PPE is part of Standard Precautions for infection prevention and control in the dental surgery.
Personal Protective Equipment (PPE) is part of Standard Precautions for infection prevention and control in the dental surgery.
Whilst protecting the dental team from exposure to infections at work, PPE should not be relied on for sole protection. PPE should be used in combination with other preventive measures such as safe working practices, adequate surgery ventilation and immunisation.
Clinical members of the dental team should be trained in proper use and selection of PPE required during clinical work and instrument decontamination.
PPE used in dentistry is required to be CE marked as this guarantees appropriate functional performance.
Used PPE is disposed of as hazardous clinical waste.
Gloves are recommended for all dental treatment but should not be worn as an alternative to hand washing. They are single use items and are donned at the start of the treatment and removed at the end of the procedure.
To avoid contaminating oneself, remove gloves aseptically so that the outside of the glove is not touched with the bare hand. Note that gloves can develop tears during use and may leak, so hands are required to be cleaned after disposing of gloves.
Gloves made of nitrile or neoprene are preferred over latex gloves as both staff and patients can become sensitised to latex and accelerators used in glove manufacture.
Sterile gloves should always be used for invasive surgery.
Heavy duty gloves rather than examination gloves are worn for cleaning of dental instruments as they are less likely to be punctured by sharp instruments and protect hands from irritant chemicals. Examination gloves can however be worn underneath heavy duty gloves.
Heavy duty gloves do not need to be worn when using an ultrasonic cleaner or washer disinfector unless manufacturer requirements state otherwise.
It is important to realise that gloves do not prevent sharps injuries.
Eyewear protects against splatter and foreign bodies such as amalgam fragments.
Spectacles do not provide sufficient eye protection as they lack side protection. Unless they have been specifically designed for the purpose, spectacles should not be worn in replacement of visors or googles.
Goggles or visors should be worn during all types of dental treatment or when manually cleaning instruments.
Visors have the added advantage of preventing contaminated gloved hands from touching the face and should be worn over spectacles and loupes.
Prior to any dental examination or treatment, patients must be given eye protection, and this must be worn at all times during the procedure.
Conventional masks are single use PPE and recommended for all dental procedures.
The main function of conventional masks is to provide barrier protection against splatter. Most masks produce a poor facial seal and therefore do not protect the wearer effectively from aerosol inhalation.
Some multi-layered masks with metal nose strips if adapted closely to the face will provide up to 70% air filtration.
Touching the outer surface of the mask should be avoided due to potential contamination. Masks should never be worn under the chin as this may contaminate skin and clothes.
Conventional masks should be removed at the end of the patient’s treatment by breaking or undoing the straps and lifting over the ears, then disposed of as clinical waste.
Unlike conventional masks, particulate respirator masks filter the inhaled air and remove microbes. They do not filter out gases.
When fitted and worn correctly, respirator masks seal firmly to the face, reducing the risk of air leakage and providing up to 98% filtering protection (FFP3 mask).
Uniforms are not usually made of materials that are impermeable to body fluids and are therefore not considered PPE.
The choice of wearing a plastic apron or gown is based on the risk.
Wear a single use plastic apron if there is a risk that clothing may be exposed to blood or saliva such as during aerosol generating procedures, or scaling & root planning when there is likely to be excessive bleeding.
Wearing a plastic apron is advised when performing instrument decontamination.
Remove the apron by breaking the neck straps and folding the apron in on itself. Be careful to only touch the inner surface as the outer surface is likely to be heavily contaminated.
Store stocks of aprons away from potential contamination.
Wear a single use, long-sleeved, fluid-repellent gown if there is a risk of extensive splashing of blood and body fluids onto skin or clothing such as during minor oral surgery, periodontal or implant surgery.
When wearing gloves with gowns, these should be worn over the cuff of the to reduce contamination and wetting.
To ensure compliance with guidelines that state hand hygiene is carried out ‘bare below the elbow’, hand hygiene should be carried out before donning the gown.
The practice should promote a specific dress code. It is necessary to present a smart and professional appearance to support health and safety legislation and infection prevention controls.
Uniforms should be short sleeved which will allow a thorough clinical or surgical scrub. If a nurse or clinician needs to wear full sleeves due to medical or religious reasons then disposable sleeves should be worn. No cardigan or jumper can be worn in the clinical area.
Uniforms should be changed on a daily basis and washed at a high temperature to prevent cross contamination. Always check the manufacturer’s instructions before washing.
Uniforms and surgery shoes should not be worn outside of the practice at any time. Staff should travel to and from work in their own clothes and change into uniform at the practice. All footwear must be safe, sensible and appropriate to the working environment.
Long hair, i.e. hair that has grown passed the shoulders, is to be tied back neatly.
One set of earrings can be worn but these must be studs or sleepers.
Rings are not allowed to be worn in clinical areas. Wedding rings are permitted; however the skin beneath must be washed and dried thoroughly.
Medical watches are allowed in clinical areas, ensuring that they are attached to the staff member’s uniform at all times.
Nails must be kept short, i.e. nails that have not grown past the fingertip when viewed from the palm. False nails, and nail varnish are not permitted.
Facial and body piercings, excluding ear piercings, should be removed or covered.
Tattoos must be covered.
Order Of Placement of PPE
It is important to ensure that personal protective equipment is applied in the correct order.
Placement of PPE should be performed in the following steps:
Order of Removal Of PPE
It is important to ensure that personal protective equipment is removed in the correct order.
Removal of PPE should be performed in the following steps:
|Step 1. Put apron over your head and fasten at the back.||Step 1. Grasp the outside of a glove with the opposite gloved hand and peel off. Hold the removed glove in the gloved hand. Slide the un gloved finger under the remaining glove at the wrist.|
|Step 2. Secure and tie mask or fit elastic around ears.||Step 2. Peel the remaining glove off over the first removed glove. Dispose of in clinical waste bin.|
|Step 3. Fit mask tight to nose and under chin.||Step 3. Unfasten or break ties at he back of the apron. Pull apron away from the neck, lifting over the head. Touching only the inside, fold or roll into a bundle. Dispose of in a clinical waste bin.|
|Step 4. Place over face and eyes.||Step 4. Handle and remove only by the headband or sides.|
|Step 5. Adjust to fit.||Step 5. Disinfect or change shield.|
|Step 6. Extend over wrist.||Step 6. Unfasten or break ties, first from the bottom, then the top. Pull away from the face without touching front of mask. Dispose of in clinical waste bin.|
|Isopharm advise the removal of PPE as stated, however guidance documents may advise that the mask is removed before the goggles/face shield.|