Infection Control Manual in Dentistry & Dental Decontamination
Infection Control Manual
in Dentistry & Dental Decontamination
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(In compliance with HTM01-05) Infection Prevention Solutions Gordon House, Station Road, Mill Hill, London NW7 2JU T: 020 8906 2777, F:020 8906 2233, E: www.infectionpreventionsolutions.co.uk
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Infection Prevention Solutions
INFECTION CONTROL MANUAL DENTISTRY AND DENTAL DECONTAMINATION (Part 1) (Fully revised 2014) General Policies 1
Introduction and Scope of Policy
2 3
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Principles of Infection Control
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Standard Statement
Breaking The Chain of Infection: Standard Infection Control Precautions
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Surgery Design – Layout
5
Hand Hygiene
6 7
Safe Use and Disposal of Sharps
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Blood Exposure Incidents, Sharps Injuries and Splash Incidents
9
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Personal Protective Clothing/Equipment (PPE)
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Staff Health
11
Staff Immunisation
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Specimen Collection
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Management of Clinical Waste
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Infectious Diseases in Patients
15
Transmissible Spongiform Encephalopathies
16
Antibiotic Policy
17
Principles of Asepsis
18
Pest Control
19
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Blood Borne Viruses
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INFECTION CONTROL MANUAL DENTISTRY AND DENTAL DECONTAMINATION (Part 2) (Fully revised 2014) Decontamination Policies
Setting Up the Decontamination Area
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Environmental Cleaning of the Dental Surgery
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The Decontamination Environment Roles and Responsibilities
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Decontamination of Dental Equipment Principles
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Decontamination Guidance for Specific Dental Equipment and Instruments
25
Hot and Cold Water Systems and Dental Unit Water Lines
26
Management of Instruments To and From the Decontamination Area
27
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Managing Blood and Body-Fluid Spillages
Cleaning Instruments Prior to Re-Processing and the Safe and Effective Use of Mechanical Cleaning Equipment
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The Safe and Effective Use of Bench top Sterilizers and the Management of Sterilised Equipment
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INTRODUCTION AND SCOPE OF POLICY INTRODUCTION The purpose of infection prevention and control is to limit the acquisition and spread of pathogenic micro-organisms, by using scientifically based knowledge and through planning, surveillance, education and research as part of the overall policy for achieving high quality dental healthcare standards.
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The Health and Social Care Act 2008, sets out a code of practice for dental professionals, to ensure that a minimum standard of care is achieved for all service user’s receiving dental treatment. Practices will be required to demonstrate compliance with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (DH 2010). This requirement applies equally to all general/independent dental practices; salaried / community dental services/networks and for primary care dentistry delivered in acute settings.
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Registration ‘All dental practices are required to be registered with the Care Quality Commission. This is the independent regulator of health and social care services in England. In order to be registered, providers must meet a set of registration requirements including one on cleanliness and infection control.’ Barry Cockcroft, Chief Dental Officer HTM 01-05: Decontamination in Primary Care Dental Practices DH 2013
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The Health and Social Care Act 2008 requires that all providers of a regulated service are registered with the Care Quality Commission (CQC), this has been in force since April 2011. A service is regulated if it appears in a list of activities described in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Compliance with the code of practice will demonstrate compliance with Regulations contained within the Health and Social Care Act 2008 and also with Outcome 8 of the Essential Standards of Quality and Safety published by the CQC (2010). CQC will measure practices against this compliance as will local commissioners of services. SCOPE OF POLICY
This policy and guidance applies to all members of staff employed in the practice and includes agency, locum and bank workers as well as volunteers.
The practice policy should encourage the individual responsibility of every member
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of staff to participate in the prevention and control of infection and to comply with other legislation and regulations applying to the safe provision of primary dental care services, such as: Health and Safety at Work Act (HSWA) 1974
Public Health (Control of Disease) Act 1984
Control of Substances Hazardous to Health (COSHH) Regulations 2002.
The Hazardous Waste Regulations 2005
Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
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This list is not exhaustive.
GOVERNANCE
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Guidance provided by the policies set out in this infection prevention and control manual together with Health Technical Memorandum 01-05: Decontamination in Primary Care Dental Practices (2013) will enable dental practices to work towards compliance with the 10 Criteria in the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance 2010.
Infection prevention and control has a key role to play in the clinical governance framework for primary dental care practices.
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The following activities should be considered an essential element of local infection prevention and control activity:
development of an annual infection prevention and control programme
six monthly infection prevention and control and decontamination audits
the implementation, monitoring and up-dating of policies
the education of all staff
surveillance and reporting of occurrences of infection
annual statement
Practices are required to have nominated leads to take responsibility for:
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infection prevention and control (IPC Lead)
cleaning and decontamination of equipment (Decontamination Lead)
cleaning and decontamination of the environment (Environmental Cleaning Lead)
The leads may be the registered manager. However, if someone else takes a lead role they should report directly to the registered manager in this regard.
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The lead for infection prevention and control prepares and reports on the annual infection prevention and control programme which outlines activities required to be undertaken to provide assurance under the Code of Practice.
INFORMATION SHARING
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Specialist advice on infection prevention and control should be available to all staff. This may be through commissioning organisations or other providers of expertise e.g. Public Health England health protection teams or the Department of Public Health at the local authority.
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The Code of Practice requires primary dental care practices provide information for service users on the practices approach to infection control, staff roles and responsibilities and to whom they should contact if there are any concerns relating to infection prevention and control.
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Primary care dental practitioners maybe required to share patient information with other healthcare professionals. They should be aware and have due regard for service user confidentiality and also be familiar with the legal requirements for safe handling of personal information. TRAINING
Details for the infection prevention and control training must be outlined in the annual infection prevention and control programme. ‘Training and education Training and education in the processes of pathogen control, decontamination, cleaning and hygiene (including hand hygiene), exposure to blood-borne viruses, and infection risk reduction, including waste disposal, should be part of staff induction programmes. They are key aspects of patient safety and service quality. Accordingly the provision of training and competency records is a key requirement. As part of verifiable continuous professional development (CPD), professionals working in this area will receive not less than five hours’ training in this area over a period of five years.’ HTM 01-05: Decontamination in Primary Care Dental Practices DH 2013
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‘Guidance for compliance with criterion 10 Staff will require ongoing training in infection prevention and control. A record should be kept of all staff training.’ The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance DH 2010
MEDICAL HISTORY
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Infection prevention and control training is a mandatory requirement at induction for all staff groups and as part of mandatory updates for all staff involved in service users’ care and decontamination processes (recommended annually). Training attendance records must be maintained and reported through internal governance frameworks. All training delivered should be evaluated by delegates.
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A thorough medical history should be obtained for all patients at the first visit and updated at each subsequent visit. Medical history questionnaires such as the BDA medical history proforma alongside direct questioning and discussion between the dentist and patient are recommended The medical history should include the following questions to identify asymptomatic patients at risk from iatrogenic exposure to classical CJD or familial disease (See Transmissible Spongiform Encephalopathies (TSEs): recipients of hormones derived from human pituitary glands
recipients of dura mater brain grafts
people with a family history of classical CJD
patients who have been contacted as potentially ‘at risk’
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In addition the medical questionnaire should be able to identify individuals who may be at risk of carrying blood-borne viruses The medical history may not identify asymptomatic carriers of infectious disease and Standard Infection Control precautions must be adopted. Strict confidentiality must be maintained on all information disclosed by patients.
MONITORING It is recommended that audits, at least annually, of compliance with this policy, are conducted. This will support compliance with the Health & Social Care Act (2008).
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REVIEW The policy should be reviewed every two years or as new guidance becomes available if sooner. WORKING RELATIONSHIPS WITH THE COMMUNITY
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There are two main groups of staff involved in the prevention and control of communicable disease in the community:
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The first group deal with the identification and control of infection and communicable disease in the community and can advise on infection control matters for General Dental Practices (GDPs) and community practices providing NHS contract work. These include: Infection Control Doctor
Infection Control Nurse(s)
Director of Public Health
Community dental advisor
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The second group are responsible for ensuring that the requirements under current legislation relating to infectious disease are met and include the following personnel in the Health Protection Units and Local Authorities:
Consultant in Communicable Disease Control (CCDC)
Health Protection Nurses and Specialists
Environmental Health Officers
Good working relationships and communication are essential between the CCDC team and local community trusts, primary care groups and the independent sector for the effective surveillance, prevention and control of infectious disease.
Where appropriate the above agencies can provide the following services to the dental team:
Advise on the content of policies to ensure that the likelihood of cross infection is minimised.
Provide guidance and advice about current infection related problems.
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Provide information about local or national trends in outbreaks of infection.
Manage outbreaks of infection or investigate incidents of cross-infection if there are implications to the community as a whole.
The Environmental Health Officers (EHOs): The majority of EHOs work for a Local Authority. They may advise on hygiene and kitchen design, pest control and waste disposal. They are also responsible for the control of pollution and other nuisances.
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EHOs are responsible for the inspection of food premises as well as enforcing the provisions of the Food Safety Act 1990. They investigate complaints about food and collaborate with the CCDC in the investigation and control of outbreaks, particularly food or water-borne illness.
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