Minimising the risk of infection transmission is vital for a dental practice to fulfil its duty of care to patients and staff and effective infection prevention is an ethical and legal responsibility for all UK practices.

As stated in HTM 01-05 guidelines, all practices are required to have an individual written infection control policy that addresses requirements unique to the practice. This document is the responsibility of the Decon Lead and must be regularly updated and readily available to all employees.


The principles of infection

There are three essential elements needed for an infection to spread: a pathogen, a target, and a route.

  • A pathogen is defined as a microorganism capable of causing harm.
  • The target is a susceptible host for pathogens to infect.
  • The route refers to the route by which the infection spreads.


Pathogens in the dental environment


There are many types of pathogen present in dental surgeries, and all have a variety of modes of infection. A dental practice will regularly encounter potentially harmful micro organisms, including TB, influenza virus, hepatitis B, adeno-virus, herpes simplex virus, vaccinia virus and antibiotic-resistant MRSA bacteria.


There are a variety of methods of transmission for these pathogens and it’s easy to see how these can be easily spread if correct infection control procedures aren’t followed.


    
    
  • MRSA bacteria: skin contact.
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  • Hepatitis B: blood and saliva.
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  • Adeno-virus: droplet infection (i.e. aerosols), faecal and oral routes.
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  • TB bacteria: droplet infection (i.e. aerosols).
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  • Herpes simplex virus: direct contact with lesion or bodily fluid.
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  • Vaccinia virus: cracks on skin.
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  • Influenza virus: droplet infection (i.e. aerosols).
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Routes of transmission in the dental environment


Understanding the routes of transmission is key for effective infection control, helping to ensure that obvious and often-overlooked risks are accounted for in a practice’s individual infection control policy. The key routes of transmission in the surgery are:




Contact with contaminated instruments


Reusable dental instruments regularly become contaminated with blood, saliva and other fluids. Reprocessing of instruments kills microorganisms, and sterilisation is a mandatory step in breaking the chain of cross-infection.


Contact with contaminated water by ingestion or inhalation


Dental unit water lines (DUWLs) are especially susceptible to biofilm, making them a prime breeding ground for bacteria. The water from the chair’s line goes into patients’ mouth via the handpiece or 3-in-one, and this has the potential to be swallowed, and may come into contact with open wounds during oral surgery.


Hand to surface/hand to patient contact


Patients who are already infected with a cold for example can easily spread the virus through their hands when they come into contact with the reception desk or doors, posing a risk of infection for the next person who touches the surface.
Exposure to contaminated aerosols


Contaminated DUWL aerosols also pose an occupational risk to dental staff. The risk of infection transmission from aerosol generating procedures (AGPs) came under added scrutiny during the COVID-19 pandemic. AGPs produce both splatter and aerosols, potentially spreading infection from infected individuals, some of whom may be asymptomatic.


Surfaces


Harmful pathogens have the potential to live on surfaces for a long time. MRSA’s maximum expected life span on a surface is up to 7 months, TB bacteria lives up to 4 months, Hepatitis B up to 7 days, and Influenza up to 48 hours . Surfaces within the practice can easily become contaminated during treatment as a result of aerosols or touching surfaces with contaminated gloves. 
What can be done?


Breaking the chain of infection by eliminating and blocking routes of transmission with rigorous infection control and the use of correct cleaning agents is fundamental.


Work surfaces should be regularly and thoroughly decontaminated with a wide spectrum microbiocidal solution with proven efficacy against HIV, HBV, HCV, TB and enveloped viruses, including coronavirus.


Additionally, thorough cross-contamination prevention calls for infection control measures that often go beyond the Code of Practice standards, requiring measures that are specific to a practice and its equipment maintenance. These measures should then be incorporated into a practice’s infection control policy and readily available for all staff.


Dentisan has a range of decontamination products that have proven efficacy against pathogens, viruses and bacteria.
Dentisan infection control solutions


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