Page updated 9 October 2006
Framework for Infection Control in Dentistry
Clinical governance, risk management and legislation
- Step 1- Look for hazards
- Step 2- Decide who might be harmed and how
- Step 3- Evaluate the risks rising from the hazards and decide whether existing cautions are adequate or should more be done
- Step 4- Record your findings
- Step 5- Review your assessment at regular intervals and revise it if necessary
- Failure to adequately decontaminate instruments and equipment
- Sharps injuries and transmission of blood borne viruses
- Direct transmission of microorganisms from hands
- Aerosol transmission of respiratory bacteria (e.g. Legionellae ) and other microorganisms found in contaminated dental unit waterlines
- Contaminated aerosols generated from airturbines and other rotary instruments, splatter and patients' respiratory and oral secretions.
Control of infection should be viewed as an integral part of clinical governance and routine dental care and is subject to legislation under the Health and Safety at Work 1974, and the Control of Substances Hazardous to Health Regulations 1999 (COSHH). Failure to comply with the relevant legislation can result in prosecutions or to a charge of serious professional misconduct. In accordance with The General Dental Council in their Standards Guidance- "Standards for Dental Professionals" June 2005 , http://www.gdc-uk.org/publications.html).
Dental professional are expected to "provide a good standard of care based on available up-to-date evidence and reliable guidance". Furthermore, they must "Find out about laws and regulations which affect your work, premises, equipment and business, and follow them". Copies of UK statutory instruments (Acts and Regulations) can be obtained in a downloadable format from the Office of Public Sector Information at www.opsi.gov.uk or can be ordered as a hard copy from The Stationery Office Bookshop at www.tso.co.uk
Duty of care for employers and employees
Employer
The employer has a duty of care towards their employees, patients and others who visit or work at the surgery to provide a safe place of work, to train staff appropriately and to provide personal protective equipment (Health and Safety at Work Act 1974). Adequate supervision and clear lines of communication are important factors here. As a requirement of clinical governance, individual practices are expected to develop their own customised infection control policy, which outlines the actual procedures used in their practice.
Enshrined within the safety legislation (The Management of Health and Safety at Work Act 1992, The Control of Substances Hazardous to Health Regulations (COSHH) 1999) is the requirement for the dentist to perform a risk assessment, to identify the hazards, to determine who might be harmed and to take appropriate and reasonable action to minimise the risks. Outlined in the table below are the 5 essential steps in performing a risk assessment.
Employees
All members of the dental team should be aware of procedures required to prevent the transmission of infection and should understand why these procedures are necessary. Employees have a duty and responsibility to themselves, patients and colleagues to comply with necessary steps to prevent cross infection in the practice. Complying with health and safety regulations is commensurate with their contract of employment.
Regular monitoring of procedures is essential and staff should be encouraged to discuss difficulties or problems in implementing the practice's infection control policy. All new staff must be appropriately trained in infection control procedures used in the surgery. Where employees are exposed to high risk hazards they must be specifically trained in this aspect of their work "on being recruited" especially if the employee is under the age of 18 years.
Performing a Risk Assessment
(Modified from 5 steps to risk assessment: a step-by-step guide to a safer and healthier workplace. HSE 1/94, London IND (G) 163(L)).
Hierarchy of risk management procedures
There is an accepted hierarchy of risk management control procedures. At the top of the hierarchy and the most effective is the elimination of the hazard by using an alternative method (e.g. replacement of difficult to sterilize instruments with single use disposable items), followed in turn by isolation of the hazard using design and engineering controls (e.g. safety needle retraction devices). When engineering controls are unavailable or inappropriate then work practice controls (e.g. hand hygiene, personal protective equipment) and work behaviour controls that result in safer practices (e.g. single handed recapping of needles) can be introduced. Administrative controls such as infection control policies and quality assurance standards (e.g. validation of sterilisation cycles, legislation on waste disposal) can be used to protect individuals, communities and the environment from infectious hazards. This hierarchy of control and prevention strategies forms the foundation for all infection control and safety management in primary dental care.
In the dental surgery the main cross infection risks arise from:
All of these modes of transmission of infection are either avoidable or the risks can be eliminated or minimised to low levels if the appropriate procedures are followed and staff adhere to the correct usage of Personal Protective Equipment (PPE).
Concept of Universal and Standard Precautions in Infection Control
Risk from Blood Borne Virusus (BBV) and Infectious Diseases in the Dental Surgery
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