This is an HTML version of an attachment to the Freedom of Information request 'Dental Practice Statistics per Year'.



Infection Prevention Procedures
This should be read in conjunction with the Infection Prevention and Control Policy (M 257A) and
documentation in (M 257C-W).
Immunisation
All clinical staff are up to date with their routine vaccinations and are immunised against Hepatitis B and
Tuberculosis (TB). The practice has additional clearance checks on file for team members who perform
exposure prone procedures (EPPs). Staff immunisation records are maintained using M 257J. The
principal will pay for the immunisation of employed team members if a charge is incurred.
Accepting patients for treatment
A patient is never refused treatment on the grounds that s/he has an infectious disease; patients who
have infections may be unaware or may be unwilling to disclose it. If a patient has a blood borne
infection the treating practitioner may obtain specialist advice before treatment commences. See the
Briefing on Ebola Guidance (B 115) for the management of patients suspected to have Ebola.
Medical History
A thorough medical history is taken by the practitioner at every consultation with the patient. The
medical history is updated by the practitioner if there is a change in status of the patient’s medical status
or prescription drugs. Confidentiality is maintained for all personal and treatment information.
Personal Protective Equipment
Clinical gloves
Non-sterile low allergy powder free latex gloves are used for clinical treatments, unless a clinician or a
patient has a latex allergy, in which case nitrile or vinyl gloves are used. Sterile surgical gloves are used
for invasive procedures. The use of gloves does not replace the need for hand hygiene. When removing
personal protective equipment, gloves are removed first.
Gloves are single-use only and are discarded as clinical waste after use on one patient or if damaged
during treatment, they are removed prior to retrieving any item from a cupboard or drawer. Used gloves
are removed by rolling inside out. Gloves are never worn outside of the treatment room. The practice is
phasing out the use of latex gloves.
Clinical clothing/workwear
Fresh clinical clothing is worn each day in the treatment room and it is changed if soiled, short sleeves
allow the forearms to be washed. Soiled clothing is stored in a specially labelled container and washed
normally at the hottest temperature suitable for the fabric to reduce any potential microbial
contamination. Clinical clothing is not worn outside of the practice and outdoor clothes are not worn
whilst treating patients. Clothing worn for decontamination is not worn outside of the practice. Footwear
is fully enclosed and in good order.
Plastic aprons
Disposable plastic aprons are worn single–use during decontamination procedures, when changing
solutions in an x-ray processor and whilst clearing up a spillage of a hazardous material. An apron is
removed by pulling down and tearing the ties, it is gathered together by handling the inside and
disposed of as clinical waste.
Household gloves
Thick household gloves are used for cleaning instruments or for clearing up a spillage of a hazardous
material. After each use they are washed with detergent and hot water and left to dry. Household gloves
used for decontamination are replaced weekly, when damaged, or if soil cannot be removed.
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Face and eye protection
During treatment, the cleaning up of spillages and decontamination procedures there is a risk of
contaminated fluids splashing into the face and eyes. Facemasks and eye protection are worn to
minimise the risk.
Protective eyewear
Protective eyewear is worn whilst treating patients, during decontamination procedures and whilst
clearing up a spillage of a hazardous material. As spectacles do not provide sufficient protection, it is
advisable to wear a visor or face shield over spectacles. Protective eyewear is also worn whilst changing
solutions in an x-ray processor. Eyewear may be reused if cleaned according to manufacturers’
instructions. This should take place when it becomes visibly dirty and/or at the end of each session.
Patients always wear protective eyewear during treatment. If patients’ eyewear is reused, it is cleaned
according to manufacturers’ instructions.
Face masks
Facemasks are worn whilst treating patients, cleaning instruments and clearing up an accidental spillage
of a hazardous material. Face masks are single use items and are changed after each patient, each
decontamination procedure and if they become wet or soiled. Masks are removed without touching the
outer surface and disposed of as clinical waste.
Latex allergy
If a staff member suspects that s/he is suffering from a latex allergy a doctor will be consulted and the
employee’s condition will be routinely monitored for the rest of their employment. A health surveillance
record will be kept with their personal file. In cases of a staff member’s latex allergy, nitrile or vinyl gloves
and non-latex ‘rubber’ dam will be substituted. If a patient has latex allergy, non-latex gloves and
‘rubber’ dam are used e.g. nitrile or vinyl.
Single-use devices
Single-use devices such as needles, aspirator tips and mouthwash cups are utilised whenever possible.
Single-use devices are never used for more than one patient and are discarded after use in an
appropriate manner (e.g. sharps bin, special waste or clinical waste).
This symbol identifies single-use devices:
Single-patient instruments (England only)
Endodontic reamers and files can be classified as single-patient instruments, meaning that they can be
reused, but only on the same patient. Here is the procedure:
Following use, endodontic reamers and files are washed [manually, but separately from other
instruments] [in a washer disinfector with other instruments].
After sterilization the endodontic reamers and files are stored separately from other instruments in a
view pack. There is a label affixed to the pack with the patient’s name, date of birth, staff name, cycle
number and the expiry date, which is up to one year after sterilization. The view pack is kept [in the
patient’s record]. If the endodontic reamers and files need to be used after the sterilization expiry date,
they are reprocessed before use.
The following sections on the safe handling of sharps, manual cleaning, washer disinfectors, ultrasonic
cleaning and hand hygiene have been laid out so that you can adapt them and print them off as posters

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M 257B – Infection Prevention Procedures, Ver 11, Folder 5, Page 2 of 19



The Safe Handling of Sharps
▪ Cover any cuts or grazes on the skin with waterproof dressings
▪ Always wear gloves when handling sharps and follow the hand hygiene guidelines in M 257B
▪ Only use sharps if absolutely necessary
▪ Use ‘safer sharps’ where it is reasonably practicable to do so
▪ Do not cap/re-sheath needles after use unless it is required to prevent a risk of injury, in which
case use a safer sharps device
▪ The primary user of the sharps will personally dispose of them into the nearest sharps
container immediately after use
▪ Do not walk with a sharp
▪ Do not rush when handling sharps, even in emergency situations
▪ If you drop a sharp, pick it up with forceps immediately
▪ Do not put sharps with dressings, tissues or other items that may hide them from view
▪ Do not put your hand into the sharps container or try to retrieve items from it
▪ Do not try to press down in the sharps container to make more room
▪ Sharps containers should be locked closed when no more than 2/3rds full. Prior to collection
they are kept in a secure area
▪ Removable scalpel blades are not used at this practice
▪ Keep sharps containers out of the reach of children and vulnerable adults on a level surface
above waist level, but below shoulder height. To avoid spillage never put sharps containers on
the floor
▪ Never:
◦ Leave sharps lying around
◦ Reach into a sharps container
◦ Pass sharps directly from hand to hand
◦ Overfill a sharps box
◦ Put sharps into domestic or clinical waste bags
◦ Rely on others to dispose of sharps for you
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The staff member undertaking decontamination wears: their clinical clothing, a single-use apron, eye
protection, facemask and heavy-duty gloves and full coverage shoes. In case of spillage of
decontamination chemicals, there are appropriate chemical neutralisers, first-aid kit and eyewash in
[
]
Instrument decontamination procedures (reprocessing) include:
▪ Separation and disposal of single-use instruments
▪ Transport of contaminated instruments to the decontamination area
▪ Storage of contaminated instruments
▪ Cleaning
◦ [Manual cleaning]
◦ [Ultrasonic cleaning]
◦ [Washer disinfector] (Practices in in Northern Ireland and Scotland must use washer
disinfectors)
▪ Inspection
▪ Sterilization
▪ Storage
All new instruments including metal matrix bands etc. are decontaminated before use and instruments
are always decontaminated before sending for repair or disposal.
Separation and disposal of single-use instruments
Single-use instruments are separated from other contaminated instruments. They are immediately
disposed of in the appropriate way as follows:
▪ Needles, scalpels, sutures, endodontic reamers and files and matrix bands etc. are placed in the
sharps bin
▪ Used and partially used anaesthetic cartridges, radiographic film covers and radiographic film
lead etc., are placed in the relevant special waste containers
▪ Aspirator tips, 3 in 1 tips, saliva ejectors, plastic syringes, bibs, disposable visors paper towels etc.
are placed in the clinical waste bin
Contaminated instruments
The practitioner removes cements and other hard materials from instruments before setting. It is our
goal to dismantle and clean instruments as soon as possible after use, if this cannot be performed
immediately, instruments are dismantled and stored in the ‘dirty’ transport container which is a rigid
leak-proof container that has a tight fitting lid and covered with [potable water] [foam] to maintain
humidity until cleaning can be carried out, note that dirty instruments are stored for the least time
possible.
If using instruments outside of the practice for example on domiciliary visits, the transport container is
labelled, and is never left on view or unattended in the transport vehicle.
Storage of contaminated instruments overnight
On the few occasions when the team members do not have time to complete the full decontamination
of instruments, the following procedure is followed:
▪ Instruments are pre-cleaned and dried
▪ They are placed in container clearly marked ‘contaminated instruments’
▪ The full reprocessing cycle of the dental instruments is carried out as soon as possible, as micro-
organisms can accumulate during storage
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M 257B – Infection Prevention Procedures, Ver 11, Folder 5, Page 4 of 19



Manual Cleaning
Take care to avoid splashing or the creation of aerosols
Maintain a dirty to clean workflow
▪ Wash your hands
▪ Wear thick rubber gloves, workwear, single-use plastic apron, full coverage shoes, facemask,
eye protectors
▪ Prepare sinks, equipment and setting down areas
▪ Dismantle and open instruments
▪ Fill the clean washing sink with cool water at a temperature recommended by the detergent
manufacturer, which should not exceed 45oC
▪ Fully immerse the instruments and keep them immersed during cleaning, with sharp ends
pointing away
▪ Agitate/scrub the instruments with long handled plastic brushes (not wire brushes)
▪ Drain the cleaning solution
▪ Rinse with [potable/distilled/RO] water using [a dedicated rinsing bowl that is only used for
rinsing in a single sink] [a separate rinsing only sink]
▪ After rinsing drain and, if they are to be wrapped for the vacuum autoclave, dry the
instruments with single-use non-linting cloth immediately
▪ Visually inspect the instruments with an illuminated magnifier:
◦ For cleanliness – re-clean items if necessary, paying attention to serrated surfaces e.g.
mosquito forceps, jaws of extraction forceps and hinges
◦ For function – discard if damaged, blunt, bent or rusted
▪ Lubricate any relevant items prior to sterilization, with dedicated ‘pre-sterilization’ lubricant
(non-oil) following manufacturers’ recommendations
▪ Dispose of cleaning cloths etc. as clinical waste
▪ Replace cleaning solution and rinse water after each use
▪ Wash cleaning brushes with hot water to remove visible soil and store head up (dry)
▪ Complete any relevant documentation
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M 257B – Infection Prevention Procedures, Ver 11, Folder 5, Page 5 of 19



Ultrasonic cleaning
▪ Fill the ultrasonic bath with [
] solution to the required level. Change the
solution after every clinical session (max 4 hours) or if it becomes contaminated
▪ Open the joints and hinges of instruments and fully dissemble them. NOTE some instruments
such as handpieces are unsuitable for ultrasonic cleaning, refer to the manufacturers’
instructions
▪ Briefly immerse instruments in cool (below 45°C, use thermometer) [using potable/RO] water
with [
detergent] in [a purpose designed container with a sealing lid] to
remove some of the blood and visible soil. Take care not to create aerosol.
▪ Irrigate devices with lumens before and after ultrasonic cleaning
▪ Place the instruments in the suspended basket and fully immerse in the bath, take care not to
overfill the basket and do not place the instruments on the floor of the bath. Delicate
instruments may need a modified basket and some instruments may be unsuitable for
ultrasonic cleaners – such as handpieces, see the manufacturer’s instructions
▪ Close the lid and set the timer for [x] minutes following the manufacturers’ instructions for
operation, do not remove the lid until the cycle is completed. Drain the basket when the cycle
is completed
▪ [Scotland only: Record whether each cycle was satisfactory, by signing a print out, checking
the data logger or writing in a log. Print outs are scanned before they fade]
▪ Following ultrasonic cleaning, rinse the instruments thoroughly with fresh [potable/distilled/
RO] water in the [rinsing sink/rinsing bowl] to remove residual soil and detergents. Rinsing is
not necessary if the instruments are going into an automated washer disinfector
▪ Visually inspect with illuminated magnifier:
▪ For cleanliness – re-clean items if necessary, paying attention to serrated surfaces e.g.
mosquito forceps, jaws of extraction forceps and hinges
▪ For function – discard if damaged, blunt, bent or rusted
▪ Lubricate any relevant items prior to sterilization, with dedicated ‘pre-sterilization’ lubricant
(non-oil)
▪ [Dry the instruments, which have to be wrapped, with a single-use non-linting cloth and
sterilize them soon after ultrasonic cleaning] [Process the instruments through the washer-
disinfector]
▪ Dispose of drying cloths as clinical waste
Carry out daily, weekly, quarterly tests as found in (M 257O) and record the results on this form,
taking into account the manufacturers’ recommendations. Servicing, repair, validation and testing by
the engineer is recorded on the Individual Equipment Record (M 271B).
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Using a Washer Disinfector
A washer disinfector carries out cleaning and disinfection. The staff member using the washer
disinfector wears: workwear, a single-use apron, eye protection, face mask, heavy duty gloves and full
coverage shoes.
Loading a washer disinfector
▪ Follow the manufacturers’ instructions on the detergents and/or disinfectants recommended
for use with the device and how to prepare for a wash cycle, these are:
▪ Do not overload or overlap the instruments
▪ Ensure that hinges and joints are opened fully
▪ Attach instruments that require irrigation to the irrigation system correctly, ensuring filters are
in place if required (for example for handpieces, if specified by the manufacturer)
▪ At the end of the cycle, check that it has completed properly, if not it is restarted
▪ Visually inspect washed instruments with an illuminated magnifier:
◦ For cleanliness – re-clean items if necessary, paying attention to serrated surfaces e.g.
mosquito forceps, jaws of extraction forceps and hinges
◦ For function – discard if damaged, blunt, bent or rusted
▪ Lubricate any relevant items prior to sterilization, with dedicated ‘pre-sterilization’ lubricant
(non-oil)
▪ Sterilize the instruments soon after cleaning
▪ Record whether each cycle was satisfactory, by signing a print out, checking the data logger or
writing in a log. Print outs should be scanned before they fade
▪ Complete the Washer Disinfector Checklist (M 257D) if appropriate
▪ Servicing, repair, validation or testing by the engineer is recorded on the Individual Equipment
Record (M 271B)
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M 257B – Infection Prevention Procedures, Ver 11, Folder 5, Page 7 of 19



Sterilization
The Weekly Autoclave Checklist (M 257E) is followed for the set up and testing of autoclaves at the
beginning of the day, and the emptying and cleaning at the end of the day. [All sterilization cycles are
recorded on the Autoclave Cycle Log (M 257F).] [The autoclave produces print outs, which are
photocopied and attached to the checklist] [The Autoclave has a digital recorder and regular backups are
taken]. To pass the start of day test the autoclave must operate within the following ranges:
Sterilizing temperature range
Approximate pressure (bar)
Minimum Hold Time in Minutes
Minimum
Maximum
134
137
2.25
3
126
129
1.5
10
121
124
1.15
15
On no account are any safety features interfered with, circumvented or overridden. In case of a test
failure, the equipment is taken out of service and the Decontamination Lead is consulted. If necessary, a
maintenance engineer will be contacted. The autoclave will not be used unless it passes all tests.
As a pressure vessel each autoclave has a written scheme of examination, it is routinely inspected and
tested by a Competent Person (pressure vessels), plus quarterly and yearly testing, inspection and
validation as required. Servicing, repair, validation and testing by the engineer is recorded on the
Individual Equipment Record (M 271B).
Using a downward displacement autoclave
The autoclave is set up and tested following the steps in the Weekly Autoclave Checklist (M 257E). After
cleaning, dry instruments are placed in the autoclave without overloading the trays. Perforated trays,
cassettes or racks are used that have been validated for the selected sterilisation cycle. Handpieces are
lubricated using a can of oil that is only used before sterilization (according to the manufacturers’
instructions). Instruments are not wrapped before sterilization. A record of the cycle or any faults is
made on (M 257F).
Using a vacuum autoclave
The autoclave is set up and tested following the steps in the Weekly Autoclave Checklist (M 257E). After
cleaning, dry instruments are placed in the autoclave without overloading the trays. Perforated trays,
cassettes or racks are used that have been validated for the selected sterilisation cycle. Handpieces are
lubricated using an oil spray can that is only used before sterilization (according to manufacturer’s
instructions). Instruments may be wrapped before sterilization. A record of the cycle or any faults is
made on (M 257F).
Using a special autoclave
[The practice has a special autoclave (type S), the instructions for use are:]
Sterile barrier systems
The following are used to wrap instruments:
▪ A flexible peel pouch (sealed view pack). This is typically supplied sealed on three sides with the
remaining side open for the insertion of dental instruments
▪ Pre-formed rigid trays with die-cut lids (the lid may be permeable or impermeable). These trays
are potentially suitable for use with displacement or vacuum sterilizers. Subject to manufacturers’
instructions, the trays may be used to contain dental instruments during the sterilization process
and in subsequent storage)
▪ Header bags. These are manufactured as sealed bags with a heat-sealed permeable closure,
which can be peeled off. This is used for storage of larger items
Instrument wrapping
Before wrapping sterilized instruments, the worktop is cleared of clutter and is cleaned with a pre-
prepared or single-use disinfectant wipe and allowed to dry.
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Instruments are wrapped AFTER sterilization with a displacement (non-vacuum) autoclave, when dry, in
one of the sterile barrier systems above [England/NI/Wales: and the expiry date of up to one year in the
future]. [Scotland: A label is affixed to the pack with the cycle number, sterilizer identifier, the word
‘sterile’, the expiry date of up to one year in the future and the signature of the staff member. If the
wrapper is not transparent the label will also identify the contents.]
Instruments are wrapped BEFORE sterilization with a vacuum autoclave using one of the sterile barrier
systems above. Following sterilization the instruments are allowed to dry and then a label with the cycle
number, the expiry date of up to one year in the future and the signature of the staff member is affixed
to the view pack. Written information is not directly written onto the wrapper as this may damage it. If
the wrapper is not transparent the label will identify the contents.
Storage of sterilized instruments
Staff hands are clean and new gloves are donned before handling unwrapped sterilized instruments.
Instruments are stored in an environment where they are protected against excessive heat and where
conditions remain dry.
Storing unwrapped instruments in a clinical area (not in Northern Ireland)
Following sterilization, unwrapped instruments are stored for up to one day in a clinical area.
Instruments are not stored on open work surfaces, they are protected from contamination [in mini-racks
placed in cupboards] [in covered drawer inserts] [in covered trays]. All unwrapped instruments stored in
clinical areas are sent for reprocessing at the [beginning] [end] of the day.
Unwrapped in a non-clinical area (not in Wales and Northern Ireland)
Following sterilization, unwrapped instruments are stored for up to one week in a non-clinical area. (A
non-clinical area in this context is designated as a clinical area not in current use or in a clean area of a
separate decontamination room.) A label is affixed with the cycle number, the expiry date of up to one
week in the future and the signature of the staff member. Instruments are not stored on open work
surfaces; they are protected from contamination [in mini-racks placed in cupboards] [in covered drawer
inserts] [in covered trays] [in enclosed boxes].
Wrapped instruments
Instruments that were wrapped before sterilization with a vacuum autoclave or after sterilization with a
non-vacuum (displacement) autoclave are stored for up to one year. [Wales: Instruments sterilised in a
non-vacuum autoclave and then wrapped in a view pack should be reprocessed after 1 month].
[Northern Ireland: Instruments are never stored overnight in treatment rooms]. Commonly used
instruments are always dealt with on a first-in first-out basis].
Before using instruments check that:
▪ If packed, the packaging is intact and the packaging indicates that sterilization has taken
place
▪ The expiry date has not passed, if it has passed send the instruments for reprocessing
▪ The instruments with the earliest use by dates are used first (first in first out)
▪ There is no visible soil
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Instrument trays
Instrument trays are [sterilized/ disposable] [have disposable covers]. When laying out instrument trays
or filling view packs these are the sets of instruments that are prepared:
Examination kit:
Fillings kit
Endo kit
▪ Mirror
▪ Mirror
▪ Mirror
▪ Probe
▪ Probe
▪ Probe
▪ Tweezers
▪ Tweezers
▪ Tweezers
▪ Periodontal probe
▪ Flat plastic
▪ Flat plastic
▪ Sickle scaler
▪ Excavator
▪ Excavator

▪ Amalgam plugger
▪ Endo guide

▪ Filling bur set
▪ Parachute

▪ Finishing burs
▪ Rubber dam set


▪ Fillings bur set


▪ Gates Glidden burs
Restorative kit
Surgical kit
Ortho kit
▪ Mirror
▪ Mirror
▪ Probe
▪ Probe
▪ Probe
▪ Tweezers
▪ Tweezers
▪ Tweezers
▪ Flat plastic
▪ Flat plastic
▪ Flat plastic
▪ Excavator
▪ Excavator
▪ Excavator

▪ Crown prep burs
▪ Surgical burs

▪ Finishing burs
▪ Scissors


▪ Periosteal elevator


▪ Mosquito forceps
Instrument kit management
Check that the following kits are wrapped and stored at the [beginning/end] of every working day:
Exam kits
10
Filling kits
5
Endo kits
3
Restorative kits
3
Ortho kits
10
Surgical kits
4
Zoning of surfaces
Areas that could be contaminated during treatment procedures are identified, planning is carried out to
keep these areas to a minimum and they are decontaminated in-between patients. If any surfaces are
difficult to clean they are protected with a single-use barrier as well as being decontaminated in between
patients. Zoned surfaces are marked as follows [
].
Decontamination of treatment areas
Disinfectant or detergent is used to reduce contamination on surfaces. Spray bottles are used to apply
cleaning or disinfecting solutions but as bacteria can contaminate the bottles and become adapted to
these solutions and grow in the spray mechanisms, all spray bottles are single-use and are never refilled.
Cleaning centres on simple techniques using disposable cloths wetted with clean water and detergent,
the surfaces are then dried. We use [
disposable cloths] and [
] detergent mixed
with water in a ratio of [
], we dry the surface with [
]. Where single-use
covers are used, these are removed and the surfaces cleaned after each patient contact. We do not use
alcohol spray or wipes on stainless steel surfaces or on dental instruments.
Decontamination of treatment areas in between patients
The areas and equipment cleaned and dried in between patients include:
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▪ Work surfaces
▪ Dental chair
▪ Curing lamp
▪ Inspection lamp
▪ Hand controls
▪ Trolleys
▪ Spittoons
▪ Aspirators
▪ [
]
▪ [
]
Decontamination of treatment areas at the end of every clinical session
The areas that are cleaned and dried at the end of each session include:
▪ Aspirator - by fitting new disposable tips and aspirating [
cc] of water through each tube,
followed by the aspiration of [ cc of
] non-foaming disinfectant/
surfactant through each
▪ Spittoon - by allowing the water to run for [ ] seconds then [ cc of
] non-foaming
detergent/surfactant is poured around and into the spittoon, this followed by running the water
for a further [ ] seconds
▪ Taps
▪ Drainage points
▪ Splashbacks
▪ Cupboard doors
▪ Sinks
▪ [
]
▪ [
]
Computer keyboards
The computer keyboards [are protected with keyboard protectors
] [are ‘easy-clean’
waterproof keyboards, which are cleaned regularly throughout and at the end of every session with
water and detergent, then dried.] The keyboards are never touched with gloved hands.
Decontamination of equipment
Ultrasonic baths, RO, sterilizers, x-ray equipment, digital sensors and other equipment are cleaned and
decontaminated according to manufacturer’s instructions on a routine basis and if sent for repair.
The reusable intra-oral film/sensor is decontaminated by
[
]
The OPG bite stick is decontaminated by
[
]
The Ceph ear pieces are decontaminated by
[
]
Any equipment defects found during decontamination are reported to the Decontamination Lead and
recorded on the Individual Equipment Record (M 271B).
Domestic cleaning of equipment is covered in M 257I.
Transporting instruments
When transporting instruments to and from other locations such as domiciliary or school visits:
▪ Decontaminated instruments are kept in clearly marked rigid containers that are leak proof and
easy to clean
▪ After use, contaminated instruments are stored in clearly marked rigid containers that are leak
proof and easy to clean with some water/foam to keep them moist
▪ A record is kept that dental instruments were transported, the date and the vehicle used.
▪ If there is no dentist travelling with the instruments, then the time of dispatch and the intended
recipient is also recorded
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▪ Records are positioned prominently within any vehicle used for transportation and should carry a
contact telephone number
▪ Note: for domiciliary and school visits etc.:
◦ A small sharps container is used, it has a mechanism for temporary closure, it is stored in
the boot of the car (not where it can be seen) and is not left unattended in the car
◦ Clinical waste is stored in designated marked rigid containers that are leak proof and easy
to clean and clearly labelled ‘used medical equipment’, it is disposed of in the clinical
waste bin on return the practice
Disinfection of impressions and appliances before sending to laboratory
Following removal from the mouth, impressions and appliances are immediately rinsed under running
water until visibly clean. [They are then immersed in the impression disinfectant bath for the
manufacturer’s recommended period of [5] minutes], and the impression/appliance is then rinsed
thoroughly and packaged for dispatch to the laboratory. If using spray disinfectant, to avoid inhalation
the object is placed inside a plastic bag and sprayed and left sealed in the bag for the time recommended
by the spray manufacturer. [A label is applied to the impression bag to inform the laboratory that the
impressions/appliances have been disinfected].
Appliances received from the laboratory are disinfected as follows: [They are immersed in the impression
disinfectant bath for the manufacturer’s recommended period of [5] minutes], [they are sprayed with
disinfectant inside a plastic bag to avoid inhalation], and they are rinsed thoroughly before they are
placed in the patient’s mouth.
Laboratory infection prevention
The Laboratory Infection Prevention Questionnaire (M 257K) is sent to our dental laboratories, it has
been reviewed to ensure that each laboratory is using appropriate disinfection methods. It is also used to
inform the laboratories that all impressions and appliances are disinfected before being sent to them.
Equipment or instruments to be sent for repair
Equipment is cleaned and disinfected and if appropriate sterilized before sending for repair. If it cannot
be sterilized it is cleaned and disinfected. The equipment is labelled as disinfected or sterilized as
appropriate.
X-ray equipment
X-ray film sleeves are handled with gloves; care is taken not to touch the actual film with the gloved
hand. Film sleeves are disposed of in the clinical waste bin. Heat sterilizable or single use film-holders are
used. Single-use covers are used on digital x-ray film, Ceph ear pieces and OPT bite sticks. On removing
the single-use cover, the equipment is disinfected according to manufacturer’s instructions.
Dental unit waterlines
Water gap
To ensure that infective agents are not introduced into the water supply this practice has an air gap
between mains water and any water delivery equipment that comes into contact with blood or saliva.
Practice water
The practice always makes sure that the hardness of water used during the decontamination cycle is
compatible with the detergent chosen. [The water used for decontamination is potable water (drawn
from the mains) it is ‘soft’ and the water hardness is checked on the local water supplier’s website each
year.] [The water used for decontamination is from a reverse osmosis filter.] [The practice uses a water
softener to treat the potable water before use.]
All taps are flushed on Monday morning or following a holiday at the beginning of the first session for
two minutes. Routine monitoring of water temperature and quality is carried out by [
] who follows the checks in the Water Management Log (M 257LB).
A Legionella risk assessment is performed regularly (M 257L).
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The water used in dental units is:
▪ [Delivered by a bottled water delivery system. The bottle is emptied at the end of the day,
washed out with [potable/RO/distilled] water and left upside to dry. If there is visual
contamination it is flushed with disinfectant and washed]
▪ [From an ‘A’ tank, which separates the mains water from the unit water]
Waterlines are flushed for three minutes at the beginning and end of the day or after a prolonged period
of non-use such as lunch. In between patients they are flushed for 30 seconds.
Waterlines are disinfected [weekly] by [
]
Other waterline procedures are:
[Patients are informed not to close the lips around the saliva ejector to form a seal.] [Sterile water is
used as an irrigant for surgical procedures.]
Waterlines are emptied at the end of the day.
Posting specimens
Diagnostic specimens are posted using the Post Office service Safebox, which can hold up to 50ml.
Safeboxes are sent special delivery or 1stst Class. The minimum quantity is a pack of 12, which can be
ordered by calling 0845 7782677. Visit the Royal Mail website for further information. Tissue biopsy or
pathological tests are always sent to an NHS facility or accredited laboratory.
The infected team member
It is the responsibility of all dental healthcare personnel to maintain an awareness of their health. Should
a person consider that s/he has contracted an infectious disease or may have been exposed to one the
Decontamination Lead should be contacted before any further work is carried out. It may be necessary
to modify working patterns or avoid certain procedures or even to stay at home. In the case of major
disease an expert opinion will be obtained. See Briefing on Engaging Individuals with HIV (B 170).
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Dealing with spilt, potentially infective materials
If there is a spill of blood or other potentially infective body fluid the following actions are taken:
▪ The process is initiated as soon as possible
▪ The staff member dons a mask, disposable apron, protective eye-wear and thick gloves
▪ Absorbent tissues or kitchen roll are placed onto the spill until it is completely absorbed
▪ Hypochlorite is made up either freshly using hypochlorite-generating tablets or at least weekly in
clean containers at 10,000ppm available chlorine. Care is taken to avoid corrosive damage to
metal fittings etc.
▪ The hypochlorite is poured onto the tissues to soak them, It is left to soak for at least 10 minutes
▪ More tissues are placed to absorb the hypochlorite solution
▪ The tissues are collected with two pieces of card such as two record cards and placed in a sealed
bag in the clinical waste bin
▪ The area is wiped with the hypochlorite solution afterwards
Clinical clothing is changed if it becomes soiled with potentially infective materials. Alcohol is NOT used
for cleaning in this situation. If the surface is metal, the surface is cleaned with water and detergent and
dried after the use of bleach, to remove any traces of bleach, which can damage metal surfaces.
Waste
The dental team members are responsible for ensuring that waste is:
▪ Correctly segregated
▪ Stored safely and securely on the premises
▪ Packaged appropriately for transport
▪ Described accurately and fully on the accompanying documentation when removed
▪ Transferred to an authorised person for transport to an authorised waste site;
▪ Appropriately registered for hazardous waste (if the practice produces more than 500kg) of
hazardous waste per year with necessary records and returns at premises
Practice waste is segregated and disposed of in accordance with the procedures in the Module on Waste
(M 269).
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Hand Hygiene Policy and Procedure
Clean hands are essential to minimise the risk of cross infection and to safeguard the health of the
hands:
▪ Fingernails are kept short, smooth and clean. Staff undertaking dental procedures do not have
nail enhancements such as false nails, nail art or nail varnish. When viewed from the palm side
no nail is visible. Nails are cleaned with a blunt ‘orange’ stick
▪ The practice does not use bar soap or nail brushes, nails are cleaned with a blunt ‘orange’ stick
▪ Hand and wrist jewellery is removed prior to the clinical session (this can be worn on a neck
chain for convenience)
▪ The bins are foot operated or sensor
▪ Hand hygiene is carried out:
◦ Before and after each treatment session
◦ Before and after the removal of PPE
◦ Following the washing of dental instruments
◦ Before contact with sterilised instruments (wrapped or unwrapped)
◦ After cleaning or maintaining decontamination devices used on dental instruments
◦ At the completion of decontamination work
▪ Hands are washed with cool water using plain liquid soap for 40-60 seconds following the
technique on the hand hygiene poster (M 257G), then rinsed thoroughly and dried with a soft,
high quality paper towel, taking care not to damage the skin:
◦ At the beginning of each clinical session
◦ If they become dirty or contaminated during a clinical session
◦ If there is a build up of antibacterial hand rub (follow manufacturers’ advice on the
maximum number of uses of hand rubs before washing)
◦ At the end of each clinical session after removing eye protection, face mask and apron
▪ [From Wales and Scotland: Before surgical or invasive procedures, such as oral surgery,
periodontal or implant surgery hands are rubbed using an antiseptic hand cleaner
(chlorhexidine gluconate 4%, povidone iodine 7.5%) for 2-3 minutes, ensuring all areas of the
hands and forearms are covered. Individuals sensitive to antiseptic cleaners will wash with a
plain liquid soap followed by two applications of an antibacterial-based hand-rub]
▪ Antimicrobial hand rubs conforming to BS EN 1500 are used on visibly clean hands as an
alternative to washing at other times. The hands are rubbed using the technique on the Hand
Hygiene Poster (M 257G) for about 20-30 seconds, until they are dry
▪ A hypoallergenic, water based hand cream is applied at the end of each clinical session
(note that it is not to be applied before donning gloves as it may damage their integrity)
▪ The Hand Hygiene Poster (M 257G) is displayed above every hand washing basi
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Ventilation
A high volume aspirator is used to keep aerosol to a minimum. The aspirator vents outside of the
building are not positioned where someone could inadvertently breathe the expelled air. A rubber dam is
used whenever possible to further reduce splatter. The treatment room is adequately ventilated. (NOTE
an open window may suffice or if there is no window, a mechanical ventilation system should refresh the
air in the surgery.)
Kitchen
The staff kitchen is kept clean and tidy. Instruments and equipment are not cleaned in the staff kitchen
sink. Clinical materials are not stored in the same fridge as food.
Tidiness
General tidiness and cleanliness of the practice is maintained for health and safety reasons and for the
comfort of our patients. Every team member is responsible for tidiness, orderliness and cleanliness.
Boxes are never left in public areas and staff regularly check the patients’ toilets throughout the day. The
Practice Manager has overall responsibility.
End of day routines
At the end of the day the treatment rooms are left tidy, with all sharp instruments stored away. It is the
responsibility of the dental nurse to ensure that clinical waste bins are emptied and sharps bins are left
where they cannot be disturbed and that all surfaces have been decontaminated.
The nurse must also ensure that no sharp or contaminated instruments or potentially infective materials
are left in the treatment room; this includes splashes around the spittoon or on the floor and appliances
that have been removed from the patient’s mouth.
Disinfectants
The disinfectants used in this practice are:
Disinfectants are stored in:
Disinfectants are disposed by:
Sharps spillage
In case of a sharps spillage, the most senior member of staff should stay by the spillage to keep other
personnel clear. The nearest person is sought to bring the sharps spillage kit, which consists of:
▪ Heavy duty gloves
▪ Dust pan
▪ Rigid piece of straight edged cardboard or plastic
▪ A spare sharps container (not assembled)
▪ A sharps container larger than containers in use in the practice (unassembled). The container
must be large enough to place the type of sharps containers used in the practice inside it
The senior staff member should wear heavy-duty gloves and gently ease the loose sharps onto the
dustpan using the rigid piece of cardboard or plastic. These are then carefully placed in the spare sharps
container and the lid applied. This procedure must be carried out with extreme caution as sharps can
penetrate heavy-duty gloves.
In the case of a single discarded sharp, if the sharp is fully visible, the senior person present may feel
able to safely pick it up and place it promptly in a sharps container. Otherwise follow the same procedure
as for a spillage.
If a sharps container has been over-filled and cannot be closed, do not retrieve items from it. Instead
wear heavy-duty gloves and place it in the larger unassembled container in the sharps spillage kit. Then
carefully assemble and lock the outer container.
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Providing and maintaining a clean environment, domestic cleaning
Our procedures for cleaning follow the National specifications for cleanliness in the NHS which should be
read in conjunction with this document.
We pay particular attention to the maintenance of appropriate standards of cleanliness and hygiene in
relation to:
▪ Dental practice premises
▪ Equipment and reusable medical devices
▪ Materials to be used in the treatment of service users, where such materials are at risk of being
contaminated
To achieve this we have appropriate documentation including a Domestic Cleaning Plan, Audit and Risk
Assessment in (M 257I) and a Practice Cleaning Checklist (M 271IC). All team members share the
responsibility for maintain a clean and safe environment. Cleaning requirements are:
▪ Identified (M 257I)
▪ Risk Assessed (M 257I)
▪ Allocated to the appropriate person (M 257I)
▪ Performed to the required standards in (M 257I)
Cleaners
The cleaners are provided with training in health and safety infection prevention, and the specific
instructions for cleaning the rooms of the practice. Details are kept in the cleaner’s staff training
record (M 222E). Staff are trained how to spot clean if required to do so. [Cleaners attend the Support
Staff Training Meetings (G 170-SST) in iComply.]
General cleaning
The practice is cleaned according to the schedule in M 257I. The colour coding for household gloves,
buckets and cleaning cloths is based on the NPSA ‘Colour coding hospital cleaning materials and
equipment’:
▪ RED - bathrooms, washrooms, showers, toilets, sinks and floors in sanitary areas
▪ BLUE - general areas including waiting rooms and consultation rooms (not treatment rooms),
decontamination floors and walls, reception and offices including sinks in general areas
▪ GREEN – kitchen/food areas
▪ YELLOW – treatment rooms and decontamination rooms
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General Cleaning Guidelines
▪ Cleaning equipment is colour coded e.g. mop heads, gloves and cloths used for toilets,
kitchens and clinical areas. Different colours are used for each area according to the list above
▪ Non-shedding cloths or paper rolls are used for cleaning
▪ General-purpose detergent is used for all environmental cleaning following the manufacturers’
instructions
▪ Equipment and materials used for general cleaning are kept separate from those used for
decontamination
▪ Mops and buckets are kept clean and dry, with mop heads stored up and buckets stored
upside down
▪ Where carpets are in place, they have regular steam cleaning and spot cleaning
Cleaning procedures
▪ Plastic bucket contents are emptied down the toilet; buckets are rinsed and cleaned with
general purpose detergent then dried. If body fluids have been in contact with the bucket, it is
rinsed after cleaning with a 0.1% (1000 ppm available Cl) hypochlorite solution
▪ Mops are disposable and the mop is discarded weekly or sooner if heavily soiled or
contaminated with body fluids. After use mops are washed with hot water and GPD then dried
and stored head up. If mop has ben contaminated it is washed with warm water and general
purpose detergent then rinsed with a 0.1%
(1,000 ppm available Cl) hypochlorite solution
▪ Dry mops are vacuumed after each use
▪ Lavatory brushes are rinsed in flushing water and stored dry
▪ Dust is kept to a minimum on floors with the use of a vacuum or dry mop
▪ Furniture and fittings are damp dusted with hot water and detergent
▪ If there is a known contamination on furniture or fittings, cleaning is followed with a 0.1%
(1,000 ppm available Cl) hypochlorite solution
▪ Walls, ceilings, equipment cases, fixtures and fittings are cleaned with hot water and
detergent. If there are splashes of blood, or known contaminated material these are cleaned
promptly with 0.1% (1,000 ppm available Cl) hypochlorite solution
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General
There is no eating, smoking or drinking in the treatment room. Disposable cups are used for the patient
mouthwash and disposable bibs are used to protect the patient’s clothes. The sharps container and
clinical waste bins are kept out of reach of the patients and their companions.
Audit, training and review
The infection prevention and control procedures are audited as follows:
[iComply members England and Northern Ireland: Twice a year using (G 180-FIC, G 180-SIC)] [Twice a
year with the IPS Audit Tool].
[By CODE members England and Northern Ireland: twice a year using (M 257P)] [Twice a year with the
IPS Audit Tool]
[Wales: Using the audit tool from PGMDE and results are reviewed at least annually. Infection prevention
and control audits are carried out in compliance with individual health board policies].
[Scotland - There is no requirement to audit infection control in Scotland – optional: We perform 6
monthly audits using either (G 180-FIC, G 180-SIC) or the IPS audit tool which we adapt to Scottish
regulations.
[Scotland: We also have regular training from the NES team, have received an action plan and request a
visit from them when there is a significant change to circumstances in the practice (e.g. multiple new
team members or equipment which no one has used before).]
Training is provided at induction, [at iComply Practice Meeting 6, at the Support Staff Training Meeting (G
170-SST)] and on the job throughout the year]. The procedures are regularly reviewed at [iComply
Administration Step 6 and the Annual Management Review]. Team training records are maintained on
form (M 222E), which is kept in the individual team member’s file. All team members undertake at least
5 hours of verifiable continuing professional development on infection prevention and control topics
every 5 years.
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