dclppm section 1 sept 2010 final

SECTION I

CLINIC AND LABORATORYASEPSIS POLICIES

AND

PROCEDURES

INCLUDING CLINICAL ATTIRE

TABLE OF CONTENTS

SECTION I

CLINIC AND LABORATORY ASEPSIS POLICIES AND PROCEDURES

Topic Page

STUDENT PROTOCOL POLICY ________________________________________ 3GEORGE BROWN COLLEGE INFECTION CONTROL PROGRAM POLICY__ 3

1. Smoking Policy______________________________________________________ 4

2. Tag policy__________________________________________________________ 4

3. Exposure Control Policy for the Dental Clinic and Laboratories___________ 5

4. Clinic Floor Plan____________________________________________________ 9

5. Equipment Operating Instructions____________________________________ 10

6. Care and Maintenance of the Operatory Procedures_____________________ 10

7. Supply Table and Portable Drawers___________________________________ 11

8. Map of Unit Supplies _______________________________________________ 12

9. Aseptic Technique Procedures_______________________________________ 13

10. Dental Unit Water Line Flushing and Charging Instructions____________ 15

11. Hand Hygiene Procedures _________________________________________ 16

12. Clinic Operatory Asepsis Procedures_________________________________ 21

13. Additional Equipment Asepsis Procedures___________________________ 29

14. Radiographic Asepsis Procedures___________________________________ 30

15. Dental Laboratory Asepsis Procedures______________________________ 32

16. Custodial Personnel______________________________________________ 34

17. Waste Disposal Procedures________________________________________ 36

As a student in the Centre for Health Sciences, dental programs, you are now a representative of George Brown College and the Dental Professions. Whether you are at school, at work, or participating in any social or school function, it is expected that you will present yourself at any of these locations in a professional manner.

When participating in clinical externships and community dental health assignments, students will be expected to follow the Exposure Control Guidelines for the Dental Clinics & Laboratories (This section of the Manual)

Further information regarding student protocol for the dental assisting and dental hygiene programs can be found at the beginning of the pre-clinic / clinic manuals for each of these programs.

This program is a very important step in client care. It is designed to reduce the potential for disease transmission to a level in which the normal body defense can cope. By acting in a reasonable and prudent manner disease transmission will be minimized for the client, student, staff and faculty member. The remainder of this section of the Manual is devoted to informing the students and staff of the College of these steps.

George Brown College Dental Clinics and LaboratoriesPolicy & Procedures Manual 3 Section 1

THE GEORGE BROWN COLLEGE INFECTION CONTROL PROGRAM POLICY

STUDENT PROTOCOL POLICY

1. SMOKING POLICY

Students are not permitted to smoke inside or outside the doors of Building B at the Casa Loma Campus. Gathering outside the entrances to the building to smoke creates a safety issue for individuals trying to enter the building. It is also unprofessional as a health care provider to be outside the doors smoking when clients arrive at the building. Please use the designated smoking areas behind building C/E.

2. TAG POLICY

Students in all programs are responsible for purchasing a set of tags that are used when borrowing supplies and equipment from the dispensary.

Dental Hygiene – blue / red Dental Assisting – green Denturism – yellow / orange / white Restorative Dental Hygiene - black

Students are not permitted to borrow any items without their tags or share tags with fellow students.

The dispensary is not responsible for lost/stolen tags and a new set must be purchased by the student as a replacement.

All items borrowed must be returned in the condition given and must be returned by the end of the day. Overnight borrowing of items is NOT PERMITTED unless permission has been given by a dispensary staff member.

The number that is on the set of tags, that the student has purchased, is the number they will use when labeling items for sterilization. Any items that are not labeled properly are considered “lost”.

Labeling of all items to be autoclaved is done with an IMS marker only. Other forms of labeling (inks) clog the filters in the autoclave. Use of anything other than the IMS marker to label autoclavable items will result in the items not being sterilized until the student has done the labeling correctly.

Items for sterilization should be labeled large & legibly with the following:

FIRST & LAST NAME* DATE PROGRAM TAG NUMBER

* For those items borrowed from dispensary, the name and program should be omitted.

At the end of the program, if all tags are returned, the initial deposit paid for the tags will be returned to the student


3. EXPOSURE CONTROL POLICY FOR THE DENTAL CLINIC AND LABORATORIES

These exposure control guidelines include appropriate procedures to protect dental clients, dental health care workers (DHCWs), both full-time and part-time employees, and volunteers while in the dental clinics or laboratories from occupational transmission of infectious diseases.

Personal protective equipment (PPE) protects the exposed skin of the hands and arms from exposure to splashing and spraying of blood/body fluids and protects from trauma or environmental injury. PPE also protects the mucosal membranes of the eyes, mouth and respiratory tract.

*PPE includes gloves, masks, protective eyewear and protective clothing and does not include clinical attire such as uniforms. PPE should be removed prior to leaving client care areas. PPE designed to be re-used (i.e. eyewear, labcoats) should be cleaned with soap and water. Contaminated items (eyewear) should be disinfected between client use according to manufacture’s instructions. Disposable PPE should be discarded immediately after use.

1. PPE-Protective Eyewear or Face-shields*

Protective Eyewear (glasses) with side-shields or face-shields must be worn during all procedures with clients whenever splashing or spattering of blood/body fluids is likely generated. Their use is required while in the dental laboratory, during all treatment procedures, while processing instruments in the decontamination area, and when mixing or pouring chemicals / materials. Protective eyewear must be provided for each client.

Protective eyewear should be cleaned and disinfected after use, between clients or whenever they become visibly soiled.

2. PPE-Surgical Masks*

Surgical masks with 95% bacterial filtration efficiency must be worn to protect the mucous membranes of the nose and mouth during procedures where blood/saliva or chemicals may be splashed or spattered. Masks are required for activities involving high-speed or slow-speed handpieces, ultrasonic instruments, air/water syringes, oral irrigators, during grinding or splashing of items that may be contaminated with client fluids.

Masks must fit snugly over the nose and under the chin and must be changed and discarded between clients or during client treatment when it becomes wet or soiled. The mask should not be allowed to hang below the clinician’s chin after use.

3. PPE-

Examination Gloves*

Properly fitting medical vinyl, neoprene, polyurethane, nitrile, powder-free disposable gloves must be used with all clients whenever blood/saliva may be contacted. Gloves used in client care are single-use items and must not be used on another client or washed with


soap. Latex gloves are NOT to be worn in the George Brown College (GBC) clinics or laboratories.

Hand hygiene must be performed before and after donning and removal of gloves. After client contact, gloves must be removed and discarded. Finger cuts must be covered with sterile waterproof dressings.

Over-gloves, or food-handler gloves, are available and must be worn over contaminated treatment gloves to prevent contamination of clean items used during treatment. (i.e. when writing in the dental chart, when removing an item from the operatory drawers or when retrieving an item from the dispensary)

Puncture-resistant utility gloves must be worn when handling and cleaning contaminated instruments, during operatory decontamination or using the boilout unit in the dental lab. Puncture resistant utility gloves must be sterilized or disinfected after use and stored appropriately

4. PPE-Labcoats*

Labcoats constitute PPE and must be worn over clinical attire during all client care sessions and laboratory sessions whenever blood/saliva or chemicals may be splashed or spattered.

All students in the School of Dental Health are required to wear designated coloured GBC labcoats in all client care areas on the fourth floor (clinic and radiography areas)

All students in the School of Dental Health will be required to wear white GBC labcoats in dental materials laboratory areas on the third floor. All GBC labcoats will be available for purchase at the GBC bookstore.

All faculty in the School of Dental Health are required to wear white labcoats in ALL clinical, preclinical and dental materials laboratory areas.

All labcoats must be clean, pressed, and should cover personal clothing, clinical attire and skin (e.g. forearms, wrists) that may become contaminated.

5. Clinical Attire

All students in the School of Dental Health are required to wear GBC scrub uniforms during all client care areas on the fourth floor (clinic and radiography areas).

Scrub uniforms must be clean, pressed, comfortable and must cover personal undergarments. Scrub pants must have a finished hem of appropriate length not in contact with the floor.

Students should not wear their uniform to and from school. Clinical attire is NOT considered general attire that is worn on a daily basis.

6. Hand DHCW must perform hand hygiene with soap and


Hygiene water when hands are visibly contaminated with blood/saliva or other potentially infectious material. When hands are not visibly soiled an alcohol based hand rub may also be performed. Hand hygiene will be performed whenever hands are visibly dirty, before gloving, after removing gloves, before leaving the restroom, before eating, drinking, applying cosmetics and after barehanded touching of contaminated surfaces or objects

Hands must be clean and well-cared for without lesions or breaks in the skin.

Fingernails should be short, with smooth filed edges to allow thorough cleaning and prevent glove tears and should be free of nail polish except for clear or light coloured freshly applied lacquer.

Use of artificial fingernails in general is not recommended.

Use of hand lotion to prevent skin dryness is recommended.

7. Hair Hair must be clean, shaped and secured to prevent it from being a hazard for either the client or the clinician. As a general guide, hair must be secured if it touches the clinician’s collar.

Male students must be clean shaven or have neatly trimmed moustaches or beards

8. Make-up Make-up must be conservative and appropriate for daytime wear.

9. Scents Strong scents such as perfume, aftershave, lotions or certain soaps may be offensive and should not be used.

Odours from tobacco, alcohol or other drugs are not permitted. Students, staff and faculty should refrain from smoking when dressed in clinical attire Students, staff and faculty members should ensure that their body odours are not offensive. It is recommended that DHCWs shower and apply antiperspirant daily. Mouthwash should be used as needed.

10. Jewellery

A watch, stud earrings and a plain wedding band without elevated stones, are the only jewellery permitted. Hand or nail jewelry should not make removing gloves difficult or compromise glove fit or integrity.

11. Shoes Shoes must provide adequate support and must be clean and in good repair.

Students in Dental Hygiene / Assisting / Restorative programs must wear white closed-toe shoes with non-skid soles and have NO laces. These maybe be purchased in the GBC bookstore.


Denturism students must wear closed toe shoes in the clinic and laboratory areas.

12. Hose Hose and/or socks must provide adequate coverage of the leg when standing or sitting. Socks must be white and hosiery must be opaque.


4. CLINIC FLOOR PLAN


5. EQUIPMENT OPERATING INSTRUCTIONS The dental clinics have 2 types of dental chairs. The chairs are manufactured by Belmont and by Marus. Each chair has different operating systems and functions. The operation of these chairs can be found in the top drawer of all operatories. Please refer to the manufacturer’s direction for correct operation of this equipment.

6. CARE AND MAINTENANCE OF THE OPERATORY

The dental unit consists of a dental chair, dental light, operator’s stool and a dental assistant’s stool and mobile carts.

There are many students from the Dental Assisting , Dental Hygiene, Restorative Dental Hygiene and Denturism Programs that share the use of each operatory in all the clinics located on the 4th floor. It is the responsibility of all students using any operatory in any clinic to follow the daily maintenance of the unit using the following guidelines:

Each Unit is to be set in the following way:

The mobile carts under the counter top. The dental chair upright and elevated it to the highest position The armrest at a 90 degree angle to the seat of the dental chair The dental lamp over the dental chair, facing the headrest. The rheostat and foot control on the chair seat on a paper towel in B409 all

others on the base of the chair The front delivery tray system neatly over the dental chair The master switch and water switch in OFF position The dental stools within the unit area on opposite side of the dental chair

Each Unit is to be maintained after its use by:

Replenishing supplies daily with only the items listed on the Map (following) Replenishing the soap and hand sanitizer when empty Disinfecting the dental chair, counter top and all cabinets. When

decontaminating units be careful not to throw away the top piece of the saliva ejector tubing, Ultrasonic handles or anything removable that is part of the unit.

Running suction (See #10 for details), cleaning traps and cuspidor after client contact.

Charging the lines and checking that the pressure is adequate on the gauge. (See #10 for details)

Removing garbage bag & replacing new plastic bag on holder

In addition to the daily maintenance of the unit all students are responsible for the following:


keeping clean the bases of the client chair, operator stool, assistant’s chair as well as the chairs themselves

keeping clean the cuspidor area keeping clean the chair lamp and arm keeping clean the handpiece, suction, syringe hoses and support arm for these

items keeping clean the rheostats for the chair and handpieces keeping debris and marks off the floor of the unit keeping clean the unit cabinetry and partitions

Cleaning supplies required for the above can be obtained from the Dispensary (including broom and dustpan).Each program will explain the process that is in place for their students if the care of the operatory is not followed.

(A copy of these guidelines is kept in the dental unit as a reminder for all students)

7. SUPPLY TABLES AND PORTABLE DRAWERS

The following items can be found on the supply tables and in portable trolleys located in the clinics.

a) Gauze Squaresb) Alcohol Swabsc) Saliva Ejectorsd) Air Water Syringe Tipse) Cotton Tip Applicatorsf) Tongue Depressor Sticksg) Cotton Rollsh) Fluoridei) Fluoride Traysj) Hydrogen Peroxidek) Oral Rinses (ie. Listerine and Chlorahexadine)l) Prophy Paste and Flour of Pumicem) Disposable Prophy Cups and Bristle Brushes


8. MAP OF UNIT SUPPLIES. The map indicates where all the items are to be kept to make replenishment simple and consistent. It is every student’s responsibility to make sure the unit is stocked with adequate supplies before they leave the clinical/pre-clinical session. Failure to do so can result in disciplinary measures from their program coordinator.


*articulating paper *calcium hydroxide* finshing & poliship strips *glass ionomer *paper pad *spatula * wedges

9. ASEPTIC TECHNIQUE PROCEDURES

To reduce contamination of materials and instrumentation, aseptic techniques must be maintained. Removal of contaminated treatment gloves and washing hands or the placement of overgloves on top of treatment gloves prior to accessing the dispensary, supply cupboard, supply table and supply trolleys is mandatory.

Dispensary - Students, staff and faculty members working in the dispensary must utilize infection control protocols associated with personal protection, aseptic techniques, and surface disinfection. All sterilized items including instruments are stored in trays or in protective sterilization wraps. Unwrapped items must be handled with transfer forceps.

Supply cupboards - Students, staff and faculty members must use an aseptic technique when accessing supplies from the supply cupboards, tables or trolleys. Over gloves worn over clean washed hands or over treatment gloves must utilize prior to taking items from the supply cupboards.

Supply tables/ trolleys - When accessing supplies that are used intra-orally, students, staff and faculty members must use transfer forceps using overgloves worn over clean washed hands or over treatment gloves.

Packaging Client-Care Items

To protect sterile instruments and supplies from contamination after the sterilization process, cleaned instruments and client-care items will be packaged prior to sterilization. Only those packaging materials provided (sterilization pouches and wrapping material designed for sterilizer use) will be used. Internal chemical indicators, found at the wrapping stations in the decontamination area, will be placed inside each instrument pack or cassette after the student has placed their name* and the date on the back of each indicator. Each wrapped instrument cassette will be sealed using sterilization indicator tape. Each instrument package or wrapped set will be labelled as indicated on page 4.Instruments wrapped prior to sterilization will remain sterile while the package or wrap is sealed. Various wraps will maintain sterilization for differing periods of time (usually 3 months).

* For those items borrowed from dispensary, the student’s name should be omitted.

Transfer Forceps

Transfer forceps are used to transfer unwrapped disinfected/sterile supplies from a container to a tray set-up. Transfer forceps are kept in transfer- forceps- jar when not in use. They are to be sterilized on a daily basis.


Removing Sterile/Disinfected Supplies from a Container

The asepsis of the contents in large containers is a concern because the containers are opened often. Aseptic containers are sterilized or disinfected at regular intervals (once per week) and whenever they become contaminated. The procedure for removing sterile/disinfected supplies from a container is as follows:

Open the container for as short a period as possible and do not talk, cough or sneeze while an aseptic container is open.

Remove the lid and hold it above your waist with the innermost side facing downward.

If it is necessary to put the lid down, invert it first so that the innermost side is facing upward.

Once the sterile/disinfected supplies are removed from the container, DO NOT RETURN THEM EVEN IF THEY ARE UNUSED.

Do not rest the forceps on any surface; deposit the retrieved item on the surface without touching the forceps to it.

Replace the forceps in the transfer forceps-jar immediately after use

The Use of Mouthwash

The use of an antiseptic mouthwash by the client prior to dental procedures can significantly reduce the number of available micro-organism for aerosolization. This mechanical removal of micro-organisms through the antiseptic properties of some mouthwashes can reduce the numbers as much as 10-100 times.

The Use of Anti-Microbial Soap

An antimicrobial soap (containing chlorohexidene, triclosan, parachlorometaxylenol PCMX), non-antimicrobial soap or alcohol based agents may be used for maintaining hand hygiene.

Use of the Dental Dam

The use of the dental dam wherever possible during high speed instrumentation has been shown to reduce the number of infectious particle. The dental dam prevents the aerosolization of saliva, however it does not prevent the aerosolization of the water from the handpieces or air/water syringe.


10. DENTAL UNIT WATER LINES

DENTAL UNIT WATER LINESFLUSHING AND CHARGING INSTRUCTIONS(for 3-way syringe, handpiece line, cuspidor drinking water line)

Full PPE Mandatory

A. Prior to each clinic: Purge all dental unit water lines.At the beginning of each clinic the dental unit water lines need to be purged.

1. a) For Marus chairs (B409): Ensure the self-contained water bottle is switched to “Off”. Ensure the water supply is switched to “City”.b) For all other chairs (Belmont chairs): Ensure the self-contained water bottle is switched to “City”. Note: Main power switch must be turned on.

2. Hold and run the 3-way syringe and handpiece line over the cuspidor. This should take at least 2-3 minutes. If the lines were previously charged, ensure you continue to purge the lines until solution is no longer evident.

3. Repeat step 3 for the cuspidor drinking water line.

Please note: If you are the operator for two consecutive clinics, then repeat step A for 20-30 seconds at the beginning of the second clinic.

B. After EACH client:

1. Hold and run the 3-way syringe and handpiece line over the cuspidor and run for 20-30 seconds.

2. Run the cuspidor drinking water line to purge as well for 20-30 seconds.

C. Last Clinic of the Week: The following protocol applies to the use of a weekly biofilm product.

1. Check the bottle of biofilm line solution. If below 1/3 full, please refill. Solution can be found in the decontamination area. Ensure that the bottle has a 2 inch headspace to allow for proper flow.

2. a) For Marus Chairs (B409): Ensure the self-contained water bottle is switched to “On”. Ensure the water supply is switched to “Bottle”.b) For all other chairs (Belmont Chairs): Ensure the self-contained water bottle is switched to “Bottle”. Note: Main power switch must be turned on.

3. Hold and run the 3-way water syringe and handpiece line over the cuspidor. You should be able to smell and/or see the coloured solution. This should take at least 20-30 seconds.

4. Similarly, run the drinking line for 20-30 seconds.

Please note: Last clinic of the week is usually Friday 1-4 pm. If Friday is a holiday, the lines must be charged at the end of the last clinic for that week. For those chairs that remain unused in the last clinic, it is the responsibility of the neighbouring unit operators to charge the lines.


11. HAND HYGIENE PROCEDURES

Improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) has been shown to terminate outbreaks and reduce transmission of antimicrobial resistant organisms. These new guidelines are to improve adherence to hand hygiene in health care settings. In addition to traditional hand washing with soap and water, the Centre for Disease Control (CDC) is recommending the use of alcohol-based hand rubs by dental health care workers for client care. Hand washing with soap and water remains a sensible strategy when the dental health care worker’s hands are visibly soiled or contaminated with blood or saliva. If hands are not visibly soiled, an alcohol-based hand rub may also be used.


i) LONG HAND WASH

It is essential that hand-care be maintained while wearing gloves as gloves provide an excellent environment for the production of microorganisms. The procedure for a long handwash should be completed at the beginning and completion of every clinical session or when the dental health care worker’s hands are visibly soiled or contaminated with blood or saliva. The procedure that should be accomplished in 1-3 minutes is as follows:

1. Remove any bandages.

2. Place a piece of paper toweling on the counter.

3. If worn, remove watch and place it on the piece of paper toweling along with a new bandage.

4. Check to ensure that a piece of paper towelling is accessible.

5. Adjust the water temperature to ensure that it is lukewarm.

6. Rinse the lower forearms and hands under the lukewarm water (water should run from the wrist to the fingertips, that is – from the least contaminated to the most contaminated).

7. Dispense a single application of hand soap into the palm.

8. Roll hands to create lather.

9. Using the Demonstration of “A Proper Medical Handwash” by CHICA-CANADA wash the lower forearm that includes the wrists, back of hands, palms and finger webs, thumb and nail area with soap for 15 seconds. Repeat this sequence for the other hand.

10. Rinse the lower forearms and hands with cool water.

11. Apply another application of hand soap into the palm.

12. Create lather and wash the lower forearms that include the wrists, palms, back of hands, finger webs, and thumbs and nail area for 15 seconds.

13. Rinse the hands thoroughly, from the lower forearms to the fingertips, with cool water.

14. Repeat steps 11-13.

15. Dry the lower forearms and hands thoroughly with paper towelling and use the paper towelling to wipe the counter area, turn the taps off and touch the waste disposal door.

16. Replace watch.

17. Cover all cuts with a bandage and, if necessary, with a finger cot.

18. Use hand lotions that are water-based in small amounts before lunch and at the end of the day to replace natural oils lost during hand washing.


ii) SHORT HANDWASH

It is essential that hand hygiene be maintained. A short handwash may be performed if hands are not visibly soiled, before placing/removing gloves or after several (5-7) alcohol-based hand rubs. Please refer to the handwashing technique previously mentioned and follow steps 1 – 10 and step 15.

iii)ALCOHOL-BASED HANDRUB

If hands are not visibly soiled, an alcohol-based handrub may also be used. The following technique may be used before placing/removing gloves prior to client care. Alcohol-based handrubs significantly reduce the number of microorganisms on skin, are fast acting and cause less skin irritation. A short handwash with soap and water is recommended after 5-7 handrubs using an alcohol-based product. Read and follow manufacturer’s recommendations for how much product to use as the volume needed to reduce the number of bacteria on hands varies by product.

1. Dispense a single application of alcohol-based product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers including finger webs and the backs of hands.

2. Continue rubbing hands together vigorously covering all surfaces of hands and fingers until hands are dry.

Note: If hands feel dry just after 10-15 seconds of rubbing, you likely used too little product.


12. CLINIC OPERATORY ASEPSIS PROCEDURES

Individual operatory set up for client care (prior to seating the client)

1. Proceed to your assigned dental operatory, place silver supply case on the back counter and put on your coloured treatment gown.

2. Place safety glasses on and PERFORM A LONG HAND WASH using liquid soap.3. Retrieve drinking cup from drawer and place under water dispenser of cuspidor.

Turn the Master switch on. Marus chairs (In B410) will require the water switch to be turned on as well. The Belmont chairs master switch will automatically turn on the water. Water levels are adjusted individually with small dials under the portable tray unit and cuspidor.

Move the dental stools and the control arm away from the dental chair. Place the rheostat and the foot control on the floor behind the dental chair. Using the foot control, lower and recline the chair slightly. Place the front delivery tray to the right of the chair (for right handed

operators) Elongate the air water syringe cart for access for the appropriate operator Move the dental light away from the centre of the dental chair towards the

light post. If required remove the dental assistant’s mobile cart out from under the

counter so that it can be accessed. Students in the dental hygiene program may require the use of the mobile cart with the cavitron, and this can be moved out to access the equipment.

Pull the armrest forward to elevate it.

4. Place on mask and perform hand hygiene.

5. Place on examination gloves.

6. Flushing and Charging Water Lines (Refer to guidelines, Section 1 page 15, copies also located in top drawer of each operatory)The following water lines need to be flushed at the beginning of EACH CLINIC for 2-3 minutes and BETWEEN CLIENTS for 30 seconds).

a) Both 3-way syringes (held over cuspidor),

b) Handpiece line (held over cuspidor)

c) Cuspidor drinking water line. (For the Belmont Chairs, you may use the switch on the front delivery cart. Run this into the cup set aside earlier, and dispose of cup when finished.

7. Wipe 3-way syringe and handpiece line with disinfectant wipe. Dispose wipe and remove and dispose of examination gloves.

8. Dispose of mask and perform hand hygiene.


9. Retrieve the following items from unit drawers for set up: 4 barrier sleeves, client bib, masking tape, barrier tape, a tray cover, 1 pr. overgloves, brown paper bag, 2 drinking cups. (Note: if operating with an assistant, retrieve x2 of tray cover, x2 overgloves, and x2 brown paper bag) Prepare overgloves with tape for attaching on the unit.

Remove any material you may require from your personal supplies and lab tags, (i.e. gloves, masks, pen, IMS marker, high volume suction tip, daisy chain, hand mirror, calculator, sealant material, Vaseline, etc. and place on the back counter for now.) Place silver supply case on the floor beside the back unit. Back counter should be clear of any personal belongings.

10. Utilizing over gloves over clean hands, retrieve a silver tray and a plastic sleeve protector for the tray from dispensary (you will need your lab tags) and an air water syringe from the supply table and any other supplies that are required for the appointment such as a saliva ejector. (Due to the limited space on the front delivery cart, depending on the stage of care being provided, students may require 2 silver trays, one for instruments and one for the use of oral self delivery supplies for example.)

Be sure to follow the guidelines under Aseptic Techniques regarding the use of Transfer Forceps and Removing Sterile/Disinfected supplies from a container when obtaining these supplies.

Return to your operatory, and remove over gloves.

11. With clean hands:

Apply barrier sleeves to

a) Saliva ejector hose

b) HVE hose

c) 3-way syringe handles

d) Handpeice lines

NOTE: Make sure to place the air/water syringe tip on the syringe handles, then place the barrier sleeve. The syringe tip will puncture a hole in the barrier cover. Be sure to expel some air from the syringe to ensure no plastic is left on the tip.

Ensure the hoses are not tangled at the beginning of your clinic.

12. Please note: any part of equipment that can become contaminated by touch, requires a barrier. The following are components of the operatory that require the operator to secure barrier film:

a) light switch (Fold barrier tape by folding top and bottom into the middle of the tacky side leaving 1/8th of an inch. This will prevent the light switch from being displaced during removal)

b) cuspidor handle

c) both cuspidor water buttons


d) operator light handle ( both handles when an operator is working with an assistant)

e) operators stool height adjustment lever and back of stool

f) dental assistant’s stool height adjustment lever and sternum rest adjustment knob ( when an operator is working with an assistant)

g) cabinet pull handle on the assistant’s cart ( when assistant and operator are working together)

h) cabinet pull on the mobile cart if the cavitron is being utilized

i) arms of client chair

j) controls on back of client chair

k) handle on front and side of delivery tray including coverage of switches below that may be utilized during appointment

l) brake switch on chair

13. Using the masking tape in drawer, attach a brown paper bag with the edge rolled, to the side of the front delivery tray. This is for non-biohazard disposables. (Attach an additional bag to the assistant cart if at chairside.) Utilize one of the drinking cups already removed from the drawer, place on the front delivery tray to collect any biohazard material for disposal.

14. Place the headrest cover on the headrest.

MOBILE “ASSISTANTS CABINET” SET-UP (For Dental Assisting Students)

15. Place a tray cover on the silver tray, and wearing overgloves retrieve the necessary supplies you will need for your clinic. For items retrieved from the dispensary you may need your dispensary tags. You may also retrieve any sundry items at the supply tables and trolley. This may include: an air water syringe, a saliva ejector, antiseptic mouthwash for the client, and cotton swab for application of a lubricant. Instruments kept in cassettes can be opened and placed on a tray. If multiple supplies are required a second silver tray may be needed. Exam kits not in cassettes may be kept on the tray.

16. Return to your operatory, and remove overgloves. Place all supplies in their appropriate places at this time. A 2nd tray may be required for the assistant cart for additional supplies.

17. If using a handpiece attach it to the correct hose on the control arm and activate for 20 seconds to expel any excess lubricant.

18. Remove mask and safety glasses and perform hand hygiene.

Greeting the client and positioning in the dental chair: Clients will be waiting in the reception area (B105) on the first floor. Remove safety glasses, masks and gloves and coloured treatment gown when leaving clinic to meet


the client. Proceed to reception to escort your client to the clinic. Please note all clients must check in to reception and must be escorted to clinic by the operator.

1. Direct your client to be seated in the dental chair. Provide any assistance, if necessary. Reposition the armrest, headrest and light to ensure client comfort. Receive any personal belongings that need to be stored for the client and place between dental unit cupboard and wall. Hang coat on hook.

2. Place your coloured treatment gown on. Place a dental bib across the client’s chest, securing it with a daisy chain. Provide the client with protective eyewear, if they do not have their own eyewear. Provide female clients with a tissue to remove any lipstick. Lubricant on a cotton-tipped applicator may also be offered to the client.

3. Direct the client to rinse with an antiseptic mouthwash for 30 seconds.

4. Put on your mask and protective eyewear.

5. Proceed to the sink and perform hand hygiene.

6. Prior to use in client-care, all sterile instrument packages or cassettes must be inspected to verify that the packaging material has not become torn, punctured or wet. If the sterilized package is dry and intact, open the sterile instrument packages or cassettes at chairside in front of the client. Review the internal chemical indicator strip with your instructor. If it reads non-sterile, proceed to dispensary with your package or cassette and chemical indicator strip for a replacement set of sterile instruments.

7. Organize mobile cart if required/delivery of air water syringe etc. for efficient delivery during implementation.

8. Place on examination gloves. Organize armamentarium on silver tray as required.

9. Recline your client and be seated on the operator and / or assistant’s stool. Reposition the dental light (switch on if required at this time).

10. Denturism students may proceed to work with their clients in an upright position.

YOU ARE NOW READY TO BEGIN YOUR PROCEDURE.

Please note:

If an impression has been taken during the procedure, please refer to Topic # 15 DENTAL LABORATORY ASEPSIS PROCEDURES page 32 of this section for instructions on proper handling and disinfection of impressions after removal from the client’s mouth.

Dismissing the client from the dental chair:

1. Turn off the dental light, and sit the chair upright.


2. With overgloves over examination gloves, reposition the cart/s, stool/s, and rheostat so they are not in the client’s way.

3. Remove the dental bib and place it into the garbage under the sink.

4. Receive the client’s protective eyewear and provide the client with a hand mirror and some paper towel run under warm water to remove any dental materials. Lower the chair and raise the armrest.

5. Remove your gloves, then mask and place them into the garbage under the sink.

6. Remove your protective eyewear.

7. Perform hand hygiene.

8. Assist the client from the chair if required.

9. Return any personal belongings to the client. Remove your coloured treatment gown to be left at the unit and escort the client to the reception area.

AFTER CLIENT TREATMENT : DISINFECTION/STERILIZATION PROCESS Return to your dental operatory and place coloured treatment gown on. Perform hand hygiene. Put on a new mask, protective eyewear and clean examination gloves. Retrieve utility gloves from silver utility case.

1. At the Operatory, place utility gloves over clean examination gloves:

Dispose of any sharps and anaesthetic carpules into the yellow “sharps” container located under the sink.

Any excess amalgam, amalgam capsules and pestles will be placed on the tray.

Place loose instruments on the silver tray and sort instruments in their appropriate cassette. Close the cassette.

If a handpiece was used, prior to removing the handpiece from the hose, flush the handpiece with the bur/prophy cup still inside the chuck by running the water/air lines briefly. Wipe any notable residue.

Remove burs from the handpiece and lock the bur block (if applicable). Remove the handpiece from the hose and rinse (if applicable). Discard the prophy cup into the garbage (if applicable). Remove the brown paper garbage bag from your mobile cart. Add it to the

regular garbage below the sink. If there is biohazard material in the small cup, place on tray and pinch it closed.

Remove lid and strainer from the suction trap. Place lid in the operator sink and rinse any excess, and place suction trap on silver tray to be cleaned in the decontamination area. Inspect cuspidor strainer, if it requires cleaning and or replacement, place on tray take to decontamination area.

Obtain container from under sink to take to the decontamination area. You will obtain the solution in the decontamination area to run through the hoses at your unit later.

Proceed to the decontamination area with your silver tray, cassettes, handpiece, bio-hazard items and plastic solution container and (and amalgam).


Please note: any other equipment that is utilized such as ultrasonic tips/sleeves, impression trays, spatula’s, radiographic film holders, etc., please see topic 13-15 in this section for specific instructions.

2. In the Decontamination area: Continuing with utility gloves over examination gloves:

a. Place biohazard into the biohazard container if applicable. b. Deposit any amalgam, amalgam capsules and pestles if applicable in

the Mercon container. c. Place cassettes into the ultrasonic cleaner. If any loose

instruments were used, utilize the plastic trays in the decontamination area to set into ultrasonic cleaner. Set the timer for 8-10 minutes. DO NOT immerse handpieces and ultrasonic inserts in the ultrasonic cleaner. Remember which machine you placed your instruments in.

d. Inspect the suction trap from the unit. If amalgam is in the trap, remove to Mercon container. If the trap is lightly soiled, rinse to clear, however if very soiled, place in garbage and request a new trap from the dispensary. Clean soiled cuspidor trap if required.

e. Lubricate the handpiece/s (while the instruments are running through the ultrasonic machine), using the automatic lubricating system (ASSISTINA) or with manual spray. Wipe the handpiece/s of excess oil. USE ONLY AN “IMS MARKER” to label an autoclave bag. All students need to label the package with: first & last name, tag #, date as well as program. Place handpeice/s into labeled autoclave bag, add chemical indicator strip labeled with name and date, seal with autoclave tape and return to dispensary window for sterilization.

f. When ultrasonic cleaner timer is completed: For cassettes: remove from the ultrasonic cleaner. RINSE THOROUGHLY under running water. Tap the cassettes over the sink to remove excess water. Dry exterior of cassettes with paper toweling. Tap cassettes again to make sure no excess water remains. Place chemical indicator strip labeled with name and date in cassette. For loose instruments that are not in a cassette: remove from plastic basket, place them on paper toweling and carefully blot them dry.

g. To Wrap Cassettes: Retrieve instrument wraps and secure around the cassettes (that already have internal chemical indicator strips that have been labeled with name and date inserted inside them ) with autoclave tape. Use large wraps for large kits and small wraps for small kits. USE ONLY AN “IMS MARKER” All students need to label the package with: first & last name, tag # as well as program. On small and large cassettes you must indicate the above on the top AND at one end of the cassette you must provide your program, tag # and contents…see diagram in the decontamination area. Return cassettes to dispensary window for sterilization.

h. To Bag Loose Instruments: Repeat procedure for labeling autoclave bag as in point “2e” above, for handpeice. Place loose instruments into


labeled autoclave bag, add internal chemical indicator strip (labeled with name and dated) and seal it and return to dispensary window for sterilization.

i. Fill empty container with 2/3rds “pink” solution for disinfecting suction lines in the operatory. Return to operatory with silver tray, filled container, and cleaned or replaced suction trap (and cuspidor strainer if applicable).


3. Return to operatory: Place silver tray on back counter. Rinse utility gloves with water and remove utility gloves onto paper towel on

the floor. Pat dry and spray with Bio-TEXT then leave to air dry. With clean examination gloves still on , remove all barrier film. Clean HVE & Saliva ejector lines, cuspidor and strainer with damp paper towel. Turn the HVE and saliva ejector suction on for Marus Chairs only. Place the suction trap and replace the cover over the trap. Run ¾ of the suction line solution through the 2 suction lines (1- high volume

and 1-saliva ejector). Clean the cuspidor using a cleanser agent (i.e. VIM or FANTASTIK if stained. Replace cuspidor strainer if applicable. Flush the remaining suction line solution into the cuspidor. Place empty container back under sink.

Flush the following water lines for 30 seconds, and charge lines ONLY IF THE LAST CLINIC OF THE WEEK. (Recall guidelines: Section 1 page 15, or a copy located in the top drawer of each operatory)

a) Handpiece line

b) Cuspidor drinking water line

c) 3-way syringe handle x 2

With wet paper toweling clean any debris from the client protective eyewear, chair, stools, counter tops, light pole, chair mount, carts and any other items requiring cleaning. Remove protective sleeve from silver tray.

4. Remove examination gloves. Perform hand hygiene and put on a new pair of examination gloves. Using disinfectant wipes, wipe the dental chair, stools, personal protective

eyewear, counter tops, silver tray, mobile cart tops and fronts (if used) light, light cover, and light switch, ultrasonic unit and the saliva ejector, HVE, handpiece and 3- way syringe hoses, IMS marker, cover of suction trap and finally the cuspidor. You may require the use of several wipes. Do not saturate the chair and do not saturate any of the knobs or buttons on the control arms or front delivery equipment.

Wipe base of chair with disinfectant wipes including housing equipment box. Place dried utility gloves which were previously disinfected into sealed baggie

to be kept in the students silver case.

5. Return equipment to its appropriate place as listed: Place the mobile carts back under the counter top if they were used. Activate your foot control to incline the back of the dental chair and elevate

it to the highest position. Lower the armrest. Center the dental light over the dental chair, facing the headrest. Place the rheostat and foot control on the chair seat on a paper towel for

the Marus chairs (B409) and on the base of the chair behind the chair for the Belmont models.


Place the control arm neatly to the left of the dental chair and turn the Master switch off.

Leave the dental stools (operator and assistant) within the unit area.

6. Turn off the Master switch and in addition the water switch for the Marus chairs.

7. Remove the garbage bag from under the sink and dispose into appropriate garbage containers located throughout the clinics. Do NOT place in biohazard garbage. Replace the garbage bag holder with a fresh bag and secure appropriately.

8. Replenish the soap dispenser and hand sanitizer if required. If “lines” solution is low, replenish. Solution can be obtained in the decontamination area.

9. Remove, mask & disposable gloves. Perform a short handwash. Make sure the supplies in drawers and cabinets have been replenished with the

items listed on the map of the unit. Do not leave personal items at the unit.

10. Return silver tray to dispensary previously cleaned and wiped with disinfectant. Do not handle with a bare hand. (i.e. The corner of a paper towel can be used.) Remember to obtain tag back for this item.

11. Perform long wash with hand soap before leaving the clinic.

NB: The previous sequence of events to disinfect the operatory and sterilize instruments is a suggested method to follow a chain of asepsis. Students may find with experience that other steps may work more efficiently for them. The most important thing to remember is that the chain of asepsis must be maintained throughout all phases of operatory preparation, client care, operatory disinfection and instrument sterilization.


13. ADDITIONAL EQUIPMENT ASEPSIS PROCEDURES

If the following equipment has been used during a client procedure, follow the steps outlined to properly disinfect and sterilize. Please note, equipment that has be tagged out and is not “owned” by the student must still have a chemical indicator strip placed in autoclave bags, but ONLY the date is required, not the student’s name.

Please review manufacturer directions for the following equipment for appropriate care. In addition listed below are protocol specific to George Brown dispensary guidelines:

i) Ultrasonic ( Dentsply Cavitron ), sleeve and tips:

Remove the cavitron tip from the unit. If possible disconnect the insert housing from the cord (NOTE: older models do not have a removable insert housing).

Rinse, dry and bag the tips in cassette with chemical indicator strip labeled with name and date. Identify with first & last name, program and tag number and hand in for sterilization.

Place the autoclavable insert (Steri-Mate) housing in an autoclave bag with chemical indicator strip labeled with date only. Seal the bag and hand into the dispensary for sterilization.

Flush all water lines into the cuspidor for 20 seconds before and after any ultrasonic procedure.

Wipe ultrasonic unit with disinfectant wipes.

ii) Air polishing ( Brassler ProphyMate) Handpiece

Note: Turn on water supply to the handpiece line prior to use. Flush all water lines over the cuspidor for 20 seconds before and after any air polishing procedure.

After client-care, flush handpiece briefly with air/water before removing from handpiece line/hose.

Turn off water supply to the handpiece line and remove handpiece. Clean out prophy powder chamber by remove plastic cap over powder chamber

and empty out any remaining prophy powder. Perform idle running of the handpiece with air alone to flush out any remaining

water and powder in the powder case. Using the air/water syringe, blow out any remaining powder in the case with air only.

Place cleaning wire through the nozzle end tip to clean tip. DO NOT PLACE IN ULTRASONIC BATH! Wipe any gross debris with a moistened paper towel. Wipe handpiece unit and

plastic powder case cover with disinfectant wipes. Place handpiece in sterilization package. Place plastic powder case cover in a

separate sterilization package and return to dispensary for sterilization.

iii) Ultrasonic (Pro-Dentec Piezo) tips, Scaler Handle and Irrigator Handle and Tip Change Kit Remove tip from handle following directions in Instruction Manual for the Unit.

Place tips and the tip change kit (including wrench and tip grip) in an autoclave bag with chemical indicator strip labeled with date only. Seal bag and place in dispensary to be sterilized.


Detach the handpiece from the cable and place into the plastic cassette. DO NOT PLACE IN ULTRASONIC BATH! Place cassette in autoclave bag with chemical indicator strip labeled with

date only. Seal bag and hand in to dispensary for autoclaving Coil cable without crimping and place in autoclave bag with chemical

indicator strip labeled with date only. Seal bag and hand into dispensary for sterilization.

Follow operating instructions regarding the liquid bottles-scaler-irrigator that are found in the operating and instructional manual kept with the unit.

Wipe unit with disinfection wipes.

iv) Light Curing UnitA disposable, protective barrier sleeve must be placed over the intra-oral light wand when the light curing unit is to be used for client care. Remove the barrier sleeve, and when unit has been allowed to cool wipe unit including the intra oral light wand with disinfection wipes.

14. RADIOGRAPHIC ASEPSIS PROCEDURESFull PPE must be worn while working with clients in the radiography clinic area (gloves, treatment gowns, masks, safety glasses). Note: Wear your dosimeter badge at all times!

Once dental radiographs have been prescribed by the dentist, please follow these recommended steps:

BEFORE TAKING THE X-RAYS:

1. Remove treatment gloves and perform a short handwash or hand sanitize.

2. Have the client rinse their mouth vigorously with pre-procedural mouth rinse for 30 seconds.

3. Leave the client in the dental chair in clinic while the student sets up the radiography unit. Once the payment form for radiographs is completed, aseptically obtain the required number of dental radiographic films from the dispensary into a clean disposable container (i.e. paper drinking cup). Record the number of dental films dispensed in the x-ray log book located in the dispensary.

4. Request any sterile equipment that you may require such as XCP instruments, Snap-a-Ray film holders. The following can be found in the radiography area: cotton rolls, a tray, tray liner and disposable paper cup. Please note that all client dental radiographs are double film packets.

5. Prepare the radiography room ensuring that all appropriate infection control barriers are in use. All radiography rooms are equipped with various Belmont/ Combex Radiography machines.

Protect all radiography equipment with clean surface barriers as indicated in the radiography area protocol booklet. (A copy of the protocol can be located on the bulletin board in the radiography area). Ensure a lead apron is available in your radiography room for your client. Place a clean


infection control barrier over the front control panel of the radiography machine ensuring all switches/buttons are covered with barrier film.

Once the radiography room is set up and ready, with your required equipment and radiographic films, seat your client in the radiography room. After the client has been seated, provide the client with a lead apron ensuring the thyroid collar and apron are securely fastened once placed on the client.

WHILE TAKING THE X-RAYS:

6. Touch as few surfaces as possible. 7. Use accepted techniques of dental radiography when exposing dental

radiographic films. Note that all client dental radiographic films are double film packets and are enclosed in an infection control barrier envelope.

8. After placing the dental film in the client’s mouth and properly positioning the PID, leave the radiography room, stay behind the lead partition or close the door (if applicable), and observe the client through the door window as you expose the

radiograph.9. Following exposure of the radiograph, with gloves on, drop the exposed dental

film in a paper cup. Be careful not to contaminate the outside of the paper cup. Repeat until theradiographic series is complete.

9. Once all the prescribed radiographs have been exposed, return your client to the clinic operatory while processing the films.

AFTER TAKING THE X-RAYS:

10. With full PPE, properly dispose of all used infection control barriers from all covered surfaces and dispose of any used disposable supplies (cotton rolls, etc.). Disinfect all uncovered surfaces that were contaminated (door knobs of the radiography room that you were using as well as the lead apron).

11. All used intra-oral radiography equipment (e.g. XCP equipment) must be completely disassembled and sterilized. This includes ultrasonic cleaning for 8-10 minutes, rinsing, packaging (include a chemical indicator strip labelled with student’s name and date, and program name) and handing in to the dispensary for sterilization.

12. Before proceeding with processing of your exposed dental films, dry any blood or excess saliva from the exposed radiographs. Open the infection barrier envelope with a steady light pull – not a strong tug. Allow the clean film packet to drop into the clean paper cup for transporting to the developing areas. USE CARE TO AVOID TOUCHING THE OUTSIDE OF THE PAPER CUP OR THE EXPOSED FILMS.

13. Remove gloves and wash hands.


FOR DEVELOPING FILM

14. With clean, ungloved hands, carry the clean paper cup to the automatic processor darkroom where the clean dental films may now be handled. Process exposed dental films, remembering that they are double film packets. Mount one set of client films and properly label the mount with client’s full name, case number and the date the films were taken. Place the second set of client films in an envelope clearly marked with the client’s name and date the films were exposed.

15. Place lead foil from the dental film packets into the ‘lead foil bins’ for proper disposal. The lead foil should not be thrown into the garbage.

16. Take care to avoid contaminating the developing equipment.

17. If you are in doubt regarding any of the procedures to be followed in the radiography clinic or unsure of how to use the equipment, please speak to a radiography faculty/staff.

EVALUATION OF RADIOGRAPHS

a) Usually takes place in one of the student’s regularly scheduled clinics.b) The client whose radiographs are being evaluated must be present in the

clinic so that they are informed of the results first-hand.c) Evaluation of radiographs must take place in conjunction with the evaluation

of the dentogram as part of the assessment phase of care.d) Radiographs must be utilized during the implementation phase of care as a

tool for optimal client care.

DUPLICATION OF RADIOGRAPHS

If a client requires duplication of radiograph(s), the student must obtain the duplicating film from the dispensary and proceed to the radiography area for processing. The instructions for duplicating radiographs are located in the processing room directly above the duplication machine.

15. DENTAL LABORATORY ASEPSIS PROCEDURES

Impressions, appliances and other items that are removed from a client’s mouth must be cleaned and disinfected before they are processed in the laboratory.

The materials and instruments used in constructing dental prostheses pose special problems in maintaining an aseptic environment. Many of these items may be damaged by exposure to heat, or chemicals that may be used for disinfection.


The use of barriers to prevent contamination of separate materials for new devices and those previously inserted in the mouth, and of unit doses of polishing materials will minimize cross contamination in the laboratory setting.

Disinfection of dental impressions and prostheses must be undertaken with caution to avoid distorting impressions and damaging the metal, porcelain or impressions. Different materials require different handling and disinfection procedures depending on the nature of the materials used.

The following may be used for disinfecting alginate impressions and sterilization of impression trays once poured up:Rinse the impression under running water immediately after removal from the client’s mouth. To remove visible bioburden, the impression may be gently scrubbed with a very soft brush and liquid detergent. Place the impression in a plastic Ziploc bag and spray thoroughly with the

appropriate disinfectant ensuring all sides are thoroughly wet. Leave the impression in contact with the disinfectant and zip the bag shut.

After the recommended manufacturer-recommended contact time remove the impression from the Ziploc bag and rinse under running water to remove any residual disinfectant. Discard bag.

After a thorough rinse, gently shake the impression within the sink basin to remove any adherent water with minimal spatter.

The impression is now ready to be poured in either plaster or stone. If an immediate pour is not possible, wrap impression in damp paper towel and place in a sealed bag.

Spatula’s utilized must go through the ultrasonic bath in a tray for 8-10 minutes, rinse, package in an sterilization pouch with a chemical indicator strip labeled with students name , program number and date, sealed and hand in to the appropriate dispensary window for sterilization.

Rubber mixing bowls are to be washed with warm water and soap, and wiped with appropriate disinfection wipes. Please ensure NO impression material is flushed into sink.

After pour up of impression, separate tray from the impression, impression material to be disposed of, and impressions trays to be cleared of any impression material. With utility gloves over clean examination gloves and appropriate PPE, impression trays are to be placed in ultrasonic bath for 8-10 minutes in a tray. Remove from ultrasonic bath and rinse well, pat dry, and place in autoclavable bags with a chemical indicator strip labeled with name and date. Seal bag and label with student name, tag number and program and hand in for sterilization.

i) Personal Protection – Barrier Control in the Laboratory

Protective eyewear, gloves and masks must be worn in the laboratory to reduce the risk of disease transmission. Gloves must not be worn when using rotary instruments in the dental laboratories. Appropriate hand washing will reduce the potential for the transmission of pathogenic microorganisms in the laboratory. Hair must be controlled.


Special precautions when handling used prostheses:Prosthesis and prosthodontic materials (ie. Occlusion rims, interm prosthesis, bite registration and non-sterilizable equipment such as face-bows ) must be cleaned with soap and water and disinfected with the appropriate disinfectant before use, if they become contaminated, and before bringing them back into the laboratory. Spraying or soaking these items in the disinfectant in a separate container, bag, or on a dental bib placed on the counter is the method of choice. Acrylic prostheses that have been worn for some time are porous; grinding of the surface may aerosolize microorganisms that have not been subjected to disinfection proceduresThese items should be handled as contaminated even after cleaning and disinfection. It is suggested that gloves be worn when grinding ‘old’ acrylic prostheses. It is also recommended that these items be redisinfected following grinding or polishing. It is not recommended that the denturist or clinician wear gloves for grinding disinfected prostheses however a disinfectant may be kept at the lathe for immediate disinfection following exposure by grinding of previously worn prostheses.

Other Precautions Appropriate hand hygiene is essential. Work gowns should be changed when necessary. Workbenches, sinks and equipment in the production area should be cleaned and

disinfected after use. Do not eat in the laboratory. Sterilize burs and stones. Instruments, attachments and materials used with new prostheses and other

appliances require cleaning and disinfection. These should be kept separate from those used on prostheses and appliances that have previously been inserted in the mouth.

Disinfect bristle brushes and rinse with water. Discard impression material and the bite registration wax from the tray. Routine cleaning and disinfection of environmental surfaces is recommended. Plastic wrap or other barriers may be used to cover pumice pans. Prostheses previously stored in a disinfectant must be thoroughly rinsed prior to

insertion. Unglazed porcelain should not be exposed to any disinfectant.

ii) Surface Disinfection

Surface disinfection is necessary when clinical work is undertaken in the laboratory. This includes the following areas with the appropriate surface disinfectant and leaving the surfaces saturated for the appropriate time. countertops face of cupboards stools gas, air controls sinks and soap dispensers mechanical vibrators


model trimmers pens, pencils, rulers, protractors when used to record client’s data

iii) Packing Laboratory Cases

Rinse and disinfect all appliances and impressions with the appropriate disinfectant for the appropriate time. Thoroughly rinse all appliances and impressions after disinfecting and place in plastic bags. Heat seal plastic bags prior to placing in laboratory containers. Discard plastic bags and packing material after each use. Disinfect the container before and after use. Disinfect all incoming and outgoing appliances.

16. CUSTODIAL PERSONNEL

Custodial personnel should wear utility gloves when handling clinic garbage.


17. WASTE DISPOSAL PROCEDURES

Waste Management General waste from dental clinic settings is considered no more infective than regular household waste. According to provincial and municipal regulations, medical waste requires special storage, handling, and disposal.

Medical waste includes: Solid waste that is saturated or soaked with blood or body fluids (e.g. gauze

saturated with blood following surgery) Surgically removed hard or soft tissue (not including extracted teeth) Contaminated sharp items (e.g., needles, scalpel blades, wires)

Treating any item that may have come in contact with blood, saliva, other bodily fluids or water, that is not likely infective, as medical waste as it is not necessary.

Non-sharp medical waste should be placed in a leak-resistant “Biohazardous” container located in the decontamination area for proper transportation and removal. Puncture-resistant “sharps containers” are found in the operatories for immediate disposal of blades, needles, syringes and unused sterile sharps.

Regular general waste may be disposed of in the regular garbage containers located throughout the clinic.

BEST MANAGEMENT PRACTICES FOR WASTES IN ONTARIO

The following four pages of diagrammatic flow charts have been developed by Environment Canada for the disposal of the following hazardous wastes. Procedures outlined in these flow charts are followed by the dental clinics here at George Brown College.

Biomedical / Pathological Wastes

Lead containing and Other Chemical Wastes

Dental Amalgam and Mercury Wastes

Silver containing Wastes


George Brown College Dental Clinics and LaboratoriesPolicy & Procedures Manual - August 2008 39 Section 1

dclppm section 1 sept 2010 final

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