Cleaning after treatment - Practical infection prevention at the chair
Cleaning after treatment
This section discusses the 'chair-related' aftercare.
The misting of alcohol is not allowed, because of the health risk that is caused by the inhalation of this disinfectant.
Using a spray bottle filled with alcohol to impregnate an instrument tissue and use it for surface disinfection of the unit is (still) permitted.
Always wear gloves when disinfecting with alcohol to prevent cross-contamination and (especially!) The occupational absorption of alcohol through the skin can lead to health damage.
- Make sure that the jar with disinfectant wipes or disinfection vials is always handled with a clean (disinfected) hand (shoe).
- Perform complex operations with a good routine.
- Consider a two-meter splash zone and disinfect all materials and equipment within this area.
- Do not allow the cleaning routine to be disturbed by distractions and conversations.
All unused sterile instruments that have been placed on the (clean) worktop in unopened packaging (to be on hand) must never be returned to the drawer or cupboard from which they came!
These unused instruments must always be repacked in the sterilization room (in laminate bags) and sterilized! The sterile packaged instruments must be provided with a date. This date is six months after the packaging date. Thus, if the instrument is packaged on 17 December 2017, the expiry date is 17 June 2018, provided that a closed box is used as an extra protective device in a closed cabinet.
Immediately after the treatment, when the patient chair is in the exit position, the worktop can already be cleaned up.
Sometimes the assistant can perform this work if the therapist is finishing a restoration without spray cooling.
Dirty zone on the worktop
- Move the used spatula, the mixing block (use 1 sheet of a mixing block), glass slide, composite gun (!), Cofferdam and possibly other pliers, endo instruments, glass slides (or use a disposable drip tray) and the like from the dirty worktop to the treatment tray. to drain to the sterilization room.
- Discard disposables (with dirty gloves) also the hygiene covers of the various hoses such as the suction hoses, the curing lamp and other instruments.
- Turn the tips of the etching gel and other syringes that have been used and throw them into the needle container.
- Apply adequate glove hygiene.
- Take the vial of (foam) disinfectant and / or make sure you have a towel that is thoroughly wet from the disinfectant. This can also be a paper towel on which spray-free 80% alcohol is sprayed. No tissue or napkin, which breaks too quickly!
- Spread disinfectant as a foam on the materials to be disinfected on the dirty workfield.
This may consist of at most some (unused) composite compu- ses, etch- or flowable composite syringes. If it was not possible, for example, to keep bonding bottles clean, then of course also.
Processing after the treatment of materials on the worktop
- Clean all contaminated materials and packaging one by one with a well-moistened disinfectant wipe and place them on the clean area of the worktop.
- Observe the exposure time of the disinfectant used.
- Well after that, everything in the relevant drawers or cupboards.
- Dispose of the small waste.
- Finally disinfect the empty cleaned worktop.
Please note: Reconditioning (reuse) of newly formed composite compules is not permitted on the basis of the instructions in the guideline (category B, minimum thermodisinfection!).
According to the manufacturer, the tips are also not suitable for reuse for material technical reasons. Due to the pressure applied to the material during spraying, the material can be separated very slowly.
In order to prevent unnecessary loss of the expensive composite, use can be made of self-filling composite tips with more or less filling, respectively for large or small restorations. Some self-filling tips also have the advantage that they have a slimmer tip, with which deep places of the preparation can be better achieved.
A Composite hygiene: a new package for each patient. B Completely filling compules with different shape of the outflow opening
Small waste can be processed to the chair as follows:
- Collect the packaging of pre-dosed materials and used disposable brushes / brushes on the traypaper of the dirty work field.
- Fold the traypaper closed and take the molded plug into your hand. This can also be done with the patient napkin.
- Work the gag in the glove by striking the glove back over the gag.
- Take the glove with an enclosed plug in the other hand (shoe) and repeat the previous action.
- Throw the enclosed gag in the double gloves into a hands-free trash can.
Small waste is processed into one plug in the examination gloves
Treatment tray, chair and unit
- Recapping the needle from the anesthetic syringe is prohibited. The needle should be removed using the opening of the special safe needle container, in such a way that the hand does not come into contact with the needle used. There are also devices on the market where the needle is electrically removed. Preferably use disposable scalpel blades. Remove scalpel blades differently using a sturdy tweezers and also let them disappear directly into the needle container. Both operations preferably take place in the sterilization room.
- Disconnect hand and corner pieces and multi-function syringe (discard disposable tip).
- Remove the extractors from the hoses, take the head support bag and discard disposables.
- Rinse the suction hose briefly with clean water, if used.
- Rinse the spittoon well with water after each patient (if used). If necessary, first remove residues of print material and similar (visible dirt) and clean with a tissue with water and detergent.
- Take the tray to the sterilization room or place the tray in the appropriate (tray) cupboard.
Tray cabinet with visible part for clean and part for dirty trays
- Disinfect the hands and put on clean gloves.
- If possible, remove visible contamination from the unit.
In fact, complete cleaning must now take place before disinfection. For the sake of practical feasibility, however, only visible contamination has been removed and immediate routine disinfection takes place immediately afterwards. This method is considered 'second best' and is customary for use in dental care equipment.
- Disinfection of the unit is realized in the following steps:
- Spray a foam disinfectant over all surfaces to be disinfected.
- Take a (disinfectant) cloth and soak it with disinfectant.
- Next, remove all parts separately with the wet disinfectant wipe. Think of the inside of the holder of the extraction unit, the spittoon, the control buttons of the headrest, etc. If necessary, add extra disinfectant on the cloth or take a new cloth.
- The headrest of the treatment chair is smooth; easy to clean and disinfect. When using a head support bag, a clean disposable head support bag is used for each patient.
- Cleaning and disinfecting the treatment chair upholstery should be carried out according to the manufacturer's guidelines.
- Give the disinfectant sufficient exposure time by allowing it to air-dry for the prescribed period!
- Clean the suction hoses at the end of the day by collecting a detergent / disinfectant in lukewarm water in the hoses.
Disinfecting the piping system
- Disinfect and / or rinse the piping system, if necessary daily and always after a long period of standstill (weekend / holidays) in accordance with the manufacturer's instructions.
For all details see the photo series about cleaning and disinfecting the unit.
A-T Disinfection of treatment unit with disinfectant-saturated (klets) wet instrument wipes
The peripherals include, for example, the curing lamp, the orange protective shield, the alginate mixer and the shaker. This equipment is used in almost every treatment.
As described earlier, we must strive to keep the peripheral equipment clean! (Keeping clean is better than cleaning ...). This certainly applies if the equipment can not be disinfected according to shape and material.
If it is decided not to use separate hand hygiene when using the peripheral equipment, it is possible under specific circumstances to cover the parts or surfaces to be touched with self-adhesive protective film or to be provided with a hygiene cover (sleeve). Preferably, such equipment is returned to the dirty working field during the treatment.
However, if you choose to replace the peripheral equipment safely in the relevant holder (for example when using the curing lamp), do not forget that after removal of the sleeve, the device must be replaced in a well-disinfected container.
Even when using a sleeve, the holder of the device must always be disinfected afterwards
When sharpening a prosthesis or a gypsum stump for a molded restoration, much sharpening is released that can be inhaled. This can best be accommodated in a dust box.
Dust cabinet for technology cutting
Make sure that no contamination is created. Make sure that the workpiece (the prosthesis) is disinfected with chlorhexidine prior to treatment and ensure that the gloves are handled with clean gloves or hands. Otherwise (the cuffs on) the sides of the cupboard could get dirty. For transport (without gloves!) To a grinding unit located outside the treatment room.
Note: tensioners for matrix straps belong to category B because they are used in the mouth. That is why they can not be counted among the peripherals.
This means that tensioners always have to be at least in the thermodisinfector to be reused (regardless of the price per tensioner!) And therefore must be present in the plural in practice.
Matrix tensioner is not peripheral equipment but instrument category B: reconditioning in the thermodesinfector!
In many practices it is customary that children can 'pick something out' after a treatment as a reward.
Children often sit or touch their mouth during treatment at the dentist with their hands. They look at their new filling by pulling the cheek out of the way, they are sitting on their lips and in their mouths to feel how the anesthesia works, and so on.
Through the drawer with toys, saliva (with possibly blood remnants) quickly finds a way to the next patient. The children often come home unnoticed with many more 'creatures' than they have chosen themselves.
Alternatively, it can be decided to:
- To place a toy machine; the children receive a coin at the desk of the assistant. After emptying the vending machine, the coins return to the counter after a cleaning cycle;
- To put a small number of presents on the counter with the announcement that they can take one but have been caught.
Hygienic solution for gift afterwards