Revised – February 2010 - RCDSO

1 Revised February 2010 Approved by Council November 2009 This is a revision to the guidelines on Infection control in the Dental Office issued in January guidelines of the Royal College of Dental Surgeons ofOntario contain practice parameters and standards whichshould be considered by all Ontario dentists in the care oftheir patients. It is important to note that these Guidelinesmay be used by the College or other bodies in determiningwhether appropriate standards of practice and professionalresponsibilities have been O Y A L C O L L E G E O F D E N T A L S U R G E O N S O F O N T A R I OCONTENTSI ntroductionPurpose of the Document 3 Professional and Regulatory Considerations3 Principles of Infection Prevention and control (IPAC)4 Patient SafetyTransmission of Micro-organisms5 Screening of Patients6 Routine Practices6 Risk Assessment7 Hand Hygiene7 Personal Protective Equipment11 General considerations Protective eyewear Protective draping Use of rubber dam and high-volume suction Latex sensitivity and allergiesHandling and Disposal of Sharps12 Additional Precautions12 Human Rights and Confidentiality13 Oral Health Care Workers Responsibilities and SafetyEducation and Training15 Immunization15 Illness and Work Restrictions17 Exposure Prevention 18 Personal Protective Equipment19 General considerations Gloves Protective eyewear Masks Protective clothing Latex sensitivity and allergiesMinimizing Droplet Splatter21 Exposure Management21 Occupational Health and Safety Requirements and WHMIS23 Prohibition of Eating and Drinking in Non-Designated Areas23 Cleaning.

2 Disinfection and Sterilization of Patient Care ItemsGeneral Considerations24 Processing of Critical and Semi-Critical Items25 Receiving, cleaning and decontamination Preparation and packaging Sterilization StorageSterilization of Unpackaged Instruments30 Processing of Heat-Sensitive Items30 Processing of Non-Critical Items31 Equipment Use and Preventive Maintenance31 Office Cleaning, Housekeeping and Management of WasteGeneral Considerations32 Clinical Contact Surfaces32 Housekeeping Surfaces33 Management of Waste34 Biomedical waste General office waste Handling of extracted teethEquipment and Area Specific Practice GuidelinesDental Unit Waterlines37 Dental Handpieces38 Saliva Ejectors38 Single-Use Devices39 Dental Radiography Equipment39 Digital Radiography Sensors and Intraoral Cameras40 Lasers and Electrosurgery Equipment40 Dental Laboratory Asepsis41 Handling of Biopsy Specimens42 General and Surgical Aseptic Technique43 Glossary of IPAC Terms45 Appendix 1 Methods for Cleaning, Disinfection and Sterilization of Patient Care Items and Environmental Surfaces48 Appendix 2 Additional Resources and Reference Materials Available on the Internet492I N F E C T I O N P R E V E N T I O N A N D C O N T R O L I N T H E D E N T A L O F F I C EIntroductionInfection prevention and control is an important part of safe patient care.

3 Concernsabout the possible spread of blood-borne diseases, and the impact of emerging, highlycontagious respiratory and other illnesses, require practitioners to establish, evaluate,continually update and monitor their infection prevention and control strategies guidelines are significantly broader than previous documents, and they reflectcurrent knowledge of the transmission of infection, and how to prevent and control this document, the following assumptions have been made: The terms oral health care worker (OHCW ) and staff are used interchange-ably. Staff encompasses all persons conducting activities within or associatedwith dental offices and includes dentists, dental hygienists, dental assistants,anaesthetists and other support persons. The term dental office includes any facility in which oral health care is provid-ed, such as traditional dental practices, community and school-based dentalclinics, and collective living centres and other institutional settings.

4 These guidelines contain practice parameters and standards, but respect theautonomy of each dental office. guidelines , by definition, are directing princi-ples, and indications or outlines of policy and conduct. OHCWs are trained to take precautions in order to protect patients and staff. Inaddition to previous instruction, it is important that all OHCWs receive office-specific training in infection prevention and control as part of their orientation,and whenever new tasks, procedures or equipment are introduced. It is recom-mended that one staff person should be appointed to manage the dental office sinfection prevention and control program and ensure that it remains infection prevention and control is the responsibility of all OHCWs,implementation and oversight rests with the principal dentist(s).Introduction3R O Y A L C O L L E G E O F D E N T A L S U R G E O N S O F O N T A R I OPurpose of the DocumentThis document is intended to provide all OHCWs with the knowledge to properlyimplement necessary infection prevention and control measures in dental practice.

5 Itconsolidates published recommendations from government and other agencies, regu-latory bodies and professional possible, recommendations are based on data from well-designed scientific studies. However, some infection prevention and control practices routinelyused by health care practitioners cannot be rigorously examined for ethical or logistical reasons. In the absence of scientific evidence for such practices, certain recommendations are based on strong theoretical rationale, suggestive evidence oropinions of respected authorities. In addition, some recommendations are derivedfrom provincial and federal regulations. Accordingly, this document presents best practices, reflecting the best evidenceand expert opinion available at the time of and Regulatory ConsiderationsDentists have an obligation to maintain the standards of practice of the professionand, accordingly, must ensure that recommended infection prevention and controlprocedures are carried out in their must maintain current knowledge of infection prevention and control procedures, and apply and maintain them appropriately and consistently.

6 To this end,it is the dentist s responsibility to ensure that staff are adequately trained in infectionprevention and control procedures, and that the necessary supplies and equipmentare available, fully operational, up-to-date and routinely monitored for addition to professional obligations, dentists also have an ethical duty to maintaina safe and healthy office environment for both patients and staff, and to adhere toall rules and regulations related to the operation of a dental practice, including workplace health and safety and environmental N F E C T I O N P R E V E N T I O N A N D C O N T R O L I N T H E D E N T A L O F F I C EPrinciples of Infection Preventionand control (IPAC)The risk of infection as a result of a dental procedure is extremely low, but it represents animportant patient safety consideration. By understanding how diseases are transmitted,and applying infection prevention and control principles (IPAC), OHCWs can developstrategies to interrupt the transmission of micro-organisms among patients and OHCWs,and from dental instruments, handpieces, devices and principles include: patient assessment; following routine practices; using barrier techniques to protect both patients and OHCWs; applying the principles of cleaning, disinfection, sterilization and storage of dental instruments; environmental cleaning; care of the overall office setting; safe handling and disposal of overall IPAC program should focus on strategies to reduce the risk of trans-mission.

7 These strategies include: a) identifying, communicating and implementing standards and guidelines by settingspecific policies and procedures;b) effective occupational health and safety programs for all OHCWs, such as writtenprocedures for the workplace and guidance on immunization; c) educating OHCWs, as well as patients and their families, about everyone s role ininfection prevention; d) ongoing review of policies and procedures, and evaluation of the IPAC program. Principles of Infection Preventionand control (IPAC)Patient SafetyThree main elements are required to spread infection:1susceptible host2causative agent3mode of transmissionBy removing any one of these elements, an infection cannot occur. This principle formsthe foundation of an acceptable infection prevention and control strategy. Transmission of Micro-organismsUnderstanding the modes of transmission of infection is necessary for designing andimplementing effective infection prevention and control patients and OHCWs can be exposed to pathogenic micro-organisms, includingviruses ( , HCV, HIV, human herpes group of viruses, human papilloma virus),bacteria ( Mycobacterium tuberculosis, staphylococci, streptococci) and othermicrobes that colonize or infect the oral cavity and respiratory the dental office, the three main modes of transmission of micro-organisms are.

8 5R O Y A L C O L L E G E O F D E N T A L S U R G E O N S O F O N T A R I OPatient Safetydirect transmission direct physical contact with blood, oral fluids or other materials indirecttransmission contact with an intermediate contaminated object, such as a dentalinstrument, equipment or an environmental surface droplettransmission contact of oral, nasal or conjunctival mucosa with droplets, spatteror spray containing micro-organisms generated from an infected person, such as by coughing, sneezing or talking6I N F E C T I O N P R E V E N T I O N A N D C O N T R O L I N T H E D E N T A L O F F I C EScreening of PatientsFrom time to time, patients who are unwell may attend at a dental office. Their healthcondition may relate to a dental problem, such as an oral infection or a postoperativecomplication, but it may also relate to a non-dental problem, such as a severe respiratoryillness ( influenza) or simply a bad order to protect other patients and OHCWs from the spread of micro-organisms,patients who appear to be ill should be rescheduled if at all possible.

9 If their dental condition is of an urgent nature, every effort should be made to separate them fromother patients by seating them in a secluded operatory as soon as possible. In this way,the spread of micro-organisms by direct or droplet transmission can be opportunity to screen for ill patients is when confirming dental appointmentsin advance. If staff learn that a particular patient has a fever or cough, dental appoint-ments should be PracticesHealth Canada uses the term routine practices to describe basic standards of infec-tion prevention and control that are required for safe patient care. A similar term, standard precautions, is used by the Centers for Disease control and Prevention in the United States. Routine practices synthesize the major principles of universal precautions, which are designed to reduce the risk of transmitting pathogens that areblood-borne, and those of body substance precautions, which are designed toreduce the risk of transmitting pathogens from moist body practices are based on the concept that all patients are potentially infective,even when asymptomatic, and that the same safe standards of practice should routinely apply to contact with blood, body fluids and secretions ( saliva), mucousmembranes and non-intact to routine practices protects both OHCWs and are four principles that are inherent in routine practices.

10 Patient Safety1riskassessment2hand hygiene3use of personal protectiveequipment4safe handlingand disposalof sharps7R O Y A L C O L L E G E O F D E N T A L S U R G E O N S O F O N T A R I ORisk AssessmentThe first step in the effective use of routine practices is to perform a risk must be done before each interaction with the patient in order to determine theinterventions that are required to prevent the transmission of risk of transmission of micro-organisms will vary, depending on the type ofdental procedure to be performed and the likelihood of exposure to blood, bodyfluids and secretions, mucous membranes and non-intact skin. Additional factors toconsider include: the health status of the patient; the characteristics of the patient, such as level of cooperativeness; the physical environment and resources available; the immune status of the involving exposure to blood, body fluids and secretions, mucous membranes andnon-intact skin require the use of appropriate personal protective equipment.