Chapter 20: Asepsis Protocols, SOP's and Checklists

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Asepsis Protocols, SOPs,
and Checklists
Chapter 20
1

Learning Objectives
Lesson 20.1: Asepsis Protocols, SOPs,
and Checklists
1. Describe what is meant by safety culture, and how
to maintain safety culture.
2. Describe the “behind the scenes” types of
infection control preparation necessary in a dental
office.
3. Describe the necessary general preparation of the
reception and clinical areas of the dental office.
4. Describe infection control procedures to be used
before seating the patient.
2

5. Describe infection control procedures used after the
patient is seated but before beginning the actual
treatment.
6. Describe the infection control procedures to be
performed during patient treatment.
7. Describe infection control procedures to be performed
after the patient appointment is completed.
8. Describe infection control procedures to be performed
when taking radiographs.
9. Describe infection control procedures for laboratory
asepsis.
3
Learning Objectives
Lesson 20.1: Asepsis Protocols, SOPs,
and Checklists (Cont.)

Safety Culture
 Commitment to dental health care personnel and
patient safety at all levels of organization
 National Institute for Occupational Safety and
Health’s Safety Culture Survey is taken by
employees
 DHCP is the abbreviation for dental health care
personnel.
 DHCP are encouraged to be involved in planning and
implementing activities that promote safety
 Patients are considered part of the care team
 Hazards for DHCP and patients are identified and
removed
4

Safety Culture
 Mechanisms are used to determine adherence to
written safety guidelines/policies
 Adverse events are studied by root cause analysis
 Communication and feedback links are developed
 Newer commercially available medical safety devices
are constantly sought and considered
 Individual accountability for safety is promoted
 Success in establishing and maintaining a safety
culture are acknowledged and rewarded
 The evaluation process and the results are documented in the
exposure control plan as required by OSHA.
5

“Behind the Scenes”
 Regulations, recommendations, administration,
recordkeeping
 Education and training
 Medical conditions and work restrictions
 Immunizations and testing
 Postexposure management
 All of these are examples of “behind the
scenes” things that need to be done in the
area of infection control.
 See the text for more details on each.
6

General Preparation
 Reception area
 Housekeeping surfaces kept visibly cleaned
 Cleaning solutions prepared fresh daily
 Touch surfaces are routinely cleaned
 Appropriate caution signs are used when floors
are wet
 Clinical area
 Mechanisms of postexposure evaluation are in
place
 Dental unit manufacturer is consulted for
appropriate methods and equipment to maintain
the recommended quality of dental water
7

Protocol Before Seating Patient
 Put on protective clothing, protective eyewear,
mask, and gloves, and clean and disinfect those
surfaces that may be touched during patient
treatment that will not be protected by surface
barriers.
 Remove all items not used during patient treatment
from countertops.
 These surfaces can include the following:
 Cuspidor rim and control knob
 Countertops
 Drawer pulls and top edges of drawers that may be used
 Sink faucet handles
 Handpiece connectors
8

Protocol Before Seating Patient (Cont.)
 Clean and disinfect items brought into the
area to be used during patient procedures
 Disinfection procedure
• Spray surface with the surface disinfectant that has been
prepared properly
• Clean surface by vigorously wiping with paper towels or
4×4 gauze pads
• Disinfect the precleaned surface by respraying it and
letting it air dry or by wiping it dry if it is still wet after the
prescribed contact time
• Alternatively, wipe with a disinfectant towelette, discard
towelette, wipe with a second fresh towelette, and let dry
 Remove and discard mask and gloves and
wash hands
9

Protocol Before Seating Patient
 What types of items might be brought into the
area?
 Articulators, casts, dies, custom impression trays,
record bases, fixed and removable prostheses,
and face-bows
10

 Follow the procedure for removing gloves
 Pinch one glove in the wrist area on one hand with the
thumb and forefinger of the other hand
 Stretch the glove out away from the wrist; slide it off
toward the fingertips halfway
 Repeat step on other hand, except slide that glove
completely off and drop it directly into the waste
receptacle
 Move back to the first hand and place the ungloved thumb
under the edge of the glove, which now has the
noncontaminated surface inside of the glove turned out
 Stretch the glove out away from the hand, slide it
completely off toward the fingertips, and drop it directly
into the waste receptacle and then wash hands
11

 Obtain surface barriers, supplies, and sterile
instruments and other equipment from the
supply area
 Cover the following surfaces with the
appropriate barrier:
 Headrest
 Control buttons on side of chair
 Light handles
 Unit light switch and view box switch
 Air/water syringe buttons/handles
12

 Cover the following surfaces with the
appropriate cover:
 High-volume evacuator control
 Unit control switches and handpiece, air/water
syringe, and high-volume evacuation holders
 Saliva ejector, handpiece, and air/water syringe
hoses
 Bracket table
 Stool backs
13

 Remove all items not used during patient
treatment from countertops
 Make sure a sharps container is available at
chairside
 What types of items might need to be
removed?
 Datebooks, articulator boxes, and cardboard and
plastic boxes
14

Protocol After Seating Patient
 Adjust chair and headrest
 Place patient napkin
 Take or update medical history, discuss
treatment, and do necessary paperwork
 Remove chart from the countertop
 Have patient rinse thoroughly with an
antimicrobial mouth rinse
 Open instrument packages or tray without
touching the instruments
 Put on mask and eyeglasses
15

Protocol After Seating Patient (Cont.)
 Perform hand hygiene (preferably in patient’s
view)
 Handwashing procedure
• Remove jewelry and gently clean your fingernails
• Lather for 15 seconds with the liquid antimicrobial or non-
antimicrobial detergent
• Rinse under cool water and towel dry
 Or use alcohol-based hand rub
 Perform surgical scrub for procedures indicated
 Put on gloves (preferably in view of patient).
Use sterile gloves for procedures as indicated;
otherwise, use nonsterile examination gloves
16

Protocol After Seating Patient (Cont.)
 Use powder-free gloves.
 Alternatively, rinse nonsterile, powdered
examination gloves with plain, cool water (no
soap) to remove excess powder and towel dry
before making impressions and bite registrations
 If desired, remove excess powder by rinsing with
water and drying before other types of procedures
 If you rinse to remove the excess powder, explain
to the patient what you are doing.
 Connect sterile handpieces and sterile or
disposable air/water syringe tip, high-volume
evacuation tip, and saliva ejector tip
17

Protocol During Patient Treatment
 Restrict spread of microorganisms from patient’s mouth
 Use rubber dam
 Use high-volume evacuation
 Touch as few surfaces as possible with saliva-coated fingers
 Keep gloved hands out of hair; do not rub eyes or bare skin or adjust
mask/glasses
 If leaving chairside during treatment is necessary, remove and
discard the gloves
• Wash hands and reglove with fresh gloves on return
 Remove contaminated gloves and wash hands before handling
cameras for intraoral photographs
 Do not wear protective clothing in lunchrooms, restrooms, or outside
the building; change protective clothing if obviously soiled.
18

Protocol During Patient Treatment (Cont.)
 Do not use items dropped on the floor or on other
nonsterile surfaces.
 Obtain sterile replacements.
 Remove and replace gloves, preferably in view of the
patient
 If gloves are torn during treatment, remove, discard,
wash hands, and reglove with fresh gloves
 Do not recap needles by hand. Insert the needle into the
cap using the one-handed “scoop” technique or a cap
holder that will not permit contact of the needle with any
part of the body
 NEVER pass syringes with uncapped needles to
someone else.
19

 Look first before reaching for a sharp
instrument
 When placing sharp instruments back on the
instrument tray, make sure sharp tips are not
pointed up and make sure they are placed in
a stable position
 If equipment is brought to chairside (e.g., light
curing apparatus), make sure it is protected
with a surface barrier or has been disinfected
before use
20

 Use an aseptic retrieval technique to obtain
supplies from bulk containers at chairside
 If one must obtain supplies (e.g., amalgam,
varnish, or cavity liner) from a central storage
area, do not take a container to the unit
unless it is covered with plastic wrap or is
cleaned and disinfected after use
21

Protocol During Patient Treatment
 Disinfect contaminated items before taking
them to the dental laboratory
 Do not handle charts with contaminated
gloves. Use an overglove or remove gloves
and wash hands
 If exposed to a patient’s blood or saliva,
immediately contact the appropriate person to
institute a postexposure medical evaluation
22

An exposure is any sharps
injury or contact with the eye,
mouth, other mucous
membrane, or nonintact skin
involving blood or saliva.
23

Protocol After Patient Treatment
 Remove gloves and then the mask by touching only the
ties or elastic band, discard them in a plastic-lined waste
container at the unit, and then wash hands or use an
alcohol hand rub
 Send the patient to the front desk for dismissal or
reappointment
 Put on fresh gloves and mask
 Place all instruments back in the tray
 Anyone who will be cleaning contaminated instruments
must wear heavy utility gloves, protective clothing, a
mask, and a face shield or protective eyewear.
 If instruments are hand scrubbed, they should be
submerged in detergent while scrubbing with a long-
handled brush to prevent splattering.
24

Protocol After Patient Treatment (Cont.)
 Place all disposable sharps, including capped
or uncapped needles, directly into the sharps
container at chairside
 Place nonsharp disposable items in the plastic-
lined waste container at the unit
 Flush the air/water syringe, high-speed
handpiece, and ultrasonic scaler into the sink,
cuspidor, or container for 20 to 30 seconds and
disconnect from hoses
25

Protocol After Patient Treatment
 Do not place needles or other sharps into the
regular trash receptacle.
 This would be a serious violation of procedures.
 What types of items are considered “sharps”?
 Sharps include needles, scalpel blades, carpules,
broken instruments and files, burs, orthodontic
wire, and other disposable items that could
penetrate the skin.
26

 Remove all surface barriers (without touching the
underlying surface) and discard in plastic-lined waste
container at the unit
 Clean and disinfect patient care–related surfaces that
were not covered and were contaminated during
treatment
 Cleaning and disinfection of surfaces that were covered is
unnecessary unless they become contaminated during removal
of the covers (see the aforementioned disinfection procedures).
 Take instruments and handpieces to the
decontamination/sterilizing area
 Remove and wash contaminated eyeglasses, and rinse
and dry them. Avoid contaminating hair
27

 Remove and dispose of the disposable gown
(if used) in the plastic-lined waste container at
the unit
 How should the gown be taken off?
• Untie the gown and pull it off over gloved hands, and do
not touch underlying clothing or skin.
 Remove gloves and discard them in the
plastic-lined waste container
 Wash, rinse, and dry hands or use an alcohol
hand rub
28

Unit/Patient Preparation
for Radiographs
 Before seating patient, prepare unit by covering
or disinfecting all surfaces that will be touched
or exposed to potentially infectious fluids
 Review or update patient’s medical history
 After washing hands, gowning, and gloving,
determine the appropriate number and type of
films to be taken
 Obtain the films from a central distribution area
or film dispenser while wearing clean gloves or
cover the digital x-ray sensor with the
appropriate barrier
29

Unit/Patient Preparation
for Radiographs (Cont.)
 Reglove and expose the films or sensor in the
recommended manner
 Place exposed films on a paper towel or in a cup.
Do not touch the film packs with contaminated
gloves
 If film packs are precovered with plastic protectors,
carefully remove the contaminated covers after
exposure and drop the film packs onto a clean surface.
 Remove surface barriers from the unit or disinfect
contaminated surfaces
 Remove gloves and wash hands or use an
alcohol hand rub
30

Darkroom Processing
for Radiographs
 Place new gloves on hands
 Carry the films to the darkroom using caution
not to touch doors, walls, work areas, or
processors with contaminated gloves
 With gloved hands, carefully open the film
packets and drop the films onto a clean paper
towel. Place contaminated film wrappers into
the designated refuse containers
31

Darkroom Processing
for Radiographs (Cont.)
 Remove contaminated gloves and place films
in the processor; perform hand hygiene
 After processing, place the films into the
appropriate mounts using care not to
contaminate the films, mounts, or charts with
instruments that were used in the operatory
32

Daylight Loader Processing
 Because of the limited operating space inside
the loader and because the hand insertion
sleeves cannot be disinfected, place only
films that are not contaminated in the loader
 This can be accomplished in two ways:
 Film disinfection
 Pre-exposure wrapping
33

 What is the film disinfection technique?
 After the films have been exposed, rinse them with
water, soak them in an appropriate bleach or
iodophor solution for 10 minutes, and while
wearing clean gloves, rinse them with water and
dry them with a clean paper towel.
 Place the films into the loader through the top.
[Only plastic film packets may be disinfected.]
34

 What is the preexposure wrapping technique?
 Wrap the film in plastic before placing it in the patient’s
mouth.
 Film packs already protected with a removable plastic
cover are available.
 After exposure, carefully open the outer wrapping or
remove the cover and drop the film packet onto a clean
surface.
 Use caution so that the clean packets do not touch the
contaminated gloves or wrapping.
 Place the films in the loader through the top, and after
donning new gloves, pass the hands through the insertion
sleeves.
35

Laboratory Asepsis
 Gloves, mask, protective eyewear, and protective
clothing are used until items in the lab are
decontaminated
 Before items are used in the lab, all dental
prostheses and prosthodontic materials are cleaned
and disinfected
 Manufacturers are consulted where needed
 Specific information regarding disinfection technique
used are included when lab cases are sent off-site
and returned
 Manufacturers are consulted regarding the stability of
specific materials (e.g., impression materials) relative
to disinfection procedures.
36

Laboratory Asepsis (Cont.)
 Heat-tolerant items used in the mouth are cleaned
and heat-sterilize
 Manufacturer’s instructions are followed for cleaning
and sterilizing or disinfecting items that become
contaminated but that do not normally contact the
patient
 If manufacturer instructions are not available, heat-
tolerant items are cleaned and heat-sterilized or
cleaned and disinfected with an EPA-registered
hospital disinfectant with low- to intermediate-level
activity, depending on the degree of contamination.
37

Chapter 20: Asepsis Protocols, SOP's and Checklists

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Chapter 20: Asepsis Protocols, SOP's and Checklists

Similar to Chapter 20: Asepsis Protocols, SOP's and Checklists (20)

More from HeatherSeghi

More from HeatherSeghi (20)

Recently uploaded

Recently uploaded (20)

Chapter 20: Asepsis Protocols, SOP's and Checklists