Patient Safety

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

INFECTION CONTROL PROTOCOL

Infection is the invasion of an organism’s body tissues by disease causing agents, their multiplication, and reaction of the host tissues to these organisms and toxins they produce.

The protocols which limit the spread of infection include:

The standard protocols are given by Organizations such as :

METHODS OF ACHIEVING STERILIZATION
AND DISINFECTION AT KOSMOS

Sterilization and disinfection can be obtained by Physical, chemicals radiations and gases. Popular methods include:

ESSENTIALS FOR STERILIZATION AND DISINFECTION

AUTOCLAVE

      Moist Heat sterilization under temperature and pressure.

  • AUTOCLAVE IN CSSD, SPDC:
  • Machine: Swingstar Autoclave
  • Cycle Followed:
    • Temperature: 121°C
    • Pressure: 15 psi
    • Time: 15 minutes
  • Items Sterilized: Instruments, clothing, glassware, heat resistant plastics.

PREREQUISITES FOR AUTOCLAVING:

  1.  Cleaning:
  • Instruments should be thoroughly cleaned with soap water and scrubbed with a brush to remove any visible debris.
  • Wash with plain water.
  • Dry all instruments.
  1.  Packaging:
  • Packaging materials allow penetration of the sterilization agent and maintain sterility of the processed item during storage.
  • Wrap clean dry instruments in green cloth bags, or use commercially available sterilization boxes or single-use pouches.
  • Handpieces can be wrapped in sterilization pouches.
  1.  Storage:
  • Store in a clean, dry, disinfected place.
  1.  Sterilization Verification
  • After proper sterilization, it should be verified by change of color of autoclave tape from yellow to black.

 

GLUTARALDEHYDE

 Glutihyde (2% Glutaraldehyde) & Exidex (2.45% Glutaraldehyde)

  • Packing Size:5L Jar
  • Instruments: Heat Sensitive items, Reusable plastic trays.
  • Directions for Use: Properly pre-clean instruments & Immerse in Glutaraldehyde in containers with lids
  • Immersion Time:
    • Total Disinfection: 10-15mins
    • Total Sterilization: 10 hours.

 

SAVLON ANTISEPTIC LIQUID
  • Composition: 3% Cetrimide, 0.3% Chlorhexidine Gluconate.
  • Recommended Dilution: For disinfection of clothing and surface
  • Add 2 capfuls (30ml) of the liquid to ½ liter of warm water.
DETTOL
  • Antiseptic Liquid:
  • Composition: 4.8% Chloroxylenol, 9% Terpineol
  • Recommended Dilutions: For disinfection of clothing and surface ;
  • Add 2 capfuls (30ml) of the liquid to ½ liter of warm water.
  • Dettol Multipurpose Hygiene Liquid
  • Composition: 4% Benzalkonium Chloride)
  • Recommended Dilution: For disinfection of clothing
  • and surface; 1 Cap (15ml) to 1L water

 

PERSONAL PROTECTION
  • PROTECTIVE CLOTHING:
    • Scrubs or aprons
    • Scrubs are to be restricted only in clinical areas.
    • Use fresh, clean scrubs each day.
  • Wash with detergent and a final rinse with
  • A solution prepared by adding 1 Cap (15ml) Dettol Multipurpose Hygiene Liquid( 4% Benzalkonium Chloride) to 1L water.
      • OR
  • A solution prepared by adding 2 Caps (30ml) Savlon (3% Cetrimide, 0.3% Chlorhexidine Gluconate ) to ½ L water.
      • OR
    • A solution is prepared by adding 1 cap (15ml) Dettol disinfection Liquid (4.8% Chloroxylenol) in ½ L water.

 

PROTECTIVE HEAD-CAPS, MASKS, EYE-WEAR, FACE-MASKS
  • Use single use disposable
  • Dispose in Yellow Dustbin After Use.
  • Change gloves after every patient.
  • Perform hand hygiene before and after using gloves each time.
HAND HYGIENE

STERILIZATION AND DISINFECTION OF INSTRUMENTS USED IN CONSERVATIVE DENTISTRY & ENDODONTICS

 INSTRUMENT

RECOMMENDED PROTOCOL 

1.  Diagnostic Instruments:

Mouth mirror, probe, tweezers, Explorers

·         Clean, Wrap, Autoclave, Store. 

·         Autoclave Cycle Followed:

2.  Kidney Tray

3.  Cotton Holder, Waste Receiver

4.  Plastic Filling Instruments 

5.   Burs

Temperature: 121°C

Pressure: 15 psi

Time: 15 minutes

6.   Rubber Dam (Clamps, forceps, punch)

7.   Dappen Dish

8.   Files and Chisels

9.   Ultrasonic Tips

10.  Saliva Ejector

11.  Plastic Instrument Tray

12.  Endodontic files- K files, H files, Reamers, Broaches, Lentulospirals, GG drills, Peeso reamers

13.  Endobox

14.  Endoblock

15.  Cotton Rolls

16.  Microsurgical Instruments

17.  Guttapercha

2.5% Sodium Hypochlorite

18.   Drape

Cloth : Autoclave

Plastic: Clean, wipe with spirit,

19.  Curing Lights, Intra-oral scanners, Intra-oral cammeras

Barrier Protecion: Wrap with clear plastic, clear Cling film

20.  Articulating Paper Holders

Clean, Wrap, Autoclave

21.  Cheek Retractors

Wipe with spirit using sterile cotton,

 wash, Use

22.  Shade Guide

23.  Oral Photography Mirror

24.  Micromotor box with handpiece

Wipe with sterile cotton using:

·         A solution prepared by adding

1 Cap (15ml) Dettol Multipurpose Hygiene Liquid( 4% Benzalkonium Chloride) to 1L water.

 OR

·         A solution prepared by adding

2 Caps (30ml) Savlon (3% Cetrimide, 0.3% Chlorhexidine Gluconate )

to ½ L water.

 OR

·          A solution prepared by adding

1 cap (15ml) Dettol disinfection Liquid (4.8% Chloroxylenol)

to ½ L water.

ü  When the surface is visibly contaminated with blood use spirit.

25.  Radiograph Head/Cone

26.  Elastomeric automated mixing Guns, Pentamix Machine

·         Discard Single use Mixing Tips in RED Dustbin.

·         Wipe with spirit/ Dettol/ Savlon using sterile cotton.

27.  Chairside Lab Instruments: Glass slab, Mixing Spatulas, Carvers, bowls

Clean instruments of any debris, flame metallic part, wipe/ wash handles with disinfectant.

28.   Handpieces: Air rotor Handpiece, Contra-angled Handpieces,Ultra-sonic scaler handpieces

·         Discharge air or water from handpiece for 30 seconds.

·         Scrub the external surface of the handpiece with detergent.

·         Lubricating the handpiece with commercially available sprays .

·         Pack in sterilization pouch.

·         Sterilize in autoclaves (If handpiece is autoclavable)

·         Sterilize in ETO for other handpieces.

29.  Three way syringe

·         Flush internal surface with water and air for 30seconds.

·         Barrier protection- wrap with cling film or autoclavable cloth which is to be changed for each patient.

·         Wipe with spirit/ Dettol/ Savlon using sterile cotton.

·         Tip can be Autoclaved

30.   Magnifying loupes, microscopes

·         Ethyl alcohol

31.  Dental units,water pipes & suction systems

·         Disinfectants such as iodophore or diluted sodium hypochlorite

ENVIRONMENTAL DISINFECTION

CLINICAL CONTACT SURFACE :

  • Clinical contact surfaces can be directly contaminated from patient materials either by direct spray or spatter generated during dental procedures or by contact with Dentist’s gloved hands.
INSTRUMENTRECOMMENDED PROTOCOL

Dental Chair

 

 

          Wipe with sterile cotton using:

·         A solution prepared by adding 1 Cap (15ml) Dettol Multipurpose Hygiene Liquid( 4% Benzalkonium Chloride) to  1L water.

                                                       OR

·         A solution prepared by adding 2 Caps (30ml) Savlon  (3% Cetrimide, 0.3% Chlorhexidine Gluconate ) to ½ L  water.

                                                      OR

·          A solution prepared by adding 1 cap (15ml) Dettol disinfection Liquid (4.8% Chloroxylenol) in ½ L water.

ü When the surface is visibly contaminated with blood use spirit

Dental Chair lights, buttons, instrument holder

 

 

Clinician chair

 

 

 

Drawer handles, Pens, Other surfaces touched with gloved hands

 

 

Patient Drapes

Cloth Material: Wash, autoclave

 

Plastic Material: Clean, rinse with dettol/savlon (15ml disinfectant in 1L water)

Patient viewing mirrors

 

Wipe with spirit using sterile cotton.

 

Countertops, Washbasin and taps

ü  Clean with Detergent.

ü  When the surface is visibly contaminated with blood use spirit.

Patient tumbler

Reusable: Wash with detergent

 

Disposable: Change for every patient, discard in RED dustbin.
Hand TowelWash with detergent, rinse with dettol
SpitoonsScrub and wash with detergent after every patient.
Mackintosh sheetClean of any debris, Wash with detergent, dry
Mobile Phones 
HOUSE KEEPING SURFACE :
  • Housekeeping surfaces (e.g., floors, walls, carpets) have limited risk of disease transmission.
  • To be cleaned only with a detergent and water using mops and cloths.
  • Household bleach can be used in 1:50 dilution.
  • When surfaces are visibly contaminated by blood clean with disinfectant.
  • Mops and cloths should be cleaned after use and allowed to dry before reuse.
  • Fresh cleaning solutions should be made each day, discarding any that remains and allowing the container to dry between uses.
LABORATARY DISINFECTION
  • Ø Decontaminate all items before they are handled in the lab.

EQUPMENT/ MATERIAL

RECOMMENDED PROTOCOL

Lathes, Trimmers, bench press, vibrators, rag wheels, Counter tops

 

Clean & Scrub with detergent.

 

Pressure pots

·         Drain water after usage.

·         Clean & scrub with detergent.

·         Use disinfectant, if required.

Lab instruments: wax spatulas, wax Knife, Glass slab, Mixing Spatulas, bowls

·         Clean & scrub with detergent.

·         Use disinfectant as used for clinical contact surfaces if required.

 

All brushes, Buffs

·         Buffs to be changed daily

·         Washed with detergent and autoclave daily.

·         Wet buffs dipped in disinfecting solution when not in use.

Pumice

·         Use  pumice mixed with disinfecting solution and surfactant(soap solution)

WASTE DISPOSAL

 

ITEM

WASTE DISPOSAL CONTAINER

Cotton, cotton rolls

 

 

 

 

 

YELLOW Dustbin

Waste Receiver Contents

Teeth, Residual PRF, Bone Graft

Gloves, Masks , Head-caps, face-shields

Impression material- Retrieved Alginate, Impression Compound

Retraction Chord

Articulating Paper

Special Trays

Record bases, bite registrations

Old discarded Dentures, Interim Crowns

Suction tips

 

 

 

RED Dustbin

Syringe without needle

Single Use Plastic Impression Trays

Automated mixing gun tips

Discarded Plastic spatulas

Disposable Patient Tumbler

Broken discarded metallic instruments- Carvers, Probes, mouth mirrors, wax knife, Metallic Spatula,

Lab burs, discarded glass slab

 

BLUE Dustbin

Needle

Destroy in needle destroyer

Needle hub

 

WHITE

Puncture Proof container with Sodium Hypochloride

BP Blades

Suture needle

Cutter blades

Diamond Burs

Orthodontic wire

Empty material containers

 

BLACK Dustbin

Office waste

Lab waste- plaster, Casts, wax

 

COVID MEASURES

Temprature Check

Temerature Check

Hand sanitizer used

Hand Sanitization using Alcohol based sanitizer

Travel history assesment

Assessment regarding previous health and travel history

Oxygen saturation check

Oxygen Saturation checked using Pulse oximeter

social distancing norms

Social distancing protocols followed

patient waiting in the clinic

Waiting time no more than 15 minutes

Patient waiting in the clinic 3

Minimum patient contact with non-clinical staff

Patient in clinical area (Mouth Wash)

Mouthwash for patient

patient in clinical (Wearing Drapes)

Draping the patient

PPE Standard Protection Gear

PPE and standard Protection gear for Operator and Assistant

Doffing of PPE

Doffing of PPE and Disinfection using silver halide spray

Changing wraps (1)

Unwrapping the chair and spraying with Hypochloride solution

Flushing the water lines

Flushing the waterlines with Disinfectant solution

Wrapping the chair

Wrapping the chair with cling wrap for next session

Patient leaving the clinic area

Changing wraps of all the chairs after a wipe down with Hypochlorite solution

Fumigation _ Fogger

Fumigation using Foggers and disinfectant solution

UV light Sterilization

UV light Disinfection for rest of the surfaces

Impression Dis

Disinfection of Impression and Models

Kosmo Dental Hospital; a Visionary Dental Hospital with cutting-edge infrastructure, dental equipment and dental devices to ensure optimum quality and safety.

Dental Hospitals in LB Nagar

1. Inhouse Ambulance

Availability of life saving medical emegencies

2. Availability of Life saving Emergency Medication

Layer 83@1X

3. Oxygen tanks and Ambulatory masks

Kosmo Dental Hospital

4. All the staff are trained in Basic Life Support (BLS), in accordance with the American Heart Association (AHA) Guidelines

PHYSICAL HARM

Prevention of Aspiration of instruments :
  • Dental instrument Aspiration is one of the accidents dreaded by every clinician, however, there are certain precautions that one can take to prevent any such events.Example of such precautions include:

 

1.Floss tied to any instrument which has choking hazard.

2. All small instruments are counted on their entry and exit from the chair area

3. Use of Rubber Dam to prevent aspiration.

Staff Sensitization to prevent Hostile environment :

Our staff is briefed about patient behaviours and thus they are on a lookout for tell-tale signs if any patient is prone to misbehaviour, intentionally or unintentionally. The staff is well equipped to handle such situations and better educated at avoiding them altogether. The staff is strictly advised not to provoke or indulge in conversations which might hurt any person/s sentiment. We believe in caring for patients and treating all of them equally.

 

Women Safety :

Women safety though a sensitive issue needs addressing in any clinical setting. We at Kosmos make sure that women are made comfortable and no environment is created which might cause any discomfort or awkwardness to our patients. Measures such as, A female staff always being there during the treatment and examination of the patient, or presence of a family member while the patient is being treated. The staff is trained adequately to ensure safety and comfort for our female patients. A complaint redressal system is also in place through which the patients can log in their grievances regarding unruly behaviour of any staff anonymously.

 

Fire Safety :

Dental Clinic is surrounded with equipment and materials which are inflammable, therefore it is necessary to have a mechanism in place to prevent any outbreak of fire. Kosmos is equipped with fire buffering systems in the building infrastructure. Apart from this there are fire extinguishers in place to counter any  mishap. The staff is well trained in fire extinguishing drills. Evacuation plans are well in place in case they are needed.

 

SPECIAL PROVISIONS FOR ELDERLY ANDPHYSICALLY CHALLENGED

Kosmos is a geriatric friendly clinic, all the facilities provided at Kosmos are designed in accordance with its ease of utility by our dearly elderly patient. Some key highlights are as follows

PATIENT CONFIDENTIALITY

The records are maintained in physical form with the clinic for a period of 5 years as stated by the DCI rules.

 Consent is obtained before starting any treatment the patient is explained in detail about the treatment in a language they are familiar with. Dental treatment involves taking photographs for record keeping and sometimes to make promotional material or awareness creating brochures. If a particular photograph is used for any of the above mentioned purposes, a photographic consent is obtained from the patient The Doctor-Patient Confidentiality Clause prevents the doctors or the clinic from sharing any case record with any other entity before a written permission is given by the patient.

Kosmos is evolving and we make our patient advise the basis of our evolution. The stated safety policies are subjected to scrutiny and amendments at all times. The following mechanism is followed to maintain the highest level of PAtient satisfaction

PRESCRIPTION SAFETY

Prescription safety is a practise of carefully prescribing any drug to the patient after determining the need, possible interactions, and associated side effects.

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