Infection Control - How Confident are You?

Dr Farzeela Merali-Rupani
Head of Clinical

We carried out a study of over 100 UK dental professionals on the topic of infection control. Our findings raised an important issue which we had long suspected – confusion is rife when it comes to complying with infection control regulations.

From our research we found that nearly one fifth (17 per cent) of the dental professionals we asked said that they feel they need guidance on the regulations. A further 17 per cent are not sure if they understand the requirements, 4 per cent admitted to not feeling confident at all and 3 per cent didn’t know.

And it’s this lack of understanding that is leaving many practices and patients vulnerable.

Just over half of those we spoke to, that’s 59 per cent, said they felt confident. But, when we dug deeper into our findings we revealed that this confidence may be misplaced:

  • Less than half (45 per cent) of dental professionals are aware of the importance of cleaning dental instruments with water that is at a temperature between 40 to 45 degrees
  • And only 47 per cent of dentists know how long dental unit waterlines should be flushed between patients; that’s less than half
  • Nearly a fifth of dentists (19 per cent) believe that dental unit waterlines do not need to be flushed between patients

Dr Farzeela Rupani, Head of Clinical for Dental Directory, said: “This research suggests that a knowledge gap exists. However, all dental professionals are aware that our patients expect high quality care and to be treated in a clean and safe environment.

“There is a theoretical risk of transmission of microorganisms and thus potential infections between clinicians and patients. The dental community recognises this risk and we should do everything to stay abreast of the rapidly evolving standard of care that is required on a daily basis.”

But it is not just patients that dentists need to consider, they also have a legal responsibility to reduce risk in the workplace in accordance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 which state:

“Where it is not reasonably practicable to avoid the use of medical sharps, the Sharps Regulations require employers to:

“Use safer sharps (incorporating protection mechanisms). The employer must substitute traditional, unprotected medical sharps with a ‘safer sharp’ where it is reasonably practicable to do so. The term ‘safer sharp’ means medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury. For example, a range of syringes and needles are now available with a shield or cover that slides or pivots to cover the needle after use.”

Dr Farzeela Rupani explains that even with the new legislation sharp items such as scalpel blades and wires should be considered as potentially hazardous and handled with care to prevent injuries and infections.

Before sterilisation or high-level disinfection, instruments should be cleaned thoroughly to remove debris.

These instruments should be washed with water that is an optimum temperature of between 40 to 45 degrees.

There has also been a change in the regulatory requirements around face masks that are used as part of the personal protective equipment (PPE). European legislation EN 14683:2014, which supersedes EN14683: 2005, has increased the face mask filtration requirements to 98 per cent for dental professionals.

“All dental professionals are required to wear
PPE. It has two roles, to act as a barrier to infection and provide physical protection from debris
and aerosols.

“If a dental professional were to become injured or ill due to a lack of personal protective equipment it could be detrimental to their health and wellbeing as well as disrupting the running of the dental practice if they need to take time off. Not providing the dental team with the correct PPE also puts the practice owner potentially in breach of Health and Safety Executive rules and GDC Standards.” says Dr Farzeela Rupani.

Worryingly only 26 per cent of dentists gave the correct answer when asked to outline the order of dress for personal protective equipment. To reduce the risk of transmission of infectious agents, personal protective equipment must be used appropriately and put on in the correct order.

The correct order for personal protective equipment is:

  • Put apron overhead and fasten at the back
  • Secure and tie mask or fit elastic around ears
  • Fit mask tight to nose and under chin
  • Place protective goggles over face and eyes
  • Adjust protective shield
  • Put on gloves extending over the wrist

In other areas the research points to dental professionals wasting considerable time replacing or cleaning instruments when they are not required to, while neglecting what actually needs to be done. This attributes to the valuable time spent with an empty patient chair, which is ultimately costly to their business.

When asked what items used in the treatment room need to either be decontaminated or re-sheathed in between patients 85 per cent said that they clean the patient chair. In fact, the cleaning of a dental chair is only required at the end of the morning session and at the end of the day according to regulations. That said, cleaning in between patients is no bad thing and shouldn’t be discouraged.   

Adding to this, over half (61 per cent) said that they clean patient bibs, when actually a new bib should be supplied to each new patient. Materials such as bibs, which come in to contact with patients, can be a host for bacteria and infection.

Over the years the industry has seen a variety of opinions about the interpretation of the regulations for infection control. And therein lies the problem. 

Dentistry is an ever evolving industry with many technological advances. Even the type of equipment used by a dentist can be different from one year to the next. So, understandably it will be hard to keep up with the ways to maintain this equipment and other carriers of bacteria in the treatment room.

Our findings also revealed: 

  • Less than half (45 per cent) of dentists know water should be 40 to 45 degrees when cleaning instruments
  • Less than half (47 per cent) of dentists know dental unit waterlines for handpieces and 3-in-1s should be flushed for 20 seconds
  • 80 per cent of dentists correctly identified CQC recommendations saying waterlines should have a dip slide test every three months
  • 29 per cent of dentists think goggles/protective eye wear needs to be replaced between patients when they don’t
  • 41 per cent of dentists believe cups should be cleaned between patients, in fact, cups should be replaced
  • Only 15 per cent of dentists know an instrument can be stored for 60 days after it has been sterilised and pouched (in Scotland). In England it can be stored for one year
  • Only 26 per cent of dentists know the correct order of dress for personal protective equipment
  • 59 per cent of dentists claim to be ‘very’ confident with the current infection control requirements

Here at DD we know that with the many tasks you need to complete each day it is hard to keep track and with time being limited we would like to help assist in making things a little easier.

Our team has produced start and end of day checklists for the surgery and decontamination room for you and your team along with the codes for some commonly used Infection Control products.

Using dedicated checklists can ensure that everything is ready for your working day, that all tasks are being completed systematically and ensure that all team members are aware of what is required. They can also assist with audit requirements.

Do you need a helping hand when it comes to getting to grips with infection control? Our experts at DBG offer infection control training designed to assist the dental team with how to operate safely, practically and in line with current legislation and guidance.

And even more help is available through DD. Contact us on 0800 028 1697 or your local Business Consultant for our free easy to use Infection Control Checklist