autoclaving protocols

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Protocol for

Infection ControlIn Dentistry

Policy Consistency GroupDate Approved 28/09/2009

Quality and Safety Committee 30/10/2009Date Ratified

Clinica

l


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Please read this protocol and sign your name below.

I confirm that I have read and understood the Infection Control in Dentistry Protocol.

Name (please print) Designation Signature Date and Time


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Contents Page no

1. Introduction 1

2. Scope.. 1

3. Roles and responsibilities 1

4. Standard Precautions... 2

5. Known Carriers of Blood Borne Viruses 2

6. Personal Protective Equipment 2

7. Aerosol and Splatter... 3

8. Surgery Cleaning Protocols 3

9. Use of Disposables. 4

10. Instrument Decontamination. 5

11. Sterilization... 7

12. New Instruments 8

13. Aseptic Storage.. 8

14. Decontamination of equipment prior to repair 8

15. Waste Disposal.. 8

16. Safe use and disposal of sharps...... 8

17. Training. 9

18. Communication 9

19. Monitoring. 10


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1. IntroductionEffective prevention and control of healthcare associated infections has to be

embedded into everyday practice and applied consistently by everyone.

It is particularly important to have a high awareness of the possibility of HCAI inboth patients and healthcare workers to ensure early and rapid diagnosis.

Effective action relies on an accumulating body of evidence that takes account ofcurrent practices. Together with this evidence multidisciplinary working between the

Dental department and the Infection Prevent and Control Team is essential.

Provider Dental services must be represented on the South Staffs Primary CareTrust Infection Control Group and report back on Infection control anddecontaminations practices which may impact on patient care and to also carry outtrend analysis for infections and compliance with audit programmes.

Working with the Infection Prevention and Control Team, Dental Managers and

senior Dental nurses must ensure that staff directly and in directly concerned withpatient care receive suitable and sufficient information on and training in themeasures required to prevent and control risks of infection, this programme ofeducation and information must be designed in collaboration with the InfectionPrevention and Control team.

All staff should be aware of infection control procedures and understand why theyare necessary. New staff must be appropriately trained before undertakingdecontamination duties.

All dental staff working in a clinical environment are reminded of the main risks ofinfection i.e. through sharps injuries, aerosol spray from high speed hand pieces,triple syringes, ultrasonic scalers and the routes of infection through eyes, mouth,nose and skin abrasions.

Infection Control needs to include all aspects of dental practice from attention topersonal hygiene- hand washing, masks, protective clothing to the cleaning andsterilization of instruments and maintenance of the equipment(HTM 01-05 Decontamination in primary Dental Care April 2009)

HTM01-05 requires that all dental practices have an infection control policy


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This protocol should be used in conjunction with the PCT Infection Control Policiesand HTM 01-05: Decontamination in Primary Dental Care.

3. Roles and ResponsibilitiesLocal Decontamination LeadThe decontamination lead for PCT Provider Services is the Head of Operations.The Clinical Director Dentistry is the local decontamination lead for the SalariedPrimary Dental Care Services (SPDCS) and has overall responsibility for managingInfection Control in Dentistry for the PCT SPDCS, the standards required by HTM01-05 and PCT Infection Control Policies.

Designated PersonsThe local management of decontamination and infection control within the PCTSPDCS dental clinics is devolved to senior dental nurses via the SPDCS BusinessManager.

Users and OperatorsDental care professionals are responsible for the use of decontamination equipment

including daily, weekly, monthly testing and housekeeping tasks. All dental staff areresponsible for compliance, and their own practice should be in accordance withnational and local policies, protocols and guidelines.

4. Standard PrecautionsA wide variety of micro-organisms may be present in the saliva and blood of

patients. During dental treatment infection may be transmitted through directcontact, droplets, aerosols or inoculation by contaminated instruments.

These guidelines are based on the recognition that asymptomatic carriers ofinfectious diseases may not be identified as such. The only safe approach is toensure that the infection control procedures are used for ALL patients ALL of thetime; the principle of Standard Precautions.

5. Known Carriers of Blood Borne VirusesPatients with HIV (who are otherwise well) and carriers of Hepatitis and other bloodborne viruses should be treated within the same Infection Control Guidelines for allother patients.

If HIV patients have a raised viral load or are unwell or have subsequently


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Operators and close support clinical staff must protect their eyes against foreignbodies, splatter and aerosols that may arise during operative procedures, especiallyduring scaling (manual and ultra-sonic), the use of rotary instruments, cutting and

use of wires, and during the cleaning of instruments.

Masks and visors/goggles must be worn for all operative procedures to protectagainst splatter. They should be close fitting and of the theatre type.

Disposable masks/visors, if used, must be discarded after every patient, not pulleddown and re-used.

Surgery ClothingTrousers and tunics are the uniform of choice.

Long sleeved tunics are recommended only if exposed skin is cracked or abraded.

All uniforms should be laundered at 60C

Uniforms visibly contaminated with blood/body fluids must be changed immediately.

Uniforms should be changed daily.

Disposable white plastic aprons should be worn when handling all body fluids and inall aspects of direct patient care including cleaning and disinfection procedures(where aerosol is generated).

Aprons must be changed between patients and following cleaning tasks.

N.B. - if aprons are not worn for the tasks then uniforms should only be worn in thesurgery environment and changed before leaving the clinic.

Footwear

Shoes are to be flat or with low heels. Open toed sandals are not recommendeddue to the risk of injury from falling instruments or chemical spillages.

N.B The above protocol may be subject to change following the ratification ofthe PCT uniform policy.


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8. Surgery Cleaning ProtocolsSurgery zoning

A zoning system should be utilised with clean and dirty areas being clearly defined.

To facilitate cleaning, the surgery should be kept simple and uncluttered

All unnecessary items must be removed from the surgery environment

Defining the areas, which may be contaminated during operative procedures is

imperative as these areas should be cleaned and disinfected between patientsusing an appropriate solution or wipe

Clinicians must remember that once their hands become contaminated with bloodor saliva, they must not touch environmental surfaces such as light handles, unithandles, chair controls, mixers and materials, computers, keyboards or telephonesetc.

Surface Cleaning and ProtectionSurfaces should be smooth, impervious and washable.

Prior to session ensure all surfaces areas and equipment are clean and dust free

Surfaces and equipment should be protected from contamination or cleanedcarefully between patients.

All work surfaces, sinks, taps and splash backs including those apparentlyuncontaminated should be thoroughly cleaned at the end of each clinical sessionusing an appropriate bactericidal surface disinfectant.

Blood spills either from a container or as a result of an operative procedure must bedealt with as soon as possible. All clinics have a blood spillage kit available.

All aspirators, drains and spittoons should be cleaned after every session with anon-foaming disinfectant

Records of surgery cleaning must be kept


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The SPDCS has identified the following dental items and instruments as single use:

- all root canal files, reamers and broaches

- plastic impression trays

- matrix bands

- plastic dappens dishes

- plastic suction tubes

- prophy brushes and cups

- plastic saliva ejectors

- steel burs

- toothbrushes


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If an automated and validated washer disinfector or ultrasonic bath is not availableor out of use then instruments should be decontaminated manually.

Cleaning: ManualUse a dedicated dental instrument cleaner (accurately diluted), with a long handledbrush under water to avoid splashing.

Cleaning by hand using a brush should only be done when absolutely necessary.

Brushes should be autoclaved between each use or washed thoroughly after eachuse with hot water and detergent.

Sharp ends of the instruments should be held away from the body

Rinse in clean water

Visually check to ensure all debris is removed.

Lubricate if required

See appendix 2 for details of manual cleaning procedure

Cleaning: Validated Ultrasonic BathAn appropriate cleaner for use with ultrasonic baths should be used in accordancewith manufacturers instructions.

Immerse briefly in cold water and detergent to remove visible debris


Open joints or hinges and immerse fully in ultrasonic bath

Set the timer (according to manufacturers instructions and close the lid).

Do not open lid during cycle.


Visually check to ensure all debris is removed.


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Cleaning: Validated Washer DisinfectorEnsure dental cement is removed

Do not lubricate hand pieces

Place instruments on trays in accordance with manufacturers instructions

Complete the cycle

Lubricate hand pieces after washer disinfector cycle

Washer Disinfectors should also be maintained and tested in accordance withmanufacturers instructions which should be at least to HTM 01-05 requirements.They should be subject to annual, quarterly, weekly and daily testing and the resultsretained in a dedicated log book.

This should include cleaning efficacy and protein residue tests.

See appendix 5 & 6

Any faults or concerns must be logged and reported and the machine taken out ofuse until the fault is identified and rectifiedSee Appendix 4

Movement of contaminated instruments between areasContaminated instruments require safe movement between the treatment anddecontamination areas.

They should be transported in leak proof, easy to clean, rigid containers with aclosable lid.

The containers should be labelled accordingly and cleaned, disinfected and driedafter use.

When contaminated instruments are transported between sites and clinics i.e.during domiciliary visits, data collection programmes etc. the vehicle must carry arecord with the instruments. The record must detail the date, details of the group ofinstruments, the intended destination/recipient and the vehicle details. The noticeshould be attached to the container holding the contaminated instruments


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The autoclave chamber and trays should be cleaned with a damp clean cloth andleft open, to dry overnight.

Autoclaves should also be maintained and tested in accordance with manufacturersinstructions which should be at least to HTM 01-05 requirements. They should besubject to annual, quarterly, weekly and daily testing and the results retained in adedicated log book.

This should include daily tests to check the temperature, pressure and holding time,as well as housekeeping tasks.

See appendix 6

All dental instruments and equipment must be cleaned and sterilized after use asdetailed in A-Z Disinfection and Sterilization Guidelines or in accordance withmanufacturers instructions.See appendix 7

12. New instrumentsNew instruments should be decontaminated prior to use (in accordance withmanufacturers instructions) and decontamination instructions retained.

13. Aseptic storageInstruments should be stored dry and protected from dust, splash or aerosolcontamination in closed or covered trays in closed cupboards or drawers.

Packaging of decontaminated instruments should be carried out in a clean areaaway from contaminated instruments and decontaminating equipment.

Instruments should be used within 21 days of the decontamination process or re-processed before use.

14. Decontamination of equipment prior to inspection service or repairEquipment and articles which have been contaminated by contact with blood orother body fluids must be rendered safe, and a statement confirming thiscompleted, prior to examination by third parties.


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training relating to infection control in dentistry will be provided in addition to this,arranged by the Senior Dental Nurse with a training facilitator role.

Trainee Dental Nurses will be trained infection control measures during theirtraining period with the PCT.

18. CommunicationFrom time to time additions, amendments and policies are issued via the BDA,Department of Health or the PCT. This information will be forwarded to each clinicand added to monthly staff meetings.

The amendments should be read, and signed as read, by all staff and then filed inthe clinics Infection Control File.

New employees will be informed of this protocol at the local induction process.Existing employees will be part of the discussion process in formulating andchanging this protocol.

A member of the dental team will attend PCT infection control meetings and linknurse meetings to provide feedback at the monthly dental team meetings.

19. MonitoringThe implementation of this policy will be monitored through regular service specificaudits and as required by the PCT.

Audits will be registered with the PCT Clinical Audit Department and the results andaction plans shared with the Dental Team

20. ReferencesHTM 01-05 Decontamination in Primary Dental Care April 2009

HTM 2010 Part 3 Validation and Verification- Sterilization NHS Estates

PCT Hand Decontamination Policy CLIN18

PCT Standard Precautions and Personal Protective Equipment Policy CLIN37

PCT Policy for Management of Clinical Sharps Injuries and Exposure to Blood andHigh Risk Body Fluids CLIN24


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C:\Documents and Settings\densid\Local Settings\Temporary Internet Files\OLK10\IC in Dentistry Protocol Sept 2009.doc

Surgery Cleaning ProtocolsAppendix 1

End of session Cleaning Schedule

Date andtime

WorkSurfacesand dentalcartsdisinfected

Drawer andcupboarddoor handlesdisinfected

Chair andlight unitdisinfected

Spittoon, filtersand aspiratorequipmentdisinfected

Sinks andtaps cleaned

Computerand keyboardcleaned

Signed Name anddesignation

Weekly scheduleDate andtime

Re-processall un-datedinstruments

Clean alldrawer frontscupboarddoors

Cleanoperatorstools

Suction/Aspiratormaintenance asrecommended byservice engineer

Compressormaintenance asrecommended byservice engineer

Signed Name anddesignation

Clinic Location Dental Surgery No.


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Appendix 2

Protocol for the Manual Cleaning of Dental Instruments

All personnel involved in the decontamination of dental instruments should be trained in the contentand application of this protocol and associated guidance.

To minimise the risk to personnel undertaking manual cleaning, the splashing and creation ofaerosols should be avoidedat all times.

Remember: Maintaining a dirty-to-clean workflow procedure will assist in the cleaningprocess.

Immersion Method

1. Wash hands.

2. Put on personal protective clothing (PPE)

3. Ensure sinks, equipment and setting-down areas are free from extraneous

items

4. Dismantle and open the instruments, as required, ready for immersion

5. Fill the clean sink (NOT wash-hand basin) with the appropriate amount ofwater and detergent (specified for the purpose). Note: ensure correct

temperature as recommended by the detergent manufacturer is maintained.

6. Fully immerse the instruments in the solution and keep under water during thecleaning process to prevent aerosols.

7. Agitate/scrub the instruments using long-handled brushes with soft plastic

bristles.

8. Drain any excess cleaning solution prior to rinsing.

9. Rinse in clean water.


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Appendix 3

Pre-use log sheet for Ultrasonic Cleaning Bath

Ultrasonic Cleaning Bath Location Make/Model Serial Number

Please undertake the following tests and tasks before using the above piece of equipment or according to manufacturers instructions

Dateand

time

Daily(before use

if not usedrecently)

remove andcleanstrainersand/or filters

Daily(before use

if not usedrecently)

fill reservoirwith freshsolution

After first load ofthe session

visually check firstload to checkcleaning efficacy

Weekly:(before use if not

used recently)

Check condition oflid/door seal

Weekly:(after first load of

the session if notused recently)

Perform a proteinresidue test oninstruments

Name anddesignation

Signed


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FAULT RECORD Appendix 4

Date andtime

Nature of Fault Reported to Reported by Action taken Incidentform

required

Outcome Name anddesignation

Signed

Equipment Type Location Make/Model Serial Number


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Appendix 5

Daily (or before each session) log sheet for washer disinfector

Washer Disinfector Location Make/Model Serial Number

Please undertake the following tests and tasks before using the above piece of equipment or in accordance with manufacturersinstructions.

Dateandtime

Clean allexternalandinternal

surfaces

Checkallfiltersand

spraysarefreefromdebris

Check allhoses andconnectorsare in good

condition

Check doorseal isundamagedand clean

andoperatingmechanismis workingorder

Replenishwatersoftener

Record thepre washtemperatures:use the first

print out ofthe day:

(must startbelow 45c)

Record thedisinfectiontemperatures:use the first

print out ofthe day:

(must stayabove 80c)

Recordthe cyclenumberand

retain theprint out.

Name anddesignation

Signed


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Appendix 6

Weekly/Monthly log sheet for Washer DisinfectorWasher Disinfector Location Make/Model Serial Number

Please undertake the following tests and tasks before using the above piece of equipment orin accordance with manufacturers instructions.

WeeklyTest

Date andtime

Performresidual soiltest usingPro-tect

or equivalent

Name anddesignation

Signed

MonthlyTest

Date andtime

Check allhoses aresecure andno leaks

Check mainspower cordundamaged

Check allinternal partsfor wear anddamage

Name anddesignation

Signed

WeeklyTest

Date andtime

Performresidual soiltest usingPro-tect orequivalent

Name anddesignation

Signed


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Appendix 7

Daily (or before use) log sheet for non-vacuum bench top steriliserSteriliser Location Make/Model Serial Number

Please undertake the following tests and tasks before using the above piece of equipment or according to manufacturers instructions

Date andtime

Cleandoor seal,chamber,shelves

and trayswith aclean,damp nonlintingcloth

Fillreservoirwith freshdistilled,

sterile orRO water

Turn onandrecordcycle

number incolumnbelow

RecordTemperature

RecordPressure

Recordtheholdingtime

Retainprint out(ifavailable)

Name anddesignation

Signed


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Appendix 8

TRANSPORT OF CONTAMINATED DENTAL INSTRUMENTS(Low Biohazard)

Please attach this notice to the container holding the contaminated instrumentsin your vehicle

Retain this record in your local clinic

Date ofTransport

Vehicle Registration No. Destination of Instruments Contact telephone number


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Appendix 9

Appliances

orthodontic andprosthetic

Rinse under clean running water until clean.

Use an appropriate disinfectant according to manufacturers instructions.

Rinse thoroughly.

If returning to laboratory ensure a label is attached to indicate that a decontamination process has taken place

Burs Steel burs -disposable,

Diamond -pre-clean then autoclave

Tungsten Carbide -pre-clean then autoclave

Acrylic Trimming Burs -pre-clean then autoclave

Bracket tables

Cover surface and use disposable instrument trays Clean with detergent/disinfectant wipe between patients

Do not use alcohol based products on stainless steel.

DentalCabinetry

Wipe cupboard doors, drawer fronts and handles at the end of each session with a detergent/disinfectant wipe


Dental chair

(includingcontrols)

Wipe and dry after each patient with detergent or disinfectant wipe.


A - Z DECONTAMINATION GUIDELINES


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DentalInstruments

including handpieces

Clean (using a validated process)

Inspect

Autoclave and inspect again

Dry Store in clean, dry covered conditions.

N.B Use within 21 days or re-process

Hand pieces

using

manual cleaningor ultrasonic bath

In addition to above:

Leave bur in place during cleaning to prevent contamination of hand piece bearing

DO NOT IMMERSE IN WATER

Remove bur

Lubricate hand piece with pressurised oil as recommended by the manufacturer, until clean oil appears out of thechuck;

Clean off excess oil

Sterilise in autoclave

If post sterilization lubrication is required then either separate canisters must be used or the nozzles changed.

Run hand piece briefly with bur in place before use, to clear excess lubricant.

Hand pieces

using a washerdisinfector

Clean outside of hand piece

Remove bur

Do not lubricate

Place in the displacement device in the washer disinfector

Lubricate before placing in the autoclave

If post sterilization lubrication is required then either separate canisters must be used or the nozzles changed. Run hand piece briefly with bur in place before use, to clear excess lubricant

Impressions Rinse under clean running water until clean.


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Use an appropriate disinfectant according to manufacturers instructions.

Rinse thoroughly.

If returning to laboratory ensure a label is attached to indicate that a decontamination process has taken place

Instrumentcontainers

Clean with detergent, rinse and dry (Do not use sodium hypochlorite)

Light cure Tip Pre-clean and autoclave or protect with a plastic disposable cover (Check manufacturers instructions)

Matrix bandholders

Remove used band before decontamination process

Operating lights

Clean after each patient with a detergent/disinfectant wipe.

Do not use alcohol wipe on stainless steel parts.

Spittoon Flush between each patient and clean with detergent/disinfectant wipe


Remove debris from the trap at the end of the session and system clean according to manufacturersrecommendations

Sinks Clean at the end of each session with cream cleaner and detergent wipe and leave dry.

Do not use alcohol base wipes or solution on stainless steel sinks

Suction

apparatus

Aspirator tubing and drainage system should be cleaned at the end of each sessions according to manufacturers

instructions


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(Or dispose of if single use)

Water Bottles Empty residual water at the end of each session.

Rinse with sterile water.

Leave a little clean water in the bottom of the bottle to prevent air locks.

Before use empty remaining water

Rinse again and re-fill with sterile water.

Water lines Flush for at least 2 minutes at the beginning and end of each day and flush for 20-30 seconds between each patient.

Work surfaces Clean with detergent/disinfectant wipe between each patient and at the end of the session