A Guide to Infection Control for Dental Nurses
Infection control is a critical area for dental nurses to understand, practice and keep updated on.
As seen during the Coronavirus pandemic, the nature of infections and emergence of new variants means infection control legislation and guidance is regularly changing.
However, many infection control protocols (ICPs) and cleaning techniques are evergreen. This blog aims to cover off some of those protocols and cleaning techniques and point you towards the most effective infection control products currently on the market.
What is cross-infection?
Cross-infection is the transmission of pathogenic bacteria, fungi, parasites or viruses (pathogens) from one place to another, either directly or indirectly.
Microorganisms can be transmitted in a variety of ways, including coughing and sneezing, touching surfaces, touching other people, through unsterilized equipment, unsanitary clothing or the prolonged use of intravenous lines.
Infection control procedures within a dental practice aim to prevent the transmission of infectious agents during patient care.
What is HTM-01-05
HTM 01-05 is the document from the Department of Health covering the standards of decontamination work required in dental practices. It was designed to raise the quality of decontamination procedures and ensure compliance across the industry.
Cross-infection control measures
There are several important cross-infection control measures that all practices should implement. These include:
Hand hygiene - Hand washing with an appropriate hand sanitizer should be carried out before and after patient contact, procedures, donning PPE and before the cleaning of instruments or surfaces
PPE - Patients should be provided with the appropriate Personal Protection Equipment (PPE) during their appointment. This is usually a bib, eye protection and a rubber dam when appropriate, and this may need to be changed should it become soiled.
Dental nurse PPE can include scrubs, gloves, eye protection, disposable aprons and face masks. PPE should not be worn outside of the practice and items that are not single use should be washed according to the manufacturer’s instructions at the highest possible temperature.
Ventilation - The dental surgery should be well ventilated to combat the infection risks posed from aerosol generating procedures (AGPs). High-volume suction should also be used when appropriate for aerosol control.
Current fallow time guidelines should be adhered to in order to aid infection control.
Manual Cleaning - Dental instruments can be hand cleaned using an appropriate detergent prior to sterilization. Warm water should be used at no higher than 45 degrees Centigrade.
Washer Disinfectors - Automated cleaning using a washer disinfector is widely considered the most effective solution for cleaning dental instruments prior to sterilization. Using a washer disinfector enables a fully audited and validated process for regulatory compliance. Manufacturer’s instructions should be followed and an appropriate detergent used.
Ultrasonic Bath - Ultrasonic baths are widely used in dental practices prior to sterilization. They use high frequency soundwaves to kill bacteria and other pathogens.
Ultrasonic cleaners can be more effective than manual cleaning, especially on complex and hinged instruments. They can also reduce the chances of splashes and sharps injuries.
Sterilization - Once cleaned, dental instruments should be sterilized using an autoclave. Autoclaves use steam and pressure to kill stubborn viruses.
Sterilization of Dental Clinical Guidance (SDCEP) guidance advises a temperature-pressure-time relationship for all small steam sterilizers of 134–137°C, 2.1–2.25 bar gauge pressure for at least a 3-minute holding time.
Packaging - Sterilized, dry dental instruments can be sealed in appropriate pouches and kept for 12 months before use. Unpouched instruments can be kept in a covered, airtight container in a non-clinical area for one week. Instruments should be packaged away from cleaning areas to reduce cross-infection risk.
Waste management - Clinical waste (blood or saliva contaminated waste) should be disposed of in orange clinical waste bags. Used sharp items should go in a Sharps Box and amalgam contaminated items in amalgam waste. A competent waste disposal company should be contracted to remove the waste from site.
It is the responsibility of the entire dental team, including dental nurses, to follow the latest Control of Substances Hazardous to Health guidance (COSHH) when handling or disposing of waste.
Zoning - Clear zoning areas for dirty to clean workflow are essential to ensure infection control compliance and reduce the risk of cross-infection between dirty and clean instruments.
A designated dirty zone should be used for cleaning the instruments. This should be the location of the sink, washer disinfector and ultrasonic bath. The autoclave is then next in the workflow, followed by a separate clean zone for pouching the clean instruments.
Schedules, Checklists & Audits - An infection prevention schedule should be in place and a checklist on hand to help ensure a safe working environment. Checklists should have separate sections for opening the surgery and closing the surgery and include tick boxes for all key infection control measures, i.e., PPE, sharps safety and sterilization.
The Department of Health has a dental audit tool available to download for free to help your practice fight infection effectively. Download here.
Infection Control Lead - All practices should have a nominated infection control lead to ensure all staff follow the correct infection control protocols and receive appropriate training.
Effective Cross-Infection Control Products
Detergents and Disinfectants
Work surfaces should be cleaned regularly using detergent. For higher risk areas this should be followed up with the use of disinfectant.
It is normally recommended that disinfectant lay wet on the surface for two to three minutes to ensure efficacy. Always make sure your detergents and disinfectants are compatible with the surface you’re cleaning.
When using a detergent for manual or automated cleaning of instruments, seek out non-foaming detergents as these are less likely to leave residue on instruments.
Top Selling Disinfectant - Clinell Universal Disinfectant Spray 500ml
Excellent Value - DEHP Safe R Surface 1Ltr With Sprayhead
Top Selling Detergent - Gigazyme 2Ltr
Excellent Value - DEHP Safe-ST Enzymatic Instrument Cleaner 1L
Disposable, non-linting clothes should be used when spray cleaning surfaces. Disinfectant and detergent sprays should be applied to the cloth instead of the surface to reduce splash.
Microfibre cloths should be used for wiping down environmental areas within the surgery, such as radiators and window sills.
Top Selling Disposable Cloths - DEHP Lint Free Dry Cleaning Cloth 32x36cm 25pk
Disposable wipes containing disinfectant can be used for quick and effective removal of dirt. Some dentists choose to use alcohol-based wipes, although HTM 01-05 identifies that “alcohol has been shown to bind blood and protein to stainless steel” and therefore “the use of alcohol with dental instruments should…be avoided”. Alcohol-based wipes can also dehydrate the surfaces of dental chairs.
Look for non-toxic, fast action, odourless wipes that have a wide compatibility with surfaces in the surgery.
PPE should be used when cleaning with wipes to avoid cross-infection. Spillage kits should be used to wipe up bodily fluids.
Top Selling Disposable Wipes - Biocleanse Ultra Disinfectant Wipes Refill 200pk
Excellent Value - DEHP Safe-ST Surface Wipe Alcohol-Free Refill 100p
Efficient hygiene using hand disinfectant gel is essential for protecting against pathogens and reducing the chances of cross-infection.
The best dental hand cleaners should be gentle on the skin to prevent dryness and soreness.
Excellent Value - Desderman Pure Gel 1Ltr
Sterilization pouches are single-use and designed to hold items during sterilization. Different pouches are required depending on the sterilization process. A variety of pouch sizes are available to cater for different instruments.
Top Selling Pouches - DEHP Sterilisation Selfseal Pouch 89x254mm 200pk