GULF DIAGNOSTIC CENTER

HOSPITAL

NURSING POLICY

Policy No: MED-DEN-P0002/09

Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 1 of 8

TITLE: INFECTION CONTROL IN DENTAL UNIT

Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

INFECTION CONTROL IN DENTAL UNIT

APPROVAL SHEET
Prepared by:
Name

Signature

Date

Signature

Date

Signature

Date

Ms Amal Bint Mohammad

Infection Control Officer
Reviewed by:
Name
Dr.Hassan Al Mahdi
Infection Control Chair Person
Mr. Zuher Arawi
Quality Manager
Approved by:
Name
Dr Emad Yassin Al Rahmani
Medical Director
Mrs. Jamal Kaddoura
Hospital Director, Co-founder

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 2 of 8

DOCUMENT AMENDMENT RECORD SHEET

Date

Description of Change

TABLE OF CONTENTS:

Page Effected

Revision
Number

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

SUBJECTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 3 of 8

PAGE NO.

PURPOSE
4
TARGET AUDIENCE
4
RESPONSIBILITY
4
POLICY
4
PREPARATION OF THE PATIENT FOR TREATMENT
4
ANTI-RETRACTION VALVE TESTING
5
STORAGE AREA IN CLINIC
6
IMMUNIZATION AND VACCINATION AGAINST HBV
6
SUMMARY OF STANDARD PRECAUTIONS:
HANDLING OF BIOPSY SPECIMENS AND EXTRACTED TEETH 7
EDUCATION AND TRAINING
7
REFERENCES
8

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 4 of 8

1. PURPOSE:
1.1. This manual consolidates recommendations for preventing and controlling
infectious diseases and managing personnel health and safety concerns related to
infection control in dental settings in order to maintain high quality of infection
control standards at all times.
2. TARGET AUDIENCE:
2.1. This is applies to all involved services of dental in the GDC Hospital and all
clinical staff should familiarize themselves with the policy.
3. RESPONSIBILITY:
3.1. It is the responsibility of each staff member of the dental services to deal and to
ensure that this policy, procedures, and guidelines are implemented and followed
meticulously.
4. POLICY:
4.1. The key to minimize the spread of infection is to decrease opportunities for cross
contamination, especially in clinics room where direct care is given.
4.2. To be used in conjunction with GDC Hospital policies and procedures.
5. PREPARATION OF THE PATIENT FOR TREATMENT:
5.1. All patients are considered as potentially infectious. Therefore, you must always
use Standard Precautions with all patients.
5.2. Place a disposable, absorbent bib on the patients chest.
5.3. Open a new, sterile tray for each patient after the patient has been seated in the
dental chair.
5.4. All surfaces are covered with adhesive film barrier or plastic cover. As mentioned
previously.
5.5. During the Treatment, Both the Dental Nurse and the Dentist should wear PPE
when exposure to blood or may be anticipated during treatment
5.6. Use of rubber dam: Reduction in microorganisms escaping from patients mouths
in aerosols or spatter can approach 100% with proper use of rubber dam,
depending on the type and the site of the intraoral procedure.
5.7. Use of HVE (high-velocity evacuation):
5.8. Minimizes dissemination of droplets, spatter and aerosols.
5.9. If during the course of treatment other materials or instruments are required,
remove gloves, or use a pair of non-contaminated tweezers for retrieval of the
item
5.10. The Dental Nurse removes the patients bib and ensures the bracket table is

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 5 of 8

pushed out of the way.

5.11. The dental nurse removes gloves, washes hands and then gives the patient the
next appointment, (this may be done by the dentist).
5.12. The dental nurse logs the case on the statistics sheet.
5.13. The dental nurse then begins cleaning and preparing the clinic for the next
patient by following the procedures listed below.
5.14. If the hand piece requires lubrication before heat-processing, use a hand piece
cleaner recommended by the manufacturer that will both remove the initial
debris and lubricate the hand piece. If the hand piece does not require lubrication
before processing, use a cleaner that does not contain a lubricant. Follow the
manufacturer's instructions for each type of hand piece used.
5.15. Reattach the hand piece in a hose and operate the drive air system to blow excess
lubricant from the rotating parts.
5.16. Failure to perform this step before heat sterilization can lead to excess lubricant
accumulation in the working assembly and gumming in the rotating assemblies
during the heat cycle.
6. ANTI-RETRACTION VALVE TESTING:
6.1. Each time the hand piece turbine is stopped while the bur is still in the patient's
mouth, almost 1 ml of microbe-laden oral fluids may be aspirated into the
average dental unit water line by the retraction valve present in the dental unit.
This fluid may contain an average in excess of 54,000 microorganisms per
milliliter, including both facultative and obligate anaerobic bacteria of medium
to high virulence. Other infectious agents including hepatitis, herpes, influenza,
and other upper respiratory viruses may also be present. This germ-laden water
may then be sprayed into the mouth of the next patient, possibly initiating an oral
or upper respiratory tract infection.
6.2. Sterilizing the handpiece between appointments, although of great significance in
the prevention of disease transmission, will not totally eliminate the problem
discussed here as almost 95% of the oral fluid aspirated into the dental unit went
past the handpiece and into the handpiece cooling water line.
6.3. Complete elimination of the retraction valve in the unit is the most effective
means of solving this problem, but, with present dental unit designs, this may
result in water dripping onto the patient. A viable alternative is the installation of
a check valve (anti-retraction valve) downstream from the retraction valve.
Installation of a check valve resulted in an almost 4,000-fold decrease in this
contamination. The attachment of a check valve will have no effect on normal
less virulent bacteria already present in tap water. These bacteria colonize the
water lines of the dental unit and are then continually shed into the water in
numbers
often
as
high
as1,000,000
CFU/ml.

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 6 of 8

Reference: Journal of the American Dental Association, Vol 109, Issue 5, 712716
7. STORAGE AREA IN CLINICS:
7.1. Storage area (if available) should contain enclosed storage for sterile items and a
separate area for disposable items.
7.2. Instruments are packaged using (no EVENT RELATED STERILITY expiry
date). This system recognizes that the product remains sterile indefinitely, unless
an event causes it to become compromised (e.g.: wet or torn package).
7.3. Packages containing sterile supplies should be inspected before use to make sure
barrier wrap has not been compromised.
7.4. If a package is compromised, the instruments should be re-cleaned, re- packaged
and re-sterilized.
7.5. All used instrument are send to CSSD. No storage area for reusable instrument
8. IMMUNIZATION AND VACCINATION AGAINST HBV:
8.1. DHCP are at risk for exposure to, and possible infection with, infectious
organisms. Immunizations substantially reduce both the number of DHCP
susceptible to these diseases and the potential for disease transmission to other
DHCP and patients. Thus, immunizations are an essential part of prevention and
infection-control programs for DHCP, and a comprehensive immunization
policy should be implemented for all dental health-care facilities
9. SUMMARY OF STANDARD PRECAUTIONS:
9.1. Remove all unnecessary items or materials from your area of contact which are
not being used for this patient.
9.2. Place all materials needed within reach and out of drawers and packets e.g. cotton
rolls, gauze, instruments.
9.3. Use disposable items e.g. air syringe tips, suction tips whenever available.
9.4. Place all the necessary instruments on a waterproof sheet and within easy reach of
the dentist.
9.5. Place protective barriers on the dental chair (disposable plastic cover), head chair
cover, seat covers, light handle cover and on all the suction and handpiece
tubings or use adhesive film barriers.
9.6. If you need to open a drawer, make sure you remove your gloves or use a clean
pair of tweezers. Do not touch any cabinets or drawers with contaminated
gloves.
9.7. Always have spare sterile gloves within easy reach, ready for you or the dentist if
needed.
9.8. If you need anything from the CSSD, make sure you get it before the start of the
treatment.

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 7 of 8

9.9. Needle stick injuries must be reported immediately for your own safety.
9.10. Dispose of used needles and sharps in puncture-resistant sharps containers.
9.11. Remove contaminated burs from the handpieces before disassembling the
handpieces from the dental unit. This prevents injuries with contaminated burs.
Also, flush through the waterlines of hand pieces, seconds to minimize the
retraction phenomenon.
9.12. Before taking the contaminated instruments to the CSSD they may be sprayed
with a disinfectant/enzyme solution in the clinic. Always take them to CSSD in
a covered container.
9.13. Remove your gown and change your gloves. Therefore, you will be wearing
clean gloves when you leave the clinic to deliver the contaminated instruments
to the CSSD.
9.14. Deliver the soiled instruments to the appropriate dispensary area.
9.15. Ensure that all surfaces in the clinic are thoroughly wiped down and cleaned.
9.16. Run solution through the suction apparatus and spittoon, flush through
waterlines of handpieces, air/water syringes and ultrasonic scalers with water
for minimum 30 seconds.
10. HANDLING OF BIOPSY SPECIMENS AND EXTRACTED TEETH:
10.1. Extracted teeth (not teeth containing amalgam) are potentially infectious
materials that should be disposed of in medical waste containers or puncture
resistant sharps containers.
10.2. Extracted teeth should be cleaned and placed in a leak proof container labeled
with a biohazard symbol and maintain hydration (water or saline) if the teeth
are to be taken to a dental laboratory or to be used for education purposes.
10.3. Extracted teeth containing amalgam should be cleaned and placed in a
separate leak proof container (water or saline) labeled with a bio-hazard
symbol.
10.4. Each biopsy specimen should be placed in a clearly labeled, leak proof
container
10.5. Be careful not to contaminate the outside of the container when placing the
specimen inside it. If the outside of the container becomes contaminated, it
should be cleaned and disinfected.
10.6. If for any reason the specimen needs to be stored overnight it should be
placed in the fridge.
10.7. The specimen must be labeled with the biohazard symbol during storage and
transport.
11. EDUCATION AND TRAINING:
11.1.

Personnel are more likely to comply with an infection-control program and

exposure-control plan if they understand its rationale. Clearly written

GULF DIAGNOSTIC CENTER

HOSPITAL
NURSING POLICY
TITLE: INFECTION CONTROL IN DENTAL UNIT
Department
Section
Distribution

: Medical Management
: Infection Control
: Hospital Wide

Policy No: MED-DEN-P0002/09
Issue Date : March 2009
Revision No.: 02
Revision Date : July 2012
Next Revision : July 2014
Page 8 of 8

policies, procedures, and guidelines can help ensure consistency, efficiency,

and effective coordination of activities.
Provide dental healthcare personnel educational information appropriate in
content and vocabulary to the educational level, literacy and language of
dental healthcare personnel.
11.1.1. On initial employment.
11.1.2. When new task or procedures affect the employee's occupational
exposure
11.1.3. Education and training regarding occupational exposure to
potentially infectious agents and infection control procedures.
12. REFERENCES:
12.1.
12.2.
12.3.
12.4.
12.5.
12.6.

CDC Guidelines for Infection Control in Dental Health-Care Settings

December 19, 2003
Disclaimer: The contents of Guidelines for Infection Control were gathered
from CDC, OSAP, ADA and OSHA. Care has been taken to confirm the
accuracy of the information present.
www.cdc.gov
www.osap.org
www.ada.org
www.osha.gov