OHCWs are more likely to comply with IPAC protocols if they understand the rationale for them. Therefore, in addition to previous instruction, it is important that all OHCWs receive office-specific training in IPAC as part of their orientation, and whenever new tasks, procedures or equipment are introduced. This training should be supplemented whenever necessary and reviewed at least annually by means of staff meetings, attendance at continuing education courses and through self-learning programs.All OHCWs must receive training that includes information about their exposure risks, IPAC strategies specific to their occupational tasks, and the management of any work-related illness or injury.
Hand hygiene is necessary:
- Before an aseptic procedure
- Before putting on gloves
- After glove removal
- Before and after direct contact with individual patients
- After contact with environmental surfaces, instruments or other equipment in the dental operatory
- After contact with dental laboratory materials or equipment
- Before leaving the clinical operatory
- Before eating or drinking
- Whenever in doubt
If hands are NOT visibly soiled (i.e. the majority of instances), the use of a 70-90% alcohol-based hand rub is the preferred method of hand hygiene. It is more effective than washing with soap and water when hands are not visibly soled and takes less time.
If hands are visibly soiled (including with powder from gloves) or after performing body functions then hands should be washed with plain or antimicrobial soap and running water.
Use professional judgement for either procedure. If you think your hands have accidentally become contaminated with body fluids, wash with soap and water to remove organic matter. However, there is sufficient evidence that alcohol-based hand rubs are superior to washing with soap and water, except in cases where the hands are visibly soiled or contaminated with body fluids.
OHCWs having direct contact with a patient must keep nails clean and short. Nail polish, if worn, must be fresh and free of cracks or chips. Artificial nails and nail enhancements must not be worn. Before performing hand hygiene, hand jewelry must be removed and arm jewellery, including watches, must be either removed or pushed up above the wrist. Rings should not be worn.
Blood-borne pathogens, such as HBV, HCV and HIV, can be transmitted to OHCWs through occupational exposures to blood, saliva and other body fluids. Significant exposures include percutaneous injuries with contaminated needles, burs or other sharp instruments, as well as accidents in which blood, saliva or other body fluids are splashed onto non-intact skin or the mucosa of the eyes, nose or mouth. However, percutaneous injuries pose the greatest risk of transmission of blood-borne pathogens to OHCWs.
In the event of a significant exposure, immediate first-aid measures should be instituted:
- For percutaneous injuries, allow the wound to bleed briefly and Then, gently wash the wound with soap and water, and bandage as needed.
- For exposures involving the eyes, nose or mouth, flush the area with copious amounts of
- For exposures involving non-intact skin, wash the site with soap and
- The dentist should then assess the source patient’s status and risk for blood-borne illnesses by reviewing the patient’s medical history and, if necessary, asking them additional questions
- The injured OHCW should be given the option of attending for a medical consultation with the nearest hospital emergency department for counselling, possible baseline blood tests (for HBs Ab, HCV Ab, HIV Ab and ALT) and consideration for post-exposure prophylaxis (PEP). When necessary, PEP should be administered as soon as possible (within hours).
All instruments must be reprocessed in a central area of the dental office that is designed to facilitate quality control and ensure safety. The instrument reprocessing area must provide for one-directional flow of instruments with clear separation of dirty and clean sides to prevent cross-contamination.
All instruments must be sterilized by either steam under pressure (i.e. autoclaving), which is dependable and economical, or dry heat. Chemiclaves and bead sterilizers are NOT acceptable methods of sterilization. For steam sterilization, dynamic air removal steam sterilizers (e.g. pre-vacuum and steam-flush pressure pulse sterilizers) are preferred over gravity displacement sterilizers.
Tabletop sterilizers with recording devices are preferred. If a sterilizer does not have a recording device, the physical parameters must be checked DURING the sterilization cycle for each load and documented. Consideration should be given to replacing the sterilizer in a reasonable time. If a sterilizer does have a recording device, the physical parameters must be checked at the CONCLUSION of the sterilization cycle for each load and documented. This is to verify that the pre-programmed cycle operated correctly, and that the required conditions for sterilization existed in the chamber.
All critical and semi-critical instruments used in dentistry, including handpieces, are available in heat-tolerant and/or single-use (disposable) forms. All heat-tolerant critical and semi-critical instruments must be heat-sterilized between uses. All single-use items must be disposed following use.
Monitoring of sterilization must be conducted through a combination of physical, chemical and biological means, which evaluate both the sterilizing conditions and the procedure's effectiveness. The dental office must have written policies and procedures for monitoring of sterilization.
Physical indicators include the gauges or displays on the sterilizer for cycle time, temperature and pressure. Some tabletop sterilizers have recording devices that print out these parameters or store them electronically.
Tabletop sterilizers with recording devices are preferred. All new sterilizers must have this feature. If a sterilizer does not have a recording device, consideration should be given to replacing it in a reasonable time.
Physical indicators must be checked and recorded for each load.
Chemical indicators (i.e. internal and external) are designed to provide a chemical or physical change as a result of exposure to a defined sterilization process. For example, heat-sensitive tape, applied to the outside of a package, changes colour rapidly when a given temperature is reached. This signifies that the package has been exposed to heat, although it does not ensure that sterilization has been achieved.
For these reasons, each package must have external and internal chemical indicators. Place a Type 1 chemical indicator on the outside of each instrument package. Also, place a Type 4, Type 5 or Type 6 chemical indicator inside each package. Some pouches incorporate Type 1 external and Type 4 internal chemical indicators.
Biological indicators (BIs or “spore tests”) are the most accepted means for monitoring of sterilization, because they directly assess the procedure's effectiveness in killing the most resistant microorganisms. The spores used are more resistant and present in greater numbers than the common microbial contaminants found on patient-care items. Therefore, an inactivated BI signifies that other potential pathogens in the load have been killed.
The following requirements apply to biological monitoring:
- A BI must be placed in a PCD and used to test the sterilizer each day that it is used AND for each type of cycle that is used. The manufacturer’s directions concerning the appropriate placement of the BI in the sterilizer must be followed.
- A BI must be placed in a PCD and included in every load containing implantable devices (e.g. dental implants, temporary anchorage devices, surgical screws/plates/staples). Implantable devices must be quarantined until the BI test results are known.
- How to use chemical indicators, biological indicators, and process challenge devices to monitor sterilization
A process challenge device (PCD) is a test used to assess the performance of the sterilization process. A PCD may be created by selecting one instrument package for the load that is the most challenging to sterilize and placing a Type 5 or type 6 chemical indicator and/or a BI inside. To identify this package, label it “PCD”. The PCD is checked at the conclusion of the sterilization cycle for the load to confirm that the Type 5 or type 6 chemical indicator has passed and/or the BI has passed. You can also use a commercially manufactured PCD.
Read How to Use Chemical Indicators, Biological Indicators and PCD to Monitor Sterilization.
Spills of blood and other body substances, such as urine, faeces and emesis, must be contained, cleaned and the area disinfected immediately. If spills occur on carpets, a disinfectant other than bleach should be used. In certain cases, cleaning carpets may not be sufficient, and replacement and disposal of carpeting may be required. For further information refer to the IPAC Standard of Practice.
In order to prevent the transmission of blood-borne viruses and other microbial pathogens to patients due to unsafe and improper handling of injectables (e.g. local anesthetics, drugs and solutions for sedation) safe practices must be adhered to when preparing and administering injectables. Single dose vials should be used when possible and are preferred to multi-dose vials.For more information refer to the IPAC Standard of Practice.