discuss how to Prevent and Reduce Cross-Contamination and cCross infection within Dental Surgery: Infection Prevention and Control Assignment, UCC, Ireland

National Dental Nurse Training Programme Of Ireland 2020/21

Infection Prevention and Control and Health and Safety in the Dental Surgery

Table of Content

1. Introduction

2. Health and Safety in the Dental Surgery

3. Infection Prevention and Control in the Dental Surgery

4. Waste Disposal

5. Conclusion

Introduction

In this assignment, I will discuss how to prevent and reduce cross-contamination and cross infection within Dental Surgery. A Dental nurse has a significant role in managing infection prevention and control (IPC), as well as following safety policy in Dental Surgery. It is extremely important, that the Dental Nurse will always respect the health and safety of herself/ himself, patients, and other members of the working team

3. Health and Safety in dental surgery

The people within the dental team are all the time at risk of many hazards within Dental Surgery. It is crucial that everyone within the dental team should be aware and should be able to recognize the different types of hazards that can occur in dental surgery. Every member within the dental team should be trained on how to lessen certain hazards in surgery and should know how to deal with them in case of an emergency. It is key that every staff member has valid, up-to-date training.

Patients, dental personnel, and the premises are covered by the protection of the Safety,Health and Welfare at Work Act (2005). We should always upskill ourselves and be up to date with any new legislation, as we are working with other people. For example, inMay 2018 a new law for General Data Protection Regulation (GDPR) has been legalized. It is clear that from this act that has been enforced people are now more protected. Therefore, patients have rights toknow how and where their personal information are going to be used. It is veryimportant that all private information is secured.

Every dental practice should providea safe environment for their workers and patients. Facilities should be up to standards,without any risk to our health. The condition of the working place must be safe, as well asthe equipment and system of work.

The ergonomic design of the workplace could prevent workers from physiological, muscular injuries and would improve the productivity of job performance. Health and safety posters and general information must be on display.

4. Complete compliance with Health and Safety legislation for hospitals, healthcare clinics and dental clinics involves: Fire Precaution (Workplace) Regulations (1999), Health and safety (First Aid) Regulations (1981), Control of Substances Hazardous to Health(COSSH) (1994), Reporting of Injuries, Diseases and Dangerous Occurrences(RIDDOR) (1995), Environmental Protection Act (1990) for a Special Waste and hazardous Waste Regulations (2005), Ionising Radiation Regulations (IRR) (1999),

General safety measures, General security measures.

To avoid a possible dangerous hazards in work, all dental staff should wear personal protective equipment (PPE) such as gowns, masks, gloves and protective glasses or face shield. Open -toe shoes, jewellery, watches should never be worn, as they increase a risk of cross-infection. We should also be aware of another “silent” type of hazard in work, which is radiation, while taking an X-ray.

Although, in dentistry there isvery little dosage of radiation, we still need to take safety precautions. Dental x-ray dosage is too low to affect the patients. Those who take radiographs are the most vulnerable. Only qualified person may take radiographs. That person should wear a badge- personal monitoring dosimeter. Dosimeters will then measure and control the level of radiation that the person is getting.

5.Infection Prevention and Control in the dental surgery

The dental team, for example Dental nurses and the dentists are constantly at high risk of cross -infection. Cross infection can occur in many ways. In direct contact with patient saliva or blood. From patient’sexhaled breath by inhaling droplet infection or inhaling other aerosols produced by awater spray. For example, when using ultrasonic scaler or when using a high-speedhandpiece during variety of treatments. Therefore, Infection Prevention and Control(IPC) in the dental surgery is extremely important and we cannot ignore it.

“All blood & saliva of all patients should be treated as potentially infectious” according to Dental Council (2015) code of practice for IPC. Infectious pathogens, transmission of diseases, microorganisms are present in our working place every single day.

Therefore, instruments and equipment used during dental treatments become contaminated. Then contamination can be passed on frompatient to patient, patient to dental nurse or operator, dental staff to patient. To avoidthis chain of transmission, or at least minimise cross-contamination and cross infection,practical routine should be taken. We should all work in a safeenvironment. By following standard precautions. Every day in work we can protect ourselves and thepatients.

Dental practitioners and dental nurses can do this in many ways. First, with following simple routine. By using PPE, barrier techniques, vaccinations, high volumeevacuation, protective barriers, disposables, rubber dam. Also flushing of dental unitwater line (DUWL), handpieces and suctions after each patient is essential. Dentalpractices should always be kept clean and tidy up to high standard. Only necessaryitems should be kept in the surgery rooms.

Disinfectant sprays with paper towels or disinfectant wipes should be used to clean. Hand hygiene technique which will followWorld Health Organization (WHO) instructions should be constantly performed, followedby alcohol hand sanitizer. Hand hygiene (HH) will prevent transfer of microbes. HHshould be performed before touching patient, clean and aseptic procedures, also afterexposure of body fluid and after touching patient and patient’s surroundings.

Disposablegloves should be changed as often as is needed. Those are only the simple and basicprocedures that we can do every day, without even thinking about it. Personal hygieneand appearance for work is also important. For our own protection, and to keepeverything as clean as possible, it is essential that every member of dental team respectthe dress code. Uniforms should be changed and washed every day. Nails short, no nailvarnish on them, hair tied up, waterproof shoes with covered toes should be wore.

Then there is more advanced level of IPC. That is when it comes to disinfection and sterilization. National Dental Nurse Training Programme of Ireland is giving a great opportunity to achieve a high level of education in that field. It also helps to understandresponsibilities and risks of taking a job opportunity as a dental nurse. Full understandingof this job title and description should be taken in consideration before taking thatposition as a work opportunity.

One of the important aspects of good quality of work is using zoning in the surgery. Weshould have two separate zones. One is contaminated, dirty zone, and the other is aclean zone. Contaminated area is the area which includes dental staff and the patient.In that moment, when operator’s hands enter patient’s oral cavity contamination begins.The whole process of spreading possible dangerous microorganisms, pathogens andblood born viruses, is starting here. Everything what gets in contact with patients mouth,directly or indirectly (for example aerosols, droplets) becomes contaminated.

Contaminated area will include: the patient, operator, dental assistant, the chair, brackettable, working area, surrounding surfaces and everything what gets in contact (hasbeen physically touched) during dental procedure. We also need to be aware of the fact,that during dental treatments droplets and aerosols are present, and are spreading too.

That’s why zoning is so important. Separate room should be also used for

decontamination of used instruments and handpieces. In decontamination room zoningshould be used as well. Local decontamination unit (LDU) should have contaminatedzone. That is were contaminated items are brought in for cleaning, disinfection andsterilization. Decontaminated zone, clean zone, is were sterilized in autoclave machineinstruments are brought in.

There are three steps of decontamination process. All of them are extremely important.Without first step, which is cleaning, the other two are not successful. In cleaningprocess, debris are physically removed, and microbes are reduced. In disinfectionprocess more microbes are killed.

Good quality disinfectants should have atuberculocidal claim to kill mycobacterium tuberculosis (mt). Surface disinfection wipesshould destroy bacteria, fungi, viruses and spores. When using disinfecting wipes toclean surfaces, we should only follow in one direction, while performing disinfection. Thedirection followed is from the cleanest to the dirtiest area, to prevent spreading ofinfection.

For cleaning and disinfection full PPE must be wore as well as heavy dutygloves. Then, those gloves should be removed. Hand hygiene (HH) and hand rubshould be used, and clean pair of gloves should be put on. Washer disinfector, which isa mechanical cleaner, is recommended to be used for a safety reason.

Although notevery practice can afford it. Washer disinfector can be easily controlled. They arevalidated, an efficient and safer to use for dental nurses. Less risk of accident andinjures to dental nurse herself during cleaning, as there would be less physical contact,for example with some of the instruments that might be sharp. Washer disinfector forthermal disinfection, has five programs: flushing, washing, rinsing, disinfection in 90°Cfor one minute, and final one, drying. Then protein test is performed.

In my practice contaminated instruments, after being used during dental treatment, arecarefully removed from working area and are placed in solution for soaking in coldsterilization bath. Then they are transported into LDU. In LDU they are placed in ultrasonic bath with enzymatic based solution. After ultrasonic bath, instruments are removed and rinsed with warm water. After drying them, under good light, they are

going through inspection process. They are checked for any remanding materials, products, stains, debris left over. Only then, when everything is clean and dry, packinginto autoclave pouches process can start. Also prior to packing, each time prior to going to autoclave machine, handpieces need to be oiled in the special oil machine.

Inspectedinstruments and lubricated handpieces are packed and sealed in special pouches. Thedate and autoclave cycle need to be written on them. Any sharp instruments should bedouble packed with care. Then followed by manufacture instructions to choose the rightprogram, all items are ready for loading into autoclave machine.

RIMD should nevertouch the chamber walls. Steam steriliser must not be overloaded. Sterilized packsshould be dry when removed. Colour indicator on the single use pouch should change,when temperature during sterilization was reached. Only then sterilization is successful

Before sterilization all packages should be labelled, with information such as name of product and a date. Also, to make sure that sterilization is successful and instrumentsafter all are safe to use on other patients, some necessary tests and regularmaintenance for autoclave machine must be carried out.

Cycles need to be recorded.Correct operating cycle must be chosen. Pass or fail cycle will indicate after completecycle. After pass cycle, load should be removed and kept for cooling. Then all items canbe transported for storage, to be kept in designated dry and clean area, where is readyfor another usage. According to Dental Council (Dental Council, 2015, p.21) “all recordsof sterilization process maintenance, periodic test and validation needs to be kept foreight years.”

In surgery room every detail is important. Not only instruments need to be sterilized, but all surgery rooms must be kept in sterile clean condition. Working area,dental unit, contaminated zones must be disinfected after each patient. Good routineand habits are needed to minimalize risk of cross infection.

Impressions that are takenduring certain treatments, before leaving surgery rooms and practice building, they mustbe disinfected and prepared for being send correctly. Every item, product, dentalmaterials that were touched by the operator hands during treatments, dental check-upsor examinations must be wiped with disinfection wipes.

Sterilization is the most important procedure when it comes to IPC. According to A-Z ofDental Nursing, sterilisation is “a process which destroys living organisms includingbacteria, spores, fungi and viruses and prevents cross-infection, protecting staff andpatients. Instruments should be sterilised in an autoclave with the temperature reaching134°-137°C for three minutes.There is one more very important aspect when talking about IPC.

How to react in caseof incident like spillages or the worst, needle stick injury. It is crucial that we all knowhow to react fast and efficient in that dangerous situation. We must stop the treatmentimmediately, encourage the bleeding, wash thoroughly with soap and water, cover withwaterproof plaster. Then immediately inform the dentist and the head nurse.

Record theaccident with date and time, and as many details of incident as possible. Then patient’smedical history needs to be checked. Finally, the most important, blood should betested for a presence of the blood borne viruses such as: hepatitis B, hepatitis C andHIV. All such incidents should be recorded in the accidental report book.

When things like that occur, we realize how important vaccinations are. In that case mainlyvaccination against hepatitis B. For our own safety it is very important, that we never re-sheath needles manually. One handed (Bayonet technique) should be used for

recapping needles, but it is recommended to use safety syringes to minimalize percutaneous injures.

In case of other incident, such as spillages, we need to follow all necessary safety precaution as well. Full PPE and disposable apron need to be worn. Staff should be informed. We should cover the spillage with disinfectant solution following manufactureinstruction for correct timing.

Then wipe it all with paper towel and dispose in clinicalwaste, yellow bin. After that the area needs to be disinfected again. Remove PPE anddispose in yellow bin. Follow with HH and report incident.When some instruments, or for example handpieces, are broken and need to be sent for repair or service, they need to be disinfected and sterilized before sending them away, following IPC.

Waste Disposal

Another very important aspect in dentistry, where IPC must be followed is correct wastedisposal. All staff should be well trained how to segregate and dispose waste withoutany harm to public and risk of cross-contamination. Waste in dental clinics, and any other medical places, can be recognised as contaminated and uncontaminated.

Contaminated waste is a clinical waste. Those must be disposed with care. They mightbe in contact with blood or body fluids. They could be a reason of transmission ofpathogens. Therefore, they put public health at risk of cross infection. Clinical waste iscategorised as non-domestic waste and can be divided in two: Hazardous waste andSpecial waste.

Hazardous waste includes potentially contaminated disposables from surgery, disposable covers, cleaning items, all sharps items, extracted teeth. Contaminated clinical waste such as disposable PPE, saliva ejectors, patient rinse cups, tissues, cotton rolls, cotton pellet, barrier wraps, used disinfectant wipes, they all must be disposed in special yellow bin or yellow bags.

Also, previously explained waste from spillage accident, needs to be disposed to the same clinical waste. Above healthcare risk waste should be labelled correctly. For safety reasons, they should be only 2/3 fulland handle by neck of the bag. Contaminated sharp items, such us needles, suture,needles, scalpel blades, local anaesthetic cartridges, burs, matrix bands, irrigating

syringes, endodontic files, and orthodontic wires, must be disposed of in yellow sharps container. For safety reasons, according to Waste Management Handbook (2011), sharps containers should be only filled up to ¾ of the space. Amalgam or amalgam capsules must be disposed in amalgam safe container. Also extracted teeth that contain amalgam restoration, should be disposed of in tooth box safe container.

Healthcare none-risk waste are domestic waste. They are all waste that were not in contact with saliva or blood, are uncontaminated waste. Those are disposed in black binor black bag.