Hygienically and safely assist the chair - Practical infection prevention at the chair

Personal protective equipment includes gloves, eye protection and the mouth-nose mask. The personal protective equipment is worn by the practitioner and assistant. The precautionary principle prevailing in working conditions (occupational health and safety) applies to the use of personal protective equipment: precautionary measures are always taken, even if the risk is small. The infection prevention measures with regard to the personal protective equipment apply to employees in the oral care practices who:

Hygienically and safely assist the chair - Practical infection prevention at the chair
Personal protective equipment includes gloves, eye protection and the mouth-nose mask. The personal protective equipment is worn by the practitioner and assistant. The precautionary principle prevailing in working conditions (occupational health and safety) applies to the use of personal protective equipment: precautionary measures are always taken, even if the risk is small. The infection prevention measures with regard to the personal protective equipment apply to employees in the oral care pr

Hygienically and safely assist the chair

 

Personal protective equipment

Personal protective equipment includes gloves, eye protection and the mouth-nose mask. The personal protective equipment is worn by the practitioner and assistant. The precautionary principle prevailing in working conditions (occupational health and safety) applies to the use of personal protective equipment: precautionary measures are always taken, even if the risk is small. The infection prevention measures with regard to the personal protective equipment apply to employees in the oral care practices who:

 

  • Perform patient-related work;
  • Carry out work with patient material;
  • Perform work in which they come into contact with (materials in) the environment of the patient.

 

Gloves

Gloves not only prevent contamination of employees' hands, but also that microorganisms are transferred from the hands of the therapist to the patient. Always wear gloves when the hands come into contact or may come with blood, saliva, mucous membranes, non-intact skin and used instruments.

 

Gloves are always used once and only for one patient (WIP, Personal Protective Equipment 2008). When removing gloves, the material can be damaged, causing the gloves to lose their protective function. In addition, the hands come into contact with patient material that came on the gloves during the removal of the gloves.

 

Non-sterile gloves are worn, but sterile gloves must be worn during CH-1 surgical procedures.

 

When to replace your gloves:

 

  • When operations take place in order from dirt to clean;
  • When the gloves are broken.

 

Always apply hand hygiene after removing the gloves.

 

Eye protection

All team members who work on the chair wear protective glasses during dental treatments. Splashes, saliva or blood, aerosols and small pieces of material (tartar and drilled restorations) can easily get into the eyes.

 

The glasses are also always worn during operations in which cutting of prostheses or other technique work is released, or where infected fluid can splash. This can be done in the treatment room, for example when changing the sieve in the extraction system. In the sterilization room, dirty instruments are often immersed in liquids or rinsed off, so that when working in this working environment, glasses must always be worn.

 

Requirements glasses:

 

  • Close the eyes and eye corners to a large extent frontally and laterally;
  • The underside of the spectacle frame is against the cheekbones to prevent the aerosol cloud from reaching the eye or eyelid from that direction.

 

You can use glasses that are removable; so after the treatment, clean and wipe with alcohol. There are also disposable glasses, where you throw away the screen and disinfect the holder.

 

A-N Sequence on and off of mouth mask, (disposable) eye protection and gloves

 

A Hand alcohol based on isopropanol. The packaging must always be hands-free in dental practice. Other packaging is for private use only. B Sensor-controlled dispenser for hand alcohol is preferred. Here combined with tap for hot / stocking water and soap.

 

Mouth-nose mask

The mouth-nose mask protects against aerosols for 20 to 30 minutes. A mouth-nose mask protects you against splashes of the mucous membranes of mouth and nose and also prevents microorganisms from the therapist's and assistant's throat from infecting the patient or the instrument during speaking. Mouth-nose masks must not be worn around the neck or under the chin and used again, as the inside and the outside of the mouth-nose mask may become contaminated when the mouth-nose mask is re-applied.

 

The protective effect of the mask decreases if it is damp or dirty. That is also a reason to throw away the mask. The mask is also discarded after each treated patient.

 

The mask is also discarded when leaving the critical area, for example for a (coffee) break.

 

Sequence on / off mask, eye protection and gloves

To prevent the personal protective equipment from acting as a source of contamination, it is good to get used to the sequence of work described below.

 

  • Greet the patient without gloves.
  • Put on the mouth-nose mask, then the protective goggles, also for a 'regular' periodic check. With the use of the multi-function syringe, moisture can suddenly splash up.
  • Disinfect the hands with hand alcohol.
  • Put on gloves.
  • After the treatment, remove the gloves and dispose of them hands-free.
  • Then take off the glasses and the mouth-nose mask. Dispose of the mouth-nose mask hands-free and then the disposable glasses screen, also hands-free.
  • Place the holder of the disposable glasses on the dirty side of the worktop to (later) disinfect with alcohol at the same time as any other items. All this after hand disinfection and with gloves on.

 

With a 'normal' pair of glasses you do the following:

 

  • Rinse visible contaminants under the (hands-free) tap and dry the glasses with a paper towel.
  • Place the glasses on the dirty side of the worktop or hold them, while a disinfectant foam or alcohol-free disinfectant is sprayed over the glasses. Rub and place the glasses on the clean side of the worktop to let the disinfectant dry in the air. All this after hand disinfection and with gloves on.

 

Hand hygiene, means and methods

Discipline for hand hygiene

Hand hygiene is defined as hand cleaning, hand disinfection and hand care with hand cream.

 

The application of good hand hygiene is of particular great value in the fight against the spread of (pathogenic) germs. Nevertheless, the attention for it and its implementation are usually below par. Even in hospitals and other places where many (resistant) bacteria occur, hand hygiene is unfortunately not always applied with the utmost care.

 

In the fine skin folds of the hands, many types of (pathogenic) microorganisms easily settle and can not be easily removed during regular hand washing. When the skin would come into contact with mucous membrane of a patient, the microorganisms of the hand can very easily 'detach' and end up in the mouth of the patient. There is also an enormous amount of microorganisms under the nails, which can not be completely removed even with a nailbrush.

 

Artificial nails have proven to be a major source of bacteria and should not be used by the staff in health care!

 

Hand hygiene; when and with what?

In case of visible pollution of the hands, it is necessary to wash them with soap and water.

 

In CH-1 surgical procedures preoperative hand disinfection is applied.

 

In all other situations, hand hygiene can best be performed with a special hand disinfectant, called hand alcohol for short.

 

Preferably use a hands-free control valve with built-in sensor instead of mechanical operation. A more luxurious version is a sensor-controlled 'total' faucet for hot / cold water, soap and hand alcohol. The use of a hands-free soap dispenser is also a must. A sensor-controlled dispenser for hand alcohol is preferred.

 

Hands-free control valve with built-in sensor instead of mechanical operation. Sensor active

 

Sensor-controlled 'total' tap for hot / cold water, soap and hand alcohol

 

Hands-free elbow tap

 

Hands-free dispenser with soap

 

Usually many more bacteria remain on the hands after hand washing than after disinfection with a disinfectant. It is strongly recommended to disinfect hands with hand alcohol for 30 seconds in places where there are many, highly virulent or even resistant bacteria, instead of washing them with soap.

 

Hand hygiene with a disinfectant takes less time than washing with soap, because the hands do not need to be dried, is less tied to one place (dispensers can be hung anywhere) and it delivers cleaner hands!

 

Hand disinfectants is the collective term for the alcohol preparations used for hand disinfection and can be composed on the basis of ethanol, n-propanol and isopropanol. Hand disinfectants must be registered as a disinfectant and can be identified by the N number on the label.

 

No preparations are used to which chlorhexidine or another disinfectant has been added, because these hand hygiene additives have no additional value. Non-alcohol-based products or combination products with a different concentration, which comply with both the EN 1500 and the health and safety rules, are possible alternatives. Disinfectant for surgical (preoperative) hand disinfection must comply with NEN EN 12791.

 

Read the product description carefully to ensure a safe product!

 

Current developments in the area of allowing and / or allowing various types of disinfectants can be followed via www.wip.nl.

 

Hand disinfectants, called hand alcohol for short, that are on the market in liquid form or as gel, are combined with a skin care product, a so-called back grease.

 

Disinfection with hand alcohol, when?

  • Beforehand. Hands should always be clean and disinfected at the start of work in the treatment room.
  • At the start of treatment, the practitioner should, after greeting the patient with a handshake, disinfect hands before putting on gloves. This prevents a possible contamination of the patient's hands (by coughing, sneezing or toilet visits) being spread in the treatment room or ending up on the instruments.
  • Even after the gloves have been removed, the hands must be disinfected. In the closed humid environment a lush growth of micro-organisms can occur on the gloved skin.
  • Torn glove. If the skin is not damaged when the glove is torn, it is sufficient to disinfect the hands before putting on new gloves.
  • Pause. Before the break, the hands, wrists and forearms must be thoroughly disinfected.
  • And of course:

- After possible hand contact with body fluids (saliva, blood) or surfaces / materials that have come into contact with body fluids;

- After toilet use;

- After blowing the nose;

- After sneezing.

 

Washing hands, how?

In the case of visible dirt, it is decided to use hand disinfectant instead of 30 seconds to wash hands. When the hands are washed, the following tools are important:

 

  • Hands-free tap. There are elbow taps, sensor taps and taps with foot control. If such a type is not present, the tap must be closed with a tissue or paper towel after washing the hands.

 

Ensure that an elbow faucet is actually closed with the elbow after use. Do not be tempted to use your hand anyway.
 

  • Soap. It is best to use liquid soap from a dispenser as a cleaning agent. The dispenser must be operable hands-free. The use of a disinfectant soap for hand disinfection has no added value. The literature shows that the effect of a disinfectant soap is less than that of a hand disinfectant (WIP 2008). Disinfectant soap does not offer the benefits as described by a hand disinfectant.
  • Towel. The hands should be dried with paper towels. A terry towel is a breeding ground for bacteria. In previous careless washes, bacteria may have entered the towel during drying. The result is that bacterial growth can take place in the towel.

 

Paper towel roll. The paper is often difficult to tear off

 

Paper towels in simple, effective dispenser

 

Paper towels are for single use. They are therefore always clean before use and after use they do not form a source of contamination.

 

The schedule below is used for a regular wash.

 

Hand washing is always a prerequisite for sterile CH-1 surgical procedures and soft disposable nail brushes are also used.

 

After this, only the basic 'house garden and kitchen' is explained in the photo report.

 

A-R Hand washing according to protocol

 

  • Set the tap to the correct temperature.
  • Moisten the hands completely.
  • Apply liquid soap from the hands-free dispenser.
  • Soap the hands by rubbing the palms together.
  • Divide and rub the soap well over the hands for ten seconds. Pay attention to the skin between the fingers and also treat the wrists and forearms.
  • Rub hands with closed fingers.
  • Rub hands with closed thumbs.
  • Rinse hands, wrists and forearms well.
  • Take a paper towel from the dispenser or dispenser:

- Dry the palms and the back of the hands well;

- Dry the skin firmly between the fingers;

- Dry the fingertips thoroughly.

  • Throw the paper towel into a hands-free trash can.

 

Application of hand cream 

On a normal working day in the dental practice, gloves are often worn for six to seven hours. The skin has to suffer from it. The sweltering climate causes easy softening of the skin, all kinds of bacteria can thrive and powder causes dehydration.

 

Due to skin specialists (dermatologists) it is absolutely not recommended to wash hands with soap and water in practice. Only the water could do the least harm. The frequent use of hand hygiene, especially washing with soap and water, can irritate the skin. This can be counteracted by the use of a moisturizing hand cream (Pittet et al. 2009).

 

Frequent use of a hand disinfectant based on isopropanol is fine, because it keeps the skin cool. In addition, the added skin care product has a beneficial effect on the skin during the long 'locked-in' hours in the gloves. The use of a separate hand cream would then no longer be necessary.

 

Prick, splash and cut accidents

In situations where risky (treatment) operations are carried out, the risk of jab, splash and cut accidents is unfortunately always present. As a result, there is always a chance of contamination with blood-borne diseases (accidental blood contact).

 

In dentistry, in principle, three viruses play a major role in such accidents (blood-blood or blood mucosal contact): hepatitis B (HBV) and hepatitis C virus (HCV) and HIV. The chance of infection with a needle stick accident is over 30% for hepatitis B. The risk of infection for HIV is very low compared to this: 0.3%; in practice, in fact, a small chance. All the controversy about infection prevention with regard to AIDS is therefore irrelevant, because the protection against hepatitis B is much more on the agenda! Vaccination is only possible against hepatitis B; not against the other hepatitis variants. For everyone, therefore, caution is required (and remains), regardless of whether you are vaccinated or not! It is urgent to strive under all circumstances to work as safely as possible.

 

It is good to realize that splash injuries (unnoticed contact of blood with micro-injuries) can in fact have the same consequences as prick and cut accidents.

 

Prevention of pricking and cutting accidents

The most important measures for the prevention of needlestick injuries are:

 

  • Remove equipment for removal of tartar only when used and always disconnect immediately after use! This prevents injuries to the forearm or elbow due to the (dirty) tip.
  • Use where pricking accidents occur substantially if possible needles with a built-in safety and protection mechanism against sharp injuries. Explanation: the Health and Safety Decree (Article 4.97, paragraph 2d) states that, where pricking accidents occur substantially, the use of safe needle systems is mandatory.
  • Safe processing of needles. Use a needle container that meets the UN approval requirements, in which also used blades and splint wires can be collected.

- The needle containers are made of hard plastic, impervious to needles and are leak-proof.

- The needle containers have a device that allows the needle to be separated from the syringe or needle holder without touching the needle with the hands.

- The needle containers can be sealed so that they can not open spontaneously or can be reopened.

 

There is a greater risk of accidents when you have to transport the used needles and other sharp objects over a long stretch. Therefore, a needle container must always be present within reach.

 

  • Recapping (inserting the needle into the case, the cap) is prohibited for health care providers. The recapping also applies to the needles of hypochlorite syringes and (long) needles for etching gel! Note: these needles can cause very unexpected injuries. With the help of an approved needle container you can remove the needle hands-free.
  • Self-employed persons may recap, but receive the advice if they still want to recap the one-hand method mentioned in the KNMT guide. If the therapist wants to overdose, recapping is necessary.
  • The removal of scalpel blades from a metal re-usable handle must be done hands-free by sliding the blade off the handle with a pair of surgical tweezers or using the Quicksmart: a handy device for safe handling scalpel blades to be removed directly in the needle container.
  • Prevent needlestick injuries when collecting needles in the container by filling them for no more than three-quarters. As the container becomes full, the needles come so close to the edge that you could prick yourself when you add another needle.
  • Safe disposal from practice. This prevents possible needlestick injuries in cleaning staff or garbage collectors. Detailed information about hepatitis and measures to prevent contamination can be found at www.hepatitis.nl.

 

In the unlikely event that a puncture, cut or splash accident occurs, the following steps must be taken:

 

There is a clear and easy-to-find accidental contact protocol available in practice.

  1. Contact is made with the KNMT-PrikPunt, the occupational health service, the local GGD or the Infection Prevention department of the regional hospital. Agreements are made about further handling of accidental blood contact. At DRS a poster is available with sharp objects and safety in practice and what to do in case of a needle accident (www.drs.nl)
  2. The handling must be completed within a few hours after the accident.
  3. The employee must report an accident with possible infection with HIV, HBV or HCV to the employer, who has a duty to report to the SZW Inspectorate (formerly Labor Inspectorate).

 

Basic protocol for needlestick injuries and contamination of mucous membranes

The following steps are described briefly in the protocol:

 

Procedure for a wound on the skin:

 

  • Let the wound bleed well (squeeze).
  • Rinse the wound with tap water or physiological salt.
  • Disinfect the wound with a hand disinfectant that is allowed on the Dutch market for this purpose.
  • If possible, record all available personal data of the 'source'.

 

Procedure for contamination of the mucous membranes:

 

  • Rinse immediately with tap water or saline or use an eyewash.
  • In case of infection of the mouth, rinse out the swab and do not swallow it. Rinse with a chlorhexidine solution (0.12-0.2%) for 30-60 sec.
  • In case of injuries or contamination of the mucous membranes, record, if possible, all available personal data of the 'source'.

 

Eye shower

If in the eyes / eyes, the eye drops should be used immediately. The Working Conditions Act prescribes that this facility is available in every practice. When splashing hypochlorite, for example, it is recommended to rinse with fresh water immediately (!) For fifteen minutes. It goes without saying that the eye shower should not only be present, but also well and quickly accessible.

 

Eye shower

 

Procedure for the notification of a needle accident

  • The needle stick must be reported so that insight can be gained into the real chance that someone will become infected. In the dental practice, clear information about the telephone number to be dialed must be available at the telephone!
  • The report must be completed within 2 hours in order to make a judgment about the risk of infection and possibly an acutely desired blood test.
  • Fill in the Occupational Health and Safety Requirement form and send it to the health and safety service and have blood taken straight away. This is necessary as a comparison material in later studies. It is recommended that blood is always taken immediately when there is an increased risk of communicable diseases. This is called a so-called zero sample. This is not studied, but is retained and compared with blood taken after three and six months. If health complaints develop during that period, comparison of the samples can show whether you might already carry the disease with you at the time of the accident or if the infection has been contracted by the needle stick. This is important for insurance!
  • Have the source (patient) examined for the presence of infectious diseases. (In case of injury during work in the sterilization room it will not be clear to which patient the instrument was used).

 

Since 2004, a judgment of the Supreme Court has allowed the source to be investigated for contagious diseases. This ignores the legislation on protecting the privacy of patients, because the interests of the person being praised count more heavily in this judgment.

 

  • Depending on the results of the blood test, further steps can be taken. You may need to take an antiviral agent for a certain (long) time. The side effects of such drugs are usually quite severe.

 

General guidelines

  • Provide optimum extraction with the large mist extractor when using spray cooling. Preferably in combination with the saliva plunger.
  • Always strive to keep clean up.
  • A clean worktop or transport tweezer for each patient is "sacred" to pick up instruments or materials from a package or tray.
  • Everything is closed, except when it is open (just to get something out)! This applies to all drawers, cupboards and packaging materials in the treatment room.
  • Wen put the stuff back on the demarcated dirty field after use. This keeps the environment of the worktop clean.
  • Always apply hand (shoe) hygiene during treatment for operations that must be performed outside the patient, the unit or the worktop (take off gloves and disinfect hands with hand disinfectants).
  • Always ensure a clean hand (shoe) and, before the pot with disinfectant wipes or the bottle with disinfectant is taken in hand.

 

Repacking during treatment

​​​​​​​As an example, four practical situations are shown on the basis of a number of photo reports.

  1. Packing from a drawer: Use the worktop tweezers to keep the handle clean.                       Take an extra mouth mirror with the help of worktop tweezers                                  
  2. Welding cotton rolls: also use the worktop tweezers to keep the dispenser clean.                     Wrap cotton rolls from closed packages                                                                     
  3. New matrix strap from storage box on worktop. Make sure that the lid of the box is unlocked beforehand so that the box with the worktop tweezers can be opened and closed hands-free.                          Packing matrix band from box on worksheet

 

To prevent the tweezers being changed, different types can be used, for example with ridges and without ridges. Another possibility to prevent change is to use rubber rings around the tweezers that are different in color. Red ringed in the mouth (is contaminated). Green ringed is clean for outside the mouth. 

 

Different appearance for different application

 

         4. Tackle endopoints and indicate:

  • Use the worktop tweezers to take them out of the box.
  • Use the patient tweezers to indicate them in the mouth. If the storage box with points with dirty gloves is operated, it must be disinfected afterwards.

​​​​​​​

A Remove GP points with worktop tweezers from packaging. B Disinfect packaging with foam. C Thoroughly rub with instrument cloth, place it on a clean work surface and allow it to air dry before storing

 

Preparing primer and bonding in a light-tight dispenser. Packaging remains clean

 

Portion of polishing paste in disposable drip glass and with disposable (!) Polishing brush

 

A Apply caries indicator to microbrush, despite the seductive shape of the packaging. B Apply sealant with a brush, despite the seductive shape of the packaging

 

For clean dosing no contact between bottle and microbrush gives (too) large drops

 

For economical dosing, direct contact between bottle and microbrush

 

Materials

Large packages (with more content than for one treatment) are easily contaminated in the case of careless use and the remaining material in the packaging can not be cleaned in any way!

 

During the treatments frequent use is made of drop bottles, tubes and jars. Its contents must never come into contact with patient material, however much the packaging also invites direct use in the mouth!

 

It is possible to ensure correct processing of all kinds of materials in different ways. Some methods are explained below.

 

In general, there are some points of attention for the described actions:

 

  • Prior to treatment, the indicated method can be performed with clean hands. The bottles and tubes will not only stay clean inside, but also from the outside! This saves a lot of time in clearing after the treatment.
  • Some materials, such as primers, contain volatile solvents. Then use a small closed compartment to prepare the material in advance.

 

If it concerns a volatile material, such as bonding, the action must take place during the treatment. The packaging, in this case the bottle of bonding, must be disinfected during cleaning.

 

If the packaging is contaminated with dirty gloves by whatever circumstances, the packaging must of course be put back on the dirty work area! After disinfection, the packaging is returned to the clean work area.

 

A-Hygienic and economical dosing: for every application clean microbrush, possibly hands-free repacking extra microbrush; after the treatment the packaging must be disinfected

 

This strict separation is crucial and requires attention and accuracy, even during busy treatment.

 

(Light-curing) material

Put (light-curing) material in a measured quantity for the relevant treatment in advance in a (disposable) glass slide or light-tight dispenser. The packaging remains clean and is placed on the clean work area in case you have to take care of it.

 

From the measured portion can be treated as often as necessary with the same instrument (brush or microbrush) during the treatment. This is especially a handy method for materials that have to be available in two different portions or for more elements. Not only do primer and bonding lend themselves to this, but also the sealant and caries indicator can be safely processed in this way.

 

Applicator

Use a disposable applicator to apply the material in the mouth. Resist the temptation by the shape of some packaging, such as the long thin tuutje on this caries indicator and this sealant brand.

 

Volatile materials

Volatile materials must be able to be handled per treatment, because they can not be put out in advance. The volatile acetone in, for example, the NT bonding also attacks the light-tight orange plastic lids of the 3M containers.

 

For each application individually, material must be removed from the bottle. Application with a microbrush is carried out according to one of the following methods:

 

  • Leave a new drop of liquid on the same microbrush without contact with the microbrush on the applicator. The applicator can be used several times during the treatment. The drops are usually very large and there is easy material loss.
  • Always keep a clean microbrush directly against the opening for an economical dose. For every subsequent application, a clean microbrush must of course be packed! In a patient with multiple restorations, the number of used microbrushes can increase considerably.
  • Grab a new microbrush in between handsfree if there is one too short. The reservoir with microbrushes can then be kept clean. The packaging with bonding must be disinfected if it has been operated with contaminated gloves.

​​​​​​​

Composite

Composite is supplied in compules. These are intended for single use. Please note that cartridge holders can be cleaned or disinfected very badly as a result of their design. So provide these guns with a protective film to keep them clean! There are also cartridge holders that are resistant to the temperature of the thermodisinfector.

 

Lay out composite light-tight on a cleanable block or dish

 

Mixing blocks

The use of traditional paper mixers does not fit in hygienic operations, unless very careful with 100% hand hygiene can be worked with these uncleanable (!) Paper tools. In practice this will not be possible in view of the nature of the work around the mixing of materials. The choice must then fall on mixing on a silicone or glass mixing plate, which can be used in the thermodisinfector after use. Another option is to choose material that can be supplied in hygienic mixing tips.

 

With a number of materials, the solution is to tear off one sheet of paper from the mixing block during laying. Place the mixing cube on the clean worktop. In this way the mixing block remains clean.

 

Cements and emergency fillings

Always assume that the package is handled with clean hands! If this does not work out, put the packaging carefully back on the dirty work area and disinfect thoroughly after the treatment has ended. An emergency filling of non-mixable (one-component) material can be prepared hygienically as follows:

 

  • Remove the material with a clean spatula or Ash 6 from the jar or tube.
  • Turn it into a ball.
  • Offer it on the thick side of an Ash 49 or put it on the tray.

​​​​​​​

Dealing with fallen objects

Instruments and materials

If they are still clean at that moment elsewhere, fallen instruments or materials can simply be pushed away with a foot against a cupboard. They should in any case not stay in the area where the wheels of a treatment chair can come. New material and instruments have to be (re) packed as described in the previous section.

 

Move the instrument with the foot out of the barrel

 

Equipment

As an example, a photo report is shown of a way to put a fallen extractor back into readiness during the treatment. This does not use a sleeve.

A-O Routing of a vacuum cleaner. For explanation, see the steps written out in the text

 

NB The use of sleeves is a good aim; keeping clean is preferable to cleaning. In a large proportion of oral care practices, the use of sleeves is not used because of the costs. In addition, the fitting of sleeves also takes time, just like cleaning, disinfecting.

 

There are many ways that lead to Rome, as the result of every method, but that a clean extractor is used again.

 

Practicing in their own practical situation and writing out the steps in a protocol can provide clarity and guidance in dealing with these unexpected situations, which at such a moment should never take a lot of time to solve.

 

  • Take the fallen suction hose with the extraction tube and remove the extraction tube.
  • Take out both gloves.
  • Deposit hands-free in the trash.
  • Disinfect your hands and put on new gloves.
  • Spray plenty of alcohol 80% in a tissue.
  • Disinfect the suction hose.
  • Take out both gloves.
  • Deposit hands-free in the trash.
  • Disinfect your hands and put on new gloves.
  • Clean the extractor again by placing an extraction tube.

​​​​​​​

With a reusable extractor the whole is deposited as quickly in the sink ('parked').

 

Perform necessary administrative actions

View the patient file and other forms

The patient file and other forms must be placed outside the splash zone on the worksheet. Keeping the patient record within the splash zone is permitted, provided that the materials used are to be cleaned / disinfected or covered with disposables.

 

During the treatment, the therapist or the assistant can inform themselves hands-free by driving to the patient record. In the extreme case, perform hand hygiene first. Only then can the patient file be picked up or turned over.

 

Looking up and presenting X-rays

Preferably, relevant X-rays are already on the computer screen or on the light box when the patient enters. This prevents searching during treatment. If a photo has to be looked for, always first ensure sufficient hand hygiene. For digital X-rays the rules of use apply as for use of the computer.

 

Use of the computer

The use of the computer during a treatment is almost unavoidable because as a rule only one part of the patient file is displayed on the screen: the treatment card or the digital X-rays or the comments, and so on. A few mouse clicks during treatment are often inevitable.

 

Only with a regime of strict hand (shoe) hygiene may the computer or mouse be operated during the treatment. The computer must be outside the splash zone and protected in such a way that dust can not nestle between the keys. We recommend using a 'smooth' and removable keyboard. Beautifully executed glass keyboards, with integrated mouse function are available for a place in the treatment room. The smooth top is very easy to disinfect, so that the keyboard can be operated during treatment.

 

Gloves off to keep keyboard clean

 

Disinfectable and dust-free keyboard

 

Medical keyboards are available; these are removable and waterproof and have an on and off switch. This prevents keystrokes when you are cleaning the keyboard, see also www.​medisch-toetsenbord.​nl

 

Preferably, however, the introduction of the transactions, the recording of remarks and the like takes place after the treatment has ended! During the time that the assistant concentrates on cleaning and disinfecting the unit, the therapist can concentrate on the administration.

 

To bypass the procedure of good hand hygiene, the keyboard and / or mouse can be provided with clean (possibly self-adhesive) cover foil for each treatment. However, the use of normally transparent cling film (cling film) is too time-consuming and inconvenient to repeat this in each patient. The temptation can then arise to disinfect the thin film, which is certainly not easy. Preferably, a disinfectable and dust-free keyboard is used for both hygienic and practical reasons. Also remember that the foil is very bright because of the bright lighting in the treatment room, which is quite disturbing when typing.

​​​​​​​

Cover with foil to keep clean, new foil for every patient!

 

Clean telephone calls and / or make appointments

The cleanest way to make appointments and answer the phone is to set up a separate desk outside the treatment room and appoint a separate desk clerk. In the absence of a separate desk employee or a telephone that is diverted to the treatment room, these activities will have to be carried out by the chair assistant.

 

Limit the 'in between' keeping to a minimum with the following measures:

 

  • Ask the patient to take place in the waiting room after treatment. Then first make everything clean and ready for the next patient. Only make a new appointment with the patient.
  • When the treatment really requires the presence of the assistant, make sure that the telephone is 'answered' by a strap after it has passed several times. Patients can then call back later or leave their telephone number so that they can be called back.
  • Set limited call times for the general number, for example from 8 a.m. to 1 p.m. Outside of those hours, the responder arrives with an emergency number. The morning program can then be adjusted and what is 'lighter' to be able to process the calls, while this approach at least gives rest during the treatments of the afternoon program.

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If the phone needs to be picked up during a treatment, always first ensure sufficient hand (shoe) hygiene and then remove the mask. (It is not excluded that when bending for typing or writing, the contaminated mouth-nose mask becomes a source of lubricating contamination.)