PCDs have a legal duty of care to protect the health and safety of patients. Every practice should have a written infection control policy and provide training to each member of staff so they are confident and competent.

While sterilisation, pre-sterilisation and the use of single use items feature strongly in the BDA's newly revised guidelines on infection control, dental team members need to also consider infection control issues closer to home. Uniform washing, personal hygiene and fashion accessories all have an impact on effective infection control.

Nurses, hygienists and therapists are in close contact with patients and this is a two-way interchange. The uniform is at the frontier of this interaction and should prevent team members from spreading infective agents to patients, family and friends.

Surgery clothing should be made of a material that can be machine-washed with a suitable detergent at 65°C for 10 minutes and should not be worn outside the practice. Changing facilities should be provided in practices and staff members must have at least one spare uniform.

Good personal hygiene is vital to infection control. Lacerated, abraded and cracked skin can offer a portal of entry for micro-organisms. Gloves must be worn for all clinical procedures and treated as single use items. Hands must be washed before gloving and a new pair of gloves should be put on for every patient. To prevent drying and cracking of skin a suitable hand conditioning cream is recommended after every clinical session.

Gloves should be replaced immediately if they get torn, cut or punctured – a likely result of long nails or sharp jewellery. The removal of all rings, jewellery and watches is recommended for hand care during clinical sessions. The wearing of a mask and protective eyewear is also essential.

The new guidance from the BDA, revised in association with the Department of Health, emphasises the need for effective pre-sterilisation cleaning, methods for sterilisation and the use of single use items. boxed-text

The interest of patients in infection control protocols cannot be underestimated. The BDA receives many telephone calls from patients questioning what dentists should be doing and asking what they can do when guidelines haven't been followed – not wearing gloves, for example. The BDA always encourages patients to ask their dentists directly about their infection control procedures to allow the dentist to explain what actually happens in practice.

The media has done a good job in making patients more aware of infection control within dental surgeries, so it is important that you are aware of the image you present to your patients and the messages that are given, frequently unintentionally. With the publication of the new infection control guidelines, the time is ripe to re-evaluate practice policies and protocols and improve the information that is available for patients.

Advice Sheet A12: Infection Control in Dentistry, has been distributed to all dental surgeries. Additional copies are available without charge through BDA Shop at www.bdashop.com.

Sterilisation guidelines

Pre-sterilisation cleaning

All instruments that are contaminated or potentially contaminated with blood or saliva must be thoroughly cleaned before being sterilised. The sterilisation process can only be as good as the initial cleaning process.

Instruments can be cleaned by hand, in an ultrasonic bath or using an instrument washer/disinfector. Ultrasonic cleaners and washer/disinfectors are preferred over hand cleaning as they are more efficient and contact with contaminated instruments is kept to a minimum, reducing the likelihood of inoculation injuries. It is important to examine the instruments after cleaning to ensure all visible debris has been removed. For most practices, ultrasonic cleaners will be the method of choice for pre-sterilisation cleaning. The solution should contain a detergent, not a disinfectant. Disinfectant solutions alone can precipitate proteins making them difficult to remove. Change the liquid in the ultrasonic cleaner at the end of each session or more frequently if it becomes heavily contaminated.

Sterilisation

Autoclaving is the method of choice, where the highest temperature compatible with the instruments is used. For dental instruments this is 134 – 137°C for three minutes. It is important to check the parameters during a cycle and a printer makes this easy.

Steam needs to condense on all surfaces of the instruments in the autoclave chamber for effective sterilisation, which means that the air must be removed from the chamber. Air is either displaced downwards by steam being introduced into the chamber or removed by a vacuum. For a long time downward displacement autoclaves were the only type used in a dental surgery; they are still considered an acceptable means of sterilisation.

More recently vacuum-phase autoclaves have become available. If you are considering purchasing one you must ensure that it is capable of sterilising dental instruments, not all are. Wrapped instruments and instruments in pouches must be sterilised using a vacuum-phase autoclave.

Effective sterilisation of handpieces continues to be the subject of debate. A vacuum-phase autoclave will remove air from the lumen of a dental handpiece allowing steam to penetrate. The presence of lubricating oil, however, may compromise the sterilisation process. Current opinion is that effective pre-sterilisation cleaning of dental handpieces and subsequent processing in a properly functioning downward displacement autoclave is acceptable.

All autoclaves must be regularly serviced and maintained. Vacuum-phase autoclaves are more complicated than conventional steam sterilisers and require more rigorous testing to demonstrate that they are functioning correctly.

Single use items

You are encouraged to use equipment that is described by the manufacturer as single use whenever possible. 'Single use' means that a device can be used on one patient during one treatment session and then discarded.