INFECTION CONTROL PROTOCOLS
Please find infection control procedures on carrying out urgent dental treatment in COVID-19 pandemic
Standard infection control- Standard Infection Control Procedures (SICPs) are infection control precautions that are applicable at all times in a dental care setting according to guidance from HTM 01-05, CQC, NICE, SDCEP.
Transmission based cross infection protocols- In addition to SICPs, transmission based precautions (TBPs) are application specific to the current pandemic and prevention of transmission according to the route of transmission
Transmission Based Procedures look at the additional cross infection procedures introduced as a direct result of and to protect against COVID-19.
These look directly at the transmission behaviour of the virus and are steps adopted to prevent and minimise the risks of these transmissions.
>Contact precautions- Prevention and control of the most common form of transmission, that is direct (such as a handshake) or indirect contact (such as sharing or touching something an infected person has touched) with an infected person.
>Droplet precautions -the virus can also be spread via droplets over short distances droplets are greater than 5µm and can travel at a distance. COVID-19 virus is expelled as droplets from the respiratory tract of an infected individual (for example during coughing and sneezing) directly onto a mucosal surface or conjunctiva of a susceptible individual(s) or environmental surface(s). Droplets travel only short distances through the air; a distance of at least 2 metres has been used for deploying droplet precautions; however, this distance should be considered as the minimum rather than an absolute
>Airborne precautions there is a risk that certain dental procedures can generate aerosol of the virus less than < 5µm from the respiratory tract aerosols stay in the atmosphere and in the air and remain air borne for a period. Aerosols penetrate the respiratory system to the alveolar level. Interrupting transmission of COVID-19 requires both droplet and contact precautions; if an aerosol generating procedure (AGP) is being undertaken then airborne precautions are required in addition to contact precautions.
Hand hygiene
Hand hygiene is essential to reduce the transmission of infection in health and other care settings. All staff, patients and visitors should decontaminate their hands with alcohol-based hand rub (ABHR) when entering and leaving areas where patient care is being delivered.
Hand hygiene must be performed immediately before every episode of direct patient care and after any activity or contact that potentially results in hands becoming contaminated, including the removal of personal protective equipment (PPE), equipment decontamination and waste handling. Refer to 5 moments for hand hygiene
Before performing hand hygiene:
· expose forearms (bare below the elbows)
· remove all hand and wrist jewellery (a single, plain metal finger ring is permitted but should be removed (or moved up) during hand hygiene)
· ensure finger nails are clean, short and that artificial nails or nail products are not worn
· cover all cuts or abrasions with a waterproof dressing
If wearing an apron rather than a gown (bare below the elbows), and it is known or possible that forearms have been exposed to respiratory secretions (for example cough droplets) or other body fluids, hand washing should be extended to include both forearms. Wash the forearms first and then wash the hands.
All staff or staff must adhere to strict hand hygiene washing thoroughly with soap and water regularly especially before and after any patient contact handling of infected materials or equipment prior to dothing and post doffing, before and after decontamination procedures, surgery cleaning, and before and after waste handling procedures.
Where soap and water is not available alcohol based hand rub should be used. Disposable tissues should be used for any respiratory droplets including via coughing or sneezing they should be made available to both patients and staff .
“Catch it, bin it, catch it bin it,kill it”
All procedures should be carried out with minimal staff where possible All staff should be trained familiar with dothing and doffing, including appropriate wearing of FFP3 masks that have been fit tested . As all patients could be asymptomatic yet infectious or patients should be treated with the same precaution as a known COVID-19 + positive patient s you to create and format headings, paragraphs, blockquotes, images, and video all in one place instead of having to add and format them individually. Just double-click and easily create content.
Decontamination of equipment and environment must be performed using either:
· a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)); or
· a general purpose neutral detergent in a solution of warm water followed by a disinfectant solution of 1,000ppm av.cl
Only cleaning (detergent) and disinfectant products supplied by employers are to be used. Products must be prepared and used according to the manufacturers’ instructions and recommended product ‘contact times’ must be followed. If alternative cleaning agents/disinfectants are to be used, they should only on the advice of the IPCT and conform to EN standard 14476 for virucidal activity.
For an individual patient, the duration that infection prevention and control precautions will need to be applied will depend on several factors.
CROSS INFECTION POST HIGH RISK OF AEROSOL EXPOSURE
Post treatment disinfection should follow HTM01-05
The instrument box should be covered and left in the surgery
Clinicians should leave the clinical room with their eye protection and respirators still on
After a full hour has been given a terminal clean of full surgery doors, door handles and mopping of floors and any surfaces that are at risk of contact and floor with a disinfectant effective against enveloped viruses
Aftercleaning with neutral detergent, a chlorine-based disinfectant should be used,in the form of a solution at a minimum strength of 1,000ppm available chlorine. If an alternative disinfectant is used within the organisation, the local infection prevention and control team (IPCT) should be consulted on this to ensure that this is effective against enveloped viruses.
Door kept closed and windows kept open during the disinfection procedure
Floor must be mopped using reusable mop head that is cleaned after use
Close sharps container and wipe with appropriate agent
Use disposable cloths or paper roll or disposable mop heads, to systematically clean and disinfect all hard surfaces or floor or chairs or door handles and reusable non-invasive care equipment in the room.
• Close any sharps containers wiping the surfaces with the appropriate
agent
• Ensure that any products used are in line with HTM01 05. If consideration is given to use of non-chlorine-based products or chlorine based products are incompatible with equipment manufacturers guidance, you should ensure that any detergent and disinfection products used are effective against enveloped viruses
• Where your usual products are not effective against enveloped viruses,
use either:
a combined detergent disinfectant solution at a dilution of 1000 parts
per million (ppm) available chlorine (av.cl.)
OR,
a neutral purpose detergent followed by disinfection (1000 ppm av.cl.)
- Follow manufacturer’s instructions for dilution, application and contact times for all detergents and disinfectants.
- For any reusable non-invasive equipment that needs decontamination, follow the guidance here (Also see diagram below)
Disinfection of Non disposable equipment
Only cleaning (detergent) and disinfectant products supplied by employers are
to be used. Products must be prepared and used according to the
manufacturers’ instructions and recommended product ‘contact times’ must
be followed. If alternative cleaning agents/disinfectants are to be used, they should only on the advice of the IPCT and conform to EN standard 14476 for
virucidal activity.
Reusable (communal) non-invasive equipment must be decontaminated:
- between each patient and after patient use
- after blood and body fluid contamination
- at regular intervals as part of equipment cleaning
