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HOSPITAL
: Medical Management
: Infection Control
: Hospital Wide
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: Medical Management
: Infection Control
: Hospital Wide
Description of Change
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 2 of 11
Page Effected
Revision
Number
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 3 of 11
1. INTRODUCTION:
1.1. Infection control is one of the most vital and significant areas in dentistry. The protocols
and procedures in this manual relate to infection control in Dental Health Care settings,
they follow the guidelines of the CDC (Centre for Disease Control) for infection control
in the dental health care settings.
1.2. Dental Health Care Professionals (DHCP) include dentists, dental nurses, oral hygienists,
administrative staff, house keeping, bio-medical and maintenance staff, all of whom may
be exposed to a range of infectious materials as well as contaminated supplies, air or
water.
1.3. The manual are designed to prevent or reduce cross infection between DHCP to patient,
patient to DHCP and from patient to patient. The manual sets out step by step
procedures to be followed inside the clinic before, during and after treatment.
1.4. Procedures are also included for infection control in CSSD, House Keeping and waste
disposal guidelines are also detailed.
1.5. Dental patients and DHCP can be exposed to pathogenic micro-organisms and other
viruses and bacteria. These include cytomegalovirus (CMV), HBV, HCV, herpes
simplex virus types 1 and 2, HIV, Mycobacterium tuberculosis, staphylococci,
streptococci.
2. PURPOSE:
2.1. This manual consolidates recommendations for preventing and controlling infectious
diseases and managing personnel health and safety concerns related to infection control
in dental settings in order to maintain high quality of infection control standards at all
times.
3. TARGET AUDIENCE:
3.1. This is applies to all involved services of dental in the GDC Hospital and all clinical staff
should familiarize themselves with the policy.
4. RESPONSIBILITY:
4.1. It is the responsibility of each staff member of the dental services to deal and to ensure
that this policy, procedures, and guidelines are implemented and followed meticulously.
5. POLICY:
5.1. The key to minimize the spread of infection is to decrease opportunities for cross
contamination, especially in clinics room where direct care is given.
5.2. To be used in conjunction with GDC Hospital policies and procedures.
5.3. This policy should be implemented and followed by all dental clinic staff in order to
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 4 of 11
provide a safe working environment and to reduce\prevent the risk of cross- infection
among patients and DHCP.
6. HOW ARE PATHOGENS TRANSMITTED?
In the dental settings these organisms can be transmitted through:
6.1. Direct contact with blood\body fluids
6.2. Indirect contact with contaminated instruments, equipment or surfaces.
6.3. Contact with mucosa of the eyes, nose, or mouth with droplets/splatter generated from an
infected person by coughing, sneezing or talking.
6.4. Inhalation of airborne micro-organisms that can remain suspended in the air for long
periods.
7. DEFINITION OF COMMON TERMS:
7.1. Alcohol- based hand rub: An alcohol containing preparation made for reducing the
number of viable micro organisms on the hands.
7.2. Antimicrobial soap: A detergent containing an antiseptic agent
7.3. Antiseptic: Germicide used on skin to inhibit or destroy micro organisms (e.g. alcohols,
chlorine, chlorhexidine, iodine).
7.4. Aerosols: Invisible contaminants suspended in the air. They are produced by the misuse
of high speed suction, ultrasonic scalars, use of prophy jets, and high speed cooled
handpieces.
7.5. Colony-forming unit (CFU): The minimum number (i.e., tens of millions) of separable
cells on the surface of or in semisolid agar medium that give rise to a visible colony of
progeny. CFUs can consist of pairs, chains, clusters, or as single cells and are often
expressed as colony-forming units per milliliter (CFUs/mL).
7.6. Decontamination: Use of chemical or physical means to remove, inactivate or destroy
pathogens on a surface or item.
7.7. Dental treatment water: Non sterile water used during dental treatment, including
irrigation of non surgical operative sites and cooling of high-speed rotary and ultrasonic
instruments.
7.8. Disinfectant: A chemical agent used on floors, walls or sinks to destroy most
microorganisms.
7.9. Disinfection: Destruction of microorganisms by physical or chemical means. Disinfection
is less lethal than sterilization because it destroys the majority of pathogenic
microorganisms but not necessarily all microbial forms like bacterial spores.
7.10. Droplet nuclei: Particles <5 m in diameter formed by dehydration of airborne droplets
containing microorganisms that can remain suspended in the air for long periods of time
7.11. Droplets: Small particles of moisture (spatter) generated when a person coughs or
sneezes or when water is converted to a fine aerosol mist by a hand piece. These
droplets can contain infectious microorganisms.
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 5 of 11
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 6 of 11
Duration
(minimum)
Water
&
non Remove soil and 15 seconds
antimicrobial soap transient
(e.g. plain soap)
microorganisms
Agent
Purpose
Indication
Before and after treating each
patient (e.g., before glove
placement and after glove
removal). After barehanded
touching of inanimate objects
likely to be contaminated by
blood or saliva. Before leaving
the dental operatory or the
dental laboratory. When visibly
soiled. Before regloving after
removing gloves that are torn,
cut, or punctured.
Antiseptic
hand rub
Surgical
antisepsis
: Medical Management
: Infection Control
: Hospital Wide
Water
&
antimicrobial soap
(e.g. chlorhexidine,
iodine
and
iodophors,
chloroxylenol,
triclosan)
Alcohol-based hand
rub
Water
and
antimicrobial soap
(e.g. chlorhexidine,
iodine
and
iodophors,
chloroxylenol,
triclosan)
Water and nonantimicrobial soap
(e.g. plain soap)
followed by an
alcohol-based
surgical hand-scrub
product
with
persistent activity
Same as above
Remove or destroy
transient
microorganisms
and reduce resident
flora
Remove or destroy
transient
microorganisms
and reduce resident
flora
(persistent effect)
Same as above
Rub hands
until
the
agent is dry
(almost 20
second)
3 minutes
Follow
manufacturer
instructions
for
surgical
hand-scrub
product with
persistent
activity
Before
donning
sterile
surgeons gloves for surgical
procedures
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 8 of 11
9.5. When you are selecting PPE, consider three key points:
9.5.1.Anticipated exposure
9.5.2.Durability and appropriateness of PPE
9.5.3.Fit
9.6. PPE are placed in the following order as per CDC guidelines:
9.6.1.Gown
9.6.2.Mask
9.6.3.Goggles/Face-shield
9.6.4.Gloves
9.7. PPE are removed in the following order:
9.7.1.Gloves
9.7.2.Goggles/face shield
9.7.3.Gown
9.7.4.Mask
9.8. Re-usable PPE (e.g. face-shields and goggles) should be cleaned with soap and water
when contaminated, and when visibly soiled disinfect with an intermediate- level
disinfectant according to manufacturers directions.
9.9. Surgical/isolation Gowns are not to be worn outside the clinical areas (zoned).
9.9.1.Protective Clothing- Gowns/Lab Coats/Jackets
9.9.2.Non-sterile gowns (single use item), lab coats/jackets should be worn (unless a
sterile gown - single use item - is required) to protect your clothes and skin from
contamination during procedures and patient care activities where it is
anticipated blood or OPIM are likely to be generated.
9.9.3.Change protective clothing if it becomes visibly soiled or penetrated by blood (as
soon as feasible).
9.9.4.No Gowns are to be worn outside the clinical area.
9.10. Masks, Goggles and Face-shields
9.10.1. Wear a surgical mask and eye protection such as, goggles or face-shield during
all procedures
9.10.2. Change masks between patients or during patient treatment if the mask become
wet
9.10.3. Protective eye wear should be used by both HCW & patient whenever it is
indicated.
9.10.4. Goggles, face/shield should be cleaned with soap and water between patients.
9.11. Gloves
9.11.1. All DHCP should wear clean non sterile gloves whenever
9.11.2. Double Gloving:
9.11.3. The effectiveness of wearing two pairs of gloves in preventing disease
transmission has not been confirmed. Studies have demonstrated a lower
: Medical Management
: Infection Control
: Hospital Wide
frequency of inner glove perforation and visible blood on the surgeons hand
when double gloves are worn.
9.12. Protective barriers must be used to prevent cross contamination.
9.13. Use barriers on any surfaces that may be faced with cross contamination. Use surface
barriers to protect clinical contact surfaces, particularly those that are difficult to clean.
These barriers need to be changed between every patient regardless of how minor the
treatment.
9.13.1. Working Services
9.13.2. The dental chair, the backs of the clinicians and assistants chair
9.13.3. The overhead light, the UV light
9.13.4. Hand pieces, triplex syringes
9.13.5. Touch control panel.
9.13.6. X-ray units, LED monitors
9.13.7. Bracket Table Handle
9.13.8. Tables, Cabinets and Hard Surfaces
9.13.9. Dental Impression Trays/Impression Tray/Metal Impression Tray
9.14. Sterile Procedures
9.14.1. Routine steps should be followed for all treatment area to maintain clinical
asepsis.
9.14.2. Shortcut should never be an option for asepsis in dentistry.
9.14.3. The dental assistant must insure that infectious diseases are not spread from
patient to patient, HCW to patient, patient to HCW.
9.14.4. Therefore, a sterile procedure is very essential and important throughout all
dental procedures. So when it is indicated it should be performed accordingly
and effectively, by maintaining good hand washing before and after completion
of the procedure taking in consideration the proper use of all required devices of
PPE through out the procedure.
9.15.
List of Disinfectants
Disinfectants
Ethyl Alcohol 70%
(Ethanol)
Isopropyl Alcohol
(Isopropanol)
Chlorhexidine 4 %
handwash
Purpose\Use
For skin
disinfection,
infant
incubators, xray equipment
and
thermometers
For skin
disinfection
(Hand scrub)
Contact Time
Effective and
rapidly acting
disinfectants (2
minutes) but
they evaporate
fast.
Precautions
Not recommended
for instrument
disinfection.
MSDS
Available
Invasive
Procedures
Theatre:-
Not recommended
for disinfecting
instrument and
Available
: Medical Management
: Infection Control
: Hospital Wide
Hydrogen Peroxide
Concentrated
"Perasafe"
Hands should
be washed for
3 minutes
10 Minutes
Hydrogen Peroxide
Surfactant
"Virkon"
It is for
endoscopes and
medical
instrument
sterilant
solution
For cleaning
10 Minutes
and Disinfecting
of surfaces
Hand Sanitizer
Hand rub
20 -30
Seconds
Hypochlorite And
Sodium
Dichloroisocyanurate
(N.A.D.C.)
Equipment and
environment
disinfectant
infant
incubators and
infant feeding
utensils.
30 Minutes
Ortho Phthal
Aldhyde (OPA)
General
disinfectant of
instruments.
10 minutes as
HLD
Detergent Solution
"Biotek"
For ordinary
cleaning of
surfaces
5 Minutes
Available
Available
Available
Available
Not
available
Not
available
: Medical Management
: Infection Control
: Hospital Wide
Policy No: MED-DEN-P0001/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 11 of 11
10. REFERENCES
10.1. CDC Guidelines for Infection Control in Dental Health-Care Settings December
19, 2003
10.2. Disclaimer: The contents of Guidelines for Infection Control were gathered from
CDC, OSAP, ADA and OSHA. Care has been taken to confirm the accuracy of the
information present.
10.3. www.cdc.gov
10.4. www.osap.org
10.5. www.ada.org
10.6. www.osha.gov