Ee eal ape 9b Ml Had Green Crescent Health Services | Infection Prevention | pate issued | Date of Renewal | Effective From Valid Til | “‘and Control Department - SRV-P-IC-DN48 | 01 January 2010 | 16 September 2019 | 18 September 2019 | 22 March 2022 Policy Title Infection Control - Dental Clinic PP Rev. No. 4 1. STATEMENT OF PURPOSE 1.1. To provide guidelines on proper infection control practices in dental care settings. 2. SCOPE 21 Dental Department 3. DEFINITIONS 3.1 NIA 4. POLICIES 41. Patients and dental healthcare workers (DHCWs) may be exposed to a variety of infectious, viral, and bacterial agents in dental care settings via blood and other oral / respiratory secretions. Multiple potential sources for microbial cross-contamination and infection exist during treatment and instrument reprocessing 4.2 Routes of microbial transmission: 4.2.1 General Routes: 4.2.1.1 Direct contact with a lesion, organisms or potentially infectious secretions when performing intraoral procedures (e.g., practicing without wearing gloves) 42.1.2 Indirect contact via contaminated instruments or disposable items (eg., accidental percutaneous exposure from used needles). 4.2.1.3 Airborne or droplet via aerosolization of microorganisms from patients’ blood or saliva while using devices that can generate droplet spatter (e.g., air water devices, dental hand pieces) 4.2.2. DHCWs and patients as modes of transmission during patient care: 4.2.2.1. Patient to DHCW transmission of potentially infectious microbes can ‘occur through breaks in the skin or through airborne exposure. 4.2.2.2. DHCW to patient transmission of potentially infectious microbes can ‘occur as a result of DHCW bleeding into a patient's mouth after sharps exposure or through respiratory droplets passed from DHCW to the patient 4.2.2.3 Patient to patient transmission can occur if instruments are improperly reprocessed or due to improper hand hygiene or improper glove wearing on the part of DHCWs. 4.3 Recognizing the potential for microbial cross-transmission is essential before applying appropriate infection prevention and control precautions during the provision of dental care. Infection Prevention and Control Department Page | of 7 Policy and ProceduresEe aby Spa bd fl tee Green Crescent Health Services Infection Prevention and Control Date Issued | Date of Renewal Effective From Valid Till Department SRV-P-IC-DN4B | 01 January 2010 | 16 September 2019 18 September 2019 | 22 March 2022 Policy Title Infection Control — Dental Clinic IPP Rev. No. 4 5. PROCEDURE Treat every patient and contaminated instrument as potentially infectious with a life- threatening blood borne pathogen 5.1 Hepatitis B Vaccination 5.1.1 All susceptible DHCWs should be vaccinated against Hepatitis B. 5.2 ‘Standard Precautions (refer to SRV-P-IC-SP04) 5.2.1 Practice standard precautions (i.e., hand hygiene and use of mask, gloves, goggles, face shield, gowns or aprons). 5.2.2. Dispose of sharps properly in puncture-proof containers; do not bend or recap (refer to SRV-P-IC-SM56 Safe Handling and Management of Sharp). 5.2.3. Use paper with impervious backing, aluminum fll, or plastic covers to protect items and surfaces (e.g., light handles or X-ray unit heads) that may become contaminated by blood or saliva during use and that are impossible to clean and disinfect. 5.2.4 Remove these covers (while still gloved), discard them, and replace them (after un-gloving and washing hands) with clean materials between patients. 5.3 Pre-procedural Mouth Rinsing 5.3.1 Patient should rinse with an antimicrobial mouth rinse before a dental procedure to reduce oral flora 5.4 Unit Dose Concept 5.4.1 Preparing or dispensing a sufficient amount of material for a particular procedure before patient contact and discard any excess at completion. Single dose solutions or medications are recommended to prevent cross- contamination. 5.5 Patient Screening and Evaluation 5.5.1. Always obtain and determine the current health status of the patient, and always perform a thorough head, neck and oral examination to identify previously undiagnosed medical problems (examination may indicate a need for medical referral for the patient, e.g., for diagnosis of active tuberculosis). 5.6 Management of Needle stick injuries/blood and body fluid exposure 5.6.1 Refer to SRV-P-IC-SI37 Management of Sharps Injury and Exposure to Blood borne Pathogens. 5.7 Work Restriction for DHCWs 5.7.1 Refer to SRV-P-IC-WR31 Work Restrictions for Infected Healthcare Workers, Infection Prevention and Control Department Page 2 of 7 Policy and Procedures |Ee eal “ope a Hl at Green Crescent Health Services Infection Prevention Date Issued | Date of Renewal | Effective From Valid Til Department |—2ndControl_| SRV-PAC-DN48__| 01 January 2010 | 16 September 2019 | 18 September 2019 | 22 March 2022 Policy Title | Infection Control ~ Dental Clinic IPP Rev. No. 4 5.8 Barrier Techniques 5.8.1. The use of barriers is important for reducing tissue contact with potentially infectious pathogens and materials, ultimately reducing cross-contamination and cross-infection between DHCWs and patients, 5.8.1.1 DHCWs must wear protective attire when performing treatment procedures capable of causing splashes, spatter, contact with body fluids, or contact with mucous membranes or when touching items or surfaces that maybe contaminated with these fluids 5.8.1.2 The type of protection depends on the dental procedure. 5.9 _ Instrument Reprocessin 5.9.1, General principles 5.9.1.1 All dental and medical instruments can be classified into three categories: critical, semi- critical or non-critical, depending on the potential risk for infection associated with their intended use and how they are reprocessed. Refer to. 5.9.2 Dental instruments 5.9.2.1 Wear heavy-duty (reusable utility) gloves when cleaning and reprocessing to lessen the risk of injury. 5.9.2.2 Clean the instruments thoroughly to remove debris prior to delivery to the Central Sterile Supply Department (CSSD) for disinfection and sterilization 5.9.2.3 Place the instruments into a container of water or disinfectantidetergent as soon as possible after use to prevent organic material from drying on their surfaces, thus making cleaning easier. 5.9.3 Dental units and environmental surfaces can be di 5.9.3.1 Clinical surfaces 5.9.3.1.1 Clean countertops and dental unit surfaces that may have become contaminated with patient material after treatment of each patient and at the completion of daily work activities. Use paper towels, an appropriate cleaning agent, and water for cleaning 5.9.3.1.2 After cleaning an environmental surface contaminated with patient material, disinfect it with a “hospital-approved" disinfectant chemical germicide labeled “tuberculocidal.” Examples of such intermediate-level disinfectants include phenolics, iodophors, and chlorine-containing compounds such as diluted household bleach (sodium hypochlorite) ‘The manufacturer's recommended contact time (kill time) should be used : cleaning, disinfection and sterilization led into [Infection Prevention and Control Department Page 3 of 7 Policy and ProceduresInfection Prevention and Control ea eb} Sb eh] Green Crescent Health Services Datelssued | Date of Renewal Effective From Valid Till Department Policy Title ‘SRV-P-AC-DN48 Infection Control - Dental Clinic IPP Rev. No.4 5.9.3.1.3 To prepare a fresh solution of a 1:100 dilution of sodium hypochlorite as an inexpensive intermediate-level disinfectant, add % cup of household bleach to 1 gallon of tap water. This solution is active for only 24 hours and must be prepared fresh each day. Caution should be exercised because chlorine solutions can corrode metals such as aluminum 5.9.3.2 Housekeeping surfaces 5.9.3.2.1 Clean floors, walls and other housekeeping surfaces a hospital-approved low-level disinfectant such as a quaternary ammonium compound. 5.10 Use and care of hand pieces, anti-retraction valves, and other intraoral dental devices attached to air and water lines 5.10.1 5.10.2 5.10.3 5.10.4 5.10.5 5.10.6 5.10.7, Heat-sterilize all high-speed dental hand pieces, low-speed hand piece components used intra-orally and reusable prophylaxis angles. Acceptable methods of sterilization include steam under pressure (autoclaving), dry heat, or heat/chemical vapor. It is NOT acceptable to reprocess high-speed dental hand pieces, low-speed hand piece components used intra-orally, and reusable prophylaxis angles by wiping or soaking these instruments in liquid chemical germicides. Follow the manufacturer's instructions for cleaning, lubrication, and sterilization of hand pieces and reusable prophylaxis angles to ensure effective sterilization and longevity of the instruments. Install anti-retraction valves (one-way flow check valves) in dental unit water lines to prevent fluid aspiration and to reduce the risk of the transfer of potentially infectious material. Ensure routine maintenance of anti-retraction valves. Run high-speed hand pieces to discharge water and air for a minimum of 20 to 30 seconds after use on each patient. If possible, use an enclosed container or high-velocity evacuation during discharge procedures to minimize the spread of spray, spatter, and aerosols Remove hand pieces and allow water lines to run and discharge water for several minutes to reduce overnight microbial accumulation at the beginning of each clinic day Use sterile water or saline as a coolantiirrigator when surgical procedures involve cutting bone. Clean and sterilize reusable intraoral instruments attached to, but removable from, the dental unit air or water lines (e.g., ultrasonic scaler tips and their component parts and air/water syringe tips) in the same manner as hand Infection Prevention and Control Department Page 4 of 7 Policy and Procedurese See Slop SUBS] Sed Green Crescent Health Services Infection Prevention ara Control Date Issued | Date of Renewal | Effective From Valid Till Department +— + : | i SRV-PAC-DNG8 | 01 January 2010 | 16 September 2019 | 18 September 2019 | 22 March 2022 Policy Title Infection Control — Dental Clinic IPP Rev. No. 4 pieces after treatment of each patient. Follow the manufacturer's instructions for reprocessing 5.10.8 Some dental instruments have components that are heat sensitive or are permanently attached to dental unit water lines. Other instruments (e.g., handles or dental unit attachments of saliva ejectors, high-speed air evacuators, and air/water syringes) that do not enter the patient’s mouth can become contaminated whit oral fluids during treatment procedures. Cover these instruments with impervious barriers that are changed after each use or, if possible, clean and then disinfect them with a “hospital disinfectant’ that is labeled “tuberculocidal’ 5.10.9 Flush all water lines to all instruments thoroughly after the treatment of each patient and at the beginning of each clinic day. 5.10.10Advise patients not to close their lips tightly around the tip of the saliva ejector to filter oral fluids 5.11 Water Quality 5.11.1 Use water that meets the EPA regulatory standards for drinking water (ie., <200 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water. Scheduled water sampling must be done to monitor water quality, 5.12 Single Use Disposable Instruments 5.12.1 Use single-use disposable instruments (e.g., prophylaxis angles, prophylaxis cups and brushes, tips for high-speed air evacuators, saliva ejectors, and air/water syringes) for one patient only and discard after use. 5.13 Handling of Biopsy Specimens 5.13.1 Place each biopsy specimen in a sturdy container with a secure lid to prevent leaking during transport. 5.13.2 Avoid contaminating the outside of the specimen container. If the outside is visibly contaminated, clean and disinfect it or place it in a biohazard bag 5.14 Disposal of Infectious Waste Materials 5.14.1 Pour blood, suctioned fluids, or other liquid waste into a drain connected to a sanitary sewer system. 5.14.2 Place solid waste contaminated with blood or other body fluids in sealed, sturdy biohazard bags that are leak proof; refer to SRV-P-IC-WMSS Waste Management Infection Prevention and Control Department | PageSof7? | Policy and ProceduresEe Syabe lop Hl SoH Green Crescent Health Services Infection Prevention Date of Renewal | Effective From Valid Til Department aed Control ee S oe | srv..ic-on4s | 01 January 2010 | 16 September 2019 | 18 September 2019 | 22 March 2022 Policy Title Infection Control - Dental Clinic PP Rev. No. 4 5.15 Dental Radiography Asepsis 5.15.1 Wear gloves when taking radiographs and when handling contaminated film packets. Other PPE (e.g., mask, protective eyewear, protective clothing) is required when spatter or splashes of blood or other potentially infectious materials is anticipated 6. RESPONSIBILITIES 6.1 All dental healthcare workers are responsible and accountable for the implementation of this policy, 6.2 _ Infection control staffs are responsible to monitor adherence to this policy. 7. REFERENCES 7.1 GCC Infection and Prevention Control Manual 3" edition. ICM-VIII-08. 8. FORMS/MATERIALS AND EQUIPMENTS 8.2 Housekeeping daily checklist — 0414-IC-04-17 9. REVISION 9.1 Will be reviewed every 3 years according to QMS-P-QM-DM13 and to be revised as needed, Infection Prevention and Control Department Page 6 of 7 Policy and ProceduresInfection Prevention sieiconteet Date Issued | Date of Renewal Effective From Valid Till Department SRV-PAC-DN48 | 01 January 2010 | 16 September 2019 | 18 September 2019 | 22 March 2022 Policy Title Infection Control — Dental Clinic IPP Rev. No. 4 APPROVAL: Infection Control Practitioner Cristina Del Rosari Lab Tech. & Pc Groen Crescent Hospital Reviewed by: Involved Head of Infection Control/infection Control Committee Chairman Dr. Mostafa Shaaban oad of Lab. 81°C Groen Crescent Hospital Head of Dental 4.09.19 Medical Director weicas rector ‘Geen Crescent Hospital Director of Planning and Development Emad J. Subin Src in et ‘Gren Cesc Hospi Signature Signature Infection Prevention and Control Department Page 7 of 7 Policy and Procedures