Infection Control, Ethics, Patient Safety and Practice Management
Standard precautions
Treat every patient as potentially infectious. For hand hygiene use alcohol rub before and after patient contact and after removing gloves; wash with soap and water when hands are visibly soiled. Wear gloves, mask, eye protection and gown. Place sharps in a puncture-resistant container filled to no more than three-quarters. Clean instruments ultrasonically, pouch and autoclave at 134 °C for at least three minutes (or 121 °C for 15 minutes); validate with chemical indicators and weekly biological spore tests (Geobacillus stearothermophilus for steam). Dental unit waterlines should deliver ≤500 CFU/mL.
Post-exposure management
Wash the wound with soap and water; do not squeeze or suck it. Report immediately. Percutaneous transmission risk is roughly 30% for hepatitis B from an HBsAg-positive source, 1.8% for hepatitis C and 0.3% for HIV. For HBV give hepatitis B immunoglobulin plus vaccine if non-immune; for HIV start antiretroviral post-exposure prophylaxis within hours, ideally under 24. Document and follow up serologically.
Ethics and patient safety
Consent must be informed and voluntary: diagnosis, options including no treatment, risks, benefits and costs. Core principles are autonomy, beneficence, non-maleficence, justice, confidentiality and veracity. Refer outside your competence. Record contemporaneously and retain records as local regulation requires. Wrong-site extraction is a recognised never-event - verify identity, tooth and side against the radiograph with a verbal read-back.
Worked example
An unvaccinated hygienist sustains a needlestick from an HBsAg-positive patient. She should wash, report, be tested, and receive hepatitis B immunoglobulin plus the vaccine series - reassurance alone is inadequate.
Traps
- Using alcohol rub when hands are visibly contaminated.
- Believing HIV is the highest-risk needlestick pathogen.
- Documenting consent without the discussion of alternatives.
- Sterilising in unsealed pouches or overloading the autoclave.