CANADIAN NATIONAL INSTITUTE OF HEALTH
Dental Hygiene Program
Spring 2012
CLINICAL MANUAL
Section IV – Clinic Operational and Safety Policies
CNIH - Dental Hygiene Program2012
Revised March 2012
Table of Contents
Infection Control Procedures
Correct Use of Personal Protective Devices
3
Cleanliness of Client Clinical and Student Assessment Documents
4
Handling of Pathogenic Waste
5
Treatment Unit and Client Preparation for Treatment
6
Post-treatment Sanitation of Treatment Unit, Equipment and Instruments
6
Processing Hand Instruments
8
Sterilization of School Instruments
8
Sanitation in the Radiography Area
8
Care of the Dental Laboratory and Equipment
10
Safety Policies
General Guidelines for Safety in the Dental Clinic
12
Emergency Protocol – Fire
13
Emergency Protocol – Medical
14
Locations of medical and emergency equipment
Steps in handling a medical emergency
15
15
Responsibilities of the Duty Student
Reception
Dispensing/Sterilization Area
Radiography Area
Case Degree of Difficulty Designation
16
17
17
19
Clinical Manual, Section IV – Clinic Operational and Safety Policies 2
CNIH - Dental Hygiene Program2012
Revised March 2012
CLINIC OPERATIONAL AND SAFETY POLICIES
INFECTION CONTROL PROCEDURES
Correct Use of Personal Protective Devices
Clean clinical clothing is required for each clinical session. (see Section II of this manual for dress code).
Non-vinyl operating gloves, face masks and protective eye wear are required when providing client
services that pose a risk of cross infection between client and operator.
Students are required to wear radiation dosimeter badges while working in the dental clinic and
radiography area. These are the property of the Institute and are on loan to students while they are in the
program. Students who lose or damage a badge will be required to pay for a replacement. Students will
pick up their badges from the storage rack in the dental clinic at the beginning of a session and return
them to the rack when leaving the area at the end of the clinic.
Healthy, intact skin is your natural barrier to infection. With frequent hand washing, maintaining healthy
skin is a challenge. Using the following technique will help:

Use lukewarm water.

Wet hands and wrists, keeping hands lower to control water flow. Avoid splashing water on clothing.

Apply germicidal soap and lather all parts of the hands thoroughly.

Use a brush to clean under fingernails if necessary.

Rinse hands well.

Dry hands well with paper towels. If taps are manually operated, turn them off using your elbows if
possible or a paper towel so that hands do not become contaminated.

Use skin conditioners and moisturizers frequently.

If skin becomes irritated to the point of increased risk for operator infection (i.e., weeping dermatitis
or open sores) consult your supervising clinician for advice on required procedures.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 3
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Operating Gloves Face Masks and Protective Eye Wear
 Operating gloves are required when performing client services that involve possible contact with the
client’s body fluids.
 Clean over gloves are used to cover contaminated operating gloves when:
–
–
–
handling the client’s files during a treatment appointment.
accessing supplies in the treatment area.
leaving the treatment unit to access supplies or to sign for a supervising clinician to come
to your unit.
 Treatment gloves are NEVER used for treatment of more than one client.
 Change treatment gloves during client care if they change colours or if they tear.
 When removing gloves for disposal:
–
–
–
wash them first.
take care not to touch your skin with the contaminated surface of the glove.
grasp the glove at the wrist and strip it off the hand so that it turns inside out.

Wash hands thoroughly.

Masks must be clean for each client. They are replaced during care of that client when they become
damp or visibly soiled. Do NOT touch them while in use.

Remove masks completely when not in use (do NOT wear them around your neck).

Remove masks by grasping the strings being careful not to touch the mask or your hair.

Protective eye wear should be disinfected between clients or when visibly soiled.

All clients should be provided with safety glasses provided by the school these are to be disinfected
after each use.
Cleanliness of Client Clinical and Student Assessment Records
All clinical documents pertaining to client care or student performance must be handled in a manner that
keeps them clean. All such documents are to be handled with clean bare hands OR if necessary during the
course of client treatment, with clean over gloves covering soiled operating gloves.
Place client chart on top of mobile or stored in chart holder.
Keep counter space free to allow for maximum working space.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 4
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Handling of Pathogenic Waste
Any item used in the delivery of treatment that has the capacity to pass infection on to someone else
(client or operator) is referred to as a biohazard or considered to be pathogenic. Many diseases such as
herpes, hepatitis, HIV etc. are spread by means of viruses or bacteria living in blood or tissue fluids. Any
instrument or disposable item which, during the course of treatment, becomes saturated with blood or
tissue fluid becomes pathogenic.
In the dental clinic items that can carry infection include; saliva ejector tips, gauze squares, soiled dental
floss, rubber polishing cups and brushes, cotton rolls etc. These are items that must be handled according
to their potential to pass on infection.
Biohazardous waste is identified as blood soaked gauze squares or other absorbent material from which
droplets of blood can be squeezed out.
Biohazardous waste is disposed of in the biohazard waste bags in the treatment units.
During clinical sessions involving client treatment, please handle waste products according to the
information in the table below:
Biohazardous or Pathogenic Waste
 Blood soaked gauze wipes and cotton rolls
Other Waste Materials
These materials can be placed in regular garbage
containers.
 Paper products (head rest and tray covers, paper
cups, glove boxes, towels from hand washing
and unit disinfection)
 Masks
 Disposable air/water syringe tips
 Used over gloves
 Barrier film from equipment
 Operating gloves (wash hands with soap and
hot water before removing gloves: strip off
hands to turn them inside out before
discarding).
Revised March 3, 2010
Clinical Manual, Section IV – Clinic Operational and Safety Policies 5
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Treatment Unit and Client Preparation for Treatment

Place foot control for handpiece on the floor.

Wash hands.

Place full distilled water bottle on unit, turn on master switches and lower chair.

Wash and dry hands thoroughly.

Obtain instruments/materials from the dispensing station.

Insert air/water syringe tip and saliva ejector tip and place the appropriate barrier film.

Flush air/water syringe (and handpiece if applicable) lines for 30 seconds.

Place protective barriers on dental chair, bracket table, hoses, prophy angle, light handles and
ultrasonic scaling unit (if to be used). Flush line from unit for 2 minutes.

Set out sealed instrument cassette on bracket table.

Verify Chemical indicator (tape or sterilization bag)

Cover bracket table with clean disposable client bib.

Sort material from client’s file (charts, x-rays etc.) as needed.

Set out operating gloves, over gloves, mask, protective eye wear for operator and client.

Greet and seat client. Place bib, safety glasses and provide antimicrobial mouth rinse.

Record client’s updated medical history. Check and record client’s vital signs if indicated.

Put on mask, safety eyewear and operating gloves. Open instrument cassette.
Post-treatment Sanitation of the Treatment Unit, Equipment and Instruments
When performing all sanitation procedures wear heavy gauge utility gloves, mask and safety
glasses.
 Wash operating gloves, strip off to turn inside out and discard with normal garbage.
 Wash hands and put on utility gloves
 Dispose of used needles in the sharps container. When ¾ full, transport to the decontamination area
for appropriate disposal.
Revised December 11, 2009
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 Dispose of biohazardous waste.
 Place contaminated disposable equipment and supplies that are not defined as biohazardous (i.e.,
barrier film, tray covers etc.) in the soiled headrest cover and dispose in regular garbage receptacle.
 Assemble cleaning supplies (disinfectant, wipes, cleaning brush, HVE solution).
 Disassemble handpiece, use scrub brush to remove debris, lubricate all parts, reassemble, purge for 30
seconds, bag and label (name, date and clinic session number) for sterilization.
 Ultrasonic inserts and prophy jet tips are rinsed, dried and bagged for sterilization.
 Examine instruments for debris and rinse off, use hand brush if needed.
 Load hand instruments into cassette and take to decontamination area for processing.
 Disinfect and store client safety glasses.
 Remove the strainer from the cuspidor, rinse thoroughly, wrap with disinfectant wipes and place in
the sink.
 Place 60 ml. (1/4 cup) of disinfectant solution in the cuspidor drain and run water through it for
several seconds. Run the remainder of the solution through the suction lines (saliva ejector and HVE).
Disinfect solution container before returning to storage.
 Bleed unit water lines for 30 secs.
Using disinfectant wipes (a new one for each step) clean the equipment as follows:
 Wipe the light switch, handle and face (NOT the back), cup filler and switches on the cuspidor
outside of the cuspidor.
 Wipe chair adjustment and bracket table switches, bracket table and supporting arm, adjustment
levers of the operator’s stool, back of the dental chair and operator’s stool (NOT the leather parts)
 Wipe all dental line tubing. (A/W line, hand piece, suction)
 Wipe the drawer and cupboard door handles, counter top, soap dispenser and inside of the cuspidor
 Using leather cleaner, wipe down the dental chair and operator’s stool.
 When light has cooled, clean back with wet paper towel.
 Return strainer to the cuspidor.
 Remove safety glasses and disinfect.
 Sanitize the sink, scrub brush, disinfectant bottle and utility gloves. Dry gloves and store cleaning
equipment and supplies.
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 Remove and discard mask.
 Wash hands.
Processing Hand Instruments
 While processing hand instruments, wear heavy gauge utility gloves
 Each cassette is placed in the instrument washer.
 When complete, the cassette is removed and instruments checked for visible debris. If not clean, they
are recycled until they pass inspection.
 An indicator strip is placed in each cassette and the cassette is wrapped and labelled with the student’s
name, date and clinic session number.
 Wrapped, labelled cassettes are placed into the sterilizer.
 Each load sterilized is logged. Sterilized cassettes are moved to storage.
Sterilization of School Instruments
 Examine instruments for debris, rinse off, use hand brush if needed.
 Identify as school equipment and return to processing area for sterilization and storage.
Sanitation in the Radiography Area
BEFORE SEATING THE CLIENT
With over gloves on complete the following:
 Collect the appropriate number of radiographs from the storage area.
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 If the film is not pre-barriered, place it in a barrier envelope.
 Place the prepared films on a clean paper towel outside the x-ray room.
 Place a clean paper cup beside the towel.
 Choose and assemble any film holding devices that you are planning to use.
 Turn on the x-ray machine and select settings as required
Place plastic barrier wrap on the following:
 The time selection and exposure switches on the x-ray machine control panel.
 Chair head rest, control switches and door knob.
SEAT THE CLIENT AND PLACE THE LEAD APRON
Remove over gloves and dispose, expose the prescribed films.
 After each exposure, open the barrier and let the film drop into the clean paper cup.
 Place the soiled barrier film and used holders on the paper towel.
 Be careful not to touch the cup or the unbarriered films with your soiled gloves.
 When all exposed films have been deposited in the cup, gather the soiled barriers in the paper towel
and place in the waste container.
 Remove gloves and wash your hands
DISMISS THE CLIENT FROM THE RADIOGRAPHY AREA.
With clean bare hands, prepare and process the films:
 Label a film packet with your name and the number and type of views taken in your series to track the
films in the processor.
 Record the number and type of views exposed on the quality control sheet posted near the processor.
 Choose and label (in pencil) a mount appropriate for the views. Include: client’s full name; date of
exposure; prescribing dentist’s name; your initial, surname and clinic unit number and number of
radiographs exposed.
 Insert the films into the processor.
 While films are developing, disinfect radiography room.
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Disinfect the x-ray room:
 Wear utility gloves.
 Remove contaminated barriers from equipment and discard.
 Bag and label used film holding devices and return to the decontamination area for sterilization.
 Disinfect, dry and store utility gloves.
 When the room is clean, turn off the light: place “sterilized “ tag on outside door knob.
Retrieve your processed radiographs.
 Insert the radiographs in the labelled mount. Ensure that the radiographs become part of the client’s
clinical records.
Care of the Dental Laboratory and Equipment
Impressions and Impression Trays
 When an impression is removed from the mouth, rinse it immediately with water to remove saliva and
any blood visible.
 Spray the impression with a disinfectant approved by the manufacturer of the impression material and
wrap it in a paper towel wet with the same disinfectant solution. Leave until ready to pour (at least 15
minutes).

Unwrap the impression, rinse with water and shake excess from the surface. Bag and transport to the
dental lab for pouring.
 When the impression tray is removed from the model, remove all traces of impression material and
utility wax from the tray and discard the material in the garbage. Ensure that material remnants are
not flushed into sink traps.
 Prepare the trays for sterilization: rinse, dry, bag, identify and transport to the appropriate area.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 10
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Rubber Bowls and Spatulas
 Scrape excess plaster from bowls before it sets and discard with garbage. DO NOT let set or un-set
plaster enter the sink drains.
 Remove plaster from spatulas immediately after use. Ensure that the handle, sides and edges of the
blade are clean.
 Protect the blade from scratches.
 Note: Spatulas used for client care must be sterilized and the rubber bowls sanitized with hard
surface disinfectant.
Model Trimmers
 NEVER wear hand jewellery while operating a model trimmer as it can become caught in the
wheel.
 Ensure that there is adequate water flow to the grinding wheel at all times during use.
 Clean residue from the wheel by holding the brush carefully against the wheel while it is in
motion.
 Turn off the machine and wipe residue from the platform.
 Clean up spills on the counter or floor.
Vibrators and Moulds
 Remove gypsum residue after use.
 Wipe clean and dry.
Mouth Guard Forming Equipment
Use and maintain only under the supervision of a staff member.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 11
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SAFETY POLICIES
General Guidelines for Safety in the Dental Clinic
 Keep personal belongings (students’ and clients’) in the treatment area to a minimum, off the floor
and out of traffic areas.
 Floors are slippery when wet. Wipe up any spilled liquids immediately.
 Always use the dental unit in a configuration that maintains its stability. Wide extension of the
bracket table can disrupt the unit’s balance.
 When seating and dismissing the client make sure that all equipment is out of the client’s path to and
from the dental chair.
 Never place equipment so that it poses a risk to the clients, operators or others.
 Never place instruments or equipment on the client’s chest or lap. This is a CDHO standard of
practice.
 Never pass instruments over the client’s face.
 Never adjust the operating light with instruments in that hand.
 Never leave young children alone in the treatment unit. If you must leave, ask a student in the
adjacent unit to watch your child client.
 If you or your client sustains an injury during a clinical session, report it immediately to the
supervising clinician for appropriate handling and reporting.
 If you sustain a cut or puncture wound with a contaminated instrument do the following:
-
remove your gloves
encourage bleeding at the site
wash hands thoroughly with soap and water
apply antibacterial preparations or alcohol to the site
report to your supervising clinician for advice on further action.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 12
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Emergency Protocol – Fire
General principles:
 Act quickly and quietly to avoid initiating panic in others.
 Do NOT use elevators.
 Do NOT stop to collect personal belongings.
 Leave the building by the nearest safe exit.
 Call the 911 emergency number from outside the building. Provide as much information as possible
to the operator. Stay on the line until advised to hang up.
 Move at least 100 meters away from the building.
 Remain outside the building until advised by the emergency response personnel that it is safe to reenter.
If you discover the fire:
 Close the door on your way out.
 Activate the nearest fire alarm and leave the building immediately.
If you hear the fire alarm:
 Close the door on your way out and leave the building immediately.
If you are providing a service to clients and hear the alarm:
 Stop work immediately.
 Accompany your client and leave the building immediately using the nearest exit.
If you are in charge of the class or activity:
 Stop all activity.
 Designate a meeting point outside the building.
 Ensure that all persons involved leave the building immediately by the closest safe exit.
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 Close all doors on the way out.
 At the meeting point, ensure that all persons involved in the activity are accounted for.
 If persons are suspected of being inside, advise emergency response personnel of this possibility.
Emergency Protocol – Medical
Aspects of Emergency Response
Where possible, advance preparation should be used to reduce the potential for occurrence of a medical
emergency during dental treatment. Recording an accurate health history for each client and identifying
those at potential risk is part of a successful medical emergency prevention plan. The second aspect of
emergency response is to know the location of life support equipment and materials and how to proceed
when an emergency does occur.
Some positive responses to health history questions may indicate that it is not in the client’s best interest
to be treated in the school dental clinic. Discuss such findings with the duty dentist. S/he will verify if this
is the case and advise the client to contact a facility that can meet his/her special treatment needs.
Even though appropriate precautions are in place, medical emergencies do happen. That is why students
are required to maintain current certification in first aid and C.P.R while providing client care at the
Institute. These qualifications are also part of the CDHO standards of practice for registered dental
hygienists.
An effective emergency response system includes:
 Ready access to a telephone to summon outside help.
 Readily available emergency equipment and supplies.
 Staff and students who know how to act efficiently during a medical emergency
Clinical Manual, Section IV – Clinic Operational and Safety Policies 14
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The school medical emergency equipment is located as follows:
Equipment
Clinic Location
Telephone

Front of clinic; Dispensing area; Client reception area
Portable oxygen tank

Front of clinic
Stethoscopes and blood
pressure cuffs

Front of clinic in labelled cupboards
Emergency kit and drug box

Shelf unit in front of clinic by window
Juice boxes

Dispensing station fridge
Eye wash station

Front of clinic
Steps in Handling a Medical Emergency
If your client experiences a medical emergency during an appointment do not leave him or her alone at
any point. Remain clam and proceed quickly and quietly as indicated below.
 Ask a classmate in an adjacent treatment unit to remain with your client.
 Approach the duty dentist or supervising dental hygienist immediately and report the type of
emergency your client is experiencing.
 Accompany them to your treatment unit.
 The staff will now direct your assistance in handling the emergency.
 If internal assistance is available, call and request it.
 If external assistance is required call 911 and advise the response team of the easiest access route to
the client.
 When the calls are completed, advise the staff that help is on the way.
 Take a copy of the emergency report form to the staff dealing with the client so that information on
actions already taken can be transported with the client.
 Meet the emergency response team at the building entry you specified for appropriate access and lead
the team to the client requiring assistance.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 15
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Responsibilities of the Duty Student
During the program, students will be assigned to assist in clinical operations for a small number of
clinical sessions. This provides students with an opportunity to experience more closely, the roles of other
members of the dental team and to learn support skills useful in employment situations. Duty students
will be assigned to the following areas: client reception; dispensing/sterilization stations; radiography
area.
All clinical attendance and dress requirements apply when on assignment as a duty student. Duty students
are required to report to their assigned areas 15 minutes prior to the beginning of the clinical session.
Students must document activities accomplished while on duty and have their participation verified by the
staff supervisor for the assignment.
Reception Duty
When assigned to clinic reception duty students are required to:

Report to the Clinic Receptionist.

Provide clients appointed for the first time with blank charts to complete personal and health
histories.

Receive payments for services from clients and issue receipts.

Greet drop-in clients and appoint immediately as a new client if a student during that clinical
session has had a last minute cancellation. If service cannot be provided immediately, take
necessary contact information and give it to the receptionist for inclusion in the client data base.

Meet clients requesting emergency care, determine their needs and consult with an appropriate staff
member regarding further service provision.

File client charts from previous clinical session.

Pull charts for the next clinical session.

Confirm client appointments.

Assist with other duties as assigned and monitored by the clinic receptionist.
Clinical Manual, Section IV – Clinic Operational and Safety Policies 16
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Dispensing/Sterilization Area
When assigned to dispensing/sterilization duty students are required to:

Assist in maintaining cleanliness/asepsis and organization in the dispensing and sterilizing areas.

Dispense properly requisitioned equipment and supplies.

Learn and complete (under supervision) routine maintenance of equipment in the areas if due.

Stock clinical boxes with consumable supplies as required.

Complete the decontamination and sterilizing cycles for incoming instruments.

Maintain sterilization and spore testing logs.

Assist with other duties as assigned and monitored by the staff member in the dispensing area.
Radiography Area
When assigned to radiography duty students are required to:

Turn on the processor and ensure it is working properly.

Top up the processing solutions as appropriate.

Check processor solution temperature for accuracy.

Carry out routine processor maintenance (under supervision) if due.

Expose and process test films for each x-ray machine to ensure proper function. Advise a staff
member immediately if machine malfunction is suspected.

Stock all radiography rooms with consumable supplies as appropriate (barriers, paper towels, facial
tissues etc.)

Monitor asepsis during exposure of radiographs.

Assist with developing exposed films.

Maintain the exposure log.

At the end of the session, return processor to “stand-by” status if another clinical session follows. If
the last clinic of the day, turn off and vent processor.
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
Ensure that all the x-ray machines have been returned to an acceptable configuration and power
switches turned off.

Ensure that all radiography rooms, dark room and viewing area are disinfected at the end of the
session.

Assist with other duties as assigned and monitored by a supervising clinician.
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CASE DEGREE OF DIFFICULTY DESIGNATIONS
Criteria
Degree of Difficulty
DD0
DD1
DD2
Plaque and Extrinsic
Stain
Stain: none
Plaque: minimal
Stain: light
minimal
Plaque: localized
scanty
Stain: light to
moderate
Plaque: generalized
scanty
Supragingival
Deposits:
localized scanty
Deposits:
generalized light
Localized light to
moderate
Subgingival
Deposits: none or
very minimal
Deposits:
generalized
scanty to light or
localized to
salivary duct
areas
Deposits:
localized scanty
Perio Status
Sulcus depth
between 1-3mm
No bleeding
present upon
instrumentation
Additional intra oral
considerations
No access
limitations
Normal tooth
position
Number of teeth
present
Generalized
sulcus depth
between 1 –
3mm
Localized 4mm
pockets
Localized
bleeding upon
instrumentation
No access
limitations
Normal to slight
variation in tooth
position
Number of teeth
present
Client Related
considerations *
Cooperative
No specific
considerations
Cooperative
Possible client
considerations
Total required
appointments
(suggested guidelines
only)
Instructor Assistance
level
Term 2 – 1
Term 3 – ½ to 1
Minimal
DD3
DD4
Stain: light to
moderate
Plaque:
generalized light to
moderate
Deposits:
localized or
generalized moderate
Stain: moderate to
heavy
Plaque: generalized
light to moderate
Deposits:
generalized light
Deposits:
generalized moderate
Generalized sulcus
depth between 1 –
3mm
Localized
4 – 5mm pockets
Localized bleeding
upon
instrumentation
Generalized 4 – 5
mm pockets
Generalized bleeding
upon instrumentation
Deposits:
generalized moderate
to heavy
Generalized 5mm
and greater pocket
depths
Generalized bleeding
upon instrumentation
Some challenges
due tooth
positioning, limited
opening,
restorations,
missing teeth, third
molars,
musculature, tooth
sensitivity,
recession, furcation
involvement
Number of teeth
present
Possible client
considerations
Some challenges due
tooth positioning,
limited opening,
restorations, missing
teeth, third molars,
musculature, tooth
sensitivity, recession,
furcation
involvement,
tenacious hard
deposits
Number of teeth
present
Possible client
considerations
Some challenges due
tooth positioning,
mobility, limited
opening, restorations,
missing teeth, third
molars, musculature,
tooth sensitivity,
recession, furcation
involvement,
tenacious hard
deposits
Number of teeth
present
Possible client
considerations
Term 2 – 1 to 2
Term 3 - 1
Term 2 – 2 to 3
Term 3 – 1 ½ to 2
Term 2 – 3 to 4
Term 3 – 2 to 3
Term 2 – 5 to 7
Term 3 – 4 to 6
Minimal
Minimal to
moderate
Moderate
Extensive
Deposits:
localized or
generalized moderate
to heavy
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Instructor Assistance
level with Case
Presentation
Term 2 and 3:
minimal
clarification
Term 2 and 3:
minimal
clarification
Term 2 and 3:
minimal
clarification
Term 2 and 3:
minimal to moderate
clarification
Term 2 and 3:
minimal to moderate
clarification
*Client Related Consideration:
Client’s human needs deficits must be taken into consideration when determining the degree of difficulty in regards to
treatment planning. Assess and reflect on the human needs deficits that apply to the client when assessing the degree of
difficulty.
Examples of considerations include:
General health, side effects of medications, client’s age, physical and emotional needs, positioning, cooperation,
language, sensitivity, required breaks, strong gag reflex, amount of bleeding and saliva, oral habits, and
psychosociocultural needs.
The list is not exhaustive. In each designation subgingival deposits must be present: all other criteria may possible be
present.
“Our mission is to provide quality education to dental hygiene students through dental hygiene theory and practice,
comprehensive oral health care to the community and to promote individual growth and development through life-long
learning”
Clinical Manual, Section IV – Clinic Operational and Safety Policies 20