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Infection Control and Cleanliness (Unit 305) APH 2014 AIM: Objectives: Legislation Department of Health document Health Technical Memorandum 01-05 (HTM 01-05) National Variations https://www.gov.uk/government/uploads/system/uploads/a ttachment_data/file/170689/HTM_01-05_2013.pdf What does the HTM 01-05 Document contain? You have 5 Minutes in your groups to identify as many contents of the HTM 01-05 document as possible. HTM-01-05 Essential Best Practice Updated policy following an inoculation injury No time scale as yet (2014) Decontamination and storage policy All of essential requirements plus: Decontamination of reusable items Hazardous waste policy Hand hygiene policy Recommended disinfectants Chemical spillage procedure Use of washer disinfector Separate storage area for sterilised items Separate facility for decontamination tasks Cleaning Socially Clean: acceptable standard of cleanliness but not disinfected or sterilised Disinfection: the killing/destruction of bacteria, fungi, some virus’ but not spores Sterilisation: killing of all micro organisms and spores to produce asepsis Asepsis: the absence of all living pathogenic micro organisms Decontamination: removal of contamination from reusable items (reprocessing) How do we achieve social cleanliness, disinfection and sterilisation? Hand Washing Dedicated hand washing sinks Elbow operated taps Nails short, no false nails or polish Wounds covered No jewellery No nail brushes Three levels of hand washing : Social, Hygienic and Surgical http://training.isopharm.co.uk/dental/ about-isopharm-training Personal Protective Equipment Gloves, clinical and household Plastic apron, to prevent uniform soiling during surgical procedures or during cleaning Safety glasses, to prevent contamination of eyes. Prescription glasses can be worn if covered with a visor Facemask of surgical quality Alcohol hand gel should NOT be used with clinical gloves as it damages nitrile or vinyl Cleaning of the clinical area HTM 01-05 recommends that dental surgeries follow this colour coding to reduce the risk of transmitting pathogens between areas. Mops and cloths should be colour coded for each area according to the guidelines below: Red - for bathrooms Green - for kitchens Blue -for non-clinical areas such as offices and waiting rooms Yellow – for clinical and decontamination areas How would you design a surgery to reduce risk of cross infection? Surgery Design All surfaces and flooring should be impervious and easily cleanable. Careful consideration must be taken when choosing fixtures and fittings for a clinical area. Surfaces should be joint less or seams heat welded. Floors coverings should be continuous, non-slip and joint less, with curved skirting where possible. Existing floors can be fitted with a curved sit on coving. Carpets must not be used in clinical areas. It is important to keep surfaces, including floors, as clutter free as possible. Boxes should not be stored on the floor as this may encourage cleaning around the obstruction instead of moving to clean underneath Disinfectants Bleach based (sodium hypochlorite) Aldehyde based Isopropyl alcohol based Chlorhexidine Gluconate based What disinfectants do you use in your workplace? (research the active ingredients) Disinfectants Bleach based Aldehyde based Use on non-metallic Use on metal Made up daily Soak laboratory items 1% clinical areas Aldehyde free safer (carcinogenic) 1% disinfect impressions 10% blood spillages Alcohol Chlorhexidine X-ray film packets Irrigation solution Not metal surfaces Skin cleanser Mouthwash Policies and procedures As a minimum the local infection control policy or policies should include: 1. Minimizing the risk of blood-borne virus transmission. It should include sharps injuries and how to reduce them taking into consideration new legislation around Safe Sharps 2. A policy on decontamination and storage of dental instruments. 3. Procedures for cleaning, disinfection and sterilisation of instruments. 4. A policy for the management and disposal of clinical waste (waste disposal policy) 5. A policy for hand hygiene 6. A policy for decontamination of new reusable instruments 7. Local policy and procedure for use of personal protective wear (PPE) 8. Spillage procedures as part of local COSHH arrangements 9. Environmental cleaning and maintenance 10. Procedures for the infection control of instruments and equipment 11. Transportation of instruments. Roles and responsibilities All staff are suitably trained. All staff are aware of the whole decontamination process. The dental team are aware of all roles and responsibilities of others. Staff are aware of the need for relevant infection control policies. Staff understand the need and have the ability to perform periodic testing where appropriate Surgery procedure at the start of the day Ensure PPE available Run through water lines Prepare detergents Clean all surfaces Cover equipment Prepare instruments and disposables Surgery procedure at the end of the day In addition to the end-of-session cleaning, HTM 01-05 states that the following should be cleaned daily: Cupboard doors. Other exposed surfaces such as dental inspection light fittings. Floor surfaces, including those distant from the dental chair. All clinical staff should be aware of these procedures, training should be provided, and these tasks should be discussed at staff meetings to ensure the procedures suit the practice Spillages How would you deal with a spillage of blood? In all instances where there is a risk of spillage, or contact with blood, body fluids or hazardous products, correct PPE should be worn. It is important to have the following in place: A policy and procedure outlining cleaning and disposal of a bodily fluid or hazardous products in a safe and effective manner by appropriate trained persons. It should be mindful of the control of substances hazardous to health. Give staff training in the correct procedure for dealing with a spillage. Ensure that they know where the spillage kit is kept, how to use it and how and where to report a spillage. Purpose kits available. Bleach should NOT be used on urine. Ventilate area. Report if necessary.