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["Infection Control Checklist"]
["v2.6 Feb  2019"]
[]
["Passed","Y"]
["Failed","X"]
["Attention Required","A"]
["Not Applicable","N"]
[]
[" ","Result","Notes"]
["Dentist/dental therapist/dental hygienist/oral health therapist"]
["Dental prosthetist – surgery and laboratory"]
["Other (specify)"]
[" "]
[null,"Result","Notes"]
["2.1   Is there an up to date Practice Manual detailing Infection Control procedures as required by DBA guidelines on infection control?"]
["2.2  Is there hardcopy/electronic access to the current version of the Australian Guidelines for the Prevention and Control of Infection in Healthcare published by the NH&MRC as required by DBA guidelines on infection control?"]
["2.3   Is there hardcopy/electronic access to the current version of AS/NZS 4815, Office-based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment? or AS/NZS 4185 OR 4187 if applicable as required by DBA guidelines on infection control?"]
["2.4   Is there hardcopy/electronic access to the current version of the ADA Inc. guidelines as required by DBA guidelines on infection control?"]
["2.5   Have all staff of the practice read the Practice manual and been trained in infection control  protocols used in the practice?"]
["2.6   Has the practitioner attended recent continuing professional development on infection control in the current CPD cycle and, if so, when?  Do practice staff attend regular updates on infection control?  "]
["2.7   Does the practice have a written or electronic record of workplace incidents  and accidents (including sharps injuries), as required by national OH&S legislation?"]
[]
["Section 3 - Personal hygiene and hand hygiene","Result","Notes"]
["3.1   Does each registered dental practitioner involved in clinical work know their antibody status for hepatitis B, hepatitis C and HIV and practise accordingly?"]
["3.2    Is there a vaccination record for each member of the clinical staff?"]
["3.3    Is there an allergy record for each member of the clinical staff?"]
["3.4    Are the finger nails of clinical staff short, free of jewellery and false nails and are hands/fingers appropriately covered when they have cuts/abrasions?"]
["3.5    Are there established protocols for hand hygiene which comply with NHMRC 2010 and Hand Hygiene Australia requirements?"]
["3.6    Are there established protocols for hand hygiene before gloving and after degloving?"]
["3.7   Is an appropriate alcohol-based liquid/gel available for waterless hand- hygiene?"]
["3.8  Are liquid soap containers disposable, or are they refilled in an appropriate manner?"]
["3.9   Is there disposable paper towel for hand drying?"]
["3.10  Are there established protocols for when to wear and how to change gloves?"]
["3.11  Are there established protocols for the disposal of gloves?"]
["3.12  Are sterile gloves available and what kind?     "]
["Latex"]
["Non Latex"]
["3.13  Are non-sterile gloves available and what kind?"]
["Latex"]
["Non Latex"]
["3.14  Are there appropriate protocols for wearing and changing protective masks for each patient and are they changed for each patient?"]
["3.15  Is there a protocol ensuring that disposable gloves are NEVER reused"]
["3.16  Is protective eyewear worn by clinical staff?"]
["3.17  Is protective eyewear offered to each patient?"]
[]
["Section 4 - Surgery","Result","Notes"]
["4.1   Does the surgery have defined “clean” and \"contaminated” zones?"]
["4.2   Are there designated hand basins for hand hygiene?"]
["4.3   Are there appropriate procedures for surface cleaning and decontamination between patients?"]
["4.4   Are plastic barriers being used appropriately?"]
["4.5  Are instrument storage areas clean and hygienic?"]
["4.7  Are there appropriate protocols in place for the transfer of instruments/materials IN to the dental operatory?"]
["4.8   Are there protocols in place for the transfer of instruments/materials OUT of the dental operatory?"]
["4.9  Are damaged items removed from use and NEVER reprocessed?"]
["4.10  Are non-critical items sorted in a manner which keeps them dust-free, clean and clear of aerosols?"]
["4.11   Items designated by the manufacturer as single use are NOT reprocessed and reused?"]
["4.12  Is the storage of packaged instruments in accordance with AS4815? (including open shelves 250mm above floor level; no rubber bands holding packets of instruments together; no over-crowding of instruments in drawers; protection from aerosols)"]
["4.13   Are patient notes written up by hand/electronically using an acceptable protocol which prevents environmental contamination of the hard copy notes or computer keyboard?"]
[]
["Section 5 – Surgery Equipment","Result","Notes"]
["5.1   Are there protocols for dental unit waterline management?"]
["5.2   Are there protocols for suction line management?"]
["5.3   Are there protocols for sterile procedures?"]
["5.4   Are there protocols for handling aerosols from air abrasion procedures?"]
["5.5   Are there protocols for handling plume from electro surgery or laser surgical procedures?"]
["5.6  Are there appropriate protocols for surface management of radiographic equipment?"]
["5.7  Are there appropriate protocols in place for surface management of X-ray film or sensors?"]
["5.8  Are  instruments used in critical sites sterile at the point of use?"]
["5.9  Are extracted teeth disposed of in accordance with local authority guidelines?"]
[]
["Section 6 - Sharps and waste disposal","Result","Notes"]
["6.1   Is there an established protocol for dealing with needlestick, other sharps injuries and splash exposures?"]
["6.2   Do suitable waste disposal arrangements exist for sharps?"]
["6.3   Do sharps containers meet Australian standards and are they located appropriately?"]
["6.4   Do clinicians manage sharps appropriately as soon as practicable after use in the surgery?"]
["6.5  Are protocols in place to ensure used sharps are NEVER passed to the dental assistant by the clinician?"]
["6.6   Do suitable waste disposal arrangements exist for contaminated material, such as blood-soaked gauze?"]
["6.7   Are SS endodontic files/reamers sterile at point of use and single use?"]
["6.8   Are protocols in place to check for appropriate re-use or disposal of SS burs after single use?"]
["6.9  Are NiTi endodontic files reprocessed according to accepted protocols?"]
[]
["Section 7 – Medicaments","Result","Notes"]
["7.1  Are LA cartridges stored appropriately prior to use to prevent environmental contamination?"]
["7.2  Is there a protocol that LA cartridges are NEVER re-used on additional patients?"]
["7.3   Are medicaments in  tubes or jars kept free of environmental contamination?"]
[]
["Section 8 - Reprocessing area","Result","Notes"]
["8.1  Is the reprocessing room appropriate in layout and size for the volume of instruments being reprocessed?"]
["8.2   Does the instrument processing area have defined “clean” and “contaminated” zones?"]
["8.3   Is there a clear work flow from dirty to clean?"]
["8.4   Are there separate sinks for washing hands and instruments?"]
["8.5   Are instruments stored appropriately prior to being cleaned?"]
["8.6   Manual washing Are instruments washed in a deep sink or under water?"]
["8.7   Manual washing -  Is appropriate personal protective equipment worn by staff undertaking manual cleaning of items? E.g. Are heavy-duty utility gloves, apron , masks and eye protection available and worn?"]
["8.8   Manual washing - Is the  detergent solution used appropriate for the purposes of instrument cleaning (e.g. not a domestic dishwashing product)?"]
["8.9   Mechanical instrument washing - Are there protocols and documentation in place for the use and maintenance of instrument washers?"]
["8.10 Mechanical instrument washing – Are cassettes used to hold instruments in the instrument washer?"]
[]
["Ultrasonic Cleaners","Result","Notes"]
["8.11   Ultrasonic cleaners - Are there protocols and documentation in place for the use and maintenance of ultrasonic cleaners? Is the chamber left dry overnight? Is the lid kept on when in use?"]
["8.12  Ultrasonic cleaners – are the detergents or additives used suitable?"]
["8.13  Ultrasonic cleaners - is  the water  degassed?"]
["8.14  Ultrasonic cleaners - is the performance of the transducers  tested? What is the frequency and type of testing?"]
["8.15   After rinsing, are the instruments from the ultrasonic cleaner free of visible debris?"]
["8.16   Is there an appropriate means for ensuring instruments are dry after cleaning?"]
["8.17   Is handpiece maintenance satisfactory?"]
["8.18  Are critical instruments appropriately wrapped or bagged?"]
["8.19   Are bagged/wrapped items  loaded properly in the autoclave chamber ?"]
["8.20 Do bagged/wrapped instruments come dry out from the autoclave?"]
["8.21  Are there protocols for batch control identification for bagged/wrapped critical instruments?"]
["8.22  Is the protocol for handling dropped bags or instruments adequate?"]
[]
["Section 9 - Sterilisation and disinfection"]
[" "]
["Total number of sterilisers in the practices "]
[]
["Type of steriliser No 1"]
[]
["Steriliser ID"]
[]
["9A   Steam Sterilisers","Result","Notes"]
["9.1  Is there an operating manual for the autoclave available on the premises?"]
["9.2   Are there protocols and documentation in place for the use and maintenance of the steam sterilizer, including:"]
["*     installation qualification?"]
["*     operational qualification?"]
["*     performance qualification?"]
["*     performance qualification report?"]
["*     air removal/steam penetration tests (pre-vacuum units only)?"]
["*     leak rate tests (pre-vacuum units only)?"]
["*     cleaning of the chamber?"]
["*      cleaning of trays?"]
["*     Loading of the chamber?"]
["*     Checking physical indicator data (display, data card, printout) at the completion of a cycle?"]
["*     Checking the chemical indicator(s) at the completion of a cycle (including external and internal indicators where present in wrapped items)?"]
["*     Recording cycle data in the log book?"]
["*     Authorising load release?"]
["9.3   Is the steriliser functioning correctly?"]
[]
["9B  Thermal disinfection (for prosthetist facilities)","Result","Notes"]
["9.4   What temperature and time is applied for thermal disinfection (boiling)?"]
["9.5   Are instruments cleaned before being placed in the boiler?"]
["9.6   Are instruments covered with water in the boiler?"]
["9.7  Is the cleaning protocol for the boiler adequate?"]
[]
["Section 10 – Laboratory","Result","Notes"]
["10.1  Do suitable arrangements exist for the decontamination of impressions?"]
["10.2 Do suitable arrangements exist for the pouring up of impressions?"]
["10.3  Do suitable arrangements exist for the decontamination of denture stages?"]
["10.4  Do suitable arrangements exist for management of buffs, pumice and polishing trays for new dentures?"]
["10.5  Do suitable arrangements exist for management of buffs, pumice and polishing trays for relines and denture repairs?"]
["10.6  Do suitable arrangements exist for the re-use of acrylic teeth and porcelain teeth?"]
["10.7  Are different gowns used for the surgery and the laboratory?"]
["10.8  Are the handpieces used for denture adjustments in the laboratory protected by  barriers appropriately?"]
["10.9  Are burs used for contaminated denture adjustments autoclaved or boiled?"]
["10.10 Is laboratory equipment including bowls and spatulas clean?"]
["10.11 Are there designated areas for the receipt and dispatch of lab work?"]
[]
["Section 11 – Practice hygiene and summary of critical points "]
["(11.6 is also recorded in earlier sections of the document)"]
[" ","Result","Notes"]
["11.1 Are the premises in general clean and hygienic?"]
["11.2 Are working surfaces in the instrument reprocessing room clean and hygienic?"]
["11.3 Are working surfaces in the dental operatory clean and hygienic?"]
["11.4 Are working surfaces in the laboratory clean and hygienic?"]
["11.5 Are instrument storage areas clean and hygienic?"]
["11.6 Are all sterilisers functioning correctly?"]
[]
[]
["Type of steriliser No 2"]
[]
["Steriliser ID"]
[" "]
["9A   Steam Sterilisers","Result","Notes"]
["9.1  Is there an operating manual for the autoclave available on the premises?"]
["9.2   Are there protocols and documentation in place for the use and maintenance of the steam sterilizer, including:"]
["*     installation qualification?"]
["*     operational qualification?"]
["*     performance qualification?"]
["*     performance qualification report?"]
["*     air removal/steam penetration tests (pre-vacuum units only)?"]
["*     leak rate tests (pre-vacuum units only)?"]
["*     cleaning of the chamber?"]
["*      cleaning of trays?"]
["*     Loading of the chamber?"]
["*     Checking physical indicator data (display, data card, printout) at the completion of a cycle?"]
["*     Checking the chemical indicator(s) at the completion of a cycle (including external and internal indicators where present in wrapped items)?"]
["*     Recording cycle data in the log book?"]
["*     Authorising load release?"]
["9.3   Is the steriliser functioning correctly?"]
[]
["Type of steriliser No 3"]
[]
["Steriliser ID"]
[" "]
["9A   Steam Sterilisers","Result","Notes"]
["9.1  Is there an operating manual for the autoclave available on the premises?"]
["9.2   Are there protocols and documentation in place for the use and maintenance of the steam sterilizer, including:"]
["*     installation qualification?"]
["*     operational qualification?"]
["*     performance qualification?"]
["*     performance qualification report?"]
["*     air removal/steam penetration tests (pre-vacuum units only)?"]
["*     leak rate tests (pre-vacuum units only)?"]
["*     cleaning of the chamber?"]
["*      cleaning of trays?"]
["*     Loading of the chamber?"]
["*     Checking physical indicator data (display, data card, printout) at the completion of a cycle?"]
["*     Checking the chemical indicator(s) at the completion of a cycle (including external and internal indicators where present in wrapped items)?"]
["*     Recording cycle data in the log book?"]
["*     Authorising load release?"]
["9.3   Is the steriliser functioning correctly?"]