impact of the ccp on dental practice

Educational Solutions for Workforce Development

Dentistry

Impact of the CCP on Dental Practice

Christine Young

Infection Control Nurse Adviser, NES


Dentistry

We’re Dentists – We’re different…………


DentistryDentistry – Risk assessment?

• Blood and Spit• Aerosol• Sharp things• Complex instruments• Lots of treatment episodes • EPP


Dentistry


Dentistry

Drivers <2007

Published guidance <2005

<>2001

2004

2005

2005

Review of Sterile Services

Review of Acute Sector

Publication of Glennie Framework

SHTMs 2010, 2030, 2031…….

Top Ten Tips (CDO)

LDU Guidance (PCSG)

LDU Guidance (HPS) version 1.2 2007

Survey of dental instruments

2004 Identified major shortcomings in IC/Deco:• Management • Facilities & Equipment• Staff Training• Re-use of single use items• Recording• Dissemination of information

GDC 2007 Core subject:

Disinfection and decontamination


Dentistry

Research questions:

• Does the CCP DS2 have a positive impact on infection control practice?

• Do Cleanliness Champions influence the infection control practices of others?

• What barriers or attributes affect the implementation of change?

Impact of the CCP on Dental Practice


Dentistry

Dental Health Services in Scotland

Private Practice


Dentistry

Results

97% Dental Nurses


DentistryImpact of CCP on Own Practice

Substantial Improvement

SlightImprovement

No change

Deterioration N/A

Awareness 50% 38.2% 11.8% 0 0

Hand Hygiene 50% 35.3% 14.7% 0 0

Environment/equipment 26.5% 26.5% 44.1% 0 2.9%

Sharing good practice 23.5% 47.1% 23.5% 0 2.9%

Relationship with colleagues

8.8% 8.8% 82.4% 0 0

Challenge poor practice 23.5% 41.2% 29.4% 0 2.9%

Evaluation of practice 29.4% 29.4% 38.2% 0 0


DentistryImpact of CCP on Other’s Practice

Substantial Improvement

SlightImprovement

No change

Deterioration N/A

Awareness 29.4% 32.4% 32.4% 0 5.9%

Hand Hygiene 32.4% 32.4% 32.4% 0 5.9%

Environment/equipment 17.6% 29.4% 47.1% 0 5.9%

Sharing good practice 26.5% 26.5% 32.4% 0 8.8%


17.6% 11.8% 64.7% 0 5.9%

Challenge poor practice 32.4% 17.6% 44.1% 0 5.9%

Evaluation of practice 26.5% 17.6% 50% 0 5.9%


Dentistry

Impact on Own and Other’s PracticeAwareness ‘I am even more aware of the importance of breaking the chain’

‘More people take notice of what you are doing and are more aware’

Hand Hygiene ‘Handwashing more frequently & use correct technique’‘Encouraged colleagues to dry hands, take time to use technique when performing HH’‘…I implemented getting regulators on all the hot taps… so there was no excuse for not washing your hands with the soap and water.’

Environment / Equipment

Responses focused on elements of SICPs such as PPE, safer sharps disposal, instrument decontamination and the environment:‘The dental nurses used to always discard the sharps needle things. We changed the whole routine of that as well. Now the dentist does that. He removes the needles. He removes the scalpels. They have a sharps bin at their side of the surgery’‘Staff aware of checking equipment is clean & using all their PPE’

Sharing good practice

‘I feel I can now confidently act as a good role model due to the course’‘I try to help others – they don’t always listen!’


‘We are introducing staff meetings to talk over improvements on a regular basis’‘Everyone is more confident in their daily duties and help each other out more’‘It’s still a them and us between dentists and nurses’

Challenge poor practice

‘I feel I have the knowledge now to challenge colleagues’‘Given me more confidence as I am more aware of correct technique’‘Everyone is good at saying if someone is doing something wrong’

Evaluation of practice

‘Know how to carry out audits correctly and implement changes’‘We all monitor cleanliness, audits are done’


Dentistry

Perceived practice to be to a high standard already:•‘Practice was at a high standard so feel the course helped improve this slightly’ • ‘We had very good policies that we had implemented before I did the programme’

Specific changes in practice:•‘Pts now notice how many times we are cleaning our hands & comment on it.’•‘As far as the surgery went, the layout of it I changed a few things like sharps bins, etc they were situated at ground level where children could possibly come into contact with them.’

Impact of CCP on clinical care

0 0

4 (12%)

16 (47%)

14 (41%)

0

2

4

6

8

10

12

14

16

18

Substantialimprovement

Slightimprovement

No change Deterioration Unable to say/notapplicable

Num

ber

‘


Dentistry

EnablersTeamwork/Team Support

‘Working with dentists about key issues’‘Good team and support from work members’‘Encouragement from peers’

Mentor Support ‘The mentors are lovely, very helpful. Gave me good feedback.’

Self motivation ‘My own keenness to see the practice move forward’‘Determination’

PC access ‘We got to use the computer in the office.’

Time (study and good ic practice)

‘Allocated time to do course work’‘....did get some time. I tended to do it between patients because we are so busy.’

CCP itself •Programme activities (online and workplace)•Audits•Theory components•Translation of theory into practice•Structure of the programme •Flexible learning

‘Good understanding of the CC role, having the correct info and procedures and facilities to successfully carry out the CC role in the work place’


Dentistry

Barriers

Lack of Team / Colleague Support

‘Initial resistance from staff’‘Apathy of some staff’‘Probably trying to change my boss’s ways of working. That was the hardest thing because he paid the bills. ‘The practice I work in, we’re all quite happy with how things run at the moment so if you are trying to change something they are not too keen on listening….’

Lack of Time ‘Time – v.busy practice’‘Time to show members of staff correct procedures’

Lack of PC Access ‘I did all the work at home and didn’t use the PC at work’

Surgery issues ‘Practice rules’‘Short staffing issues’


Dentistry

Job Role

Positive impact:

• additional training responsibility

• became a practice resource

Short term impact:

• an initial change before the status quo was resumed

No impact:

• ‘Had hoped for an increase in responsibility but that didn’t happen. I don’t know what else I have to do to try and prove myself to get any more responsibility. Very frustrating…’

• ‘I thought I might have a bigger role and more confidence in me with the hassle of me going into this….’


Dentistry

Cleanliness and order are not matters of instinct; they are matters of education and like most great things, you must cultivate a taste for them

Benjamin Disraeli


Dentistry

The clean person is not the one that runs away from dirt but one who takes the time and effort to tidy-up a dirty environment

Adbulkabir Olatunji

impact of the ccp on dental practice

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