Surgery Procedures

Numerous studies have shown that the keyboard and mouse are especially vulnerable to contamination by staff, and that the micro-organisms may remain viable for weeks. 

Procedures at the Start of the Day

The procedures and sequences are likely to vary from practice to practice where the environment and equipment will be different.

However the following indicates the typical procedures that would be carried out at the start of the day within a surgery, where a practice has a separate decontamination room there will be separate procedures throughout the day.

Ensure Appropriate PPE is Available

The PPE appropriate to the tasks should be put on as described in the personal protection section; this would include gloves and plastic apron and will also include mask and visor depending on the work being carried out.

Preparing all Water Lines

The Dental Unit Water Lines, aspirators, spittoons should be prepared in accordance with the manufacturers’ instructions. DUWLs should be flushed for at least two minutes at the start of each session, taking care to avoid splashing and the generation of aerosols.

Prepare Detergents

If liquid detergents are used (for impression disinfection for example) it will be necessary to make up a solution of the appropriate concentration and temperature as defined by the manufacturer. Where disposable detergent wipes are used this would not be necessary.

Clean all Surfaces

Clean the surfaces defined by the cleaning protocol, working from high to low avoiding the use of dry cloths, as these will disperse dust into the atmosphere rather than removing it.

Cover Equipment

If used, fit disposable single-use covers to surgery items such as inspection light handles and headrests. While these are recommended, they are not a substitute for regular cleaning they should be removed, discarded as clinical waste and surfaces should be cleaned after each patient contact with new covers fitted.

Prepare Instruments and Disposable Items

It is important to only set out the instruments required for a particular patient treatment, all instruments set out for a patient treatment must be considered to be contaminated, even if they are not used.

The packaging of instruments into commonly used sets, such as examination and restoration, may be of benefit to the workflow and reduce the need to select individual instruments.

Likewise, the storage system used should minimise the handling required to remove additional instruments should this prove necessary but this should be avoided if possible to minimise the opportunities to contaminate the stored instruments.

Computer Equipment

Some equipment such as the mouse, keyboard and monitors all have the potential to harbour pathogens and thus present the risk of cross infection of patients and staff.

Numerous studies have shown that the keyboard and mouse are especially vulnerable to contamination by staff and that the micro-organisms may remain viable for weeks.

Ideally the principals of hand hygiene applied to patient contact should also be applied to computer use but this may be difficult to implement in a working environment.

it is strongly recommended that the mouse and keyboard wherever possible are sealed units so that they can be cleaned and disinfected between patients or decontamination activities to mitigate the risk of cross infection. A combined detergent and disinfectant wipe is an effective method of cleaning.

Day Lists and Lab Work

These should be checked to ensure that the surgery can be set up for patients with ease and to assist the dentist in keeping to time with appointments

HTM 01-05 states that areas and items of equipment local to the dental chair that need to be cleaned between each patient include:

  • Local work surfaces.
  • Dental chairs.
  • Curing lamps.
  • Inspection lights and handles.
  • Hand controls including replacement of covers.
  • Trolleys and delivery units.
  • Spittoons.
  • Aspirators.
  • X-ray units.

In addition, computer keyboards and mouse should be cleaned as part of the work surface cleaning. Where combined detergent and disinfectant wipes are used, a separate wipe should be used for each surface to prevent the spread of contamination.

DUWLs should be flushed for 20 to 30 seconds.

Dental chairs should also include the dentist and dental nurse stools, and these should all be checked for visible damage such as rips and tears.

Reusable instruments should be sent to the decontamination room where applicable.

Clinical waste needs segregating and disposing of appropriately.

PPE should be changed.

Procedures at the End of Each Session

As stated in HTM 01-05, the following items should be cleaned after every session:

  • Taps.
  • Drainage points.
  • Splash backs.
  • Sinks.

Procedures at the End of the Day

In addition to the end-of-session cleaning, HTM 01-05 states that the following should be cleaned daily:

  • Cupboard doors.
  • Other exposed surfaces such as dental inspection light fittings.
  • Floor surfaces, including those distant from the dental chair.

All clinical staff should be aware of these procedures, training should be provided, and these tasks should be discussed at staff meetings to ensure the procedures suit the practice.