Lab 201 Pre Reading Knowledge:

Infection Prevention and Control

Today’s session is all about strengthening your understanding and practice of infection prevention and control (IPC) - a core skill that underpins every aspect of safe dentistry. As you learned in your pre‑work, infection control protects:

• Patients from preventable infections

• Clinicians and staff from exposure to bloodborne pathogens and microorganisms

• The wider community by preventing the spread of infectious diseases

• The clinical environment by reducing cross‑contamination on surfaces, instruments, and equipment

• Your professional practice by ensuring you meet legal, ethical, and regulatory standards

Because you’re still learning in a preclinical environment, it can sometimes be hard to visualise exactly how cross‑contamination happens during real patient care. Today’s exercises are designed to help you create strong mental models of how contaminants move through a dental setting and how easily they can spread when controls aren’t followed.

In this workshop, you’ll be:

• Practising hand hygiene to clinical standards

• Donning and doffing PPE correctly

• Working through activities that demonstrate how cross‑contamination occurs and how to prevent it

• Building the habits that will support you once you enter the clinic

The transmission of infection has existed since the beginning of time. While transmission of infection or disease is generally considered undesirable, exposure to certain infectious agents and the resulting immune response can sometimes provide lasting protection (immunity) against reinfection.

In everyday life, the risk of infection transmission is reduced by following basic hygiene practices (e.g., handwashing, covering sneezes), limiting contact with individuals who are unwell, and through vaccination. In clinical and simulated clinical environments, however, the risk is heightened due to the nature of the activities being performed and the shared use of equipment and facilities.

In simulated dental settings, students regularly engage in procedures that mimic exposure-prone and invasive techniques. Although no real patients are involved, strict infection prevention and control procedures are still essential to reduce the risk of cross-contamination between individuals and to establish safe, professional habits. Maintaining a clean and organised workspace, properly handling instruments, and following personal protective protocols are all critical to upholding safety in the preclinical environment.

"As a registered dental practitioner, you cannot delegate your responsibility for implementing infection control protocols in your practice; if even one registered dental practitioner fails to follow infection control guidelines, the entire practice is in breach."

(Australian Dental Association, 2022)

Infection control

you may be wondering what infection prevention and control is. Well, it's a process that involves using evidence based practises to reduce the chances of transmission of infectious diseases in healthcare facilities. So this also includes dental facilities or dental clinics. The aim is to create a safe environment not only for patients but also for healthcare workers and also the general public. By understanding how infectious agents are transmitted, we can then go ahead and apply principles of infection prevention and control and to aid in reducing the risk of transmitting communal communal diseases and decrease the transmission of healthcare associated infections. Healthcare associated infections, uh, are defined as an infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This also includes infections that may present after a patient has been discharged, in which case the infection was very likely in the incubation period. Also note that it's not just hospitals where healthcare associated infections can occur. It could be, uh, a dental clinic or an aged care facility, or the physio or a podiatrist, basically anywhere that allied health or, uh, general health is practised. So basically, the definition is saying that a A an infection has been transmitted in that healthcare facility, generally as a result of, um, infection prevention and control procedures not being strictly adhered to. And generally the the healthcare associated infections are preventable. So healthcare associated infections have an impact on morbidity and mortality rates of the healthcare users and contribute to excess healthcare costs for the individual, but also for the community. So it's estimated that approximately 200,000 patients a year will attain a healthcare associated infection whilst attending UM, a healthcare facility in Australia alone. So it's not only a problem in Australia, it's a worldwide issue. So it with the world health asso uh World Health Organisation has noted that approximately about 7% of all patients in developed countries and 10% in developing countries will attain a healthcare associated infection at some time. Currently in Australia, there's no universal surveillance system used to collect epidemiological data on healthcare associated infections. Um, if that but each state and territory has their own individual system for recording the data on healthcare associated infections, so as a result of that, it's pretty challenging to get an accurate overview of the impact of healthcare associated infections in Australia. So I would suggest probably that the estimation of 200,000 patients a year is a very low estimation, and it's probably quite a bit higher. There's particularly very little evidence about the impact of healthcare associated infections occurring in dental practises. Um, in this sort of situation, it's very hard to follow up with patients once they have left the dental setting. So generally they're only in at one time point, and you may not see them again, possibly for another six months or 12 months. So it's very hard to tell whether or not they have attained an infection in the healthcare facility. But the healthcare associated infections definitely can be transmitted in healthcare settings, Um, due to the nature of the work and the exposure to bodily fluids such as saliva and also blood, so these infections can occur readily if appropriate. Infection prevention and control procedures are not, um, implemented correctly, so this poses the question. Who is responsible for infection prevention and control? And I think recently, with the outbreak of COVID-19, we've all become very aware of General infection prevention and control procedures, and it it shows pretty clearly that everyone is responsible for preventing the transmission of communicable diseases. But particularly in healthcare settings, we have the healthcare workers that are responsible. Uh, so the nurses, doctors, um, support staff and also auxiliary staff. So that could be administration staff managers. Um, also CEO S. Um also, patients are also responsible, So it's important that we are discussing infection prevention, control strategies with patients and also visitors as well and also carers. Um, if they're bringing in someone into your dental clinic, it's also important to educate the carer of what you expect for infection prevention and control. The Dental Board of Australia requires every dental practitioner and dental student so oral health therapists and dentists to adhere to their policies and guidelines on infection prevention and control. So in dental facilities, the responsibility for compliance cannot be delegated to others within the facility, uh, such as dental assistants or administration staff, or the practise manager or whoever else, maybe in the clinic at the time. The practitioner is solely responsible for ensuring that they practise in a safe and hygienic manner to ensure the safety of the public. The practitioner is also required to ensure that staff members are appropriately trained in infection and prevention and control, and that they comply with infection prevention and control policies and procedures that have been implemented. Failure to do so by a staff member warrants warrants a warning, um, to the employee. And dismissal would be appropriate if policies and procedures are continually not adhered to because that puts the public at risk of attaining a healthcare associated infection. So, as we briefly mentioned, it is the employer's responsibility that all staff working in healthcare facilities undergo training for infection prevention and control, and that they understand the policies of each specific healthcare facility to prevent the transmission of healthcare associated infections in the dental setting. It's mandatory to have an infection prevention and control manual, which outlines all of the policies and procedures that need to be followed by every staff member to ensure that the facility is safe and compliant. There are also specific national guidelines that have been developed by governing bodies. Um, that may assist assist us in complying with infection prevention and control processes and policies, so the the staff training must include every healthcare worker that is in that setting. So it's important that support staff such as administration staff or sterilisation nurses or dental assistants, um, also have thorough knowledge of infection prevention and control. Cos they are generally the ones that are implementing that, um, throughout the day. And you must have a very clear outline of your expectations and of what procedures are done and and with what products you have for them to use a part of. The staff training also includes ensuring that you have appropriate staff orientation, Uh, for when new staff members commence at your practise. It's very unfair to expect, uh, that a staff would come in with the appropriate knowledge to apply infection prevention and control, um, procedures straight away, because every individual practise has their own, um, their own specific procedures that they follow in every setting, even though they might have the same end result or the same outcome for preventing infections. They do have often different strategies or approaches of doing that, or even just using different products as a part of, uh, dental practitioners registration as well through the Dental Board of Australia, we must continue professional development in infection prevention and control. And, if interested, there are also postgraduate studies for infection prevention and control. Um, there's, uh, postgraduate certificates and also master's degrees, that you can go ahead and do an infection prevention and control. And these, uh, infection prevention and control professionals, after doing postgraduate training, generally work in hospital based settings, um, and also involved in, um, policy development. So governing bodies affect and influence how we practise healthcare in Australia. And also there are specific governing bodies that are responsible for guiding us on how to deliver safe and reliable and high quality healthcare. Um, in particular for dental practises. There's a su, uh, a a bunch of governing bodies that we must understand how they operate and also understand their required documents that they have published. So, First of all, you must be aware of the individual healthcare facility and how their governing body works. So the individual healthcare facility could be a private dental practise. It could be a public dental practise operating in a hospital. It could also be, um, a general public or private hospital setting, and the governing body there is generally made up of managers or senior staff that are responsible for supporting staff members for implementing infection prevention and control, and this support could be by way of staff training. Or it could be by providing funding necessary to ensure that standards are met. There are also a National Health and Medical Research Council in Australia, and they have written guidelines for the prevention and control of infection in healthcare. So this is a really important document that all healthcare facilities must have and adhere to their policies. And it outlines how infection, uh, can be prevented. Uh, transmission can be prevented in healthcare settings. Uh, another board is the Dental Board of Australia. So for all dental practitioners, uh, you will be registered through APRA to the Dental Board of Australia. And they stipulate the legislation requirement for us adhering to in infection prevention control guidelines and stating that we will be safe and ensure that we adhere to all necessary protocols for infection prevention and control. And in Australia and New Zealand, there are also standards that are issued. So there is two, particularly for dental that we we need to know about. The first one is standard 4815, and this is an office based healthcare facility document that outlines how to reprocess reusable medical devices and instruments and equipment, and also how to maintain the associated environment for that. So office based healthcare facilities for dental practises are generally your smaller private practises. Then there's also the standard 4187, and that also outlines how to reprocess reusable medical devices in health service organisations. So they're generally your larger office. Uh, sorry, your larger hospital based settings, and they normally have a centralised, uh, sterilisation unit. So the the Dental Board of Australia has enlisted the Australian Dental Association, and what they have done is taken the their standards and the National Health and Medical Research Council guidelines and amalgamated the two and and summarised them to be very specific just for dental settings. So they have their own guidelines for infection control, um, which you can access and also if you are a member of the Australian Dental Association, which currently is only for dentists. Um, there are also other handy guides in there that you can use for staff training and also templates for creating your own um, office based of space manual as well for infection prevention and control. So they all of these documents are required documents that you must have in your facility to make sure that it's operating safely. And each facility, um, must have the documents available to all staff so that they can reference them at any time that they need to give you an overview of what possible diseases could be transmitted in dental settings. Just gonna outline a few here for you. So imagine any disease that can be transmitted by bodily fluid or blood or saliva. So we're looking at respiratory diseases. So including influenza COVID-19 or just a general cold, then also bloodborne Viruses can be a possible disease risk Uh um, in dental settings. So this includes hepatitis, B, hepatitis C, HIV and A I DS. And then there are other chemical diseases such as tuberculosis, measles, chickenpox, gastrointestinal disease, staphylococcus, a candida and the herpes simplex virus. So if you've had a chance to have a look at what vaccinations are required for healthcare workers in Australia, you'll note that the ones listed here match up pretty well with what we are expected to be immunised against. So in order to prevent disease transmission, there must be a way to break the onflow and sequence of the chain of infection. So infection prevention and control focuses primarily on using policies and procedures to specifically target the breakdown of the chain infection. So the chain of infection is a very important aspect that we must understand in order to prevent transmitting disease from one person to another. So as you can see there, there are six key links to the chain of infection. And if we can intercept somewhere in that chain and break that link from occurring, then the disease has no ability to transmit to another person. So the six links are a causative agent, a reservoir, a portal of exit means of transmission and a portal of entry, and lastly, a susceptible host. So a causative agent is a pathogen. So that is, uh, a micro organism that is, has the ability to cause disease. So that could be a bacteria, a virus, a fungi or protozoa, and and the diseases that you might see in the dental settings, as we mentioned before, could be influenza blood borne diseases such as HIV or hepatitis B um, or hepatitis, C, chickenpox, measles, tuberculosis and so on. Then you need to have a reservoir. So that's somewhere where the path pathogens can survive and multiply. So for us in the dental setting that is humans, so that could be, uh, yourself as a dental practitioner that could be staff members or a patient or carers or visitors to that healthcare facility. Then there must be a portal of exit. So that's how the pathogen exit the reservoir. So in a dental setting again, that could be via blood, um, or saliva or any other, um, bodily fluids or respiratory respiratory droplets. And then we need to have a means of transmission. So how that, um, causative agent is going to transmit from one person to another? So there are three main ways. So that's by contact or by droplets or by airborne roots, and we'll go into those modes of infection a bit later on. So for the dental setting again, that could be patients blood entering the dental professionals open wound on their hand. Or it could be via an injection or tion, and it could also be passing infectious agents from dental professionals hands after contacting infectious site and then, uh, then them not performing hand hygiene before contacting another patient or transmitting infectious agents to an environment environmental surface. Or it could be from respiratory chocolates with coughing or sneezing or talking. Um, and it could also be via inhalation of infectious agents. Then there needs to be a portal of entry. So that's where the the pathogen enters. Enters somebody else so that could be via wounds and the mouth, nose or eyes, um, via the mucosa. Then lastly, you need to have a susceptible host. So susceptible hosts can be anybody. But those at higher risk particularly include those that are immunocompromised, um, the elderly, those that have a reduced immune status. Um, anyone with open wounds, people who have, uh, comorbidities so other diseases, you know, like diabetes, heart disease, um, and also dependent on the virulence of the agent. So how easily transmiss permissible it is. And again, the susceptible hosts in dental settings again might be patients or visitors, um, dental professionals or other staff members. And this can also include, uh, clinical or administrative. Basically, it's anyone that may be entering the healthcare facility, so the modes of transmission from the chain of infection are particularly important in healthcare facilities because these three areas are where we can focus our infection prevention and control strategies around. And these are things that we can actually control. Whereas we don't really have control over causative agents or the reservoir or portal of exit or portal of entry or who the susceptible host is. But we can control, um at how disease is transmitted via contact or droplets or by airborne. So there are different strategies for each of those where we can implement precautions to prevent disease transmission. So the first one that we'll look at is contact transmission. And from that there are two specific routes of transmission. There is direct and indirect transmission. So direct involves a pathogen directly, um, being, uh placed into a person, so that could be via injection. Um so anywhere where the skin or mucus membranes are penetrated, it could be the pathogen is ingested by the patient or person, and it could also be via open wounds. Um, with indirect. We're looking more at the surrounding environment, equipment and hands, so environment can be, um um at a point where pathogens can live on surfaces? UH, same with equipment there, maybe pathogens on surfaces when you're treating someone with a communicable disease, and if those environment mental surfaces or the equipment are not appropriately cleaned in between use, then that pathogen can be transmitted from one person to another very easily. This is the same for hands. If there's pathogen on the healthcare workers' hands, then they can transmit a disease directly to a patient as well. Um, and even if, for instance, they treat one patient who has, let's say, influenza, a chemical disease, they enter their mouth and treat them, and then they do not wash their hands before treating the next person. Then they can directly transmit the disease to the next patient like that. So the next mode of transmission is droplet. So this image gives a very descriptive demonstration of how droplets can be transmitted, and they usually occur when someone's coughing or sneezing or talking. And these are a bit larger, so they're normally more than five microns in size, but because of their weight, they can only travel less than one metre. So you you might notice recently, um, a lot of our infection prevention control policies for preventing COVID-19 include social distancing, so ensuring that you are 1.5 metres away from each other and this is to reduce the TR the chances that droplets respiratory droplets transmit from one person to another. The next mode that we'll look at is the airborne route, so airborne particles are smaller than droplets, so they're normally less than five microns in size, and they can easily be inhaled due to their their size. But because they're a bit lighter and a bit smaller than droplets, they can travel further so they can generally travel more than one metre. So airborne is a particular airborne transmission is particularly important in dentistry. Um, because a lot of the equipment that we use are called aerosol generating equipment. So we're yet to use, um, a lot of aerosol generating equipment in the simulation lab, but you'll come to use, uh, Handpieces. So a high speed handpiece in particular uses air and water at the same time, and it sprays out this this fine mist. So if pathogens become trapped in this aerosol generating equipment, then the aerosols can actually be be suspended in the air for some time. so other, uh, aerosol generating equipment in dental settings include ultrasonic scalers, and they, too use water spray, Um, and also the triplex syringe. So that sprays, um, with the water and the air. So generally, the guidelines at the moment state that the triplex, if you're just using the air by itself or the water by itself. It's not, um, an aerosol generating equipment. But when you press both buttons at once, so you're getting the air and water spray happening simultaneously, then that is an aerosol generating equipment. But it's worthy to note that if you are using air on a wet surface that that, too will create aerosols and the potential for transmission of disease via the airborne route. SPEAKER 0

So what is hand hygiene? It It's the removal of micro organisms from our hands by using soap and water or alcohol based hand rubs or antiseptic hand wash, and for healthcare settings. There are five recommended, uh, moments for hand hygiene, and these are not only used in Australia, but they're used worldwide, and they were first implemented by the World Health

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Organisation. Um, and in Australia we have the National Hand Hygiene

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Initiative that also has adapted them, um, and promotes them within Australia. So the first recommended moment for hand hygiene is, um, prior to touching a patient. There's also it's also required before you perform a procedure, you also need to perform hand hygiene, uh, after a procedure or body substance exposure risk. You also need to do hand hygiene after touching a patient and again after touching uh, patients around. So when we're working in the Latrobe Health School, you'll get a good understanding of how and when to use uh, hand hygiene procedures. It's really important to note that hand hygiene must also be performed prior to putting on gloves and also after glove removal. Hand hygiene must also be performed at other times and they include before and after you have tea or lunch breaks. Um, after you've visited the bathroom and upon entering and exiting the clinic, and also very important to perform at hand hygiene with soap and water when hands are visibly soiled. Yeah, So if your hands are visibly soiled, it's not enough just to use the alcohol based hand rub. You must actually use soap and water at that at that time point. So for successful hand hygiene, dental professionals are not permitted to wear jewellery below the elbow, so objects like rings or bracelets or watches cannot be worn. There's also to be no false nails or nail covering, so nail coverings include nail polish or shellac or gel,

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or anything else that you may have on top of

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your nails and nails are to be kept short. So the reason for this is because those such objects

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can harbour harmful pathogens and and can be quite challenging

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to clean under. So if you're wearing a ring and you're performing hand

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hygiene, it's near impossible to actually clean off the micro

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organisms underneath that surface and also impossible to dry dry

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underneath their well. So if it's not dry. Then it's a prime, a prime site for microorganisms to

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to, um, continue to grow and develop. So to prevent micro organisms from entering damaged skin, Um, from wounds or rashes or cracked skin, you must really implement appropriate, um, hand care so this can be done

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by using um, moisturisers and also applying wound dressings, particularly

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dental setting. They must be waterproof dressings, and the use of moisturisers will help prevent irritation to skin. So if you have cracked skin or open wounds, then

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they are a potential site where pathogens can enter and

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disease can be transmitted to in healthcare settings. It's really important that there's appropriate promotional material and education around hand washing and when to use it, and also how to use hand rub. So again, the World Health Organisation has created posters that you can put up in any healthcare facility, and it and it clearly outlines the steps required for successful hand hygiene. So on the screen there we have two posters. So one is how to hand wash and the other is how to hand rub. So these two posters are critical for your learning, as particularly, um, when we're working in the Latrobe Rural Health School Dental clinic. We expect that you will know the steps of how

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to hand wash and how to hand rub.

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And prior to treating each other in the clinic, you will have to go to the national, um, hand hygiene initiatives website and complete a dental module there that will give you a hand hygiene certificate to say that you're compliant and you understand how to perform, um, hand hygiene

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and also when to perform it. So just try and practise at home these steps for

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for how to hand, wash, note the time that's required for each of the procedures. Um, and also just have a good look at the sequence there. So you'll note, um, 0.2 until 0.8 is exactly the same. So you really only need to to memorise a few steps, and it just varies at the start, um, as

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to whether or not you're using soap and water or

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whether you're applying the alcohol based hand rub. So the key main points there is the first step is to dispense the appropriate ma um, um soap or the alcohol based hand rub to your hands. Then you're gonna rub your hands palm to palm, then you're going to rub your, uh, right palm over left dorsum with interfacing fingers, and then you're gonna swap your hands over and put your left palm over your right dorsum and move them back and forth. Then you're gonna place your palms together and interlace your fingers and rub them back and forth to make sure that you get in between the fingers. Then you're going to interlock your fingers together and, um, move in opposing direction, um, to ensure that the tops of your fingers are cleaned, then you need to ensure that you are using a rotational rubbing motion to clean both of your thumbs. So doing your left and then your right, and then you will do rotational rubbing backwards and forwards to ensure that the the fingertips are are done appropriately as well. So for your left, left fingers and your right fingers, so again really important to memorise those steps and you'll be, um, we'll be looking at marking that off to ensure that you can, um, perform appropriate hand hygiene.

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So this next video that I'm going to play for you just shows you the steps required to perform successful hand washing with soap and water. So you can see in the video, uh, Jenny's dispensed soap onto her hands and then wets her hands, rubbing her palms together. And then she goes ahead and and rubs her right palm over her left dorsum and vice versa. Her left palm over her right dorsum and then does palm to palm with interlaced fingers. And then she does the backs of her fingers and rotational rubbing of her thumbs, then rubbing her fingertips as well. And then finally, she rinses off the soap with the water, and lastly, she gets a paper towel and dries her hands thoroughly.

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So as we discussed before, there are the five moments for hand hygiene and the National Hand Hygiene Initiative. Uh, Australia has developed this promotional poster, which again you can pop up in your surgery, where you maybe working, and it clearly outlines the 55 moments when you're required to perform hand hygiene. The only thing that it's not mentioning is when you're wearing gloves. So again, I stress prior to putting gloves on, you must perform hand hygiene and again after you removed removed gloves it's essential that you perform hand hygiene, then gloves are a barrier, and they're a great way to reduce the amount of pathogens on our hands. But unfortunately, gloves are not 100% protective. They do have microscopic tears in them, so there is always the possibility that micro organisms can still be transmitted through gloves, although it's very reduced. And also, sometimes when you're operating, you may get, um, a tear in your gloves from, say, a burr or a sharp device, and you you may not notice until later on. So it's really important that prior to putting on your gloves and after removing them, you'd still do hand hygiene. So just to refresh again what the five moments for hand hygiene were, UM, it is first before you touch a patient. Second is before you begin a procedure with a patient. Third is after a procedure or after there's been bodily fluid exposure risk. Then fourth is after you've touched the patient. Fifth is after touching a patient's surrounds.

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So the National Hand Hygiene Initiative Australia has also got promotional videos that they, um, have developed and in conjunction with the Australian Dental Association. So there's a link there on your screen, which I recommend that you watch it clearly, um, describes and shows you when to perform hand hygiene and how to perform it, particularly for dental settings. So it shows you those five moments for hand hygiene opportunities and the links there. They're both the same video ones just directly to the YouTube and ones via the Hand Hygiene Association. Um, but the hand Hygiene Association is actually now called the National Hand Hygiene Initiative. So if you don't have luck with one of the links, try the other one, but definitely something that you need to watch. So you can either pause the lecture now and go ahead and watch that now, while while the five moments of hand hygiene are fresh in your mind Or, um, wait until the end of the lecture and come back and watch that then. personal protective equipment, and this is used to prevent transmission of micro organisms from aerosols, splashes, droplets and, uh, direct or indirect contact. So it includes wearing gloves, uh, masks, eye protective eye protection, protective clothing such as, uh, gowns and also footwear. When entering a dental clinic, you must wear enclosed UH, fully enclosed leather shoes and full length pants. So this will protect you from chemical splashes and also sharp injuries, which could occur if an instrument or or sharp object is dropped onto bare skin. So when wearing the mask, you must ensure that it covers both the nose and the mouth, including the chin, and when wearing the mask it it should never be touched by your hands, especially if you're wearing gloves and especially if they are contaminated as well and mask. It's really important if you're wearing a tie on masks that it it can't be worn around the the neck. So if you're not wearing it, you should never pull down a mask and wear it around your neck. And, um, leave it there in between patients really important also to note that masks are single use. Uh, the disposable medical masks are single use items, and they must be changed between each patient that you see when removing the masks. You can only remove it by touching the strings or the loops at the back. And it's really important never to touch the front of the mask because this is where it's, um, going to be contaminated by pathogens and microorganisms. So eye protection is also to be worn by all dental professionals. So this will prevent foreign objects from entering the eye and also protect from splashes and droplets and aerosols that can occur during dental treatment. It's also going to prevent you from getting any of the materials or products in your eye. If you wear prescription glasses, it's really important to note that they're not a a form of appropriate eye eye eye protection. Often they have, um, open sides that the sides aren't concave around it and and protective, and you can can get ones that are specifically designed to be eye protection with prescription lenses added in. And if you have those, that's fine. But otherwise eye protection is to be worn over the top of prescription glasses to protect the orbital region. Also, it's important to be wearing a gown. If, for instance, you treat a patient in your casual clothes or your work clothes, imagine that you've got aerosols and droplets back splashes on your shirt, and then you exit the clinic. You're taking those pathogens with you. Imagine you then sat down to have lunch. It's highly likely that you will, um, maybe contact your shirt and then touch the food that you're eating. And then you can potentially spread pathogens to yourself via that way. And also, you could potentially take home the pathogens to your family and friends as well. The other thing to note with personal protective equipment is to ensure that your personal attire is also going to be protective for you. So as we discussed, ensuring you have the enclosed leather shoes and the full length pants will help protect you. Other things to note is to ensure that you have your hair tied back and you have good personal hygiene. And if you're wearing a uniform, it's really important that that that uniform is clean and ideally, when you wash that uniform at home, if you don't have the services available at work to wash them at work, Then when you're washing them at home, they should be washed in a separate cycle, um, to your normal clothes when wearing personal protective equipment or P PE. It's really important that you know the sequence for putting on and taking off the P PE Cos these are vital stages where pathogens can be transmitted. Um, either from yourself to the patient or vice versa. So again, when you're coming into the Laro Rural Health School Dental clinic, these are steps that you must know and must follow as well. So please ensure you take the time to look at these steps thoroughly and practise um, the steps at home prior to coming into the clinic so that when you come in, you will be efficient at at putting on and taking off. P PE. This is, um, taken particularly seriously at the moment with the transmission of COVID-19 and you'll often see at hospitals or testing centres. Um, if you go and have a covid test that there'll be actually a spotter that works there, that their sole job is actually to watch people put on and take off P PE to ensure that no transmission of disease occurs so the first thing to note is that it's important to perform hand hygiene prior to putting on your P PE. So first of all, you'll do that, and then you'll put your gown on after performing hand hygiene. So the gowns generally, uh, that we have available at the dental clinic are disposable gowns, and they have ties that you just tie up at the back of your neck and around your waist. After putting your gown on, you'll then place on a mask so the mask can either be ear loop or ties. And it's important that you secure the little, um, metal band at the top of your nose so the blue surface of the mask must be facing out and the white side is facing towards your skin. And then you wanna just make sure that you squeeze the metal across the top of your nose to to ensure that it fits snugly against your nose, and then you'll place on protective eyewear or a face shield. So we have protective glasses, um, that you'll be able to use at the dental clinic, and then it isn't added here. But I highly recommend prior to placing on those gloves that you perform hand hygiene before doing that again, and we'll be expecting that of you in the dental clinic as well. So ensuring that right the moment right before putting on your gloves that you will be performing hand hygiene. Then, after you've completed the procedure or your treatment, you need to remove your P PE. So first of all, you will take off your gloves. So be very careful when you do this, because the outside of the gloves is contaminated with, um, saliva or blood, and when you're taking it off, it's very important to grasp the outside of the glove with the opposite hand and then peel it off. And then you scrunch up the glove that you've removed in your opposite hand and slide your finger underneath the, um, the the glove that's remaining and peel it off over the top of the first glove and discard it directly into the waist. So we'll demonstrate that for you in the dental clinic how to do that appropriately, and it's really important that you do it in a very controlled manner because you don't want to be splashing, um, droplets around. If your hands are contaminated with saliva or blood. Then, directly after removing your gloves, you will perform hand hygiene. And next you will take off your protective eyewear. So again, be very cautious because the outside of the eye protection is contaminated, and you should only remove it by handling the, um, the handles or the headband at the back of the the eyewear. Next, you will remove your gown, and this is a very important step that you must follow properly because the outside of the gown is probably going to be the area that is most contaminated because the patient's head is directly next to the gown. When you're working, um, so it's highly likely that there's aerosols or droplets or splashes, um, on there. So first you need to undo the ties at the back, and then you'll pull the gown away from your neck and shoulders and, um, by touching the inside of the gown only, And as you do it, you'll roll the the gown down and away from your body and turn it inside out as you go as you go. And then, once you've got it into a bundle, you'll discard that then and then you'll go ahead and take off your mask. And again, just be very cautious that the front of the mask is contaminated, so never touch the front of the mask. You'll grasp either the ties or the elastic loops at the side and pull it away from you and and place it straight in the bin. Then, once you've done that very important to finally perform hand hygiene again with either alcohol based hand rub or soap and water. the next standard precaution is safe sharks management. This one is particularly important because the ramification of having an injury with a sharp instrument or device, um, means that there is potential for transmission of bloodborne viruses. There are lots of steps involved in performing safe sharps management, and they include ensuring that all sharps are disposed of directly after use. So that means as soon as you you've used it, you're placing the sharp, uh, for example, needle or scalpel directly into to a puncture proof container at point of use. Um, rather than putting them back onto, say, a bracket tray or onto the bench something like that. Because if you place it onto those sort of areas, then it's likely that someone's gonna come along and injure themselves with that sharp device or instrument. It's really important as well that ideally, we're using single use sharp devices, especially needles. They must be single use, and they cannot be reused on other patients, so very important again to be to be disposing of those, uh, safely and appropriately. Also, it's es essential that there is no recapping, which is replacing the lid on needles. Um, this is is gonna pose a risk for a a sharp's injury and also you shouldn't be bending or breaking the needles after use. And when you're using the sharp device, it's also important that you, when you're retracting the cheeks or mucosa that you're using an instrument rather than your fingers. This again will prevent a sharp injury. And also sharps are not to be passed directly from one person to another. And it's really important that the responsibility for the safe disposal of the Sharps instrumental device is not deferred to others. So it's essential that the per person that is using the device must be the one that is responsible for the safe disposal disposal of the the sharp instrument for the equipment. As we discuss sharp instruments and devices pose a risk of injury to dental professionals with the possibility of transmission of bloodborne viruses such as hepatitis, B, hepatitis C and HIV. So it's been found that the majority of incidents that occur when using a sharp device on a patient and also directly after the use of a sharp device is is disposed of. So some examples of sharps in the dental clinic include local anaesthetic needles burs that you place into your hand pieces, uh, periodontal scalers and curates scalpels and antic files. So with your burs and ultrasonic tips when they're in the handpiece, it's really essential that they they are removed from the handpiece immediately after use to minimise the the chances of a sharp injury to yourself or to others. It's very easy when walk past a handpiece or a scaler that has a BUR or a tip in place to easily scratch yourself and penetrate your skin. So it's very important that these are removed, um, at point of use so that you don't don't incur a sharp's injury at that point if a needle stick injury does occur, uh, there are steps that you need to do immediately following that, so the first thing you must do as soon as the sharp injury occurs, you must stop what you're doing and remove yourself from that area and report that immediately to a demonstrator or supervisor at the time. From there, immediate follow up care will be arranged for you, so that will include washing the area or the injured site immediately with soap and water, and then performing first aid. If required. Then you'll be required from there to complete incident reports and, um, be referred to a general practitioner for blood testing and counselling as well. Generally also, after that initial blood test, you'll be required to have follow up blood tests as well. And this is also the case not only for yourself but also for the source patient. So whichever patient, um, the device was used on so infection prevention and control measures such as safe handling of sharp safe disposal and vaccination against bloodborne viruses such as hepatitis B are advised to prevent acquiring a bloodborne disease from a sharps injury. The next standard precaution is environmental cleaning. So pathogens can be found in the surrounding environment of healthcare settings, for example, on benches or equipment, Um, X ray machines and door handles. Anything that is within the the clinic. Infectious agents then have the potential to be transmitted to patients and healthcare workers, uh, by direct contact with contaminated surfers services or by indirect contact from hands that have been in contact with contaminated objects and then transferred on um to a patient. Environmental surfaces are required to be decontaminated with detergent and mechanical cleaning between patient use and after spills or splashes occur. So if there's been a contamination with infectious substances, then disinfect disinfectant. Also be used after physically cleaning with detergent. So when you're cleaning with detergent and following up with disinfectant that's known as a two step process. There are some products available that allow for a two in one A two in one clean where the detergent and disinfectant, um, is combined in an impregnated wipe. And this allows for a one step, uh, physical clean. So that's like the Glenelg universal wipes that we use, uh, currently at the university. They are a two in one wipe. It's really important to note that disinfectants alone cannot be used, um, by themselves to clean, Um, because, unfortunately, they are not effective. Disinfectants are not effective unless by a BB burden is removed from the surface prior to use, and this must be done with detergent. So if you are using disinfectant, it's very important that you use detergent first or you use a two in one product that has detergent and dis disinfecting properties, so each facility that you go to will have their own procedure for decontamination of the environment although the principles will be the same, their steps may or products may vary, and it's and it's vital that you have an understanding of the steps involved and products used specific for that setting. When decontaminating the environment, full P PE is required, so this includes gloves, gown, mask and glasses, especially in the dental dental setting, where the environment is likely to be contaminated with saliva and blood from splashes or aerosols in dental settings. There are also designated areas areas, um, within the clinic, for example, for administration of clean storage and contaminated zones. So that would be your clinical zone. Where the patients share and and light and operating Um, bracket tray is so It's really important that anything from the contaminated zone is not transferred to the administration or clean zones, um, to ensure that cross contamination of micro organisms do not occur. So any item in the clinical or contaminated zone must be cleaned or reprocessed or sterilised or disposed of prior to use for the next patient. So if you are treating a patient and you're required to retrieve an item from a clean drawer, um, as we saw in the hand hygiene demonstration video, you must first remove your gloves and then perform hand hygiene. Then you'll retrieve the item from the draw. Then you'll perform hand hygiene again prior to replacing your gloves. This will ensure that the drawer, the drawer and the contents are not contaminated and that your hands are not a carrier for micro organisms from the surrounding environment. For environmental cleaning, you can use barriers so barriers, Uh, as in the picture that we have there, maybe, um, a plastic covering that goes over the top of your equipment. So this covering must be water resistant to prevent penetration of of fluids. So normally, it's used to reduce contamination of the surfaces and equipment, and you place it onto equipment that is frequently touched or likely to be contaminated with blood or bodily fluid. So in healthcare settings, barriers can be placed over items that are diff difficult to clean and likely to be exposed to to bodily fluids. So for the dental setting, this may include triplex syringes, handpiece couplings, um, and suction handles and hoses. So plastic barriers are not to be seen as a replacement for cleaning. And if you are using barriers, then all surfaces underneath the barrier, once it's been removed, are to be decontaminated, as they don't provide 100% guarantee that cross infection has has not occurred. Barriers when you're using them have the potential to be, um, moved as you're using them. Um, they may tear, or they may come off completely during treatment. That's create a void where microorganisms can can transmit through. So that's why it's very important, regardless of use or, um regardless of use or placement that all barriers in the clinical zone are to be changed between patients as they could be contaminated from droplets or splashes and aerosols from use during procedures. The next standard precaution is reprocessing of reusable devices, So this involves, um completing processes and steps to ensure that any instruments that are reusable so they can be used multiple times, uh, on different patients are cleaned and reprocessed appropriately so that there's no transmission of micro organisms from one person to another. So it's important that a sequence of events occurs, and that's from transitioning a dirty instrument or device to ensure that it's cleaned and then ster uh, sterilised, if appropriate. So there are categories that we use to determine how an instrument should be reprocessed, and we'll go through those, um, on the next slide. And it's important to note that with a dirty instrument when you're using it in the in in the clinic that it is pre-cleaned at point of use. So we'll teach you in the clinic how to clean over your instruments prior to trans, transporting them to the reprocessing area or the sterilisation room. And this is to ensure that the bio burden or the blood or debris doesn't harden on the instrument, um, prior to being cleaned, because once it becomes hard and firm on the instrument, then it's actually more challenging to remove in the reprocessing area. And it's more likely, then, that after processing, there may still be some contamination on that instrument. So once the dirty instruments been pre-cleaned and sawed into categories, then you have an understanding of how it should be processed from there. So from there you can do uh, manual cleaning or mechanical cleaning. So manual would involve using a brush and soap and water to to scrub off any debris that maybe on the instruments and mechanical, involves using ultrasonic cleaners or a washer, disinfect, uh, to mechanically clean the instruments or devices. And then from there they would get sterilised in an autoclave and then be placed into sterile storage. So in Australia, all reusable instruments and devices must be approved by the Therapeutic Goods Administration and all processes required for appropriate handling. Uh, must be supplied by the manufacturer of the instrumental device and used in conjunction with the required documents that we've spoken about previously. So it's very important that any item that you use that is marked as single use must not be reprocessed. That instrument just be used must be used, uh, for that once and then then disposed of appropriately so prior to reprocessing, the instrument must be placed into a category, and we use the sporting classification for this to determine then how the instrument must be reprocessed if it's a reusable instrument or device. So the three categories are critical, semi critical and noncritical, so critical instruments are those that penetrate sterile tissue, and they require sterilisation in bags or pouches or wraps, uh, with batch control identification. So these may include extraction, forceps, elevators, um, or other surgical instruments. So batch control identification is a means for tracking the instrument to the patient. And it involves, um, collecting, placing data on the on the instrument, including the date that it was processed, which autoclave cycle it went through and also, um, the the load number that it it went through. We'll go through more information about Repro re reprocessing reusable instruments in year two, so we'll just give a brief overview of that today, um, knowing that we'll come to cover that at at a later date. There are also semi semi critical instruments, and they have contact with intact nonsterile mucosa, or non intact skin. And these, too, must be sterilised. Or they could be single use disposable. So for these, you don't need a batch control ID or the tracking, and they include objects like mouth mirrors, tweezers or restorative instruments such as flat plastics or ball burnishes. And the final cate category is noncritical instruments or equipment, and this is instruments that have contact with intact skin. So for these, it's suitable to clean with detergent or place through the thermal disinfect disinfectant. Um, and they are items such as, uh, face bows, glasses, bib chains or Willis gauges, which are are measuring devices. So now we're gonna talk about the difference between cleaning and disinfection. So cleaning is the removal of foreign material such as soil or organic matter, and it must be done prior to disinfection and sterilisation. So really important to make it clear that if an item cannot be cleaned, then it cannot be disinfected or sterilised. So if that's the case, then that item must be a single use item. So as we talked about before, it's important to clean your instruments at point of use. Um, as dried material makes it harder to clean, and therefore disinfection and sterilisation would be in ineffective. So cleaning can be done by hand with the use, uh, by hand with the, uh, soap and water and brush, or by use of an ultrasonic cleaner. Um, it's probably not recommended to perform manual cleaning with a a scrubbing brush and soap and water. If the facility has the option for use of mechanical machines when you are cleaning, thick utility gloves must be worn over the top of standard medical gloves when cleaning instruments. Um, and this is to prevent sharps injuries from occurring. Disinfection is a process that inactivates non-sporting infectious agents by way of therm, thermal or um, chemical means so this can be done thermally by using a washer. Disinfect. So a washer disinfect looks much like a domestic washing, um, dishwasher, but it is a chemical grade washing machine, and it's really important that you do not use a a domestic dishwasher in place of a thermal washer. Disinfectant and disinfection can also be achieved by using chemicals, so things like alcohols or chlorine for Halide um, hydrogen peroxide or ammonia compounds. And there are three levels, um, of disinfection that you can achieve. There's high level, intermediate and low, so high level is where, um, the disinfection process kills all microbial pathogens. Um, except a large number of bacterial in the sprees and intermediate kills all microbial pathogens as well, except any bacterial in Dispos. And it's bactericidal and fungicidal and vocal and low level kills most vegetative bacteria as well as some viruses. And but it can't be used to destroy bacterial in interposes, uh, fungi or small non lipid viruses. So after the reusable device or instrument has been cleaned, then it is then ready to be sterilised. So sterilisation is a process that renders instruments and devices free of all forms of micro organisms and for office based settings. The the auto club that you use is generally a benchtop auto club, like the one, in the picture there. But if you're in a hospital based setting, then normally you use a much larger automated commercial auto, clove and auto class work by using steam and pressure and and temperature to achieve an environment that kills off the micro organisms. So it's important that the temperature of the order clove reaches 134 °C, and that temperature and pressure is held for a minimum of three minutes, so steam steriliser operate in four stages. So the first is that when the door is closed, the air is removed with a mechanical pump from the chamber, and it's then replaced with steam. So once that happens, the chamber is then heated to the specified temperature. Um, determined by what cycle you select for the cycle. Um, and then all areas of the chamber must be accessible by that steam to ensure that every item is sterilised. The second is time, so penetration time, uh, which is calculated from the least accessible part of the chamber being reached. Um, um, the sorry, the least accessible part of the chamber reaching the optimal temperature and also holding time, which is the minimum time for the entire load to reach the standards needed. And the third part is the steam is removed and the load is dried, and the fourth is, uh, the filtered air then enters into the chamber to restore atmospheric conditions inside the auto club. So it's important to note that when you're removing instruments from the auto cloth that if they come out wet, then unfortunately they're classified as unsterilized. So they would have to go through the reprocessing, um, steps again. So the items must come out from the auto pile dry, and there are specific logs that you must take when you are reprocessing instruments as well. So it's important that you're noting down, uh, who's operating the auto club at the time, the date that the loads are being reprocessed, what the contents are, and also the cycle type and the load numbers that you're using. And again, we'll talk more about this in second year after the items have been sterilised. They'll then be, um, placed into sterile storage until they are ready to be used. The next standard proportion is respiratory hygiene and cough etiquette. So to prevent transmission of respiratory secretions from one person to another, either directly or indirectly, respiratory hygiene and cough etiquette must be adhered to. So this is, um, something that is appropriate not only for healthcare professionals but for, um, the patients and members of the public. And these are These are activities that now most people are now aware of, especially since, uh, the COVID-19 pandemic. So the cough and res, uh, respiratory etiquette includes covering sneezes and coughs with your inner elbow or using a tissue. If you are using a tissue, it's important to dispose of the tissue immediately after use and then performing hand hygiene with soap and water, uh, immediately after another. Standard precaution is the aseptic technique, and these techniques are to be used during in invasive clinical treatments such as surgical extractions and implant procedures to reduce the presence of pathogens from hands, surfaces and equipment. So things like surgical hand scrubs and the use of sterile gloves and maintaining aseptic working fields are all elements that contribute to successful aseptic technique. This procedure is important to prevent pathogens from entering susceptible sites during invasive procedures. So things, um that are invasive or procedures that are invasive will not occur in the literal health school and generally not a technique that oral health therapists need to perform. But it is important for dentists that in your senior years of training, you will learn how to apply aseptic techniques. The next standard precaution is waste and linen linen handling. So this is really important so that you are not transmitting disease from your clinical setting outside. For example, if you use an external linen service for, uh, cleaning your towels and linen, Um, and also, when the waste is being transported to a waste management service, that transmission of disease does not occur in the other settings. So every state in Australia has their own legislation in relation to waste management. So it's really important to seek out state and territory resources for where you're working, uh, for waste management so that you can adhere to the regulations in your location. So standard precautions are to be implemented when handling waste with um, with hand hygiene to follow after handling waste. And it's important with the linen that all linen is to be placed into appropriate linen linen bags prior to being transported to the appropriate laundry. If you need to handle used linen at any time, then P PE must be worn, and hand hygiene is to be performed after handling as well, and it's very important that you separate clean laundry away from contaminated laundry, so ensure that you have a clean area for storage of the clean laundry and you have a separate um, a separate area for where the contaminated laundry is stored prior to it being transported for reprocessing. So in addition to standard precautions, you also need to be aware of transmission based precautions. And these are to be implemented in addition to standard precautions in situations where the standard precautions alone are not enough to pre prevent disease disease transmission from patients with known or suspected infectious diseases. So these diseases might be, um, tuberculosis or measles, SARS COVID-19 or mumps. So transmission based preca precautions include contact precautions, droplet precautions and airborne precautions. So ways of applying these transmission based precautions can include wearing P two respirators, uh, having single patient, dedicated equipment using, UM, single a single isolation rooms for the patients. Um, also having negative pressure rooms. And you can also implement enhanced environmental cleaning and also limiting patient transport between facilities. So it's important to note that you're not expected to be treating anyone with known infectious diseases as part of your, um, placement or training at Latro Health School Dental Clinic. So there's no need to implement transmission based precautions in either setting. But it's really important that you have an understanding that those options are available. Another procedure that we must perform in dental settings is water line management. So in our dental unit water lines. So things that operate our high speed handpiece or our ultrasonic cleaners. Anything that passes water through the lines has potential to, um, have a formation of biofilm. So microbiomes in an organic matrix is known as biofilm and biofilms form in water tubing due to the fluid dynamics. So this is best described by how the fluid flows through the tubing, where the fluid in the very centre of the tube moves the fastest. And as the fluid is further away from the centre of of the tube, the flow of the liquid is reduced just due to the friction on the extremities of the tube, when the biofilm adheres to the walls of the tubing, where it is able to colonise as the water velocity is practically motionless in in at that point. So dental water uh, dental unit water lines can become contaminated by using poor quality water, uh, failure, failure to use aseptic techniques when filling the bottles, and also not cleaning storage bottles appropriately. So water for use in dental chairs, ideally, should be distilled or reverse osmosis water. So some examples of microorganisms that can be found in dental unit. Water lines include Legionella, Oral Streptococci, Staphylococcus, Aries and Candida Albicans. So to prevent our waterline biofilm from forming in our dental unit water lines, uh, such as handpieces triplex and ultrasonic lines these lines they must be flushed regularly. So it's recommended that at the start of the day, the dental water unit lines are flushed for two minutes with running water, and also they need to be flushed for, um, at least 30 seconds between patients as well. So after you flush for 30 seconds between patients and then at the end of the day, the water lines need to be, um, run, dried and left dried until the next, until their next um, use. So suction hoses are also a place where biofilm can form as well, and they need to be flushed with detergent at least daily to remove the bio burden from the lines. So it's recommended that this is completed at the end of the day, and in addition, the suction lines, um, throughout the day should be flushed with a cup of water between uses and if they are, the suction line is heavily soiled with blood, um, or other debris. Then it's important that a detergent is used to be is used to flush through that line at the completion of treatment as well. So to ensure that infection prevention and control standards are met, there are additional required documents that every practise must have, in addition to the guidelines that we spoke about from the AD A and the National Health and Medical Research Council and the Dental Board of Australia. So these include, um, having a site specific infection prevention and control manual that clearly outlines the procedures and policies involved for that setting. You also need to have a record of the health status of healthcare workers, so this includes whether or not they have um Bloodborne viruses. You also need to have incident records, which will record, for example, if someone's had a sharp injury or any other exposure to blood or bodily fluids. And as we briefly discussed, you also need to have a log book for reprocessing reusable instruments. So that clearly outlines, um, how and when the instrument was reprocessed and you also need to have a stra, a staff training or education logbook to prove that staff have been ade adequately trained and understand how to perform infection prevention and control procedures, and there also needs to be a vaccination record. So any healthcare worker, um, is required or recommended to have vaccinations to prevent getting communicable diseases. And the Australian Immunisation Handbook outlines what vaccinations you're required to have. And this includes hepatitis, B, influenza, measles, mumps and rubella, pertussis, varicella and also, if you're working in remote indigenous communities, uh, you're also recommended to have hepatitis A, and I assume in the near future they'll also add in COVID-19 to this list. So as they are strongly recommended. If, for instance, a healthcare worker decides not to go ahead with, uh, the influenza vaccination, then in your vaccination record, you must clearly state that that person has denied uh, the recommendation for getting a vaccination against influenza and outline their reasons for that choice as well, and also stipulate that guidance has been provided as to why um, you recommend them to have that particular vaccination and as a staff member or a healthcare worker, it's also important that you yourself do not attend healthcare settings when you have acute diseases or transmissible diseases. So things like conjunctivitis, gastroenteritis, glandular fever, hand, foot and mouth disease, Influenza, pertussis, head lice, uh, staph or step in, uh, strep infections, tuberculosis, um, viral rashes or respiratory tract infections because you also could be a point for transmission of healthcare associated infections. And it's really important that you do not bring those transmissible diseases into the healthcare setting. Since the beginning of the COVID-19 pandemic, the Australian Dental Association has also recommended additional precautions to put in place to prevent transmission of COVID-19 in dental settings. Um, so this includes providing prescreening of the patient so prior to them, even entering the clinic. It's really important that you screen the patient by by phone prior to the appointment, and this is to assess their in, um, risk status. So if you're going to assess whether or not the patient is a vulnerable patient, for example, whether or not they are elderly or immunosuppressed and also which location the patient is coming from, For example, if they're coming from a hot spot, then you would likely defer treatment. And also you want to advise the patient prior to entering that they do not bring additional people into the health care setting. So in dental settings we, as we discussed. If you're using aerosol generating equipment, it can potentially transmit the disease, um, to other people that are within the clinical area. So if they're bringing along Children or or a career or someone like that, that's fine. But you really need to make sure that they're limiting the amount of extra people that they are bringing with them and make sure it's the bare necessity. Once the patients are in the clinic, we're now asking them to do a preprocedural mouth rinse to reduce the viral load, uh, in their mouth. So this can be done with an essential oil, Um, or it could be done with chlorhexidine, and there are other products available as well. Also, when they're in the clinic, you're gonna be reviewing their medical history to see their disease risk status and also will be performing hand hygiene. So that's applicable not only for the healthcare workers but also for the patients and their, um, additional person that they maybe bringing with them. And it's important that we educate the patients about performing cough and sneeze etiquette as well. So the AD A also recommends enhanced environmental cleaning and also using rubber dam and a high volume suction, Um, when you're doing aerosol generating, Uh, when you're using aerosol generating equipment. So those sort of equipments include using a high speed handpiece, an ultrasonic scaler or the the triplex syringe. So all of these additional precautions, um, are going to help prevent the transmission of COVID-19, but they're also going to enhance our ability to prevent the transmission of any other disease as well. So, in summary, the overall aim of infection prevention and control is to prevent the transmission of healthcare associated infections in healthcare settings. So it's really important that we have an understanding of how disease is, is transmitted and know how to apply the specific standard and transmission based precautions to prevent a disease from transmitting. You may be wondering what would happen if you don't adhere to the infection prevention and control um, procedures and policies that have been recommended to us. Well, if you don't if you don't adhere to them, then there's a high chance that healthcare associated infections would occur, which then have the role on effect of increased morbidity mortality rates and increased consumer and community um, economic burden, and also personally you maybe fined or deregistered, or even the practise that you work for maybe shutdown in response to lacking, to adhere to the the procedures and policies. And also there's potential for you to face legal ramifications as well. So it is quite a serious offence to be non compliant with infection prevention and control. So it's really important that we have a thorough understanding of how the procedures and policies, um, come into play in dental practises. So the overall arching aim for the infection prevention and control is to, uh, to improve consumer outcomes with infection prevention and control policies and procedures.

Healthcare-associated infections (HAI) can arise wherever healthcare activities occur - including simulated clinical labs. Although no live patients are present, students frequently handle sharps, contaminated instruments, and shared work surfaces; without effective precautions, microorganisms can still be transferred between people, equipment, and the learning environment. The same core principles of infection prevention and control therefore apply, regardless of setting.

A Two-Tiered Approach in Simulated Clinics

The Australian Guidelines for the Prevention and Control of Infection in Healthcare mandate a two-tiered strategy:

1. Standard precautions – the baseline protocols used for every procedure in the simulation clinic.

2. Transmission-based precautions – additional measures applied only when a specific infection risk is identified (e.g., a student with a confirmed communicable illness).

Standard Precautions in the Preclinical Lab

Standard precautions assume every person, surface, and instrument could be infectious or susceptible. They are designed to minimise risk while allowing efficient skill development. In a simulated dental environment, they include:

• Performing hand hygiene before gloving and after glove removal.

• Wearing appropriate PPE: gloves, masks, eye protection, gowns.

• Using environmental barriers (e.g., plastic covers) on items that are difficult to disinfect.

• Reprocessing reusable instruments and handling sharps safely.

• Disposing of contaminated waste correctly.

• Maintaining respiratory hygiene and cough etiquette.

• Undertaking regular environmental cleaning of benches, manikins, and simulation units.

• Applying aseptic non-touch techniques when indicated.

• Correctly handling linen and clinical gowns.

By the end of Semester 1 you should be competent in:

• The Five Moments of Hand Hygiene (as defined by Hand Hygiene Australia).

• Correct selection, donning, and doffing of PPE for simulated dental procedures.

National data show oral-health professionals have one of the highest hand-hygiene compliance rates (≈ 94 %), a benchmark we aim to uphold in the simulation clinic. Developing these habits now ensures they carry over seamlessly to patient care later.

Remember: even in a simulated setting, strict adherence to standard precautions protects you, your peers, and the wider clinical environment - and cultivates professional behaviours essential for safe practice.

As the name suggests, Personal Protective Equipment (PPE) refers to equipment and clothing used by individuals to reduce the risk of infection transmission. Importantly, PPE is not only used to protect the individual wearing it, but also to safeguard others - such as peers, educators, and the broader simulated clinical environment.

Although no real patients are present in simulation, students regularly work with materials and instruments that mimic clinical procedures, many of which involve simulated exposure to body fluids such as saliva and blood. As such, PPE must be worn at all times during simulation sessions.

Standard PPE in the simulated clinic includes:

It’s important to remember that no form of Personal Protective Equipment (PPE) is completely fool proof. While PPE provides a strong layer of protection - and should give you a sense of safety when used correctly - gloves are not entirely impermeable, and masks cannot filter out all particles.

In the simulated clinical environment, it’s essential to remain vigilant and support PPE use with other key infection control practices. These include proper hand hygiene, aseptic techniques, safe handling of sharps, and staying up to date with recommended vaccinations. Developing these habits in simulation ensures you are well-prepared for real clinical settings.

Water-line management

In dental settings, water line management is critical due to biofilm formation in water lines of dental units, which can be contaminated by microorganisms like Legionella and Candida albicans. To prevent this, water lines must be flushed regularly, with specific protocols for daily and between-patient flushing. Suction hoses also require daily cleaning.

Water Line Management in the context of dental clinics refers to the protocols and practices aimed at maintaining the cleanliness, safety, and quality of the water used in dental procedures. Since dental unit waterlines (DUWLs) can become contaminated with bacteria, fungi, and biofilms, proper management is essential to prevent the transmission of infections through water that comes into contact with patients.

Key components of water line management include:

1. Water Treatment

• Filtration: Dental units often use filters to reduce the microbial load in the water before it reaches the handpieces or other dental instruments. These filters help remove particles and bacteria.

• Chemical Treatments: Some clinics use chemical disinfectants in waterlines to reduce microbial contamination and prevent biofilm formation within the pipes.

2. Routine Flushing

• Flushing Waterlines: To prevent the buildup of bacteria and biofilm, it is essential to flush waterlines at the beginning of each day and between patients. Typically, waterlines should be flushed for at least 20-30 seconds to expel any stagnant water and reduce microbial growth.

3. Regular Cleaning and Disinfection

• Cleaning and Disinfection: Dental waterlines require regular cleaning using specific cleaning agents designed to remove biofilm and contaminants. The frequency of cleaning depends on the manufacturer's instructions but is typically done weekly or bi-weekly.

• Disinfecting Solutions: Some dental units are designed to accept special disinfectant solutions that help control microbial growth in waterlines. These solutions are typically used periodically in addition to regular cleaning.

4. Use of Sterile Water for Certain Procedures

• In some cases, particularly for high-risk procedures or when treating immunocompromised patients, sterile water may be used instead of tap water. This ensures that the water used is free from any potential pathogens that may cause infection.

5. Monitoring Water Quality

• Microbial Testing: Regular testing of the water quality is important to ensure that the waterlines are free from harmful levels of bacteria and other pathogens. Water quality should be tested at least quarterly.

• Water Quality Standards: Dental clinics should adhere to national or international standards for water quality, ensuring that the water meets safety criteria for patient care.

6. Maintenance of Waterline Equipment

• Regular maintenance and servicing of dental units are essential to ensure that waterlines are functioning correctly. This includes checking for leaks, replacing filters, and ensuring that the disinfection systems are working effectively.

Effective water line management helps reduce the risk of waterborne infections, maintaining a hygienic and safe clinical environment for both patients and healthcare professionals.

Water Management & Infection Control 

So in addition to standard precautions, you also need to be aware of transmission based precautions. And these are to be implemented in addition to standard precautions in situations where the standard precautions alone are not enough to pre prevent disease disease transmission from patients with known or suspected infectious diseases. So these diseases might be, um, tuberculosis or measles, SARS COVID-19 or mumps. So transmission based preca precautions include contact precautions, droplet precautions and airborne precautions. So ways of applying these transmission based precautions can include wearing P two respirators, uh, having single patient, dedicated equipment using, UM, single a single isolation rooms for the patients. Um, also having negative pressure rooms. And you can also implement enhanced environmental cleaning and also limiting patient transport between facilities. So it's important to note that you're not expected to be treating anyone with known infectious diseases as part of your, um, placement or training at Latro Health School Dental Clinic. So there's no need to implement transmission based precautions in either setting. But it's really important that you have an understanding that those options are available. Another procedure that we must perform in dental settings is water line management. So in our dental unit water lines. So things that operate our high speed handpiece or our ultrasonic cleaners. Anything that passes water through the lines has potential to, um, have a formation of biofilm. So microbiomes in an organic matrix is known as biofilm and biofilms form in water tubing due to the fluid dynamics. So this is best described by how the fluid flows through the tubing, where the fluid in the very centre of the tube moves the fastest. And as the fluid is further away from the centre of of the tube, the flow of the liquid is reduced just due to the friction on the extremities of the tube, when the biofilm adheres to the walls of the tubing, where it is able to colonise as the water velocity is practically motionless in in at that point. So dental water uh, dental unit water lines can become contaminated by using poor quality water, uh, failure, failure to use aseptic techniques when filling the bottles, and also not cleaning storage bottles appropriately. So water for use in dental chairs, ideally, should be distilled or reverse osmosis water. So some examples of microorganisms that can be found in dental unit. Water lines include Legionella, Oral Streptococci, Staphylococcus, Aries and Candida Albicans. So to prevent our waterline biofilm from forming in our dental unit water lines, uh, such as handpieces triplex and ultrasonic lines these lines they must be flushed regularly. So it's recommended that at the start of the day, the dental water unit lines are flushed for two minutes with running water, and also they need to be flushed for, um, at least 30 seconds between patients as well. So after you flush for 30 seconds between patients and then at the end of the day, the water lines need to be, um, run, dried and left dried until the next, until their next um, use. So suction hoses are also a place where biofilm can form as well, and they need to be flushed with detergent at least daily to remove the bio burden from the lines. So it's recommended that this is completed at the end of the day, and in addition, the suction lines, um, throughout the day should be flushed with a cup of water between uses and if they are, the suction line is heavily soiled with blood, um, or other debris. Then it's important that a detergent is used to be is used to flush through that line at the completion of treatment as well. So to ensure that infection prevention and control standards are met, there are additional required documents that every practise must have, in addition to the guidelines that we spoke about from the AD A and the National Health and Medical Research Council and the Dental Board of Australia. So these include, um, having a site specific infection prevention and control manual that clearly outlines the procedures and policies involved for that setting. You also need to have a record of the health status of healthcare workers, so this includes whether or not they have um Bloodborne viruses. You also need to have incident records, which will record, for example, if someone's had a sharp injury or any other exposure to blood or bodily fluids. And as we briefly discussed, you also need to have a log book for reprocessing reusable instruments. So that clearly outlines, um, how and when the instrument was reprocessed and you also need to have a stra, a staff training or education logbook to prove that staff have been ade adequately trained and understand how to perform infection prevention and control procedures, and there also needs to be a vaccination record. So any healthcare worker, um, is required or recommended to have vaccinations to prevent getting communicable diseases. And the Australian Immunisation Handbook outlines what vaccinations you're required to have. And this includes hepatitis, B, influenza, measles, mumps and rubella, pertussis, varicella and also, if you're working in remote indigenous communities, uh, you're also recommended to have hepatitis A, and I assume in the near future they'll also add in COVID-19 to this list. So as they are strongly recommended. If, for instance, a healthcare worker decides not to go ahead with, uh, the influenza vaccination, then in your vaccination record, you must clearly state that that person has denied uh, the recommendation for getting a vaccination against influenza and outline their reasons for that choice as well, and also stipulate that guidance has been provided as to why um, you recommend them to have that particular vaccination and as a staff member or a healthcare worker, it's also important that you yourself do not attend healthcare settings when you have acute diseases or transmissible diseases. So things like conjunctivitis, gastroenteritis, glandular fever, hand, foot and mouth disease, Influenza, pertussis, head lice, uh, staph or step in, uh, strep infections, tuberculosis, um, viral rashes or respiratory tract infections because you also could be a point for transmission of healthcare associated infections. And it's really important that you do not bring those transmissible diseases into the healthcare setting. Since the beginning of the COVID-19 pandemic, the Australian Dental Association has also recommended additional precautions to put in place to prevent transmission of COVID-19 in dental settings. Um, so this includes providing prescreening of the patient so prior to them, even entering the clinic. It's really important that you screen the patient by by phone prior to the appointment, and this is to assess their in, um, risk status. So if you're going to assess whether or not the patient is a vulnerable patient, for example, whether or not they are elderly or immunosuppressed and also which location the patient is coming from, For example, if they're coming from a hot spot, then you would likely defer treatment. And also you want to advise the patient prior to entering that they do not bring additional people into the health care setting. So in dental settings we, as we discussed. If you're using aerosol generating equipment, it can potentially transmit the disease, um, to other people that are within the clinical area. So if they're bringing along Children or or a career or someone like that, that's fine. But you really need to make sure that they're limiting the amount of extra people that they are bringing with them and make sure it's the bare necessity. Once the patients are in the clinic, we're now asking them to do a preprocedural mouth rinse to reduce the viral load, uh, in their mouth. So this can be done with an essential oil, Um, or it could be done with chlorhexidine, and there are other products available as well. Also, when they're in the clinic, you're gonna be reviewing their medical history to see their disease risk status and also will be performing hand hygiene. So that's applicable not only for the healthcare workers but also for the patients and their, um, additional person that they maybe bringing with them. And it's important that we educate the patients about performing cough and sneeze etiquette as well. So the AD A also recommends enhanced environmental cleaning and also using rubber dam and a high volume suction, Um, when you're doing aerosol generating, Uh, when you're using aerosol generating equipment. So those sort of equipments include using a high speed handpiece, an ultrasonic scaler or the the triplex syringe. So all of these additional precautions, um, are going to help prevent the transmission of COVID-19, but they're also going to enhance our ability to prevent the transmission of any other disease as well. So, in summary, the overall aim of infection prevention and control is to prevent the transmission of healthcare associated infections in healthcare settings. So it's really important that we have an understanding of how disease is, is transmitted and know how to apply the specific standard and transmission based precautions to prevent a disease from transmitting. You may be wondering what would happen if you don't adhere to the infection prevention and control um, procedures and policies that have been recommended to us. Well, if you don't if you don't adhere to them, then there's a high chance that healthcare associated infections would occur, which then have the role on effect of increased morbidity mortality rates and increased consumer and community um, economic burden, and also personally you maybe fined or deregistered, or even the practise that you work for maybe shutdown in response to lacking, to adhere to the the procedures and policies. And also there's potential for you to face legal ramifications as well. So it is quite a serious offence to be non compliant with infection prevention and control. So it's really important that we have a thorough understanding of how the procedures and policies, um, come into play in dental practises. So the overall arching aim for the infection prevention and control is to, uh, to improve consumer outcomes with infection prevention and control policies and procedures.