About the Authors Dr Caroline L. Pankhurst BSc, BDS, MSc, PhD, MRCPath, is a former Clinical Senior Lecturer in Oral Microbiology at the Dental Institute of King’s College London and a Specialist in Oral Microbiology. Professor Wilson A. Coulter BSc, BDS, PGCert Ed, MSc, PhD, FRCPath, is a Professor of Oral Microbiology at the University of Ulster and former Consultant/Reader in Oral Microbiology at the School of Medicine and Dentistry, Queen’s University Belfast. The authors are dentally qualified medical microbiologists with extensive experience in the field of infection control in dentistry. They have published numerous scientific studies in the field, the findings of which have been presented at conferences around the world. Both authors have served on government advisory bodies on infection control and decontamination, and teach dentists, nurses, therapists and hygienists at both pre- and post-qualification level in the UK and overseas.

“This is a reputable source of infection control and prevention protocols, and this update is necessary to maintain current guidelines on infection control. The book can be used as an additional resource for U.S.-based practices, but it may not be suitable as the sole book because some information is pertinent only to U.K. practice. The book is very thorough if used for proper practice guidelines, but more detail may be necessary based on individual practices” Maria Prassas, RDH, MEd, MOT, University of Illinois at Chicago College of Dentistry on behalf of Doody’s

• Foreword viiiPreface ixAcknowledgements xAbout the companion website xi1 Essentials of infection control 1Why do we need infection control in dentistry? 1Relative risk and risk perception 2Risk assessment and the management decision‐making process 3How to perform a risk assessment in a dental practice 4Hierarchy of risk management control 6Infection control and the law 7Legal acts under which dental practice is conducted 8Published standards and guidance 12Team approach to prevention of infection 132 Communicable diseases in the dental surgery 16How infections are spread 16Reservoirs and sources of infection 18Infectious diseases by route of infection in dentistry 19Infectious disease by route of transmission in the dental surgery 20Emerging and re‐emerging pathogens 283 Occupational health and immunization 34Occupational health hazards 34Building a culture of safety 35Organizing staff health in a dental practice 37Immunization requirements for dentistry 39Protecting women of childbearing age 39Occupational vaccines to protect against hepatitis and TB 43Health checks and the consequences of blood‐borne virus infection 46Health clearance 47Duty of care to patients 504 Sharp safe working in the dental surgery 53Why sharps prevention is important 53When do sharps injuries occur? 55Preventable sharps injuries 56How to avoid a sharps injury 56Managing sharps injuries and splashes 60Occupational health risk assessment for BBV exposure 62Management of hepatitis C exposures 62Postexposure prophylaxis for HIV and hepatitis B 64Recording of sharps injuries 66Clinical governance and accident risk assessment 665 Hand hygiene 68Hands as a source of infection 68Hands as a source of hospital‐acquired infection 69Hand hygiene and teamworking 70Hand hygiene technique 76Hand care and prevention of dermatitis 826 Personal protection for prevention of cross‐infection 85Why we wear personal protective equipment 85The role of gloves 86Choosing a suitable glove for the task 88Managing an allergy to NRL gloves 88Managing latex allergies in patients 90Masks and when to use them 91Protective eyewear and visors 95Protection during cardiopulmonary resuscitation 97Tunics and uniforms 99Protective barriers – plastic aprons and surgical gowns 1027 Sterilization and disinfection of dental instruments 105Decontamination cycle 105Why has cleaning become so important? 106Legal requirements and technical standards for decontamination 107Where should instrument decontamination take place? 110Design of dedicated decontamination units 110Purchasing of dental equipment 117Cleaning of dental instruments 118Disinfection of dental handpieces 121Mechanical cleaning with an ultrasonic bath 124Thermal washer disinfectors 126Instrument inspection 130Dental instrument sterilization 130Suitability of sterilizer for different loads 130Sterilizer installation and validation 131Steam purity and maintenance of water reservoir chamber 132How do you know your sterilizer is working? 133Loading the sterilizer 138Storage of wrapped and unwrapped instruments 138Single‐use items 142Variant CJD and rationale for single‐use items 144Disinfection of heat‐sensitive equipment and hard surfaces 144Disinfection of dental impressions 1468 Dental surgery design, surface decontamination and managing aerosols 148Dental surgery design 148Survival of microbes on surgery surfaces 153General cleaning 154Surface decontamination in the dental surgery 156Management of aerosols and splatter 162Managing large blood or body fluid spillages 1649 Management of dental unit waterlines 167What are biofilms? 167Risk to staff and patient health from dental unit waterlines 168Methods to reduce the biofilm 173Control of legionellae in the dental practice water supply 18010 Healthcare waste management 182Legislation on hazardous waste disposal 182Types of waste 184What is hazardous waste? 185Clinical waste segregation and classification 189Amalgam waste and installation of amalgam separators 193Mercury in the environment 193Disposal and handling of hazardous waste in the surgery 195Safe handling of clinical waste prior to disposal 197Bulk storage of waste for collection 197Transport of hazardous waste 198Benefits of waste segregation 19811 Transport and postage of diagnostic specimens, impressions and equipment for servicing and repair 201Legal framework 201Collecting specimens 202Transport of specimens to the laboratory 203Transport restrictions 204Fixed pathological specimens 205Transporting impressions 206Equipment to be sent for service or repair 206Appendix 208Table A.1 Daily infection control clinical pathway 208Table A.2 Decontamination methods for specific instruments and items of dental equipment 211Table A.3 Examples of hand and hard surface disinfectants and dental unit waterline biocides 214Index 217

About the Authors Dr Caroline L. Pankhurst BSc, BDS, MSc, PhD, MRCPath, is a former Clinical Senior Lecturer in Oral Microbiology at the Dental Institute of King’s College London and a Specialist in Oral Microbiology. Professor Wilson A. Coulter BSc, BDS, PGCert Ed, MSc, PhD, FRCPath, is a Professor of Oral Microbiology at the University of Ulster and former Consultant/Reader in Oral Microbiology at the School of Medicine and Dentistry, Queen’s University Belfast. The authors are dentally qualified medical microbiologists with extensive experience in the field of infection control in dentistry. They have published numerous scientific studies in the field, the findings of which have been presented at conferences around the world. Both authors have served on government advisory bodies on infection control and decontamination, and teach dentists, nurses, therapists and hygienists at both pre- and post-qualification level in the UK and overseas.

“This is a reputable source of infection control and prevention protocols, and this update is necessary to maintain current guidelines on infection control. The book can be used as an additional resource for U.S.-based practices, but it may not be suitable as the sole book because some information is pertinent only to U.K. practice. The book is very thorough if used for proper practice guidelines, but more detail may be necessary based on individual practices” Maria Prassas, RDH, MEd, MOT, University of Illinois at Chicago College of Dentistry on behalf of Doody’s

• Foreword viiiPreface ixAcknowledgements xAbout the companion website xi1 Essentials of infection control 1Why do we need infection control in dentistry? 1Relative risk and risk perception 2Risk assessment and the management decision‐making process 3How to perform a risk assessment in a dental practice 4Hierarchy of risk management control 6Infection control and the law 7Legal acts under which dental practice is conducted 8Published standards and guidance 12Team approach to prevention of infection 132 Communicable diseases in the dental surgery 16How infections are spread 16Reservoirs and sources of infection 18Infectious diseases by route of infection in dentistry 19Infectious disease by route of transmission in the dental surgery 20Emerging and re‐emerging pathogens 283 Occupational health and immunization 34Occupational health hazards 34Building a culture of safety 35Organizing staff health in a dental practice 37Immunization requirements for dentistry 39Protecting women of childbearing age 39Occupational vaccines to protect against hepatitis and TB 43Health checks and the consequences of blood‐borne virus infection 46Health clearance 47Duty of care to patients 504 Sharp safe working in the dental surgery 53Why sharps prevention is important 53When do sharps injuries occur? 55Preventable sharps injuries 56How to avoid a sharps injury 56Managing sharps injuries and splashes 60Occupational health risk assessment for BBV exposure 62Management of hepatitis C exposures 62Postexposure prophylaxis for HIV and hepatitis B 64Recording of sharps injuries 66Clinical governance and accident risk assessment 665 Hand hygiene 68Hands as a source of infection 68Hands as a source of hospital‐acquired infection 69Hand hygiene and teamworking 70Hand hygiene technique 76Hand care and prevention of dermatitis 826 Personal protection for prevention of cross‐infection 85Why we wear personal protective equipment 85The role of gloves 86Choosing a suitable glove for the task 88Managing an allergy to NRL gloves 88Managing latex allergies in patients 90Masks and when to use them 91Protective eyewear and visors 95Protection during cardiopulmonary resuscitation 97Tunics and uniforms 99Protective barriers – plastic aprons and surgical gowns 1027 Sterilization and disinfection of dental instruments 105Decontamination cycle 105Why has cleaning become so important? 106Legal requirements and technical standards for decontamination 107Where should instrument decontamination take place? 110Design of dedicated decontamination units 110Purchasing of dental equipment 117Cleaning of dental instruments 118Disinfection of dental handpieces 121Mechanical cleaning with an ultrasonic bath 124Thermal washer disinfectors 126Instrument inspection 130Dental instrument sterilization 130Suitability of sterilizer for different loads 130Sterilizer installation and validation 131Steam purity and maintenance of water reservoir chamber 132How do you know your sterilizer is working? 133Loading the sterilizer 138Storage of wrapped and unwrapped instruments 138Single‐use items 142Variant CJD and rationale for single‐use items 144Disinfection of heat‐sensitive equipment and hard surfaces 144Disinfection of dental impressions 1468 Dental surgery design, surface decontamination and managing aerosols 148Dental surgery design 148Survival of microbes on surgery surfaces 153General cleaning 154Surface decontamination in the dental surgery 156Management of aerosols and splatter 162Managing large blood or body fluid spillages 1649 Management of dental unit waterlines 167What are biofilms? 167Risk to staff and patient health from dental unit waterlines 168Methods to reduce the biofilm 173Control of legionellae in the dental practice water supply 18010 Healthcare waste management 182Legislation on hazardous waste disposal 182Types of waste 184What is hazardous waste? 185Clinical waste segregation and classification 189Amalgam waste and installation of amalgam separators 193Mercury in the environment 193Disposal and handling of hazardous waste in the surgery 195Safe handling of clinical waste prior to disposal 197Bulk storage of waste for collection 197Transport of hazardous waste 198Benefits of waste segregation 19811 Transport and postage of diagnostic specimens, impressions and equipment for servicing and repair 201Legal framework 201Collecting specimens 202Transport of specimens to the laboratory 203Transport restrictions 204Fixed pathological specimens 205Transporting impressions 206Equipment to be sent for service or repair 206Appendix 208Table A.1 Daily infection control clinical pathway 208Table A.2 Decontamination methods for specific instruments and items of dental equipment 211Table A.3 Examples of hand and hard surface disinfectants and dental unit waterline biocides 214Index 217

About the Authors Dr Caroline L. Pankhurst BSc, BDS, MSc, PhD, MRCPath, is a former Clinical Senior Lecturer in Oral Microbiology at the Dental Institute of King’s College London and a Specialist in Oral Microbiology. Professor Wilson A. Coulter BSc, BDS, PGCert Ed, MSc, PhD, FRCPath, is a Professor of Oral Microbiology at the University of Ulster and former Consultant/Reader in Oral Microbiology at the School of Medicine and Dentistry, Queen’s University Belfast. The authors are dentally qualified medical microbiologists with extensive experience in the field of infection control in dentistry. They have published numerous scientific studies in the field, the findings of which have been presented at conferences around the world. Both authors have served on government advisory bodies on infection control and decontamination, and teach dentists, nurses, therapists and hygienists at both pre- and post-qualification level in the UK and overseas.

“This is a reputable source of infection control and prevention protocols, and this update is necessary to maintain current guidelines on infection control. The book can be used as an additional resource for U.S.-based practices, but it may not be suitable as the sole book because some information is pertinent only to U.K. practice. The book is very thorough if used for proper practice guidelines, but more detail may be necessary based on individual practices” Maria Prassas, RDH, MEd, MOT, University of Illinois at Chicago College of Dentistry on behalf of Doody’s

• Foreword viiiPreface ixAcknowledgements xAbout the companion website xi1 Essentials of infection control 1Why do we need infection control in dentistry? 1Relative risk and risk perception 2Risk assessment and the management decision‐making process 3How to perform a risk assessment in a dental practice 4Hierarchy of risk management control 6Infection control and the law 7Legal acts under which dental practice is conducted 8Published standards and guidance 12Team approach to prevention of infection 132 Communicable diseases in the dental surgery 16How infections are spread 16Reservoirs and sources of infection 18Infectious diseases by route of infection in dentistry 19Infectious disease by route of transmission in the dental surgery 20Emerging and re‐emerging pathogens 283 Occupational health and immunization 34Occupational health hazards 34Building a culture of safety 35Organizing staff health in a dental practice 37Immunization requirements for dentistry 39Protecting women of childbearing age 39Occupational vaccines to protect against hepatitis and TB 43Health checks and the consequences of blood‐borne virus infection 46Health clearance 47Duty of care to patients 504 Sharp safe working in the dental surgery 53Why sharps prevention is important 53When do sharps injuries occur? 55Preventable sharps injuries 56How to avoid a sharps injury 56Managing sharps injuries and splashes 60Occupational health risk assessment for BBV exposure 62Management of hepatitis C exposures 62Postexposure prophylaxis for HIV and hepatitis B 64Recording of sharps injuries 66Clinical governance and accident risk assessment 665 Hand hygiene 68Hands as a source of infection 68Hands as a source of hospital‐acquired infection 69Hand hygiene and teamworking 70Hand hygiene technique 76Hand care and prevention of dermatitis 826 Personal protection for prevention of cross‐infection 85Why we wear personal protective equipment 85The role of gloves 86Choosing a suitable glove for the task 88Managing an allergy to NRL gloves 88Managing latex allergies in patients 90Masks and when to use them 91Protective eyewear and visors 95Protection during cardiopulmonary resuscitation 97Tunics and uniforms 99Protective barriers – plastic aprons and surgical gowns 1027 Sterilization and disinfection of dental instruments 105Decontamination cycle 105Why has cleaning become so important? 106Legal requirements and technical standards for decontamination 107Where should instrument decontamination take place? 110Design of dedicated decontamination units 110Purchasing of dental equipment 117Cleaning of dental instruments 118Disinfection of dental handpieces 121Mechanical cleaning with an ultrasonic bath 124Thermal washer disinfectors 126Instrument inspection 130Dental instrument sterilization 130Suitability of sterilizer for different loads 130Sterilizer installation and validation 131Steam purity and maintenance of water reservoir chamber 132How do you know your sterilizer is working? 133Loading the sterilizer 138Storage of wrapped and unwrapped instruments 138Single‐use items 142Variant CJD and rationale for single‐use items 144Disinfection of heat‐sensitive equipment and hard surfaces 144Disinfection of dental impressions 1468 Dental surgery design, surface decontamination and managing aerosols 148Dental surgery design 148Survival of microbes on surgery surfaces 153General cleaning 154Surface decontamination in the dental surgery 156Management of aerosols and splatter 162Managing large blood or body fluid spillages 1649 Management of dental unit waterlines 167What are biofilms? 167Risk to staff and patient health from dental unit waterlines 168Methods to reduce the biofilm 173Control of legionellae in the dental practice water supply 18010 Healthcare waste management 182Legislation on hazardous waste disposal 182Types of waste 184What is hazardous waste? 185Clinical waste segregation and classification 189Amalgam waste and installation of amalgam separators 193Mercury in the environment 193Disposal and handling of hazardous waste in the surgery 195Safe handling of clinical waste prior to disposal 197Bulk storage of waste for collection 197Transport of hazardous waste 198Benefits of waste segregation 19811 Transport and postage of diagnostic specimens, impressions and equipment for servicing and repair 201Legal framework 201Collecting specimens 202Transport of specimens to the laboratory 203Transport restrictions 204Fixed pathological specimens 205Transporting impressions 206Equipment to be sent for service or repair 206Appendix 208Table A.1 Daily infection control clinical pathway 208Table A.2 Decontamination methods for specific instruments and items of dental equipment 211Table A.3 Examples of hand and hard surface disinfectants and dental unit waterline biocides 214Index 217