Infection prevention and control

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When it comes to Care Quality Commission (CQC) inspection and compliance, probably the one essential outcome that most dental practices say gives them greatest concern is Outcome 8: Cleanliness and infection control.

As a provider of dental care you want to ensure that you, your staff and your patients are not exposed to the risk of infection. The most effective way to achieve this is through a comprehensive infection control policy and process that forms part of your surgery's overall Health and Safety Policy.

Your infection prevention and control policy will be a mixture of processes that are national, such as following the decontamination steps as in HTM 01-05 (2013) and local to your practice such as how you arrange staff training and responsibilities. Your policy will use a variety of advice and guidelines available with careful planning and delegation of responsibilities, ensuring that your practice is infection free should not be all time-consuming and fraught.

Getting started

Before you begin developing your infection prevention and control policy you must ensure that your dental practice has an effective infection control team in place. In a small practice the team may just be the lead dentist or dental nurse and one or two others; in larger establishments the workload can be shared across the whole team.

Appoint an Infection Prevention and Control Lead (IPC lead)

The IPC lead will report to the registered provider or registered manager.

The IPC lead will oversee and monitor staff as they carry out various tasks relating to infection control in different departments within the dental practice. Make your IPC lead responsible for the cleaning standards throughout the practice, including the non-clinical areas. The CQC inspect the whole establishment and your patients will give their opinion on what they see and understand. They won't know if the ultrasonic cleaner's surfaces or the aspirator is cleaned at the end of each day, but they will be able to say if the toilets are dirty or there are bags of rubbish in the corridor.

Allocate appropriate staff to be responsible for undertaking infection control cleaning in the various departments such as:

  • Decontamination room(s)

  • Hygienist room(s)

  • Surgery(ies)

  • Waiting/reception areas

  • Administration areas

  • Toilet and cloakroom facilities.

The role of the IPC lead

An effective IPC lead will be responsible for the management and structure of infection prevention and control in the practice and oversee the delivery of local policies and their implementation. The IPC lead will be report directly to the registered provider or registered manager.

The IPC lead must:

  1. 1

    Have the authority to challenge, assess and make recommendations

  2. 2

    Be part of the practice governance team

  3. 3

    Produce an annual statement regarding compliance and make it available both internally and externally (eg CQC if required).

Allocate resources to infection control

Ensure a budget and time is allocated to allow sufficient resources to be made available for staff training, purchase of equipment or maintenance (of building and equipment) to be planned.

Adhere to regulations and essential standards of compliance

The CQC gives no guidance within the Essential Standards of Quality & Safety relating to Outcome 8, Cleanliness and Infection Control. They refer all providers (including dentists) to the Department of Health publication The Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

The Code of Practice itself is comprehensive and easy to follow and its ten criterions are used by the CQC to assess compliance with Outcome 8 (Table 1).

Table 1 Criteria used by the CQC to assess compliance with Outcome 8

Dental practices must adhere to the Health Technical Memoranda (HTM) 01-05, 2013 edition. When writing or reviewing your Infection Prevention and Control policy (Table 2) and processes use both The Code of Practice and HTM 01-05 (2013) as the main references. For example HTM 01-05 (2013) recommends a layout for a decontamination room to meet essential quality requirements (Table 3).

Table 3 Plan for decontamination room

Build up a support network

Your practice does not have to work in isolation. There are some excellent resources available for dental practices to use in developing an effective infection control policy that will lead to best practice including:

  • The local deanery

  • The MHRA and local health protection agency

  • The British Dental Association (BDA)

  • The local CCG (clinical commissioning group)

  • Equipment manufacturers

  • Local colleagues to share ideas.

Don't forget that the Internet has many examples of helpful policies, guidelines and hints and tips on audit that have been posted by dental practices and health trusts to give you ideas on how others are delivering effective infection prevention and control.

Preparing your infection prevention and control policy

Once you have appointed the IPC lead, identified specific staff to be responsible for different areas in the practice and familiarised yourself with the requirements of the Code of Practice and HTM 01-05 (2013), you can now write your policy (together with the IPC lead).

The policy outline given here (Table 2) shows the different areas that need to have clear instructions explaining how infection will be minimised. A range of appendices showing how you will achieve its aims and objectives should support your policy. For example, the cleaning regime of the decontamination room and surgeries can be created and recorded on Check Lists (Table 4).

Table 4 Check List template

Once you have completed your infection prevention and control policy and processes, circulate it to all staff.

Ongoing compliance

An effective policy is one that can be used as a working tool. The policy should be available for reference. The successful delivery of a policy is demonstrated through observation:

  • Does the practice look and smell clean?

  • Are staff dressed appropriately (is there protective clothing available)?

  • Do staff know what to do when asked, for example about a needlestick injury or clearing up body fluids?

Written evidence – results of audits

  1. 1

    Minutes from staff meetings

  2. 2

    Annual report from the IPC lead

  3. 3

    Completed Check Lists

Staff training - training matrix

  • Individual staff training records

  • Appraisal records.

Patient input - questionnaires/feedbacks should include something about the cleanliness of the practice.

In summary

Appoint a competent IPC lead and support them to develop the infection prevention and control policy. Allow time and budget to train staff and implement changes and systems as required. Develop a network for support and advice. Allow staff to take responsibility for specific areas. Work through the IPC lead to monitor, assess and adjust the infection prevention and control processes put in place.

Working as a team will help develop and deliver an effective infection prevention and control culture within your dental practice.

Useful resources to help you achieve best practice in infection prevention and control in your practice

There are four CPD questions based on this article. To take part, visit www.nature.com/bdjteamcpd.

To contact Martha, email info@cqcconsultancy.co.uk or visit www.cqcconsultancy.co.uk