Newsletter: March 2017

Infection prevention and control In recent months, the Dental Council has been made aware of three separate cases relating to breaches of infection prevention and control standards at dental practices.

Infection prevention and control

In recent months, the Dental Council has been made aware of three separate cases relating to breaches of infection prevention and control standards at dental practices. Two have received media attention due to the potential risk to public safety. These cases highlight for us the importance of following the Council's infection prevention and control practice standard; and the responsibilities and obligations that practitioners have in relation to this area.

These cases follow a recent review of this practice standard, which the Council updated following consultation, in March last year. We encourage all oral health practitioners to take this opportunity to review their processes with reference to the infection prevention and control practice standard.

Compliance with this standard is fundamental to delivering safe care and the Council takes any breach of this standard seriously. The recent breaches put patient safety at risk, and jeopardise the public's trust in the profession and standard of oral health care in New Zealand.

Infection prevention and control is often a shared responsibility within a dental practice, sometimes involving non-registered staff members. It is fundamental that all dental staff are fully aware of and comply with the requirements of the practice standard to ensure effective and safe infection prevention and control. However, the practitioner is ultimately responsible for the infection prevention and control associated with his or her practice, and has an ethical responsibility to address identified issues with other practice staff members and/or management. 

Practices with one person responsible for reprocessing instruments (solo practitioners with one dental assistant or large practices with a dedicated sterilising staff member) may have less risk of a breach of protocols than practices that have a number of staff members involved in reprocessing instruments. Checklists, independent verification or random spot-checks by the practitioner, and notices on the reprocessing equipment indicating the current status of a particular load can be helpful.

If there is a breach of standards a prompt and professional response is essential. There needs to be a risk assessment of the nature of the specific breach, and it would be prudent to seek advice from your local Medical Officer of Health or local infectious disease specialist, if available – especially if it involves critical items. Batch control identification (tracking) of critical items is also important, to ensure that patients that could have been exposed to potentially infected items can be accurately identified and contacted. All affected patients may need to be advised of the need for initial and follow-up testing, as appropriate.

The installation and regular maintenance of equipment must be carried out by qualified technicians. Anti-retraction valves need to be fitted and the appropriate flushing (for about 30 seconds) of air and water lines between patients, and at the start and end of the day, is necessary.

As always, good, clear communication with patients is critical. When communicating with patients following a breach, practitioners are reminded:

• It is vital to demonstrate empathy. Recognise this will be unknown territory for most patients and has potential to cause real concern and upset. Acknowledge the issue.
• Prepare clear messages, based on your expert advice obtained, about initial testing and follow-up testing.
• Different patients will have different comfort levels and information requirements. Where possible, provide patients with phone numbers or other avenues for more information should they require it.
• Be prompt, responsive and transparent in your communication with affected patients or their parents/carers.

In light of the recent infection prevention and control breaches, we urge all oral health practitioners to re-familiarise yourself with your practice's infection prevention and control procedures. Have team discussions to ensure everyone is fully aware of their responsibilities and roles, and ensure that the practices within your environment, and your delivery of care comply with the Council's practice standard, to protect the safety of the public.