IPAC – Basic Principles

IPAC explained

Infection Prevention and Control (IPAC) has always been an important part of safe patient care in the dental office. Concerns about the spread of disease and the increased spread of contagious illnesses (like COVID) have required dental offices to establish, evaluate, continually update, and monitor IPAC strategies and protocols.

The Royal College of Dental Surgeons of Ontario (RCDSO) sets out IPAC standards that all dentists must follow. The RCDSO is only one part of a larger system in Ontario that provides guidance to dentists on IPAC standards. Other key bodies include the Ontario Ministry of Health, Public Health Ontario, the Ontario Dental Hygienists’ Association, and local Public Health Units.

General principles

The risk of infection as a result of a dental procedure is extremely low, but it represents an important patient safety consideration. The strategies being used throughout our office are designed to interrupt the transmission of micro-organisms whether direct, indirect, or by droplets among people, from dental instruments, devices, and equipment.

Screening of patients

Especially during COVID, our patients have become accustomed to our extensive screening protocols prior to their appointments. Patients must be cleared before being seen by anyone in the office at this time.

Standard precautions

The dental office has always followed what are known as “universal precautions” – these routine practices are based on the concept that all patients are potentially infective, even when asymptomatic, and that the same safe standards of practice should routinely apply to any form of contact.

Risk assessment

Before each interaction with a patient, the dental office will obtain as much information as possible to allow us to determine the risk of transmission.

  • Patient’s health status – if they are ill and considered to be contagious, the appointment may be deferred
  • Patient’s characteristics eg. Level of co-operativeness
  • Physical environment and available resources
  • Patient’s immune status
  • The type of procedure – Procedures involving exposure to blood, body fluids, mucuous membranes, and non-intact skin require a higher level of PPE than procedures involving no exposure.

Hand hygiene

Hand hygiene is the single most important measure for preventing the transmission of micro-organisms.

Hands must be sanitized:

  • Upon arrival and departure to and from the office
  • When visibly soiled
  • Following personal body functions
  • Before and after direct contact with individuals
  • After contact with environment surfaces or equipment
  • After contact with dental laboratory materials or equipment
  • Before eating or drinking

Personal protective equipment (PPE)

Dental professionals wear personal protective equipment to shield themselves from exposure to potentially infectious material and thus prevent themselves from becoming a vector for transmission from patient to patient.

Protective eyewear – glasses or plastic shields

  • The conjunctival mucosa of health care workers must be protected from spatter and debris created during dental procedures. This protective eyewear or plastic shield should be cleaned and disinfected between patients and whenever it becomes noticeably contaminated.
  • The office has an eye-wash station available for both dental staff and patients to aid in managing contact with any body fluid or dental chemicals.

Protective draping – bibs, head-rest covers, etc.

  • By their nature, the provision of dental services can involve the creation of droplets, spatter, and spray contaminated with blood, saliva, other body fluids, and debris.
  • Protective barriers are used when and wherever feasible.

High-volume suction

– minimizing ingestion or inhalation of contaminated material and debris.

Masks

  • Appropriate masks that cover the nose and mouth should be worn during dental procedures to protect the respiratory mucosa of dental staff from contact with potentially contaminated droplet material.
  • Masks lose efficiency over time, as they become moist from the individual’s breathing; accordingly, masks should be changed when they become contaminated, wet, or more often, such as during longer appointments.

Protective clothing

  • Dental care providers wear uniforms or scrubs while working in the office. These are not worn outside the office.
  • Whenever spatter or spray is anticipated during dental procedures, additional protection is worn (such as long-sleeved gowns or lab coats).

Gloves

  • Hand hygiene protocols are followed before donning gloves and after removing them.
  • Gloves must be worn when in contact with mucous membranes, non-intact skin, or body fluids is anticipated.
  • The same pair of gloves must NOT be used for more than one patient.
  • Gloves are put on immediately before the activity for which they are indicated.
  • Gloves must be removed and discarded immediately after the activity for which they were used, and hand hygiene performed
  • Gloves must not be washed or re-used.
  • Double-gloving may be utilized for some specific procedures, which may involve the handling of multiple sharp instruments or during longer appointments.

Exposure prevention

  • Avoiding occupational exposures through percutaneous injuries (needle-sticks, cuts with sharp instruments).
  • Use extreme caution when passing sharps
  • Needles remain capped prior to use
  • Needles inspected before use, ensuring they are not bent, have not been re-capped, or otherwise manipulated with both hands
  • Following use, needles are recapped as soon as possible, using a one-handed scoop technique
  • When sutures are place, instruments are used to retract tissue
  • Burs are removed from handpieces immediately following procedures
  • All sharps are identified and removed from trays before cleaning
  • Used sharps are collected in a labelled puncture-resistant container (to be disposed of by a medical waste service)
  • Heavy-duty utility gloves, appropriate clothing and brushes all are used when cleaning contaminated instruments by hand, prior to sterilization

Immunization

All providers are adequately immunized against:

  • Hepatitis B
  • Measles
  • Mumps
  • Rubella
  • Varicella
  • Influenza
  • Diphtheria
  • Pertussis
  • Tetanus
  • Polio
  • COVID-19

In the midst of the COVID-19 pandemic, IPAC protocols have been made stronger than ever. The dental office has extra levels of protection in place to create a safe care environment. See our COVID-19 Protocols to know what to expect at your next dental appointment.

Our dentists and dental staff get the most current evidence-based information on IPAC techniques. We pursue continuing education activities as part of our commitment to lifelong learning. If you have questions about health and safety in our office, ask your dentist. We all want to make you feel more comfortable and secure about your dental visits.

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Cliffcrest Dental

2995 Kingston Rd, Scarborough,
ON M1M 1P1, Canada