Infection prevention and control: essential documentation
by Jane Renehan
Jane Renehan explores the infection prevention and control policies and protocols that every dental practice should have in place.
The question – Dear Jane…
Can you describe what infection prevention and control documentation is essential for a dental practice to have?
In addition, what policies and protocols will an inspector expect to find if they visit?
Answer
The Dental Council’s Code of Practice Relating to: Infection Prevention and Control (2015) sets the minimum standards for infection prevention and control in Ireland.
This is the standard that other statutory bodies (such as Health and Safety Authority and HSE) will use as their reference when carrying out dental practice inspections.
Practice specific
All dental practices must have a formal, written infection prevention and control (IPC) policy document that is specifically for that practice.
The policy must reflect national legislation and existing good practice guidelines.
How do you make your IPC policy ‘practice-specific’? A site-specific or practice-specific policy will clearly identify the practice using its name, address, and usually practice logo.
The practice principal or clinical director, together with the decontamination lead, will be identified on the first page.
The policy should be dated, as it requires review at least every 12 months. The date it is put into circulation must be clear to the reader.
Standard precautions
The policy begins by setting out how the practice manages the core elements of standard precautions. These are:
- Hand hygiene
- Respiratory hygiene and cough etiquette
- Environmental cleaning
- Personal protective equipment
- Zoning and patient positioning
- Surface barriers
- Rubber dam
- Prevention of sharps injury
- Management of dental unit waterline biofilm
- Cleaning and disinfection of suction systems
- Cleaning and maintenance of portable equipment used in patient areas
- Disinfection of dental impressions.
Education and training
In addition, it should address IPC education and training for all clinical staff. The policy must include written procedures for reporting, risk assessment and medical follow-up following occupational exposures (for example, needlestick injuries).
How the IPC procedures are managed in your practice will depend on many factors, such as:
- The layout and equipment available on your premises
- The type of dental treatments you provide
- The skill set of your dental team.
Your policy should give an exact description of how IPC operates in your practice. Each practice operates differently; therefore, each policy will be different.
Take the time to get your policy accurate. Collaborate with your staff, as they are the ones who know the processes inside and out.
Keep your policy short and easy to read. Where possible use images or photos.
Do not make the mistake of simply downloading a generic template from the internet. Templates can be seen as a lazy approach to compliance and can be interpreted by inspectors as an absence of understanding the regulations.
Moreover, many downloadable compliance templates and checklists originate from the UK. They may not, therefore, reflect Irish dental codes of practice or our national healthcare guidelines.
Practice protocols
The Dental Council’s Code of Practice Relating to: Infection Prevention and Control (2015) identifies a number of essential documents in addition to the practice IPC policy. These include practice protocols on:
- Decontamination of dental instruments
- Healthcare risk waste management
- Hand hygiene
- Staff training in infection prevention and control.
Each of these protocols should be audited annually. In addition, it is recommended that a risk assessment be carried out in all areas covered by the code of practice at least annually, or after a significant change in the practice (such as refurbishment, community infectious disease outbreak etc).
The Dental Council’s IPC code of practice reminds practitioners to be aware of their obligations under the Health Protection Surveillance Centre (HPSC) National Guidelines for the Control of Legionellosis in Ireland (2009).
The HPSC requires practices to have a site-specific legionella control plan. This may be checked at the time of a Health and Safety Authority inspection.
Practice folder
The IPC policy should be available as a hard copy in the practice IPC folder. This should be stored close to where it is most often required, usually the local decontamination unit (LDU). Also contained in the folder are your site-specific practice protocols.
Can you go paperless? Yes, but only if you are fully confident that all staff can access the documents at any time. For example, your IPC policy may be required afterhours if the cleaner gets a needlestick injury. Will a soft copy be readily available then?
My recommendation is essential documents should be available as a hard copy in a clearly labelled IPC folder, which is in a location known to all staff.
Where to begin
If you are starting this process from scratch or looking to update your current documents, why not adopt the technique that works well for me?
When I visit dental practices to support the development of IPC policy and protocols, I begin by carrying out a visual assessment of the existing processes. Next, I discuss with staff and management what is working well and where gaps exist. Staff are usually solution focused and anxious to get things working right.
By involving staff in the exercise, it helps to get buy-in for any upcoming changes. I find a common problem in practices is the lack of consistency in IPC processes. Everyone is doing things their own way. Consistency is achieved when the agreed process is down in writing and followed by everyone.
Finally, agree an IPC document that is practice-specific and that works for everyone. I hope by sharing my technique it will guide you to try this in your practice.
Make it work!
Engage your entire dental team when developing or updating your documents. Keep the paperwork simple but relevant.
In my experience, your decontamination lead is the best person to curate your IPC documents and keep the content relevant for your staff. The decontamination lead will provide suitable refresher and induction training. The lead will also ensure that your IPC system is monitored by performing audits and risk assessments as appropriate.
Don’t forget that these documents are just one element of a suite of paperwork, which includes the practice safety statement, decontamination equipment documentation, hazardous waste forms, pressure vessel test reports, waterline sample results and any other documents specific to the practice relating to infection prevention and control.
Achieving consistency in infection prevention and control is a team sport. Success comes when each person knows their role and plays by the same rules.
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