Infection Control, Patient Safety and Professional Ethics
This domain tests the systems that keep patients and staff safe: standard precautions, correct reprocessing of instruments, sharps injury management, waterline hygiene, wrong-site prevention, and the ethical and legal duties that frame consent and confidentiality.
Standard precautions and reprocessing
- Hand hygiene at the WHO five moments, gloves, eye protection and masks for every procedure; treat all patients as potentially infectious.
- Clean instruments in an ultrasonic bath or washer-disinfector before sterilisation; debris left on instruments defeats steam penetration.
- Steam sterilisation at 134 degrees Celsius for about 3 minutes (or 121 degrees for 15 minutes), with wrapped pouches, chemical indicators and weekly biological spore testing using Geobacillus stearothermophilus.
- Critical items that enter bone or sterile tissue must be sterilised, not merely disinfected; high-level disinfection suits semicritical items, and glutaraldehyde is not a sterilant substitute for heat-stable instruments.
- Dental unit waterlines form biofilm: flush lines, use independent reservoirs or filters, and follow the manufacturer's regime.
Sharps injury and staff safety
- After a needlestick: encourage bleeding, wash with soap and water, do not scrub or suck, report immediately, and record the source patient.
- HIV post-exposure prophylaxis should start as soon as possible, ideally within hours; hepatitis B status determines whether vaccine or immunoglobulin is needed; hepatitis C requires baseline and follow-up testing because there is no prophylaxis.
- Never recap needles by hand; dispose immediately in a rigid sharps container filled no more than three-quarters.
Patient safety and ethics
- Confirm patient identity, tooth and side against the radiograph and the record before extraction; a wrong-tooth extraction is a never-event.
- Informed consent requires capacity, disclosure of material risks and alternatives, and a voluntary decision documented in the notes.
- Confidentiality can be breached only with consent, legal obligation or serious public interest; sharing clinical images on social media requires specific consent.
Worked example
A dentist sustains a needlestick from a patient with unknown HIV status. The correct sequence is to wash, report to the occupational health service immediately, test the source with consent, start post-exposure prophylaxis within hours if indicated, and arrange follow-up serology, while maintaining the source patient's confidentiality.
Traps
- Recapping needles or using cold disinfection for surgical instruments.
- Waiting for the end of the day to report a sharps injury.
- Posting identifiable patient photographs without written consent.