About the Authors
Dr Caroline L. Pankhurst BSc, BDS, MSc, PhD, MRCPath, is a former Clinical Senior Lecturer in Oral Microbiology at the Dental Institute of King's College London and a Specialist in Oral Microbiology.

Professor Wilson A. Coulter BSc, BDS, PGCert Ed, MSc, PhD, FRCPath, is a Professor of Oral Microbiology at the University of Ulster and former Consultant/Reader in Oral Microbiology at the School of Medicine and Dentistry, Queen's University Belfast.

The authors are dentally qualified medical microbiologists with extensive experience in the field of infection control in dentistry. They have published numerous scientific studies in the field, the findings of which have been presented at conferences around the world. Both authors have served on government advisory bodies on infection control and decontamination, and teach dentists, nurses, therapists and hygienists at both pre- and post-qualification level in the UK and overseas.

Foreword viii

Preface ix

Acknowledgements x

About the companion website xi

1 Essentials of infection control 1

Why do we need infection control in dentistry? 1

Relative risk and risk perception 2

Risk assessment and the management decision]making process 3

How to perform a risk assessment in a dental practice 4

Hierarchy of risk management control 6

Infection control and the law 7

Legal acts under which dental practice is conducted 8

Published standards and guidance 12

Team approach to prevention of infection 13

2 Communicable diseases in the dental surgery 16

How infections are spread 16

Reservoirs and sources of infection 18

Infectious diseases by route of infection in dentistry 19

Infectious disease by route of transmission in the dental surgery 20

Emerging and re]emerging pathogens 28

3 Occupational health and immunization 34

Occupational health hazards 34

Building a culture of safety 35

Organizing staff health in a dental practice 37

Immunization requirements for dentistry 39

Protecting women of childbearing age 39

Occupational vaccines to protect against hepatitis and TB 43

Health checks and the consequences of blood]borne virus infection 46

Health clearance 47

Duty of care to patients 50

4 Sharp safe working in the dental surgery 53

Why sharps prevention is important 53

When do sharps injuries occur? 55

Preventable sharps injuries 56

How to avoid a sharps injury 56

Managing sharps injuries and splashes 60

Occupational health risk assessment for BBV exposure 62

Management of hepatitis C exposures 62

Postexposure prophylaxis for HIV and hepatitis B 64

Recording of sharps injuries 66

Clinical governance and accident risk assessment 66

5 Hand hygiene 68

Hands as a source of infection 68

Hands as a source of hospital]acquired infection 69

Hand hygiene and teamworking 70

Hand hygiene technique 76

Hand care and prevention of dermatitis 82

6 Personal protection for prevention of cross]infection 85

Why we wear personal protective equipment 85

The role of gloves 86

Choosing a suitable glove for the task 88

Managing an allergy to NRL gloves 88

Managing latex allergies in patients 90

Masks and when to use them 91

Protective eyewear and visors 95

Protection during cardiopulmonary resuscitation 97

Tunics and uniforms 99

Protective barriers – plastic aprons and surgical gowns 102

7 Sterilization and disinfection of dental instruments 105

Decontamination cycle 105

Why has cleaning become so important? 106

Legal requirements and technical standards for decontamination 107

Where should instrument decontamination take place? 110

Design of dedicated decontamination units 110

Purchasing of dental equipment 117

Cleaning of dental instruments 118

Disinfection of dental handpieces 121

Mechanical cleaning with an ultrasonic bath 124

Thermal washer disinfectors 126

Instrument inspection 130

Dental instrument sterilization 130

Suitability of sterilizer for different loads 130

Sterilizer installation and validation 131

Steam purity and maintenance of water reservoir chamber 132

How do you know your sterilizer is working? 133

Loading the sterilizer 138

Storage of wrapped and unwrapped instruments 138

Single]use items 142

Variant CJD and rationale for single]use items 144

Disinfection of heat]sensitive equipment and hard surfaces 144

Disinfection of dental impressions 146

8 Dental surgery design, surface decontamination and managing aerosols 148

Dental surgery design 148

Survival of microbes on surgery surfaces 153

General cleaning 154

Surface decontamination in the dental surgery 156

Management of aerosols and splatter 162

Managing large blood or body fluid spillages 164

9 Management of dental unit waterlines 167

What are biofilms? 167

Risk to staff and patient health from dental unit waterlines 168

Methods to reduce the biofilm 173

Control of legionellae in the dental practice water supply 180

10 Healthcare waste management 182

Legislation on hazardous waste disposal 182

Types of waste 184

What is hazardous waste? 185

Clinical waste segregation and classification 189

Amalgam waste and installation of amalgam separators 193

Mercury in the environment 193

Disposal and handling of hazardous waste in the surgery 195

Safe handling of clinical waste prior to disposal 197

Bulk storage of waste for collection 197

Transport of hazardous waste 198

Benefits of waste segregation 198

11 Transport and postage of diagnostic specimens, impressions and equipment for servicing and repair 201

Legal framework 201

Collecting specimens 202

Transport of specimens to the laboratory 203

Transport restrictions 204

Fixed pathological specimens 205

Transporting impressions 206

Equipment to be sent for service or repair 206

Appendix 208

Table A.1 Daily infection control clinical pathway 208

Table A.2 Decontamination methods for specific instruments and items of dental equipment 211

Table A.3 Examples of hand and hard surface disinfectants and dental unit waterline biocides 214

Index 217

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