Dental council of new zealand code of practice control of cross infection



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NEW ZEALAND DENTAL ASSOCIATION

DENTAL COUNCIL OF NEW ZEALAND

CODE OF PRACTICE

CONTROL OF CROSS INFECTION

IN DENTAL PRACTICE


Revised April 2002

Adopted by NZDA Board April 2002

Endorsed by the Dental Council of New Zealand as a joint Code of Practice June 2002

Reviewed and approved by NZDA Executive August 2002



CONTROL OF CROSS INFECTION

IN DENTAL PRACTICE

1 THE CODE OF PRACTICE - RATIONALE
1.1 The objective of this Code of Practice is to protect patients and dental health care personnel against the risks of cross infection in the dental surgery environment. The major risk of infection to dental health care personnel is the repeated exposure to blood and to mixtures of blood and saliva, which may be contaminated with a wide variety of microorganisms including blood-borne viruses. Patients carrying blood-borne viruses may be asymptomatic and unaware of their carrier or infectious status. Medical histories and physical examinations cannot reliably identify all carriers of blood-borne diseases.
1.2 All blood and saliva must be considered infectious. Screening of patients may not detect all potentially infectious agents.
1.2.1 In New Zealand, Hepatitis B Virus (HBV) infection is endemic, and Hepatitis B is the most common serious infection transmitted in the dental surgery environment. Asymptomatic carriers of HBV with no history of clinical hepatitis or jaundice, are prevalent in some geographic areas and amongst certain ethnic groups, particularly Maori, other Polynesians, Chinese and people of South East Asian decent.
1.2.2 The Hepatitis C Virus (HCV) is blood-borne and transmitted in similar ways to HBV; measures to control HBV cross infection should also be effective in controlling HCV.
1.2.3 The Human Immunodeficiency Virus (HIV) is also of concern because of the serious consequences of this infection, although transmission in the dental surgery environment is extremely unlikely because of its low prevalence in New Zealand and relatively lower infectivity.
1.2.4 Infection control measures designed to protect against the asympotomatic HBV carrier should protect patients and dental health care personnel against other blood-borne infectious agents including HIV, and are the appropriate model for dental practice. Disinfection regimens that inactivate HBV may not inactivate more resistant micro-organisms such as Mycobacterium tuberculosis.

2 THE CODE OF PRACTICE - RESPONSIBILITY/IMPLEMENTATION
2.1 Dentists have a professional responsibility to ensure the safety of their patients and staff. The dentist, as leader of the health care team, is responsible for implementing this Code, and its introduction requires all staff to be thoroughly trained and fully informed of the Code. Practice procedures in infection control should be reviewed, reinforced and updated regularly, with copies of the Code document available in the surgery.
2.2 The principle embodied in this Code of Practice document is to treat all patients’ body fluids, such as blood and saliva, as potentially infectious.
2.3 Standard precautions and procedures are those that dental health care personnel must follow when in contact with biological hazards from contamination with patient body fluids. These precautions and procedures provide protection from any potential pathogen(s) that may be present in body fluids. The following Guidelines apply with all patients.
3 GUIDELINES FOR STANDARD PRECAUTIONS AND PROCEDURES
3.1 Medical History
A thorough medical history should be obtained from all patients at the initial patient appointment and updated at all recall visits. It will assist in determining health disorders relevant to proposed dental treatments, but cannot be relied upon to identify patients who are asymptomatic carriers and who are unaware of their infectious state.
3.2 Vaccination
The New Zealand Dental Association recommends that all clinical dental personnel should be vaccinated against HBV as this is the most effective method of personal protection against acquiring HBV infection from patients. Vaccination does not, however, reduce the need for strict adherence to effective infection control practices, as other chronic virus carrier states are known to exist for which there is no vaccine available.
3.3 Personal Hygiene
3.3.1 Fingernails should be short and clean. Rings, watches and arm jewellery should not be worn.


      1. Hands should be washed using surgical soap and/or an antiseptic handwash and dried with a single use disposable paper towel. This reduces the numbers of resident and transient micro-organisms which are capable of transmitting disease. Handwashing should occur before and after every patient contact.

Any cuts or open skin lesions should be covered with a waterproof dressing. Dental health care workers who have exudative lesions or weeping dermatitis of the lower arms/hands or face, should refrain from direct patient contact until the condition is resolved.


3.3.3 Personnel may wear a specific uniform. A clean and freshly laundered uniform should be worn each day/duty. The uniform can be domestically laundered.
3.3.4 Food and drink must not be consumed in the clinical and sterilising areas.
3.4 Personal Protective Equipment
The Health and Safety in the Workplace Act requires compliance with the wearing of personal protective equipment (PPE) by health care workers when dealing with biological hazards in their workplace.
3.4.1 Gloves
Latex or vinyl non-sterile, disposable, properly fitting gloves protect clinical dental personnel from exposure to blood and saliva through cuts and abrasions, often found on the hands but not always visible. These gloves must be worn for all patient examinations and procedures unless extraordinary circumstances apply.
Gloves are single use items and must not be used on another patient. They should be replaced as soon as possible if damaged. If soiled, gloved hands can be washed clean during treatment of the same patient. However, repeated washing may damage the integrity of the glove barrier, and changing of gloves is recommended in this situation. It is mandatory to change gloves before treatment of another patient.
3.4.2 Masks/Chin-Length Shields
Facemasks should be routinely worn during dental treatments capable of causing splash or splatter. This includes procedures in which there is use of high-speed hand pieces, ultrasonic scalers, manipulation with sharp cutting instruments during periodontal and prophylaxis treatments, spraying air and water into the patient’s mouth during treatment and intraoral surgical procedures.
Masks/shields should be changed when they become wet, ie typically between patients. In situations where a heavy aerosol is generated, masks/shields may need to be changed during the course of the treatment. Changing the mask/shield between patients also prevents a potential route of cross-infection if the gloved hand accidentally touches a contaminated face mask/shield.
3.4.3 Protective Eyewear
Protective eyewear is worn to protect eyes and mucous membranes from damage from macroscopic particles, chemical injury, and microbial infection. Eyewear must be impact resistant and should have solid side shields to afford peripheral protection. They should not distort vision and must be able to be decontaminated with a cleaning agent/disinfectant between patients.
Patients should be requested to wear protective eyewear during their treatment.
3.4.4 Outer Protective Clothing
For clinical practice, regardless of what is personally worn (street clothes/corporate uniform), outer protective clothing should be worn when undertaking procedures that involve the likelihood of body fluid contamination. The outer occupational garment should be fluid resistant but need not be fluid proof. The garment should be made of material that does not permit blood or other potentially infectious materials to pass through or reach the dental health care worker, clothes or epithelial or mucosal tissues, ie ideally a disposable, semi-pervious, non-woven gown. The outer protective garment should have a high neck and long sleeves to protect the arms if splash and splatter occur.
Protective garments should be changed at least daily and definitely when visibly soiled.
Protective garments and protective equipment must be removed before leaving the clinical area.
3.5 Work Methods
Transmission of infection can potentially occur from patients to dental care personnel and vice versa by a number of pathways in the dental surgery environment. Work habits of the dental care team must be developed so that the risks of cross infection are minimised.
3.5.1 The concept of a primary clinical area around the patient should be developed. This area would include the work surfaces of both the dentist and the dental assistant, but excludes clinical notes, computers and x-ray viewers, which should be kept away from the primary clinical working area.
3.5.2 Touching instruments, equipment and furniture outside the primary clinical working area during treatment, spreads contamination beyond the primary clinical area.
3.5.3 Touching surfaces, stored instruments and materials by contaminated gloved hands should be avoided to prevent spreading contamination. By using overgloves or transfer forceps to remove additional instruments from a drawer, contamination can be avoided.
3.5.4 A system of sterile instrument delivery (such as a tray system) should be developed. Each patient treatment should be carefully planned so that all instruments and materials necessary for patient care are available within the primary clinical area, thus further reducing surface contamination. It is unnecessary and impractical to adopt measures of asepsis and control of cross infection that are more appropriate for an operating theatre environment.
However, where surgical procedures are being undertaken, the sterility of instruments should be further maintained by:

- use of packaged sterile gloves

- use of disposable sterile surgical drapes on bracket tops

- maintaining a no-touch technique


3.5.5 There is a danger of contamination being spread via aerosols; critical items outside the primary clinical area should therefore be stored under cover or removed from the bench tops. Drawers and cupboards should not remain open during treatment, otherwise contents should be considered to have become contaminated.
3.5.6 Effective sterilisation and disinfection of potentially contaminated equipment and surfaces must be carried out between all patients.
3.5.7 Disposable materials and equipment should be used where appropriate.
3.5.8 A new sterile disposable needle and a new cartridge of local anaesthetic must be used for each patient requiring local anaesthetic.
3.5.9 Particular care should be taken to avoid needle-stick injuries and cuts from sharp items. Needle-stick injuries offer the greatest potential for serious cross infection and resheathing needles increases the risk of unintentional needle-stick injuries. Gloves do not provide protection against this injury.
When recapping the dental syringe, a one-handed technique should be used - either a scoop technique or preferably with a protective recapping device. Needle recapping must never involve two hands because of the potential for injury. Workflow practices should be developed to minimise cross-reaching by assistants and inadvertent needle-stick injury.
3.5.10 Minimising Aerosols and Splatter - in order to reduce the risk of disease transmission in the dental environment, the spread of blood and saliva can be minimised by reducing the generation of aerosols and splatter and reducing the bacterial load. This can be achieved by –

1 Use a high volume evacuator which exhausts externally during aerosol-creating procedures such as ultrasonic and airturbine procedures.

2 Use of a rubber dam reduces the risk of contamination by infective aerosols. (Use whenever possible to isolate an area of the patient’s mouth during treatment.)

3 Use of an antimicrobial mouthwash by the patient for 30 seconds prior to any intraoral procedure - especially high speed instrumentation - reduces the resident and transient microorganisms which are capable of transmitting disease.

3.6 Sterilisation
3.6.1 Sterilisation

The complete destruction of all micro-organisms on an inanimate object or instrument.


3.6.2 Disinfection

The destruction of organisms in the non-sporing or vegetative state using either heat and water (thermal) or chemical means.


Note:

1 Disinfection of instruments has been replaced by sterilisation. In dentistry, chemical disinfectants have limited use.

2 Immersion in a cold chemical disinfectant solution instead of the use of an autoclave is not appropriate for several reasons:


  • Sterilisation by chemical solutions cannot be biologically monitored.

  • Instruments sterilised by chemical solutions must be handled aseptically, rinsed in sterile water and dried with sterile towels – procedures that are generally not practical.

  • The effect of chemical ‘sterilisation’ is variable, from sterility at one extreme to minimal reduction in microbial contamination at the other.

  • Contact time to achieve sterility is 6-10 hours.

3.6.3 Decontamination



The cleaning - either through manual or mechanical method - of visible dirt or bioburden.
3.6.3.1 Decontamination MUST occur prior to disinfection or sterilisation procedures.
All used instruments are to be thoroughly cleaned before any sterilisation procedure. Autoclaving of instruments that have not been cleaned, bakes the blood and mucus onto them, which may leave viable bacterial and viral contamination underneath and within the baked layer. The steam does not have access to these organisms.
The use of utility gloves over clinical gloves during cleaning is highly desirable to reduce the risk of injury by sharps.
Household detergents are not to be used as they interfere with the sterilisation process. Purpose- designed detergents are available to facilitate cleaning. Ultrasonic machines should then be used to remove non-visible bioburden. All items/instruments are rinsed after cleaning and prior to being placed in the ultrasonic machine.
Heavy items such as extraction forceps do not allow the ultrasonic machine to work well and should be placed into the ultrasonic machine separately.
All items are then rinsed before being placed in the steriliser.
3.6.3.2 An Autoclave MUST be used for Sterilisation
All reusable, heat-stable instruments and other items that come into contact with the patient’s blood, saliva, or mucous membranes, must be sterilised before reuse. All hand pieces must be sterilised. The majority of reuseable dental instruments are heat stable and should withstand repeated exposure to heat sterilisation cycles. The autoclave must be loaded and operated according to the manufacturer’s instructions; an incorrectly stacked or overloaded steriliser will be inefficient, preventing total access to the instruments by the steam.
Note: Items that are not heat stable (eg. plastic saliva ejectors, some x-ray film holders, and polishing cups) should be single use and discarded after use.
3.6.3.3 Controls MUST be Performed
To ensure the effectiveness of the sterilising cycle initially, the autoclave should be calibrated by the supplier and the whole sterilisation process from cleaning through to packaging and loading, validated by the dentist.
3.6.4 Validation
3.6.4.1 An on-site chemical and biological test to establish that the loaded autoclave will consistently achieve sterilisation. (AS/NZS 4815:2001 Appendix H is an acceptable validation procedure.)
3.6.4.2 An autoclave should be recalibrated following service, and the sterilisation process also revalidated following service and any modification of technique, packaging, load size or content, also any technical changes to the autoclave. If there is no deviation from the verified sterilising process, sterility of processed instruments can be assumed.
3.6.4.3 As confirmation that instruments have been exposed to the verified sterilisation process, chemical indicators should be included in every load/package. Any change in colour (eg lightening) may indicate that the autoclave has become inefficient and cannot be relied upon to produce acceptable sterility.


        1. Monthly biological testing of the autoclave is suggested to confirm ongoing validation of the sterilisation process.

        2. Clear and adequate records should be kept of routine testing of the autoclave.


Any failure of a biological test indicates a need for revalidation or service.
Note: Instruments that are to be stored should be sterilised in correctly sealed packaging that is intended for this purpose. Pins, staples or paper clips should not be used as these make holes in the wrap that permit entry of microorganisms. Sterile packaged instruments should be correctly stored in a designated area that does not compromise sterility.
Some earlier models of autoclaves were not designed to take packaged instruments as they do not have a drying cycle. If instruments from such autoclaves are packaged and sealed after autoclaving to prevent them from being contaminated, they cannot be considered to be a sterile pack.
3.7 Cleaning & Disinfection
3.7.1 Environmental Surfaces
Surfaces most likely to become contaminated with bioburden (body fluid/soilage/splatter) as a result of treatment procedures, are to be cleaned and then disinfected after each patient consultation. These surfaces include, but are not limited to, the patient chair, dental tray, spittoon, overhead light handle, x-ray head and any items/surfaces which have been contaminated with bioburden from dental personnel gloves, eg composite syringes, capsules, spatulas, mixing slabs, curing light surfaces and drawer handles.
Disposable contact wrap or commercially available ‘fitted’ covers, where applicable, can be used on frequently contaminated surfaces, eliminating the need for cleaning/disinfecting. The wrap/cover must be changed between patients.
Note:

Using a disinfectant on, for example, a bracket top between patients, does not result in a sterile surface and if incorrectly used, merely functions as a cleaner. Where sterility of instruments is to be maintained, they should not be in contact with a disinfected but non-sterile bracket top. The bracket top should be covered with a disposable sterile plastic drape. These are readily available and inexpensive, providing a sterile surface from which to work.


3.7.2 Selection of Cleaning Agents
These agents are solutions used for cleaning all items of equipment and environmental surfaces. They also assist in the removal of bioburden which MUST always occur prior to any disinfecting process.
Cleaning agents for manual cleaning should be:

  • biodegradable

  • non-corrosive

  • non- toxic

  • non-abrasive

  • low foaming

  • free rinsing

  • preferably liquid

  • mildly alkaline (pH range 8.0-10.8) to assist in protein breakdown

In addition, cleaning agents should not contain any of the following agents:



  • perfumes

  • chlorine

  • fatty soaps

  • glycerine

  • lanolin

  • optical brighteners

Cleaning agents must be labelled correctly, displaying manufacturer’s name, directions and expiry date; material safety data sheets (MSDS) should be held for each cleaning product.


3.7.3 Making up Cleaning Solutions
Cleaning solutions can be either purchased as bulk concentrated solution or as a ready to use solution in the dispenser. Bulk concentrated solution may be financially practical; however, the following points need to be considered:

1 An accurate protocol for the correct dilution/strength of the working solution needs to be developed and correct measuring devices used.

2 Labelling of dispenser containers must be correct.

3 Hygienic handling and correct storage of bulk concentrated solution containers are necessary to minimise contamination and spoilage of contents.

4 Containers used to finally dispense the cleaning agent should themselves be either discarded after use or cleaned/disinfected in an appropriate manner to further prevent contamination and bacterial growth in the solution with potential for cross-infection.
Ready-to-use solution is advantageous because -

1 Errors in dilution strength are avoided.

2 Appropriate labelling of product is self-evident.
3.7.4 Cleaning Cloths
Cloths should be disposable, used once and discarded. Cloths should be damp but not dripping, to avoid further dilution of the cleaning solution.
3.7.5 Excessive Bioburden
Where there is heavy soilage of body fluids/mucous splatter, the bioburden must be first cleaned away using paper towels with gloved hands, and disposed of into the rubbish. The area is then treated as any other contaminated surface.
3.7.6 Technique

Items/surfaces are to be cleaned, followed by application of a disinfectant. The disinfectant must be left wet on the surfaces so that the required contact time can be achieved for adequate surface disinfection. At completion of the required contact time the disinfectant is then wiped away.


If a combined detergent/disinfectant is used, the product should be used once to clean away soilage and then reapplied and left wet on the surfaces for the required contact time for disinfection. The detergent/disinfectant is then wiped away. This is the preferred technique.
Notes:

1 Pump spray is preferred to aerosol fine mist spray as the release of aerosols should be controlled as much as possible.

2 Manufacturers’ recommendations regarding contact times MUST be followed to ensure effectiveness.

3 Surfaces that are not, and will not, be touched or otherwise contaminated during patient treatments, need not be cleaned and disinfected between each patient but should be cleaned and disinfected at the end of the work day.


3.7.7 Delicate Surfaces (eg around light and chair switches)
The cleaning agent and/or disinfectant should be applied onto a damp cloth and then onto the surface. Avoid applying excess solution as it can seep into joint and cracks thus making drying more difficult and potentially damaging equipment.
3.7.8 Selection of Chemical Disinfectant Agents
Factors that determine the effectiveness of chemical disinfectants:

Satisfactory contact - Disinfection is not possible unless the solution has direct and complete contact with all surfaces for the correct length of time.
Avoiding neutralisation - Hard water, plastic, rubber, organic waste/bioburden and many detergents reduce the effectiveness of many chemical disinfectants.
Concentration - A solution reconstituted below the recommended strength will not be fully effective; higher concentrations are not necessarily more efficacious and are a waste of resources.
Stability - Dilutions may deteriorate with age. The expiry date on the container must be checked before use.
Speed of action - Some chemical disinfectants destroy micro-organisms more readily than others.
Range of action - Not all chemical disinfectants destroy the same range of micro-organisms.
Cost - Using a chemical disinfectant inappropriately is expensive and inefficient.
3.7.9 Commonly Used Disinfectants in the Dental Setting
3.7.9.1 Hypochlorites (eg Milton, Domestos, Presept)

Hypochlorites destroy a wide range of micro-organisms and are effective against the Hepatitis B and HIV viruses. Their activity is reduced in the presence of organic matter, and they are corrosive at concentrations necessary for environmental disinfection.


1 For use on environmental surfaces – 1000ppm free chlorine or 0.1%
To make up a 1000ppm solution that is stable for 1-30 days, dilute a 5.25% NaOCl solution by one part bleach to 15 parts water. This solution must then be stored in a closed brown bottle. Solution to be dispensed into squeegee bottles on a daily basis and any unused solution discarded at the end of the day.
2 For use directly on blood and body fluids – 10,000ppm or 1%
Caution: Care must be taken to obtain the correct dilutions.

Not recommended for: upholstery (bleach/fade), benchtop units, chrome and other metal surfaces.

Recommended for floors, ceramic basins, body fluid contamination.

Contact time: 10 minutes.


3.7.9.2 Alcohol

Isopropanol or ethanol in 70% - 90% solution is suitable to rapidly disinfect physically clean surfaces and some clinical equipment. It evaporates quickly leaving the surface dry, but penetrates organic material poorly. Alcohol destroys most viruses but not spores.


Caution: These solutions are flammable. The solutions must be stored in a cool, well ventilated area. Care must be taken when spraying solution for alcohol dispersion into the atmosphere. Squeegee bottles are more appropriate than spray bottles. Alcohol damages the shellac mounting of lensed instruments and tends to swell and harden rubber and certain types of plastic tubing after prolonged and repeated use. It can also bleach rubber and plastic tiles.

Not recommended for: delicate monitoring or electronic equipment.

Recommended for: physically clean bench tops, chrome and stainless steel surfaces and ceramic basins.

Contact time: at least two minutes is necessary to destroy HIV.


3.7.9.3 Phenolics and Quaternary Ammonium Compounds

These two groups are used mainly in detergents. Microbial kill ability at varying strengths remains difficult to verify; however, their ability to inactivate bacteria through destruction of cell walls is proven. The effectiveness of both is influenced adversely by hard water and soap.


Recommended for: floors, bench tops, walls, furniture.
Note: Environmental surfaces, floors and walls should be smooth to facilitate cleaning. Carpet is not allowable in the clinical environment.

Contact time: ten minutes.




    1. Water Lines

3.8.1 Many dental unit water lines contain retraction valves to prevent dripping, and the potential exists for infectious material to enter the water lines. The water supply to handpieces, air/water syringes and ultrasonic scalers should be flushed for 30 seconds prior to the commencement of treatment each day and for 20 seconds after each patient.


3.8.2 Additional steps should also be taken to ensure non-contamination of water lines -
3.8.2.1 Anti retraction valves (one-way flow check valves) may be required by Local Body Regulations to be installed to prevent fluid aspiration and reduce the potential for transfer of potentially infective material into the public water supply. Routine maintenance of these valves is necessary to ensure effectiveness.
3.8.2.2 Fitting a bottled water supply to the dental unit to supply all water lines allows the use of distilled water, and also provides the ability to flush through and disinfect water lines daily.
3.9 Disposal of Wastes
3.9.1 Contaminated sharp disposables (needles, scalpels and local anaesthetic cartridges) must be handled with extreme care to avoid injuries. They must be placed in a rigid impervious container, which can be sealed prior to disposal.
Sharp containers shall meet the requirements specified in AS/NZS 4031:1992 or AS/NZS 4261:1994 as appropriate.
Commercial management of sharp disposables is recommended.
3.9.2 All contaminated disposables, including waste drugs and other surgical waste, should be placed in a secure container. Disposal is not permitted in general refuse services provided by the local authority.
Commercial management for the disposal of hazardous medical waste is available in most major centres in New Zealand and is recommended.
3.9.3 Liquid wastes should be disposed of by carefully pouring into the sewerage drainage system followed by a free flow of running water, eg flushed down toilet or sluice.
Note: Local Body Regulations apply to the final disposal of the various categories of waste. The New Zealand Standards Association is currently (2000/01) updating the first draft of the New Zealand Standard 4304:2000 Management of Health Care Waste. Dentists are strongly encouraged to contact their Local Body Authority for specific instructions on the disposal of clinical waste.
3.10 Technical Laboratory Items
3.10.1 Impressions and appliances should be rinsed under running water to remove saliva and visible blood. They should then be sealed in a suitable container (eg an autoclave pouch), and labelled as disinfected or not disinfected prior to dispatch to the laboratory, which should in turn, apply its own code for the control of cross infection.


      1. In the laboratory, technicians should wear gloves when handling contaminated items.

3.10.3 Completed appliances should be disinfected before insertion.


Note: Because the compatibility of an ever increasing variety of impression materials with a disinfectant varies, manufacturers’ recommendations for proper disinfection should be followed.
3.11 Instruments for Repair
All heat-stable instruments, including hand pieces, should be cleaned and sterilised and sealed in a suitable container (eg an autoclave pouch) as for normal patient preparation before being sent for repair. For the service person’s information, the item should be labelled as ‘sterile’.


  1. CONCLUSION

The NZ Dental Association has broadened its Code for the Control of Cross Infection in Dental Practice to reflect current knowledge of infection transmission and disease.


Within the context of a constantly evolving information base, dentists are encouraged to continually evaluate their infection control strategies and procedures. In this way, the profession can ensure that a safe environment will exist for all.

ACKNOWLEDGEMENTS

The New Zealand Dental Association acknowledges the support and assistance of Francie Morgan, Independent Infection Control Consultant, in the revision and preparation of these Guidelines.



BIBLIOGRAPHY

1 Recommended infection control practices in dentistry. Morbidity and Mortality Weekly Report RR-8, May 28, 1993 (ftp://ftp.cdc.gov/pub/Publications/mmwr/RR/RR4208.pdf).


2 Recommendations for hygiene in dental practice, including treatment for the infectious patient - Federation Dentaire Internationale Technical Report No 10 International Dental Journal 37: 142-145, 1987.
3 Greenspan, D et al AIDS and the Dental Team, Copenhagen: Munksgaard 1986.


  1. Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-prone Invasive Procedures - Morbidity and Mortality Weekly - Report 40; 1-9 1991

5 Referees' Reports requested by Dental Council of NZ, 22 October 1992.

5.1 Dr Robin Woods AM, BDS, FRACDS, FICD

Chairman - Australian Dental Association Infection Control Committee

- (Australian) National Health & Medical Research Council - Dental Health Committee - FDI Commission on Dental Products.

5.2 Helen Hefferen, Scientist

NZ Communicable Disease Centre
6 Definitions - Sterilisation and disinfection from Faculty of Dentistry University of Otago - April 1993
7 APIC (Association for Professionals in Infection Control and Epidemiology

Principles and Practice, Mosby  1996


8 Introduction to Sterilisation, Disinfection and Infection Control. Second Edition. Gardner/Peel, Churchill Livingsone  1991. Pgs 34-35.
9 Occupational Safety and Health in Dental Practice. NZDA Guidelines 1996
10 Code of Practice for Cleaning, Disinfecting and Sterilising Resusable Medical and Surgical Instruments and Equipment, and Maintenance of Associated Environments in Health Care Facilities, AS 4187, 1994.
11 Infection Control and Applied Epidemiology Principles and Practice Association for Professionals in Infection Control and Epidemiology INC, 1996

i) Chapter 88, Dental Office



  1. Section E Cleaning, Disinfection and Sterilisation

12 Applied Microbiology for Nurses, Gould and Brooker  2000. Chapter 5, pgs 103-112


13 Infection Control Recommendations for the Dental Office and the Dental Laboratory, American Dental Association (ADA) Council on Scientific Affairs and ADA Council on Dental Practice, Journal American Dental Association, 1992: 123(8) (Supplement).


  1. Australian/New Zealand Standard AS/NZS 4815:2001


COMPLIANCE CHECK LIST



General



Staff training



Documemted infection control policy



Policy reviewed, reinforced, updated.



Practice follows “Standard Precautions”



Bioburden removed prior to disinfection or sterilisation



Hepatitis vaccination for staff or signed declination



Staff aware of cuts and needle-stick potential



Current medical histories for patients


Personal Hygiene



Staff fingernails short and clean



No personal jewellery



Efficient handwashing before and after treatments



Cuts and open skin lesions covered


Personal Protective Equipment



New pair of gloves per patient


Work Methods



Work methods minimise risk of cross infection



Designated primary clinical area



No cross contamination of primary clinical area



All environmental surfaces, floors and walls smooth and easily cleaned



Sterilised instruments segregated



Required instruments available in the primary clinical area



Staff wear protective glasses and barrier face masks



Patients offered protective eyewear



Outer protective clothing worn/laundered/disposable/confined to surgery



No food or drink in the clinical areas



Disposable local anaesthetic and needles



Protocol to be implemented for needle-stick/sharp injury/body fluid splash - OSH



Documentation of all needle-stick/sharps injury/body fluid splash - OSH


Sterilisation, Cleaning & Disinfection



Only sterile instruments penetrate tissues.



All heat stable instruments sterilised



All heat sensitive equipment disposable and discarded



Cleaning and disinfecting agents stored correctly



Instruments precleaned, autoclave correctly loaded, stacked, suitable water



Autoclave maintained, calibrated and sterilisation process validated



Water lines flushed / anti- retraction valves / bottled sterile water



Correct disposal of sharps, contaminated disposables, liquid wastes



Impressions and models rinsed, disinfected and contained for transport



Instruments and handpieces sterilised before dispatch for repair




NZDA Code of Practice Control of Cross Infection in Dental Practice

Revised April 2002



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