Basic Guide to Infection Prevention and Control in Dentistry

Dr Caroline Pankhurst BSc BDS MSc Ph.D MRCPath, is a former Clinical Senior Lecturer at the Dental Institute of King's College, London and a Specialist in Oral Microbiology. Dr Wil Coulter BSc, BDS, PGCert Ed, MSc, PhD, FRCPath, is a Consultant/Reader in Oral Microbiology in the School of Medicine and Dentistry Queens University Belfast and the Belfast Hospital Trust. The authors are dentally qualified medical microbiologists and members of the Royal College of Pathologists with extensive experience in the field of infection control in dentistry. They have published a number of scientific studies in the field, the findings of which have been presented at numerous conferences. Drs Pankhurst and Coulter serve on government advisory bodies on infection control and decontamination, and teach dentists, nurses, therapists and hygienists at both pre- and post qualification level.

Chapter 1: Essentials of control of infection . * Introduction: Why do we need infection control in dentistry?. * Relative risk and risk perception. * Risk assessment and management decision making process. * How to perform a risk assessment. * Hierarchy of risk management control. * Infection control and the law. * Legal Acts under which dental practice is conducted. * Published standards and guidance. * Team approach to prevention of infection. * References and websites. Chapter 2: Communicable diseases in the dental surgery. * How infections are spread. * Reservoirs and Sources of infection. * Routes and transmission of infection. * Infectious diseases by route of infection in the dental surgery. * Direct and indirect contact spread of infection: HSV, MRSA. * Prevention of spread of infection by direct and indirect contact. * Parenteral transmission of infection via the blood stream: HBV, HCV, HIV. * Preventing BBV infection in the occupational setting. * Spread of infection by airborne and respiratory secretions: Tuberculosis, Influenza,. * Emerging and re-emerging pathogens. * Why do infections emerge/re-emerge?. * The impact of emerging infection on dentistry. * Pandemic flu and avian flu. * SARS-CoV. * vCJD. * West Nile Virus. * References and websites. Chapter 3: Occupational Health and immunisation. * Introduction: Building a culture of safety . * Organising staff health in your practice . * Immunisation requirements for dentistry. * Protecting woman of child bearing age. * Who should be immunized against Hepatitis B? . * Health clearance and the consequences of blood borne virus infection. * Health Clearance for registration with the General Dental Council. * References and websites. Chapter 4: Sharp safe working in the dental surgery * Introduction: Why sharps prevention is important * When do sharps injuries occur * Preventable sharps injuries * How to avoid having a sharps injury. * Safe handling of sharps and needles * Use of safety devices * How to avoid sharps injuries - sharp safe disposal * Managing sharps injuries * Occupational health risk assessment for BBV exposure * Management of Hepatitis C exposures * Post exposure prophylaxis (PEP) * Recording of sharps injuries. * Clinical governance and accident risk assessment . * References and websites. Chapter 5: Hand hygiene. * Introduction: Hands as a source of infection * Microbial colonisation of the hands. * Hands as a source of hospital acquired infection. * When to Clean Your Hand * Hand hygiene Technique. * Hand Care and prevention of irritant dermatitis . * References and websites. Chapter 6: Personal protection for prevention of cross infection * Background. * The role of gloves. * Choosing a suitable glove for the task * Managing an allergy to NRL gloves * Masks, Visors and goggles and the protection of mucous membranes and the airway * Types of masks and when to use them * Protection during cardio-pulmonary resuscitation. * Protective eyewear and visors * Tunic/uniforms * Protective barriers- Plastic aprons and surgical gowns * References and websites. Chapter 7: Sterilization and disinfection of dental instruments . * Decontamination cycle. * Why has cleaning become so important? . * Legal requirements and technical standards for decontamination. * Where should sterilization take place? . * Design of Dedicated decontamination units. * Purchasing of dental equipment . * Pre-sterilization cleaning of dental instruments. * Dental instrument sterilization . * Types of water and Steam purity. * How do you know your sterilizer is working?. * Loading the sterilizer. * How to operate the sterilizer. * Storage of wrapped and unwrapped instruments . * Instrument traceability. * Single Use Items * Disinfection of heat sensitive equipment * Disinfection of dental impressions. * References and websites. Chapter 8: Dental surgery design, disinfection and managing aerosols . * Dental surgery design . * Surface Cleaning and Decontamination: General cleaning, Surface cleaning . * Zoning work areas . * Managing Aspirators, Suction apparatus and Spittoons . * Managing Aerosols and Splatter . * Managing Large Blood or Body Fluids Spillages . * -Splashes and spots . * -Small spills . * -Large spills . * References and websites Chapter 9: Dental unit waterlines * What are biofilms?. * Risk to staff and patient health from dental unit water lines. * -Legionellae. * -Pseudomonas. * -Mycobacterium. * -Endotoxin. * Methods to reduce biofilms. * Control of Legionella in dental unit water lines. Chapter 10: Healthcare Waste management . * Legislation on hazardous waste disposal . * Types of waste . * What is hazardous waste? . * Hazardous Waste Regulations and the European Waste Code. * Amalgam waste and installation of amalgam separators . * Segregation and disposal of clinical waste . * Safe handling and storage of clinical and hazardous waste prior to disposal . * Transport of clinical waste . * Completing Consignment Notes for hazardous waste and keeping records . * References and websites . Chapter 11: Transport and postage of diagnostic specimens, impressions and equipment for servicing and repair. * Legal framework . * Collecting specimens . * Transport of specimens to the laboratory . * Sending non-fixed diagnostic specimens by Post . * Transport restrictions . * Fixed pathological specimens . * Transporting Impressions . * Equipment to be sent for service or repair . * References and websites. Chapter 12: Resources . * Table 12.1 Daily infection control clinical pathway. * Table12. 2 Decontamination methods for specific instruments and items of dental equipment. * Table 12.3: Hand and hard surface disinfectants and dental unit waterline biocides. * Further sources of information