Abha International Private Hospital Policy No.

: AIPH/IPC/IPP/036
Title: Infection prevention & control Guide Classification:
lines in Dental Department □CPP □APP □OPP □IPP □New □Revised □Renewal
Applicability: Dental Staff Effective date: 06 Feb 2017
Infection prevention & control Staff High Risk: □yes □No Expiry date: 05 Feb 2019

1. Purpose

1.1. To provide policies and procedures to ensure that all personnel involved in patient care develop an
awareness of the following:
1.1.1. Sources and method of transmission of infectious diseases from dental patients to dental
employees and vice versa.
1.1.2. The level of cleanliness and contamination of gloved hands.
1.1.3. The instruments and equipment being used and objects that may be touched and maintain that
awareness.

2. Definition

2.1. AIPH – Abha International Private Hospital

2.2. IPP – Interdepartmental Policy & Procedure
2.3. IPC – Infection Prevention & Control.
2.4. PPE – Personal Protective Equipment

3. Responsibilities

3.1. Dental Staff

3.1.1. Before doing any procedure in the dental department do all infection prevention & control
guidelines to prevent any infection or contamination to the patient.
3.1.2. Before the procedure make sure that:
3.1.2.1. Staff will be doing the hand hygiene procedure.
3.1.2.2. Staff must make sure that all medical waste will be properly disposed before calling
another patient.
3.1.2.3. Staff must make sure any blood and body fluids are being cleaned before another
patient will enter the clinic.

3.1.3. Implement the Infection prevention & control Guidelines.

3.1.4. Request for education needed if necessary for the department.

3.2. Infection prevention & control Staff

3.2.1. Observe the implementation of the Dental department on the Infection prevention & control
guidelines.
3.2.2. Educate the Department if necessary.

4. Policy

4.1. All personnel should:

4.1.1. Adhere to the Hospital Employee Health Program. Vaccination for Hepatitis B is strongly
recommended, although vaccination alone is not a cause for relaxation of strict adherence to
methods of asepsis, disinfection and sterilization, since no vaccine is available at present for
many blood borne pathogens.

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 4.1.2. Adhere to the Infection prevention & control policies and procedures relative to their work
areas.
4.1.3. Adhere to Standard Precautions in all of the dental facilities.
4.1.4. Adhere to the Dental Services Department Dress Code.
4.1.5. Attend documented annual Infection prevention & control In-service and when Changes such as
modification of tasks or procedures, or institution of new tasks or procedures affect the
employee’s occupational exposure.
4.1.6. Report all blood and body fluid exposures (needle sticks, puncture wounds, etc.) to immediate
supervisor and the employee health clinic and follow the protocol for blood and body fluid
exposure.

5. Procedure:
Procedure steps Responsibility
5.1 Clinic Attire: Dental staff
5.1.1. All staff involved in direct patient care (dentists and support
staff) must wear high-necked, long-cuffed, sleeved cover
gowns when clothing or skin is likely to be exposed to body
fluid. This condition is not dependent upon an aerosol being
contact produced by rotary instruments. It applies during all
procedures involving patients. Cover gowns should be worn
by all personnel involved in the treatment regardless of their
role in patient care.
5.1.2. These gowns must be changed daily or when visibly soiled.
Gowns shall not be worn in cafeteria, or places that are a
great distance from the treatment rooms, including out of the
building. Other protective garb such as gloves and masks
should not be worn outside of the treatment rooms.
5.1.3. Use water resistant (plastic) aprons underneath the gown to
protect the trunk from blood & fluid exposure.
5.1.4. The clinic clothing may not be taken home and washed by
the employee, but must be discarded into the clinic laundry.
5.1.5. Personal clothing (sweaters, etc.) shall not be worn during
patient treatment.

5.2 Other:
5.2.1 Long hair must be either covered or restrained, away from the
face and uniform collar. When hair contamination is anticipated
due to spray and splatter a hair, cover must be worn. (Long hair
is defined as hair which extends below collar level).
5.2.2 Uncovered jewelry must not be worn during dental procedures.
A watch worn under the cuff of the cover gown, and thus
protected by it is acceptable.
5.2.3 Food or beverages must not be present in patient care,
laboratory, and decontamination and sterilization areas.
5.2.4 All disposable protective barriers shall be discarded prior to
leaving the operatory or work area.
5.2.5 Pens/pencils shall be protected with plastic barriers, and shall be
cleaned and disinfected with an approved disinfectant solution,
if contamination has occurred.
5.2.6 Non-sterile items such as hand mirrors, timers, pencils, patient
record, audio-visual aids, toothbrush kits, etc. must never be
placed on the bracket table. When performing charting, a
convenient location should be chosen and the surface must be
cleaned and disinfected before being used as a writing table. The
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 cabinet top should never be used as a writing table if it is also
being used as an auxiliary bracket table.
5.2.7 Hepatitis B Vaccination - All susceptible DHCWs should be
vaccinated against Hepatitis B.

5.3 Patient Management: Dental staff

5.3.1 The medical history of each patient should be obtained and
updated (current illnesses, hepatitis status, recurrent illnesses,
unintentional weight loss, lymphadenopathy, oral soft tissue
lesions or other infections should be included).
5.3.2 All patients should be asked routinely about a history of TB and
symptoms suggestive of TB.
5.3.3 Persons with known active pulmonary TB, or those who warrant
a high index of suspicion for TB, should not be provided
elective dental care.
5.3.4 Dental treatment should be postponed until medical chart shows
that the patient is undergoing treatment and compliance with TB
medications is documented.
5.3.5 A high index of suspicion of pulmonary TB should be
maintained in a patient with any of the following: recent history
of productive cough lasting in excess of three weeks, bloody
cough, fever, complaints of fatigue, chills, night sweats.
5.3.6 If emergency dental care must be provided for a patient who has,
or is strongly suspected of having infectious pulmonary TB, the
following TB isolation practices should be implemented:
5.3.6.1 Dental healthcare workers must use a well –fitting
particulate respirator (N95 mask) with HEPA
(High Efficiency Particulate Air) filter approved
by Hospital for use with TB. A surgical mask is
not adequate protection.
5.3.6.2 As soon as it is available, patient must be treated
only in a room equipped with ventilation
parameters specific to TB management, including
the following:
5.3.6.2.1 Patients diagnosed with Active
Pulmonary TB must be treated in the
Dental Services Department’s
designated operatory.
5.3.6.2.2 While waiting, the patient shall wear
a surgical mask to prevent droplet
spray form coughing or sneezing.
5.3.6.2.3 Use of an antimicrobial mouth rinse
that has residual activity is required
before and after treatments.
5.3.6.2.4 Rubber dam and high volume
evacuation must be used during
dental procedures.

5.3.6.3 Protective eyewear should be provided to each

patient when treatment involves risk of eye injury
to include the use of rotary instruments, curettes,
prophyjets and chemicals or when spray or
splatter is anticipated.
5.3.6.4 Eyewear must be disinfected between each patient
using soap and water, and disinfectant spray or

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 approved disinfectant solution. Eyewear is not
heat sterilizable.
5.3.6.5 The patient should never be allowed to handle
instruments from the bracket table or instrument
tray.
5.3.6.6 The following procedures should be performed in
the patient’s presence:
5.3.6.6.1 Sterile trays and the hand piece
opened.
5.3.6.6.2 Suction tips and saliva ejectors
placed on the hose.
5.3.6.6.3 Paper cup placed on its stand.

5.3.6.7 The patient should be discouraged from bringing

family members into the operatory.

5.4 Cleaning and Disinfecting Dental Operatory and Environmental Surfaces: Dental staff

5.4.1 All surfaces must be disinfected between patients and at the

beginning and end of the work day with an approved
disinfectant spray. The inside and outside of all drawers and
cabinets shall be disinfected weekly. Disposable blood/saliva
impermeable barriers such as plastic wrap or aluminum foil must
be used when possible to shield surfaces from direct or indirect
exposure. Areas difficult to clean and disinfect include:
5.4.2 All dental and medical instruments can be classified into three
categories: critical, semi- critical or non-critical, depending on
the potential risk for infection associated with their intended use
and how they are reprocessed
5.4.2.1 Light handles –small plastic baggies are preferable to
foil.
5.4.2.2 Light control.
5.4.2.3 Chair switches.
5.4.2.4 High volume evacuation control and hose.
5.4.2.5 Air water syringe.
5.4.2.6 Saliva ejector.
5.4.2.7 The entire bracket table.
5.4.2.8 Dental chair.

5.4.3 Any area covered with a surface barrier does not need to be
disinfected between patients. Contaminated barriers shall be
discarded and replace with new clean barriers at the end of each
case.
5.4.4 Precautions shall be taken to prevent cross-contamination from
patient to drawers, counters, instruments and other items located
in a clean area of the operatory.
5.4.5 Disinfectants used must be selected from the Hospital approved
list.
5.4.6 The manufacturer’s directions on disinfectant’s label should be
followed.
5.4.7 Dentists and specialists, dental hygienists, dental nurses and
assistants are responsible for the cleaning and disinfection of
their assigned areas.
5.4.8 Heavy duty puncture-resistant rubber gloves face masks and
protective eyewear must be worn during surface cleaning and

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 disinfection.
5.4.9 Sweet water must be used to dilute disinfecting agents requiring
dilution.
5.4.10 Protective eyeglasses must be worn when mixing solutions.

5.5 Treatment of dental records: Dental staff

5.5.1 Care should be taken to avoid contamination of the dental record
when in operatories by handling the dental record and x-rays
before gloving. Dental records must not be touched after hands
or gloves have been contaminated by blood or saliva. Dental
record entries should be written after gloves are removed and
hands washed to prevent contamination with blood and/or saliva.
5.5.2 Dental records must be kept out of the splatter zone during
treatment.
5.5.3 In case of contamination with blood or saliva, the plastic
surfaces of the dental record shall be wiped clean with
disinfectant. The same procedure should be followed for dental
records with cardboard surfaces or, if disinfection is impossible,
the dental record should be replaced.
5.5.4 Dental records shall not be brought into an area designated as an
eating area. If necessary for patient care review, dental records
may be brought into these areas for scheduled clinical
conferences. All surfaces in the room shall be considered
contaminated and treated as such. The surfaces shall be cleaned
with an approved disinfectant and absorbent paper toweling and
then disinfected.
5.5.5 Dental record movement around the clinic shall be kept to a
minimum. Dental records should go between the treatment area
and the business office in a route as straight as possible.
5.5.6 Antimicrobial hand scrub and disposable non-sterile gloves
should be available. If preferred, gloves may be worn while in
the business offices and removed upon leaving the area.

5.6 Surface Cleaning:

5.6.1 Sterile wrapped/bagged items in drawers should be separated
from non-sterile items.
5.6.2 Counters must be free of excessive supplies and equipment, i.e.
those supplies not being used on the seated patient.
5.6.3 Use of 70% alcohol, quaternary ammonia compounds or
antiseptic agents for surface disinfection within operatories and
clinical locations are considered inadequate.
5.6.4 The spray-wipe-spray technique for cleaning shall be used to
clean and disinfect all high touch’ areas including the cuspidor
and strainer, as follow:
5.6.4.1 Spray the surface and/or equipment with a
disinfectant.
5.6.4.2 Wipe dry the surface with paper toweling and
discard.
5.6.4.3 Spray surface and/or equipment with
cleaner/disinfectant and leave in contact for 10
minutes.
5.6.4.4 Set up for next clinical procedure.
5.6.4.5 Remove the protective plastic cover(disposable)
of the chair.
5.6.4.6 Replace with a new chair cover.
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 5.6.4.7 Spray –wipe-spray’ technique is performed in
three stages. The first ‘spray’ stage is a cleaning
stage. The surface is then ‘wiped’ clean. The
third stage is to ‘spray’ the area a again and leave
in contact for 10 minutes. This is the disinfecting
stage.
5.6.4.8 At the end of the day, counter tops, desk and
cabinet tops shall be cleared to facilitate janitorial
cleaning. The floor shall be cleaned daily by
Housekeeping.
5.6.4.9 The chairs will be cleaned with antiseptic spray at
the end of the day and left for drying. Replace the
chair cover.
5.6.4.10 All procedures and manipulations of potentially
ineffective materials must be performed carefully
to minimize droplets, splatters and aerosols, when
possible. The use of rubber dams, where
appropriate, high volume evacuation (HVE) and
proper patient positioning is recommended.
5.6.4.11 Air and water syringes must be changed after each
patient use and metal air/water syringe tips must
be sterilized between patients.
5.6.4.12 Ultrasonic scalers must be sterilized between
patients.
5.6.4.13 Water lines must be flushed for a minimum of
three (3) minutes at the beginning and end of
each day, and for 30 seconds between patients. A
treatment of cleaning solution should be
evacuated through the evacuator line at the end
of each day. The unit’s solid waste filter trap
must be cleaned and replaced at least once a
week or more if necessary. Irrigation for surgical
procedures shall be performed using bottled
sterile water administered from a sterile syringe
by hand (or from a surgical unit with a close
water system) – no water should be used from a
dental unit (chair) lumen which does not have a
closed water system during these procedures. It
is recommended that the dental unit’s water be
turned off during invasive surgical procedures.
5.6.4.14 Hand pieces, air/water syringes and ultrasonic
scalers shall be kept covered when not in use.
5.6.4.15 Bulletin boards shall be used for displaying
posters, information, schedules, etc. to allow for
easy cleaning of wall surfaces and should be
located outside of the splatter zone.
5.6.4.16 Tissues and other patient care items shall be
placed behind or beside the patient (not in front
of the patient).

5.7 Material and Equipment: Dental staff ,

5.7.1 All decontamination and sterilization of instruments shall be CSSD Staff.
performed in the Central Sterilization Supply Department.
5.7.2 All instruments (including burs and other rotary instruments)
shall be sterilized between patients.

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 5.7.3 All gross soil, i.e. cement, bone fragments, sponges must be
removed from instruments and trays with gauze sponge (while
wearing gloves) before they are returned to the Central
Sterilization Supply Department.
5.7.4 Soiled burs shall be placed on the used bur block or in a
specimen cup prior to sending to the Central Sterilization Supply
Department.
5.7.5 Used instruments shall be returned to the Central Sterilization
Supply Department in plastic, impervious bags or in a container
with lid and soaked in antiseptic solution or water and detergent.
Gloves must be worn to transport contaminated instruments –
not those gloves worn during patient treatment, but a new pair
donned for the transport. This is the only time that gloves are
worn outside the operatory.
5.7.6 All burs, hand pieces and other instruments not being used on
the seated patient shall be sent back to CSSD for re autoclaving.
5.7.7 During procedure all drawers and cabinets shall remain closed.
They may be opened only if necessary, using over gloves or a
paper towel. Alternatively, the gloves may be removed to open
drawers before proceeding after re-gloving.
5.7.8 Anesthesia shall be prepared only after need is established.
5.7.9 Gauze squares, cotton rolls and other disposables must be sterile
for use.
5.7.10 Matrix bands should be selected and pre-positioned on tray
before beginning of the procedure.
5.7.11 Sterile pliers should be used to select items pre-packaged from
the manufacturers, e.g. stainless steel crowns, temporary crowns,
wedges, etc.
5.7.12 All equipment shall be cleaned and maintained according to the
manufacturer’s instructions. Any sterile item dropped on the
floor must be considered contaminated and returned to the
Central Sterilization Supply Department for sterilization.
5.7.13 Hand pieces, air and water syringes, chuck keys, ultrasonic
scalers and dental units shall be sterilized between patients.
5.7.14 All impressions and prosthetic appliances shall be treated as
follows:

5.7.14.1 Rinsed with running water to remove gross soil

and blood.
5.7.14.2 Rinsed again with water.
5.7.14.3 Immersed again in the disinfectant, [1:10
dilution for 10 minutes] by wrapping it in a
dripping paper towel and placing it in a zip lock
bag to send to the laboratory.
5.7.14.4 Clorox or other disinfectant solutions shall be
changed daily or more frequently if necessary.
5.7.14.5 Zip lock bag shall be handled with clean gloves
only.
5.7.15 When returning dentures to the operatories from the laboratory,
one 50/50 dilution of mouthwash should be placed in the zip
lock bag with the dentures.
5.7.16 The patient must rinse with an antiseptic mouth rinse prior to
having impressions made or trying-in dental prosthetic devices.
5.7.17 Single packing is done for the instrument and set packs are
avoided.

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 5.7.18 Sterile pouches and trays containing instruments should be
opened just prior to patient use. Only those instruments, burs,
etc. needed for the present patient should be opened. Other
sterile instruments must remain in the packages until needed.
When applicable, the instrument trays should be re-wrapped
with the original wrapping and placed into impervious plastic
bags before being returned to the Central Sterilization Supply
Department.
5.7.19 Contaminated dental and laboratory burs that are in need of
replacement may be disposed of in the operatory or the Central
Sterilization Supply Department in sharp containers. Old
diamond burs must be sent to the Central Stores for exchange or
replacement.

5.8 Handling Biopsy Specimens: Dental staff

5.8.1 Specimens must be put in a sturdy container with a secure lid to
prevent leaking during transportation. In case of leakage, the
container must be transported in a plastic bag.
5.8.2 Care shall be taken to avoid contamination of the outside of the
container. If contaminated, it shall be cleaned and disinfected or
placed in an impervious bag and labeled contaminated.
5.8.3 Extracted teeth used should be considered infectious and be
classified and handled as clinical specimens in the same manner
as biopsy specimens. Standard Precautions applies when they
are being handled. Store in sodium hypochlorite solution, 1:10
dilution, or an approved disinfectant solution to transport.

5.9 Centers for Disease Control (CDC) Recommendation:

5.9.1 Because retraction valves in water lines may cause aspiration of
patient material back into the hand piece and water lines,
antiretraction valves (one-way flow check valves) should be
installed to prevent fluid aspiration and to reduce risk of transfer
of potentially infective material. Routine maintenance of
antiretraction valves is necessary.
5.9.2 Dental Services Department water lines that do not have such
valves must have them installed.

5.10 Dental staff should do prevention of Sharp Injuries and refer to Prevention and Dental staff
Handling Sharp Injuries.

5.11 Dental staff should have a strict compliance on sharp disposal. Refer to Sharp
Disposal..

5.12 Dental staff should use the Transmission based precautions, refer to Isolation /
Transmission Based Precaution, if the patient is positive with communicable
diseases.

5.13 Dental Staff should follow the Medical Waste Management. Refer to Medical
Waste Management.

5.14 Dental Staff should follow the Blood and Body Fluid Spill Cleaning if there is
any spill happens. Refer to Blood and Body Fluid Spill Cleaning.
5.15 Dental Staff should know when to send the White Coat of the Physician for
Laundry. Refer to Laundry Functions / Laundry Management

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 5.16 For Dental Procedures in Operating room the staff should know how to gowning
and gloving. Refer to Gloving & Gowning.

5.17 Dental Staff should use appropriate PPE for every procedure. Refer to Personal
Protective Equipment.

5.18 Dental Staff should do Hand hygiene before and after every patient. Refer to
Hand Hygiene.

5.19 If being exposed by any occupational exposure the dental staff should follow the
post exposure prophylaxis. Refer to Post Exposure Prophylaxis

5.20 Dental Staff should follow standard precautions for all the patients and consider
any potential fluid as infectious. Refer to standard precautions.

5.21 Safe injection practices are intended to prevent transmission of infectious

diseases between one patient and another, or between a patient and DHCP during
preparation and administration of parenteral (e.g., intravenous or intramuscular
injection) medications. Preparing or dispensing a sufficient amount of material
for a particular procedure before patient contact and discard any excess at
completion. Single dose solutions or medications are recommended
to prevent cross-contamination. Refer to policy safe injection practices.
5.22 Dental Unit Water Quality - Dental unit waterlines (i.e., plastic tubing that Dental staff, IPC
carries water to the high-speed hand piece, air/water syringe, and ultrasonic Staff &
scaler) promote bacterial growth and development of bio film due to the Laboratory staff.
presence of long narrow-bore tubing, inconsistent flow rates, and the potential
for retraction of oral fluids. Dental health care personnel and patients could be
placed at risk of adverse health effects if water is not appropriately treated.
Use water that meets EPA regulatory standards for drinking water (i.e., ≤ 500
CFU / mL of heterotrophic water bacteria) for routine dental treatment output
water. The testing of water to be done bi-annually.

5.23 Dental Radiography Asepsis - Wear gloves when taking radiographs and when Dental staff
handling contaminated film packets. Other PPE (e.g., mask, protective eyewear,
protective clothing) is required when spatter or splashes of blood
or other potentially infectious materials is anticipated.

6. Cross Reference

6.1. Transportation of used instruments.

6.2. Cleaning, Decontamination, Disinfection, sterilization & storage of instruments
6.3. Personal Protective Equipment
6.4. Hand Hygiene
6.5. Prevention and Handling Sharp Injuries
6.6. Sharp Disposal
6.7. Post Exposure Prophylaxis
6.8. Blood and Body Fluid Spill Cleaning
6.9. Laundry Functions / Laundry Management
6.10. Gloving & Gowning
6.11. Medical Waste Management
6.12. Isolation / Transmission Based Precaution

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7. Forms / Attachments
7.1. Attachment 1: Modified CDC/Spaulding Classification of Contaminated Patient care items
and Environmental Surfaces
7.2. Attachment 2: Guide for the Selection of Appropriate Disinfection Methods for Items
Transported to or from the Dental Laboratory

8. Materials / Equipment

8.1. Personal protective equipment:

8.1.1. Mask
8.1.2. Gloves
8.1.3. Apron/Gown
8.1.4. Face shield/ Goggles.

8.2. Hand washing facility:

8.2.1. Running water hot and cold
8.2.2. Soap solution
8.2.3. Disposable Hand towel.

8.3. Waste disposal:

8.3.1. Colour coded bags black/yellow/red
8.3.2. Sharp containers
8.3.3. Sticker label
8.3.4. Plastic Fasteners
8.3.5. Waste transportation trolley

8.4. Spill kit

8.5. Disinfectants
8.6. Disposable cleaning towels.

9. CBAHI Standard Reference

9.1. DN.6.

10. Reference

10.1. Dental Infection Prevention Guidelines for Infection prevention & control in Dental Health-Care
Settings www.cdc.gov/mmwr/PDF/rr/rr5217.pdf

10.2. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental
Settings: Basic Expectations for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention,
US Dept of Health and Human Services; October 2016.

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 Attachment 1: Modified CDC/Spaulding Classification of Contaminated Patient Care
Items and Environmental Surfaces

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 Attachment 2: Guide for the Selection of Appropriate Disinfection Methods for Items
Transported to or from the Dental Laboratory

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 Name Title Signature Date

Prepared By

Reviewed By

Approved By

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