DTUK1010

April 19-25, 201014 Infection Control Tribune United Kingdom Edition T he Department Of Health’s Decontamina- tion Health Technical Memorandum 01-05 Decontami- nation in primary care dental practices says – “Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised as much as possible”. Unfortunately, everyday pa- tients and all of a practice’s staff members face the potential risk of coming into contact with po- tentially harmful, even fatal, hidden threats from various mi- croorganisms which might be covering the surfaces of every piece of equipment they come into contact with. The hidden threats from these potential haz- ards are frequently overlooked, maybe even ignored, even though they represent a signifi- cant risk to all concerned. There cannot be a dental practice in the country that is unaware of the cross infection risks posed by inadequate decon- tamination and subsequent steri- lisation of their dental equip- ment. Therefore, the routine use of ultrasonic cleaners, washer disinfectors, various types of autoclave or steam steriliser is taken for granted. However there may be many equally dangerous, hidden, threats lying undiscov- ered and neglected on virtually every hard surface within the practice, certainly within the clinical areas. What are these risks? Virtually every day, each indi- vidual is exposed to count- less millions of microorgan- isms which are entirely safe and present no threat to any- one. However, there are also a multitude of pathogenic micro- organisms, which can cause in- fections, also circulating in the population. These microorgan- isms can be transferred from one individual to another in a variety of ways. The most likely routes within the dental practice envi- ronment are :- Hands - probably the most im- portant vector for the transmission of infection between patients and/ or the practice’s team members. Indirect contact - via an in- termediate carrier (eg crawling or flying insects or an inanimate ob- ject) which has become contami- nated with infected organisms. Inhalation - whereby patho- genic microorganisms are ex- haled or discharged into the at- mosphere by an infected person and then inhaled by another per- son (eg the common cold). Direct contact - when one person infects another person by direct person-to-person contact (eg chicken pox). Ingestion - when microor- ganisms capable of infecting the gastro-intestinal tract are ingest- ed (eg “common” stomach bugs). Many of the above can be relatively easily prevented by taking appropriate basic hygiene precautions. These include wash- ing hands between patients and wearing appropriate protective clothing (disposable gloves, face masks, etc). Such precautions protect the patient from the den- tist and visa versa. However, not all of them! Some of the above, those involving intermediaries eg inanimate objects, necessitate the thorough implementation of ap- propriate and effective cleaning regimes in between patients. The Chain of Infection TheChainofInfectionwasfirstde- scribed by Storr and Clayton-Kent in 2004. It consists of the source of the infection, the mode by which it is spread, the person at risk and any potential points of entry. The easiest way to break this chain is by interrupting the mode by which it is spread. Because hands represent the most important vector for the transmission of infection between patients and members of the practice team, the single most effective way to prevent the spread of pathogenic microor- ganisms within any clinical envi- ronment is effective hand wash- ing. This should be performed for at least two minutes when entering and leaving the clini- cal area, between patients, after visiting the toilet, when chang- ing gloves and whenever one’s hands are visibly soiled. Alcohol gels can be used on visibly clean hands, but if used regularly they cause a build up. Therefore, they should never be used solely, as an alternative to effective hand washing with soap and water, and it is never acceptable to wash or gel gloves with a view to reus- ing them. Gloves should always be replaced in be- tween patients. Best Practice for hard surfaces Ideally, all basic de- contamination proc- esses for small items of equipment etc should take place away from any other activities, preferably in two dedicated decontamina- tion rooms with a clearly defined route from dirty to clean. This is not possible for larger items of equipment, fixtures and furnish- ings however. Therefore, wher- ever possible, any work surfaces and equipment should be imper- vious and easily cleanable. The work surfaces and floor cover- ings should be continuous, non- slip and ideally seamless. Wher- ever possible, carpets should be avoided within any clinical or associated areas. Coving should be used between the floors and walls to prevent any dust and dirt accumulating in corners and crevices, with any unavoidable joins welded or sealed shut. A thorough and effective cleaning protocol can be eas- ily based upon utilising simple techniques employing disposa- ble cloths moistened with either clean water or a suitable alco- hol-based or alcohol-free disin- fectant. Alcohol-free wipes are particularly suitable for alcohol susceptible surfaces eg the leath- er and synthetic upholstery of dental chairs, plastics, vinyl’s etc. Wherever possible, cleaning us- ing dry cloths should be avoided because this creates dust, which can form another hazard. Should any blood contami- nation occur, one per cent sodium hypochlorite with a yield of 1,000 ppm free chlo- rine is recommended (unless the PCT policy advises some- thing else). However an even higher free chlorine yield of 10000 ppm is better still. Con- tact times should be reason- ably prolonged and instigated as quickly as possible. Care should be taken to avoid corrosive dam- age to metal fittings etc. Use of alcohol within the same clean- ing process is not recommend- ed because it binds blood and protein to metal surfaces. Even if they appear uncon- taminated, all clinical areas should be cleaned in between patients using disposable cloths or microfiber materials. The ar- eas and equipment to be cleaned in between patients include all the work surfaces, chairs, cur- ing lights, inspection lights, keyboards and mice, hand con- trols, X-ray units, trolleys, spit- toons and aspirators. Disposable single-use protective covers are available for use on many of these items, but they should not be considered or used in place of implementing a thorough and regular cleaning protocol. Therefore, in between patients they should still be removed and the underlying surfaces cleaned. The main areas and items of equipment to be cleaned af- ter each session include taps, drainage points, splashbacks, cupboard doors and sinks. While items of furniture that need to be cleaned regularly include win- dow blinds, door handles, inci- dental chairs and furniture. Hard surface disinfectants Nowadays, more environmen- tally-friendly materials (eg Am- monium Chlorides and Ethanol) are available compared with the unpleasant smelling and aggressive chemicals (glu- Simple ideas for eliminating the risk of cross-infection Kathy Porter, Senior Dental Nurse (Decontamination) at Birmingham Dental Hospital, describes the common cross infection threats faced by everyone in the dental practice and “Best Practice” for eliminating them