Flu shots and immunisation for dental staff

Time for Flu shots and immunisation checks for dental staff

Get the flu shot immunisation today

It’s never too late to vaccinate/ immunisation for health

There is nothing that bonds all the dental team together better than having your flu shots at work!

Why now?
April is the ideal time to arrange your flu shots. The peak season for flu is late July August so having the flu shot now means you will build up immunity by the time the risk of catching the flu is greatest.
Flu vaccinations are one of the recommended vaccinations for healthcare workers (or anyone in contact with the public!)

Immunisation for Dental Staff

The ADA’s latest News Bulletin outlined the requirements for Dental Staff immunisation. SmartDentist subscribers have an easy way to meet staff immunisation obligations. To find out more you and your staff can do an online training course on the flu and your immunisation obligations. This will earn you CPD points as well!
Dental practices with accreditation need to fulfil staff training obligations so encourage each staff member to learn and join in the conversation about immunisation, the flu and infection control.

SmartDentist is the easy solution to fulfilling all your immunisation requirements with:

  • a practice policy that includes management of staff refusal;
  • employee and pre-employment immunisation forms;
  • an immunisation register;
  • information for staff on vaccine preventable diseases

Mandatory immunisation of healthcare workers

Queensland Health now require job applicants for dental roles to supply evidence of vaccination or evidence that they are not susceptible to prescribed vaccine preventable diseases.

Dental practices would be wise to follow the lead of Queensland health and use their pre-employment forms and their evidence criteria (all available online).
SmartDentist has pre-employment forms and recommends dental practice adopt this vaccination requirement for new staff. It helps streamline the practices obligations and reduces stress if a sharps injury occurs.

End of month -online marketing and advertising

End-of-month bookkeeping is a way of life for most of us running a dental practice. What about also having an end-of-month reconciliation of your online presence?
Save money, worry and time by checking your own online presence, marketing, advertising, and SEO free with free Google tools. Would that be too hard? No and someone on your staff would love to do this. Don’t they love playing on the internet!
SmartDentist wants to help you do this easily.
Check out our newest policy on SmartDentist
End of month: Online Marketing and advertising
With links and a checklist of your online presence, this policy helps dental practices to gather together all their online marketing details they need to ensure the practices online presence stays relevant, effective and up-to-date.
Online marketing details?
Did you know Google and Bing provide a range of free tools that are used by SEO and marketers to keep track of your online marketing. Yes – they are free!
The policy allows you to gather the details for these in the one place and gives simple lists of tasks to keep your website and social media presence working well. For each of the Google tools you simply need to register. So once you have registered to use these tools you will need somewhere to note where you store your username and password. e.g. these are your online marketing details!
If you have ever wondered or worried after being approached about your inadequate google ranking? Have you had visits from sales people wanting to help boost our Google Local Business listing?
You can pay someone to review these FREE TOOLS and report their finding back to you. You can pay someone to remind you to pay them to add a photo on your Google Local Page listing…or
use this new policy with lists and links and free tools (all together on one page) so you can actually check out what is happening in your online life. The policy also gives you lists of easy tasks to keep your online presence working for you.

Policy task example
Google MyBusiness Task:

  • Add a new photo each month to your Google Local Business listing.
    [ Do your staff all have an iPhone/android phone at work? Why not have a photo competition for your Google Local Business photo needs.]

Do you have a practice facebook page?
Then use this “End of Month” policy to remind you to “share” information into your facebook presence. Need ideas of what to share? The policy includes websites which should provide you with a new share idea each month.

Marketing and My own practice website

Two years ago Google announce that having a https site was a ranking signal

…and we all want to rank well with Google!

While the change doesn’t make that much sense for dental practice sites I decided that I would update my practice website from http to https. (Read about Google search and https)
For localdentist websites, my site is the “crash-test-dummy”.
Along with making my site into a https site I have made “under the boot” SEO changes.
Below are the changes I have just recently made to my site.

  1. https – This is a cost change because of the need to purchase an SSL certificate. This is a yearly extra cost.
  2. Structured data added. See the lowest part of my website with details such as open hours etc. This has been setup with special data coding. Google recommends this coding and may utilise it in page rankings someday. Read more… You wont see the extent of these changes unless you used the developer tools on your web browser and look at the source code of the page.
  3. Facebook share and follow links – allowing practices to easily “share” the monthly website updates into their other social media such as Facebook.
    Recent pages have a facebook share friendly image for excellent presentation.
  4. Increased Search engine friendly links to the extensive range of Localdentist pages. Practices can now just let me know if they want individual pages removed or replaced with their own content.

If you have a “localdentist” websites then these changes will be integrated into your site over time(except https). If you would like to change your site to https like mine please contact me.
For subscribers who do their own website or have a wordpress site I am happy to help or provide training.
SmartDentist users – happy to help with your end of month marketing updates!

Online presence

Facts and Myths Infection Control

infection control myths and facts

Facts and Myths of infection control (heard or read in 2016)

  1. Via “tracking” you can demonstrate a patient hasn’t got an infection from your practice (controlling infection control!)
  2. An ultrasonic is needed even if you have a washer-disinfector.
  3. It’s quicker to ask the ADA than seek the answer yourself.
  4. No-one has ever got an infection from a dental practice.
  5. Ever Sterilisation cycle needs a PCD (Helix or Bowie Dick)
  6. An ICMP (infection control management plan) replaces your sterilisation manual.

Let’s look at the statements –
1. Tracking instruments
Tracking is required to keep dentists and their staff “on the ball”. Tracking tries to demonstrate that a particular pack of instruments has been through a particular steriliser cycle. BUT unless your tracking system takes a picture of the pack with the steriliser tape color changed you aren’t even really demonstrating the pack went through a cycle!
Most systems only tell you that you know the number of a cycle that has been completed.

However that doesn’t mean I disagree with tracking. We track all our instruments because I think it is good idea. However personally I would be cautious about investing a lot of money into a scanning tracker system at this stage because I think they will improve in the future. I imagine a time when the scanner picks up the changes in the packaging that occur with sterilisation rather than just reading a bar code that remains unchanged in the steriliser.

Of course sterilisation is a theoretical practice. When we sterilise we do so with an assurance that the possiblity instruments have one viable bacteria on them is one item in one million. However we know that if instruments are not cleaned properly then this figure is incorrect and people have been infected via instruments that have been through sterilisers (not dental instruments) at correct time, temperature and pressure.
If stats were taken literally:
21,000 dentists in Australia  X 48 sterilisation cycles = 1 million cycles
So does that mean that you never want to be the 49th patient a dentist sees because you are likely to have THE VIABLE micro-organism!
Nahhh… but it isn’t that simple.

Track all your instruments for convenience because simple systems are the quickest and the best.

2. Ultrasonic Cleaners
Ultrasonic cleaners were basically introduced for staff occupational health and safety (safe non-scrubbing). They are designed to reduce operator error in instrument cleaning. However in dentistry we all know that unless you remove composite and cements from instruments immediately chairside then an ultrasonic cleaner nor a washer-disinfector are not going to work.
Washer-disinfectors are used similarly to ultrasonics in dental practices so generally if you use one then you dont need the other. You should speak to other dentists who use washer-disinfectors or ultrasonics when you are looking to buy a new one. Some washer-disinfectors have an ultrasonic mechanism built in.

Testing ultrasonic cleaners each morning is for the benefit of the practice. It is of no use placing instruments into an ultrasonic cleaner that is not working!!!
Also remember that research has shown if you place instruments into dirty ultrasonic cleaning liquid they will be dirtier than when you put them in.

3. ADA versus Google
It’s always nice to speak to a person at the ADA but for many issues it is quicker googling and asking the source. Examples: Fair Work – look up the staff award and read it yourself. You are supposed to have an award accessible for the staff anyway; Long Service leave – this is a state based function and Victoria has a really helpful help line.
The ADA committee members have a wealth of knowledge but you need to allow time to get onto the correct person.
Other options of information:
Generally some of the facebook groups for dentistry are interesting for different opinions and you can often get a quick response as dentists play online. The ADA Inc site has helpful HR resources but check that they are current and applies to your own state.

Remember the ADA in Australia is a professional group of dentists and have no power to set “rules”. Even the ADA infection control guidelines can be seen as an “interpretation” of AS 4815 and the NHMRC guidelines. The Dental Board resources should be looked at first for clinical advice. The Oral Therapeutic Guidelines are also important for conventional requirements. The ADA has representatives on the Therapeutic Guidelines Committees and on Standards Australia committees.
For SmartDentist subscribers check out your “Clinical Guidelines” [Resources > Clinical Guidelines] first as this is a group of documents to help you make effective clinical decisions.

4. No-one has ever got an infection from a dental practice (other than the contriversial HIV dentist)
This is not correct. There have been documented cases of infection transfer.
The recent 4 cases of Infection control breaches in 4  NSW practices has had a review and they know 26 people from the practices have now newly discovered they have BBV.
http://www.health.nsw.gov.au/Infectious/reports/Documents/dental-investigation-report-2016.pdf
Check out this most recent review on dental transmission.
https://www.cdc.gov/oralhealth/infectioncontrol/pdf/pathogentransmission.pdf

5. Every sterilisation cycle needs a PCD
Helix or Bowie Dick devices are required at the start of each day for an empty steriliser. They aim to “challenge” a Process – hence the name Process Challenge Devices. The process they “challenge” is the ability of the steriliser to remove all air from the steriliser so it can fill up totally with steam. You can use a specific device made to test this in your normal cycles but these tend to be slightly different in nature. While this is heavily promoted by a particular supplier of these consumables (yes, they sell them) the evidence for their use has not been declared manditory by AS 4815.
The requirement by Australian Standards is to have the device used at the start of the day.

6. An ICMP (infection control management plan) replaces your sterilisation manual.
No your sterilisation policy manual is only part of the infection control management plan. The idea of a “management plan” is that you:

  1. Work out what you need to manage.e.g. what are your infection control risks? Name and sham each one of them. Use a Risk analysis tool to document the risks and have them in your risk register so you can review them at a later date.
  2. Document how you are managing these infection control risks. e.g. this is via your policies and procedures so this is where your infection control manual fits in. You cant just use the ADA guidelines as that document isn’t a procedure manual and says in some parts…”you can do this….or you can do that”.
  3. Plan staff training so everyone is part of implementing your plan

SmartDentist subscribers have an online Infection control management plan – easy!

Sterilizer records for dental practice

[or how to put your old Mobile phone to good use]

Login to SmartDentist and check out the “Steriliser Documents and Monitoring Policy”, or if you aren’t part of SmartDentist look at the ADA guidelines for Infection Control P28 (and P20).

How do you improve the efficiency of your document storage and collection?

  1. Establish a routine. Doing the same thing for every instrument is most efficient although it isn’t required. If staff don’t need to work out separate processes for different instruments the time saving is immense.
  2. Use an old Mobile Phone. Are you collecting paper copies of sterilisation documents? If you are then use an old mobile phone to take photos of printout and your sterilisation log sheets and download these when the phone gets full. You can leave the phone with its charger in the steri room. The additional benefit is that the photo’s taken with the phone will be dated (make sure it is always charged so the date is correct)
  3. Sterilisation log book -(our practice has a sterilisation log page). All tests are recorded within the one sheet. Our packs are labeled with a date and cycle self-inking stamp; and so it out sterilisation log page. The sterilisation log page can be scanned onto the computer (make sure it is located somewhere so it is saved for 7 years e.g. into patient computer software is ideal) for storage or a photo can be taken and the image stored.

See SmartDentist’s Reference and document links page to download a sample Sterilisation log page as this might help you with your own system.
SmartDentist also has a “What tests do I need for my steriliser?” aid. See RESOURCES.

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.]

Who sets the rules for dental infection control? [WEEK 1]

Who sets the rules for dental infection control? [Week 1]football-referee-with-hand-gestures_318-42804.png

Many dentists and staff get quite confused about the rules for infection control.
The Dental Board is the government regulator of dentistry and they say that dental practices should use 3 documents to guide their infection control procedures.

The documents are:

  1. The Australian Standard for reprocessing instruments (e.g how you clean and sterilize instruments) . Unless you are a hospital you will use AS 4815. An alternative standarad is a new version of AS 4187. This is a very very hard standard to meet so just ignore it for now. SmartDentist subscribers have access to AS 4185  via their login. It is 97 pages long and was finished in 2006.
  2. Australian Guidelines for the Prevention and Control of Infection in Healthcare published by the National Health and Medical Research Council (NHMRC). This document is available online and was finished in 2010 and is 262 pages long.
  3. ADA guidelines for infection control. This has just been revised and is about 50 pages long.

So why have 3 documents, and why don’t they just tell us what to do?

  • Each document is different. Yes, sometimes they can be interpreted to be in conflict or at least not clear about requirements.
  • The easiest document to read and understand is the ADA guidelines.
    ABOUT THE ADA GUIDELINES: Because the ADA is an organisation of dentists it is easy to understand that a government regulator would not be happy in just letting dentists decide on their own standards. Similarly the ADA looked at the other 2 documents which have wide ranging membership and tried to be practical and sensible in what it says dentists should do and use out of those other documents.
  • These documents are the source to go to if you are in dispute about what should be done in your practice.
  • You DON’T really want people to tell you exactly what to do because they don’t work in your building, with your equipment, with your staff or know exactly how your workplace functions. For example; in a big hospital do you need a first-aid kit when staff have access to emergency hospital care; do you need a designated spill kit for large spills of blood in a suburban dental clinic.
  • *When a sales person say…the ADA now requires you to ‘x’ then ask them to show you in the ADA guidelines before you buy their sales item. The ADA is not the government or controling body of dentists. They are a voluntary organisation.

Order of priority (by me)

  1. ADA guidelines: if that still does not solve your dilemma then –
  2. NHMRC guidelines for an overview of concepts and information apon which to base a decision.
  3. AS 4815 on technical requirements for sterilising and record keeping – just remember that it is nearly 20 years old and some things weren’t even invented e.g. USB sticks instead of printers.

NOTE: For those that play tennis, have a hit of golf or drive –

  1. Rules of Tennis – 30 pages
  2. Rules of Golf – 208 pages
  3. Road Rules NSW – 188 pages

 

Dental Practice Accreditation – what’s new

Even if you are not doing Dental Practice Accreditation you may like to hear about what is happening.

  1. I haven’t heard that Dental Practice Accreditation is about to become compulsory for private practitioners. This is despite some CPD courses advertising using fear and innuendo about “impeding compulsory accreditation” as a marketing suggestion. (Which is great for SmartDentist!)
  2. New fees have been released for dentists undertaking the next round of dental re-accreditation. Yes it is higher. Also on offer is a 3 hour practice inspections for an extra $1500. Technically the accreditation surveys can look and question you on any of the 108 required actions.
    If you are looking at the most cost-effective you would take the 4 year option with a 30 minute phone interview. (That makes it $379.50 per year for the accreditation logo!)
  3. Slight variations in accreditation requirements with changes from the governing body, ACSQHC. e.g. traceability and the need to monitor staff use of clinical guidelines.
    With respect to the specifics of QIP acceditation you need to supply your steriliser validation certificates which all practices should get each year. Also staff (Dental Assistants) Education and Training Register. Yes, SmartDentist has had staff training and a register for years! With SmartDentist you can even add in your own competency training for staff and set up a whole staff training calendar.
  4. For those using the ADA Policy templates the policies have been slightly modified. Instead of 10 policies they have changed the number to 6 but the missing policies are just included under the Governance policy heading. I think it will be more sensible at present to leave the policies separate. Especially in light of No.6 below but you can do either in SmartDentist.
    You might notice that the ADA/QIP has taken on-board the SmartDentist idea of a compliments and complaints register.  You will also find that the Hand Hygiene Audit has been modified so it is similar the SmartDentist original hand hygiene audit (more sensible).
    Be conscious of the wording in the ADA templated policies. Instead of using the ADA wording “ensuring our staff do …” I think that dentists might decide more sensible and safer wording would be “take steps to ensure our staff do …”.
  5. Only one ADA member needs to work at a practice for it to use the ADA templates and accreditation model. e.g. the owner doesn’t need to be an ADA member.
  6. In 2017 the Standards against which dentists will be accredited will change. If practices are using Smartdentist the change should be as seemless as possible because we will “map” the old accreditation actions to the new Standards for you!
    The new standards will lead to changes in accreditation requirements. Stay tuned.

Add any instagram photo to any text field in SmartDentist

Instagram photos into SmartDentist

So excited to find that you can actually add instagram photos into any SmartDentist editable area.!!
Take lots of pictures and be really SMART!

Just an easy cut and paste of the embed code from instagram. In the image shown I have added some text to explain the photo and then the embed code was added so we have a great pictorial version of information.
We are going to have a new staff member soon so the staff team are taking lots of photos to help them train and learn.

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!