CLINICAL

STANDARD OPERATING
PROCEDURES

Primary Dental
VERSION 3.2 MASTER

1
TABLE OF CONTENTS
TABLE OF CONTENTS........................................................................................................................................................ 2
PURPOSE AND SCOPE ...................................................................................................................................................... 5
RESPONSIBILITY AND ACCOUNTABILITY ..................................................................................................................... 5
COMPLIANCE ...................................................................................................................................................................... 6

Section One: INFECTION PREVENTION & CONTROL ................................................................................ 7

DEFINITIONS & UNDERPINNING KNOWLEDGE .......................................................................................... 8

INFECTION PREVENTION ................................................................................................................................................. 8
STANDARD PRECAUTIONS .............................................................................................................................................. 8
TRANSMISSION-BASED PRECAUTIONS ........................................................................................................................ 8
CONTACT PRECAUTIONS ................................................................................................................................................. 9
DROPLET PRECAUTIONS .................................................................................................................................................. 9
AIRBORNE PRECAUTIONS ............................................................................................................................................... 9
STERILISING, DISINFECTING AND CLEANING ............................................................................................................. 9
DUTY OF CARE ................................................................................................................................................................. 10

1.1. Employee & practitioner health ............................................................................................................ 11

TEAM MEMBERS WITH AN INFECTION ...................................................................................................................... 11
VACCINATIONS ................................................................................................................................................................ 12

1.2. DENTAL ENVIRONMENT .......................................................................................................................... 13

CLEAN ZONES................................................................................................................................................................... 13
CONTAMINATED ZONES ............................................................................................................................................... 15

1.3. HAND HYGIENE ......................................................................................................................................... 17

ALCOHOL-BASED HANDRUB ........................................................................................................................................ 17
HANDWASHING ............................................................................................................................................................... 18
HAND CARE ...................................................................................................................................................................... 20

1.4. PERSONAL PROTECTIVE EQUIPMENT ................................................................................................... 23

GOWNS .............................................................................................................................................................................. 24
DURAPEL SPILL RESISTANT DENTAL JACKETS .......................................................................................................... 25
DISPOSABLE GOWNS ...................................................................................................................................................... 25
CHANGING AREA ............................................................................................................................................................. 25
EYEWEAR ........................................................................................................................................................................... 26
MASKS ................................................................................................................................................................................ 26
GLOVES .............................................................................................................................................................................. 27
STORAGE OF GLOVES AND MASKS ............................................................................................................................. 28
FOOTWEAR........................................................................................................................................................................ 28
REMOVAL OF PPE ............................................................................................................................................................ 29
PPE FOR PATIENTS .......................................................................................................................................................... 30

1.5. PPE WHEN REPROCESSING INSTRUMENTS ........................................................................................ 31

HEAVY DUTY GLOVES ..................................................................................................................................................... 31
APRONS ............................................................................................................................................................................. 32

1.6. CLEANING AND DISINFECTING PRODUCTS........................................................................................ 33

1.7. STERILISATION ROOM MANAGEMENT ................................................................................................ 38

AUTOCLAVE START OF DAY PROCEDURE .................................................................................................................. 39
ULTRASONIC CLEANER START OF DAY PROCEDURE .............................................................................................. 40
INSTRUMENT REPROCESSING AREAS AND ACCESSORIES .................................................................................... 40
ULTRASONIC UNIT FOIL TEST ....................................................................................................................................... 42

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 VACUUM TEST .................................................................................................................................................................. 44
HELIX TEST ........................................................................................................................................................................ 45
CLOSING THE STERILISATION ROOM ......................................................................................................................... 47

1.8. DAILY CLINICAL ROOM MANAGEMENT .............................................................................................. 51

START OF DAY SET UP .................................................................................................................................................... 51
BETWEEN PATIENTS – CLEANING THE CLINICAL ROOM ....................................................................................... 54
RED/GREEN CARD ........................................................................................................................................................... 57
END OF DAY PROCEDURES ........................................................................................................................................... 57

1.9. PROCESSING OF RE-USABLE INSTRUMENTS ..................................................................................... 59

CLASSIFICATION OF INSTRUMENTS ........................................................................................................................... 59
OVERVIEW OF INSTRUMENT FLOW IN STERILISATION ROOM ............................................................................ 61
SORTING, CLEANING AND DRYING ............................................................................................................................ 63
MANUAL CLEANING ....................................................................................................................................................... 64
HANDPIECES ..................................................................................................................................................................... 66
NICKEL-TITANIUM (NITI) ENDODONTIC FILES ......................................................................................................... 68
BURS ................................................................................................................................................................................... 69
CLEANING IN THE ULTRASONIC UNIT ....................................................................................................................... 70
PACKAGING INSTRUMENTS .......................................................................................................................................... 72

1.10. BATCH CONTROL IDENTIFICATION .................................................................................................... 73

RECORDING OF CYCLE DATA ....................................................................................................................................... 73
ASSIGNING ITEMS TO A BATCH ................................................................................................................................... 74

1.11. STERILISATION OF INSTRUMENTS ...................................................................................................... 80

STORAGE OF STERILISED INSTRUMENTS ................................................................................................................... 84

1.12. BCI IN THE CLINICAL ROOM ................................................................................................................ 85

ASSIGNING ITEMS TO A PATIENT ................................................................................................................................ 85
RECORDING INSTRUMENT BATCH DETAILS ............................................................................................................. 86
MANUALLY ENTERING BATCH INFORMATION ........................................................................................................ 86

1.13. MANAGEMENT OF SHARPS .................................................................................................................. 89

HANDLING OF SHARPS .................................................................................................................................................. 89
DISPOSAL OF SHARPS .................................................................................................................................................... 90

1.14. MANAGING BLOOD & BODY FLUID EXPOSURES ............................................................................ 91

SHARPS & NEEDLE STICK INJURIES ............................................................................................................................ 91
OTHER EXPOSURES ......................................................................................................................................................... 92

1.15. WASTE MANAGEMENT .......................................................................................................................... 93

DISPOSAL OF CLINICAL WASTE ................................................................................................................................... 93
AMALGAM WASTE MANAGEMENT ............................................................................................................................. 94

1.16. SURGICAL PROCEDURES ....................................................................................................................... 95

DEFINITIONS AND SCOPE ............................................................................................................................................. 95
PRACTICAL REQUIREMENTS FOR A SURGICAL PROCEDURE ................................................................................ 96
WHEN A STANDARD EXTRACTION BECOMES A SURGICAL EXTRACTION ......................................................... 98
FOLLOWING A SURGICAL PROCEDURE ...................................................................................................................... 99

1.17. WATER QUALITY MANAGEMENT ...................................................................................................... 100

DENTAL UNIT WATERLINES ........................................................................................................................................100
WATER FOR AUTOCLAVES ...........................................................................................................................................101

Section Two: CLINICAL ASSISTING .......................................................................................................... 103

2.1. WORKING WITH CENTRALISED INTRUMENTS AND MATERIALS ................................................. 104

TREATMENT TRAY SET-UP ...........................................................................................................................................104
STORAGE OF CONSUMABLES .....................................................................................................................................108

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 CENTRALISED INSTRUMENTS AND HANDPIECES ..................................................................................................109
TREATMENT TRAY STORAGE IN THE CLINICAL ROOM.........................................................................................110

2.2. MORNING HUDDLES .............................................................................................................................. 111

TEAM HUDDLES .............................................................................................................................................................111
MINI-HUDDLES ..............................................................................................................................................................113
10 TIPS FOR SUCCESSFUL MORNING HUDDLES ....................................................................................................114

2.3. RADIOGRAPHY ......................................................................................................................................... 116

OPG RADIOGRAPHS ......................................................................................................................................................116
SET-UP ..............................................................................................................................................................................117
PROTECTIVE APRONS ...................................................................................................................................................118
TAKING A RADIOGRAPH ..............................................................................................................................................119
GENDEX DENOPTIX QST SYSTEM ..............................................................................................................................120

2.4. IMPRESSIONS AND LAB WORK ............................................................................................................ 129

PREPARING IMPRESSIONS ..........................................................................................................................................129
LAB WORK IN..................................................................................................................................................................131
PREPARING LAB WORK FOR THE APPOINTMENT ..................................................................................................132

2.5. FOUR HANDED DENTISTRY .................................................................................................................. 133

KEY POINTS FOR EFFECTIVE FOUR-HANDED DENTISTRY ....................................................................................135

2.6. MEDICATION MANAGEMENT ............................................................................................................. 138

STORAGE OF SCHEDULE 4 AND SCHEDULE 8 DRUGS ..........................................................................................138
STORAGE OF LOCAL ANAESTHETIC CARTRIDGES .................................................................................................140

2.7. Nitrous Oxide ........................................................................................................................................... 141

SAFE STORAGE ...............................................................................................................................................................141
SAFE HANDLING ............................................................................................................................................................141

Section Three: EQUIPMENT MAINTENANCE ......................................................................................... 143

DAILY DENTAL UNIT MAINTENANCE ........................................................................................................................144
DENTAL UNIT FILTERS ..................................................................................................................................................147
SUCTION UNIT WEEKLY MAINTENANCE ..................................................................................................................149
ANNUAL PREVENTIVE MAINTENANCE .....................................................................................................................149

APPENDICES ..................................................................................................................................................... 151

APPENDIX A ....................................................................................................................................................................152
APPENDIX B ....................................................................................................................................................................155
APPENDIX C ....................................................................................................................................................................157
APPENDIX D ....................................................................................................................................................................159
VERSION CONTROL.......................................................................................................................................................160
DOCUMENT LOCATION ...............................................................................................................................................160
SOP MAINTENANCE ......................................................................................................................................................160
UPDATES ..........................................................................................................................................................................161

primary medical & dental centre

address

ph:
email:

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INTRODUCTION TO STANDARD
OPERATING PROCEDURES
DOCUMENT
PURPOSE AND SCOPE
The Primary Dental Clinical Standard
Operating Procedure (SOP) document
describes the mandatory processes and
guidelines for the Dental team at Primary
Dental to follow.
The instructions and processes are to be
implemented by all dental employees,
contracted temp agency workers and
independent dental practitioners in order to
provide a high standard of care and safety
to patients.
The document does not include the policies
of Primary Dental but all details within the
SOPs must comply with those policies.
RESPONSIBILITY AND
ACCOUNTABILITY
Each employee is responsible for ensuring
they follow these procedures and
understand the objectives of each directive
described within the SOP. Reporting line
managers are accountable for ensuring their
direct reports follow these procedures.
Dental Coordinators must be able to
identify when a procedure is not being
followed and rectify with their team. Six-
monthly quality reviews assess each centre’s
compliance with many of the areas in the
SOPs and corrective actions are taken if any
areas are found to be non-compliant.
Employees not meeting the requirements
set out in the SOPs will be consulted and
performance management may be required
if the lack of compliance is repeated or of a
serious nature. Actions deemed as serious
misconduct can lead to dismissal.
In order to minimise the risk of transmission
of a preventable disease occurring within
the dental centre, the infection prevention
and control procedures outlined in this
document must be followed by everyone
working in the dental centre, whether
engaged as an employee or as an
independent dental practitioner.
The ADA's Guidelines for Infection Control
(third edition) state:
"Registered dental practitioners are legally
required to comply with all of the Dental
Board of Australia’s policies and guidelines,
which includes ensuring that mandatory
infection control guidelines are instituted in
full in their practices." (page ii)
Although dental practitioners are
responsible for infection control within the
practice and have a legal duty of care to
patients, many of the procedures relating to
infection prevention and control are
performed by dental employees as a
requirement of their role.
Each dental employee, contracted temp
agency workers and independent dental
practitioners are required to read and sign
acknowledgment of the directives within
this document upon commencement at the
dental centre and whenever a new version is
released.
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COMPLIANCE
THE INFORMATION WITHIN THE CLINICAL
SOP DOCUMENT INCORPO RATES AND
COMPLIES WITH THE FOLLOWING
DOCUMENTS, GUIDELINES AND POLICIES:
• National Safety and Quality Health
Service (NSQHS)
• The Dental Board of Australia’s
Guidelines on Infection Control
• Current Australian Dental
Association (ADA) Guidelines for
Infection Control
• NHMRC Australian Guidelines for
the Prevention and Control of
Infection in Healthcare.
• ADA Practical Guide to Infection
Control
• SAI Global AS/NZ 4815:2006 and AS/NZ
4187
• Work Health and Safety Policies and
Guidelines
• Healius Company Policies
• Primary Dental Policies
• Primary Dental Position Descriptions
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SECTION ONE:
INFECTION
PREVENTION &
CONTROL

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DEFINITIONS & UNDERPINNING
KNOWLEDGE
INFECTION PREVENTION
The purpose of infection prevention
activities in the dental practice is to prevent
the transmission of disease-producing
agents such as bacteria, viruses and fungi;
• From the dental team to patients
• From patients to the dental team and
• From one patient to another
Infection prevention focuses on limiting or
controlling factors influencing the
transmission of infection or contributing to
the spread of microorganisms.
STANDARD
PRECAUTIONS
Standard precautions involve the
assumption that all blood and body
substances are potentially infectious i.e.
every person is a source of infection.
Therefore, safe work practices and
protections must be in place to ensure all
patients are treated equally, regardless of
their known or presumed infectious status.
Standard precautions also apply when
handling known contaminated items in
situations such as instrument reprocessing.
1
https://www.ada.org.au/Transmission-
Based-Precautions
TRANSMISSION-BASED
PRECAUTIONS
Transmission-based precautions 1 are
implemented where standard precautions
alone may be insufficient to prevent further
infection. Transmission-based precautions
are applied in addition to standard
precautions to target infective agents based
on their mode of transmission.
When undertaking transmission-based
precautions, the patient should not be kept
waiting in the waiting area. A streamlined
process for entry in, and exit out of the
facility, reduces the risk of environmental
contamination. Medical history and other
details should be completed prior to the
patient entering the practice, e.g. over the
telephone, and the patient is seen at the
end of the day to allow time for additional
environmental cleaning.
During dental treatment under
Transmission-based precautions, the dental
assistant does not leave the room during
the procedure. An additional staff member
should be available to serve as a “runner” if
the clinician needs items that are outside
the operatory.
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 and other measures will not allow a delay
CONTACT PRECAUTIONS until the patient is no longer infectious.
Contact precautions prevent direct
transmission (via blood or body fluids
coming into contact with mucous
AIRBORNE PRECAUTIONS
membranes or broken skin) or indirect Airborne precautions are required where
transmission (via contaminated hands, health care workers and patients are at risk
clothing, surfaces or devices). Infectious of inhaling small infective particles.
agents that require contact precautions Airborne precautions, such as wearing P2
include methicillin-resistant Staphylococcus (N95) surgical respirators, are designed to
aureus (MRSA) and Clostridium difficile. reduce the likelihood of transmission of
microorganisms that remain infectious over
Contact precautions include: patient
time and distance when suspended in the
isolation, placement of PPE prior to entering
air. These agents may be inhaled by
the patient room, removal of PPE without
susceptible individuals who have not had
causing environmental contamination, strict
face-to-face contact with (or been in the
adherence to hand hygiene procedures,
same room as) the infectious individual.
limited patient movement within the
Infectious agents for which airborne
healthcare facility, greater stringency for
precautions are indicated include measles,
decontamination of impressions and
chickenpox (varicella), and Mycobacterium
laboratory work, environmental cleaning of
tuberculosis, as well as novel respiratory
the patient setting using a TGA registered
pathogens such as H5N1 (avian) influenza,
disinfectant following the manufacturer’s
H7N9 influenza.
instructions.
The implementation of airborne precautions
requires a negative pressure room, and this
DROPLET PRECAUTIONS aspect makes airborne precautions not
suitable for use in a typical office-based
Droplet precautions are required where
practice setting.
large infected respiratory droplets from
coughing, sneezing or talking are directly
transmitted via contact with mucosa (eyes,
nose or mouth) or indirectly via hands or
STERILISING,
from contaminated surfaces within 1 metre.
Infectious agents that require droplet
DISINFECTING AND
precautions include seasonal viral influenza. CLEANING
Droplet precautions require barrier use,
Sterilisation, disinfection and cleaning are
surgical mask, patient placement and
methods of preventing cross contamination.
surface decontamination. These precautions
The term ‘sterile’ means the complete
include (1) the patient is seen as the last
patient of the day; (2) ensuring that staff destruction of all microbes and their spores.
providing treatment have been immunised All critical and most semi-critical items must
against the currently circulating influenza be sterilised before being reused.
strains; (3) use of a pre-procedural mouth
‘Disinfection’ is the inactivation of microbes
rinse; (4) use of a rubber dam for restorative
but not their spores. Disinfection should
procedures; (5) minimising the use of
aerosol-generating techniques; and (6) only be used for non-critical items that
applying two complete cycles of cleaning cannot withstand the heat of sterilisation.
for environmental surfaces. In general, there Cleaning with detergent and water reduces
will be few situations encountered where
the microbial load on a surface by breaking
the patient has a significant dental
up and removing the biofilm. Cleaning is
emergency and where the use of analgesics
required for equipment and items which

9
come into contact with intact skin only. For
example, the dental chair and bench tops.
Cleaning is an essential component to the
sterilisation and disinfection process. An item cannot
be considered sterile or disinfected unless it is clean
first.

DUTY OF CARE
Dental Practitioners and dental practice
employees have a legal duty of care to their
patients and must ensure that effective
infection control measures are in place and
adhered to within the practice. The Dental
Board of Australia stipulates that dental
practitioners must practise in a way that
maintains and enhances public health and
safety by ensuring that the risk of the
spread of infectious diseases is prevented or
minimised. Dental practitioners must ensure
the premises in which they practice are kept
in a clean and hygienic state and to ensure
that, in attending a patient, they take such
steps as are practicable to prevent or
minimise the spread of infectious diseases.

Dental practitioners must take reasonable

steps to accommodate a patient’s disability.
It is a breach of anti-discrimination laws for
dental practitioners to refuse to treat or
impose extra conditions on a patient who
has a disability such as being infected with
or being a carrier of a blood borne virus.

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1.1. EMPLOYEE & PRACTITIONER
HEALTH
TEAM MEMBERS WITH AN INFECTION
As per the NHMRC's Guidelines for the Prevention and
Control of Infection in Healthcare (2019), healthcare workers
with signs or symptoms of an acute illness or infections
should seek appropriate medical care from a doctor
qualified to manage their condition. Where there is a risk of
the healthcare worker transmitting the infection to a patient
or other healthcare worker (eg if he or she is infected with
an acute or other transmissible infection, carries a blood
borne virus, or has a predisposing skin condition), the
healthcare worker should be counselled about work options
and either rostered appropriately or provided with
equipment, information and facilities to enable him or her
to perform their duties without placing others at risk.

The NHMRC's Guidelines for the Prevention and Control of

Infection in Healthcare (2019, page 198-200) outline the
exclusion periods for healthcare workers with acute
infections. This guideline applies to dental employees and
independent dental practitioners working in a Primary
Dental facility.

RESPIRATORY HYGIENE & COUGH

ETIQUETTE
Respiratory hygiene and cough etiquette should be
applied as a standard infection control precaution at all
times. Covering sneezes and coughs prevents infected
persons from dispersing respiratory secretions in the air.

Dental team members with signs and symptoms of

respiratory infection, regardless of cause, should:

• Cover nose and mouth with disposable single use

tissue and dispose of tissue in nearest waste bin
after use

• If no tissue available, cough into inner elbow

11
 • Perform hand hygiene after contact with respiratory
secretions and contaminated objects

• Keep contaminated hands away from eyes

ABHR and tissues should be neatly kept in the patient

lounge or reception areas with a waste bin nearby, to
encourage and enable their use by patients and those
visiting the centre. We cannot make the use of ABHR and
tissues mandatory for patients, but their presence
demonstrates our commitment to infection prevention.

VACCINATIONS
To prevent the transmission of vaccine preventable
diseases, the Australian Immunisation Handbook
recommends all healthcare workers directly involved in
patient care be immunised against:

1. Hepatitis B

2. Pertussis / Tetanus (dTpa)

3. MMR (Measles, Mumps, Rubella)

4. Varicella (Chickenpox)

5. Influenza (annually)

As of February 2020, all independent dental practitioners

working in a Primary Dental facility are to provide evidence
of immunity or serological records related to viruses
numbered 1-4 in the list above.

All dental clinical employees are also required to provide

evidence of immunity or serological records related to
viruses 1-4 in the list above prior to their contract of
employment being generated. All Healius Medical Centre
clinical employees are required to complete a pre-
employment screening for risk factors associated with
Tuberculosis to confirm if further testing and/or vaccination
against Tuberculosis is required. This screening applies to
Primary Dental's employees.

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1.2. DENTAL ENVIRONMENT
The dental clinical and sterilisation areas must have clearly
defined clean and contaminated zones.

Clean and contaminated zones in the sterilisation area

A are demarcated with green lighting in the clean zone and

red lighting in the contaminated zone.

B must be identified with signage.

Handwashing sinks must be clearly marked as such.

CLEAN ZONES
THE CLEAN ZONES OF THE DENTAL PRACTICE
INCLUDE:

• Admin areas – including reception area, dentist

administration desks

• Patient lounge areas

• Meal break areas and restrooms

• Designated ‘clean’ zone in the Sterilisation room

• Clean zones in each surgery eg desk area where

clinician makes notes, benchtops

Although external contract cleaners may be engaged at the

location, it is the responsibility of the team to ensure the
centre is maintained to a high standard of cleanliness to
reduce the risk of transmission of pathogens and to
maintain an environment that reflects the standard of
infection control and professionalism that patients expect of
us. It is the visible cleanliness of the centre that patients will
use to make a judgement of our standards of infection
control and hygiene.

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CLEANING THE CLEAN ZONES
It is important that all surfaces in the dental department be routinely
cleaned to prevent the spread of infection. The below table outlines
the frequency of cleaning required for items and surfaces in the
clean (non-contaminated) areas of the dental centre.

If an object or surface appears dirty or visibly soiled, it should be

attended to as soon as possible.

High traffic areas need to be cleaned more frequently than objects or

subjects that are used less.

Area to be cleaned Frequency Clean with

Reception desk

Administration desk
IC-100
Bathroom basin Daily or neutral detergent

Hand washing sink

Patient refresh station

All hard surface floors in the dental department Floor cleaner

Computer monitor and keyboard

Consult room, desk and Cabinetry

Cabinetry in OPG room

Visual check of walls and kickboards for scuff marks IC-100

Waiting room - tables or neutral detergent

Weekly
Door handles and doors

Telephone handsets in all areas of the dental department

Cupboard doors in sterilisation area, laboratory and

clinical rooms

Shelving in clinical rooms, sterilisation and laboratory area

Window sills and windows Weekly Window cleaner

Stock cupboard shelves IC100

As needed
or neutral detergent

14
CONTAMINATED ZONES
The contaminated zone is the area, which becomes
contaminated by aerosols, splashes and droplets originating
from the patient’s mouth. Aerosols generated from patient
care may extend up to approximately 1 metre.

The contaminated zone also encompasses the areas

potentially contaminated with materials or instruments used
on a patient during a procedure (bracket trays, working
surface on top of trolleys, benches) as well as the
instrument reprocessing area (‘dirty’ zone) in the
sterilisation room.

15
Floorplan of Primary Dental "Centre name" showing contamination 'dirty' zones and 'clean' zones.

KEY

1. Model Trimmer

2. Vacuum former

3. Water distiller

4. Autoclave

5. Biosonic- Ultrasonic bath UC125

6. Lubrina Oiler
Contaminated zones Non contaminated zones
7. Gendex scanner

Want to read more about the zones of the dental centre?

Go to the ADA Guidelines for Infection Control, Page 13, – Environment

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1.3. HAND HYGIENE
ALCOHOL-BASED HANDRUB
Alcohol-based handrub (ABHR) is the gold standard of
care for hand hygiene practice in healthcare settings.

Alcohol-based handrub is the hand hygiene product of

choice for all standard aseptic (non-surgical) procedures,
when hands are visibly clean.

Alcohol-based handrubs should be used (when hands are

visibly clean) instead of handwashing because they:

• Substantially reduce bacterial count on hands

• Require less time than handwashing

• Are more accessible

• Are self-drying

• Are gentler on skin and cause less skin irritation and

dryness than frequent soap and water washes, since
all handrubs contain skin emollient (moisturisers)

At Primary Dental the ABHR of choice is Microshield

Angel Blue Hand Gel Antimicrobial (HSH code JJ-70088)
or AQIUM Antibacterial Hand Gel 375ml (HSH code AQ-
AQIUM375ML)

Reference: Hand Hygiene Australia, Alcohol-Based Handrubs,

accessed 10 th July 2019. https://www.hha.org.au/hand-
hygiene/alcohol-based-handrubs

17
HANDS MUST BE DECONT AMINATED USING AN ABHR:

HANDWASHING
WASH HANDS WITH A HANDWASH SOLUTION AND WATER WHEN:

Handwashing must always be undertaken in a dedicated

handwashing sink.

For instructions on how to handwash and handrub,

please refer to the World Health Organisation’s How to
handrub and How to Handwash poster in Appendix A.

The 5 Moments for Hand Hygiene poster (refer to Appendix

A) describes the five moments in the dental clinical
operatory when hand hygiene is required. These posters
may be displayed above a handwashing sink as a reminder
of the importance of following the correct hand hygiene
protocols.

18
For general handwashing, when hands are not
visibly dirty but a handwash is desired, the
preferred product is MICROSHIELD Handwash
Mild Neutral Formula (pH7 Soap Free)

For a procedural or aseptic hand wash (non-

surgical), the preffered product is
MICROSHIELD 2 Chlorhexidine Skin Cleanser
(with 2% Chlorhexidine Gluconate)

For surgical procedures, an antiseptic

product must be used and the surgical hand
scrubbing technique must be followed. The
preferred product for surgical handwashing
is MICROSHIELD 4 Chlorhexidine Surgical
Handwash (with 4% Chlorhexidine Gluconate)

It is recommended to use a hand moisturiser

2-3 times per day when working in gloves and
frequent hand hygiene is required.
The preferred moisturiser to use with the
MICROSHIELD range of hand hygiene products
is MICROSHIELD Moisturising Lotion.

19
HAND CARE
Any abrasions, cuts or lesions must be covered with a
water resistant dressing. Intact skin is the first line of
defence against infection. The frequent use of soap,
detergents and paper towels by clinical staff can result
in dry skin and in some cases Dermatitis

DERMATITIS

The most common skin irritation is irritant contact

dermatitis. The symptoms include:

• Dryness

• Irritation

• Itching

• Cracking and bleeding (in severe cases)

The following factors can contribute to dermatitis:

• Fragrances and preservatives in hand care products

• Washing hands before or after ABHR

• Donning gloves while hands are still wet

• Using very hot water

• Failure to moisturise appropriately

• Using poor quality, rough paper towels

HAND AND SKIN CARE PROTOCOL

• Dental team members suffering from dermatitis,
skin infections or infected lesions should be
examined by a medical practitioner before
recommencing duties, for their own protection and
in order to minimise potential cross-infection.

• Lacerated, chafed or cracked skin can allow entry of

microorganisms. Any cuts, abrasions, lacerations and
wounds need to be covered with waterproof
dressing

20
 • Artificial fingernails can harbour microorganisms
and must not be worn by dental clinical workers
including dental practitioners and dental assistants

• Any nail polish, including clear polish, is not to be

worn.

• Frequent moisturising and using compatible, TGA

approved moisturising products is essential to avoid
skin sensitivity

HAVE YOU DEVELOPED A SKIN CONDITION?

It’s best to contact your doctor for advice on how to

manage it while you’re at work.

Please let your dental coordinator know if your doctor

recommends a handwashing product that’s not available in
your dental centre. Providing a letter from your doctor
helps those responsible for stock ordering understand the
nature of the condition and what can be done to prevent or
help minimise your symptoms.

HANDY TIP
Prevent skin conditions by:

• Patting your hands dry

instead of wiping or rubbing

• Making sure your hands are

completely dry before
putting gloves on

• Using a moisturiser of the

same brand as the hand
soap and ABHR.

Want to read
• U more about Hand Hygiene? Comprehensive
informationscan be found on the website for the National
Hand Hygiene
i Initiative
https://www.safetyandquality.gov.au/our-work/infection-
n
prevention-and-control/national-hand-hygiene-initiative
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21
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BARE BELOW THE ELBOWS
Dental employees and dental practitioners who have
direct contact with patients or a patient’s environment
(the clinical team) must comply with the steps below:

• Bracelets, wrist watches and rings with stones or

ridges are not to be worn when providing clinical
care. A single ring / band may be worn but should
be avoided if possible.

• Long sleeved clothing must be rolled up above the

elbow so as to not interfere with effective hand
hygiene practices.

• Nails should be kept short and clean - artificial nails

must not be worn and no nail polish.

22
1.4. PERSONAL PROTECTIVE
EQUIPMENT
The correct use of the required PPE is mandatory for all situations
in which there are likely aerosols or any risk of infection.

PUT ON PPE REMOVE PPE

IN THE FOLLOWING ORDER: IN THE FOLLOWING ORDER:

23
ALL PPE MUST BE WORN IN THESE SITUATIONS:

• Set up of clinical rooms

• Assisting / providing treatment to patients chairside

• Clinical room change-over procedure

• End of day cleaning of clinical room

• General cleaning

• Opening and closing of sterilisation room

• Handling contaminated items

• When pouring up and trimming models in the lab

GOWNS
THE TWO CLINICAL GOWN OPTION S ARE:

• Durapel™ spill-resistant dental gowns

(white with embroidered Primary Dental logo)

• Disposable gowns

Both types of gowns are only to be worn in clinical and

sterilisation areas.

Gowns must be removed before entering break areas,

restrooms and before leaving the centre.

It is not necessary to wear a disposable gown over a dental

gown except during a surgical procedure or where there is a
high risk of being splashed with blood or other body fluids.

Gowns must be changed daily and whenever visibly

soiled or contaminated.

24
DURAPEL SPILL RESISTANT DENTAL
JACKETS
The clinical jackets do not need to be removed between
patients. Please leave them on unless visibly soiled or
contaminated.

It is recommended to put ‘worn/contaminated’ work

clothing into a plastic bag after your shift for transporting
them home and change into non-clinical ‘clean’ clothing
for travelling home.

DISPOSABLE GOWNS
Where the Clinical Jackets are not available, the blue
disposable gown can be worn for multiple patients without
removing it.

The disposable gown must be removed:

• When visibly soiled or contaminated with blood or

other body fluids

• Before leaving the clinical area and moving to a

break/meals area or going to the bathroom.

Once removed, the disposable gown should not be put

back on, as doing this increases the chances of your skin
or clothing becoming contaminated.

The disposable gown can be discarded into the general

waste unless visibly soiled.

CHANGING AREA
It is recommended to designate a changing room/area
where team members can have the privacy to change into
and out of their clinical attire upon arriving and before
leaving the dental centre for the day. This includes the
pants and the clinical jacket/tunic or scrubs (tops and
pants) worn in the clinical room and/or sterilisation area.

Dental gown care instructions and replacement guidelines can

be found in the Uniform Policy on Sapphire

25
EYEWEAR
Protective eyewear must be worn when providing treatment to
patients or assisting chairside, when cleaning the clinical room
and when working in the sterilisation and laboratory areas.

Eyewear should be cleaned with detergent between every

patient and at the end of the day.

Prescription glasses don’t provide adequate protection

and if needed should be worn with protective eyewear
or a face shield on top.

Protective eyewear must be removed when not in use and

not worn on top of your head or around your neck.

MASKS
• Should be adapted to the bridge of the nose

• Must cover your nose and mouth, cover your chin

and upper neck.

• Should not be touched with your hands while in use

• Remove the mask by the loop or tie, do not touch

the facial surface of the mask

• Must be discarded directly into a waste bin after use

– not kept on the bench or in a pocket

Masks must not be worn around the neck or chin when

not in use!

26
GLOVES
Gloves must be used whenever there is a risk of exposure to
blood or body substances.

Non-sterile examination gloves must be worn for all non-

surgical dental procedures. Routine extractions do not
require sterile gloves, however if the extraction becomes a
surgical procedure (where the dental practitioner is required
to cut into soft tissue or bone) it becomes mandatory for
the dental assistant and dental practitioner to apply surgical
aseptic techniques, including wearing sterile gloves as the
patient is more exposed and their risk of infection increases.

GLOVES ARE SINGLE USE ONLY AND MUST BE

CHANGED:

• Any time you leave the clinical contamination zone

• After each patient’s procedure

• As soon as they are damaged or heavily

contaminated with blood

• After reprocessing instruments, wiping surgery,

general cleaning

• Before touching anything classified as ‘clean’ such

as an x-ray film removed from its packet.

GLOVES MUST NOT BE WORN WHEN:

• Greeting patients

• In the reception and patient lounge area

• Writing notes, scripts or referrals

• Using the telephone

• Entering cupboards or drawers

• Using the computer (unless barriers are used)

• In break areas and / or restroom

• Touching your face or hair

• Adjusting PPE during a procedure

LATEX ALLERGY

27
A latex allergy is a reaction to certain proteins in latex.
Symptoms of a latex allergy may include dermatitis, itchy skin,
skin lesions, hay fever symptoms, and drop in blood pressure.

If you have a latex allergy please inform your Dental

Coordinator immediately to ensure your work area is latex
free and that you have latex-free gloves and other non-latex
items available.

If a patient or dental clinical team member has an allergy to

latex the nitrile latex-free gloves are recommended.

STORAGE OF GLOVES AND MASKS

Both open and unopened boxes of gloves and masks must
be stored away from potential aerosol or droplet
contamination from a patient.

They should not be stored on a bench but can be kept in

the mask/glove box compartments built into the cabinetry.

If no compartments are built into the cabinetry, gloves,

masks and tissues must be kept in a drawer or cupboard or
outside the contamination zone of the clinical room
(considered to be 1 metre from the patient's mouth)

FOOTWEAR
Open footwear should not be worn in the clinical areas or
the sterilisation room. This includes ballet shoes or other
fashion shoes which expose a large area of the foot to
potential injury. Sturdy, closed in footwear must be worn to
minimise the risk of injury from dropped instruments and
sharps.

28
REMOVAL OF PPE

PPE MUST BE REMOVED BEFORE ENTERING THE

FOLLOWING AREAS:

Admin areas – including reception

area, dentist admin desks

Patient lounge areas

Break / Food preparation

areas and restrooms

29
PPE FOR PATIENTS
For the comfort and safety of each patient, the chairside
dental assistant is to make sure that for the entirety of each
procedure, the patient is wearing:

1. A fluid resistant bib - to protect the patient’s clothes

and upper chest/neck area (where exposed) from
splashes, droplets and aerosols

2. Tinted protective eyewear - with sufficient adaption to

prevent splashes, droplets and aerosols entering the
eyes and protect the patient’s eyes in the case of an
instrument, material or sharp item being dropped by
the dental practitioner or assistant.

The bib and protective glasses should only be applied when

the patient is finished their initial discussions with the
dentist and are ready to be reclined in the dental unit.

Pass the patient the protective glasses and allow them to

apply them themselves. Young children may need some
help applying them.

The bib should be changed during treatment if it becomes

soaked with water or contaminated with blood.

The protective glasses can be removed once treatment is

complete and the patient sits up to rinse.

The bib should only be removed when the patient can leave
the dental unit chair. If the dentist is completing notes or a
treatment plan, keeping the bib on the patient gives the
signal that they are to stay seated, giving the dentist the
time they need to enter item codes, notes and treatment
plan details before the patient ‘runs’ out the door.

The used patient bib must be disposed of directly into the

general waste or clinical waste if heavily contaminated with
blood or saliva.

The bib-chain and glasses must be wiped thoroughly

between patients using a low-lint cloth and neutral
detergent solution (IC-100). When the glasses have dried,
check for streaks and remove with a clean tissue before the
next patient enters, otherwise the patient may perceive the
glasses are dirty.

30
1.5. PPE WHEN REPROCESSING
INSTRUMENTS
HEAVY DUTY GLOVES
There is a higher risk of sharps injury when you are
manually handling dental instruments.

We particularly want to avoid any sharps injuries when

working with contaminated (dirty) instruments, as there is a
higher risk of receiving an infectious agent.

Most sharps injuries occurring at Primary Dental have

happened when scrubbing, handling or drying
contaminated instruments.

TO REDUCE THE RISK OF A SHARPS INJURY, IT IS

MANDATORY TO WEAR HEAVY-DUTY PUNCTURE-
RESISTANT GLOVES WHENEVER HANDLING LOOSE
INSTRUMENTS IN THE STERILISATION ROOM
INCLUDING WHILE:

• Removing instruments from treatment trays

• Loading and unloading instruments from the

ultrasonic unit

• Scrubbing instruments

• Drying instruments

• Packing instruments into steri pouches

The heavy-duty gloves available for this purpose are the

Hu-Friedy lilac utility gloves.

These should be worn on top of clean examination gloves.

They are to be cleaned with neutral detergent and water

at the end of the day and hung up to dry. They are to be
bagged and sterilised in the autoclave once per week.

31
There must be a range of sizes available to fit all team
members who handle contaminated instruments in the
sterilisation room as poorly fitting utility gloves can be a
hazard when handling small instruments and burs.

An alternative is the single-use, blue Matador gloves.

These gloves are puncture resistant and still allow the Matador
dexterity required when handling small instruments and Heavy duty
burs.

These are worn instead of the examination gloves when

handling loose instruments in the sterilisation room.

APRONS
A waterproof disposable apron is to be worn when
reprocessing instruments in the sterilisation room. Aprons
are also recommended when performing any lab work,
handling chemicals or any heavy-duty cleaning like cleaning
out a plaster trap. This must be different to the gown used
in the clinical room.

When not in use the apron should be hung up to dry.

The apron should be changed daily or more often if visibly

contaminated, damaged or compromised.

clea
n

HANDY TIP
Mark your apron with a permanent
marker to show which side is clean
(the side against your clothing) and
which is contaminated (the outside)
so you aren’t using the
contaminated side against your
clothing.

32
1.6. CLEANING AND
DISINFECTING PRODUCTS
When making up a detergent solution, the manufacturer’s
dilution ratio must be strictly adhered to.

A film can form

preventing
Too much effective
sterilisation.
detergent It can also damage
the instruments.

Too little
doesn’t
detergent clean
properly

If a dental unit is new or within its warranty period, the

dental unit’s manufacturer’s instructions must be followed
in respect to cleaning and maintenance.

Do not mix cleaning agents or chemicals together.

33
 Purpose Product When How

Clinical Cleaning of dental IC 100 in spray bottle Start and end of day, after any Spray the IC100 foam onto MediClean low lint wipes at
Room unit, all benchtops Or patient procedure time of use or pre-soak MaxiWipes (250 tub) in IC-100.
and hard surfaces, IC-100 in MaxiWipes tub
equipment not Does not need to be diluted.
required to be
sterilised after use. IC-100 foaming bottles must be correctly labeled.

Disinfection of dental Durr FD 322 with Mediclean • At the start of the day, after MaxiWipes can be soaked in FD 333 in the MaxiWipe
units. wipes the damp dust has been tub.
Or completed, before the first
Disinfection of all Durr FD 333 wipes patient of the day Use soaked wipes or pre-soaked wipes to wipe over all
benchtops, hard surfaces and allow to dry.
surfaces and any • and before lunch break.
equipment not
required to be Do not leave until the end of the
sterilised after use. day.

All surfaces must have been

cleaned with a detergent first
before disinfecting

34
 Purpose Product When How

Sterilisation Instrument IC-100 spray When contaminated instruments Always wipe dirty instruments on gauze at point of use
Room pre-cleaning cannot be cleaned straightaway. to remove excess material or bio matter.

Spray IC-100 foam onto contaminated instruments to

dissolve protein residues, blood and other body fluids
while waiting to be reprocessed.

Can also be soaked in IC-100 solution (does not require

dilution) in a tub in the dirty steri sink.

Biosonic unit BIOSONIC Cleaner & Rust Fill Biosonic unit at start of day and Follow dosage instructions per cleaning solution label.
solution Inhibitor change solution at least once
during the day. More frequently if
the solution becomes cloudy.

Wiping handpieces Kerr Caviwipes To be wiped prior to sterilisation. Wipe over handpiece after oiling to disinfect
prior to sterilisation All handpieces must be sterilised
after being used on a patient.

35
 Purpose Product When How

Dental Unit Daily suction unit Durr Orotol Plus and Daily at end of day Add 2 capfuls of Orotol Plus to the OroCup and fill with
Suction disinfection Orocup water to the 2L line. Attach both suction lines to the
Lines OroCup lid and allow the suction unit to evacuate the
majority of the solution. Leave 250ml of solution to tip
down the spittoon drain.

Weekly suction unit Durr MD 555 Weekly, before lunch break Add 2 capfuls of MD 555 to the OroCup and fill with
treatment and water to the marked water line. Follow the same
disinfection protocol as with Orotol Plus (above).

36
 Purpose Product When How

Dental Unit Daily suction unit Alprojet Daily Daily at end of day Prepare a 5% (100ml of solution with 1900ml of warm
Suction disinfection water) solution in the OroCup.
Lines
Attach both suction lines to the OroCup lid and allow
the suction unit to evacuate the majority of the solution.
Leave 250ml of solution to tip down the spittoon drain.

Weekly suction unit Alprojet Weekly Weekly, before lunch break Prepare 5% (100ml of solution with 1900ml of warm
treatment and water) in the OroCup. Follow the same protocol as with
disinfection
Alprojet Daily (above).

37
1.7. STERILISATION ROOM
MANAGEMENT
At the start of each day, the Sterilisation room needs to be
set up in preparation for the day.
There are a number of tasks required and effective time
management is necessary to ensure tasks are being
completed in the shortest time.

THE 3 KEY STEPS FOR SET UP OF THE STERILISATION ROOM ARE AS FOLLOWS:

Ultrasonic
Cleaner

Autoclave

Instrument
Reprocessing
Areas and
Accessories

38
AUTOCLAVE START OF DAY PROCEDURE

Turn On Autoclave

Run Vacumm Test

Must be completed while chamber is still cold

Once Vacuum test has finished check if successful Record result on

Autoclave Cycle Log

Wipe over door seal and inside chamber with a damp lint-free cloth
Water Only - No Detergent to be used

Add B&D/Helix test to the steriliser

Begin B&D/Helix test cycle

Once B&D/Helix test has finished check if successful

Record result on Autoclave Cycle Log

Complete Instructions on how to perform the Vacuum and

B&D/Helix Tests can be found on page 44-45

39
ULTRASONIC CLEANER START OF DAY PROCEDURE

Turn on Ultrasonic Unit

Damp dust inside and outside of ultrasonic unit

Fill Ultrasonic unit with Water

Add Biosonic Solution

Run De-gas cycle for 5 mins

Complete the Foil test (30 seconds)

Record the Result of the Foil Test

Ensure the test result has been witnessed

Complete Instructions on how to perform the Foil Test

can be found on page 42

40
INSTRUMENT REPROCESSING AREAS AND ACCESSORIES

RESTOCK
Replenish Levels and Confirm Sufficient Supplies available

Sterilisation Tray Set Up

IC-100 Bottles Low Lint Cloths
Pouches Consumables

SET UP
Prepare the area and tools for the day

Instrument New Set of

Procedure
Drying and Clean White Autoclaved
Trays for the
Inspection Apron Instrument
day
Area Brushes

PREPARE
Ensure you are prepared for your day

Water Distiller Complete Daily Steri Proceed to

Refill and Start Cycle Room Checklist Clinical
Room Set Up

Complete Daily Steri Room Proceed to Clinical Room 41

Checklist Set Up
ULTRASONIC UNIT FOIL TEST
Once per day a Foil Test must be performed on each
ultrasonic unit to ensure it is removing debris from
instruments effectively.

THIS TEST MUST BE PERFORMED DAILY.

You must wear an apron, mask, protective eyewear and

gloves when performing this test.

1. Cut a piece of aluminium foil approximately the length

of the ultrasonic bath less 2-3 centimetres at each end
and approximately twice its height.

2. Take the basket out and hold the top of the foil above
the solution so the lower half is in the solution and
standing upright across the length of the unit.

Never place your fingers inside the ultrasonic unit while

it is turned on.

3. Turn the ultrasonic unit on for 10 seconds.

4. Turn unit off and remove the foil.

5. Examine foil.

For Biosonic UC 150 units it is recommended to use three

smaller pieces of foil with the top of the foil wrapped
around a small rod, so you are not required to hold the foil
during the test. See image below.

To here

42
 Is there an even pattern of
indentation and/or even small holes
along the length of the foil?

yes no
Machine is in
working order Repeat the
and test has Foil Test
been passed

Ask a second staff member

to review the foil from the
test and initial/sign the Foil
Test log form as a witness

If it still fails the second test advise your dental coordinator

and report it to Dental Repairs as the unit may require a
service. The unit should not be used until it has been
assessed by a technician. Your dental coordinator can assist
to find a temporary replacement unit.

Examples of a successful foil test and an unsuccessful foil

test should be kept in the folder with the Foil Test Log
forms to use as a reference for new team members.

REPLACE THE SOLUTION IN THE ULTRASONIC UNIT:

• Midway through the day (usually before or after

lunch)

• If the solution becomes cloudy or hot.

• More frequently when there is a higher volume of

instruments being reprocessed.

The unit must be de-gassed after every refill.

43
VACUUM TEST
The Vacuum test is designed to check that the air from the
chamber of the autoclave is being removed effectively.

It must be completed on each autoclave at the start of every

day before the Helix test.

1. Ensure autoclave is cold & empty

2. Turn the autoclave on

3. Close steriliser door and select ‘Vacuum test’ in menu.

4. Start Vacuum test.

5. Continue setting up the sterilisation room and clinical

rooms while the Vacuum test is running.

6. When test is complete, check that the cycle has

passed successfully (as seen on digital screen and/or
print-out).

7. Sign printout (where applicable), photocopy and

attach to autoclave logs.

8. On daily autoclave log, record as Passed and provide

cycle details as required.

IF THE VACUUM TEST FAILS:

• Record that the Vacuum cycle has failed on the

autoclave cycle log form.

• Turn autoclave off to cool the chamber

• Ensure that the chamber has cooled completely

(allow to cool for at least an hour)

• Wipe over the door seal with a damp cloth and

• Repeat the test.

If the second test also fails, report to Dental Repairs as the

autoclave may need to be assessed by a service technician.

44
HELIX TEST
The Helix test show whether steam from the autoclave is
penetrating hollow and tubular items such as handpieces.
The Helix test must be performed after the Vacuum test, at
the start of each day.

1. Take the Helix test device (shown in image below)

and place an indicator strip in the appropriate
position in the device.

2. Place the device in a sterilisation pouch

3. Place in the centre of the bottom tray and at the

back of the chamber. No other instruments should
be in the chamber.

4. Select Helix cycle on the menu. Some units may

refer to B&D cycle.

5. Start cycle.

WHEN CYCLE IS COMPLETE:

Remove Helix device from autoclave using the tray handle,

not the bag containing the device, and allow it to cool.

45
 Has the indicator changed its colour?
Indicator strips will turn black if successful.

yes no

the Helix test has

the test is successful
failed

Sign and photocopy the

Record the cycle as
autoclave printout and
Failed on the autoclave
keep with steriliser log
cycle log form
form.

Selotape the B&D

Indicator Strip to
Repeat the Helix test
the Autoclave Log
Sheet for that day

If the second test fails,

contact Dental Repairs.

Signing off on the cycle indicates you were the person to

unload the cycle and determine if the cycle was successful
or not.

Hollow and/or tubular instruments and all handpieces must

not be processed in the autoclave if the Helix cycle fails, as
it cannot be guaranteed they have been successfully
sterilised.

Records of all steriliser tests and cycles must be kept for a

minimum of 7 years.

46
CLOSING THE STERILISATION ROOM
The sterilisation room must be cleaned and closed before
the team exits for the day. Effective time management is
essential and tasks need to be completed simultaneously to
minimise the time taken to close the centre.

The following procedures are to be completed once all

contaminated instruments have been through the ultrasonic
unit and have been dried and bagged, in preparation to be
sterilised the next working day.

The bur and instrument brushes used during the day are to
be left to dry out overnight. They should be bagged and
autoclaved the following day. Two sets of bur and
instrument brushes are required to manage this effectively.

PPE must be worn for sterilisation room end of day

procedures.

SUMMARY OF STERILISATION ROOM

END-OF-DAY PACK-UP

Drain and clean ultrasonic unit

Clean benches & sinks

Wash Aquasorb towels

Unload last autoclave load

DRAIN & CLEAN ULTRASONIC UNIT

47
 Turn ultrasonic unit off and remove basket

Open drain of the unit to empty the solution

Once empty, flush unit with fresh water

Using a dry low-lint towel, wipe the inside of the

unit to remove debris and excess water

Using IC-100 on a low-lint towel, wipe outside

of unit including the lid

CLEAN BENCHES AND SINKS

Ensure
benchtops are Wipe all Rinse & wipe
tidy and free benchtops sinks
from clutter

Use low-lint cloths

and IC-100 solution

48
WASHING AQUASORB TOWELS

Fill a large bucket with 4 litres of warm

water and 2 pumps of Clinidet

Hand wash towels in the bucket for 2

minutes

Wring towels out thoroughly then hang

to dry

Dry towels can be bagged and

autoclaved but must not be added to a
load with instrument packs

TIMING OF THE LAST AUTOCLAVE CYCLE

The final autoclave cycle must be turned on early enough to
complete the cycle before the last staff member finishes for
the day. In most cases an hour before closing time is
sufficient. 60mins

For example, if the centre closes at 7pm, the final autoclave

load should begin by 6pm at the latest, ensuring there is
enough time to remove the load from the autoclave and let
the instruments cool before putting them away

The autoclave must not be left on overnight. Do not

leave a cycle going after the team has left for the day.

Leaving the autoclave on unattended creates a number of

risks that can have serious consequences for team
members, patients and the centre’s equipment.

If your team are regularly running out of instruments or

handpieces before they can be reprocessed, please contact HELP

49
your dental state manager so they can assess how best to
resolve the issue.

DO NOT compromise or take short cuts with any infection

prevention procedure. If the centre has run out of an item
or instrument and you aren’t sure what to do, please
consult your dental coordinator or dental state manager.
There are often multiple ways to manage any immediate
issues, so please alert your dental state manager or practice
development coordinator as soon as possible if any
infection prevention / control issue arises.

50
1.8. DAILY CLINICAL ROOM
MANAGEMENT
To maintain the highest standards of infection control and
professionalism it is important that the clinical room is
adequately prepared before the patient enters.

START OF DAY SET UP

1. Perform Hand Hygiene and put on PPE

2. Ensure distilled water bottle on chair is full and if

not, fill with distilled water. Place ICX tablet in filled
water bottle.

3. Flush all air and water lines on chair for a minimum

of 2 minutes. This includes all handpiece lines,
ultrasonic line and air/water syringe.

4. Ensure detergent bottle contains an adequate

amount of detergent for the day (undiluted IC-100).

5. Damp dust – If using IC-100 wipes, wipe over the

benches and all dental chair surfaces in clinical room
and dry using dry Mediclean wipes.

The wipes should be wet enough to pick up any

particles that have settled overnight but should
not be so wet that they leave behind droplets of
water.

6. Remove gloves, perform hand hygiene.

7. Apply barriers to any hard to clean areas or areas

that will be touched frequently with contaminated
gloves during the procedure.

51
 BARRIERS MAY BE RESTRICTED TO:

• Adhesive plastic barriers on –

• Dentist’s bracket tray handle and touchpad keys and

• Keyboard mouse and keyboard (if within

contamination zone).

• Plastic sheaths on –

• Air/water syringes (both Dentist and Dental

Assistant’s side)

8. Cover curing light and intra-oral camera with a

barrier sleeve. These often come with their own
custom-fit barrier sleeve.

X-ray sensor plates should be placed in a barrier

sleeve that is changed between patients, especially
if left in the contamination zone.

9. Select the appropriate treatment tray for the next

procedure and put it on top of the dentist bracket
tray/mat.

Do not open any instrument pack until the patient has

entered the clinical room. They should be opened in view of
the patient so they can see they have been sterilised.

Check instrument and handpiece sterilisation pouches have

not been damaged. Check for tears, rips, holes that could
expose instruments and check that the indicator has
changed to black.

52
 HANDY TIP
Turn instrument packs over so
the instruments can’t be seen by
patients as they enter the room,
as the sight of sharp dental
instruments can make some
patients anxious.

10. Place evacuator (suction) tips onto adaptors.

11. Place a small bib on the assistant’s side of the bench

and set up any additional equipment or
medicaments that may be required during the
procedure. Have an instrument pack with tweezers
(and spatula if required) available but do not open
pack until patient is seated.

Only the burs and instruments needed for that procedure

should be on the bracket tray or bench. All other burs
must be stored away in a drawer or cupboard to avoid
contamination from droplets and/or aerosols.

12. Have items for the patient’s safety and comfort

ready and in reach, such as a cup of water, a tissue,
the patient bib and protective glasses.

13. Ensure the patient’s walking path and entry to the

chair is free from obstacles.

14. Look over the whole clinical room to make sure

everything is set-up and ready to go.

53
BETWEEN PATIENTS – CLEANING THE
CLINICAL ROOM
A. REMOVE CONTAMINATED ITEMS
1. Dentist must remove all sharps and dispose of single
use sharps into sharps container at point of use. Burs
and ultrasonic scaler tips must be removed from the
handpiece and placed onto treatment tray after use
or at the end of the appointment. Ultrasonic scaler
tips should never be left on the scaler handpiece
without the tip being protected by the wrench. This is
a common cause of sharps injuries, especially when
the handpiece is placed into the delivery unit with the
tip sticking up and exposed.

2. Place all instruments used during the appointment

and other reusable items to be sterilised, onto the
treatment tray

3. Remove all handpieces and place onto the treatment

tray.

Under no circumstances are handpieces to be wiped over

and reused, they must be autoclaved after every use.

If a handpiece or scaler was not used during a procedure

it must still be removed from the coupling or if the
unopened pouch is in the contaminated zone (eg tray or
bench) the handpiece must be autoclaved/reprocessed
with all contaminated instruments.

4. Flush air and waterlines e.g. handpiece lines,

ultrasonic scaler and air/water triplex syringe for a
minimum of 30 seconds

5. Remove all barriers and general waste and dispose of

in the general waste bin in the clinical room

6. Clinical waste should be kept on the treatment tray so

it can be disposed of in the clinical waste bin in the
sterilisation room.

7. Place/Clip transport lid onto tray

8. Transport instruments and clinical waste to

sterilisation area.

9. Remove your dirty gloves in the sterilisation room and perform

hand hygiene before going back into the clinical room.

54
 HANDY TIP
IC 100 foam can be sprayed to cover
contaminated instruments if they cannot
be cleaned immediately.

The IC 100 dissolves protein residues,

blood and other body fluids from the
surface of instruments, so these particles
don’t dry onto the instrument.

B. WIPE OVER THE CLINICAL ROOM

The order of wipe-down must go from the least
contaminated to the most contaminated areas

Clean Dirty

High Low
1. Put on a clean pair of gloves to commence the wiping down
of the clinical room

2. Dispense IC-100 foam onto a minimum of 3 lint-free cloths -

do not spray directly onto equipment.

WIPE 1

Wipe all benches and equipment used in the procedure that

wasn’t covered by a barrier, including:

a) Amalgamator

b) X-ray arm

c) Intra oral camera handle

d) Curing light paddle

e) Patient bib-chain

f) Protective glasses for patients

55
WIPE 2

Wipe over:

• Overhead light and handles

• Dentist’s bracket tray, control pads and handles

• Handpiece motors, couplings and hoses

• Dental chair upholstery

WIPE 3

• Wipe Air/Water syringe on assistant’s side

• Suction hoses

• Suction hose holder and arm bracket and

• Spittoon

Remove PPE and perform hand hygiene.

The clinical room is now ready to be set-up again for the

next patient

HANDY TIP
Swabbing Technique: Use one
hand to wipe surfaces with the
cloth. Use your other hand to
handle the surfaces that need
decontamination, while you use
the other hand for swabbing.

For instructions on how to set up the clinical room

between patients, follow Start of Day Setup from
applying barriers (page 52)

56
RED/GREEN CARD
Each clinical rom should have a card with one green side
and one red side. This is useful to show that a clinical room
is either clean or contaminated (not yet cleaned).

Using this routinely helps avoid the risk of a patient being

brought into a clinical room that is yet to be cleaned.

It is also helpful to the dental assistants when they are

working as a team and helping each other in their
downtime, so they can easily see what needs to be done
without having to ask.

A dental assistant should not leave an empty clinical room

without showing that the room is clean or contaminated.

GREEN SIDE UP RED SIDE UP

the room has been cleaned the room is still contaminated
and is ready to be set up. and needs to be cleaned

END OF DAY PROCEDURES

For the end of day procedures in the clinical room please
refer to Section 3 – Equipment Maintenance.

Please ensure each Daily item on the Clinical Room

Checklist is completed and signed off.

RE-STOCKING
Each clinical room is to be re-stocked by the end of the day
and should have enough consumables as typically required
for the next two days. Clinical rooms should not be heavily
stocked (full) as this makes it more difficult to manage the
centre’s ordering and inventory levels.

57
FLOORS
The floors in all clinical areas including the sterilisation
room, clinical rooms and shared clinical corridors must be
vacuumed and mopped when visibly dirty or soiled. If there
are no cleaners performing this overnight, the dental team
must be responsible as this can affect the patient’s
experience and is an infection prevention measure.

Brooms must not be used to sweep the floors as this causes

dust to be dispersed across the floor.

Use a damp (not soaking wet) mop with a neutral detergent

solution to mop the floors after vacuuming. The mopping
technique should be enough to remove any visible dirt or
stains without leaving the floor slippery or wet.

58
1.9. PROCESSING OF
RE-USABLE INSTRUMENTS

CLASSIFICATION OF INSTRUMENTS
Not all instruments that are reprocessed carry the same risk
of contamination. The classification of instruments is based
on their intended end use, and this affects the choice of
methods of processing.

Any items that are able to withstand the process of

steam sterilisation, should be steam sterilised.

THERE ARE DIFFERENT CLASSIFICATIONS OF

INSTRUMENTS:

CRITICAL ITEMS
Critical items are used to enter or penetrate into tissue,
cavity or bloodstream, such as oral surgical procedures.
Examples include:

• Dental forceps and elevators

• Flap retractors

• Single use disposable items such as local

anaesthetic needles, sutures and scalpel blades

59
SEMI CRITICAL ITEMS
Semi critical items are used in procedures where the items
come in to contact with intact mucosa or non-intact skin.
This is the majority of dental procedures with intra-oral
work. Examples include:

• Mouth mirrors

• Metal impression trays

After processing, semi-critical items should be stored in a

way to prevent contamination from splashes and aerosols
prior to use. They can for example, be kept in bags in
hygienic drawers / cupboards or closed containers

NON CRITICAL ITEMS

Non critical items are used when in contact with intact skin,
but do not go in the mouth. Examples include:

• Patient hand mirrors

• Protective eyewear for patients

• Bib chains

These items can be cleaned with a neutral detergent

solution after each patient treatment

60
OVERVIEW OF INSTRUMENT FLOW IN STERILISATION ROOM

61
62
SORTING, CLEANING AND DRYING
SINGLE USE ITEMS
SINGLE USE ITEMS MUST BE DISCARDED AFTER
A SINGLE USE. THIS INCLUDES:

• Disposable air/water syringe tips

• Prophy cups

• Plastic evacuator tips

• Micro brushes

• Plastic dappen dishes

• Plastic impression trays and

• Disposables such as cotton rolls, gauze, dry guards

etc.

These should be discarded in the clinical room’s general

waste bin, or if heavily soiled with blood or other bodily
substances, the clinical waste bin in the sterilisation room.

SINGLE USE ITEMS CONSIDERED SHARPS MUST BE

DISPOSED OF IN THE CLINICAL ROOM’S SHARPS BIN
BY THE DENTIST IMMEDIATELY AFTER BEING USED.
THIS INCLUDES:

• Endodontic Files

• Slow Speed Burs

• Matrix Bands

• LA Cartridges

• Needles

• Wedges/ Etch tips/ Flowable composite tips

• Scalpel blades

• Suture needles

• Orthodontic bands & wires

63
MANUAL CLEANING
All PPE including an apron and thick utility gloves must
be worn when sorting, cleaning and drying instruments
in the sterilisation area.

If instruments are unable to be processed immediately, they

must be sprayed with IC100 foam to prevent any bioburden
hardening onto the instrument.

THE FOLLOWING ITEMS MUST NOT GO INTO THE

ULTRASONIC UNIT OR THE AUTOCLAVE:

• Plastic items such as bond dishes

• Treatment trays

• Protective glasses

• Rotary endo units (and their leads)

They should be thoroughly cleaned to remove any debris or

contaminated matter:

• Wipe with a Caviwipe

• Place on a low-lint or Aquasorb cloth on the clean

side of the sterilisation room to dry

64
THE FOLLOWING ITEMS CANNOT GO INTO THE
ULTRASONIC UNIT BUT ARE CLEANED MANUALLY
AND STERILISED IN THE STERILISER:

• Glass slabs - should be cleaned by wiping with a

CaviWipe, rinsed, dried and bagged to go through
the autoclave.

• Handpieces and handpiece motors cannot be

submerged in water and must not be put in the
ultrasonic unit - Instructions can be found on the
following page.

• Syringes, scissors and non-critical and semi-

critical instruments with hinges
(screws will loosen) – lightly scrub with a brush
that’s mildly wet with IC-100 solution, rinse with
water and dry. Bag separately for sterilising with
hinges open.
This does not include extraction forceps, which must
be cleaned in the ultrasonic unit prior to
sterilisation.

Do not scrub plastic or glass items with a hard brush as

this can scratch them. Use a cloth with a neutral
detergent or, if necessary, orange solvent.

HANDY TIP

Reduce the time to clean these

items by wiping off any
medicament straight after use
– so it doesn’t set on the glass
or plastic.

65
HANDPIECES
All dental handpieces must be cleaned and sterilised after
each use. Internal components of handpieces may be
contaminated and require oiling to preserve the inner
working components.

Handpiece processing starts in the clinical room after the

completion of a patient’s treatment and then is completed
in the sterilising room

Never hold a handpiece under running water or submerge it

in water. Never put a handpiece in the ultrasonic unit.

1. Scrub handpieces gently with a wet, non-abrasive

bristle brush.

2. Ensure handpiece is visibly clean

3. Oil before sterilising

4. After oiled, wipe over the handpiece with a Caviwipe

to remove excess oil residue

Under no circumstances are handpieces or ultrasonic

handpieces to be wiped over and reused, they must be
autoclaved after every use.

OILING HANDPIECES
1. Remove head of handpiece if it is detachable

2. Place the handpiece in the oiling machine with the

correct coupling.

3. Face the handpiece down and close the lid to the

oiler

4. Press the button on the oiling machine to start the

cycle.

5. When cycle ends, carefully remove handpiece

66
OILING HANDPIECES
1. Remove head of handpiece if it is detachable

2. Ensure oil can has an attachment that correctly fits

into the end of the handpiece.

3. Wrap gauze around the head of the handpiece to

catch excess oil.

4. Place the oil can attachment in the end of the

handpiece and squirt the oil until it comes out the
head of the handpiece.

5. If the oil comes out dirty or discoloured, spray again

until the oil runs clear.

6. Wipe handpiece over with a caviwipe

7. Stand handpiece upright (head up) to allow excess

oil to drain out before sterilisation.

All handpieces must be bagged individually.

Ultrasonic handpieces must not be cleaned or bagged with

the tip attached to the handpiece. The tip and wrench must
be bagged separately to the handpiece.

67
NICKEL-TITANIUM (NITI)
ENDODONTIC FILES
Only nickel-titanium (Ni-Ti) rotary endodontic files can be
re-used and only on the same patient and the same tooth.
All other endodontic files such as:
- H-files
- K-files
- Lentulo spirals
- Barbed broaches
are single-use only and must be discarded into the yellow
sharps bin after use.

NiTi rotary files can only be used for three (3) of the same
patient’s visits and then they must be discarded. The
process for cleaning rotary endodontic files is described
below:

1. Immediately after use, remove stoppers

2. Insert the files into a scouring sponge soaked with

Odontohex 2% Chlorhexidine Gluconate Solution

3. Clean the files by using 10 vigorous in-and-out

strokes in the sponge

4. Soak the files in a small metal bowl in Biosonic UC32 Odontohex

enzymatic cleaning solution for 30 minutes Chlorhexidine Gluconate
5. Place the bowl in the ultrasonic unit (ensuring that
there is not too much enzymatic cleaning solution
as the bowl needs to float) for a 15 minute cycle

6. Drain and rinse in running water for 20 seconds and

then dry

7. Label pouch with name of patient and number of

use (1st Use / 2 nd Use) for that patient

8. Place NiTi files into endo foam to preserve integrity

of bag (and reduce risk of sharps injury)

9. Add the NiTi files for each patient into the

corresponding pouch and seal UC32 enzymatic cleaning
solution
10. Initial the pouch to verify the files have been
cleaned correctly and proceed to autoclave for
sterilising.

68
BURS
Dental burs are reprocessable but can be difficult to
effectively clean due to their small size and complex shape.

Using a worn or damaged bur can result in frictional heat,

excessive vibration, increased discomfort for the patient,
trauma to dental hard tissues and reduced efficiency.

Only the dental practitioner should decide when a high

speed bur is no longer suitable for use and to be discarded.

AT THE COMPLETION OF TREATMENT, BURS

SHOULD BE PROCESSED AS FOLLOWS:

• Single-use burs must be discarded into sharps

container

• Reusable burs are a contaminated sharp item and

therefore, appropriate PPE must be worn when
reprocessing burs, including puncture resistant
gloves

• Scrub with a bur brush and place in a small

perforated metal container to prevent them from
being lost or damaged

• Rinse well under running water to remove traces of

ultrasonic cleaning fluid. A short burst of hot water
will help them dry by evaporation

• Bag the bur stand in an appropriate sized sterilising

bag and process in a wrapped cycle in the autoclave

69
CLEANING IN THE ULTRASONIC
UNIT
Ultrasonic cleaners are used in the sterilising room to assist
with the mechanical cleaning of dental instruments and
items. They work by subjecting instruments to high
frequency, high energy sound waves, which loosen and
dislodge debris.

Ultrasonic cleaners clean but do not disinfect

instruments

Daily performance (foil) tests are necessary to establish the

efficiency of the transducers

Carefully place the remaining metal instruments into the

basket of the ultrasonic unit, avoiding the instruments
overlapping whenever possible. You have overfilled the unit
if you can hear a loud, high pitched metallic sound while in
use.

Smaller items such as rubber dam clamps and matrix rings

can go into the tea strainer or perforated container wit h the
burs, to stop them being lost in the unit.

Once loaded, close the lid of the unit. Never run a cycle
with the lid off.

Start the cycle for a minimum of 10 minutes for a light

load and increase the cycle time as the load increases (15
minutes for medium loads, 20 for heavier loads).

Gloves must be worn when operating the ultrasonic unit -

never touch the unit with bare hands.

DO NOT place hands into the ultrasonic unit during a cyc le

70
WHEN THE CYCLE IS FINISHED:

1. Lift the basket of instruments out of the unit

2. Under the tap of the dirty sink, thoroughly rinse the

instruments (still in the basket) with warm to hot
water. If your sterilisation room has a 'dirty' sink on
each side of the ultrasonic unit, the instruments
should be rinsed in the second sink.

3. Tip the instruments onto the microfibre cloth for

drying, on the dirty side (before the bagging area)

Never remove the instruments from the basket by

hand.

4. Wearing clean Matador puncture resistant gloves,

each instrument needs to be checked for any
remaining debris, blood or other material
(bioburden). Pick each item up one at a time,
inspect it for any bioburden and if clean, carefully
place it neatly on the drying cloth to dry.

5. If an instrument is not yet clean, it must be

scrubbed with a brush in the IC-100 solution in the
dirty sink until the bioburden has been removed and
the instrument is clean.

All instruments are required to be individually dried with a

lint free cloth and inspected. DO NOT try to dry all
instruments at once by covering them with a towel as this is
likely to cause a sharps injury.

REPLACE THE SOLUTION IN THE ULTRASONIC UNIT:

• If the solution becomes cloudy or hot.

• Midway through the day (usually before or after

lunch)

• More often when processing a high volume of

instruments.

The unit must be de-gassed for 5 minutes after every refill.

The dirty sink should be checked for debris throughout the

day and cleaned if necessary.

71
PACKAGING INSTRUMENTS
The purpose of packaging instruments prior to sterilisation
is to maintain their sterility in storage by providing a barrier
against recontamination. Sterilisation pouches should be
used only once and then discarded.

All instruments and hand pieces must be thoroughly clean

and dry before being packaged and sterilised. Ensure that
you visually inspect each instrument. If an instrument is put
in the steriliser wet, or if it still has bioburden on it, it
cannot be considered sterile.

Sterilising pouches come in a range of sizes, therefore all

instruments and handpieces can be packaged for
sterilisation.

Instruments with hinges or ratchets must remain open

and unlocked. E.g. Extraction forceps, scissors,
anaesthetic syringes

1. Wearing clean Matador puncture resistant gloves or

Hu-Friedy heavy duty gloves, place dry instruments
into the appropriate sterilisation pouch. Instruments
can be packaged individually or in specific
treatment packs, for example, exam or filling packs.

2. To seal the pouch, peel off the plastic strip and fold
the flap down along the adhesive strip. It is
important that the adhesive strip is folded exactly
on the dotted fold line to prevent any air from
entering the pouch. Any leak in the seal of the
pouch may let air in, in which case the contents
inside the pouch are no longer sterile.

HANDY TIP

Pack instruments into pouches by

the handle end first, so they can
be opened without touching the
working end.

72
1.10. BATCH CONTROL
IDENTIFICATION
RECORDING OF CYCLE DATA
As a requirement of the current Australian Standards, and a
quality assurance and risk reduction measure, autoclave
cycle data must be checked and recorded for every cycle
performed on each autoclave.

All critical site instruments (eg instruments used for surgical

procedures, dentoalveolar surgery / surgical tooth removal,
periodontal surgery, electrosurgery and dental implant
placements) must be recorded in the patient’s records

At Primary Dental we go one step further and record cycle

data for all instruments that are sterilised in the autoclave
for every patient, regardless of the procedure they have
been used for. This means we can track all instruments
used on a patient in the event of an infection control
incident.

Autoclave maintenance records must also be retained to

show the performance of the autoclave has been assessed
and passed. This includes any records of services or
maintenance, validation and calibration and performance
tests such as spore tests.

All cycle data relating to the sterilisation of instruments

must be kept for 7 years.

73
ASSIGNING ITEMS TO A BATCH
Tracking details must be written on each pouch immediately
before loading the pouches into the steriliser.

WHEN THERE ARE ENOUGH INSTRUMENT POUCHES

TO PUT A CYCLE THROUGH THE STERILISER, WRITE
ON THE OUTER EDGES OF THE PLASTIC SIDE OF THE
POUCH WITH A MARKER PEN:

• Number of the Autoclave (#1 or #2) if you have

more than one autoclave

• Date of cycle (dd/mm/yy)

• Cycle number the pouch will be processed in (see

Autoclave Sterilisation Log out to get the next cycle
number)

• Initials of the person loading the pouches into the

steriliser

By writing your initials on the pouches prior to them

being sterilised you are confirming that you have
checked that the instruments are clean and dry, that the
bag is sealed correctly, that the bag is not damaged and
the cycle and date details are correct.

Due to the chemical composition do not use pen or permanent

marker to write on the pouches – it must be a felt tipped non-
toxic marking pen.

All instruments must be tracked - not just critical

instruments.

74
THIS PAGE LEFT INTENTIONALLY BLANK

75
THIS PAGE LEFT INTENTIONALLY BLANK

76
ASSIGNING ITEMS TO A BATCH
WITH THE D4W STERILISATION
MODULE
PREPARE BY ADDING BARCODE LABELS TO THE
POUCHES DURING DOWNTIME

• Print barcode labels and stick them on each

sterilisation pouch, one box at a time.

• Mark the outside of the box of barcoded pouches as

BARCODED, so you know which box is ready to use.

Once the instruments are cleaned and dried, package them

into the barcoded pouches and seal the pouch by following
the Packaging instructions on page 66.

WHEN THERE ARE ENOUGH INSTRUMENT POUCHES

TO PUT A CYCLE THROUGH THE STERILISER, WRITE
ON THE PLASTIC SIDE OF THE POUCH WITH A
MARKER PEN:

• The date of the next cycle and

• The initials of the person loading the pouches into

the steriliser.

By writing your initials on the pouches prior to them being

sterilised you are confirming that you have checked that the
instruments are clean and dry, that the bag is sealed
correctly and that the bag is not damaged.

Due to the chemical composition do not use pen or

permanent marker to write on the pouches – it must be
a felt tipped non-toxic marking pen.

All instruments must be tracked - not just critical

instruments.

77
SETTING UP A NEW CYCLE IN THE D4W
STERILISATION MODULE

Click on Location Management tab

Click on Sterilisation tab

Go to Autoclave drop down list and

select the steriliser used for that cycle

Click Add button to add a new cycle

In the popup window, enter the cycle

number (can be found on the steriliser
printout) in the Cycle ID field.

Go to the Staff dropdown list and select

your name.

Check that the cycle was Tested

(select Y)

Check that the cycle Passed (select Y)

78
SCANNING POUCHES INTO THE CYCLE

Click the Scan button

(Centre-bottom of window)

Scan the barcode on the pouch by

holding it in front of the scanner.

Press the escape key [Esc] on your

keyboard to exit this screen

Double click on the Contents field

Select the correct instrument or pack

from the dropdown list.

Click OK button (lower right).

Click Scan button and repeat for each

pouch in that cycle

79
1.11. STERILISATION OF
INSTRUMENTS
DO NOT LOAD THE STERILISER UNTIL YOU ARE READY
TO START THE CYCLE.

If the steriliser were to be loaded and not turned on,

another person could see the chamber door open or
unlocked and assume the instruments have been sterilised.
This can potentially result in unsterilised instruments being
released and treated as if they are sterilised. If no-one
identifies that the instruments are not sterilised there is a
risk they could be used on patients.

DON’T BE THE CAUSE OF AN INFECTION CONTROL

BREACH!

1. Only load the trays into the steriliser when you have
enough pouches for a load.

2. Start the cycle immediately after loading the trays

into the steriliser.

3. Don’t release a load without checking if the

indicator strip on each pouch has changed colour
and the load parameters have been validated.

80
When there are enough packaged instruments to start a
cycle -

• Load the pouches onto the trays with the paper

side of the pouches facing down.

Do not overload the trays.

Avoid overlapping the pouches where possible, but

instruments must not overlap.

OVERLOADED TRAY

CORRECTLY LOADED TRAY

This is to ensure that the steam in the chamber can

penetrate the pouches effectively.

• Load the trays into the steriliser

• Remove gloves and perform hand hygiene.

• Select 134C Wrapped cycle on the steriliser display

menu.

• Close the steriliser door and start the cycle.

• Complete the steriliser’s log with the date of the

cycle and the cycle number.

81
WHEN THE STERILISATION CYCLE IS COMPLETE

1. Remove gloves and perform hand hygiene.

2. Before unloading the instruments, ensure that a

printout of parameters has been produced (if the
steriliser has a printer). Tear the printout off.

If using a USB or flash card to store cycle data, the

steriliser’s display screen will show if the cycle has
met its parameters.

3. On the printout, check the cycle has maintained

134C for at least 3 minutes.

Q. What if the steriliser was not at 134C for at least 3

minutes?

A. Check if the steriliser shows an error message

Does the steriliser show

an error message?

YES NO

Stop using the steriliser and inform your Re-pack the

dental coordinator immediately. instruments into
Check the steriliser instruction manual for new pouches, add
the error message and try any tracking details
troubleshooting tips. and attempt to
sterilise them again.
If you are unable to resolve the error
complete a Dental Equipment Fault Log
and send to Dental Repairs
(dentalrepairs@healius.com.au) and they
will contact a service technician.

4. Open steriliser door with a non-gloved, clean hand.

The steriliser door, display screen and printer must be
treated as clean surfaces.

82
5. Check that the indicator on each sterilisation pouch
has changed colour.

Ensure all cycle success parameters

have been achieved. ie. Pressure,
Temperature, Holding time.

If any indicator has not changed

colour, this indicates the load has
not been processed adequately, and
must therefore be reprocessed.
Repack the entire load of
instruments and re-sterilise.

6. Remove the trays from the steriliser one at a time

using the tray handle.

The steriliser’s chamber, the trays and the

instrument packs will be hot!

7. Carefully tip the instrument packs from each tray onto

the wire cooling rack on the CLEAN side of the
sterilisation room.

83
STORAGE OF STERILISED
INSTRUMENTS
Once the instruments have cooled, store them centrally in a
drawer or cupboard in the sterilisation area, ready to be
used for a tray set-up. Items belonging to a specific clinical
room can be transported back to the clinical room in a
plastic tub.

The items that have been sterilised most recently are put
behind the older packs. Storing in this way ensures the
packs that have been sterilised on the earliest date will be
the next ones to be used.

Keep bagged items in drawers neat by using drawer dividers

or tubs and group similar items by category. E.g. Exam
packs, Filling packs, Endo packs

It may help new and temporary staff to label the dividers on

the inside of your drawers. Do not label the outside of the
drawers as this quickly makes the cabinetry look messy and
unprofessional. Sticky labels on cabinetry doors can collect
bio-hazards.

DAMAGED POUCHES
All instrument pouches should be checked at least once per
month to check for any signs of damage.

If a pouch becomes wet or damaged or is no longer sealed,

the instruments may be exposed to contaminants.

These pouches must be removed from storage and the

instruments must be re-packaged and re-sterilised.

Instruments and hand pieces must remain in the sterilised,

sealed pouches until immediately before use.

84
1.12. BCI IN THE
CLINICAL ROOM

ASSIGNING ITEMS TO A PATIENT

All sterilised and all reprocessed items used in a clinical
procedure must be recorded in the patient’s D4W records,
so it is possible to trace a particular instrument to both the
patient it was used on and the autoclave cycle it was
sterilised in.

This includes all critical, semi-critical and non-critical items.

Once instruments are removed from their pouch, keep the

pouch aside and bundle with the other pouches of
instruments used during that patient’s appointment.

Make sure you can identify the correct contents of each

pouch once the instruments have been removed. If a
barcode system isn’t available you may need to write the
contents manually on each pack.

HANDY TIP

Instead of writing the actual contents

on each pouch, some teams prefer a
coding system that assigns a number
or abbreviation for each type of
instrument pack. This way, only the
number or the abbreviation needs to
be written on each pouch instead of a
list of instruments, saving time

85
RECORDING INSTRUMENT BATCH
DETAILS
If entering instrument details cannot be completed immediately,
the pouches must be stored away from the contamination zone
and remain clean.

Instrument batch details must be entered before the patient’s

appointment is complete, to reduce the risk of entering the
wrong batch details into a patient’s records.

MANUALLY ENTERING BATCH

INFORMATION
When a barcode scanning system is not available, the batch
information for all reprocessed and sterilised instruments
used on that patient must be manually recorded in the
patient’s D4W record.

THE DETAILS THAT MUST BE RECORDED IN THE

PATIENT’S RECORD INCLUDE THE:

• Contents or type of instrument pack, Eg. Exam pack

• Date on the pouch (date it was packed)

• Initials on the pouch (person who sealed the pouch)

• Autoclave number (where more than one autoclave

is in use)

• Autoclave Cycle number

86
TO ADD TRACKING DETAILS TO A PATIENT’S RECORDS

Open the patient’s record and go to the Treatment tab

Add the provider’s D4W

code in the Prv column
before you can add the Item
code

Enter Steri in the next blank

row of the Item column

Open a new note by clicking

in the Nt column

In the note screen, add a

date/time stamp and your
initials or first and last name.

Add the details for each pack

on a separate line
Once finished select OK

The empty pouches can be disposed of in general waste once all the details have been
transferred to the patient’s file.

87
BARCODE TRACKING SYSTEM
When using the barcode tracking system, the instruments
within each pouch have already been recorded onto the
barcode, so there’s no need to write the contents of each
pouch onto the pouch itself.

1
Go into patients file in D4W.

Select the Treatment tab across

the top of the screen,

In the Item column, type the item

code ‘Steri’

Select Notes column and then

click on Hide Fast Notes.

2
Select Sterilisation button and
then Scan button (both are on
right-hand side of window)

Begin scanning the barcode on

each of the pouches used for that
patient,

3
Once all pouches have been
scanned

Click Esc

then OK

Enter your D4W username and

password.

To add any additional instruments, repeat step 2 & 3.

88
1.13. MANAGEMENT OF SHARPS
SHARPS INCLUDE:
• Endodontic Files - including rotary files, K and H
files, reamers, spirals, gates gliddens

• Slow Speed Burs

• Serrated metal interproximal strips

• Matrix Bands

• LA Cartridges

• Needles

• Wedges/ Etch tips/ Flowable composite tips

• Scalpel blades

• Suture needles

• Orthodontic bands & wires

HANDLING OF SHARPS
• Sharps are to be handled with care at all times.

• Burs should be removed from handpieces after use

and before removing handpiece from the dental
unit.

• Scaler tips must be covered by the torque wrench

when not in use – no exposed scaler tips when the
handpiece is standing in the delivery unit.

• Sharps are never to be passed by hand between

team members.

• If a sharp item is required to be passed between

team members it should be placed in a rigid tray
before being passed.

• Sharps are never to be passed over a patient. They

are to be passed behind the patient.

• Incorrectly discarded and dropped sharps are to be

picked up with artery forceps, not with hands.

• Needles are never to be manipulated, bent or re-

capped by hand.

• Syringes and sharps are never to be dismantled by

dental assistants.

89
 • The dental practitioner who uses a sharp is
responsible for its disposal.

DISPOSAL OF SHARPS
Dental Assistants:

DO NOT remove sharps left on a bench

DO NOT remove sharps left on the treatment tray
DO NOT remove burs or scaler tips from a handpiece

• Burs and scaler tips must be removed by the dentist

before removing the handpiece or scaler from the
unit.

• Needles and scalpel blades are never to be removed

by employees. Only by Dentists.

• Dental practitioners must place all single use sharps

items in the sharps container immediately after use.

• The dental practitioner who has used a sharp item is

responsible for its safe and immediate disposal after
use.

• Qlick Smart should be used to remove and dispose

of scalpel blades. Disposable scalpels must be
placed directly into the sharps container.

• When filled close to the maximum capacity line, the

sharps container should be sealed and disposed of
with the clinical waste bin.

• If a filled sharps container needs to be stored before

it can be removed from the centre, it should be kept
in a cupboard away from public access and
particularly out of reach of children, until it can be
disposed of.

If you feel anyone is not disposing of sharps in the

correct manner, please address this issue with your
manager.

Refer to Page 9 & 10 of the ADA Guidelines for Infection

Control.

90
1.14. MANAGING BLOOD & BODY
FLUID EXPOSURES
SHARPS & NEEDLE STICK INJURIES
The following steps outline what actions to take in the event of a sharps injury .

STOP WORK IMMEDIATELY

1. Allow wound to bleed freely but DO NOT squeeze or
suck to induce bleeding

2. Immediately wash thoroughly with soap and water

3. Report incident to Dental Coordinator as soon as

possible

4. Locate the Medical Centre Needle Stick and

Exposure Kit hanging up in the sterilisation room or
behind the reception desk.

5. Follow the instructions contained within the kit.

They will broadly include:

a. During business hours (Mon – Fri, 9am – 5pm

AEDT), phone the Health Surveillance
Coordinator who will guide you through all
necessary steps

b. Outside of business hours, initial management

should be guided by an on-duty GP, using the
“Afterhours Exposure Pack” found within the kit

6. The Health Surveillance Coordinator or GP will

coordinate initial treatment, which may include

91
 bloodwork, onsite immunisation/booster, and or
referral to an Infectious Disease Specialist for
consideration of Post Exposure Prophylaxis

7. Ensure that an incident report in regarding the

exposure event is completed.

8. The Health Surveillance Coordinator will follow up

with all exposure incidents and coordinate future
testing, as required.

OTHER EXPOSURES

STOP WORK IMMEDIATELY

Splash to Eye

Rinse gently but thoroughly with water

or saline, with eyes open (for at least 30
seconds).

Splash to Nose

Immediately wash thoroughly with water

several times.

Splash to Mouth

Spit out blood/fluid and rinse mouth

thoroughly with water.

Contact with Open Skin

Immediately wash thoroughly with soap

and water.

Follow steps 3 – 8 on previous page

92
1.15. WASTE MANAGEMENT
DISPOSAL OF CLINICAL WASTE
Clinical waste is any waste resulting from dental clinical activity that has the potential to cause
injury, infection or offence. The following table gives an overview of clinical waste disposal.

Any disposable items (gauze, cloths, Clinical waste

gloves, tissues, dry guards, cotton rolls,
bibs) that are:
• Moderately - Heavily blood
stained
• Stained / soiled with vomit or
other body fluids

Any disposable items (gauze, cloths, General waste

gloves, tissues, dry guards, cotton rolls,
bibs) that are:
• Wet with water or saliva or
• Soaked in cleaning solution or
• Only lightly soiled or stained or
• Tissues with normal nasal
discharge

Body tissues Clinical Waste

(Skin, mucous membrane, bone fragments,
gingiva, etc.)

Teeth Wrapped in a paper towel and

No amalgam added to general waste
No blood or minimal blood or
placed in a disposable cup and
covered in setting plaster and
added to general waste

Teeth Wrapped in a paper towel and

No amalgam added to clinical waste
With blood or
placed in a disposable cup and
covered in setting plaster and
added to clinical waste

Amalgam & extracted teeth with amalgam
Place in a sealed, airtight container filled with
water.
Container to be stored in a cupboard in a clinical
room or sterilisation area (usually under the ‘dirty’
sink)
To be picked up by a licensed waste contractor
(see next page).

93
AMALGAM WASTE MANAGEMENT
All amalgam waste must be carefully managed to avoid
environmental mercury exposure.

Amalgam waste must be controlled during the placement and

removal of amalgam fillings, when handling extracted teeth
which contain amalgam and also when emptying amalgam
filters/ traps in the dental chair and suction unit.

Full PPE must always be worn when handling amalgam.

The following items should be disposed of in a CMA

Ecocycle General Amalgam Jar (large) half filled with water.

• Scrap amalgam after placing

amalgam fillings
HANDY TIP
• Amalgam capsules (if they contain
residual amalgam) New amalgam jars can be
ordered through the same
• Scrap amalgam from instruments
company that collects your
• Extracted teeth containing amalgam full amalgam jars, Ecocycle.
• Amalgam from amalgam separators
(chair and suction unit)

• Amalgam from suction filters

Your Cattani suction unit in the plant room will alert you
when the amalgam container is 95% full (alarm code I14)
and again when the container is 100% full (I15) and needs
to be removed and replaced with a new container

The contact details for CMA Ecocycle are:

Danielle Smith, Ecocycle

5-11 Reo Crescent, Campbellfield Victoria 3061

T: +61 (3) 9308 9415 | F: +61 (3) 9308 9416
E: danielle.smith@ecocycle.com.au

94
1.16. SURGICAL PROCEDURES

DEFINITIONS AND SCOPE

Asepsis: Freedom from infection or infectious (pathogenic)
material

An aseptic technique aims to prevent pathogenic (infectious)

organisms, in sufficient quantity to cause infection, from
being introduced to susceptible sites by hands, surfaces and
equipment.

For detailed information on standard and surgical aseptic

techniques, including definitions, background knowledge,
requirements and risk minimisation, please read the NHMRC’s
Australian Guidelines for the Prevention and Control of
Infection in Healthcare (2019), chapters 3.1.6 - Aseptic
Technique and 3.5.3 - Surgical Procedures. A shortcut to this
document is available on the Desktop of every computer
monitor in our dental centres.

A surgical aseptic technique is to be used for all invasive

dental procedures.

THIS INCLUDES:

• Oral surgery procedures

• Periodontal surgery

• Surgical endodontics

• Elevation of a mucoperiosteal flap

PLUS THE TWO MOST COMMON SURGICAL

PROCEDURES PERFORMED IN OUR CENTRES:

1. Surgical removal of a tooth

2. Dental implant placement

95
PRACTICAL REQUIREMENTS FOR A
SURGICAL PROCEDURE
Where it has been pre-determined that a surgical procedure
is to be performed in the dental centre, the following
procedures must be followed as a minimum standard.

Working surfaces including the operator’s tray (if being

used) and assistant’s working surface must be covered with
a sterile drape.

Instruments to be used must remain as sterile as possible.

Open from their packet by pulling one end of the packet
apart and opening the packet away from you, allowing the
instrument to leave the packet without being touched and
without it touching the outer edge or outer surfaces of the
packet.

THE DENTAL PRACTITIONER AND SCRUBBED

ASSISTANT MUST WEAR FULL SURGICAL PPE
INCLUDING:

• Enclosed footwear

• Protective eyewear

• Mask

• Hair net – with long hair tied back

• Surgical (sterile) gown

• Surgical (sterile) gloves

All hand and wrist jewellery, nail polish and artificial nails
must be removed, without exception.

Hands must be cleaned using an antiseptic surgical ABHR or

an antiseptic surgical handwash solution - MICROSHIELD 4
Chlorhexidine Surgical Handwash (with 4% Chlorhexidine
Gluconate) or equivalent product.

According to the World Health Organisation, an antiseptic

ABHR is the preferred hand hygiene product for surgical
procedures. Techniques for using a surgical ABHR can be
found in Appendix B.

The practitioner and scrubbed assistant must perform

surgical hand hygiene before donning their mask or
protective eyewear.

96
They then apply a mask and protective eyewear, only
touching the ties of the mask and the arms of the protective
eyewear.

They then perform a shorter surgical hand hygiene using

ABHR and are helped to don the sterile gown (without
touching the outer side of the gown) and the sterile gloves
(without touching their own skin with the outside of the
sterile gloves). Instructions for donning sterile gloves can be
seen in Appendix C.

For surgical sessions (where a whole morning or afternoon

of surgical procedures is planned), a second dental assistant
can be utilised as a ‘scout’ assistant. This person’s role is to
help the dentist and ‘sterile’ assistant by performing tasks
that cannot be done while wearing sterile gloves such as
opening instrument pouches and removing used/waste
items. They also help with the set-up and clean-up for the
surgical procedures.

The scout assistant performs hand hygiene and wears

standard clinical PPE and remains out of the contamination
zone as much as possible. They may wish to use the
antiseptic handwash solution or surgical ABHR, although
this is not a requirement.

BARRIERS ARE TO COVER THE:

• control panel

• bracket tray handles

• light handles

• suction hose

Attach a sterile surgical evacuation (suction) tip

97
TO MAINTAIN A STERILE FIELD, THE FOLLOWING
SHOULD BE OBSERVED:

• The scout assistant should not touch or reach over

the sterile items or areas

• The scrubbed assistant shall not touch or reach over

unsterile items or areas

• Movement within the sterile field must not

contaminate the field - sterile personnel must stay
close to the field

• The sterile set up shall not be covered

WHEN A STANDARD EXTRACTION

BECOMES A SURGICAL
EXTRACTION
There are times when a simple extraction turns into a
surgical procedure for example, when a part of a tooth
breaks off during the procedure and it needs to be
extracted in pieces.

Should this occur, the procedure needs to stop and the

following precautions should occur as a minimum.

The dental practitioner will need a sterile surgical handpiece

and sterile surgical bur/s

Only saline solution is to be used during surgical

extractions. If using a surgical motor this may have its own
saline bag attached. If using a surgical handpiece on a
dental unit line, the water coming through the handpiece
should be stopped. Saline can be used to cool the direct
operating field via a sterile syringe.

The assistant must change the evacuation tip to a sterile

surgical evacuation tip

98
OTHER SURGICAL ITEMS TO HAVE READY MAY
INCLUDE:

• Scalpel handle and blade

• Sutures

• Sterile gauze

• Artery/ suture forceps

FOLLOWING A SURGICAL
PROCEDURE
After any surgical procedure it is recommended to take the
following precautions:

Remove and replace the suction adapters, as they will

typically be covered in more blood than for standard
procedures

Run the suction lines with Orotol Plus as per end of day
procedure

Clean and disinfect the dental unit and working surfaces of

the clinical room with IC 100 and then FD 333.

99
1.17. WATER QUALITY
MANAGEMENT
DENTAL UNIT WATERLINES
Air and water lines must be flushed for a minimum of two
minutes at the start and end of each day and for 30 seconds
between patients.

DENTAL UNITS WITH EXTERNAL WATER

BOTTLE (ADEC)
For dental units with an external water bottle attached such
as the Adec dental units, the bottle must be filled using
distilled water.

An Adec ICX water treatment tablet must be added to the

water bottle whenever it is refilled.

THE STEPS FOR CHANGING THE WATER BOTTLE ON

AN ADEC CHAIR ARE:

1. Unscrew the bottle from the dental unit before the

bottle is completely empty and drain any remaining
water. The assistant needs to be monitoring the
water bottle between patients to make sure they
anticipate when the bottle needs to be refilled,
avoiding the interruption of running out of water
during a procedure.

2. Rinse inside the water bottle with some distilled

water and pour out again in the contaminated sink
in the sterilisation room.

3. Add the ICX tablet to the empty bottle

4. Fill the bottle to the fill line with distilled water and
screw bottle back onto the dental unit

5. Reattach the bottle to the dental unit and Wait for 2

minutes until ICX tablet is dissolved before using
the waterlines.

Check the water bottle's level after each appointment, anticipating when it needs
to be refilled to ensure it doesn't run out during a procedure as this causes a
significant interruption to the procedure.

100
FOR KAVO DENTAL UNITS
The Kavo dental units have been installed with a DentaPure
Municipal Water cartridge. The Kavo dental units are
plumbed in a way that directly uses the building’s main
water supply as its source of water instead of using a water
bottle attached to the dental unit.

The DentaPure cartridge reduces bacterial exposure by

eluting non-allergenic iodine into the dental waterline.

The cartridge must be changed every 365 days (yearly). The

replacement date must be recorded in the dental unit’s
service logbook.

Dental Coordinators are required to schedule this

replacement as a part of the annual dental unit service,
which is completed by an approved technician.

Image: The Dentapure DP365M

WATER FOR AUTOCLAVES

Only distilled water or water that has been de-ionised
through a reverse osmosis unit shall be used in an
autoclave.

If a water distiller is not available it is necessary to keep an

adequate amount of bottled distilled water in stock to
adequately maintain use of the autoclaves.

Please check with your dental coordinator or dental

state manager to be sure you are using distilled or de-
ionised water before adding it to the tank of the
autoclave.

Standard tap water must not be used to fill an autoclave as

it will cause an error message and damage the unit.

Some centres may have a special tap near a sink in the

sterilisation or laboratory area that is connected to a reverse

101
osmosis unit under the bench. If this is the case, this water
can be used to fill the autoclave.

Many newly refurbished sterilisation rooms include a reverse

osmosis unit built into the autoclave’s water supply, so
distilled water is not required. If this is the case the autoclave
may fill automatically when it requires water.

102
SECTION TWO:
CLINICAL
ASSISTING

103
2.1. WORKING WITH
CENTRALISED INTRUMENTS AND
MATERIALS
TREATMENT TRAY SET-UP
The bench space on the clean side of the sterilisation room
(after the autoclave and instrument pack cooling area) is to
be used for setting up treatment trays for the most
common procedures.

Pre-setting treatment trays for each procedure is much

more efficient than setting up every item needed for a
procedure between appointments. It reduces the time
needed to set up the clinical room for a procedure,
minimises the opening and closing of drawers in the clinical
bay (which exposes clean items to the contamination zone)
and reduces the need to store instruments and
consumables in each clinical room.

Standardised treatment trays for the most common

procedures are to be set-up in the sterilisation room with as
many items as possible, so they are ready to go when
needed.

COMMON TRAYS THAT CAN BE PRE-MADE INCLUDE:

• Check-up and clean trays

• Filling trays

• Extraction trays

• RCT trays

When setting up trays, don’t stop at just a small white bib,

an exam pack and a piece of gauze.

104
STANDARD PRE-SET ITEMS ON A CHECK-UP & CLEAN
TRAY MAY INCLUDE:

• Small white bib (tray liner)

• Exam pack
• A piece of gauze

• A prophy handpiece (or slow speed)

• Ultrasonic handpiece

• Ultrasonic tip

• Suction tips

• Air/water syringe tip and barrier sleeve

• Barrier sleeve for air/water syringe tip

• A piece of floss

• Prophy cup

• Dappen dish with prophy paste

• Bitewing holder (if needed)

105
FOR A FILLING TRAY, STANDARD ITEMS MAY
INCLUDE:

• Exam pack

• Filling pack

• Handpieces

• Transfer tweezers & spatula

• LA syringe

• Bur kit

• Suction tips

• Gauze

• Cotton rolls

• Floss

• Air/water syringe tip and barrier sleeve

• Articulating paper and holder

106
Add a green patient bib on top of the items when the tray
is complete with all the items required.

If there are any items still to be added, please DO NOT add

the green bib.

The green bib on the tray is to show that the tray is

complete and ready to go.

If there is no green bib added to the tray, other team

members can identify that something is still to be added
and check for the missing item/s before taking it into the
clinical room.

Don’t forget to lock the tray lid onto the tray when it’s
complete and store the tray on the glass shelves above the
‘clean’ sterilisation bench.

If your centre doesn’t have adequate shelving on the clean

side of the sterilisation room to store the pre-set trays, you
may need to purchase some tray stackers to place in the
cupboards above the clean bench.

The pre-set trays must not be left uncovered and need to

be stored in a way that minimises the risk of aerosols and
droplets contaminating the clean tray and its contents.

You may need to order more tray lids (across a number of

orders) so you have at least 6 lids per clinical room. Tray
lids must be locked on each tray when it is being
transported between rooms.

107
STORAGE OF CONSUMABLES
All items that are pre-set on the trays should be stored as
close to the tray station as possible. Don’t store them
elsewhere throughout the centre. Each consumable item has
one storage home only.

All items must be stored in a way that protects them from

exposure to aerosols and droplets and must not be stored
out in the open, uncovered.

The most frequently used items should be stored in the

easiest to reach spaces, such as just below or above the
bench. For maximum efficiency, minimise the amount of
movement needed to access each item and try to keep
items that commonly go together in the same space.

For example, any items that go on all pre-set trays are best
kept closest to the tray set-up bench. Such items include:

• Small white bibs

• Cotton rolls

• Gauze

• Air/water syringe tips and sleeves

• Exam packs

• Suction tips

• Handpieces

Image above: An example showing items to go in the drawer

closest to the tray set-up area.

Since Check-up & Clean trays may be the most commonly

used, the items that go on this tray should also be kept
closest to the tray set-up bench.

108
CENTRALISED INSTRUMENTS AND
HANDPIECES
Handpieces and instrument packs are to be stored centrally
rather than in each clinical room. Doing this improves the
chance of items being available for any clinical team when
they are needed.

If instruments or handpieces are stored or ‘reserved’ in a

clinical room, it creates unnecessary interruptions in the
schedules of both clinical teams to request, locate and
hand-over the item. It also tends to create tension between
the clinical teams, especially if it’s perceived that items
aren’t available when they are needed and the perception
that items are being ‘stock-piled’ in a clinical room.

Centralising handpieces, instruments and stock is a more

patient-centric approach, as each item is only removed from
the centralised storage area when needed for a patient’s
procedure.

Each type of instrument pack or handpiece should be neatly

stored with other packs/items of the same kind. Eg. All
exam packs together, all filling packs together, all
handpieces separated into groups such as high speed, slow
speed, prophy. This saves time when looking for a particular
item or pack compared to when all items are mixed
together without grouping.

Do not label the outside of the cupboards or drawers. Only

the inside surface of cupboard doors and the inside of the
drawers should be labelled to show where each specific
item is stored.

HANDY TIP
Wherever possible, keep all items
needed for one type of procedure
in the same drawer or cupboard
space. This is more efficient and
avoids having to open multiple
drawers at a time. It also makes
ordering much easier!

109
TREATMENT TRAY STORAGE IN
THE CLINICAL ROOM
Dental Assistants should check the procedures ahead in the
schedule and ensure the trays are ready for those
procedures. If there is a suitable area to store the trays in
the clinical room, they may store the trays for the next few
appointments in the clinical room. If there is no purpose-
built treatment tray shelves the clean trays must be stored
out of the contamination zone and away from the view of
patients. Inside a closed cupboard is typically the best
option.

The assistants must also be aware of the procedures the

rest of the team are performing at the same time and
ensure they are not withholding instruments that their
team members may need.

For example, if two dentists are performing a scale and

clean every 30 minutes but there are only enough
handpieces for 6 patients, don’t take more than three
handpieces, otherwise your team member will be unfairly
disadvantaged and need to re-process their handpieces
more frequently.

The ‘hoarding’ or hiding of any Primary Dental purchased

item, including instruments, equipment, materials or
medicaments in a clinical room so as not to allow another
clinician or team member to use the item will not be
tolerated. The dental team must work in a cooperative,
collaborative manner to ensure the whole team has a day
that’s productive, calm and free of unnecessary stress.

110
2.2. MORNING HUDDLES
All Huddles are a fantastic way to get your day off to a gr eat
start. When used correctly they keep the team organised and
aware of what’s going on in the dental centre for the day.
Huddles help your team members work as one cohesive team
instead of working as separate, siloed clinical rooms. Your
team will be able to provide a better experience for each
patient and you will feel more prepared for any surprises that
may otherwise create stress.

TEAM HUDDLES
Some teams prefer to have a morning huddle with the
entire team working on the day, so everyone hears the same
information and the whole team are aware of what’s
happening in the centre for the day. This is only possible if
all (or the majority) of dentists in your centre start their first
appointments at similar times.

The Morning Huddle Checklist (See Appendices) is a helpful

tool to make sure the huddles stay relevant and valuable to
the team and to make sure all important points are being
covered. A laminated copy of the Checklist should be taken
to the huddle by the person running the huddle and
followed step-by-step to ensure nothing is left out.

IF YOU ARE CONDUCTIN G A WHOLE TEAM HUDDLE,

SOME ITEMS ON THE MORNING HUDDLE CHECKLIST
CAN BE REVIEWED FOR THE WHOLE TEAM AT TH E
SAME TIME, INCLUDING:

• Reviewing the previous day’s schedule

• Follow-up calls to be made today

• Checking all appointments are confirmed

• Checking for any lab work due back or required

today

• Checking the next day’s schedule

• Presentation Check

• Communication Items

• Goal and language for the week

111
 • Team Wellbeing

• Joke (or motivational moment) for the day

The section where each dentist’s schedule for the day is

reviewed is performed by each dentist and their dental
assistant (DA) for that day.

When it’s their turn, the dentist and their DA move to the
computer screen (or wherever their appointment book is
displayed) and verbally discusses each patient scheduled for
the day. One of the team is controlling the appointment
book (usually the dentist) and the other is taking notes on
their printed day-sheet against each patient’s appointment.
If it’s not clear what is being done for each appointment,
they may need to open the patient’s record to access
treatment notes, medical history, treatment plans etc.

ITEMS TO BE DISCUSSED INCLUDE:

• The treatment planned for that appointment

• Which tooth is being treated?

• Which local anaesthetic will be used and whether it

requires an infiltration or block injection?
(determines short or long needle)

• Which shade/s of composite will be used?

• Do they require x-rays? Bitewings are generally

taken every 18 months to 2 years.

• Are they using a rubber dam?

• Treatment specific or shared equipment required

• Is the patient due for an examination?

• Does the patient need further appointments

booked?

• Information about the patient the team will find it

helpful to know. Eg. Significant allergies,
impairments or injuries, social issues, payment
issues, dental anxiety, VIPs.

Please note that information discussed during morning

huddles must remain confidential. Only relevant
information is to be discussed, with the intention of
helping each patient have the best possible experience.

It is also helpful for each dentist and DA to take a higher

level overview of their day’s schedule to consider how they
can plan ahead for the day. Some items to consider include:

112
 • Where they can see emergencies if they arise

• Whether any appointments are longer or shorter

than needed

• Times a second room could be used for efficiencies

• When they will be able to take meal breaks

• When the dentist can return phone calls

• Who is available to cover lunch breaks, if running

behind schedule?

Some of these items may not need to be discussed with the

whole team, but could be discussed between the dentist
and DA before or after the huddle.

MINI-HUDDLES
If each dentist is starting at a different time, it may be more
efficient to run individual ‘mini-huddles’ for each clinical
room. The dentist, dental assistant and the dental
coordinator (or whoever is working on the reception desk)
should be present, however huddles are still beneficial when
only the dentist and their assistant are present. All items on
the Morning Huddle Checklist are to be addressed in every
mini-huddle. The person running the mini-huddle is
responsible for relaying any important information from the
mini-huddle to the rest of the team.

113
10 tips for successful morning huddles

114
115
2.3. RADIOGRAPHY
It is important that x-rays are handled, positioned and stored
correctly so that they do not need to be re-taken as this
unnecessarily increases the patient’s exposure to radiation.

Radiographs (commonly known as x-rays) are typically taken

at certain appointment types, so it’s best to have the type of
radiograph and holder you will need ready to go.

The terms film and imaging plate are used interchangeably in

the below instructions, all meaning the intra-oral phosphor
plate on which the x-ray image is captured.

OPG RADIOGRAPHS
For centres with an OPG unit within the dental centre, best
practice for any appointment of which you know an OPG will
be required (typically every new patient, consults for
extraction of 8’s, any patient with perio and every 5 years for
all other adult patients) is to take the OPG on the way to the
clinical room, to minimise movement of patients in the
corridors and their time spent in the dental centre.

Barriers used on the OPG unit must be removed and put in a

general waste bin directly after using the OPG unit.

It works very well when the dental coordinator or dental

assistant has their OPG license and can take the OPG as soon
as the patient arrives. This saves time and makes the team
look organised and professional.

HANDY TIP
To be more prepared, discuss
with your dentist which x-rays
are required for each patient
that day during your morning
huddle and add them to your
day sheet.

116
SET-UP
When the dentist requires an x-ray to be taken, the assistant

prepares by checking the:

• Size of the film required and the

• X-ray holder they prefer to use.

When an assistant has worked with a dentist for a while they can

usually anticipate which type of holders the dentist will use.

THE MOST COMMON HOLDERS ARE:

THE KWIK BITE HOLDER - FOR BITE WING X-RAYS

THE STRAIGHT PERIAPICAL HOLDER

Sometimes known as a SnapX, Snap-a-Ray or Snap holder

THE RINN SYSTEM - ANTERIOR AND POSTERIOR

VERSIONS

By learning how the holders are set up in the correct

orientation and how the films are placed in the holders you
will be able to set the film and holder up for the dentist so
it’s ready to use when needed, making your treatment
procedures more efficient.

117
PROTECTIVE APRONS
Protective (lead or lead substitute) aprons are no longer
recommended or required for use with every patient.

Our current digital radiography systems require a much

smaller radiation dose than systems used in the past.

Dentists may still choose to use a protective apron on

children and some adults, such as pregnant women for the
patient’s peace of mind. The clinician’s decision is to be
followed.

Thyroid collars may also be preferred by some clinicians,

especially for developing children. These cover the neck and
upper chest area of the patient to protect the thyroid tissues,
which are more sensitive to radiation exposure.

Protective aprons and thyroid collars are to be wiped over

with neutral detergent solution on a low-lint wipe after each
use and allowed to dry naturally.

They should be wiped with a disinfectant wipe such as Durr

FD 333 wipes at the same time as disinfecting the dental unit
on the days they have been used for a patient.

Protective aprons must be hung appropriately when not in

use and should not be stored folded or hanging over the
edge of a bench.

For more information on protective aprons for patients go

online to view ARPASNSA’s guiding document: Safety
Guide: Radiation Protection in Dentistry, Radiation
Protection Series Publication No. 10. Protective apron
recommendations are on page 51

118
TAKING A RADIOGRAPH
1. The assistant places the lead apron or thyroid collar
on the patient (if dentist chooses) and hands the
dentist the film and film holder (already correctly
set-up if possible).

2. The x-ray tube and controller should already have a

clean barrier in place. Place the x-ray tube near the
patient’s head and where the dentist can reach it.

3. Do not leave the clinical room until the dentist has

successfully placed the film in the patient’s mouth.
You may be required to assist if a different film or
holder is required.

4. Leave the room – stand outside the clinical room

and behind a wall, so there is less risk of scattered
radiation. If your x-ray controller button/pad is in
the clinical room, take it out of the room with you to
pass to the dentist.

5. Once the dentist is happy with the film set-up, they

will leave the clinical room and activate the X-ray
exposure (take the X-ray).

Only the dentist is to activate the x-ray.

Dental Assistants who have obtained their Certificate

IV in Dental Radiography and have a current radiation
license can also take intra-oral x-rays.

The external packet of the film is in is now a

contaminated item.

6. The film is now ready to be processed and stored in

the patient’s file.

119
GENDEX DENOPTIX QST SYSTEM

PREPARING THE PLATE

1. Insert the imaging plate into the barrier pouch with
the black side of the plate visible through the
clear side of the barrier pouch. Seal the envelope.

2. Ensure the computer and DenOptix unit are switched

on.

3. The system is ready to scan when the green LED light

4. Launch the imaging software (VixWin) and ensure the

patient name is correct.

120
AFTER TAKING THE X-RAY
5. Open the barrier pouch from the V in the edge of the
pouch and let the plate fall into the transfer
container.

Do not touch the transfer container or imaging plate

with contaminated gloves.

6. Remove gloves and perform hand hygiene

HANDY TIP

If the dentist removes the barrier

and puts the plate in the
transport container, the assistant
can remove their gloves and
perform hand hygiene at the
same time so they are able to
process the x-ray faster!

7. Remove gloves and perform hand hygiene in the

clinical room.

8. Take the transport container and plate to the Gendex

unit.

9. Gently open the lid of the Gendex unit and remove

the inner carousel.

121
10. Insert the imaging plate into the carousel by sliding
the right side of the imaging plate into the correct
size mounting hole in the carousel.

Ensure that the blue side is facing out.

11. Insert the carousel and close the lid.

12. Once the Gendex unit has been loaded and the
patient file opened, click on the scanner icon on the
imaging software toolbar to start the processing.

13. Select the plates you want to scan and the resolution
and select Scan.

14. Once scanning is complete, remove the image from

the imaging plate by exposing the front (blue)
surface to direct intense light for 2 minutes.

Fluorescent light is highly recommended.

122
DURR VISTASCAN MINI

1. Slide the image plate fully into the light protection

cover. The black (inactive) side of the image plate
must be visible.

2. Pull off adhesive strips and firmly seal the light

protection cover by pressing together.

3. The active side of the image plate must point

towards the X-ray tube. The black side faces away
from the patient.

AFTER TAKING THE X-RAY:

4. Clean and disinfect the light protection cover. Place
the light protection cover with the image plate on a
detergent wipe. Allow the light protection cover to
fully dry.

123
 Light erases the image on the image plate – Never
handle exposed image plates without the light
protection cover.

5. Remove protective gloves, perform hand hygiene.

6. Check the X-ray scanner unit and computer (if

attached) is on.

7. Select the patient in D4W and follow the link to the

X-ray/Imaging software.

8. Once the X-ray software has opened for the correct

patient, select the exposure values and the desired
resolution

9. Click the Scan button.

10. When ScanManager is active, select the correct job

on the X-ray unit touchscreen.

11. The touchscreen will display an animation

requesting insertion of the image plate.

12. Once the bar above the animated sequence has

turned to green, insert the image plate.

13. Place the light protection cover with its image plate
central and aligned straight on the unit’s insertion
slot.

The open end of the cover faces downwards towards

the slot.

The inactive side of the image plate points towards

you.

124
14. The fixing mechanism now moves automatically into
position and takes hold of the light protection cover
with the image plate. Gently press the image plate
downwards out of its cover until the image plate is
automatically drawn into the unit

15. The light protection cover will be held in place by

the fixing mechanism and is not pulled into the unit.

16. Scanning progress is displayed on the touch screen.

After processing, the image plate is erased
automatically and falls into the collecting plate.

17. Save the X-ray image.

18. Remove the empty light protection cover and

discard in the general waste.

19. The image will now be available in the x-ray

software in the clinical room.

125
SOREDEX DIGORA OPTIME

IMAGE PLATE PACKING

126
127
AFTER TAKING THE X-RAY
1. Reserve the scanner from your clinical bay

2. Remove the barrier pouch but keep the image plate

covered by the light protection cover.

3. Hold the image plate with its cover on against the

unit’s insertion slot, with the silver button facing to
the right.

After the imaging plate has been processed a

window opens that shows a preview image and a
dental chart.

4. Click the tooth / teeth on the chart that correspond

to the tooth / teeth in the image. Tooth numbers
are assigned to the selected teeth.

The tools at the top of the window allow the image

to be manipulated.

5. Click OK to save the image and tooth numbers.

128
2.4. IMPRESSIONS
AND LAB WORK

PREPARING IMPRESSIONS

TO DECONTAMINATE AN IMPRESSION:
1. Thoroughly rinse impression with cold running water
in the designated dirty sink of the laboratory or
sterilisation room.

2. Thoroughly spray the impression with a detergent

solution (Clinidet). This ensures the removal of
microorganisms.

3. Rinse again with cold running water until all visible

detergent is removed.

4. Wrap the impression in a moist paper towel so the

impression doesn’t dry out, which would cause it to
lose its shape.

PREPARING THE IMPRESSION FOR PICKUP

1. Place the impression in a container with a lid or a
single-use sealable plastic bag.
Such containers and lids or bags must be single
use or cleaned and decontaminated with a diluted
detergent before and after use.

2. Complete the lab form and attach it to the

impression container / bag.

• Write ‘DECONTAMINATED’ on the lab form and

initial it to verify you have decontaminated the
impression.

• Include the date and time of the patient’s next

appointment.

3. Phone the lab for pick up.

129
 4. Fill out the courier pick up request slip, as instructed
by lab technician. Attach this to the impression
container/ bag.

Leave the impression in the LAB OUT tray if the impression

is being picked up in the next few hours.

Impressions may sometimes be stored in the refrigerator to

prevent them from drying out, especially when the
impression will only be picked up later or the next day.
Please check with your dentist for their preference.

Make sure sufficient time is allowed for the lab work to

be returned before the patient’s next appointment. If in
doubt, it’s best to add additional time, to avoid having
to reschedule the patient.

IN DENTAL4WINDOWS:

1. Find the patient’s

next appointment

2. Add an
appointment
status of ‘L’ - Lab
Work Needed.

This is a prompt to check

that the lab work has
been received before the
patient’s next
appointment.

130
LAB WORK IN
Dental Assistants should routinely check for any lab work
due for return the following day as a part of their morning
huddles, regardless of who will be assisting for that dentist
the following day.

IN DENTAL4WINDOWS:

When lab work returns:

Change the ‘L’

appointment status in
the patient’s next
appointment to an ‘M’
status

M = Lab Work Arrived

IF LAB WORK HAS NOT YET ARRIVED:

• Call the lab to ensure it will be returned before the

patient's appointment time.

If lab work has been delayed and cannot be delivered before

the appointment:

1. Confirm when it will be delivered and

2. Reschedule the patient’s appointment.

HANDY TIP
If lab work arrives early and there is
an available appointment, call the
patient and let them know – they
may be able to attend earlier.
Exceeding their expectations in this
way will make your patient feel like
you’ve made them a priority

131
PREPARING LAB WORK FOR THE APPOINTMENT
Prepare room for issuing the lab work – If there’s a spare
clinical room available, you may find it efficient to set it up
for the insert / try in, so the dentist can see the patient in
the second room while their first room is being prepared for
their next patient.

Remove the lab work from the package.

You must keep the lab invoice for the dentist to sign and
date. The lab will not be paid without the dentist’s signature
on the lab invoice.

Put the prosthetic on the treatment tray, ready to try in.

Models should be bagged (in a new bag), sealed and given

to the patient to take home.

Any alginate impressions that have been returned and are

no longer required can be discarded in the general waste.

Plastic, single-use impression trays must not be re-used.

Metal impresion trays must be cleaned and steam sterilised
before being re-used.

All prosthetics must be washed with cold running water

before insertion and between adjustments for the comfort
of the patient.

Any removable prosthetic such as a nightguard,

mouthguard, retainer or denture should be put in a suitable
plastic box/container for storage between use and the
patient given printed care instructions.

HANDY TIP
Improve the way a mouthguard,
nightguard, denture or crown is
presented to a patient by putting it
in a small box or even folding it in a
low-lint cloth, instead of leaving it in
a plastic bag.

132
2.5. FOUR HANDED DENTISTRY
Four-handed dentistry means that the dental assistant’s two
hands are assisting the dentist’s two hands, helping to
reduce the amount of time a dental procedure may take by
increasing efficiency.

The principles of four-handed dentistry are:

1. Use ergonomically designed equipment to minimise

unnecessary motion

2. Seat the operating team and patient comfortably, in

ergonomically designed equipment

3. Minimise the number (and range) of motions for

each procedure

4. Position the operating team as close to the patient

as possible with the legs of the assistant parallel to
the patient’s chair

5. Utilise pre-set trays:

• Minimise the number of instruments to be used

• Place instruments in sequence of use

• Place in order from left to right or top to bottom

6. Position the required equipment and materials in

the correct area in advance

7. The dentist empowers the assistant to use their full

scope of clinical skills by involving the assistant as
much as possible and delegating tasks within their
legal scope.

133
The work area around the patient is divided into four
‘zones of activity’

1. Operator’s zone

2. Assistant’s zone

3. Transfer zone

4. Static Zone

ZONE OF ACTIVITY FOR A RIGHT-HANDED

DENTIST

ZONE OF ACTIVITY FOR A LEFT-HANDED

DENTIST

134
KEY POINTS FOR EFFECTIVE FOUR-
HANDED DENTISTRY

TEAMWORK
THE TEAM MUST:

• Have great verbal and non-verbal communication

skills

• Be aware of each other’s need

• Recognise the need to reposition the patient,

operating team or overhead light when necessary to
improve access and visibility and

• Reduce unnecessary movement by only transferring

instruments within the transfer zone.

KEY POINTS FOR THE DENTIST

• Develop a standardised routine for basic dental
procedures and a non-verbal signal to communicate
a need to exchange an instrument.

• When necessary, give advance verbal direction to

communicate a need for a different instrument or
material.

• Be willing to accept input from the assistant if/when

chair positions need to be adjusted.

• Maintain a working position within the operator’s

zone.

• Avoid legs interfering with the static or assistant’s

zone.

• Confine eye focus to the field of operation.

• Confine hand and arm movement to the transfer

zone.

• Avoid twisting and turning to reach instruments by

allowing the assistant to transfer instruments.

• Exchange instruments only in the transfer zone.

• Avoid removing instruments from the pre-set tray

by returning instruments to the assistant after use.

135
Dental assistants must not place or remove burs from a
handpiece or accept any contaminated object considered a
sharp. This remains the responsibility of the practitioner.

STRATEGIES FOR THE DENTAL ASSISTANT

• Develop a thorough understanding of each
procedure.

• Recognise the patient’s needs through observation.

• Anticipate the Dentist’s needs and recognise any

change in the procedure.

• Be seated as close to the patient as possible with

legs parallel to the long axis of the patient’s body
(facing the bench behind the patient’s head).

• Be alert to changes in position of the dentist and

determine a non-verbal signal to indicate to him or
her that chair positioning needs to be improved.

• Maintain the order of both the instruments and

dental materials according to their sequence of use.

• When transferring a dental instrument to the

operator, orient the working end of the instrument
so it is pointing in the direction of use. This will
change depending on whether the procedure is on
an upper or lower tooth.

• Work with the operator to establish and follow a

safe, standardised, and predictable instrument
transfer protocol.

• When working with a right-handed dentist, transfer

instruments using your left hand.

• Remove debris from instruments before returning

them to the pre-set tray.

• Keep the mouth mirror clean while in use to assist

the dentist’s visibility.

• The assistant may use the air/water syringe on their

side to assist with moisture control and/or visibility.

• Maintain a clean work area at all times.

Verbal and non-verbal communication between the dentist

and the assistant is vital to successfully implement the
concepts of true four-handed dentistry.

136
Four-handed assisting is not often taught during an
assistant’s formal training; therefore it will take practise
and patience to get to a stage where it becomes more
efficient. It will certainly feel awkward at the start, but
with persistence and a willingness to learn together, you
will find a method of working that is of benefit to all
involved.

Reference

Betty Ladley Finkbeiner CDA-Emeritus BS MS, Increasing

Productivity by Effective Use of Four-Handed Dentistry - Part
1: An Overview of the Concept, Dentalcare.com,

https://www.dentalcare.com/en-us/professional-
education/ce-courses/ce428/strategies-to-ensure-effective-
four-handed-dentistry, accessed 21 st July 2019

137
2.6. MEDICATION
MANAGEMENT
STORAGE OF SCHEDULE 4 AND
SCHEDULE 8 DRUGS
Schedule 4 drugs must be kept in a room or enclosed area to
which the public does not have access.

THIS INCLUDES PRODUCTS SUCH AS:

• All local anaesthetics are S4 – Lignospan, Citanest,
Articaine, Octopressins, Mepivacaine, Prilocaine

• Ledemix Cement/Liquid and Ledemix Paste

• Duraphat

• Odontopaste

• Any materials that contain Triamcinolone in

combination for topical endodontic use

• Xylocaine Pellets

SCHEDULE 8 DRUGS

Schedule 8 drugs must not be kept in any Primary Dental

centre. The facilities do not provide the storage
requirements of Schedule 8 drugs.

If any Schedule 8 drug is found onsite please notify the

dental state manager, take it to the nearest pharmacy for
disposal and make a report on Q Pulse, noting it as a
medications incident.

138
STORAGE OF SCHEDULE 4 AND
SCHEDULE 8 DRUGS
Schedule 4 drugs must be kept in a room or enclosed area to
which the public does not have access.

THIS INCLUDES PRODUCTS SUCH AS:

• All local anaesthetics are S4 – Lignospan, Citanest,
Articaine, Octopressins, Mepivacaine, Prilocaine

• Ledemix Cement/Liquid and Ledemix Paste

• Duraphat

• Odontopaste

• Any materials that contain Triamcinolone in

combination for topical endodontic use

• Xylocaine Pellets

IN VICTORIA, ALL DENTAL S4 DRUGS MUST BE KEPT

IN A LOCKED CUPBOARD:

1. Cupboard should be located close to the dental

surgeries

2. The dental assistant in charge of opening the clinic

or the dental coordinator may open this cupboard
and remove S4 products required for the working
day once the dentist has arrived on site.

3. The cupboard is to be locked at all times apart from

when retrieving stock.

4. At the end of the day, remaining S4 drugs must be

returned to the locked cupboard and secured.

SCHEDULE 8 DRUGS

Schedule 8 drugs must not be kept in any Primary Dental

centre. The facilities do not provide the storage
requirements of Schedule 8 drugs.

If any Schedule 8 drug is found onsite please notify the

dental state manager, take it to the nearest pharmacy for
disposal and make a report on Q Pulse, noting it as a
medications incident.

139
STORAGE OF LOCAL ANAESTHETIC CARTRIDGES
Cartridges of local anaesthetics must be stored
appropriately to prevent environmental contamination by
aerosols, splatter and droplets generated by clinical patient
care.

Cartridges should be kept in their blister pack until use

to protect them from contamination by dust, aerosols and
droplets. Cartridges must never be stored loose out of their
blister packaging.

Only the amount of LA carpules reasonably required for the

day should be kept in the clinical rooms and the rest should
be stored in the stock cupboards.

This will also help with ordering an accurate amount of LA,

as over-ordering occurs when the clinical rooms are over-
stocked.

Boxes of local anaesthetic should be stored at room

temperature. They don't need to be stored in a fridge,
except if the centre's room temperature may rise above the
maximum temperature recommended by the local
anaesthetic manufacturer (see box for temperature
parameters).

Food or drink must not be stored in a fridge used for

storage of medicaments or materials.

140
2.7. NITROUS OXIDE
SAFE STORAGE
1. Keep all cylinders upright and restrained at all times
to prevent falling. This applies to cylinders on
trolleys and stationary replacement or empty
cylinders in designated areas. If your centre does
not have a system in place to keep cylinders secure,
or the current mechanisms are faulty/ insufficient,
please contact your dental state manager.

2. Storage area should be well ventilated, below 50

degrees°C, and at least 3m from heat sources or
combustible materials. You must have a sign
displayed to indicate where the cylinders are stored
on site.

3. Never store objects on top of cylinders.

SAFE HANDLING
1. Do not drag, roll, slide or drop cylinders.

2. If possible, when moving cylinders even for short distances,

use a cart designed to transport cylinders.

3. Follow general manual handling precautions.

4. If cylinder appears damaged or malfunction is suspected,

please notify the dental state manager for your centre.

5. Do not use the product if it is not clearly labelled.

Please notify the dental state manager for your
centre.

*Please refer to safety data sheets for more information.

These can be found via the WHS link on Healius’
intranet Prime.

141
THIS PAGE LEFT INTENTIONALLY BLANK

142
SECTION THREE:
EQUIPMENT
MAINTENANCE

143
DAILY DENTAL UNIT
MAINTENANCE
Always follow the dental unit’s manufacturer’s instructions
regarding regular maintenance.

In addition to the end of day procedures, basic daily

maintenance of the dental unit includes the following
procedures:

• Remove and clean footrest cover and beneath

cover with IC-100 on a low-lint towel

• Clean under spittoon bowl (if in use)

• Raise the height of the unit and wipe over the

bellows (if present) and/or the surfaces beneath the
unit’s chair

• Gently wipe the overhead light with a soft cloth

DENTAL UNIT EVACUATOR SYSTEM

(SUCTION)
Full PPE must be worn, including gloves, gowns, protective
eyewear and a mask when handling suction cleaning and
disinfecting solutions.

Run suction solution through the suction lines at the end of

every day if the unit has been in use.

Daily Weekly

Product
Name
Orotol Plus MD 555
To remove blood and
Purpose For disinfection
protein build-up

144
 Daily Weekly

Product
Name
Alprojet D Alprojet W
To remove blood and
Purpose For disinfection
protein build-up

1. Fill the OroCup with 1900ml water and add 100mls

of the daily or weekly suction cleaning product.

2. Attach both suction lines to the OroCup lid and

allow the suction unit to evacuate the majority of
the solution.

Hoses should never be immersed in the solution.

3. Leave approximately 250ml (1/8 th) of the solution in

the OroCup and tip this down the spittoon drain (if
the spittoon is in use).

4. Wipe the spittoon with a low-lint wipe sprayed with

IC-100.

OroCups can be ordered via Henry Schein Online.

145
 HANDY TIP
Close the door to the clinical
room (where possible) before
attaching the suction hoses to the
OroCup to reduce the noise
travelling throughout the centre.

146
DENTAL UNIT FILTERS
Filters are to be taken to the sterilisation room at the end of
the day to be cleaned in the dirty sink. They can be
scrubbed using a soft brush and warm water.

Amalgam scraps must be disposed of in a suitable amalgam

jar (see section on Amalgam waste for more info).

Disposable yellow manifold filters should be checked and

cleaned daily and if needed, replaced weekly.

The coarse yellow spittoon filter is to be checked and

cleaned each week and changed monthly (if required).

147
Filters can be left to soak in a cup of water overnight. They
should be rinsed under warm water (in the ‘dirty’
sterilisation room sink) before being returned to the dental
unit.

148
SUCTION UNIT WEEKLY MAINTENANCE

Ensure you are wearing full PPE - gloves, gowns, protective

eyewear and a mask when handling and cleaning the
suction unit’s filter.

▪ Turn off the power at the power point, then

▪ Turn off the suction unit’s power switch on the unit.

▪ Turn YELLOW filter handle to the LEFT.

▪ Remove and place in a container or plastic bag to

transport to sterilisation room.

▪ Clean in the ‘dirty’ sink by gently scrubbing with a

soft bristled brush and warm water. Do not use any
detergents when cleaning the filter.

▪ When clean, return to suction unit and turn to the

RIGHT to close, gently do not over tighten.

▪ Turn the unit on

ANNUAL PREVENTIVE MAINTENANCE

The dental units, x-ray units, autoclave/s, suction unit and
compressor all require an annual preventive maintenance
service. It may be possible to schedule services for multiple
pieces of equipment at the same time if serviced by the
same technician or the same maintenance company.

If these pieces of equipment are not serviced annually the

equipment may become more prone to performance issues
and the manufacturer’s and supplier’s warranties may be at
risk.

149
Safety parameters are typically checked as a part of the
service, to ensure the equipment is suitably safe to be used
by the dental team and safe for patients.

The dental coordinator is responsible for coordinating the

annual servicing of equipment. In some situations the
dental coordinator may delegate this task to another
member of the team to facilitate.

Service dates and records are checked for every dental

centre as a part of the six-monthly Quality Review process.

Reports and certificates from each service must be kept

on site and a copy sent to the Dental Centre Support
team to add to the central equipment register.

The dental coordinator is to add an alert to the dental

centre’s email calendar one month before the next annual
service is due, as a reminder that the annual service needs
to be booked. At the time of the reminder, please contact
Dental Centre Support to enquire if the annual service has
been booked or if the booking is yet to be made.

AUTOCLAVE SERVICING
All autoclaves must be serviced every 12 months by a
qualified technician.

An autoclave must also be re-calibrated and validated if it is

moved to a new location; this also includes a significant
move within the same centre.

Calibration certificates and validation reports must be filed

in the autoclave maintenance folder and kept in the dental
department. A copy of any service reports must be sent to
Dental Centre Support to be added to the central autoclave
register.

150
APPENDICES

151
APPENDIX A

152
153
154
APPENDIX B

155
156
APPENDIX C

157
158
APPENDIX D

159
VERSION CONTROL
Version control for earlier versions can be requested from Dental Support.

VERSION AUTHOR DETAILS DATE

V3.0 Luke Rees with contri- All sections updated. WHS section removed. Title changed, 22nd July 2019
butions by Jade Dell, Branding updated. Document design by Deb Trebilcock,
Christian Hinora, Linda Coalmine Canary
Leslie-Dam, Parul Verma,
Marie McBay, Michele
Gherlenda, and Michael
Ilievski
V3.1 Luke Rees and Marie Changes made to reflect the requirement of independent 28 th February 2020
McBay dental practitioners to follow the Clinical SOP, customised

For Browns SOP per centre with the equipment and cleaning products

Plains used in each location, added floorplan for each centre

showing clean and contaminated zones, added information
about waterline management, added patient PPE
instructions, minor changes to content to make instructions
more clear to follow. New approver due to changes in
management. New sections included on surgical assisting,
immunisations, dental team member health, schedule for
environmental cleaning. More information regarding
removal of amalgam waste added.
V3.2 Luke Rees, Marie McBay Changes made to include various equipment and products 28 th May 2020
"Centre and Michele Gherlenda used within Primary Dental Centres. Added transmission-
name" based precautions, new section on designated changing
rooms, new section using green and red card to demark

Customised whether the clinic is clean or contaminated, added section

to each to include opg radiographs.

centre

DOCUMENT LOCATION
This document can be accessed and downloaded from the Dental area in Sapphire. It is
recommended to save a copy to each monitor in the centre instead of printing hard copies.
Colour hard copies may be requested via the Dental Centre Support team.

SOP MAINTENANCE
ARE THERE ANY ERRORS IN THIS DOCUMENT?

Please contact your dental state manager or clinical excellence representative if you see any
errors in the document or and updates required to be made.

DO YOU HAVE ANY PROCESS IMPROVEMENT, IDEAS OR SUGGESTIONS?

We’d love to hear them! We encourage you to share your ideas with your clinical excellence
representative or state manager.

160
UPDATES
The Clinical standard operating procedures may be updated or revised from time to time.
Updated or revised versions of this document will be made available on Healius Medical
Centres' intranet, Sapphire and all dental employees and dental practitioners will be informed of
the updated version.

Clinical Standard Operating Procedures Version 3.2 approved 2nd June 2020
Luke Rees
National Dental Manager
Service Excellence and Engagement

© 2020 Helius Limited

All rights reserved. No parts of this work may be reproduced in any form or by any means - graphic, electronic, or mechanical,
including photocopying, recording, taping, or information storage and retrieval systems - without the written permission of the
publisher.

Products that are referred to in this document may be either trademarks and/or registered trademarks of the respective owners. The
publisher and the author make no claim to these trademarks.

While every precaution has been taken in the preparation of this document, the publisher and the author assume no re sponsibility for
errors or omissions, or for damages resulting from the use of information contained in this document or from the use of progr ams
and source code that may accompany it. In no event shall the publisher and the author be liable for any loss o f profit or any other
commercial damage caused or alleged to have been caused directly or indirectly by this document.

Released MONDAY, 31 AUGUST 2020

161