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College of Dental Sciences of the Radboud
University Nijmegen and Medical Centre
Protocols for the prevention of infections
of patients, students, teachers and the dental
team
1
Infection Prevention Protocols
College of Dental Sciences of the Radboud
University Nijmegen and Medical Centre
Protocols for the prevention of infections of patients, students, teachers and
the dental team
The protocols for the prevention of infections of patients and staff were drawn up by the
Committee on Infection Prevention/Dental Patient Care of the Radboud University Nijmegen
Medical Centre and were laid down by the Administration of the dental faculty. These
protocols describe which measures are to be taken and by whom, how and when.
The dental infection prevention protocols are working agreements which all the participants in
clinical practice have made with one another. It is therefore selfevident that lecturers, students
and other dental team staff remind one another of the agreements and point out any possible
oversights.
The measures stated apply without exception to every member of staff and student in the
dental clinic and the departments where work with patients and/or patient materials (mucous
membrane, saliva, blood, plaster models, etc.) or instruments and equipment used to treat
patients takes place. This means the measures apply to:
dentists + dental hygienists;
dental assistants;
desk staff;
dentistry and oral hygiene students;
radiology staff;
dental laboratory staff;
disinfection/sterilization staff;
instrument service staff.
If anything is unclear or if you have questions or suggestions, please contact B.G.J. Pennings,
Infection Prevention Consultant on extension 3614640.
On behalf of the Committee on Infection Prevention/Patient Care
B.G.J. Pennings
Infection Prevention Consultant
April 2009
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Infection Prevention Protocols
Protocol 1: Hepatitis B vaccination
Staff, students and patients who come into contact with blood or blood contaminated patient
material, run the risk of being infected with the Hepatitis B virus. Vaccination against
Hepatitis B offers good protection against Hepatitis B infection.
In the dental division the following are eligible for vaccination:
•
dentists, dental students;
•
oral hygienists, oral hygiene students;
•
dental assistants;
•
desk staff;
•
radiology staff;
•
dental laboratory staff;
•
disinfection/sterilization staff;
•
instrument service staff.
In 2000, the Executive Board of the Radboud University Nijmegen Medical Centre agreed to
a plan of action in order to arrive at an operationally feasible Hepatitis B vaccination policy. (
Please refer to KWINT, Requirement 4.12: Vaccination Policy Hepatitis B at Radboud
University Nijmegen Medical Centre). The plan states that the employer takes care of
adequate prevention policy in the form of vaccination and the screening of staff that present a
potential risk.
Code of conduct for staff who present a potential risk and work at the Radboud University
Nijmegen Medical Centre:
At the dentistry division, the following types of staff are seen as potential risks:
•
dentists;
•
oral hygienists;
•
dental students;
•
oral hygiene students
•
dental assistants.
In order to protect patients from being infected by the Hepatitis B virus, these groups of staff
and students who perform procedures that constitute a risk are obliged to prove that they have
been sufficiently vaccinated. If this is not the case, they are obliged to periodically prove that
they do not carry the Hepatitis B virus.
Vaccination is carried out by the Working Conditions and Environmental Service (AMD =
Arbo en Milieu Dienst). Students and staff are only allowed into patient treatment if they can
submit proof of vaccination against Hepatitis B issued by the AMD.
Vaccination only prevents infection by Hepatitis B. It does not reduce the risk of infection by
Hepatitis C, HIV and other blood transmissible disorders. That is why the prescribed
preventive measures apply to all dental division staff.
What to do if infection has possibly occurred?
To this end, refer to Protocol 6: Procedure notifying of sharps, splash and needlestick injuries.
This protocol applies to all injuries involving potentially infected material.
Laid down by IPC: 20.08.91
Reviewed by Committee on IP/PC: April 2005
3
Infection Prevention Protocols
Protocol 2: Personal hygiene
2.1 Clothing
Clothing must be clean and dry. Furthermore, additional requirements may be set for clothing
for reasons other than hygiene. Protective clothing is worn during the treatment of patients
and contact with patient material. Please refer to Protocol 3: Personal Protection.
2.2 Hand care
Please refer to Protocol 4: Hand cleaning and hand disinfection;
Please refer to Protocol 11:Use of non-sterile gloves.
2.3 Nail care
Fingernails should be cut short and clean. Nail polish should be intact i.e. not lumpy or
chipped.
2.4 Hair
Hair should be clean and well looked after. Long hair should be worn up or tied up. If a
headscarf is worn, this should be white, short, clean and dry.
2.5 Beard and moustache care
Beards and moustaches should be well looked after, clean and short.
2.6 Oral care
The mouth should be well looked after, no halitosis due to poor dental hygiene, garlic,
alcohol, nicotine (tar).
2.7 Jewellery
The wearing of rings, bracelets, chains and pendant earrings is prohibited during the treatment
of patients and activities that might bring the wearer into contact with blood or bodily fluids.
Wristwatches may not be worn during the treatment of patients.
Simple stud earrings and earrings (nothing may hang from them) are permitted.
2.8 Handkerchiefs
Disposable tissues must be used instead of handkerchiefs while on duty. After blowing your
nose, the tissue must be disposed of and good hand hygiene must be applied.
2.9 Eating, drinking and smoking
Eating, drinking and smoking is prohibited where work with patients or patient material takes
place. Patient material or objects that have touched such materials may not be taken into areas
where eating and drinking take place.
2.10 Notification obligation in case of infection
Staff and students with an infection must report this. For further details, please refer to
Protocol 5: Infections among staff.
Laid down by IPC on 20.08.91
Reviewed by the committee on IP/PC: April 2005
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Infection Prevention Protocols
Protocol 3: Personal protection
3.1 Clothing
Dentistry distinguishes between uniforms and protective clothing.
3.1.1 Uniforms:
Uniforms have both a recognizability aspect and a protective aspect for the patient and the
member of staff. Because uniforms are also worn outside the treatment rooms, they provide
insufficient protection for both patient and caregiver. The departments may lay down
additional requirements for uniforms.
3.1.2 Protective clothing:
In order to provide optimum protection from infection to both patient and dental team the
wearing of protective clothing during the treatment of patients is being introduced. The
protective clothing consists of short-sleeved, long lab coats which are supplied and washed by
the Dentistry and Oral Hygiene departments.
You are not allowed to wear this clothing in certain areas outside the treatment rooms.
3.1.3 Clothing regulations during the treatment of patients
Protective clothing must always be worn closed, and the lower arms should always be
uncovered. If your own clothing has long sleeves, these should be rolled up under the
protective clothing’s sleeves. You may not wear anything over the protective clothing. If the
protective clothing becomes visibly soiled with blood or other bodily excretions, clean
protective clothing must be donned immediately. Wearing a plastic apron is recommended if
the activities to be carried out are likely to severely soil the protective clothing.
3.2 Masks
The mask should be worn so it covers both the mouth and nose if there is a risk of infection
due to aerosols in the event of bloody procedures and for activities which cause spray (e.g.
multifunctional syringe, drill cooling and ultrasonic plaque removal devices).
The mask should be replaced after every patient, as it could otherwise be a source of infection
for the hands whilst donning and removing it. A wet mask offers no protection and should
therefore be replaced.
The wearing of masks around the neck is prohibited outside treatment rooms.
3.3 Protective glasses
The wearing of protective glasses is compulsory if bloody procedures are to be carried out and
also for activities which cause spray (e.g. multifunctional syringe, drill cooling and plaque
removal devices) and activities with spray risks (including grinding and milling).
The lenses must be big enough to actually protect the eyes. If the glasses are removed and put
back on again during the treatment, they must be disinfected after every patient, as they can
otherwise constitute a source of infection for the hands during the treatment of the next
patient.
Laid down by IPC on 20.08.91
Reviewed by the committee for IP/PC: April 2005
5
Infection Prevention Protocols
Protocol 4: Hand cleaning and hand disinfection
Radboud University Nijmegen Medical Centre prefers hand disinfection with hand alcohol
over washing with soap and water, because the disinfection of the hands with alcohol is more
effective and faster. Only if the hands are visibly soiled is washing with soap and water
necessary.
4.1 Hand hygiene
Hand hygiene includes measures taken to prevent the transfer of micro-organisms (infection)
and dirt to other people or objects via the hands. These measures consist of:
disinfection: the use of hand disinfectant (hand alcohol) which kills transient and some of
the resident flora in situ.
hand cleaning. This concerns the mechanical removal of dirt and transient flora through
the use of soap and water.
When working from clean to dirty, the hands need not be disinfected between the various
treatments. If the method is the opposite way around, from dirty to clean, then the hands will
have to be disinfected in the meantime.
4.2 Disinfection
Hand alcohol disinfection technique:
3 ml. hand alcohol on dry hands;
thoroughly, meticulously rub into the palms and backs of the hands, the area between the
fingers, the fingertips, thumbs and wrists for 30 seconds;
after this procedure the hands will have air dried.
4.3 Cleaning with soap and water
The following is required for the proper cleaning of hands with soap and water:
liquid soap dispenser;
disposable towels;
mixer tap with hot and cold water; preferably elbow operated;
open waste bin or foot operated bin lid.
Technique for washing hands with soap and water:
open the tap and adjust the temperature (not too warm). Taps should be elbow operated;
thoroughly wet the hands and then cover them in a thin layer of soap from the dispenser;
rub the hands together for 10 seconds; the palms, backs, areas between the fingers,
fingertips, thumbs and wrists should be properly soaped;
then thoroughly rinse the hands under running water;
carefully shake the water off the hands;
thoroughly dab the hands dry with a disposable towel. That includes the wrists and the
area between the fingers;
throw the used towel in the designated bin.
4.4 Important
In order to be able to properly wash or disinfect the hands/wrists, there should be no
obstructions such as rings, wristwatches or bracelets.
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Infection Prevention Protocols
Repeated hand washing and the wearing of gloves during work constitutes a considerable
burden on the skin. In order to prevent skin problems, it is important to thoroughly dry the
hands before donning gloves. There should be no soap residue left.
It is recommendable to use hand cream at the end of your shift/practical training so as to
ensure that your hands stay undamaged.
Due to the risk of contamination through residue, soap and alcohol dispensers may not be
refilled. The entire bottle must be replaced;
Laid down by IPC on 20.08.91
Reviewed by the committee on IP/PC: April 2005
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Infection Prevention Protocols
Protocol 5: Prevention of infection of staff and students
5.1 General measures
People with infectious diseases and inflammations are dangerous as they could infect others.
This particularly applies to those directly or indirectly involved in the treatment of patients.
The protocols for the use of gloves (Protocol 11), hand cleaning and hand disinfection
(Protocol 4), personal protection (Protocol 3) and personal hygiene (Protocol 2) have been
drawn up in such a way that they guarantee sufficient safety for patients, other staff and
students. It is therefore everyone’s individual responsibility to carefully adhere to these
protocols.
In situations in which it is uncertain whether the usual methods provide sufficient safety, it is
advisable to get advice from the practical training leader, infection prevention consultant
and/or the occupational health care service. A department head or practical training leader can
also request that a member of staff or a student gain advice.
5.2 Reporting infections
The Infectious Diseases Act makes it compulsory for heads of institutions to report unusually
high numbers of ill staff. Infections among staff can be a sign that infection risks are present.
A single infection need not give rise to concern. If, however, within a given population
several infections occur, further examination of the causes can be necessary. With respect to
this signalling function, it is important that infections are centrally reported at an institution.
Students and staff should therefore report:
prolonged diarrhoea
jaundice
skin complaints such as felons, impetigo and furuncles.
Students and staff must report infections by e-mail to the infection prevention consultant:
[email protected].
Depending on the nature of the infection and the daily activities, students or staff members
should themselves contact the company doctor, who determines whether the activities should
be adapted or temporarily terminated. The company doctor will refer them to their own
general practitioner for any possible treatment.
5.3 Specific measures
5.3.1 Hepatitis B
Due to the risk of Hepatitis B infection, every student and member of staff who comes into
contact with patients or patient materials is vaccinated against Hepatitis B. The Dentistry
Administration has decided that those who pose a risk will only be allowed into patient
treatment if they can prove they were vaccinated against Hepatitis B. Hepatitis B virus
carriers will not be allowed into patient treatment as long as no formal permission has been
granted.
5.3.2 Tuberculosis
Every student or member of staff who has stayed in an area where tuberculosis is endemic
should report to the Working Conditions and Environmental Service (AMD) upon their return
to be screened for tuberculosis.
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Infection Prevention Protocols
Students/members of staff are themselves responsible for reporting to the AMD in a timely
manner and adhering to the agreements made.
5.3.3 MRSA
Dentistry staff and students who have worked in a foreign hospital or who were admitted
there in the past three months are potential MRSA carriers. If they carry out, assist in the
carrying out of, or are present during the carrying out of surgical procedures, they have to be
screened for MRSA before being permitted to execute the above-mentioned activities.
Members of staff and students must report to the AMD themselves.
5.4 Measures before and after residing abroad
Students or staff who temporarily resided abroad, can – depending on the country they stayed
in – become infected with micro-organisms that do not occur in the Netherlands or only occur
very occasionally. A number of measures are taken in order to prevent them becoming
infected during their activities or stay abroad, so they do not constitute an additional
infectious risk to patients and staff upon their return. Vaccination and screening can limit this
risk to a minimum.
5.4.1 Exchange programme or internship abroad
It is important that the AMD is contacted at an early stage, six months before the planned date
of departure in order to get all the necessary vaccinations. The AMD doctor determines which
vaccinations are required (partly depending on the destination country). Before departure the
AMD will make appointments for check ups after return. It is important for these check ups to
have been carried out before activities at the faculty are resumed.
Students/members of staff are themselves responsible for notifying AMD in a timely manner
and for going to the appointments made.
5.4.2 Foreign guests
All foreign guests and students must submit a health declaration with their application for a
stay at Radboud University Nijmegen. If they are to be involved in treating patients they must
have themselves screened for Hepatitis B and or prove their vaccination, and may have to be
screened for any other infectious diseases the AMD indicates.
The host or coordinator ensures that the guests submit the required documents in a timely
manner and, if the AMD orders them to do so, that the guest is screened for MRSA after their
arrival in the Netherlands.
Laid down by IPC: 20.08.91
Reviewed by the committee on IP/PC: April 2005
9
Infection Prevention Protocols
Protocol 6: Procedure for the notification of sharps, splash and needlestick
injuries
6.1 General
Sharps, splash and needlestick injuries create the risk of the transmission of blood borne
disease, such as Hepatitis B, Hepatitis C and HIV. The risk of infection depends on the
quantity of blood the person has been in contact with.
Sharps and needlestick injuries occur when a person pricks or cuts themselves with :
a needle that is possibly contaminated with patient blood or serum;
an instrument that was used on or in a patient;
an object that has possibly been in contact with patient blood or serum.
Splash injury occurs when mucous membrane (e.g. of an eye or mouth) or damaged skin is
contaminated by spatters of blood or fluids mixed with blood (e.g. bodily fluids).
6.2 The following applies to all sharps, splash and needlestick injuries:
Allow the wound to bleed properly, then rinse thoroughly under a warm tap, dry and disinfect
with iodine tincture or 70% denatured alcohol. Mucous membranes must be rinsed as well as
possible using water or a physiological salt solution. Thoroughly rinse the eyes using an eye
washer after splash injury to the eye(s).
It is important for staff and students to report sharps, splash and needlestick injuries in order
to recognize unsafe activities and situations, and to be able to prevent the infection of the
member of staff or patient in a timely manner. This is what the telephoned report is primarily
intended for. If in a particular situation or during a particular treatment, sharps, splash or
needlestick injuries occur frequently, this can be an indication that this activity is high risk. It
is also possible that no protective measures have been agreed on (yet) or that the protective
measures in place are not adhered to properly.
6.3 Reporting procedure
Sharps, splash and needlestick injuries should be reported as quickly as possible (preferably
when the patient/source is still on hand for further examination) to the Working Conditions
and Environmental Service (AMD = Arbo Milieu Dienst). You can find a direct link to the
AMD's needlestick injury reporting procedure on the DigiTand screen: Behandelaar >
informatie > Infectiepreventieprotocollen > prikletselmelding AMD.
Before filling in the needlestick accident form, it is important for you to get in touch with the
AMD as soon as possible on Tel.: (36) 15400. This in connection with the necessary followup activities.
The AMD can be reached on weekdays between 08:30 and 17:00. Outside these hours you
should call the Accident and Emergency department at Radboud University Nijmegen
Medical Centre on Tel. (36) 14187. You can report needlestick incidents to the AMD online
or by printing out the reporting form and sending it to the AMD.
The AMD determines the risk of infection and the follow-up activities on the basis of the
information concerning the type of incident and the source patient’s medical history
(increased risk of carrying HBV, HCV or HIV).
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Infection Prevention Protocols
Laid down by IPC: 20.08.91
Reviewed by the committee on IP/PC: April 2005
11
Infection Prevention Protocols
Protocol 7: Use of the dental treatment unit
7.1 Measures before treatment:
Do not take unnecessary items (bags, clothing, pencil case, etc. ) into the treatment unit
and, if they are necessary, never put them on the worktops;
Keep equipment and materials that are not immediately required as far away from the
splash zone as possible;
Wear a protective coat;
Rinse the cooling-water pipes for the multifunctional syringe, micromotor and air rotor
according to the instructions before every practical training session;
Then briefly rinse the pipelines before every patient;
Disinfect the unit and the worktops with 70% alcohol;
Start the computer and log in;
Know which treatment you are going to carry out and what you require to do so. Put out
the required instruments and materials. Ensure the sterile/clean and non-clean objects are
clearly separated;
Put out gloves, a mask and protective glasses;
Collect the patient.
7.2 Measures during treatment:
Wear gloves, protective glasses, a mask and a protective coat according to the protocols;
Work from clean to dirty;
Ensure that you always have a clear separation between sterile/clean and non-clean items;
Disinfect the gloves when working from dirty to clean;
Avoid creating aerosols by using an evacuator;
Disinfect the gloved hands before leaving the dental treatment unit.
7.3 Measures after the treatment:
If necessary update the file;
Wear gloves while tidying up and cleaning;
When tidying up/cleaning always work from critical and relatively clean places to less
critical/more soiled places such as, for example, the washbasin and the dental chair;
Tidy up, throw away refuse and unused disposables, put sharps and amalgam in the
designated containers;
Disinfect contaminated and touched non-sterilizable accessories or packagings such as
tubes, cotton roll holders, wedge box, etc. using 70% alcohol and return these to the
central intake desk without re-infecting them;
Remove cement residue from instruments, tooth plaque fluid as well as debris on drills,
files, etc. with 70% alcohol (prevent needle stick injuries). Hand the instruments in to the
central intake desk;
Clean/disinfect the treatment unit: remove visible dirt and then disinfect with 70% alcohol
contaminated unsterilizable materials such as buttons, the lamp's handle, surfaces and
anything else that was touched;
Rinse the suction unit and the spittoon with plenty of water; if necessary clean with soap;
Remove visible blood spatters from the floor;
Leave the chair, unit and their surroundings behind in an orderly manner;
Disinfect your hands after taking off your gloves.
Laid down by IPC 27-10-1992
12
Reviewed by the committee on IP/PC: April 2005
Infection Prevention Protocols
Protocol 8: Measures for the dental treatment of identified high-risk
patients
8.1 Which patients does this involve?
Identified high-risk patients are those patients who upon referral or on the basis of their
history proved to be carriers of one of the following pathogenic micro-organisms or are
currently suffering from infection.
This involves:
blood contact transmittable disorders: Hepatitis B (HBV) and Hepatitis C (HCV) and HIV;
contagious paediatric diseases such as the mumps or chickenpox;
patients with mucous membrane/oral area skin/bronchial infections;
open lung tuberculosis (not yet effectively treated)
patients with severely weakened immune systems, for example, as a result of a recent
organ transplant or chemotherapy*.
* It is important to do your utmost to prevent the infection of patients with severely weakened immune systems.
Generally, it is always preferable to postpone a dental examination and/or treatment
until the danger of infection is over.
8.2 Who determines what is supposed to happen?
In educational practice, the outpatients clinic’s primarily responsible dentist is responsible for
deciding to register an identified high-risk patient or not. He/she also ensures that
preconditions are present which allow any possible treatment to be carried out in a responsible
manner.
If history or the referral indicate that the patient is high-risk, this is reported to the primarily
responsible dentist or oral hygienist. He/she determines:
whether the patient is indeed an identified high-risk patient;
whether, and if so, how long examination and/or treatment must and can be postponed.
If it is impossible to postpone the treatment, it must first be ascertained whether the essential
treatment can be carried out in the patient’s own environment.
If this also proves impossible, then the primarily responsible dentist determines:
which additional measures are required (please refer to 8.3 and 8.4)
whether more detailed advice should be gained from the infection prevention consultant or
the AMD.
In the event that people are permanent carriers (of Hepatitis B, Hepatitis C, HIV), treatment
postponement is not an option, and the patient will be treated, taking into account the
additional measures listed under 8.3 and 8.4.
A patient with an infectious disease that as yet cannot be effectively treated can constitute a
serious infection risk to those around them, and will therefore have to be nursed in isolation
(e.g. open tuberculosis). If an isolated patient needs to undergo dental treatment which cannot
be postponed, the referring party ensures that dental treatment is carried out at the institution
the patient is in. The institution then makes effective protective materials available to the
dental team.
13
Infection Prevention Protocols
8.3 Additional measures before and during treatment
Compliance with the generally applicable recommendations (please refer to the other
protocols) offers both the dental team and the patient(s) sufficient protection from infection.
Nevertheless, it is desirable, particularly in an educational environment, to take a number of
additional measures.
Treatment of identified high-risk patients does not take place in educational rooms, but in
separate treatment rooms;
Treatment is not carried out by undergraduates, but solely by fifth-year dental students or
third-year oral hygiene students, while sufficient supervision and staff are provided;
Identified high-risk patients should preferably be treated at the end of the morning or
afternoon programme;
Qualified dental chair assistants should be available;
Ensure there is a bowl of chlorine of the correct concentration present so that any molds
that have been made or prostheses can be disinfected in the treatment room. This chlorine
solution can be used after the treatment to clean the suction unit and the spittoon;
Disposable materials should be used as much as possible.
8.4 Additional measures after the treatment
Waste and single-use materials (including disposables that were laid out, but were not
used) must immediately be thrown in a bin liner, which must then be closed and disposed
of in a responsible manner;
Suction unit and spittoon must be rinsed through with the chlorine solution;
Treatment unit must be cleaned and disinfected according to the existing procedure. Please
refer to Protocol 7: Use of the Dental Treatment Unit.
Laid down by IPC: 27.10.1992
Reviewed by IPC: April 2001
14
Infection Prevention Protocols
Protocol 9: Disposal of contaminated sharps
In order to prevent needlestick injuries, needles must be used on patients once and then be
disposed of in the designated sharps container. Sharps containers are present in every
treatment unit.
9.1 The use of needles
Although reinserting the needle into the protective cover is the best way of preventing
needlestick injuries, this recommended method is unachievable at the dentistry department
due to the screw on cartridge syringes.
Alternatives for reinserting the needle into the cover are:
Using a protective cap* to protect the hand when reinserting the needle into the cover.
Recapping. The cover is then laid down on the edge of the tray or work surface and the
needle is reinserted without holding the protective cover. The needle and the cover are
then unscrewed and disposed of in the designated sharps container.
* A protective cap can be obtained from the desk and should be handed in together with the cartridge syringe after treatment.
9.2 Additional anaesthetic injection
If additional anaesthetic injection is required, a new needle must be used (the one already
used is no longer sterile).
9.3 Sharps containers
If the sharps container is full, it should be handed in to the central intake desk-assistant or
dental assistant.
Please make sure the sharps container is not too full, because if it is, someone could easily
prick themselves on an upright needle trying to dispose of their needle. The sharps container
should be disposed of when it is 80% full.
The full sharps container should be closed and delivered at the central intake desk, and should
be disposed of in a hospital waste container. The warehouse/transport service removes full
containers and replaces them with new ones.
Laid down by IPC 26.04.1994
Reviewed by the committee on IP/PC: April 2005
15
Infection Prevention Protocols
Protocol 10: Disinfecting moulds and dental work
Dental technicians run the risk of infection through the transmission of micro-organisms
between the dental practice and the dental laboratory. On the other hand, dental laboratories
(DL) should be viewed as places where patient-alien pathogenic micro-organisms can be
found.
In order to reduce the risk of transmission of pathogenic micro-organisms, it is necessary to
first disinfect moulds and partially or entirely finished restorative appliances (dental work)
before submitting them to the DL for further processing. Restorative appliances from the DL
can host large numbers of micro-organisms, partly because they are transported and stored
wet. They should therefore be rinsed under running water (if necessary disinfect first) before
fitting takes place.
A simple, safe and effective method is the use of chlorine tablets. A chlorine compound in
tablet form: 1 tablet dissolved in 1.5 litres of water gives you 1,000 p.p.m. active chlorine,
enough to inactivate HIV, HCV and HBV.
Method:
1. Make a solution of 1 tablet to 1.5 litres of water in a closed container. This solution is
unstable. A new solution must therefore be made every morning and afternoon;
2. Rinse mould or dental work under a running tap to remove visible blood and saliva.
Beware of spray. Aerosols can contain micro-organisms;
3. Apply sticker to the mould or dental work with your name on it;
4. Soak the mould or dental work in the chlorine solution for 5 minutes (must be entirely
submerged);
5. After 5 minutes, use gloves or an instrument to remove the mould or dental work from the
solution;
6. Allow the mould or dental work to drip, then thoroughly rinse under a running tap.
7. Send to DL:
Put the mould or dental work in a clean plastic bag labelled with a sticker:
'DISINFECTED' .
Laid down by IPC on 07.12.1995
Reviewed by the committee on IP/PC: April 2005
16
Infection Prevention Protocols
Protocol 11: Use of disposable, non-sterile gloves
Method:
1. The wearing of disposable, non-sterile gloves is essential for every activity which
comprises more than a visual check according to the no-touch technique, i.e.:
- direct contact with oral mucous membrane, saliva or blood;
- contact with materials and instruments which are contaminated with saliva or blood.
2. A new pair of gloves should be worn for every new patient and these should be put on as
close to the start of the treatment as possible. If during the treatment work takes place
from dirty to clean (e.g. after touching patient files, photographs, desk material, the
telephone, etc.) these gloves must be disinfected with hand alcohol. Please refer to
Protocol 4: Hand cleaning and hand disinfection.
3. You may not leave the dental treatment unit before disinfecting your hands/gloves with
hand alcohol. The gloves must also be disinfected immediately after the patient’s
treatment. If the gloves have become visibly soiled with blood or dirt then you should take
them off before leaving the treatment cubicle, and then disinfect your hands with hand
alcohol.
4. Always wear gloves during the cleaning and disinfecting of the dental treatment unit. Not
only to prevent infection, but also to ensure your hands do not dry out too much due to the
alcohol.
After cleaning, you should take off the gloves and disinfect your hands with hand alcohol.
Please refer to Protocol 4: Hand cleaning and hand disinfection.
5.
-
Gloves may not be worn outside the treatment room:
during the collecting and readying of instruments and materials for the next treatment;
when receiving the patient;
when outside the clinical treatment rooms, X-ray department, sterilization department,
dental laboratory and the instrument service.
Other rules apply for instructors
They must disinfect their gloves with hand alcohol in the dental treatment unit in which they
have just seen a patient. The gloves must always be replaced if contact with blood has taken
place.
Maximum glove wearing time
A pair of gloves may not be worn for longer than 45 minutes. A new pair must then be put on.
Skin complaints
If skin complaints develop on the hands it can be desirable to temporarily wear a different
type of glove. If the complaints do not disappear or get worse it is a good idea to contact the
AMD.
Laid down by IPC 22-10-1991
Laid down by the dentistry division board FMW 28.11.91
Reviewed by the committee on IP/PC: April 2005
17
Infection Prevention Protocols
Protocol 12: Digital intra-oral X-rays
The transmission of infectious diseases can occur through the contamination of hands,
equipment and materials used to make intra-oral X-rays.
The X-ray facilities in the clinical rooms are used by large numbers of students. It is very
important that every new user can be certain that the previous user has implemented the
correct cleaning and disinfection procedure.
Method:
Clean and/or disinfect your gloved hands before leaving the treatment area;
Get an X-ray cassette and go to the X-ray booth and set it up to take an X-ray;
Get a phosphor plate right before taking the X-ray. Insert the phosphor plate into the
disposable protective cover so that light and saliva cannot get into it. Properly close the
protective cover;
Put a clean napkin down on the clean storage surface with the X-ray cassette on top of it
with its mounted position indicating device and the phosphor plate (in cover) and if
necessary a cotton wool roll;
Set up the headrest, adjust the height of the chair, put the X-ray tube in the correct position
and give the patient the lead shield. Check the exposure variables;
Place the phosphor plate, aim the X-ray tube and expose;
Put the disassembled position indicating device back in the cassette, place the phosphor
plate on the napkin and dry it;
Make the patient put the lead shield away themselves;
If making an endodontic length determination X-ray, the rubber dam frame must be placed on
the napkin. When making more than one exposure, the storage surface of the films/phosphor
plates can be disinfected with a tissue and 70% alcohol and collected outside the X-ray zone
in a plastic cup.
Disinfect the storage surface with 70% alcohol, the X-ray tube, the exposure button and
the controls, and everything else which has been touched by contaminated hands (in the
event of visible soiling, first clean and dry);
Take off your gloves and disinfect your hands with hand alcohol before leaving the X-ray
booth;
Disinfect the protective cover which holds the phosphor plate using a tissue and 70%
alcohol;
Take the cassette and the phosphor plate(s) and walk the patient back to the treatment unit;
Take the phosphor plate(s) to the read-in device for further processing. Try to remove the
phosphor plate from the protective cover right before reading in.
Do not wear gloves when using the read-in device and always ensure your hands are
clean!!!!
Return the phosphor plate(s) as soon as possible after reading in and further processing to
the central intake desk
Laid down by IPC on 26.03.1998
Reviewed by the committee on IP/PC: February 2006
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Infection Prevention Protocols
Code of conduct for health care students
Health care workers are supposed to serve people who need help and ask for it with their
knowledge and skills. They are thereby expected to act in a decent manner, not cause offence
through their behaviour, not discredit colleagues or their study programme, respect patient
privacy and adhere to medical secrecy. All this is to take place in accordance with the
standards and values of Dutch society.
If you wish to successfully study dentistry (medicine, veterinary medicine), you not only
require sufficient basic cognitive, social and motor skills, but also need to be prepared and
interested in dealing with people. The people you deal with can have very different
backgrounds and can be from all walks of life. In most cases they put their lot in your hands
and trust you to solve their problems. People visiting a dentist (doctor, vet) can sometimes be
confused or feel threatened and be very anxious. Now and again, patients can also be
aggressive. You have to be able to deal with this without distinguishing between patients. In
the Netherlands, the caregiver may not make any distinction on the basis of race, religion,
gender, or social status when dealing with the patient and his/her supervisor. This is also
strictly enforced within the study programmes. Moreover, dentistry (medical) students
practise, for example, physical examinations on one another. When practising on one another
they are randomly paired. No exceptions can be made for race, religion, gender, etc.
Students must observe clothing regulations during the preclinical and clinical practical
exercises in the study programme. These regulations pertain to working hygienically.
This means that clothing must always be clean, but also that lower arms must be bare and not
laden with jewellery, wristwatches, bracelets or any other type of adornment. This enables the
careful cleaning of hands and lower arms. The face must be uncovered in order to facilitate
communication, except during patient treatment when it should be covered by a mask.
Wearing a white headscarf is permitted. Aspiring students who, on the basis of religion or
otherwise, have a problem with physical contact with people of the opposite sex and/or having
their face uncovered, should realize that the treatment obligation, communication principles
and hygiene regulations cannot be ignored for any reason.
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Infection Prevention Protocols