Aim:
This article aims to refresh the reader’s knowledge of cross infection control, personal protective equipment and vaccinations required to work in the clinical environment.
By the end of this Article you should be able to:
- Define the term Cross Infection
- Discuss the importance of hand and eye protection for the oral health care team within the dental surgery
- List the infectious diseases that the dental team should be vaccinated against
What is cross infection?
Cross infection is the term used to describe the transference of micro organisms from one person to another either directly from one person to another or indirectly via different surfaces. In the dental surgery for the dental team this can occur in many ways, through coming into contact directly with a patient’s saliva, breathing in the aerosol from the use of high speed drills, being in the close vicinity of patients who have an infectious condition such as the flu virus, not using personal protective equipment such as mask, gloves and eye protection and not washing hands regularly. Microorganisms can be transferred to patients through poor cross infection control procedures such as not cleaning and sterilising equipment and instruments correctly, not disinfecting the surfaces of the dental surgery effectively and by contaminating clean surfaces with dirty gloves this spreading infection.
What is the responsibility of the dental team?
As a registrant of the General Dental council (GDC) it is a dental team member’s responsibility and duty to put patients’ interests first and act to protect them. This premise is in line with the standards set out by the GDC. Controlling cross infection in the dental surgery is an important aspect of patient protection. One of the guidance set out by the department of health published in April 2009 is the document Health Technical Memorandum 01-05: Decontamination in primary care dental practices (DOH HTM 01-05). This sets out standards for decontamination within the dental surgery in order to control cross infection. The document advises on what is regarded as essential practice and best practice in respect to cross infection control procedures. The guidance includes:
• The use of single use items where possible
• The use of washer disinfectors prior to sterilisation procedures
• Storage of sterilised instruments as far away from dental chair as possible
• Clean and dirty zones and preferably separate decontamination room
• Use of a separate hand wash basin for hand hygiene procedures
• The use of personal protective equipment
• Decontamination of water lines in the dental surgery
• Disinfection of impressions and laboratory work
• Maintenance and safety of decontamination equipment
Hand Hygiene
Hand hygiene is an essential part of preventing infection in the dental practice. Hand hygiene incorporates hand washing and the use of hand disinfecting using either anti bacterial gels or rubs. “Hand hygiene is crucial in preventing the spread of infection and the recontamination of surgical instruments and devices.”(Department of Health, 2009). It is important to ensure hands are clean before donning gloves as wearing gloves are not a substitute for unclean hands. Staff should have hand hygiene training as part of their induction to the clinical environment, it is important to periodically refresh training in hand hygiene throughout the year.
According to the department of health’s document HTM 01-05 (2009), hand hygiene should be practiced before and after each treatment session, before and after the removal of personal protective equipment, following the washing of dental instruments, before contact with the instruments that have been steam sterilised (whether wrapped or not), after cleaning or maintaining decontamination devices used on dental instruments and at the completion of decontamination work.
Hand washing basins should be separate from sinks used for disinfection of contaminated instruments and equipment. Ideally any soap, gel or hand cream dispensers should be wall mounted. Hands can be washed using a mild liquid soap (not a bar). Wet the hands first before applying the liquid soap, this will help to reduce irritation. Perform hand washing under running water and ensure the hands are rubbed together for approximately 15 seconds. Once finished the hands should be visibly clean, if they are not clean, repeat this procedure again. The procedure should be systematic ensuring all areas of the hands have been washed, including palms, backs of the hands, knuckles, in between the fingers, the thumbs, finger tips and wrists, a six- or eight-step method poster may be displayed above hand washing sinks which can help to ensure the technique is followed. The hands should then be dried using disposable paper towels to avoid re-colonisation of bacteria. Ensure the hands are dried thoroughly as micro-organisms are more easily transmitted on wet surfaces than dry ones. Following hand washing it is also important to ensure a hand cream is used to help avoid cracking of the skin which could harbour bacteria or become a risk for infection.
Finger nails should be short, nail varnish free with no false fingernails as long nails can harbour bacteria. Additionally, rings, bracelets and wrist watches should not be worn by any staff undertaking clinical procedures. The Department of Health (2009) states that “a wedding ring is permitted but the skin beneath it should be washed and dried thoroughly, and it is preferable to remove the ring prior to carrying out dental procedures. “
The importance of hand and eye protection for the dental team
Eye protection and hand protection are important items of personal protective equipment available to the dental professional and according to the department of health guidance HTM 01-05 “when used appropriately, and in conjunction with other infection control measures, PPE forms an effective barrier against transmission of infection.”
Gloves are essential to protect hands from becoming contaminated with microorganisms from patients or other sources of infection; they also serve to protect hands from chemicals used in the dental surgery in both disinfection and in the materials used in dentistry. Gloves help to “minimise the risk of cross infection by preventing the transfer of organisms from staff to patients and vice versa.” (DOH HTM 01-05) Gloves used are single use with clean gloves being used for each patient and disposed of in clinical waste after each patient avoiding cross contamination of organisms from patient to patient. The use of gloves in the protection of dental professionals in very important as our hands carry transient and resident bacteria and are the “most common mode of transmission of pathogens” (Sharon Kelly – 2008). Not only are our hands at risk of spreading infection, they are at potential risk of becoming infected when not protected by gloves. Herpetic Whitlow is an infection of the skin that is caused by the Herpes Virus. The Herpes virus also manifests in the form of a herpes labialis otherwise known as a cold sore. If a member of the dental team were to come into contact with a cold sore without donning gloves they are at risk of being infected with the virus in their hands and getting a herpetic whitlow. This skin infection can then be passed on to other parts of the body such as the eyes or other fingers through touching these areas with the infected finger and in some people can lead to a skin condition known as eczema herpeticum. This condition could potentially threaten the career of the dental professional as the infection can lead to numbness in the fingers hindering the person’s clinical ability and also spreading of the infection to the eyes which could potentially cause blindness. It is therefore very important that members of the dental team don gloves for others and their own protection.
Eye protection is another essential method of personal protection against infection. “During cleaning procedures, there is a risk of contaminated fluids splashing onto the face and into the eyes. Therefore, the dental team should ensure protection of their mucosa from splashes and other contaminated fragments that may escape during these procedures.” (DOH HTM 01-05) If corrosive chemicals such as phosphoric acid used in acid etch to prime tooth surfaces accidently get into a person’s eye this has the potential to cause burns and permanent damage to the eyes. Infection from aerosols could also enter the dental professionals body system via the eyes should they not be wearing adequate eye protection. For example again if the patient was to have a cold sore and the operator was to carry out treatment (not normally recommended when a patient has a cold sore due to cross infection risks) that used an aerosol, members of the dental team not wearing eye protection are at risk of infecting their eyes with the virus and potentially causing permanent damage to their eyes. Therefore, the wearing of eye protection such as goggles or visors for both patient and dental team members is an essential part of cross infection control and also protection from the various chemicals used in the dental surgery.
What diseases should dental professionals be vaccinated against?
According to the departments of health document HTM 01-05 “Staff involved in decontamination should demonstrate current immunisation for hepatitis B and, subject to local policy, tetanus.” It would also be advisable to be vaccinated against other general diseases usually vaccinated against as a child such as:
• Tuberculosis
• Polio
• Measles
• Mumps
• Rubella
There are many cross infection control procedures that can be put in place to protect patients and members of the dental team alike and hand and eye protection and infectious disease vaccinations are three very important methods of doing so which should be observed by all member of the dental team.
References
Department of health (2009) Decontamination: Health Technical Memorandum 01-05: Decontamination in primary care dental practices. London, Department of Health
General Dental Council (2005) Standards for Dental Professionals. London, General Dental Council
Live Lecture by Sharon Kelly (2008) University of Leeds, Leeds
Bibliography
Bupa (2009) Herpetic Whitlow Fact Sheet [internet], available HERE [ accessed 02/2012]
Department of health (2009) Decontamination: Health Technical Memorandum 01-05: Decontamination in primary care dental practices. London, Department of Health
General Dental Council (2005) Standards for Dental Professionals. London, General Dental Council