In this article I will establish the role and responsibilities of the DICL and other members of the dental team. In each of our practices, the practice manager is the Infection Control Supervisor (ICS) and the head nurse is the DICL.

He/she is responsible for ensuring that all dental nurses comply with all the practice procedures and policies which are in place, as outlined in HTM01-05 and Code of Practice Health and Social Care Act 2008.

The procedures work from an unclean to a clean flow path, ensuring that there is no possibility of cross-infection or cross-contamination and ensuring that the full process is recorded and documented. This is important in case there is an enquiry due to a patient suffering an illness (for example, tuberculosis) that could have been contracted in a dental practice due to poor infection control.

The practice manager (ICS) works closely with the head nurse (DICL), who is responsible for creating the task rotas. These rotas ensure that all the necessary steps are taken during the course of the day. This leads to weekly, monthly, quarterly and yearly reports which are kept as part of our record-keeping. This is our evidence to show that we are meeting all required standards and ensuring that our patients and our staff are protected from healthcare associated infections (HCAI).

All dental nurses take responsibility for the tasks on the rota system. In this way we can ensure that each dental nurse knows exactly what to do. It also ensures that if someone calls in ill or takes leave we have other trained and fully competent dental care practitioners (DCPs) in place who can take responsibility immediately and without constant supervision. We work towards having contingency plans in place to make sure that the practice always runs as smoothly as possible. This ensures that patient care is not adversely affected by any HR issues.

The DICL is also the Decontamination Lead (DL). She/he is organisationally responsible for the implementation of an operational policy for decontamination. She should ensure that the operational policy clearly defines the roles and responsibilities of all personnel who may be involved in the use, installation and maintenance of all our decontamination equipment. She/he is also responsible for the effective and technically compliant provision of our decontamination procedure. This is a live document which gives clear guidance and instructions on what infection control processes must take place. It covers equipment and cleaning materials, and details current legislative requirements. The DL monitors the implementation of the policy, and may delegate specific responsibilities to key personnel. The extent of such delegation should be clearly set out in the operational policy, together with the arrangements for liaison and monitoring.

The DICL is also responsible for carrying out induction training with all new employees who join the team, and for training and monitoring trainee nurses who have just started their training. This means that the trainee nurse is shadowed by the DICL until it has been established that the trainee knows exactly what to do and understands why she is doing it. We have established that this takes around 4 to 6 weeks, depending on the individual. We also engage our dentists in the training activity of trainee nurses, and we ask for regular feedback to ensure that what has been taught is being implemented consistently.

We have implemented a training programme that covers all aspects of infection control. Once each task has been taught and addressed we mark this off on the individual nurse’s Training Schedule. This is a checklist of tasks and procedures that need to be performed on a daily basis. It begins with a hand hygiene induction and then the trainee nurse is taken through the sterilisation process, working from a flow path of unclean to clean. Once the trainee nurse has demonstrated and agreed that she has a good understanding of what is required and why, we ask the nurse to sign the training schedule if she now feels comfortable to work unsupervised. All clinical staff are asked to sign the Infection Control Policy as well as the Infection Control Statement once they have read the documents and they understand what they are signing.

The NI (Nominated Individual) is responsible for ensuring all staff implement infection control policies and guidelines and that adequate resources are available to meet infection control standards and requirements. The NI also actively manages staff to ensure they receive appropriate infection control training, including training at induction and annual refreshers. Infection control training must be monitored via the appraisal process and be incorporated into personal training objectives.

Hand hygiene training is carried out bi-annually to ensure that all clinical staff are constantly reminded about how important hand hygiene is. This is the most basic part of preventing cross-infection between DCPs and patients.

We monitor CPD activity to ensure that our staff are attending courses regularly and that they are also reading current articles on dental care in general.

Our NI conducts in-house training once a year on infection control, making use of technical media. We do in-house training to ensure that our staff are not only being taught according to HTM01-05 and the Code of Practice, but fully understand the procedures and policies that have been put in place within our own surgeries.

Our NI is also responsible for keeping up-to-date with current guidelines and regulation or legislation changes. The Infection Control policy is a live document and is open to amendments depending on legislative changes. If this policy is not kept up-to-date, we risk non-compliance. The NI informs all the staff of any changes during a monthly staff meeting. An induction is carried out and monitored to ensure the changes are being implemented. The NI does this by carrying our unexpected spot-checks on a regular basis, and if any concerns are highlighted they are addressed immediately with the ICS and the DICL and once again followed up until she is assured that the changes have been implemented.

I consider the contribution of the DICL to be one of great importance in ensuring a practice is fully compliant in all areas of Decontamination and Infection Control.

Author: Sharon Holmes RDN

Dental nursing for children can be challenging but very rewarding. I became a dental nurse in 2006. My training involved rotation in different dental departments, and I was able to work with adults as well as children – but I knew I wanted to be a children’s dental nurse from the day of my graduation.

I come from a small family; I have no brothers or sisters, and only few cousins. I used to get attached to children very easily, and I always wanted to take a challenge and work in a child-dominated environment. I was warned many times that it can be challenging to work in a dental practice full of children.

I decided to take this challenge, and have been a dental nurse for a paediatrics department in one of the very busy London hospitals since 2007. I have loved my job from the start, and don’t regret a minute spent with my little patients.

Children and dentistry often do not go together easily. Some children are scared of dentists, and do not want to attend dental appointments. Common fears relate to pain, having teeth pulled out, injections, or just the unknown. Unfortunately, there are not many NHS paediatric dentists where time and play can be introduced into dental appointments. Many dentists do not specialise in treating children and try to help just because they are a family dentist of the child’s parents.

The very first visit to the dentist for a little patient is a crucial one and will be remembered forever. The particular treatment needed and the way the appointment is conducted can make it either a very successful experience or a complete disaster.

The other very important factor in a child’s level of fear is the parents. If a parent is scared of the dentist, the fear is automatically projected onto the child. From a very early age, children can sense the fear and insecurity of their parents in many different situations - including visits to the dentist.

Children should visit the dentist as early as when they are two years of age, and should have their teeth checked with the mirror. The sooner a child is introduced to the dental clinic, the easier it will be for them in the future.

Children react in many different ways to stress. Most of my young patients have some kind of fear, and they need longer appointments to understand the reasons why they are afraid to sit in a dental chair. A very common sign of anxiety is withdrawn behaviour - the child does not want to talk to the nurse or the dentist, is very quiet, and does not communicate. Very often, children begin to cry before anything is done, and do not want to open their mouths for a simple examination with a plastic mirror.

At the other end of the spectrum are the chatterboxes and the children who cannot stop asking questions. In this way they can delay the treatment and not allow the dentist to do anything. Recently I was assisting my dentist with an extraction of a baby tooth. The patient was a ten-year-old girl, and she constantly asked the same question about why we use the mirror. I was trying to show her the spare mirror so that she was able to touch the equipment, but she was still very apprehensive about the dentist performing the treatment.

The clinic in which I work is very busy, and I see children with different dental problems and levels of anxiety. I work closely with my dentists and take a very active role: I interact with my little patients as well as helping the dentist with the treatment. I take more or less initiative depending on the dentist I am working with, but I always play with the children and distract them during the dentist-parent conversation.

At my dental clinic we use the ‘tell-show-do’ method to introduce our young patients to the dentist. I often spend time with individual patients to show them the equipment and materials we use for fillings. I show them the chair and how they can change the position of the light if it becomes too bright.

Different age groups need different types of language to be used. For older kids and teenagers I usually talk about fashion, music and which sports they play at school. For younger children, there are many words in paediatric dentistry which can be used to describe equipment in a nice, friendly way. We speak the language of our patients, not the language of their parents, using words like: sleepy juice (local anaesthetic), sally straw (suction), mashed potatoes (impression plaster), and bubble-gum gel (topical gel) – as well as referring to the tooth fairy, of course. Children like playing, so I try to play with them for as long as the schedule allows. We suck the water from the cup, we hoover the mouth, we catch the butterflies in the tummy, we dive in the sea using inhalation sedation, or we sing songs.

It is very important that I spend most of my time talking with the child rather than the parent. Although we understand that parents want to know what the treatment plan is and they ask lots of questions, it is not advisable to ignore the child. Parents can be very anxious or ask questions in too direct a manner. They tend to name the things loudly in front of the child and push them to be brave.

I like to show children new things and spend time with them prior to the actual treatment. Unfortunately, some parents do not like to waste time and demand to have most of the treatment done on the first visit. I get very upset when children are forced to obey, and I do not agree with parents who would like to use force. I understand the need to be firm in many other situations, but not when fear is taking over my little patient. However, I also have to be alert to the opposite situation – some children play with the emotions of the dentist and the parent, pretending to cry but with no tears coming down their cheeks. They are promised big presents and money for a tooth being taken out.

I always keep my eyes wide open and try to assess the situation from the very beginning. I will never leave my dentist to deal with the situation on her own. Chaperoning is a part of my job and it is vital where there are controversial situations and disagreements over a treatment plan.

In situations which cannot be resolved easily where the child becomes uncooperative, they can be referred to our play specialist, who is trained in delivering dental education through play. She usually spends a few hours with a patient before each appointment. She uses role play and allows the patient to be a dentist. She looks for body language signs and explores previous experiences the child has had in a dental clinic.

I think nurses who would like to work with children need time - time to learn the small steps small patients need in a dental chair. We must be very patient and happy to play. We need more time to build a bond between us and our patients. We must listen to patient needs and be able to tell good stories on demand.

Dental nursing in a paediatric department can be a very physical job. There is running around involved, and siblings and parents of patients often need looking after as well, which can be very time-consuming. We need to remember that children can be unpredictable and we must protect ourselves. Children bite, shout, cry, run away, cannot sit still for a long time and lose concentration very quickly.

However, nothing is more rewarding than a child’s smile. My patients laugh and joke with me. They draw for us, sing and play music. It is an amazing experience to work with children of so many different ages and to follow their individual stories.

When I was a child, I spent long hours at the dentist’s surgery due to problems with my teeth. I never had a nurse to talk to or to hold my hand. I had to deal with fears on my own and in my own way. I always expected the worst and did not like the unknown.

I want my patients to have a better experience, and I love what I am doing. I encourage any nurse who would like to try working with children. It is hard work, but full of fun and joy.

Sylvia Bourgeois RDN

The 30th of October marked a change in General Dental Council (GDC) fees for Dentists and Dental Care Professionals (DCPs). The fee for dentists has increased by £314.00 and the fee for DCPs has decreased by £4.00.

Nurses and other DCPs have been delighted by the news that their fee will not be increasing by £8.00 as was previously proposed. However, there has been an outcry from dentists - their association, the British Dental Association (BDA), is now taking the GDC to court. Read more here.

The GDC’s decision followed a careful analysis of more than 4,000 responses to a consultation which ran for a nine week period until 4th September 2014.

GDC Chief Executive and Registrar, Evlynne Gilvarry said:

"We will continue to seek efficiencies in the way we work but significant savings will require wholesale change of our outdated legislation. We will continue to press vigorously for a completely new legal framework, and meanwhile, we are working to achieve a significant interim legislative* change which will improve the way we deal with cases at an early stage and reduce costs.

In addition, as the number of complaints we receive is a key driver of costs, we are committed to examining why complaints are increasing and what we, and the dental sector, can do to reduce these."

The new fees must be paid by dentists by 31st December 2014 and by DCPs by 31st July 2015.

The General Dental Council (GDC) is seeking to appoint dentists, dental care professionals and members of the public (lay) to the roles of Fitness to Practise (FtP) Panel members.

The GDC acts at the regulatory body for more than 108,00 dental professionals in the UK. The GDC has the power to act by removing a dental professional's registration if they fall short of the standards set.

Members of the Ftp Panel will play a critical role in protecting patients. Members sit in public hearings and will consider cases where a dental professional's fitness to practise may have been impaired due to conduct, performance, or health. Applications for restoration to the registers and appeals against registration decisions will also be heard.

Applicants will require excellent analytical skills and judgement, as well as strong communication skills. An ability to work as part of a team is essential, as is being able to make reasoned and, on occasion, very challenging decisions. The GDC is seeking individuals who are committed to ensuring patient safety, and approach work with both integrity and objectivity.

For more information, visit the recruitment website at www.gdcpanelappointments.com

Applications must be made through the GDC website. The deadline for applications is noon on Tuesday 18 November 2014.