Our last blog looked at the first two standard precautions within the Australian Dental Association’s Guidelines for Infection Prevention and Control – hand hygiene and personal protective equipment (PPE). Here, we run through the next four standard precautions and how they should be implemented to keep dental practice employees and patients safe.
3. Surgical procedures and surgical aseptic technique
The principles of the surgical aseptic technique must be applied to all dental surgical procedures.
Hand hygiene and glove requirements are detailed in Part 1 of this blog. Long hair must be tied back and covered with a disposable cap or hair net; beards should also be covered.
Dental practitioners performing oral surgical procedures must also meet requirements regarding sterile drapes, sterile irrigation solutions, and sterile instruments with batch control identification.
Supplies used during oral surgery, such as sterile cotton pellets and gauze, can be packaged and sterilised in the dental practice. However, most clinics find it more efficient and practical to buy disposable drapes, gowns, gauze, and other sterile supplies.
4. Management of sharps
Inappropriate handling of sharps is the primary cause of penetrating injuries in the dental setting. For this reason, it’s crucial that all sharp instruments are handled and used with care, both during and after treatment.
Instruments such as scalpels and scalers must never be passed by hand between employees; they should be placed in a cassette or puncture-resistant tray or bowl after each use and carried from the surgery to the reprocessing area in a lidded puncture-resistant container.
Dental practices must have an easily accessible, clear set of instructions on what to do in the event of a sharps injury.
Disposal of sharps
Used disposable needle syringe combinations and burs, empty glass cartridges of local anaesthetic solution, needles, scalpel blades, orthodontic bands, endodontic hand files, and all other single-use sharp items must be discarded in an approved, clearly labelled, puncture and leak-proof sharps container conforming to AS 4031:1992 Non-reusable containers for the collection of sharp medical items used in health care areas or AS/NZS 4261:1994 Reusable containers for the collection of sharp items used in human and animal medical applications. Sharps containers must be sealed when filled to the line marked on the container or three-quarters full and collected by licensed waste contractors for disposal.
Scalpel blade removers are a convenient way to remove, contain and dispose of scalpel blades in one click.
Any reusable sharp instruments should be placed into an appropriate stand or container. Dental assistants should be trained to check that the dentist has removed sharps such as burs and orthodontic wires before commencing the changeover procedure.
5. Management of clinical waste
A dental clinic’s waste management must meet local regulations.
Domestic waste goes into the standard waste stream, while clinical waste must be placed into leak-proof, thick yellow waste bags with a biohazard symbol that conform to AS/NZS 3816:1998 Management of clinical and related wastes. These bags should be placed into secure storage containers until collected by licensed waste contractors. Small bags can be used to collect waste chairside, then placed into medical waste bags. Gloves, masks, and protective eyewear must be used when handling medical waste bags.
A variety of environmental controls that reduce the risk of transmission of infectious agents should be considered when designing or refurbishing a dental practice.
Dental practices must have clearly defined clean and contaminated zones that are physically segregated. After gloving, staff may move from the clean zone to the contaminated zone but never in the reverse direction. Instruments and materials must follow the same workflow.
A dental clinic should have a practice-wide cleaning schedule that specifies the cleaning approach and frequency for various parts of the practice. This schedule should include aspects like door handles, telephone handsets, toys and tablet devices in the waiting room, and dental equipment that doesn’t come into contact with patients but is in an area where contamination could occur.
High-touch hard surfaces should be cleaned daily using detergent wipes designed for use on clinical hard surfaces. In the post-COVID environment, a two-step approach incorporating detergent and disinfectant is recommended.
Working surfaces in the contaminated zone must be cleaned after every patient using a pH-neutral or mildly alkaline detergent followed by a disinfectant. Neutral detergents are most suitable for dental clinic cleaning because they’re less likely to damage metals, cause skin irritation, or leave residue on surfaces.
Special products may be needed for cleaning soft surfaces such as the upholstery of the dental chair and employee stools. These products usually contain conditioning components and less alcohol than hard surface cleaners, so upholstery is less likely to degrade over time.