Infection Control Guidelines for Healthcare Practices

ACSQHC

Leads national improvements in healthcare safety and quality.

AICG

Provide evidence-based recommendations for infection prevention and control.

Hand Hygiene

The most important strategy for infection prevention.

Alcohol-based hand rub (ABHR)

Recommended when hands are visibly clean.

Aseptic Technique

Practices to protect patients and healthcare workers from infections.

Aseptic Non Touch Technique (ANTT®)

Focuses on protecting key parts and sites through non-touch methods.

Personal Protective Equipment (PPE)

Includes updated guidance on regulation, risk assessment, and managing breaches.

Standard Precautions

Apply to all patients.

Transmission-Based Precautions

Used for specific infections or risks.

Aerosol-Generating Procedures (AGPs)

Procedures or behaviours that generate aerosols requiring specific precautions.

Environmental Controls

Ventilation and environmental cleaning are critical, especially after AGPs.

Cleaning and Disinfection

Removal of contaminants is essential before sterilisation.

Sterilisation and Monitoring

Use of steam sterilisers, biological indicators, and chemical indicators to ensure effective sterilisation.

Batch Control Identification (BCI)

Links sterilisation cycles to patient records for traceability.

Exposure Management

Clear protocols for managing blood and body fluid exposures.

Fit Testing and Fit Checking

Ensures particulate filtration respirators fit healthcare workers properly.

Clinical Support Staff

Includes dental assistants, laboratory assistants, and sterilising staff.

Competent Person

Infection control tasks must be performed by individuals with appropriate education, training, and experience.

Bare Below the Elbow

Requirement for clinical staff to remove wrist/nail jewellery and wear short sleeves.

Fomite

Inanimate objects that can transfer infectious agents.

Gap Analysis

Assessment to identify and address gaps in compliance with new standards.

Fallow Time

Rest period after AGPs to allow aerosol settling before cleaning.

Fit Test/Fit Check

Ensures respirators fit properly for airborne precautions.

Hand wash

Hand hygiene using liquid soap and water.

Healthcare workers (HCW)

All people delivering healthcare services with patient or body substance contact, including dental practitioners and support staff.

Infection prevention and control (IPC)

Creating safe healthcare environments by using evidence-based practices to reduce the risk of spreading infectious agents.

Multidrug-resistant organisms (MRO)

Microorganisms resistant to one or more classes of antimicrobial agents, including bacteria, fungi, and viruses.

Negative pressure room

Specialized rooms for isolating/treating patients with airborne diseases, designed to prevent the spread of infectious agents by maintaining lower air pressure than surrounding areas.

National Hand Hygiene Initiative (NHHI)

Promotes alcohol-based hand rub at the point of care when hands are visibly clean.

Penetrating injury

Injury from a sharp object (e.g., needle, scalpel) contaminated with a patient's blood or saliva.

Particulate filter respirator (PFR)

Respirators (e.g., P2/N95) that reduce respiratory exposure to airborne contaminants.

Reusable medical device (RMD)

Any instrument or device intended for processing and reuse (e.g., dental handpieces).

Single-use item

Devices intended for use in a single patient visit, marked with a specific symbol.

Standard aseptic technique

Routine infection control strategy for procedures involving critical instruments, focusing on protecting critical parts and sites (includes ANTT®).

Steam steriliser

Device (autoclave) using moist steam under pressure to sterilise RMDs.

Sterile barrier system (SBS)

Packaging that minimises microorganism ingress and allows aseptic presentation of sterile items.

Surgical aseptic technique

Used for all surgical procedures, maintaining a sterile field with additional measures (sterile gloves, drapes, equipment, etc.).

Traceability

The ability to trace the history, application, or location of an item (e.g., RMDs).

Purpose of IPC

Prevent or minimise transmission of disease-causing microorganisms between patients, staff, and the environment.

Implementation of IPC

Requires understanding IPC principles, clear procedures, ongoing staff training, and regular monitoring.

Adaptation of IPC

IPC procedures must be modified for new or re-emerging diseases and for different care settings (e.g., home visits, aged care).

Transmission of microorganisms

Microorganisms can spread by direct or indirect contact, inhalation, ingestion, injection, or splashes.

Aerosol and Droplet Spread

Dental procedures and normal behaviours (breathing, talking) generate droplets (>5 microns) and aerosols (<5 microns), which can contaminate air and surfaces.

Susceptibility

Infection risk is influenced by the microorganism's virulence and the host's susceptibility (age, health, immune status).

Key IPC Measures

Environmental cleaning and RMD reprocessing: Reduces surface contamination.

Personal hygiene

Effective hand hygiene and cough etiquette.

PPE use

Correct use of gloves, masks, gowns, and eye protection.

Disposable products

Use when appropriate (e.g., wipes, towels).

Risk minimisation

Use of high-volume evacuation, dental dams, and pre-procedural rinsing.

Respiratory hygiene

Cover mouth/nose when coughing/sneezing, use tissues, perform hand hygiene after.

PPE

Use gloves, masks, eye protection, and gowns during procedures and device cleaning.

Preventing blood and body fluid exposures

Measures to avoid injuries and contact with potentially infectious materials.

Routine Cleaning Frequencies

Surfaces and objects in dental practices require cleaning at different intervals, depending on their use and risk level.

High-touch surfaces

Act as fomites and should be cleaned regularly based on risk assessment.

Multi-resistant organisms (MROs)

Both detergent and disinfectant are required for cleaning, either as a two-step process (detergent then disinfectant) or a single-step process (combined product).

Cleaning methods

Should avoid generating aerosols; use damp dusting, dust-retaining mops, and HEPA-filtered vacuums.

Mops and cloths

Must be cleaned and dried after use, or single-use options should be used.

Environmental Cleaning in the Dental Operatory

Surfaces in treatment areas must be non-porous, impervious to water, smooth, and easy to clean.

Work surfaces in the contaminated zone

Are cleaned after every patient with a neutral or mildly alkaline detergent.

Detergent solutions

Must be freshly prepared daily and discarded at day's end.

Cleaning products

Should be ARTG-listed Class 1 Medical Devices and used as per manufacturer instructions.

Spittoons and dental chair upholstery

Require special cleaning products as per manufacturer's instructions.

Contaminated zone management

Must be clearly defined to prevent cross-contamination, and all items within it are considered contaminated during treatment.

Bulk supplies

Must be stored outside the contaminated zone to avoid contamination.

Protective barriers

Should be used for hard-to-clean equipment, following manufacturer instructions.

Clean and contaminated zones

Must be clearly marked, and staff must understand and follow protocols for each.

Personal items

Should not be brought into clinical areas.

Consumables

Should be pre-dispensed and stored in closed containers to prevent contamination.

Waste handling

Used glass anaesthetic cartridges are disposed of as sharps; polymer cartridges are emptied and disposed of per local regulations.

Cleaning sequence

Clean from least to most contaminated surfaces (high to low, clean to dirty) to reduce cross-contamination.

Dental chair cleaning

Use a minimum of two wipes or towels, progressing from cleaner to dirtier areas.

Key compliance points

Maintain a cleaning schedule covering all areas and document cleaning protocols.

Dental Chair Waterlines

Waterline biofilms are formed by environmental organisms and require specific protocols.

Bowie-Dick Test

Checks air removal and steam penetration in pre-vacuum steam sterilisers (Type B cycles).

Test Pack

Contains a standardized test load and a Class 2 chemical indicator (usually integrated).

Pass Criteria

Uniform color change on the indicator (no original color remaining).

Fail Criteria

Incomplete color change → suggests air removal failure (e.g., vacuum pump issues, residual air).

Mandatory Daily Test

Required for pre-vacuum sterilisers (before any live load).

ISO 11140-6:2022

Standard that replaced EN 867-5:2001 for sterilization compliance.

Process Challenge Devices (PCDs)

Used for additional testing when sterilizing hollow/lumened instruments (e.g., handpieces, suction tips).

Daily Vacuum Leak Test

Required if no automatic air detector is present.

Bowie-Dick Test Frequency

Daily test required for pre-vacuum sterilisers.

Sterilizer-Recommended Test Packs

Must be used for compliance.

Record Keeping Duration

Retain records for 7+ years (longer for pediatric patients).

Troubleshooting Failures

Possible causes for Bowie-Dick test failures include vacuum pump failure, air leaks in the chamber, or incorrect test placement.

Chemical Disinfection Regulation

All instrument disinfectants must be TGA-registered (ARTG-listed).

High-Level Instrument Disinfectants

Minimum requirement for semi-critical RMDs (contact mucous membranes/non-intact skin).

Intermediate/Low-Level Disinfectants

May be used for non-critical RMDs (intact skin contact).

Hospital-Grade Disinfectants

NOT suitable for RMD reprocessing.

Usage of Chemical Disinfectants

Only for heat-sensitive items when sterilization/thermal disinfection isn't feasible.

Safety Training

Staff must be trained in handling (PPE, ventilation, spill kits).

Potency Test Strips

Must be used to verify disinfectant effectiveness.

UV Cabinets

Not acceptable for RMD disinfection.

Shelf Life of Sterilized RMDs

Event-related, depends on storage conditions: temperature, humidity, handling.

Optimal Storage Conditions

No fixed expiry if stored optimally (24/7 air-conditioning recommended).

Suboptimal Storage Conditions

Shorter expiry (e.g., 3-12 months) if conditions are high humidity/temperature.

Packaged RMDs

Store in closed drawers/cupboards to prevent contamination from aerosols/splashes.

Non-packaged RMDs

Store in sealed containers/cassettes to avoid dust/moisture.

Integrity Checks

Discard if wet, torn, dropped, or past expiry.

Stock Rotation

Rotate stock to use oldest packs first.