Case Studies in Infection
Training in Infection Control
The Bug Blog
Page updated 9 October 2006
Environmental hygiene is an important component of good infection control. Overall, the practice environment should be clean, dry, well lit and well ventilated.
Should be of a sufficient size to allow ready access (including wheel chair access) to the dental chair and for the dentist and DCP to perform procedure unhindered (typical size 15m 2 ). (For surgery designs visit Department of Health Estates & Facilities Directorate (formerly NHS Estates) hosted by the Department of Health website)
Room should be well ventilated (open window), exhaust ventilations or air-conditioned.
Recommended fresh air supply rate should not < 5-8 litres per second per occupant or 8-10 complete air changes per hour.
Air-cooled air conditioning is preferred to water cooled, filters should be replaced regularly.
Ventilation systems should exhaust to the outside of the building.
Free standing or desktop mechanical fans should be avoided if possible as they circulate dust, splatter and aerosols around the surgery.
Clean and dirty areas for practice should be clearly identified to reduce the risk of cross contamination.
The room should be uncluttered to allow easy access for cleaning.
Work surfaces should be impervious, sealed and a single run and easy to clean. Wherever possible curve up at the wall.
Floors should be non-slip, continual lino and wherever possible curve up the wall by at least 3 inches (to allow effective routine cleaning and cleaning of blood/body fluids spills).
The floor should be cleaned daily with detergent and warm water.
Carpets are not appropriate in the treatment area of the surgery or the instrument decontamination area as they are difficult to keep clean and cannot be reliably disinfected. Bacteria and fungi have been found growing in carpet in surgeries
Dental chair covering should be impermeable, intact and easy to wipe down.
Blood splashes should be wiped off immediately. Wear gloves and wipe area with a disposable alcohol wipe. Alternatively if hypochlorite is compatible with chair covering (check with manufacturer's instructions) a paper towel soaked in diluted hypochlorite (1:100 dilution household bleach) can be used and the hypochlorite rinsed off with clean water. Clean area with water and detergent. Dry the surface with disposable paper towels. Discard gloves alcohol wipe, paper towels as hazardous waste.
Should be of a suitable construction that allows easy cleaning and does not allow a build up of dust.
Lighting used for patient examination must be fitted with a heat filter.
Handles should be covered with disposable plastic cover or cling film , which is replaced between patients
Should be clean, coverings intact and in a good state of repair.
Upholstered furniture should be wipeable. Cloth upholstered furnishings unless they are specially coated are harder to keep clean and cannot be reliably disinfected. Hence uncoated fabrics are not suitable for use in areas where patient treatment takes place or where contaminated materials are managed (e.g. instrument processing area).
An easily accessible hand washbasin should be available in the room, preferably with elbow operated mixer taps. It should be specifically dedicated for hand washing and not used for cleaning instruments (or crockery!)
Handwashing sinks should not be fitted with plugs or overflows and the water jet must not flow directly into the plughole, this reduces the production of contaminated aerosol from the outflow pipe
Wall mounted (so can be elbow operated) antimicrobial hand wash solution and non-medicated soap solution (with pump applicator). Antimicrobial solutions and soaps can become contaminated with microbes and support their growth. Do not top up half empty containers. Either, completely empty, clean and dry containers before refilling or use disposable containers.
Wall mounted alcohol hand rub/gel for hand decontamination for use on clean hands between patients.
Provide wall mounted absorbent disposable paper towels ( these should be disposed of as domestic waste not clinical waste)
Separate foot operated clinical waste sack holders should be conveniently located in the surgery for hazardous infectious waste and non-hazardous clinical waste.
An approved sharps container correctly assembled should be located within easy reach of the clinician, but out of the reach of unauthorised persons and children. Sharps containers SHOULD NEVER BE PLACED ON THE FLOOR
There should be adequate storage to enable the room to remain uncluttered and ensure that work surfaces are readily accessible and easy to clean.
Lockable cupboard(s) should be available to store medicines/disinfectants/chemicals in accordance with Control of Substances Hazardous to Health (COSHH) 1999 regulations.
Sterile stock should be stored on shelving in a secure, cool, dry and clean environment in order to maintain the integrity of the sterile product and its packaging.
Shelving should be readily cleanable and allow for free movement of air around the stored product.
Protective clothing should be readily available in the room, including disposable latex gloves and latex-free alternatives (sterile and non-sterile), disposable plastic aprons, masks and protective eyewear (goggles and visors).
Personal belongings should be kept in a separate room
Food and drinks should not be consumed in the clinical areas. Store food in a separate fridge from medicines and dental materials
The practice should have a nominated person to oversee that cleaning standards are maintained. A written protocol may be useful to ensure that standards are maintained
All areas should be cleaned and damp dusted regularly. Detergent and hot water is adequate for most routine cleaning requirements. The surgery should be cleaned and damp dusted daily
Equipment such as mops, buckets and cloths should be specifically designated for the area of use and stored clean and dry. Mops should be washed regularly and stored inverted after use