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