Hospital Policies and Procedures
Dental Personnel Cleanliness
The following guidelines apply to all clinic personnel including faculty, pre- and post-doctoral students, and staff who have patient contact and may come into contact with blood, body fluids, and tissues.
1. Personal Hygiene :
- Hair must be secured away from the face and not be in contact with clinical surfaces during treatment
- Beards or mustaches must be covered by a face mask and shielded if still exposed when the mask is properly worn
- Jewelry should not be worn on the hands or arms during patient treatment. This includes rings other than wedding bands and watches
- Watches are discouraged due to contamination potential if the garment sleeve and gloves do not fully cover the watch
- Nails must be clean and short.
- Artificial nails have been shown to harbor microorganisms and are highly discouraged.
2. Hand washing:
- Hand washing is the single most important means of preventing the spread of infection. It is mandatory before treatment between patients and after glove removal, during treatment if the gloves are damaged, and before leaving the clinic area
- Using the antiseptic soap provided, washing the hands twice for fifteen seconds, prior to seeing the first patient
- Hands should be washed well above the wrists by vigorous and thorough scrubbing
- Hands should be rinsed and then dried using fresh paper towels
- Faucet handles are considered a source of contamination and should be turned off using dry paper towels
- The hands must be washed for fifteen seconds each time, after the initial time of removing gloves. If hands are not visibly soiled, an alcohol based antiseptic hand rub is also adequate
- Thoroughly dry the hands before putting on gloves.
- Surgical hand scrubs must be carried out, as defined by the appropriate department
- Routine use of barriers for personal protection, such as glasses, masks, gloves, and isolation gowns, are required when exposed to blood, saliva, gingival fluid, and aerosols generated during treatment, since all are considered to be contaminated and potentially infectious
- Departmental variations on these procedures are possible but these must be reviewed by the Infection Control Committee and approved in writing prior to implementation
- Appropriate clinical attire must be worn under the conditions described above. With the exceptions noted below, the following are guidelines for acceptable clinical attire:
- Protective glasses with side shields or a face shield must be worn when treating patients or performing lab work. These will be provided for faculty, staff and students use from the supply station in each clinic. Protective lenses should be washed when soiled. This may be done using detergent and water or an appropriate cleaning disinfectant
- A properly fitted mask must be worn and must be changed when wet or for each treatment session. When removing the mask do not touch the mask itself, use the straps
- Gloves must be worn for all patient contact. They must be changed between patients or if torn, worn, or punctured. Hands must be washed or sanitized before donning and after removing gloves
- Gloves are not to be worn when not being used for a dental procedure or during an operation
- Examination gloves are satisfactory for most procedures
- Sterile surgical gloves are available for procedures which require them to be used
- Gloves should fit over the knit cuffs of protective garments
- Isolation gowns are provided for faculty, post-doctoral students, students and staff who assist at the chair side. These must be worn at all times during patient contact
- Bare skin cannot be exposed when spray, splatter, or aerosols are anticipated. Garments shall be zipped or closed so that street clothes do not show above the neck. These gowns are not to be worn outside of the clinical area; nor are they to be worn in simulation lab or laboratories
- Garments used during clinical or operational treatments may not be worn in classrooms, office areas, or personal offices. Garments should be changed after two clinical sessions (a session is one-half day) or when visibly soiled. Soiled isolation gowns are to be placed in the containers provided in the clinic areas. The faculty, staff, post-doctoral students, and students are to clean their own clinic jackets
- Plastic bags are available from the dispensary for carrying clinic jackets to a laundry facility
- In simulation labs, a lab coat (NOT the isolation gown) must be worn
- In Oral and Maxillofacial Surgery and in Periodontics clinics during surgery or root planning, isolation gowns may be worn. These are available in the respective treatment area. Gowns must be deposited in the proper Black receptacle with the sign Used Gown. They will be collected from those areas and laundered.
The Use of Non-Sterile Gloves during Routine Dental Care:
- Examination non-sterile gloves are dispensed by the box provided by the Central Supply station and are available in each clinic area
- Non-sterile gloves are worn for the operator's protection AS WELL AS the protection of the patient
- Gloves are to be worn in the operatory while involved in direct patient care or evaluation
- When the student, faculty, post-doctoral student, or assistant leaves an operation area for any reason, the gloves must be removed and discarded in the proper place
- Hands should be washed or sanitized
- Upon return to the operation area hands must be washed or sanitized
- When hands are gloved, practice scrupulous aseptic technique. Do not touch anything other than instruments and devices used in treatment
- Remove gloves when obtaining items from movable supply carts
- Should gloves become torn for any reason, immediately stop the procedure, remove the gloves, thoroughly wash hands, and re-glove.
Needle Recapping and Sharp Objects Disposal:
- Needles may be recapped for re-injecting the same patient, however they are not to be recapped using two hands
- The cap should be placed on the counter or bracket tray, the tip of the needle placed in the cap and the cap "scooped" up onto the needle and tapped to place
- Use a hemostat or cotton pliers to hold the capped needle when removing it from the syringe barrel
- Used anesthetic needles and other "sharps" must be disposed of in the proper puncture-proof containers available in each clinic
- Anesthetic cartridges are not considered “sharps,” medically regulated waste (unless visible aspirated blood is present) or hazardous chemical waste. They should be disposed of into safe containers such as empty plastic bottles or other containers and disposed of in the general waste.
ALL INSTRUMENTS USED INTRAORALLY MUST BE STERILIZED. No unpackaged instruments may be kept or stored for patient treatment
Those areas that do not ordinarily make contact with the patient directly or contact only unbroken skin, but may be touched by contaminated substances, are "touch and splash" surfaces. These include the countertops, chairs and other surfaces. Proper disinfection. Operatory countertops are not to be cluttered with extra supplies or personal items. Only those items necessary for immediate treatment are to be on the countertop. If patient charts are being used, they should be kept away from the “touch or splash” areas.
Unit Cleanup and Disinfection
- Personnel (technicians and nurse aids) are the ones responsible about this matter
- Everyone should be wearing utility glove
- Dispose of syringe needle, scalpel blades, or any other potentially sharp object in the puncture proof "SHARPS" container.
Clinical Responsibilities for Instrument Handling
- Only instruments with a university dental hospital inventory control bar code will be accepted for sterilization procedures, with the exception of the instruments of those surgeons who might have a preference for certain instruments of their own
- All instruments must be turned into the central sterilization area in a manner that will allow inspection before packaging for sterilization
- Multi-instrument specialty kits which allow selection of components based on size and shape (for example: implant drill kits) will be packaged with an auxiliary container in which to place the instruments that were actually used for patient care
- All unused instruments will remain in the original kit.
- Used instruments will be placed in the auxiliary container to insure proper reprocessing prior to sterilization
- Cleaning and debridement of all implant drills and components will be the responsibility of the clinical department using the kit. After proper debridement and cleaning, the instruments will be placed in the auxiliary container for transportation to the central sterilization area. A final inspection of all components will be the responsibility of central sterilization personnel. Items not cleaned to proper standards will be returned to the clinical department for proper cleaning.