The CDSA Standard of Practice: Infection Prevention and Control Standards and Risk Management for Dentistry is intended to protect dentists, their staff and their patients from infectious disease transmission. Dental Health Care Personnel must apply this Standard of Practice in a diligent and conscientious manner. The CDSA Infection Prevention and Control Standard of Practice Document is evidence based to the largest extent possible, and established on current references.
These standards set minimum requirements for infection prevention and control policies and procedures as well as minimum requirements for cleaning, disinfection and sterilization of reusable medical devices in all dental facilities and settings. Higher standards may be required based on specific circumstances. Standards and guidelines established by Health Canada, the Public Health Agency of Canada, Occupational Health and Safety and the Canadian Standards Association (CSA) may also be applicable.
Safety Engineered Syringes
This video outlines the responsibilities of all registrants as it pertains to Safety Engineered Syringes (SES).
Safety Engineered Syringes Important Links:
Respiratory Protection Plan
This video details the requirement for all registrants to have a Respiratory Protection Plan (RPP) in place.
Respiratory Protection Plan Important links:
FAQs
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Do I need a office policy manual?
Yes, every dental office or clinic must have a written office-specific IPC policy and procedure manual outlining all steps of reprocessing. This manual must be printed and kept current.
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Do I need to take a Workplace Hazardous Materials Information System (WHMIS) course?
No, you must have a WHMIS manual present and complete ensuring chemicals used, stored, handled or disposed of in the workplace are properly labeled and current Material Safety Data Sheets (MSDS) documentation available. Ensure that Alberta Occupational Health and Safety (OHS) policies and procedures are in place, office specific and completed for first aid-plan, equipment and services, worker exposure to chemicals, worker exposure to blood and body fluids, and worker exposure to sharps.
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Can I wear artificial nails?
No, you may not wear artificial nails, nail enhancements or long nails. Ensure nails are kept short. Nail polish is acceptable but must be fresh and chip free.
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What is the correct decontamination process?
Clinical contact surfaces must be cleaned and disinfected using a two-step disinfectant process, ensuring correct wet contact times as specified by the manufacture (wipe once to clean and then use another wipe to disinfect).
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Can I use high-level disinfectant (HLD)?
It is strongly recommended that dental offices stop using high-level disinfectant (HLD). Use disposable products or products that can be put through a steam autoclave.
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When do I use a biological indicator?
Sterilizers must be monitored daily with a biological indicator (BI) process challenge device (PCD) test pack (a package or tray that contains instruments that will present the most challenging conditions to sterilize that day) at the beginning of each day for each load, type of cycle used (wrapped and unwrapped) and each sterilizer used. The biological indicator shall then be incubated according to the manufacturer’s instructions.
A PCD can be commercially manufactured or prepared in-house following the PCD MIFU. An in-house PCD can be made with a cassette or bag that includes metal instruments, a BI and a Type 5 CI.
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Where do I place the biological indicator?
The biological indicator (BI) process challenge device (PDC) test pack should be placed in the area of the sterilizer considered least favorable of sterilization.
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What type of chemical indicator do I use?
Both internal and external chemical indicators shall be included with each package prepared for sterilization. Each instrument pack or cassette must have an external Type 1 process indicator applied to, or visible from, the exterior of the package, and an internal chemical indicator. Type 5 or a Type 6 chemical indicator must be used inside the material and/or instrument package.
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Where do I place the chemical indicator?
The chemical indicator is placed inside the package in an area considered the most difficult for the steam to penetrate.
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What type of mechanical monitoring do I use?
Physical parameters are monitored and recorded for sterilizer(s) time, temperature and pressure for each cycle before the door of the autoclave is opened. Printouts from the sterilizer(s) must be initialed before the sterilized instruments are removed, this print out must be kept as part of the record keeping. If the sterilization parameters are downloaded to an electronic data recorder or digital recorder the physical parameters need to be printed and verified as part of the record keeping.
All sterilizers used in dental clinics must come equipped with either a printer or an electronic data recorder that records cycle parameters. Sterilizers without this capability must be adapted or replaced by January 1, 2023.
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Do I need a sharps container?
Approved sharps container shall be available at point of use (operatories) and/or reprocessing area. Sharps would include all needles, scalers, laboratory knives, wires, burs, broken glass, scalpel blades, explorers and endodontic files and reamers, etc. Sharps container must be puncture-resistant, with leakproof lids that are tightly fitting that seals and prevents leakage (sides and bottom), not over filled and no transferring occurs between containers. Sharps containers must be labeled and have appropriate hazard warning. Sharps containers must be disposed of regularly by properly by an approved registered company.
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Do I need a biohazardous waste container?
Approved biohazardous waste container (colour-coded red, and visibly display biohazard symbol) shall be available. Biohazardous waste would include non-sharp biomedical waste capable of causing an infectious disease (blood saturated gauze; salvia saturated gauze or removed tissue) and must be segregated. Biohazardous containers must be labeled and have appropriate hazard warning. Biohazardous containers must be disposed of properly by an approved registered company.
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What procedure do I follow for placement of implants and/or temporary anchorage devices(TADs)?
All devices used must be reprocessed using the correct sterilization cycle as specified by the manufacturer’s instructions. Chemical internal Type 5 integrating indicators (responds to time, temperature and presence of steam) must be used inside the wrapped cassette. Ensure cassettes are wrapped using two layers; they can be wrapped sequentially or consecutively using the hospital technique (envelope style) or 2 in 1 wrap. Wrapping shall be prepared in a manner that will allow adequate air removal, steam penetration and evacuation to all surfaces. A biological indicator (BI) process challenge device (PCD) test pack must be used with each load of implants, implant equipment/devices, implant surgical instruments and material and temporary anchorage devices (TADs). Implants, implant equipment/devices, implant surgical instruments and material and temporary anchorage devices (TADs) must be quarantined until the results are known, tracked for date, load and sterilizer used, this information must be recorded in the patient’s chart at time of placement. Sterile field must be established and maintained.
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When do I use a Bowie-Dick test?
A Bowie-Dick (Class 2 chemical indicator) test is used for all pre-vacuum sterilizers at beginning of each day prior to first load run and in an empty chamber according to manufacturer’s instructions for placement with results monitored and documented. After documentation the test strip can be discarded.
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What is the correct procedure for package labeling?
Packages (peel pouch and/or cassette) must be labeled with sterilizer number, load number and date reprocessed (peel-pouch: plastic side, bottom of the peel pouch / cassette: on indicator tape) with an approved soft-tipped marker (e.g., Sharpie #13601 or #13801) or an approved labeler and labels (e.g., 3M 1256 or a labeler and labels which have been validated for use in a steam sterilizer). Regular date stamps, ballpoint pens or regular sharpies are not suitable for labeling these packages. Labeling of packages must be done in manner that will not compromise the package integrity.
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How long do I have to keep sterilization records?
While there is no mandatory time, it is recommended as with any other dental record in the office, a minimum period of 10 years. Some hospitals keep sterilization records for 20+ years.