Standard Operation Procedures
STANDARD OPERATION PROCEDURES
Cerritos College has established standard operating procedures (SOP's) protocol for infection control that will include both the use of personal protective equipment and mandatory work practices necessary to prevent the transmission of disease at all times. The Cerritos College faculty and students are responsible for ensuring compliance of this protocol.
ENGINEERING AND WORK PRACTICE CONTROLS PROTOCOL
Engineering and work practice controls are to be used to minimize or eliminate exposure. The manner in which a task is performed is evaluated for safety, and if appropriate, changed, in an effort to reduce the likelihood of a workers exposure to potentially infectious materials.
a. Handwashing is mandatory:
1. Before treatment
2. Between patients
3. After glove removal
4. During treatment if an object is touched that might be contaminated by another patient's blood or saliva
5. Before leaving the operatory
6. After removing other personal protective barriers
b. Following contact with blood or other potentially infectious materials;
1. Flush mucous membranes immediately with water
2. Wash any skin exposure with soap and water
c. Nails must be clean and short
2. Recappiing, sharps-contaminated needles and sharp instrument
a. DO NOT use a two-handed technique
b. DO use a one-handed technique or a mechanical device
c. DO NOT bend, break, or shear
NOTE: Needles should not be removed manually from disposable syringe or otherwise handled manually.
3. Sharps disposal-contaminated needles:
a. Deposit in a sharps container that is:
2. Puncture resistant
3. Leakproof from side and bottom
4. Colored container labeled with biohazard symbol
5. Disposed of as soon as possible after use
6. Easily accessible
7. Maintained upright
b. Replaced before overfilled
c. When the container if full, the student will contact the instructor and inform them of the need for replacement. The instructor will
then replace the full sharps container with a new one. The full sharps will be disposed of in specially marked containers
d. Placed on counter everyday
e. Container will be closed when moving locations to prevent spills or content protrusion
f. If reusable, do not open, empty or clean where it would expose employees or students to the risk of injury
g. Move to a locked storage cabinet each night
4. Prohibited activities in the work are (classrooms):
a. Eating, drinking or smoking
b. Applying cosmetics or lip balm
c. Handling of contact lenses
d. Food and drink shall not be stored in refrigerators or freezers along with biohazardous materials, or upon shelves, cabinets,
or counter tops in work areas
5. Blood specimens/saliva or other potentially infectious materials:
a. Shall be placed in a biohazard-labeled container that prevents leakage during collection, handling, processing, storage, transport or
b. The container is to be closed and color-coded or labeled with a biohazard symbol for storage, transport, or shipping
c. These items should be placed in red bags that are found in the Northwest counter in the back of HS 307
d. Biohazard containers are in the back of room HS 307
e. Cerritos College maintenance departments (MOT) picks up and dispoases of biohazard materials
PERSONAL PROTECTIVE EQUIPMENT (PPE)
In reference to occupational exposures, protective equipment is required when splashes,
exposure or aerosolization of blood or
saliva is likely anticipated.
All personal protective equipment shall be removed before leaving the work area.
If a garment is penetrated by blood or saliva,
it shall be removed immediately or as soon as feasible. When personal protective equipment is removed, it shall be placed in an appropriately designated area or container for storage, washing decomntamination or disposal. Disposal of protective equipment
is done by the facility.
a. Shall be worn for all patient treatment
b. Shall be worn for all preclinical procedures done at dental operatory chairs and indicated procedures at dental laboratory desks
c. Wash hands before donning gloves and after glove removal
d. Shall be replace when torn or punctured
e. Shall not be washed, decontaminated or reused
f. May not be worn outside of clinic area
g. Wear over-gloves when documneting charts, evaluation sheets, gathering extra supplies, etc.
h. Worn when developing radiographs, to open the exposed contaminated packet, being careful not to touch the film
i. Utility gloves shall be worn for cleaning contaminated instruments, units and supplies
j. Utility gloves may be decontaminated for reuse if not compromised (cracked, peeling, torn, punctured or deteriorated)
k. Examination gloves will be supplied to the students by the staff at Cerritos College
l. If allergic to latex, alternative gloves may be used
m. Finger cots are to be used if there is a laceration, hangnail, or open wound regardless of size of trauma. See instructor
for these, and they will be supplied by the staff at Cerritos College
n. Disposable gloves must not be washed or oherwise reused
o. Disposable gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured,
or when their ability to function as a barrier is compromised
p. Gloves must be removed and hands washed before leaving the clinic or lab area
a. Appropriate fitting
b. Wear when performing all types of procedures where aerosols are being produced
c. Wear during all pre-clinical procedures done at dental operatory chairs
d. Wear during all laboratory procedures where aerosol or dust may be inhaled
e. Use new disposable mask for each patient
f. Do NOT wear mask while obtaining information from patient
g. Shall not be worn outside of clinic area
h. Mask must be changed if they become damp or wet
i. Masks will be supplied by Cerritos College staff
3. Eye wear:
a. Worn in combination with masks
b. Goggles, face shields or glasses with solid side shields
c. Disinfect after each patient
d. Used for all pre-clinical, clinical and laboratory procedures
e. Students will supply their own protective eyewear
f. All patients of Cerritos College (except for x-ray) will wear protective eyewear
g. Clean eyewear with soap and water and lenses should be disinfected with an appropriate solution
h. After disinfecting, store protective eyewear in a plastic bag by itself
i. If regular prescription glasses are used as protective eyewear, they shall have clip-on side shields
a. Shall be worn for all patient procedures
b. Shall be worn for all preclinical procedures done at dental operatory chairs and indicated laboratory desk
c. These gowns will be "medium level requiring fluid-resistant material"
d. They may not be worn outside the preclinic, clinic and other laboratory areas
e. Fresh gowns should be worn each session/day
f. Shall be long sleeves, high neckline, long enough to cover lap when sitting is required in occuaptional exposure situations
g. Gowns will be removed immediately by gloved hands if contaminated with blood and placed in appropriately tagged gab
h. Gowns will be supplied to students by Cerritos College
All faculty and students shall ensure that the work site is maintained in a clean and sanitary condition. Adequate measrues must be used in each preclinic, clinic and other laboratory areas to control possible transmmission from contaminated surfaces.
The primary methods used to control microbial transmmissions in the dental setting are:
1. Surface disinfection:
a. Contaminated work surfaces shall be decontaminated after completion of patient care with the appropriate disinfectant solution
(between each patient).
b. Disinfectant solution will be an EPA-registered product that is tuberculociadal.
c. Mask and protective eyewear will be worn during surface disinfection procedure.
d. Hands should be washed, utility gloves worn, and disinfectant spray or disinfectant gauze used for surfaces.
e. Uncovered contaminated surfaces in the dental setting will be decontaminated with the spray-wipe-spray technique.
f. Cabinet doors and drawers must be closed during treatment time.
g. Any surface (horizontal or vertical) within 3 feet of the patient's mouth must be considered contaminated after
providing treatment that produces spatter.
h. At the end of procedure (preclincial and clinical) the student will properly dispose of soiled material, instruments,
and disinfect the equipment and the work area.
i. Disinfectant will be supplied by Cerritos College.
j. Spray-wipe-spray technique of disinfection will be used. In addition, the disinfectant solution will remain in contact
with the surface for the length of time as specified by the manufacturer.
2. Disposable coverings:
a. Protective coverings are used to cover equipment and environmental surfaces:
1. Plastic wrap
2. Aluminum foil
3. Imperviously backed absorbent paper
4. Plastic sleeve covers
b. Plastic bags are used to cover:
1. Chair, headrest and controls
2. Arm holding suction and handpiece
3. Treatment tray
c. Plastic wrap, plastic sleeve covers, are used to cover:
1. Light handles
2. Light switch
3. X-ray controls
4. Air and water syringe
5. Unit hoses
d. These protective barrier coverings will be supplied by Cerritos College.
e. Paper covering is used to cover counter tops and cart top.
f. Protective coverings are placed on all surfaces potentially touched during patient treatment.
g. Shall be changed after each patient or when they become overtly contaminated.
3. Cubical maintenance:
a. All bins, pails, cans intended for reuse shall be inspected and decontaminated on a regular basis.
b. Shall be decontaminated immediately upon visible contamination.
c. Custodial service is in charge of inspection, emptying, and lining waste containers with plastic bags.
d. Red bags or impervious paper bags are used for potentially infectious materials or blood-
e. Red bags are placed in specially marked containers.
f. Broken glassware shall not be picked up directly with hands, use:
1. Brush and dustpan
4. Regulated waste:
a. Contaminated sharps are placed into approved sharps containers after each patient
appointment or as indicated.
b. Other regulated waste
1. Is containerized in rigid-walled, heavy gauge red-bag lined, leak resistant
2. No toxic chemicals or explosives are to be placed in containers.
3. Filled sealed containers are stored in a locked storage container outside until
4. Disposal of regulated waste shall be in accordance with applicable regulations of
United States, States and Territories, and political subdivisions of States
STERILIZATION AND DISINFECTION
Cerritos College will use available technology and devices to remove hazards from
the worker or visitor. The sterilization center is located
in the center lab. There is a contaminated area and a clean area. Only contaminated itmes will be placed in the contaminated side and sterile items will be allowed in the clean area. The students at Cerritos College will be instructed as to the procedure for contaminated items and will not be allowed to perform and functions of sterilization and disinfection until instructors have had the students practice and be evaluated on these procedures. Biological monitoring will be completed on all sterilizers at least once a week and will be assigned to indicated faculty each semester.
1. Handling instruments at scrub station:
a. Utility gloves will always be used.
b. Rinse instruments in cold water.
c. Holding solutions will be used if decontamination cannot be done immediately.
d. Use ultrasonic device if available instead of hand scrubbing.
e. Rinse and dry instruments.
f. Place in sterilization cassettes and bags.
g. Must be chemiclaved or autoclaved according to standards.
h. All sterilized instruments should be kept in sealed sterilized bags.
i. If a package is opened for a selected instrument, the whole package must
2. Handling chair and units:
a. Use utillity gloves in the disinfection of the chair and unit.
b. Place surface barrier appropriately.
c. Remove barriers after each patient.
d. Any contaminated surfaces must be cleansed with a surface disinfectant
3. Handling handpieces and Air-water syringe tips:
a. Utility gloves will always be used.
b. Flush the air-water syringe before procedures.
c. Outside surfaces of handpieces are to be scrubbed, rinsed, dried, and lubricated.
d. Package for sterilization.
e. Before use, LUBRICATE handpieces again.
f. Air-water syringe tips are to be sterilized before reuse, if the metal tips are used.
If plastic tips are used they will be discarded after each use.
g. The handle and tubing of the air-water syringe and the handpiece will be covered
with plastic barriers.
4. Handling evacuation system:
a. While disinfecting the evacuation system, always use utility gloves.
b. Uncovered contaminated hoses should be disinfected.
c. Flush evacuation system with water after each patient.
d. If known infectious diseased patients have been treated, flush with 1:110 household
5. Handling disposable items:
a. Disposable items are used whenever possible to prevent cross contamination.
b. Sample list of available disposable items:
1. Saliva ejectors
2. Air-water syringe tips
3. High speed evacuation tips
4. Prophylaxis angles
5. Fluoride trays
6. Plastic impression trays
7. Prophylaxis cups and brushes
8. Head rest covers, full chair covers, etc.
6. Handling x-ray equipment and film:
a. Use only sterile film holders.
b. Always wear mask, gloves, gowns and safety glasses while making patient
exposures, making sure you always wash hands thoroughly before putting
c. Clean and disinfect the following surfaces with approved disinfectant.
1. Lead apron, thyroid apron
2. Any surface not covered with a barrier
d. Cover the following with disposable wrap:
1. X-ray tubehead
2. X-ray cone
3. Exposure button
4. Control panel
5. Chair arms
6. Chair headrest
e. Place films and film holders on sterile tray cover only.
f. Wipe off each film and place in cup to transport to the darkroom.
g. Following exposure of patient radiographs, remove barriers, clean and
disinfect all surfaces that were not covered. Remove gloves or put on
overgloves to enter darkroom.
h. Wash hands after glove removal.
i. Dispose of all contaminated items.
j. Follow aseptic protocol for processing all radiographs.
The suggested film handling techniques include:
1. Use prepackaged barrier film. After exposure, remove barrier envelope
with gloves. Then process uncontaminated film in darkroom or automatic
developer with daylight loader.
2. Careful handling: Wear new gloves before entering dark room or automatic
developer with daylight loader. Open film packets without touching the film
itself. Deposit film on to towel and dispose of outer wraps and gloves. The
films can then be processed without contaminating darkroom equipment.
3. Dispose of lead foil into recycling bin, do not discard as trash.