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Draft revised Australian Guidelines for the Prevention and Control of Infection in Healthcare submission

ID: 
21
Personal Details
First Name: 
Laurence
Last Name: 
Walsh
Specific Questions
2. Basics of infection prevention and control: 

 


3. Standard and transmission-based precautions: 

The section on gowns (recommendation 7) says  

It is suggested that clean aprons/gowns should:
Be appropriate to the task being undertaken.
Be worn for a single procedure or episode of patient care where contamination with body substances is likely. The used apron/gown should be removed in the area where the episode of patient care takes place.

With a LOW quality of evidence

But later it said  Gowns and aprons must be changed between patients

I suggest that the wording of this recommendation be revised to Gowns and aprons should be changed between patients"

The evidence base for recommendation 7 is LOW and this aligns with the statement being a SHOULD rather than a MUST.

In the same section the text goes on to say "The provision and laundering of cloth gowns presents a cost to healthcare facilities, as does the provision and disposal of single use gowns/aprons. These costs would likely be outweighed by the costs and consequences of not wearing aprons and gowns'.

The last statement can readily be challenged. Using single procedure gowns for every dental patient - or plastic gowns worn over dental clinic gowns would be a radical and expensive change for routine (non-surgical) dentistry, and such a change would not align with a risk assessment approach (some dental procedures do not generate splashes of saliva for example).

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The section on managing surfaces with barriers needs to provide advice which is more clear and bettwe explained.

The current text reads "Surface barriers (e.g. clear plastic wrap, bags, sheets, tubing or other materials impervious to moisture) help prevent contamination of surfaces and equipment. Surface barriers on equipment (e.g. air water syringes, bedboards, computer keyboards) need to be placed carefully to ensure that they protect the surfaces underneath and should be changed and cleaned between patients. Cleaning clinical surfaces including equipment should always occur between patients or uses, regardless of whether a surface barrier has been used or not."

The previous section of text stresses the use of detergents for surface cleaning, but the section above adds confusion because there are situations where specialized devices that are used in the mouth (such as intra-oral scanners for rcording digital impressions, or intra-oral sensors used for direct digital radiology have custom barriers that are replaced between patients - but the application of detergent onto the device is not recommended by the manufacturer (nor is it needed). Hence there should be discussions about specialized electromedical or optical devices where there are specific issues and following the manufacturer's instructions regarding the use of a custom barrier is critical.  

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The discussion on aseptic technique currently reads

"Standard aseptic technique—Clinical procedures managed with Standard aseptic technique will characteristically be technically simple, short in duration (approximately less than 20 minutes), and involve relatively few and small key sites and key parts. Standard aseptic technique requires a main general aseptic field and non-sterile gloves. The use of critical micro aseptic fields and aseptic technique is essential to protect key parts and key sites.

Surgical aseptic technique—Surgical aseptic technique is demanded when procedures are technically complex, involve extended periods of time, large open key sites or large or numerous key parts. To counter these risks, a main critical aseptic field and sterile gloves are required and often full barrier precautions [50]. Surgical aseptic technique should still utilise critical micro aseptic fields and aseptic technique where practical to do so."

Some surgical procedures in dentistry are very short in duration (e.g. less than 5 minutes), and so application  of the text above for for very short simple surgical procedures (vs extended non-surgical procedures) will be difficult unless the wording is altered.

Table 8 states for surgery that

"Standard operating room precautions required" which is too vague (as it implies HEPA filtered air, etc).

 This comes up again in 3.4.3 

"The discussion in this section applies to all surgical procedures regardless of setting.
While there is less evidence for surgical procedures in office-based practice than in hospitals, the same principles apply"

 Operating team members must wear sterile operation or procedure attire"

What is needed in this section is clarification around surgery that is done in the small office practice environment (not just the operating theatre).


Page reviewed: 24 September, 2019