Patient Safety - Kosmo Dental Clinic

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:

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.

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.

Storage:

Store in a clean, dry, disinfected place.

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.

INSTRUMENT	RECOMMENDED 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
Patient Drapes	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
Patient tumbler	Disposable: Change for every patient, discard in RED dustbin.
Hand Towel	Wash with detergent, rinse with dettol
Spitoons	Scrub and wash with detergent after every patient.
Mackintosh sheet	Clean 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

Patients Entry in The Clinic
Patients Wating In the Clinic
Patients in the Clinical Area
Post Patient Leaving the Clinical Area
Disinfection Methods for Clinical Areas

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

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

Provision of Ramps
Provision of wheelchair
Ergonomic Dental Chair for Elderly which provides additional lumbar support.
Geriatric friendly lavatories
The clinic is brightly lit and devoid of blind corners which might cause any unfortunate trauma.
Use of Dental models to explain the treatment more effectively to the elderly.

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

Randomly patients are asked to review the safety measure and feedback is obtained from them.
Every month all the safety policies are reviewed by the management and new policies if required are decided and brought into force in the upcoming cycle.
The staff has to follow a two strike policy, after which they are liable to imposition of penalties or negative credit which affect their appraisal.

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.

We at Kosmos Follow these rules during prescribing Determine patients past history with any drug, side effects, known allergies.
Past medical histories and ongoing drugs with which the prescribed drugs might interact in a damaging manner
We urge our Patients to complete the course of the antibiotics prescribed, as it might develop unwanted resistance to infections later in life.
The fresh new prescription is issued if the old prescription is to be renewed.
No over-writing and corrections are allowed on the prescription.

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