POLICIES AND PROCEDURES MANUAL

INFECTION CONTROL IN DENTAL CLINICS

DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 1 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

I. OBJECTIVES
1. To provide policies and procedures to ensure maximum prevention of healthcare
associated infections in patients and personnel.
2. To prevent cross contamination between patients.
3. To prevent the transmission of infectious diseases from dental patients to dental
employees and vice versa.

II. SCOPE
1. Head of Dental Department
2. All Dental Staff
3. Infection Control Team

III. DEFINITION OF TERMS

1. Infection control is the prevent and control of the transmission of infection.

IV. POLICIES
1. All Dental staff must familiarize with these procedures as outlined. They are to be
implemented in dental practice to prevent healthcare associated transmission of
blood borne and other infectious disease.

V. PROCEDURE:

1. Standard Precautions shall be used during patient care activity and with all patients
(refer to Isolation Precautions: Transmission-Based Precautions).

2. Hand hygiene is the single most important means of preventing the spread of
infection and healthcare-associated infections. Refer to Hand Hygiene for technique,
frequency and agents used for hand hygiene.

3. All personnel shall:

3.1 Adhere to the Hospital Employee Health Program. Vaccination for
Hepatitis B is strongly recommended (refer to Blood and Infectious Fluid
Exposures, Employee Hepatitis B Screening and Immunization Program).

3.2 Adhere to the Infection Control policies, procedures and practices

relative to their work areas.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 2 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

3.3 Adhere to the OHHC Dress code. Unacceptable attire includes sheer
fabrics, denim clothing, and form fitting clothes, slits in skirts that go above
the knee, leggings, jeans, and beach-type open toe sandals. Identification
badges should be worn at all times and should be easily visible.

3.4 Complete annual Infection Control In-service.

3.5 Report all Blood and Body fluid exposures (BBFE), needle sticks, puncture
wounds to immediate supervisor and the Infection Control and follow the
protocol for Blood and Body Fluid Exposure (refer to Blood and Infectious
Fluid Exposures).

4. Protective Attire and Barrier Techniques for Personal Protection:

4.1 Gloving is mandatory for those directly involved in treatment involving

intraoral procedures, but is not a substitute for proper hand hygiene (refer
to Hand Hygiene).

4.1.1 Gloves must be worn when skin contact with body fluids or
mucous membranes is anticipated or touching surfaces that may be
contaminated with these fluids.

4.1.2 Sterile gloves are required during surgical procedures. For

other procedures non-sterile gloves are acceptable.

4.1.3 After contact with each patient gloves must be removed and
hands must be re-washed and re-gloved before treating another
patient.

4.1.4 Torn, cut or punctured gloves must be removed immediately,

or as soon as is compatible with patient safety. Hands must be
washed thoroughly and re-gloved before completing the procedure.

4.2 Protective eyewear with solid side shields or chin-length face shields
must be worn to protect the eyes when splashing or spattering of blood or
other body fluids is anticipated.

4.3 Masks must be worn by all personnel to protect the face, oral mucosa,
and nasal mucosa when splatter/spatter of blood or body fluids is
anticipated. Masks shall be changed between patients and when visibly
soiled/wet, and shall not be worn outside the operatory.

4.4 Clinic Attire:

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 3 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

4.4.1 All staff involved in direct patient care must wear OHHC
approved high-necked, long sleeved cover gowns when clothing or
skin is likely to be exposed to blood or body fluid, refer to dress code
for individual areas as outlined or yellow Gown Disposable. OHHC
approved scrub suits may be worn by individual units if approved by
DSD. Hospital issued scrub suits (tops or pants) shall not be worn
home or outside the medical facility.

4.4.2 Gowns must be changed daily and when visibly soiled. Gowns
shall not be worn in lunch rooms, during staff breaks, to the rest
room, or out of the building.

4.4.3 Yellow Gown should be changed between each patient, and

when it’s visibly soiled or contaminated with blood for same patient.

4.4.4 Patient should wear eye protective during the procedure.

4.5 Other:

4.5.1 Dental personnel shall limit contamination by avoiding contact

with objects such as charts, telephones, cabinets, pens, etc. during
the patient treatment process. A second pair of gloves shall be used
over the treatment gloves when it is necessary to handle these
objects.

4.5.2 Personnel with exudative lesions or dermatitis shall refrain

from all direct patient care and from handling dental patient care
equipment until cleared by the Hospital Employee Health Clinic
physician.

4.5.3 Food or beverages must not be present in patient care areas,

laboratory, and decontamination and sterilization areas.

5. Use and Care of Sharp Instruments and Needles:

5.1 Refer to Needle stick and sharps injury management Policy.

5.2 Orthodontic wires, bands and wooden wedges are considered sharps
and shall be disposed of in a puncture-resistant container.

6. Spills of Liquids or chemicals:

6.1 Biological Spills (blood & body fluid, cytotoxics and mercury):
Housekeeping personnel are trained to clean up blood and body fluid,
Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 4 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

cytotoxic and mercury spills. DSD staff should isolate the spill before
contacting housekeeping.

6.2 Chemical Spills: Housekeeping staff are not responsible for cleaning up
chemical spills. In the event of a chemical spill refer to the Material Safety
Data Sheet (MSDS) in your area and inform the clinic’s Safety Officer. A
chemical spill kit is available in each Dental clinic.

7. Patient Management:

7.1 The medical history of each patient shall be obtained and updated
(current illnesses, hepatitis status, recurrent illnesses, unexplained weight
loss, lymphadenopathy, oral soft tissue lesions or other infections should be
included). All patients shall be asked routinely about a history of TB and
symptoms suggestive of TB

7.2 Patients with a history of TB (Tuberculosis) or suspicion of TB shall be

treated as outlined in Management of Tuberculosis.

7.2.1 Elective dental treatment should be postponed until patient

has been cleared by the patient’s treating clinician.

7.2.2 During transport or while waiting for treatment, the patient

shall wear a surgical mask to prevent droplet spray from coughing or
sneezing.

7.3 During dental procedures all patients shall be treated as potentially

infectious, (refer to Isolation Precautions; Transmission Based Precautions).

7.4 Use of an antimicrobial mouth rinse that has residual activity is

recommended before treatments. The patient must rinse with an antiseptic
mouth rinse prior to having impressions made or trying in dental prosthesis.

7.5 Appropriate use of rubber dams, high velocity air evacuation and proper
patient positioning should minimize the formation of droplets, spatter and
aerosols during patient treatment.

7.6 Protective eyewear shall be provided for each patient when treatment
involves the risk of eye injury including the use of rotary instruments,
prophy jets and chemicals.

7.7 The following procedures shall be performed after the patient has been
seated:

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 5 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

7.7.1 Sterile trays and hand piece opened;

7.7.2 Suction tips and saliva ejector placed on the hoses;

7.7.3 Paper cup for mouth rinse placed on its stand.

7.8 Family members, when acting as chaperones or accompanying patients,

may not be present during certain procedures or treatments (including but
not limited to operative procedures, invasive diagnostic procedures and x-
ray procedures).

8. Cleaning and Disinfecting Dental Operatory and Environmental Surfaces:

8.1 All surfaces must be disinfected between patients at the beginning and
at the end of the work day. The inside and outside of all drawers and
cabinets shall be disinfected weekly.

8.2 Use “spray-wipe-spray” method, which is done in three stages:

8.2.1 Spray surfaces and equipment –spray shall be used

(intermediate level of disinfectant).

8.2.2 Wipe surfaces with soft paper towels and discard.

8.2.3 Spray surfaces and equipment again with the same solution. At
this stage the contact time must be used – for 2 minutes, (for 2
minutes). This is the disinfecting stage so the contact time must be
used to kill micro-organisms adequately. Therefore, spray-wipe-
spray and then leave it on for the recommended contact time. All
disinfectant must be wiped off thoroughly after the contact time, it
must not be left to dry off as it may damage the equipment. Set up
for the next patient.

8.2.3.1 Always wipe from cleaner areas toward dirtier areas.

Do not wipe a dirty area then smear it on to a less dirty one.
Example: after wiping cuspidor, touch nothing else with that
paper towel discard, de-glove, wash hands and re-glove.

8.2.3.2 Dental unit waterlines shall be purged daily at the

end of each day when in use. Waterlines must be
disinfected following dental chair manufacturer’s guidelines.
If Clorox solution is used for disinfection, the procedure
should be performed weekly, and follow “DSD Instructions.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 6 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

8.2.3.3 Wear correct personal protective equipment: Heavy

duty gloves (or double gloves if heavy duty not available),
mask and protective eyewear when cleaning and
disinfecting the dental operatory.

8.3 The disinfectants to be used in dental clinic must be:

8.3.1 Effective against both lipophilic and hydrophilic

viruses;

8.3.2 With tuberculocidal claims (high and intermediate

level disinfectants);

8.3.3 Assessed regularly (the concentration and the

expiration date) and changed if necessary. Disinfectants that
need to be diluted before use shall be prepared daily;

8.3.4 Disinfectant must remain in contact with the

instrument or surface to be sterilized/disinfected for the
appropriate time needed (contact time).

8.4 Sterilization of all critical items and disinfection of non-critical

items:

8.4.1 The definitions of critical and non-critical items:

8.4.1.1 Critical items: instruments that contact oral

tissues or oral fluid such as blood or saliva (e.g.
forceps, scalpels, hand pieces, scalers, air/water
syringes, burs, mouth mirrors, all hand instruments,
endodontic files and etc.

8.4.1.2 Non critical items: those that contact only

intact skin e.g. external components of x-ray tubes,
curing light, amalgamators and shade guides.

a. Heat stable items, such as face bow forks,

metal impression tray, orthodontic pliers,
and metal spatulas that come in contact
with oral tissues shall be sterilized in
autoclave.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 7 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

b. Points, wheels, disks, brushes, and burs

used chair side shall be discarded after use if
disposable or sterilized in autoclave.

c. Articulators face bows, torches and

wooden-handled spatulas shall be cleaned
and disinfected (if they are not covered by a
barrier) after manipulations chair side.

d. Rubber mixing bowls can be autoclaved,

but they will become distorted if
overheated or with repeated exposures.
They shall be cleaned and disinfected after
use chair side.

e. Items such as shade guides shall also be

cleaned and disinfected to avoid cross-
contamination.

8.5 All non-disposable items shall be cleaned and sterilized in CSSD.

8.5.1 Transferring of Contaminated items shall be carried on

in covered trays.

8.6 General cleaning

8.6.1 Cleaners shall do their work according to a schedule

followed by the foreman.

8.6.2 Sinks shall be cleaned and disinfected daily.

8.6.3 Floors shall be also cleaned and disinfected daily.

8.6.4 Walls, windows and doors shall be cleaned monthly.

8.6.5 200 ppm chlorine (1:25) is appropriate for general

housekeeping purposes such as cleaning floors, walls and
other housekeeping surfaces.

9. Disposal of Waste Materials (Refer to waste Management Policy)

9.1 Liquid wastes shall be carefully poured into a drain and flushed
with water.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 8 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

9.2 Biohazard waste includes:

9.2.1 Waste capable of causing infectious disease.

9.2.2 Waste that is capable of having a poisonous effect.

9.3 Biohazard medical waste in dentistry includes:

9.3.1 Hard and soft tissue removed during surgery, and

teeth.

9.3.2 Blood and saliva soaked materials used during

procedure.

9.3.3 Gloves soaked in blood, saliva or other body fluids.

9.3.4 X-ray packs/covers that have been contaminated

inside the oral cavity.

9.4 Non-biohazard waste in dentistry includes:

9.4.1 Matrix bands (should be disposed of in sharps

containers).

9.4.2 Masks, caps, paper napkins, surface covers, paper

towels.

9.4.3 Impression materials.

9.4.4 Gloves that are tinged with blood, saliva or other body
fluids.

9.5 Procedure for disposal of medical waste:

9.5.1 Medical waste shall be placed in a yellow bag attached

to the work table and/or other accessible area.

9.5.2 Upon completion of the procedure the waste bag shall

be closed and placed in the trash container marked
infectious waste.

9.5.3 All other trash used during procedure must be placed

in the general/noninfectious waste bin.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 9 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

9.5.4 Collect and Store dry dental amalgam waste in a

designated, airtight container and Dispose it when their
contents are ¾.

10. Handling Biopsies and Other Specimens:

10.1 Specimens must be placed in a sturdy container with a secure

lid to prevent leaking during transportation. The container must
have the patient’s name, medical record number, identification
number, date, and specimen type clearly written on it. Care shall be
taken to avoid contamination of the outside of the container

10.2 Extracted teeth used for education of patients or dental

healthcare workers should be considered infectious and be handled
as clinical specimens in the same manner as biopsy specimens.
Standard Precautions shall apply when they are being handled.
Teeth shall be stored in Clorox solution 1:10 dilution before
transporting to the IRC. Teeth shall be cleaned by ultrasonic and
sterilized by the method used for heat sensitive items.

4.11 Water Quality:

11.1 An alternate water supply that bypass community

water systems and dental unit by providing sterile or
distilled water directly into water line attachments(i.e.,
separate reservoir) combined with chemical treatment.

11.2 Chemical disinfection involving periodic flushing of lines

with a disinfectant followed by appropriate rinsing of lines
with water or a continuous release chemical disinfection
system.

11.3 Filtration involving in line filters to remove bacteria

immediately before dental unit water enters instrument
attachment.

V. REFERENCES

1. Guidelines for Infection Control in Dental Healthcare Settings, December 2012.

www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

2. APIC 2014.

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 10 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

VI. SIGN-OFF AND REVISION HISTORY

Owner

INFECTION CONTROL

Initiator

JAN MARVIN M. PALIJO, MSN, RN – CHIEF NURSING OFFICER

Reviewer

GINA M. GARCIA, MD – CHAIRMAN, DEPARTMENT OF MEDICINE

Approvals:

ARGYLL T. ARCIGAL, MD
CHIEF OF CLINICS

CHERRY PINK D. ORDINAL, MD

QMD Head

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT

 POLICIES AND PROCEDURES MANUAL
INFECTION CONTROL IN DENTAL CLINICS
DOCUMENT CONTROL REVISION NO. EFFECTIVITY DATE PAGE
NO. JANUARY O1, 2019 11 of 11
00 REVIEW DUE
IC-01-040 DECEMBER 31, 2020

RICO M. RAYOS DEL SOL, MD

Chief Medical Officer

NEIL ANDREW S.J. DE LUMEN, MD

President

Revision History

Revision Effectivity Review Prepared/Revise

Details of Revision
No. Date Due d by

Prepared by: Reviewed by: Conforme: Approved by:

JAN MARVIN M. PALIJO, MSN, RN GINA M. GARCIA, MD JM PALIJO MSN,RN/ R. RAYOS DEL SOL, MD NEIL ANDREW S.J. DE LUMEN, MD

CHIEF NURSING OFFICER CHAIRMAN, DEPARTMENT OF MEDICINE RZ DE LUMEN, MD PRESIDENT