Dental Clinic Sterilisation and Infection Control for NABH (DHSP 3rd Edition)

The chapter in numbers

NABH's Dental Healthcare Service Providers (DHSP) standards, 3rd Edition, have two sections: Section A for dental hospitals and educational institutions and Section B for dental clinics. The infection prevention and control (IPC) chapter looks like this:

Thirteen Core elements make IPC one of the chapters a dental clinic cannot afford to get wrong. Our DHSP accreditation page explains the programme, fees and four-year cycle.

The six standards

The programme and its people (IPC.1–IPC.2)

The infection control programme must be documented (IPC.1.a, Core), identify high-risk activities with written guidance for each, and be reviewed at least once a year. The clinic has an infection control committee and team, and a designated infection control nurse (a registered nurse with additional structured training).

Management provides the resources the programme needs (IPC.2.a, Core), earmarks funds in the annual budget and runs in-service infection control training at least once a year. Staff get pre- and post-exposure prophylaxis, including vaccination such as hepatitis B and tetanus as required. Every patient-care area needs at least one easily accessible washbasin with running water and hand rub (IPC.2.e, Core).

Chairside practice (IPC.3)

Four Core elements apply at the chair: standard precautions at all times, hand hygiene following recognised guidelines such as the WHO's, safe injection and infusion practice ("one needle, one syringe, only one time") and implementing the antimicrobial policy with monitoring of rational use. An antibiotic stewardship programme is the chapter's Excellence element.

The clinic environment (IPC.4)

Engineering controls cover the design of patient-care areas, with an optimum spacing of one to two metres between dental chairs, air quality, water supply and water-quality testing, and controls for aerosols. Construction and renovation need an infection risk assessment. Two elements are Core: housekeeping procedures and safe handling of biomedical waste, segregated in colour-coded bags and containers as the law requires and handed to an authorised vendor. See our biomedical waste authorisation page.

Surveillance (IPC.5)

Surveillance targets the clinic's high-risk areas (Core), and the infection control team verifies the data. Two more Core elements set routine checks: hand hygiene compliance monitored at least once a month for all staff in direct patient care, and monitoring of housekeeping effectiveness at a frequency the clinic defines. Results go back to the staff, outbreaks are identified and acted on, and corrective action follows the analysis.

Sterilisation: the new standard for clinics (IPC.6)

For Section B clinics, IPC.6 is a new standard in the 3rd Edition. It has five parts:

1. Space and zoning (IPC.6.a): a layout with one-way flow and separate clean and dirty areas, preferably with distinct areas for receiving, washing, cleaning, packing, sterilisation, sterile storage and issue.
2. Written reprocessing guidance (IPC.6.b, Core): cleaning, packing, disinfection or sterilisation, storage and issue of items in line with national or international guidelines, such as the CDC's 2008 guideline. Reprocessing can be outsourced to a provider that meets central sterile supply department standards.
3. Single-use items (IPC.6.c): if any single-use item is reused, the items, the number of reuses and the process are defined and monitored, and the patient is informed.
4. Validation (IPC.6.d): physical and chemical tests daily, biological tests at least weekly, the Bowie-Dick and leak rate tests, a unique number and content description for every load, and temperature, pressure and time records.
5. Recall (IPC.6.e): written guidance for withdrawing items if sterilisation fails, made practical by batch labels with the date and machine number.

What assessors check in a dental clinic

• The infection control manual, its annual review and committee minutes.
• A washbasin, soap and hand rub in every operatory, and the last three monthly hand hygiene audits.
• The reprocessing room: one-way flow, separate dirty and clean zones, and staff who can explain each step.
• Autoclave logbooks with daily chemical indicators, weekly biological indicator results, Bowie-Dick and leak tests, and load numbers on packs.
• Packs labelled with batch, date and machine, and a recall procedure that staff know.
• Waste segregation at the chair, needle disposal and the waste vendor's records.
• Staff immunisation records, especially hepatitis B.

Getting ready

1. Write or update the infection control manual against all 39 elements, with the 13 Core elements first.
2. Redesign reprocessing for one-way flow, even in a small room, using marked zones.
3. Start the autoclave validation log today: daily, weekly and per-load records.
4. Begin monthly hand hygiene audits and share the results.
5. Train every chairside assistant; our NABH questions for staff guide is a good drill.

Small clinics with up to 8 chairs can also start with NABH entry-level certification for dental clinics. Our dental clinic accreditation guide covers the rest of the standard.