Describe the role of the dental nurse in minimising the risk of cross infection during and after the treatment of a patient.

Write short notes on mercury spillage and non sterile needle sick injury.

Minimising cross infection

• To avoid the risk between patients all disposable items should be thrown away immediately at the end of the procedure - all sharps in the sharps bin, all clinical waste in the special yellow bags

• - All non disposable instruments must be scrubbed clean of blood and debris placed in the ultrasonic bath for 5minutes, rinsed then autoclaved

• Forceps elevators and surgical instruments should be sealed in sterilisation pouches (if using a vacuum autoclave) so they can be handled after autoclaving with no risk of losing sterility

• Mouthwash cups are assumed to be disposable

• Extracted teeth or roots should be disposed of in the sharps bin or in special waster containers for extracted teeth

• Any spattering of open work surfaces should be removed with a sodium hypochlorite or aldehyde wipe-over

• Even if there is no obvious spattering, the work surfaces should be wiped over with isopropyl alcohol

• The aspiration unit should be run through with sodium hypochlorite at 10% concerntration to remove blood contamination, and the spittoon should be wiped and flushed throughout

• Only after all the above has been carried out fully should be next patient be brought into the clinical area

Mercury spillage

• Mercury used for amalgam fillings is highly toxic

• It can enter the body by inhalation of mercury vapours of amalgam particles and by absorption through the skin

• The incidence of mercury spillage in the dental surgery can be greatly reduced by the use of pre-dosed amalgam capsules

• These are prepared with the correct alloy powder and mercury liquid, separated by a diaphragm until mixing occurs in the amalgamator

• The use of capsules removes the need for liquid mercury to be kept on the premised and for the amalgamator to be regularly refilled

• Water amalgam also contains mercury so it should be handled with care

• It should be stored in sealed jars of old x-ray fixer until collected by an authorised waster metal company

• All spillages should be reported to the dentist

• If a mercury or amalgam spillage occurs on a minor scale the debris should be sucked up into a disposable syringe and transferred to a waster metal container

• Small amalgam capsules and droplets of mercury should be surrounded by a mercury absorbent paste, most spillage kits contains this a flowers of sulphur to be mixed to a paste with calcium oxide and water

• The paste should be painted ar5und the spillage area to prevent further spread, then over the actual spillage

• Once dried, the paste and the entrapped mercury should be wiped using wet disposable towels

• The operator must wear gloves throughout the procedure

• Waste amalgam should be gathered using wet absorbent towels, but only when gloves are used.

• Seriously large mercury spillages must be reported to the Health and Safety Executive, they may decide that, until professional decontamination can take place, the risk of exposure is too great and consequently close down the dental surgery for a while

• Blood pressure machines (sphygmomanometers) and thermometers contain mercury and should be handled carefully to avoid breaking them resulting in a mercury spillage

Dirty needlestick injury

• It is an injury with a needle that has been used on a patient

• The pricked site must be squeezed immediately to encourage bleeding

• The areas should be flushed with alcohol, dried and covered with a waterproof dressing

• The dentist must be informed immediately

• The patients' notes should be checked for any history posing a serious cross infection risk

• As no patient's medical history details can be safely assumed to be complete, the matter should be reported to the local occupational health adviser who will be based at the nearest hospital

• They will give advice regarding the necessity of blood monitoring to ensure no disease transmission has occurred

• Generally no serious problems should be encountered if the dental nurse if fully vaccinated - as all staff should be. However, it should be remembered that not all HIV positive patients know of their HIV status and patients may be suffering from odd tropical blood borne infection