Infection prevention and control in dentistry is vital for safe patient care. The College is committed to working with local public health units, Public Health Ontario and the Ministry of Health and Long-term Care to help protect the public.
The following is a list of issues that public health units focus on during dental facility inspections. This is not an exhaustive list. Members must follow the College's IPAC guidelines and public health guidelines as well as the recommendations of manufacturers of sterilization and other dental office equipment to ensure patient safety at all times.
Public Health Ontario also has a list of frequently asked questions for public health units.
Important IPAC issues dentists should know about
- In the sterilization area (also called re-processing area), no sterile instruments can be stored on the dirty side. There must be a work flow in terms of cleaning and sterilizing the instruments from the dirty side to the clean side. They cannot go back and forth between the sides.
- Instruments must be pre-cleaned before going into the ultrasonic unit. They should be scrubbed with a brush and the brush should be soaked in a disinfectant when not in use.
- All autoclave cycles must be recorded. You need a log for each autoclave and each cycle. You should indicate in the log that all bags are checked after each cycle to ensure that the internal and external chemical indicators have changed colour. If your autoclave has a USB that is recording the cycle temperature, time and pressure, you should print this information at the end of the day and keep the sheets in a binder.
- Spore testing must be done daily along with a control run and documented in the logbook. Keep all documentation of the spore tests, autoclave cycles and indicators. This way you are showing three different methods of ensuring that the sterilization has worked (chemical, biological and mechanical).
- The autoclave bags must have a "class 4" internal indicator and an external indicator. Bags should not be overfilled. Instruments cannot be overlapped and on top of each other. There must be room between instruments. If they are overlapped, it is possible that the temperature in that area did not reach the appropriate level. All instruments that lock or close (forceps, scissors, etc.) must be open when in the autoclave bags. Check the manufacturer’s recommendation regarding how many instruments can be placed in the bag.
- If a dynamic air removal-type sterilizer (such as a steam autoclave) is used, an air removal test with a Class II chemical indicator (such as a Bowie-Dick Test) needs to be performed every day the sterilizer is used. The results need to be recorded in the sterilization logbook.
- All instruments must be kept in the autoclave bag and not opened until they are about to be used. This is called opening at "point of use".
- In terms of writing on the autoclave bags, some public health units want the date of sterilization written on the plastic side of the bag (using a felt tip marker). For implant instruments all units want the bags dated. This is not necessary for implantable devices. These refer to implants and membranes, which come from the manufacturer in sterile packaging. The manufacturer does the spore testing and does not release the product until they verify the tests.
- If you use cassettes these must be wrapped. Heat indicating tape must be used on the outside of the package and once they are sterilized write the date and time they were sterilized on the outside of the wrapping. Ensure those instruments have been sterilized and remain sterilized until use. You should have a master list that indicates what instruments are in each type of cassette.
- The ultrasonic unit needs to be tested as per the manufacturer’s recommendations. Follow the testing frequency recommended by the manufacturer.
- Personal protective equipment (PPE) - Staff must wear glasses when sterilizing instruments (re-processing), heavy gloves if very sharp instruments are being cleaned, etc. Each office is required to have a percutaneous injury (needle stick) protocol and manual about what to do if a staff person gets a percutaneous (needle stick) injury.
- Focus on how the wrappings on the digital radiographs are handled and how the films are handled. An inspector may look at whether saliva transfer from the films or staff members' gloves onto the scanner, keyboard, etc.
- All keyboards/mice in the operatories need to have barriers. Any keyboard/mouse that may be touched with a dirty glove needs to be covered.
- Check all expiry dates on products, including hand sanitizers, disinfectants, anaesthetic carpules etc.
- Gloves and masks have to be changed between patients, leaving the rooms, etc. Staff cannot walk to the front or around the office with gloves on, except when bringing instruments to the sterilization area.
If you need more information or have other questions, please contact our practice advisory service.