Infection Prevention and Control

Infection prevention and control includes decontamination, disinfection, sterilisation, waste management, water management, personal protective equipment, hygiene, cleaning, equipment, immunisation, inoculation injury procedures and training
This document gives an overview of infection prevention and control requirements for dental practices in the UK. For specific details refer to the relevant links at the end of this document
Providers in each UK country are expected to meet their respective infection prevention and control requirements:
- England: the requirements of HTM 01-05, 2013 issue, the Code of Practice on the prevention and control of infections, the CQC and other relevant guidance
- Wales: the requirements of updated WHTM 01-05 and relevant Welsh guidance. The key differences to the standards in Wales are that instruments cannot be stored unwrapped in a non-clinical area and endodontic instruments must be single-use
- Northern Ireland: Decontamination in Primary Care Dental Practice HTM 01-05, 2013 edition, HTM 01-05 (PEL (13) 13), Standard 13 of the minimum standards published by DHSSPS. The key differences to the standards in Northern Ireland is that providers must work to HTM 01-05 'best practice' including having a separate decontamination room, having a washer disinfector, not storing instruments in clinical areas and treating all endodontic instruments must be single-use
- Scotland: requirements of the Scottish Dental Clinical Effectiveness Programme, guidance from Health Protection Scotland, National Infection Prevention and Control manual and other relevant guidance. The key differences to the standards in Scotland include the requirement to have a separate decontamination room, to have a washer disinfector, to have a data logger or printer fitted to washer disinfectors and sterilizers and that all endodontic instruments must be single-use. Scottish guidance does not distinguish between 'Essential' and 'Best practice. All guidelines must be followed
This overview is supplemented by templates (M 257A – M 257W), which, once adapted, will lead you to compliance with the requirements above, the Code of Practice¹, The 'National Specification for Cleanliness in the NHS'² and other guidance.
HTM 01-05 and WHTM 01-05 defines two levels of compliance:
- 'Essential quality requirements' – all primary dental care practices should be working at or above the essential quality requirements
- 'Best practice' – requirements all dental practices should be working towards. The date for 'best practice' has not been set up in England and Wales yet. New facilities should meet 'best practice' provisions wherever reasonably practical.
Key infection prevention and control requirements:
- Appointment of an individual in charge of infection prevention and control
- A policy outlining the practice arrangements, written infection prevention procedures for the team to follow, logs for documenting essential tasks
- Infection control training is part of practice induction for all team members
- Arrangements for the management of equipment, water, and waste
- Emergency arrangements and access to occupational health and expert medical advice
- Regular team training on health and safety responsibilities and infection prevention and control
- The monitoring of infection prevention and control activities including infection prevention audits and an annual review of infection prevention to achieve continuous improvements in standards

Getting Started

1. Review the literature

Familiarise yourself with the latest literature on infection prevention for your country. This will give you the background to modify the templates accompanying this overview to meet the requirements of your practice and the current research.

2. Meeting the 'essential quality requirements'

Complete the Infection Prevention Action Plan (M 257N) and adapt the policy, procedures and checklists to reflect your practice arrangements. This can be delegated to a suitably trained team member.

3. 'Best practice'

Complete a gap analysis and create an action plan for 'best practice' by using information in (M 257S) to help you set a timetable for moving towards best practice.

4. Audit and review

Perform six-monthly audits of infection prevention using (G 180-FIC and G 180-SIC) or (M 257P for non-members of iComply). All results should be analysed in an annual review using (M 258A).

5. Patient charter

Inform patients about your commitment to infection prevention by displaying the Charter on Patient Safety (M 257W) in reception and on your website.

Additional modules

Always use the latest versions of the templates, available for download from iComply.cc

Selected Definitions

Alcohol-based hand rub – a preparation for reducing the number of viable microorganisms on the hands. It can be used in-between patients (if there is visible contamination on the hands they should be washed).

Autoclave - the standard for sterilisation is to use an autoclave full of steam at 134°C under these conditions the sterilisation process takes approximately 3.5 minutes. There are two types commonly used in dentistry:

Type N - air removal by passive displacement with steam. For unwrapped, non-hollow instruments
Type B - vacuum. Each cycle should be validated, suitable for wrapped instruments and those with lumens including handpieces

Decontamination – removal, inactivation or destruction of pathogens and other microorganisms from a surface or instrument with physical or chemical means. Decontamination includes cleaning, disinfection, sterilisation, transport and storage.

Disinfection – destruction of pathogens and other microorganisms by physical or chemical means. NOTE disinfection destroys the majority, but not all microbial forms such as spores.

Domestic cleaning – does not apply to items of equipment or cleaning which would be classed as decontamination

Endotoxin – a toxin formed by the breakdown of a gram-negative bacteria. Bacterial endotoxins can be active even if the bacteria from which they are released have been killed.

Universal precautions – the routine precautions sufficiently robust to deal with known and unknown infection risks.

Hand hygiene – minimising the risk of the hands both transmitting and acquiring infection, it includes removing jewellery and watches, hand-washing, hand disinfection, donning gloves and skin-care.

Minimum Infective Dose (MID) – the number of bacteria, or any other microorganism that are necessary to cause an infection. The concept of the MID is important when disinfection is considered where the object of the process is to kill, or reduce the microbial load to below the MID.

PCO – Primary Care Organisation includes Regional Teams

Personal Protective Equipment – gloves, mask, protective eye wear, aprons, shoes and clinical clothing.

Prion – a protein particle (lacking nucleic acid) that has been implicated in certain diseases such as CJD. "Recent research has indicated that a low level of prion contamination may theoretically be present on some instruments following contact with dental tissues. Where this risk is most pronounced the Chief Dental Officer for England has published requirements for endodontic files and reamers to be single use. For all other instruments used in dentistry the risk of prion transmission will be usefully reduced by compliance with the decontamination procedures described in the Health Technical Memorandum HTM 01-05".

Single-use – a medical device which is intended to be used on an individual patient during a single procedure and then discarded. It is not intended to be used on another patient.

Single-patient use – a medical device, which is intended to be used on an individual patient at more than one visit. It is not intended to be used on more than one patient.

Sterile – free from all living micro-organisms.

Sterilisation – the use of a physical or chemical procedure to destroy all viable infectious agents including resistant bacterial spores and viruses.

Sterile and sterilised – dental instruments may be defined as sterilised rather than sterile at the point of use, they should however be in a sterile state at the end of the decontamination process.

Washer disinfector – an automated machine used to wash and disinfect medical devices.

Waterlines – the 'internal plumbing system' in the dental unit. They have been shown to become colonised with microorganisms such as bacteria, protozoa and fungi, which form a biofilm on the inner surfaces. They are also called DUWL or dental unit waterlines.

Zoning – identifying areas that could become contaminated during treatment. These areas are kept to a minimum and disinfected in between patients.

Further Information

England