The surgery is designed in such a way that all areas prone to contamination are easily accessible for cleaning, disinfection and sterilization. The surgery is divided into ‘zones’ in order to control infection spread.
Contaminated Zones :- These zones relate to those areas in the immediate working environment. They also include the hand pieces, suction systems and bracket table.
Clean Zones :-Those are areas away from the immediate working environment which include registers, patient record cards, radiographs, drawer handles, door handles etc.
Sterilization Zone :- This is the area where all instruments are sterilized. Before any treatment commences, all the instruments are set so as to prevent contamination of drawers and other items. The dental chair is adjusted using foot controls. The bracket table handle is covered with disposable covers, for single patient use. The spittoons are made of a ceramic and can be easily disinfected. Disposable patient aprons are used. The dental chair, headrest and the dentist’s chair are covered with smooth upholstery which is non-absorbent. The flooring is done with vinyl with is easily cleaned and disinfected. The sink taps are operated by elbow control. Disposable tissues are used for wiping instruments. Disposible hand towels are used after every wash by the dentist and the assistant
.
INSTRUMENT CLEANING AND STERILIZATION
It involves 3 stages : Pre-sterilization Cleaning, Autoclaving and Aseptic Storage.
Presterilization Cleaning :-All instruments are cleaned to remove any residue and blood after use, by the assistant using heavy duty gloves, warm water and a long – handled brush. They are then placed in an ultrasonic bath before sterilization.
Autoclaving :- The pre cleaned instruments are pouched and placed in a tray and autoclaved. Specific temperature / time combinations have to be applied.
Eg:
-
134 – 1370C for 3 minutes,
- 126 – 1290 C for 10 minutes
Hand pieces are cleaned externally and internally with oil spray before autoclaving.
The ultrasonic scaler tips are cleaned using a disinfectant (Cidex S.A.). Then it is placed in ultrasonic bath and then sterilized.
Burs are disinfected in a solution which is a disinfectant for burs and rotary instruments.
Aseptic Storage :-The sterile instruments are stored in dry covered conditions in UV cabinets.
Hand Pieces, Scalers and other instruments are disinfected on a table top UV apparauts just before use.
WATER SUPPLIES :
The dental unit has a water supply which is a bottled water supply, with a plastic bottle containing water from the tap connected to the dental unit. The water is replaced whenever required. Incorporating an air gap in the water supply to the surgery prevents the backflow of oral contents into hand pieces, ultrasonic scalers and 3 – in – 1 syringes.
CHEMICAL DISINFECTANTS
Disinfection is used for surface contamination of hard surfaces. The disinfectant used is bactericidal, virucidal and fungicidal. After every patient, all contaminated hard surfaces are sprayed with disinfectant. Work surfaces include light handles, light switches, bracket table, spittoon etc. The chemical disinfectant used is Pursue solution. Gloves and eyewear are used when handling this material. Hexidisplus tissues are used for cleaning small instruments.
AEROSOL INHALATION
The air turbine and ultrasonic scalar creates contaminated aerosol containing micro-organisms and tooth particles which when inhaled can cause chronic coughs, bronchitis etc. The problem is managed by providing good ventilation in the surgery through air conditioning, and high volume aspiration. Protective eye wear and masks are always worn.
DISPOSABLES
Disposable items are those which cannot be sterilized and which are not re-used. The following are disposable items used in the practice:-
- Sterile gloves
- Instrument Trays
- Facemasks
- Mouthwash cups
- Patient aprons
- Aspirator tips
- Syringes and needles
- Clear matrix bands and polishing strips
- Applicator Brushes
- Impression Trays
- Tissues
CROSS INFECTION POLICY
- All staff to be immunized against Hepatitis B checked.
- The practice provides protective clothing, gloves, masks and glasses. These are worn as directed by the Dentist.
- All staff will be trained in the control of cross infection.
- Instruments are sterilized by autoclave.
- Disinfection is by Cidex.
- All working areas used during treatments will be kept to the minimum.
- Hand / Glove disinfected by gel.
- The DSAs are responsible for maintaining the cleanliness of the following areas / equipment :- work areas, instruments, all devices. The cleaners for floor, general maintenance.
- All impressions are disinfected.
- Sterilized instruments are stored in cabinets.
- All used sharps are placed in the sharps boxes.
- Injuries due to sharps will be treated as in the Practice’s Guidelines and reported.
- Accidental spillage of infected material will be handled in accordance with the practice guidelines.
- All the start of the day, water should be run through water sprays and appropriate hand pieces for two minutes.
- All staff should observe total confidentiality in all matters.
- Anyone developing any reaction to the chemicals or gloves must inform the dentist in charge.
IMMUNISATION OF STAFF
All staff are required to be immunized against Hepatitis B. This is to be completed before the employment commences. Every 3 – 5 years, a blood test is done to check if the antigens are present. A booster dose is given whenever required.
CLINICAL WASTE
Human tissues, blood and other body fluids and secretions, drugs, pharmaceutical products, swabs, dressings, syringes, needles other sharp instruments – all consist of clinical waste. Sharps are placed in a separate container. Sharps include sheathed needles, local anesthetic cartridges and scalpel blades. All clinical wastes are collected in black bags by IMAGE. Unused amalgam is placed in labeled plastic containers with water. Extracted teeth are stored in labeled plastic containers after cleaning.
LABORATORY WORK
Both metal and plastic stock trays are used in the practice. Metal trays are sterilized before they are reused. Plastic stock trays are disposed. All laboratory work is disinfected before being sent. The impressions are disinfected with cidex and cast is poured soon.
General Guidelines For Cross Infection Control Procedure And Improvement
All clinical staff must exercise care to avoid contamination of non – working areas. Contaminated areas should be vigorously disinfected or alternatively have covering changed between patients. These may include :-
- Chair Switches
- Light Handles
- All unit switches and control
- Drawer Handle, Bracket Trays, Surface of all work areas, Instrument tubes and couplings.
- Contaminated, items must be sterilized before serviced or repaired.
- No food or drink should be consumed in clinical or sterilization areas.
PROTOCOLS FOR CROSS INFECTION PROCEDURES
DISINFECTION OF IMPRESSIONS
- Gloves, masks, protective clothing and eye wear are worn to avoid splashes.
- Impressions are first rinsed in cold running water to remove blood, saliva, debris and other visible contaminations.
- An impression disinfectant is used. Alginate impressions are covered in wet gauze to avoid shrinkage.
AFTER TREATMENT
- All instruments are cleaned thoroughly and made ready for autoclaving.
- The 3 way syringe tip is removed and placed in the autoclaved.
- Contaminated areas and working areas like the dental chair, unit, light etc. is cleaned and disinfected.
- Aspirator tips are cleaned and placed in the tray for cold sterilization.
- Disposables like gloves, masks, mouth wash cups, patient aprons etc. are disposed and new ones replaced for the next patient.
- Sharps are disposed in the sharps box.
- Used needles are sheathed.
- Clinical waste is separated in black sacks.
- Impressions are disinfected.
- Mouth mirrors, probes and tweezers are disposed and new ones replaced.
- The surgery is prepared for the next patient.
RADIOGRAPHS
- Clean gloves are worn.
- Place the required number of film packets to be used on a clean tissue.
- The radio graphed films are placed on a clean tissue on a designated work top.
- The film packet, X-ray tube and control button are disinfected.
- The film holder is placed on a tray for sterilization in the autoclave. |
