Infection control of hands [Week 3]

IMG_1757The ADA guidelines say you need in your infection control manual…

Information and specifications in the manual must include:
• methods of hand hygiene (both routine and surgical);

SmartDentist subscribers: Go now and delete you old hand hygiene policy and go to the Common Policy Library and select the latest Hand hygiene Policy. It will come with links to

  1. Hand Hygiene Australia ;
  2. My favourite youtube video on Hand Hygiene;
  3.  WHO: Hand wash and Hand rub poster;
  4. Donning surgical gloves (Ansell site)
  5. Latex allergy help site.

TASK for this week
Download the Hand hygiene poster; save it to a UBS; go to Office Works and get a copy printed for each wash sink (0.88 cents per copy) and laminate it (1.75 per copy).
Get some blue tack and put them up at work!
(See picture above: I really do do what I say. Here is a selfie of me with the 5 posters – one for each surgery and one for the steri-room)

 

 

Let’s follow the ADA [WEEK 2]

Let’s follow the ADA [WEEK 2*]Screen Shot 2016-02-05 at 4.16.03 pm

The Dental Board says you MUST have your own infection control manual.
So what does that look like? Guess what. There isn’t ‘one’ answer to that question.
But we are going to follow the ADA guidelines with our OWN manual.
To save you checking what the ADA guidelines says you need to include in an infection control manual I have copied the text from P31. (see below)

This week’s 5 minute infection control task* is to login to SmartDentist.com.au and go to POLICIES and find the link to the Common Policy Template Library. You will find a list with all our infection control policies. There are 16 in my list so make sure each one of these policies is ADDED to your policy list. This is very quick and I don’t expect you to read them at this time – just make sure you have added them in preparation for our future blog articles.
If you don’t subscribe to SmartDentist you could audit your policies against this list or alternatively start a Word Doc with the list so you can begin to create your own infection control manual.

(From P31 of ADA guidelines for infection Control 2015-
Information and specifications in the manual must include:
• methods of hand hygiene (both routine and surgical);
• personal protective equipment requirements;
• setting up the treatment area between patients;
• environmental cleaning protocol;
• defined zones that require barrier protection and cleaning between patients;
• protocol following an exposure incident, e.g. a sharps injury;
• handling and disposal of sharps;
• waste disposal;
• processing of reusable items (cleaning, packaging, sterilisation, disinfection, storage);
• processing of radiographs in a manner to avoid cross-contamination;
• quality control mechanisms including documentation for the maintenance and monitoring of equipment;
• immunisation requirements;
• single-use items;
• recording of information during patient treatment in a manner to avoid cross-contamination;
• use of computers and computer-run equipment during patient treatment in a manner to avoid cross-contamination;
• management of waterlines used in direct patient contact; and
• handling latex allergy in dental patients and dental staff.
Practice infection control manuals must be regularly updated if and when new guidelines are produced by the Dental Board, the ADA or the NHMRC.)

[* Each week we will be looking at infection control compliance – just for 5 minute.]

Closer scrutiny -infection control in dental practices

“But no-one  else I know is…”

The most common complaint I have heard from dental practitioners, who have been “required” to make changes to their infection control practices, is that no-one else is actually doing what they are now required to do.
Of course this isn’t true but we do all have a universal wish to be treated fairly and to conform to the ‘norms’ of our peers.

The Dental Board of Australia (the Dental Board) should be commended for holding a forum of infection control stakeholders in late 2015.

The DBA got together with the ADA, consumer reps, the State regulators of dentists and representatives of the Australian Commission on Safetyand Quality in Health Care.
With the numerous cases of infection control breaches in NSW that have resulted in massive patient notifications about the risk of acquired infections, it isn’t a surprise that government bodies and regulators are really keen to have conformity and a universal standard of excellence for dental practices in infection control.

It will be interesting to see if the DBA chooses to include accreditation as a formal requirement for Dental Practices in the future.

Traceability and unnecessary confusion from ADA Inc

On 1st Oct 2015 the new ADA Guidelines for Infection Control were released and include the statement that “the ADA does not support traceability”.
However the ADA supported dental practice accreditation program was changed on the 8th Sept 2015 so that a ‘traceability’ system is now a compulsory requirement of dental practice accreditation.

Wow, are you a bit confused? And if you are a dentist or dental practice manager you are not the only one confused.

Has the ADA decided to drop dental practice accreditation?
I don’t believe so.

The confusion has occured because the ADA ICC has decided to define traceability as a protocol whereas other organisations such as Standards Australia AS 4815 (Office -based reprocessing…) or Standards Australia 4187 define it less prescriptively. The ACSQHC which governs dental practice accreditation requires traceability but they also say that this is a term that will vary depending on your healthcare context.

The ADA Guidelines for Infection Control 2015 state “BCI (Batch Control Identification) is clearly designated as a mandatory requirement in AS/NZS 4815 and AS/NZS 4187.” However AS/NZS 4187 doesn’t appear to mention BCI or Batch Control Identification. AS/NZS 4187 appears to call these same actions as  ‘traceability’.

The definition of traceability shows how strongly ADA ICC feel for their current definition of traceablity as a protocol. In the 19 years I served as a member of this Committee they were consistent with their current definition.

However as no-one else uses the term the same way perhaps the ADA could have made things less confusing for dentists if they had explained the differences (e.g. Standards Australia and the ACSQHC) and used the same terms the same way!

SmartDentist has a new CPD exercise for staff and dental practitioners on Traceability and the Dental Practice requirements. In this CPD exercise I tell you what we do in our own general dental practices so it may give you ideas for stream-lining a simple manageable system. I would like others to let me know clever ways they manage this requirement.

SmartDentist now also has a new templated Traceability Policy for practices that want to set out all the connecting parts of their traceability system clearly.

PS. I think the new ADA Guidelines for Infection Control are a great improvement in clarity and readability in most aspects.

Dental Board Self-Audit tool Infection Control

Dental Board of Australia has released a self-audit to help dental practitioners determine if they are meeting their infection control obligations.

While to self-audit tool isn’t totally comprehensive and they do say you may want to “delete items as appropriate to your workplace” it is a helpful reminder and check to see if you are “on track”.

SmartDentist has added the DBA word doc to our list of audits & we have filled it in with the SmartDentist resources that will help practitioners conform to requirements.

To use SmartDentist for audit recording and reminders just

  1. Go to Maintenance > Audit Schedules > Add an Audit schedule
  2. Select the Dental Board Audit and write in details about where you wish to store the results once you have completed the audit.(We will scan the results into a folder called Audits in our Oasis Practice Correspondence area)
  3. Select a start date and how frequently you wish to do it. (I picked once a year)

And you are set to go!
Luckly SmartDentist clients have policies and access to the compulsory documents so the audit will be easy.

Check out how SmartDentist helps with the self-audit here!

Teeth extraction and warfarin – receipes for caution

Feb 2015 – Coroner reports a dentist to the Dental Board of Australia following an inquest into the death of a female patient.

The death of anyone is the worst nightmare for any health care practitioner. And to be implicated in the cause of death is quite tragic.
This case was one where the female patient was on warfarin and died of blood loss two days after teeth had been extracted.

The dentist was criticised by the coroner for a number of things:

  1. No written note of the INR
  2. Not following the therapeutic guidelines on managing a patient who is on warfarin with minor oral surgery.

One of the thought provoking inferences was that the dentist should have been using tranexamic acid mouthwashes with this patient.

Tranexamic acid mouthwashes – these are not available but you can mix an equivalent with dissolvable tablets. The patient will need to buy 100 tablets and use 9 of these over the course of 2 days. If the dentist purchases and sensibly redistributes these the labeling and control of these tablets could turn out to be a nightmare. Also just writting the original script needs lots of consideration as these tablets are NOT to be taken orally for people who have had blood clots in many parts of their body.(Many patients on warfarin fit into this category)

Decisions, decisions.
I can’t imagine the families distress at losing their mother with a preventable incident.

I would like to fully incorporate all the learning from this tragedy into improving safety and quality in my practice. The big question is how to best manage the use of tranexamic acid, without causing another problem to someone else!

Infection control: Revision of AS/NZS 4187

Dental practices with a concern about infection control should be aware that AS 4187 is being revised.

AS 4187 covers processing of Medical and Surgical instruments and is relevant to dental practices, although most of us use the more friendly AS 4815 for office base health care.

It is quite possible that AS 4815 will be dropped leaving dental practice to negotiate the difficulties in this hospital standard. I sympathise with the Royal Melbourne Dental Hospital where I act as a clinical supervisor.

Some of the more difficult aspect of AS 4187 will be:

  1. Validating cleaning of instruments in an objective manner rather than visual inspection (which could be objective!)
  2. Water quality testing
  3. Tracability of individual instruments to individual patients. This may mean each instrument is recorded in the patients records. That may mean over 500 instrument recordings per dentist per day.
  4. Validating and performance qualification  of wrapping, sealing and containment of instruments
  5. Collecting and documenting of all manufacturers reprocessing instructions and validating against practices procedures.

The reality is that dental practices have led the way in sterilisation of instruments and our practices are immensely safe (so safe that it is difficult to find any evidence based measures for improvements). This is because we are intimitely involved in our sterilisation processes – we do it ourselves. We talk to and know and work with the people who sterilise our instruments. Hospitals and doctors have removed themselves from these ‘grass roots’ processes so they require massive documentation to try and gain control over this critical part of your medical treatment.

Difficult decisions need to be made for this draft document.
Context is everything so hopefully the finished product will be one that allows for safety with common sense. The committee are doing a great job with a complex task!

Get your own privacy policy online – ADAVB!

It is Privacy Awareness week 2014 and it is great that the ADAVB has taken onboard correction of some of the major problems that SmartDentist pointed out within the ADAVB Privacy manual for dental practices.

Yes, if you were using the ADAVB privacy policy it is really important you change some of the wording or you might really be in trouble!

We would be expecting that the ADAVB should have its own privacy policy online this week (in line with its own recommendations for dentists!) and it should offer an opt-out for all members who are tired of junk mail generated from the ADAVB’s mailing list. (No, we don’t need another American Express credit card!)  We are pleased to see the ADA Inc has taken on a long standing suggestion from SmartDentist that they needed a formal complaints mechanism and I am sure the ADAVB will also make their complaints mechanism more transparent…which is the theme of this years PRIVACY AWARENESS WEEK!

On the wish list: Can we get the ADAVB website to have dates in Australian format instead of the USA “month/day/year” format? And the removal of the term ‘zip’ code as I think every state in Australia has a ‘postcode’.