use. However, decontamination will often be carried out towards the end of a treatment session Storage of used/contaminated instrument during the working day until they are able to be taken to the decontamination room for processing Contaminated dental instrument must be placed in an approved, clean, rigid, leak-proof labelled and secure transit container with a tight fitting lid. This container should be stored safely in an appropriate container clearly marked as containing contaminated instruments. 4.6 Storage of contaminated instruments overnight (Monday to Thursday) On the few occasions when the dental staff members do not have time to complete the full decontamination of instruments at the end of a working day the following procedure should be followed: Pre-clean if necessary Place instruments in washer/disinfector switch on, run the cycle & leave overnight Continue the reprocessing of the dental instruments the next working day by reprocessing these instruments through the complete decontamination process starting with cleaning because micro-organisms can accumulate during storage Storage of contaminated instruments over weekends, Public Holidays or days when the clinic is not operational the next working day On the few occasions when the dental staff members do not have time to complete the full decontamination of instruments at the end of a working week the following procedure should be followed: Pre-clean and dry instruments at end of clinical session. Place in red box and clearly mark contaminated instruments Version No.3.2 December 205 Page 4 of 48

15 Continue the reprocessing of the dental instruments the next working day by reprocessing these instruments through the complete decontamination process starting with cleaning because micro-organisms can accumulate during storage 4.7 Protocol for leaving contaminated instruments unprocessed overnight 4.7. Monday to Thursday if clinic operational next day Pre-clean instruments if necessary Place instruments in washer disinfector and run cycle leaving overnight Continue reprocessing the dental instruments the following morning as per decontamination process Over the weekend or if the clinic is not operational the next day Pre-clean instruments if necessary Place instruments in the ultrasonic bath and run cycle Remove instruments and rinse Dry instruments Put instruments in washer disinfector trays and store in red box Clearly mark DIRTY INSTRUMENTS and date Continue reprocessing the dental instruments on the first working day as per decontamination process 4.8 Sterilisation (unwrapped instruments) 4.8. Autoclaves basic working principles and loading Before being sterilised, all used instruments must be thoroughly cleaned. Steam under pressure in an autoclave is the method of choice for the sterilisation of all dental instruments. Steam sterilisation is dependent on direct contact between the load material and saturated steam under pressure, in the absence of air. The highest temperature of 34 o C with a minimum holding time 3 minutes is recommended wherever possible. The majority of bench top autoclaves currently in use achieve the above conditions by heating sterile water within the chamber to produce steam at the required pressure and temperature. Air is passively displaced from the chamber by the steam. This type of autoclave is for sterilising unwrapped instruments only, and no wrapping material or pouches should be used. They are also unsuitable for the sterilisation of narrow lumen instruments. All instruments should be placed in the autoclave so that there is free circulation of steam. Items such as bowls, which may retain air and condensate, should be supported within the autoclave chamber in a manner that will facilitate complete air removal and drainage of condensate. Autoclaves must not be overloaded and manufacturers loading instructions should be followed at all times. Version No.3.2 December 205 Page 5 of 48

16 Ensure that instruments with joints or hinges are opened fully and instruments that need taking apart are fully disassembled before they are placed in the autoclave. Used bottled sterile water and fill the reservoir to the maximum level at the start of each session and check the reservoir water level each time before the machine is used Testing of Autoclaves To ensure adequate performance, equipment must be maintained and tested regularly. A logbook must be kept for each autoclave. The logbook must contain results of routine monitoring, examinations, tests, faults, repairs user name etc, (see Section I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items) Sterilisation Temperature Bands, Holding Times and Pressure for Sterilisation with High Temperature Steam STERILISATION TEMPERATURE RANGE ( O C) Minimum Normal Maximum APPROX. PRESSURE (bar) MINIMUM HOLD TIME (min) Decontamination process when treatment is carried out, out with the dental surgery Domiciliary Visits and National Dental Inspection Programme Clean instruments may be transported to the place of care in either sealed sterilisation pouches or in a clean, sturdy transit container with a tight fitting lid. This container should be clearly marked as containing clean instruments Fluoride Varnish Application visits to Nursery and Primary Schools Disposable instruments should be transported to the place of care in their original packaging. Following use they must be placed in the appropriate clinical waste containers i.e. yellow bags or sharps containers and returned to base clinic or nearest Health Centre for disposal. Following treatment contaminated instruments must always be transported back to the Clinic in a sturdy, leak-proof, labelled transit container with a tight fitting lid for decontaminated in the appropriate manner. All waste must be segregated into clinical and domestic waste and taken back to the Clinic or Health Centre for disposal. Tooth brushing Programme in Nursery and Primary Schools no instruments used. All clinical waste i.e. gloves and old toothbrushes are disposed of on site in the appropriate waste bags which are provided and disposed of by each establishment visited. Version No.3.2 December 205 Page 6 of 48

17 4.20 Storage of sterile dental instruments All dental instruments must be cleaned and sterilised after use as detailed in Table Specific Items A-Z. They should be stored dry and protected from dust, splash or aerosol contamination in closed or covered trays or in sealed pouches then placed in closed cupboards or drawers To avoid inadvertent contamination, storage drawers or cupboards must be kept closed during procedures. TABLE SPECIFIC ITEMS ANAESTHETIC CARTRIDGES APPLIANCES PROSTHETIC/ ORTHODONTIC ASPIRATORS or TUBING BURS BRACKET TABLES CHAIR: HAND CONTROLS Single patient use only. Discard into appropriate sharps container. Treat as for impressions. Senior Dental Nurse will provide details of the approved product that should be used to decontaminate appliances and appliances under construction If gross contamination an ultrasonic bath containing a general purpose neutral detergent and water solution should be used for cleaning prior to rinsing and disinfection. Clean regularly according to manufacturer s instructions and flush through daily with their recommended non-foaming disinfecting agent. Steel burs and debonding burs: Disposable, clinician or dental nurse to discard into sharps container after single use. Tungsten Carbide, Diamond burs, Finishing burs and Stones: Pre-clean then sterilise in an autoclave after each patient use. Wash daily and between each patient using the appropriate detergent wipe followed by alcohol wipe. In the event of contamination, clean with appropriate detergent wipe and then wipe over with 70% isopropyl alcohol impregnated wipe. Clean daily and between each patient, before use, using the appropriate detergent wipes. CAVITRON HANDPIECES CAVITRON HEADS CURING LIGHT DRAINAGE SYSTEM Wipe over between use with appropriate detergent wipe and 70% isopropyl alcohol impregnated wipe. A sterile Cavitron head must be used for each patient. Pre-clean and autoclave after each use, or discard into sharps container if disposable. Cover tip when in use with a transparent impervious polythene cover. Wipe over after use with appropriate detergent wipe. Clean after every session, using cleaner recommended by manufacture, e.g., Orotol or MC 000. Version No.3.2 December 205 Page 7 of 48

18 HANDPIECES HEADRESTS A hand piece that has been fully decontaminated must be used for each patient: remove bur during cleaning to prevent contamination of hand piece bearing clean outside of hand piece with appropriate detergent wipe - do not immerse; do not use alcohol wipes place flat in Washer Disinfector for cleaning Before placing a handpiece in the autoclave lubricate the hand piece with pressurised oil, as recommended by the manufacturer, using canister until clean oil appears out of the chuck Clean/wipe off excess oil sterilise in autoclave lubricate hand piece after sterilisation, if recommended by manufacturer, using canister 2 run hand piece briefly before use to clear excess lubricant Each morning run water through the line for 2 minutes before use to clear the water line. If the unit has been out of operation for more than a few days, increase time to 5 minutes. Wipe over between patients with the appropriate detergent wipes and an alcohol wipes Version No.3.2 December 205 Page 8 of 48

19 IMPRESSIONS AND LAB WORK AT ALL STAGES Impressions and all lab work in general must be decontaminated before leaving the surgery. Immediately on removal from the mouth, rinse under running water until visibly clean to remove saliva, blood and debris - avoid splashing. Wear PPE. The responsibility for ensuring these devices have been cleaned and disinfected prior to dispatch to the laboratory lies solely with the dentist. However, the task is often delegated to the dental nurse. It is good practice to agree the cleaning and disinfection process with the laboratory and label the device to indicate disinfected status. This removes uncertainty and, for impressions, also removes the possibility of repeated disinfection, which may detract from quality. Immediately on removal from the mouth, the device should be rinsed under running water to remove saliva, blood and debris. Continue the process until it is visibly clean. The device should then be disinfected following the manufacturer's recommendations. Products that are suitable for the disinfection of impressions, prostheses or appliances are CE marked to demonstrate conformity to European Directives. The Senior Dental Nurses will advise on the products that should be used. See Section I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) There are two methods of disinfection: immersion and dipping. Immersion in disinfectant (following the manufacturer s recommendations for dilution and duration) can be effective but may be compromised by the limited working life of the disinfectant, which is affected by the frequency of use and the presence of biological debris. Dipping avoids the prolonged immersion that can distort hydrocolloid and polyether impression materials. The recommended contact time is still necessary, during which the impression must not be allowed to dry out. MATRIX BANDS MOUTHWASH CUPS NEEDLES OPERATING LIGHT SALIVA EJECTORS Following disinfection, the device must be thoroughly rinsed in water before packaging to send to the laboratory with a confirmation that it has been disinfected. Items received from a laboratory should also be disinfected. Disposable - discard into sharps box after single patient use. Disposable - discard after single patient use. Disposable clinician or dental nurse to discard into sharps containers after single patient use. Clean daily before use and after each patient with the appropriate detergent wipes and alcohol wipes. Use disposable or autoclave between patients. Version No.3.2 December 205 Page 9 of 48

20 SPITTOON SINKS SYRINGE 3-IN-ONE WORK SURFACES Clean using appropriate detergent wipes and alcohol wipes as often as required. Clean using appropriate detergent wipe, once a day or as often as required. Use disposable tips for each patient. Use disposable cover and discard after each patient. Each morning run for 2 minutes before use to clear the water line. If the unit has been out of operation for more than a few days, increase time to 5 minutes. Wipe over with appropriate detergent wipes and or chlorine releasing solution 4.2 Decontamination of equipment prior to inspection, service or repair Equipment and articles which have been contaminated by contact with blood or other body fluids must be rendered safe, and a statement confirming this completed, prior to examination by third parties (see Section I: Decontamination of Equipment and the Environment (including the use of single-use and single-patient use items, Control of Infection Manual) 4.22 Spillages Spillages of blood or body fluids must be cleaned up as soon as possible. In all surgeries items required to deal with spillages must be easily accessible, either as individual items or in the form of a spill pack Waste disposal The producers of waste are responsible for it until final disposal and must comply with the Duty of Care obligations in terms of the Environmental Protection Act 990. All waste must be segregated into clinical and domestic waste (see Section K: Guidelines for the Management of Healthcare Waste, Control of Infection Manual) 4.24 Accidental exposure to blood or body fluids If any member of staff sustains a significant injury* or contamination** involving exposure to blood or body fluids, first aid treatment should be carried out immediately (see below) and medical help sought - see Section G: Blood borne Virus Infection: Prevention, Control of Infection Manual. In the event of an incident each clinic should refer to their Response Pack and follow the guidance it contains The rapid management of the exposed person can make the difference between them becoming ill or remaining well Version No.3.2 December 205 Page 20 of 48

21 First Aid Action: Encourage wounds to bleed by gentle squeezing. DO NOT suck the area. Wash thoroughly with soap and warm running water, - DO NOT SCRUB the area Irrigate eye or mouth splashes thoroughly with water. Do not swallow mouth rinsing water Remove contact lenses, if worn, before irrigating eyes Open up the clinic response pack, complete the paperwork and follow the advice it contains e.g. Contact SALUS for further advice or during the Out of Hours period, contact nearest A&E Dept A significant injury is penetration of the skin by a needle or other sharp object that is, or is suspected to be, contaminated with another person s blood or body fluid, or when a human bite breaks the skin. ** A significant contamination is contact of broken skin, mucous membrane or eyes with another person s blood or body fluid Appendix STANDARD OPERATING PROCEDURES (SOPs) Version No.3.2 December 205 Page 2 of 48

22 . STANDARD OPERATING PROCEDURE SURGERY SET UP Power up the surgery Switch on the following items Dental compressor Computer, monitor all peripheral PC equipment SWITCH ON Suction motor Dental chair Dental operating light Amalgamator Curing light X-ray machine Any other electrical equipment that is used regularly in the surgery Clean the surgery CLEAN Wash hands in accordance with the Hand Hygiene Policy and put on fresh PPE Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for Dental Surgeries Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Fill water bottle on dental cart with sterile water Run through all lines on dental cart (do not attached hand pieces or 3 in tips during this flushing process) Remove PPE and wash hands in accordance with the Hand Hygiene Policy Set up for patient COVER & CHECK Put on fresh PPE Cover curing light tip when in use with a transparent impervious polythene sheath Check surgery has a sufficient supply of stock (materials, sundries and disposables) before session starts Check integrity and location of Emergency Equipment ( Emergency Drugs box, Emergency Oxygen Cylinder and Resuscitation Equipment Check that ceiling lights are working normally Version No.3.2 December 205 Page 22 of 48

23 Check surgery floor is clean and dry and no trip risks are present Remove PPE and wash hands in accordance with the Hand Hygiene Guidelines Dental staff should perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on PPE Once patient has been shown into the surgery SET OUT Hand pieces can be removed from bags and put onto couplings or motors Disposable single use items can be laid out or set up e.g. 3 in tip, aspirator tip, mouthwash cup, patient bibs, etc Local anaesthetic syringe can be set up and loaded Materials and instruments expected to be required should be looked out 2. STANDARD OPERATING PROCEDURE SURGERY CLEANING BETWEEN PATIENTS Dispose of all waste and sharps in the appropriate bags or containers in the surgery REMOVE Remove all items from the dental cart e.g. tray, instruments, hand pieces, 3 in tip, cotton wool rolls, gauze squares, etc Remove all materials and disposables including tray liner from the instrument tray. Remove, empty and dispose of mouthwash cup in the clinical waste orange bag Remove any disposable protective covers from items of equipment e.g. curing light covers, and dispose of in clinical waste orange bag Dispose of any nursing roll or patient protective bib in the clinical waste orange bag Remove and dispose of 3 in tips in clinical waste orange bag Remove and dispose of aspirator tips in clinical waste orange bags Place instruments and items to be decontaminated into an appropriate container used for transportation of 'dirty' instruments to the decontamination area/room Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines Take instruments in a container to the decontamination area/room Return to surgery Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Wipe clean and dry the following areas using a neutral detergent wipe followed by 70% isopropyl alcohol impregnated wipe All work surface including handles or controls touched by gloved hands or obviously contaminated during the procedure Delivery unit surface (bracket table and handle) WIPE Version No.3.2 December 205 Page 23 of 48

24 Wipe clean and dry the following areas using a neutral detergent wipe Delivery unit controls Couplings and motors Hand piece tubing Hand operated chair controls including those on nurse side of unit if present Spittoon and surfaces of aspirator unit Aspirator tubing Operating light handle (even if disposable cover used) Operating light lens cover Mouse Keyboard Amalgamator controls if used Curing light controls if used Cavitron controls if used Safe Air or gas burner controls if used Sink on Nurse side and taps if used X-ray head and X-ray control panel if used Eye protection for patients Eye protection for staff All dental chair upholstery including headrest (and chair arms Upholstery on Dentist and Dental Nurses stools Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines Set up for next patient COVER Put on fresh PPE Cover curing light tip when in use with a transparent impervious polythene sheath Remove PPE, dispose of in clinical waste orange bag and wash hands in accordance with the Hand Hygiene Guidelines Once patient has been shown into the surgery Dental staff should perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on PPE Instruments can be removed from bags and put onto trays Hand pieces can be removed from bags and put onto couplings or motors Disposable single use items can be laid out or set up e.g. 3 in tip, aspirator tip, mouthwash cup, patient bibs, etc Local anaesthetic syringe can be set up and loaded Materials and instruments expected to be required should be looked out SET OUT Version No.3.2 December 205 Page 24 of 48

25 3. STANDARD OPERATING PROCEDURE SURGERY SHUT DOWN Dispose of all waste and sharps in the appropriate bags or containers in the surgery REMOVE Remove all items from the dental cart e.g. tray, instruments, hand pieces, 3 in tip, cotton wool rolls, gauze squares, etc Remove all materials and disposables including tray liner from the instrument tray. Remove, empty and dispose of mouthwash cup in the clinical waste orange bag Remove any disposable protective covers from items of equipment e.g. curing light covers, and dispose of in clinical waste orange bag Dispose of any nursing roll or patient protective bib in the clinical waste orange bag Remove and dispose of 3 in tips in clinical waste orange bag Remove and dispose of aspirator tips in clinical waste orange bags Place instruments and items to be decontaminated into an appropriate container used for transportation of 'dirty' instruments to the decontamination area/room Put sharps bin, boxes of gloves and other items sitting on the work surface away into cupboards Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines Take instruments in a container to the decontamination area/room Clean the surgery Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Clean and disinfect the suction system by aspirating litre of non-corrosive, nonfoaming disinfectant into each aspirating tube Clean and disinfect the suction trap Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for Dental Surgeries Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove water bottle on dental cart, empty and leave overnight to dry Remove PPE, dispose of in clinical waste orange bag and wash hands in accordance with the Hand Hygiene Guidelines Seal clinical waste bags in accordance with the Guidelines for the Management of Health Care Waste tied off with a swan neck, taped and labelled with clinic initials and date. Store clinical waste bags in the locally agreed designated area for collection and disposal CLEAN Power down the surgery Switch off the following items Dental compressor Computer, monitor al all peripheral PC equipment - follow log off procedure Suction motor Dental chair but before switching off raise the chair Dental operating light SWITCH OFF Version No.3.2 December 205 Page 25 of 48

26 Amalgamator Curing light X-ray machine Any other electrical equipment that is used regularly in the surgery Surgery security and safety Place all paperwork containing patient identifiable information in a locked file or cupboard Ensure no materials or products are stored on the surgery floor Final check of work surface and equipment Ensure store cupboards, filing cabinets, compressor room, other rooms used by dental department, etc are locked Switch off surgery light Lock surgery SECURE 4. STANDARD OPERATING PROCEDURE DECONTAMINATION ROOM SET UP Power up the decontamination room Switch on the following items Lights Air exchange system Ultrasonic Bath if used that day Autoclave Washer disinfector SWITCH ON Clean the decontamination room Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Clean and dry 'dirty' boxes used for transportation of contaminated dental instruments Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for decontamination rooms Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines CLEAN Testing and monitoring Put on fresh PPE Fill Ultrasonic cleaner using approved detergent and fill with water to the maximum level Run the 'empty' test cycle for the Ultrasonic bath if it is to be used that day. Fill autoclave with bottled sterile water to the maximum level as marked n the reservoir Carry out the daily safety check for autoclaves as described in the Autoclave CHECK Version No.3.2 December 205 Page 26 of 48

27 Logbook Run the 'empty' test cycle for the autoclave and record the outcome in the Autoclave Log book Complete the Autoclave Logbook to record the outcome of the test cycle and the daily safety checks Ensure decontamination room is well stocked with required materials and supplies e.g. gloves, hand washing materials, wipes, sterilisation pouches, tray liners etc. Check decontamination room floor is clean and dry and no trip risks are present Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines 5. STANDARD OPERATING PROCEDURE DECONTAMINATION ROOM SHUT DOWN Clean the decontamination room Perform hand hygiene in accordance with the Hand Hygiene Guidelines and put on fresh PPE Wipe clean and dry all areas and items listed in the Daily Cleaning Schedule for decontamination rooms Remove all instruments from the ultrasonic cleaner Drain the ultrasonic cleaner if it has been used Remove all instruments from the autoclave Drain all water from the autoclave Complete daily log record for autoclave and ultrasonic bath Clean containers used for transporting 'dirty' instruments. If trolleys wipe with neutral detergent wipes. Dispose of all wipes used for cleaning and all nursing roll used for drying in the clinical waste orange bag Seal clinical waste bags in accordance with guidance contained within the Policy for the Management of Health Care Waste tied off with a swan neck, taped and labelled with clinic initials and date. Store clinical waste bags in the locally agreed designated area for collection and disposal Remove PPE, dispose of in clinical waste orange bag and perform hand hygiene in accordance with the Hand Hygiene Guidelines CLEAN Power down the decontamination room Switch off the following items: Washer disinfector Air exchange system Ultrasonic Bath Autoclave Lights Lock decontamination room door and return key to safe storage SWITCH OFF Version No.3.2 December 205 Page 27 of 48