The case for infection control

As practitioners, we are held accountable to the standard of our peer cohort – GDPs to GDPs, specialists to the standards of specialists, hygienists to the standards of hygienists, etc.

But, there are some situations in which all dental practitioners remain accountable, to the same professional standard, regardless of their level of experience. Cross infection is one such area.

There is a fundamental trust by the patient that the dental profession will ensure their safety by controlling the risk of exposure to blood borne viruses whilst undergoing treatment. And yet, there are apparently some practices where that trust has been broken in this vital area.

What’s it got to do with me? I’m not the principal

We understand that this sounds like the practice’s problem, however this is far from the case. Each year when a practitioner renews their registration with AHPRA, they sign a declaration confirming their compliance with the requisite standards and as such they are essentially committed to fulfil the non-delegable duty to maintain the relevant cross infection standards.^[2]

Those standards are subject to revision, with frequent updates. Consequently, DPL would strongly recommend that you review the published standards annually, before renewing your registration.

But I do all the right things in my surgery

Your duty to protect all patients means that your responsibility for cross infection does not stop at the door of our own surgery. It extends beyond, into the sterilisation room and flows to the whole practice. In short, our duty is to the public, and all the patients of the practice, not just the ones who sit in our chair.

What should I check?

• Have you read your practice’s cross infection manual? Do you even have one? If you don’t then you need one – it’s a requirement, and it has to be practice specific.
• Are the requisite tests being performed in the sterilisation room at the appropriate intervals? For example, foil test, helix text, biological tests and chemical indicators.
• Do you know where to find the steriliser test results (which must be kept for a minimum of 7 years)?
• Did the steriliser pass the tests?

If the tests are not undertaken at the recommended intervals, or not logged so they can be verified in the future, then you cannot be sure about the sterility of the equipment you are using. If you cannot confirm that you are using sterile equipment, then you should put down tools and not treat patients until you can be sure.

Talk to the practice manager and principal immediately to bring your concerns to their attention so they can be rectified and the treatment of patients can recommence.

There’s no way I could have that conversation with my principal!

Start by asking yourself if you really want to work for someone who is not interested in meeting the relevant standards required to protect patients. Although this might be a tough conversation to have, ultimately it is about your own integrity. The privilege of being a practitioner is accompanied by the responsibility to take actions to protect the public.

What if the principal won’t listen?

Breaches of cross infection measures are a major and significant issue that cannot be ignored. They can constitute a notifiable offence.

Section 140 of the National Law defines 'notifiable conduct’:

1. Intoxicated by alcohol or drugs; or
2. Engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
3. Placed the public at risk of substantial harm in the practitioner’s practice of the professional because the practitioner has an impairment; or
4. Placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.' ^[3]

^{[1] Guidelines on Infection Control (June 2010) at dentalboard.gov.au 
[2] Page 2 of Guidelines on Infection Control (June 2010) at dentalboard.gov.au 
[3] Mandatory Notifications Guidelines for Registered Health Practitioners (March 2014) at dentalboard.gov.au}