POLICIES, PROCEDURES AND GUIDELINES
AUSTRALIAN INFECTION PREVENTION AND CONTROL GUIDELINES:
Authorised by Dr Scott Davis, President, Australian Dental Association. (2023). Guidelines for Infection Prevention and Control Fifth Edition. Australian Dental Association, St Leonards, Australia.
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Australian Government National Health and Medical Research Council Australian Commission on Safety and Quality in Healthcare (2024). Australian Guidelines for the Prevention and Control of Infection in Health Care. Sydney, Australia.
NEW ZEALAND INFECTION PREVENTION AND CONTROL GUIDELINES:
Dental Council Te Kaunihera Tiaki Niho. (2024). Infection prevention and control practice standard. Wellington, New Zealand
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DEFINITIONS:
The Australian Commission on Safety and Quality in Health Care (ACSQHC): ACSQHC leads and coordinates key improvements in safety and quality in healthcare across Australia. Its purpose is to contribute to better health outcomes and experiences for all patients and consumers, and improved value and sustainability in the health system, by leading and coordinating national improvements in the safety and quality of healthcare.
https://www.safetyandquality.gov.au
Australian Guidelines for the Prevention and Control of Infection in Health Care (AICG): This is a joint publication of the Australian Commission on Safety and Quality in Healthcare (ACSQHC) and the National Health and Medical Research Council (NHMRC).
Active air removal: Processes for enhancing the removal of air and penetration of steam into load items that are hollow or porous. Examples include positive pressure methods using steam pulses (purge under pressure, assisted air removal) with alternating inflow and outflow of steam, and negative pressure methods using a vacuum pump (single vacuum pulse, pre-vacuum, preliminary vacuum) or multiple vacuum pulse (fractionated vacuum).
Aerosol-generating behaviour (AGB): Normal activities of people that create aerosols, including breathing, speaking and shouting.
Aerosol-generating procedure (AGP): These include procedures that use any of the following devices: high-speed handpieces, low-speed/prophy handpieces, surgical handpieces, ultrasonic and sonic devices, air polishing devices and hard tissue lasers. Use of the triplex when air and water are used together or when used with air on a wet surface is considered an AGP.
Australian and New Zealand Standards (AS or AS/NZS): Documents produced by Standards Australia that set out specifications, procedures and guidelines that aim to ensure products, services and systems are safe, consistent and reliable. These are referred to as either AS or AS/NZS followed by the relevant standard number and the year of publication.
Alcohol-based hand rub (ABHR): An alcohol-containing preparation (liquid, gel or foam) designed to reduce the number of viable microorganisms on the hands without the use or aid of running water (National Hand Hygiene Initiative, 2023).When hands are visibly clean, the recommended product for hand hygiene in healthcare is ABHR.
Antibacterial hand wash: A detergent-based formulation with proven antibacterial activity, intended to be used with water in a handwashing procedure.
Australian Register of Therapeutic Goods (ARTG): The database of the Therapeutic Goods Administration (TGA) that provides information on therapeutic goods that can be supplied in Australia.
https://www.tga.gov.au/resources/artg
Aseptic technique: The techniques that maintain objects and areas as free from microorganisms as possible. This is required during invasive procedures such as surgical procedures or extractions, i.e. where the defences of the body are breached. Aseptic technique is an element of standard precautions. These measures protect patients from healthcare-associated infections and protect healthcare workers from contact with blood and other body fluids.
Aseptic Non-Touch Technique (ANTT®): A method to achieve asepsis by the unique approach of Key-Part and Key-Site Protection, through a combination of standard precautions, non-touch technique and the use of ‘critical’ and ‘general’ aseptic fields.
https://www.antt.org/what-is-antt.html
Autoclave: See steam steriliser.
Aseptic technique: Aseptic technique is an element of standard precautions. Aseptic technique is a set of practices that protects patients from healthcare-associated infections and protects healthcare workers from contact with blood, body fluid and body tissue.
Bare below the elbow: All wrist, or nail jewellery (e.g. rings with stones or non-smooth surfaces, bangles and bracelets), watches and wearable devices such as ‘Fitbits’ must be removed by clinical staff, and skin below the elbow is not to be covered by clothing, prior to clinical staff engaging in direct patient care or in the reprocessing of reusable medical devices (RMDs), as their presence impairs correct hand hygiene, compromises the fit and integrity of gloves and promotes the growth of skin microorganisms. The bare below the elbow concept also includes wearing short sleeves (including for jackets and scrubs) and not wearing clothing with long sleeves unless rolled up and secured above the elbows.
Batch control identification (BCI): Also referred to as tracking or traceability, BCI is the ability to link a patient procedure involving RMDs back to the records for a specific steriliser cycle. This is done for an individual set, package or cassette of RMDs, by transferring batch information from the label into the patient’s record for that appointment. This includes the date of processing, cycle or load number, and if more than one steam steriliser is in use, its identification number.
Biological indicator (BI): A test system containing viable microorganisms providing a specified resistance to a specified sterilisation process. A common configuration is for a BI to contain the highly heat-resistant spores of Geobacillus stearothermophilus – hence the terminology ‘spore test’ was previously used.
Blood and body fluid exposure (BBFE): An incident involving exposure to blood or other human material. BBFEs include needle stick injuries, cuts with sharp objects or contact of mucous membranes or non-intact skin with blood, tissues or other bodily fluids that are potentially infectious.
Blood-borne viruses (BBVs): A term that includes hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). These viruses are transmitted primarily by blood-to-blood contact.
Bowie-Dick type test: An air removal and steam penetration test for porous loads in steam sterilisers with pre-vacuum cycles. For small steam sterilisers with pre-vacuum cycles, the degree of challenge in such tests must match (or be equivalent to) the reference porous load challenge described in ISO 1114.6:2022.[1]
Communicable Diseases Network Australia (CDNA): A network comprising government representatives (state, territory, federal and New Zealand) and representatives from relevant organisations that provides national public health coordination and leadership and supports best practice for the prevention and control of communicable diseases. The CDNA also provides nationally consistent advice and guidance to public health units in responding to a notifiable disease event such as a pandemic.
https://www.health.gov.au/resources/collections/cdna-series-of-national-guidelines-songs
Chemical indicator (CI): A device (such as a strip or card) that reveals whether there has been a change in one or more sterilisation process variables. Chemical indicators may respond to heat, steam or other factors.
Cleaning: The removal of visible contaminants, including material residues and biological materials, to render an item visibly clean and suitable for further processing (such as steam sterilisation) or for intended use (in the case of non-critical items). For RMDs, mechanical cleaning methods are preferred due to their greater consistency.
Clinical support staff: Those staff, other than registered dental practitioners, who assist in the provision of dental services – including but not limited to dental assistants, dental laboratory assistants, sterilising/reprocessing assistants and dental technicians. It is recognised that some individuals may have both clinical and administrative roles.
Competent person: Someone who has acquired, through education, training, qualification, experience or a combination of these, the knowledge and skill enabling that person to competently perform the task required.
Contaminated zone: That area of work in which direct contamination by patient fluids (blood and body fluids, including saliva) may occur by transfer, splashing or splatter of material. It includes the operating field in the dental operatory, as well as the area for cleaning RMDs within the reprocessing room.
Dental Board (DBA): The Dental Board of Australia.
Dental practitioner: An inclusive term for those registered by the DBA to provide clinical dental care to patients. This includes general dentists, dental specialists, dental prosthetists, dental therapists, dental hygienists and oral health therapists.
Dental staff: An inclusive term for all those employed in a dental practice setting – namely, dental practitioners, clinical support staff and clerical or administrative staff.
Disinfectant: A substance:
- that is recommended by its manufacturer for application to an inanimate object to kill microorganisms; and
- that is not represented by the manufacturer to be suitable for internal use.
Disinfection: Destruction of pathogenic and other kinds of microorganisms by physical or chemical means.
Endodontic file: An instrument used during endodontic therapy (root canal treatment). Includes hand and rotary engine-driven instruments. May also be referred to as ‘root canal instruments’ (as per ISO 3630-1:1992[2]). ‘Endodontic files’ is the more common contemporary term, as per the Global Medical Device Nomenclature (GMDN) code.
Exposure incident: Any incident where a contaminated object or substance breaches the integrity of the skin or mucous membranes or comes into contact with the eyes (i.e. BBFE).
Exposure prone procedures (EPPs): Procedures where there is a risk of injury to dental practitioners resulting in exposure of the patient’s open tissues to the blood of the practitioner. EPPs are defined in the 2019 edition of the CDNA Australian National Guidelines for the Management of Health Care Workers Known to be Infected with Blood-Borne Viruses Procedures and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses as procedures where the fingertips are out of sight for a significant part of the procedure, or during certain critical stages, and in which there is a distinct risk of injury to the healthcare worker’s (HCW) gloved hands from sharp instruments, needle tips and/or sharp tissues, including spicules of bone or teeth.
Fallow time: A period in which an operatory is ‘rested’ before being used again to allow aerosols suspended in the air to settle, after which any settled particles can then be removed through the environmental cleaning processes.
Fit check: A test performed each time a HCW puts on a particulate filter respirator (PFR, P2/N95 respirator) to make sure it is properly applied. This ensures the respirator fits the user’s face snugly (i.e. creates a seal) to minimise the number of particles that can bypass the filter through gaps between the user’s skin and the respirator seal.
Fit test: A validated method for matching particulate filter respirators (P2/N95 respirators) with an individual HCW’s face shape, which is performed by an appropriately trained person.
Fomite: An inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host by serving as a passive vector. Common examples include high-touch surfaces (doorknobs, switches, mobile phones and other personal electronic devices).
Gap analysis: An approach to achieving conformity to a standard that begins with an assessment of what is currently in place and how that compares to the mandatory requirements of a new standard. This identifies the gaps that must be addressed to ensure conformity with the new standard and informs the development of a staged plan of action that helps to plan resources and timeframes.
Hand hygiene: A general term applying to processes that aim to reduce the number of microorganisms on hands. This includes applying alcohol-based hand rub to hands or using a soap solution (plain or antimicrobial) and water.
Hand wash: Hand hygiene that uses both liquid soap and water.
Healthcare workers (HCW). All people delivering healthcare services who have contact with patients or body substances. This includes dental practitioners and clinical support staff.
Helix test: A term that was used prior to 2022 for a process challenge device with a coil design for assessing air removal and steam penetration in hollow loads. This term is no longer current and is included here for historical reference only.
Infection prevention and control (IPC): The creation of safe healthcare environments through the implementation of evidence-based practices that minimise the risk of transmission of infectious agents (NHMRC, 2019).
Instructions for use (IFU): Detailed, action-oriented, step-by-step written and visual instructions provided by the manufacturer of equipment to guide the user in the use of and/or reprocessing of that item
Multidrug-resistant organisms (MRO): Microorganisms that are resistant to one or more classes of antimicrobial agents.Multi-resistant organisms can include bacteria, fungi and viruses.
Negative pressure room: A patient care room used to isolate/treat persons with a suspected or confirmed airborne infectious disease. Environmental factors are controlled in negative pressure rooms to minimise the transmission of infectious agents that are usually transmitted by droplet nuclei associated with coughing or aerosolisation of contaminated fluids. The air handling system operates at a lower pressure with respect to adjacent areas such as the hallway or corridor and is exhausted to the outside (NHMRC 2019, p. 306). The negative pressure room must comply with the Australasian Health Facility Design guidelines.
National Hand Hygiene Initiative (NHHI): The NHHI promotes the use of alcohol-based hand rub at the point of care for all clinical situations where hands are visibly clean.
National Health and Medical Research Council (NHMRC): An expert body supporting the translation of health and medical research into better health outcomes and promotion of the highest standards of ethics and integrity in health and medical research.
Penetrating injury: Any injury from a sharp object such as an injection needle, scalpel blade, dental bur, matrix band or denture clasp contaminated with a patient’s blood or saliva.
Particulate filter respirator (PFR): Particulate filter respirators are designed to reduce the wearer’s respiratory exposure to airborne contaminants such as particles, gases or vapours. P2/N95 respirators are types of PFR.
Process challenge device (PCD): A device that contains a chemical indicator (e.g. Class 2) in a special container that poses a defined resistance to air removal and steam penetration. For small steam sterilisers, such tests must match the level of challenge posed by the reference hollow load described in ISO 1114.6:2022.
Personal protective equipment (PPE): A variety of barriers used alone, or in combination, to protect mucous membranes, skin and clothing, from contact with infectious agents. PPE includes gloves, masks or respirators, protective eyewear, face shields and gowns/aprons.
Product family: RMDs that have similar attributes in terms of processing and present a similar challenge to cleaning and sterilisation processes because of similar shape, size and material of construction, and the presence or absence of lumens. Examples of separate product families include solid metallic dental hand instruments (e.g. excavators, extraction forceps, periodontal probes, Gracey curettes), solid metal hand instruments with polymer grips (e.g. ergonomic scalers), polymer items (e.g. mouth props, dental dam frames), hollow items (piezoelectric scaler barrels, high-speed air turbine handpieces, metal triplex tips, metal suction tips), and sealed sterilisable surgical motors.
Reusable medical device (RMD): This refers to any instrument or device (such as a handpiece) where the item is designated or intended by the manufacturer as suitable for processing and reuse. These items may be separately packaged or formed into sets.
RMD recall: The identification and retrieval of non-conforming RMDs and the identification of patients for whom they may have been used. Non-conforming includes a failure to clean or sterilise items.
Single-use item: A device supplied to a dental practice that is specified by the manufacturer as being for use in a single visit of patient care. These will be marked with a specific symbol:
Standard aseptic technique: IPC strategy applied to routine procedures that involve the use of critical instruments (e.g. extractions). Standard aseptic technique aims to promote asepsis by protecting the critical (active) parts of RMDs and the critical site during the procedure. This includes the Aseptic Non-Touch Technique (ANTT®) for critical sites.
Standard precautions: First-line IPC practices that are applied to all patients, regardless of their perceived or confirmed infectious status, to ensure a basic level of IPC. These evidence-based practices are designed to both protect healthcare personnel and prevent the spread of infections among patients.
Steam steriliser: A device that uses moist steam under pressure for sterilising RMDs. Previously referred to as an autoclave. May be categorised in terms of size (based on EN13060, into large (60 litres and above) or small), and by the types of cycles (B, S and N).
Sterilant: An agent which achieves a sterility assurance level of 10−6 [1 in 1 million].
Sterile barrier system (SBS): The minimum package that minimises the risk of ingress of microorganisms and allows aseptic presentation of the sterile contents at the point of use. Within the SBS may be a containment device, such as a cassette, to facilitate the organisation of RMDs. A sterile barrier system, such as a pouch, may be supplied in a form that is ready for filling and final closure or sealing. Examples include paper-plastic pouches and non-woven polypropylene wrap for steam sterilisation, and polyethylene pouches for low-temperature hydrogen peroxide gas plasma sterilisation.
Surgical aseptic technique: Techniques applied to all surgical procedures where a sterile field must be maintained to ensure asepsis of the surgical site. Consists of additional measures including the use of sterile gloves, surgical hand hygiene, sterile drapes and equipment covers, sterile irrigation solutions and RMDs (such as surgical instruments) that are sterile at the point of use (with batch control identification).
Therapeutic Goods Administration (TGA): A branch of the Commonwealth government that evaluates, assesses and monitors medicines, medical devices and biological agents.
Tracking: Also known as traceability. Labelling and record keeping processes that connect the sterilising history of an RMD and the clinical use of the RMD. Includes batch control identification (BCI) as a component.
Transmission-based precautions: Additional IPC practices used in situations where standard precautions alone may be insufficient to prevent infection (e.g. for patients known or suspected of being infected or colonised with infectious agents that may not be contained with standard precautions alone). There are three types of transmission-based precautions: contact, droplet and airborne precautions.
[1] Sterilization of health care products.
[2] Dental root canal instruments. Part 1: Files, reamers, barbed broaches, rasps, paste carriers, explorers and cotton broaches. European Standards in Dentistry.
