INDIAN DENTAL ASSOCIATION

CLINICAL ACCREDITATION NETWORK

MANUAL OF GUIDELINES

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 CONTENTS

Clinical Standardization &

Certification Programme Page Page 02

Dental Records Documentation Page 05

Emergency Protocols Page 13

Infection Control Protocol – A Page 17

Infection Control Protocol – B Page 27

Biomedical Waste Disposal Page 35

Terms & Conditions Page 38

Application Form Page 45

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 Indian Dental Association, Kerala State

CLINICAL STANDARDISATION & IDA CERTIFICATION GUIDELINES

The Clinical standardization Programme sets to achieve a standard of dental practice, which is practically
feasible, consistent with accepted practice norms worldwide and keeps up to date with evolving trends and the
local practice scenario from time to time. The standards will be based broadly on the three categories.

I. Patient centered standards : ( Functions related to providing patient care )

II. Clinic centered standards : ( Functions and requirements specific to every establishment )
III. Management centered standards : ( Functions related to providing a safe, effective, and well-managed clinic )

I. Patient centered standards : ( Functions related to providing patient care )

a. Patient Rights and Education

b. Patients care and access
c. Documentation

a. Patient Rights and Education

1. Treatments offered should be displayed for the benefit of the patients, and the
staff should be trained to perform the services offered by the clinic.

2. All the doctors working in the clinic should wear badges clearly displaying their
names & designations.

3. The dentist should inform the patient of the proposed treatment and any
reasonable alternatives, in a manner that allows the patient to become involved in the
treatment decisions. Under this principle, the dentist's primary obligations include
involving patients in treatment decisions in a meaningful way, with due consideration
being given to the patient's needs, desires, abilities and safeguarding the patient's
privacy.

d. Documentation ( Ref : Annexure - 1 )

Patient Records
• The Clinic should have a well defined documentation and record keeping process. Dentists shall
maintain patient records in a manner consistent with the protection of the welfare of the patient.
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 Upon request of a patient or another dental practitioner, dentists shall provide any information
in accordance with applicable law that will be beneficial for the future treatment of that patient.
Dentists are obliged to safeguard the confidentiality of patient records.
Informed Consent
• Processes should be developed where informed consent is obtained for treatment procedures to
be undertaken. Informed consent should be documented, especially for surgical procedures with
inherent risk factors.
Case Sheet

• A case record in proper format is mandatory.

e. Patient care
Proper General Amenities
• Patients should be provided with basic amenities like running water, toilet facility in the
premises, potable water etc
Emergency medication and Equipment ( Ref : Annexure - 2 )
• Emergency equipment and medications as provided in Manual shall be available in the Dental
clinics.
• Staff should be trained to carry out essential life saving procedures ( BLS ).
• A proper protocol to be developed for shifting the patient to a facility where better care can be
obtained if an emergency arises.

:
II Clinic centered standards ( Functions and requirements specific to every establishment)
a. Hand-hygiene instructions to be displayed
b. Prevention and Control of infection
c. Essential Equipment
d. Management of Medication
e. Management of Bio Medical Waste
f. Radiation Protection Guidelines

a. Prevention and Control of infection ( Ref : Annexure – 3(A),(B) )

A written protocol specific to the Dental clinic shall be developed, maintained, and periodically
updated for proper instrument processing, operatory cleanliness, and management of injuries. The
protocol shall be made available to all personal at the dental clinic and could also be produced to the
patient.

• Proper sterilization Protocols: Should have a written infection control protocol adapted as per
the needs and choice of the Dentist but based on the accepted norms as in ( Ref.. )
• Use of Personal Protective Equipment : wherever and whenever possible
• Use of Disposables and Injection Safety
• Educate and Train Clinic Personnel on standard infection control practices

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 b. Essential Equipment
The following working equipment is mandatory
• Autoclave ( N- class or above)
• Sufficient sets of hand instruments should be available depending on the number of chairs
and patient turnover
• Needle Destroyer
• Dental X-Ray Machine ( AERB approved ) *
• Blood Pressure monitoring equipment (BP apparatus)
• BLS Accessories
*Optional

c. Management of Medication
Only authorized persons shall prescribe medication and if medications are stocked in the clinic it shall
only be in accordance with the prescribed laws.
Only those medications within the prescribed period of use may be used in the clinic

d. Management of Bio-Medical Waste ( Ref : Annexure - 4)

Proper Biomedical Waste management scheme should be in place to ensure that any waste, which is
generated during the diagnosis or treatment. Such waste is handled without any adverse effect to human
health and the environment.

e. Radiation Protection Guidelines

The clinic must ensure full compliance with the Regulations and safe radiological practice for the
protection of the patient and others. A dentist who delegates the taking of dental radiographs must
ensure that the person to whom this task is delegated has received training in accordance with the
Regulations of AERB.

III. Management centered standards : ( Functions related to providing a safe, effective, and well-managed
organization with regulatory requirements )

a. Responsibilities of Management
b. Personal Safety and Quality improvement
c. Professional Development & Ethics

a. Responsibilities of Management

Statutory Requirements
• All Dental Surgeons practicing should have valid Dental Council Registrations.
• Registration under the paramedical & Clinical Registration with Local bodies should be valid
and should adhere to Labour regulations.
• Proper Biomedical Waste handling ( as per rules of KPCB )
• Registration of X-Ray machines with AERB (optional)

Professional Indemnity
All dental surgeons working shall have indemnity coverage to insure against the inadvertent
eventualities that may arise in the course of providing treatment. **
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 Insurance
In the better interests of the Clinic it is advisable to have a Fire and theft Insurance that covers
the clinic.

b. Personal Safety and Quality improvement

Immunization
• Dentist and auxiliary staff should be immunized for Hepatitis B.
Updation
• Staff should be provided with regular training and skill enhancement programmes.

c. Professional Development & Ethics

• Dental clinics and practitioners should adhere to the code of ethics as prescribed in the Dentists
Act.
• Should be well informed of the developments and trends in infection control. Should attend at
least one CDE programme on infection control / BLS every year.
• At least one of the auxiliary staff members in a clinic should have successfully attended a training
programme.

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 ANNEXURE - 1
DENTAL RECORDS
DOCUMENTATION

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 ANNEXURE- 1

DENTAL RECORDS DOCUMENTATION

Indian Dental Association

DentaI treatment records provide documentation of patient treatment and the facts and reasoning behind the
chosen treatment. Dental patient records must be legible, complete, and filled out in a timely manner. The
record is primarily a record of care and treatment rendered, and provides a base of information for subsequent
care. It is also a legal document. Dental records should consist of documents related to the history of present
illness, clinical examination, diagnosis, treatment done, and the prognosis.

It is mandatory for Dental clinics to produce and maintain adequate patient records. The ability of clinical
practitioners to produce and maintain accurate dental records is essential for good quality patient care as well
as it being a legal obligation.

The Need for Record keeping

• Care for the patient
• Means of communication
• Mandatory legal Requirement
• Defense in case of legal issues

Case records can be stored in electronic (computerised ) or manual format (written ) both follow the same
general principles but adequate protection should be envisaged to prevent data loss and a hard copy of the
record is advisable.

General Outlines of case record keeping :

• Treatment Records, X-rays to be retained for at least three years after the completion of treatment.
• Patient autonomy and privacy is paramount. Confidentiality of patient records is a must.
• For academic and research purposes original names should not be used without patient consent and without
consent photographic images should not reveal the identity of the patient.
• Case record Information may be used in the preparation of legal reports containing only relevant dental
treatments.
• Dental case record is the property of the Dental clinic, though the patient has the right to see or obtain a copy of
the same.
• In case Radiographs are handed over to the patient it should be noted and the relevant radiographic findings
should be noted.
• Treatment charges are to be noted in the case sheet if the circumstances so demand that the treatment has been
charged more than the usual.
• Issue receipts whenever possible for the treatment rendered. Receipts reduce fraudulent claims in court.

Computerised or Electronic Patient Records ( CDRs)

They can help reduce operating costs, streamline workflow, improve quality of care, and enhance patient safety.
The greatest advantage is that they take up less space than paper records.

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 • Practice management systems : are primarily focused on patient demographics, appointment
scheduling, billing, and management reports
• Electronic dental record (EDR) systems : are used to record diagnoses, dental history, progress notes,
treatment plans, allergies and other clinical information.
• Dental imaging systems : are used to capture, store and display digitized dental images and x-rays.
Imaging systems are often interfaced with the practice management of EDR systems.
When adopting a system it is advisable to go in for a system that combines all three aspects of CDRs.

Recommendations for Manual Record Keeping

1. Use a consistent style for entry.

a. Use the same abbreviations and notations, Use ink and write legibly - pencil can fade and opens up the
question of whether or not the records have been altered
b. Date and explain any corrections, Very important in a legal aspect, it may be a fatal error if records appear
doctored in any way. These unexplained corrections can undermine the credibility of the entire record
and of the treating dental surgeon.
c. Use single-line crossout - when corrections are done this preserves the integrity of the record. Do not use
correction fluids - may indicate that there has been an attempt to hide information.
2. Note concerns about patient needs - by doing this you are documenting that you have listened, empathized,
understood, and acted upon the wishes of the patient. It also enables an explanation to be given should a patient’s
wishes be unobtainable or unrealistic, and can help you legally. Use quotations to indicate patient comments as
distinct from your own.
3. Never write derogatory remarks in the record
4. Negative views about patients, such as their failure to follow your advice or attend appointments, should be
recorded in a dispassionate and objective manner.
5. Confine your comments to necessary information about the patient's treatment. Stick to facts, especially those
related and relevant to provided dental care.
6. Maintain a chronological order

Recommendations for Computerised Record Keeping ( CDRs )

• Securely backup your data. (Regular scheduled backup is necessary)
• Use upto date software systems with regular updation.
• Use original software programmes
• Use current and effective computer antivirus utility
• Use effective and foolproof online security policies

Informed Consent
It may be advised to get an informed consent for treatment procedures to be undertaken. Informed consent
should be documented, especially for surgical procedures with inherent risk factors. When in doubt always
obtain written informed consent.

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The informed consent should include the information provided to patients about his or her dental problems that
the dentist observes, the nature of any proposed treatment, the potential benefits and risks associated with that
treatment, any alternatives to the treatment proposed, and the potential risks and benefits of alternative
treatments, including no treatment.

The following should be typically included in the dental case record sheet:

I. Patient identity Data -

a. Name,
b. Date of birth,
c. Address
d. Phone numbers,
e. Employment details
f. Emergency contact information.
II. Dental history
III. Medical history
a. List of systemic disease — diabetes, rheumatic fever, hepatitis, and the like
b. Any ongoing medical treatment
c. Any bleeding disorders, drug allergies, smoking and alcohol history
d. Any cardiac disorders
e. Relevant family medical history
f. Pregnancy
IV. Chief Complaint
V. Clinical examination to include an accurate charting
VI. Provisional Diagnosis
VII. Treatment plan
VIII. Treatment progress and treatment notes
IX. Documentation of informed consent

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 ANNEXURE – 2
EMERGENCY PROTOCOLS

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 ANNEXURE – 2
EMERGENCY PROTOCOLS

Setting Priorities: Patient Safety Must Come First

An emergency is a medical condition demanding immediate treatment. Emergencies do occur in dental offices.
Every dentist should have the basic knowledge to recognize, assess and manage a potentially life- threatening
situation until the patient can be transported to a medical facility. Successful patient management relies on
understanding the patho- physiologic processes and how to correct them. Keep in mind that some emergencies
end in disaster even in hospitals where there is optimal management. People have heart attacks every day- they
may just happen to be in your office at the time. You need to know what to do to give the patient the best
chance of recovery.

Preparation For Emergencies

Prevention

Comprehensive medical history must be recorded for all patients and must be updated regularly. An assessment
should be made to judge patients with severe medical conditions as to their suitability for management in
general dental practice. Patients with severe or unstable medical conditions should be referred for treatment
in dental hospital.

Training

All staff in the dental clinic should have appropriate training. A team approach to management of medical
emergencies should be developed. Protocols should be in place so that all staff members know their role in
managing emergency situations. Having a handy Emergency Drug Kit is essential; however preparedness to
follow the correct emergency management protocol and correct administration of the drugs is paramount. To
be able to be effective; get trained, conduct mock drills and practice regularly. Know the basics of recording and
evaluating vital statistics, ABC of resuscitation, how to administer oxygen, intramuscular and where appropriate
intravenous delivery of medicines are required. Training and certificate programmes for the same must be
availed.

Equipment and Drugs

Drugs and emergency equipment must be readily available and up-to-date. They should be stored to
facilitate easy identification. The equipment must be checked frequently to make sure it is operational.

In case of a medical emergency, the employees should notify the dentist immediately. The
paramedics/ambulance must be called immediately. Until trained medical personnel arrive, the staff
should do what is necessary to make the sick or injured person comfortable. If needed, a certified
person should administer CPR (cardiopulmonary resuscitation) or first aid. A recommendation is that
at least one full time employee besides the dentist should receive training in first aid and CPR.
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Emergencies can include accidental or willful bodily injury, central nervous system stimulation and
depression, respiratory and circulatory disturbances, as well as allergic reactions.

In a medical emergency, be prepared to take the vital signs of blood pressure, pulse, respiratory rate
and temperature. Such information is valuable in reporting the status of the injured person. The dentist
should administer basic life support and maintain an open airway while providing, if necessary, oxygen
using a device for its delivery under positive pressure. Dentists through continuing education should
become familiar with the prevention, diagnosis and treatment of common emergencies that they may
encounter during routine care with some individuals. In addition, the entire staff should get
appropriate training so that each staff person knows their responsibility and can act promptly.

RECOMMENDED EMERGENCY DRUGS & EQUIPMENT LIST- ADULTS

DRUG PREPARATION DOSAGE & ROUTE INDICATION

Hydrocortisone Sodium Anaphylaxis,Syncope

Vial 100 mg IM/IV
Succinate. Adrenal Crisis, Asthma
100mg/puff
Salbutamol Inhaler Asthmatic attack
2-3 puffs
Anaphylaxis,
Adrenaline Tartrate 1ml Ampule (1:1000) .5ml SC/IM
Status Asthmaticus

Atropine Ampule .6mg IM/IV Bradycardia (<60/min)

5mg Capsules
Mephentermine 30mg IM Hypotension
/Ampule
2ml Ampule
Nefedipine Sublingual Hypertensive crisis*
25mg Tabs
2ml Ampule IM/IV
Chlorpheniramine Allergy
25mg Tabs 1-0-1 Oral

Diazepam Ampule/Tab 5-10mg, 5-10mg IM/IV Epileptic Seizures

Nitroglycerine .5mg Tab Sublingual Anginal Pain

Alprazolam .25, .5mg Tab Oral Anxiolytic

Deriphyllin Ampule IM/IV Asthma

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Aspirin Tab 150 mg Chew MI

1mg powder in 1ml of

Glucagon Bottle Hypoglycemic crisis
distilled water

Dextrose 25% 25ml plastic bottle Slow IV Hypoglycemic crisis

Amynophilline I V Infusion Asthmatic attack

Isosorbid Dinitrate Tab 10mg Angina

Glucose powder, BP Apparatus, Stethoscope, Oxygen Mask &

OTHER
Cylinder, IV Infusion set, Ambu Bag, Oropharyngeal Airway,
REQUIREMENTS:
Betadine Ointment, Bandage, Adhesive plaster.
Oxygen
a. Cylinders should be of sufficient size to be easily portable but also allow for adequate flow rates (e.g.10
litres per minute, until the arrival of an ambulance or the patient fully recovers).

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 ANNEXURE – 3 (A)
Infection Control Protocol

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 ANNEXURE – 3 (A)

Infection Control Protocol

Indian Dental Association Kerala State

This document has been conceived to provide a reference to the Dental surgeon to practice and promote safe
practices in a systematic manner therein providing the Patient, Doctor and Clinic Personal a safe and clean
environment.

A written protocol specific to the Dental clinic shall be developed, maintained, and periodically updated for
proper instrument processing, operatory cleanliness, and management of injuries. The protocol shall be made
available to all personal at the dental clinic and could also be produced to the patient.

All steps to prevent the three modes of spread of infection namely Patient to Patient, Patient to Personal,
Personal to Patient have been addressed and is based on the fundamental principal followed worldwide of
Standard Precautions. Standard precautions shall be practiced in the care of all patients.

“Standard precautions” are a group of infection prevention practices that apply to all patients,
regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.
These include: hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on
the anticipated exposure, and safe handling of sharps. Standard precautions shall be used for care
of all patients regardless of their diagnoses or personal infectious status.

NB : Treat all Patients as a potential risk patient, and there is no additional precautions needed
while treating a known risk patient. In other words, the same sets of instrument processing,
personal protection equipment, and engineering and work practice control precautions can be
expected to protect against all blood borne disease agents.

Infection control Practices have been prescribed based on the level of risk associated with their intended use.
Instruments and equipment should be cleaned and reprocessed according to the risk. The three categories are
critical, semi-critical and non-critical.

“Critical items” These include all instruments, devices, and other items used to penetrate soft tissue
or bone. These confer a high risk for infection if they are contaminated with any microorganism.

“Semi-critical items” are instruments, devices and other items that are not used to penetrate soft
tissue or bone, but contact oral mucous membranes, non-intact skin or other potentially infectious
materials (OPIM).

“Non-critical items” are instruments, devices, equipment, and surfaces that come in contact with
intact skin, but not oral mucous membranes or penetrate soft tissue or bone.
The need for appropriate cleaning, disinfection, and sterilization of patient-care items is absolutely mandatory.
Because it is neither necessary nor possible to sterilize all patient-care items, clinical policies must identify

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whether cleaning, disinfection, or sterilization is indicated, based primarily on an item’s use. This policy provides
a practical approach to the prudent selection and proper disinfection and sterilization processes.
The Dental Surgeon is at his liberty to develop a particular policy according to its practicality based on the
broad outline provided.

“Dental Clinic Personnel” (DCP), Personnel in the dental clinic might be occupationally exposed to infectious
materials. DCP includes dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and
commercial), students and other persons not directly involved in patient care but potentially exposed to
infectious agents (e.g., administrative, clerical, housekeeping or maintenance personnel).

“Other Potentially Infectious Materials” (OPIM) means any one of the following :
• Body fluids such as saliva in dental procedures and any body fluid that is visibly contaminated with blood,
and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.
• Any unfixed tissue or organ (other than intact skin) from a human (living or dead) eg : Extracted teeth.
• Any of the following, if known or reasonably likely to contain or be infected with human
immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) :
1. Cell, tissue, or organ cultures from humans or experimental animals;
2. Blood, organs, or other tissues from experimental animals; or
3. Culture medium or other solutions.

Personal Protective Equipment: ( PPE )

1. All Dental surgeons shall wear surgical facemasks when attending to a patient.
2. Plastic face shields or protective eyewear should be used whenever there is potential for excessive aerosol
spray, splashing or spattering of the following: droplet nuclei, blood, chemical or germicidal agents or OPIM.
3. Face shields and protective eyewear shall be cleaned, disinfected, or disposed appropriately.
After each patient treatment, face shields and protective eyewear should be cleaned, disinfected, or disposed.
Protective eyewear and face shields should be cleaned with soap and water when visibly soiled, and disinfected
between patients. Protective eyewear if provided to the patient should also be cleaned and disinfected after
each use.

Hand Hygiene :

All DCP ( Dental Clinic Personal ) shall thoroughly wash their hands with soap and water at the start and end of
each workday or whenever they enter or leave the Dental clinic. DCP shall wash contaminated or visibly soiled
hands with soap and water and put on new gloves before treating each patient. If hands are not visibly soiled
or contaminated an alcohol based hand rub may be used as an alternative to soap and water. Hands shall be
thoroughly dried before donning gloves in order to prevent promotion of bacterial growth and washed again
immediately after glove removal.

Gloves:

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 1. Medical exam gloves shall be worn whenever there is contact with mucous membranes, blood or OPIM. When
processing contaminated sharp instruments, needles, and devices gloves should be worn.
2. During surgical procedures sterile surgical gloves may be used.
3. While cleaning soiled / contaminated instruments utility gloves should be worn to prevent puncture wounds.
4. All Personal shall perform hand hygiene procedures before donning gloves and after removing and discarding
gloves. Examination Gloves should be properly disposed after single use.
Utility gloves : When processing contaminated instruments and using hazardous chemicals Utility gloves should
be used. Utility gloves can also be decontaminated by washing them with soap and water during wear, or by
using disinfectant spray or wipes or by autoclaving.

Needle and Sharps Safety:

1. Needles shall be recapped only by using the scoop technique or a protective device.
2. Needles shall not be bent or broken for the purpose of disposal.
3. Disposable needles, syringes, scalpel blades, or other sharp items and instruments shall be placed into
sharps containers for disposal as close as possible to the point of use.
4. Needle burner should be used to destroy the tip before handing the waste to the waste provider.

Sterilization and Disinfection :

Cleaning, disinfection and sterilisation are all procedures that are used in the instrument reprocessing [Link]
is always essential to adhere to time tested measures which should be evaluated and updated at regular intervals
to ascertain the effectiveness of the process.

• Cleaning is the physical removal of foreign material. The process that removes contaminants
including dirt, and large numbers of micro-organisms and organic matter (e.g. blood, bone debris ).
It is an essential prerequisite to disinfection and sterilisation.
• Disinfection is a process used to reduce the number of micro-organisms but not usually effective
against bacterial spores. The process does not necessarily kill or remove all micro-organisms, but
reduces their number to a level which may not be harmful to health.
• Sterilisation removes or destroys all forms of microbial life including bacterial spores.

The most important factor for effective sterilization and disinfection of i nstruments is to have appropriate
or sufficient number of instruments is to be possessed to ensure the prescribed turnover time between
patients . ( Always increase the number of commonly used instruments )

Each Dental instrument or piece of Dental equipment which comes into contact with a patient is a potential
source of infection. These are divided into 3 groups of risk.

Table # 1
Infection-control categories of patient-care instruments and suggested process

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 Category Dental instrument or item Process required after cleaning

Surgical instruments, periodontal scalers Sterilization by autoclaving and holding in

Critical
tips, scalpel blades, surgical burs sterilized state.

Dental mouth mirror, amalgam

condenser, reusable dental impression Sterilisation by autoclaving or High level
Semicritical
trays, dental handpieces,light cure Disinfection.
tips,Dental burs

Orthodontic pliers, Extraorally adjusting

tools in prosthodontics,Radiograph head
Noncritical / cone, blood pressure cuff, facebow, Intermediate or Low Level Disinfection
pulse oximeter, Shade guides,Camera

Wherever and whenever possible Autoclaving should be the preffered mode of Sterilisation.

Cleaning
Thorough cleaning and drying should always precede disinfection and sterilisation procedures. It may be manual
or mechanical using ultrasonic cleaners or washer/disinfectors that may facilitate cleaning and decontamination
of some items and reduce the need for handling.
Manual Cleaning
All items requiring disinfection or sterilisation should be dismantled before cleaning. Cold water is
preferred for cleaning as it will remove most of the protein materials (blood, sputum, etc.) that
would be coagulated by heat or disinfectants and would subsequently be difficult to remove. The
most simple, cost effective method is to thoroughly brush the item, keeping the brush below the
surface of the water to prevent the release of aerosols. The brush should be decontaminated after
use and dried. Rinse items finally in clean, warm water and dry.
Environmental cleaning
Floors, surfaces, sinks and drains should be cleaned with water and detergent. Routine use of
disinfectants is unnecessary.
If there is spillage, e.g. blood, sputum, although cleaning is preferred, disinfection before cleaning is
sometimes recommended. Clean/wipe wearing gloves using 0.5-1% sodium hypochlorite (5,000-
10,000 ppm of Cl2 ) (household bleach) or a disinfectant with appropriate activity. Gloves should be
worn. If spillage is immediately removed, general disinfection of the room is not necessary; thorough
cleaning will suffice.

Cleaning must precede any disinfection or sterilization process. Products used to clean items or surfaces prior
to disinfection procedures shall be used according to all label instructions.

Heat Sterilisation :
Heat sterilization should always be the prefered choice of sterilization.

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Autoclaving :
Steam sterilisation is the most common and preferred method employed for sterilisation of all critical and Semi-
critical items that are not damaged by heat and moisture. Steam sterilisation is dependable, non toxic,
inexpensive, sporicidal, with rapid heating and good penetration of fabrics.
• 121°C for 20 min for unwrapped items, 30 minutes for packaged items at 1.036 Bar (15.03psi) above
atmospheric pressure.
• 134°C for 4 min for unwrapped items in a gravity sterilizer or wrapped items in a vacuum assisted steriliser at
2.026 Bar (29.41 psi) above atmospheric pressure.
As a possible alternative for unwrapped instruments or utensils, a timed pressure cooker with a mechanism to
guage the pressure may be used. Holding time of at least 30 min once the pressure is reached .

Dry heat
A hot air oven equipped with fan or conveyor, which will ensure even distribution of heat. The recommended
temperature and time for sterilisation of medical equipment is as follows:
• 170°C for 2 hours
• 180°C for 1 hour

Moist heat ( Boiling )

Is considered at the most a intermediate level disinfection process where the load of microorganisms are
reduced ( HBV, HCV and HIV viruses are destroyed ) but can never be considered as sterilization as spores are
not destroyed and the effectiveness varies . Recommended time is 20 minutes.
Examination instruments and instruments that do not come into direct contact with blood may be disinfected
(under special circumstances) using boiling but can always be used as a disinfectant process prior to Autoclaving
or Dry heat sterilization.

Disinfection
Disinfection is the inactivation of disease producing microorganisms. Disinfection does not destroy bacterial
spores. Disinfectants are used on inanimate objects; antiseptics are used on living tissue. Disinfection usually
involves chemicals, heat, or ultraviolet light. Levels of disinfection vary with the type of product used. All
germicides must be used in accordance with intended use and label instructions.

If a critical item is heat-sensitive, it shall, at minimum, be processed with high-level disinfection . They can
be disinfected or sterilized by following the manufacturer’s instructions for the length of time items must be
submerged to achieve the desired result.
If a semi-critical item is heat sensitive, it shall, at minimum, be processed with high level disinfection . They
can be disinfected or sterilized by following the manufacturer’s instructions for the length of time items must
be submerged to achieve the desired result.

Non-critical surfaces and patient care items : These shall be cleaned and disinfected with a
registered hospital disinfectant (low-level disinfectant labeled effective against HBV and HIV. When

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 the item is visibly contaminated with blood or OPIM intermediate-level disinfectant with a
tuberculocidal claim shall be used.

Clean and disinfect all clinical contact surfaces that are not protected by impervious barriers using hospital grade
low- to intermediate-level germicide after each patient. The low-level disinfectants used shall be labeled effective
against HBV and HIV. Use disinfectants in accordance with the manufacturer's instructions. Clean all housekeeping
surfaces (e.g. floors, walls, sinks) with a detergent and water or hospital grade disinfectant.
Table # 2
Methods for Sterilising and Disinfecting instruments and environment

Process Method Examples Category

High temperature Autoclaving, dry heat, Heat-tolerant critical and

chemical vapor semicritical
Sterilization
Liquid immersion High level Disinfection. Only for Heat-sensitive
critical
High-level
Chemical sterilants / high- Heat-sensitive -
disinfection Liquid immersion
level disinfectants Semicritical
( HLD )
Noncritical with visible
hospital disinfectant with
Intermediate - level Blood and Clinical contact
Liquid contact label claim of
Disinfection ( ILD ) surfaces; blood spills on
tuberculocidal activity
housekeeping surfaces

Noncritical without visible

hospital disinfectant with
Low - level blood and Clinical contact
Liquid contact no label claim of
Disinfection ( LLD ) surfaces; housekeeping
tuberculocidal activity
surfaces

Table # 3
Classification of Disinfectants

Type Dental instrument or item Process required after cleaning

This process kills mycobacterium

High-level
tuberculosis var bovis **, bacteria, fungi,
disinfection Effective against some spores but not all
and viruses.
( HLD )
Intermediate -
kills mycobacterium tuberculosis var bovis **
level
Destroys Microorganisms but not spores indicating that many human pathogens are
Disinfection
also killed.
( ILD )
Low - level It kills some bacteria, some viruses and
Disinfection least effective fungi, but does not kill bacterial spores or
( LLD ) mycobacterium tuberculosis var bovis **
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** a laboratory test organism used to classify the strength of disinfectant chemicals.

Table # 4
Suggested Chemical Disinfectants and Properties

Agent Advantages Disadvantages Efficacy Indications

Fast acting, Flammable, Excellent activity Intermediate level

Nonstaining drying, against gram + and disinfectant. (ILD)
evaporates gram- organisms; Used primarily for
Alcohol quickly rapidly bactericidal disinfecting external
Ethyl and isopropyl against vegetative surfaces and as an
60-90% bacterial; antiseptic for disinfection of
tuberculocidal, the skin
( ILD )
virucidal, and
fungicidal but not
sporicidal
Fast acting, low Corrosive; Effective against Depending on
Chlorine Household
level of toxicity; inactivated by bacteria, concentration, is HLD, ILD,
bleach (5% sodium low cost; broad organic material; mycobacteria, fungi, LLD
hypochlorite spectrum activity unstable; efficacy and viruses, high Use 1 part bleach with 9
solution with 50,000 decreases with concentrations of parts water (1:10 or 500
ppm available increase in pH; chlorine required to ppm) for disinfection of
chlorine) chlorine solutions kill mycobacterium blood spills
( Depending on be made fresh tuberculosis ; not
Use 1 part bleach to 99
concentration is HLD, daily; Should not sporicidal
parts water (1:100 or 5,000
ILD, LLD ) be used on
ppm)) for disinfection of
instruments and
countertops and floors
medical devices
Rapid action; Corrosive; Bactericidal, Primarily to be used as an
Iodophors
low toxicity and inactivated by virucidal, antiseptic antiseptic
(combination of iodine
irritation; organic material; mycobacteriocidal, formulations are not
and carrier; best
effective carrier staining;; may fungicidal; not indicated for disinfectant
known is povidone-
burn tissue sporicidal use. Manufacturer
iodine)
instructions must be
followed for dilution
Effective in Unstable; may Bactericidal, HLD not for use on
presence of cause contact fungicidal, virucidal, noncritical items due to
organic matter; dermatitis mycobactericidal, toxicity and cost
Glutaraldehyde noncorrosive; following skin and sporicidal;
( HLD ) noncoagulation exposure and may Effective
of protein be irritating to Concentration is 1%-
material eyes, nose and 1.5%
throat;
Broad spectrum; Potential Bactericidal, Can be used as a ILD Can be
Formaldehyde not affected by carcinogen; tuberculocidal, used in Formaldehyde
liquid and gaseous organic matter irritating fumes fungicidal, virucidal, chambers, takes longer
forms in limited use; and odor. and sporicidal time to disinfect
( HLD, ILD )

22
 Stable over wide Can be staining to Excellent High Level Disinfectant
Orthopthaladehyde pH range of 3-9; skin and clothing microbiocidal activity
(e.g., Cidex OPA) requires no
contains 0.55.% activation;
orthophthaladehyde materials
compatibile
( HLD )

Good cleaning Not sporicidal, Bactericidal, Considered LLD; Used for

Quaternary agent; less tuberculocidal, or fungicidal; effective decontamination of hospital
irritating to virucidal against against lipophilic environment (walls, floors,
Ammonium
hands than some hydrophilic viruses furnishings); should not be
Compounds
detergents viruses; less used for disinfecting
(used in 0.4%-1.6 microbiocidal in instruments and medical
aqueous solution) presence of devices
Benzalkonium organic matter
Chloride Eg : Lysol and materials
such as gauze and
( LLD )
cotton’
incompatible with
soap
Broad spectrum Leaves film on Bactericidal, Considered ILD to LLD; Used
Phenolics (used surfaces; virucidal, fungicidal, to decontaminate hospital
in 0.4%-5% inactivated by and tuberculocidal; environment (walls, floors,
aqueous solutions; organic matter; not sporicidal furnishings); should not be
Eg : common Phenyl may cause tissue used on instruments and
Solution irritation; medical devices
corrosive to
( ILD to LLD ) certain materials;
Sporicidal at Oxidizing Bactericidal, Used for High level
higher properties may be fungicidal, virucidal, disinfection of soft rubbery
Hydrogen concentrations; damaging to sporicidal; articles. and 7.5% hydrogen
by-products certain peroxide; 30 min at 20◦ HLD
Peroxide environmentally Instruments claim, MEC is 6% for 7.5%
( HLD ) friendly hydrogen peroxide and
0.85% phosphoric acid
combination;

Paraformaldehyde
Paraformaldehyde tablets are very effective against a wide spectrum of organisms. The tablets should be
employed only in containers which are as tight-fitting as possible (preferentially instrument cabinets, boxes and
plastic bags). Paraformaldehyde tablets are well suited for the reduction of the bacterial population and the
storage of nonwrapped sterilized instruments. For this purpose, 1 tablet/dm3 is needed. The exposure time
required for bacterial count reduction is no less than 3 hrs ( can be used for the disinfection of handpieces ).

Dental Lab areas:

• Devices used to polish, trim, or adjust or contaminated intraoral devices shall be disinfected or sterilized. Sterilized
items should be stored in a manner so as to prevent contamination.

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• All intraoral items such as impressions, bite registrations, prosthetic and orthodontic appliances shall be cleaned
and disinfected with an intermediate-level disinfectant before manipulation in the laboratory and before
placement in the patient's mouth. Such items shall be thoroughly rinsed prior to placement in the patient's mouth.
• Face masks / protective eyewear should be worn by technicians while trimming or polishing procedures.
• Used gypsum products and impressions are Biomedical wastes and should be dealt with appropriately.

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 ANNEXURE 3 (b)

Infection Control Protocol

25
 ANNEXURE – 3 ( B )
Infection Control Protocol
PROCEDURAL INSTRUCTIONS

1. Pre-Treatment Procedures
2. Procedures during treatment
3. Post-Treatment Procedures
4. Infection control during radiographic procedures

1) PRE-TREATMENT PROCEDURES
The process of infection control should begin before the patient arrives, during preparation for clinical
treatment. This reduces the risk for transmission of infectious agents during patient care, makes the treatment
session more efficient and the post treatment infection control process easier and more effective.
• Remove unnecessary items and unused equipments from the operatory.
• The operatory should be arranged to facilitate thorough cleaning following each patient.
• Use prearranged tray set-ups for routine or frequently performed procedures whenever possible.
• Pre-Plan the materials needed during treatment. Set out all instruments, medications and impression materials
needed. This includes individually sterilized bur blocks with only those burs needed for the procedure. Also put
out a rubber dam setup if one will be needed.
• Use disposable items and unit-dose materials whenever possible. The use of disposable items saves time during
cleanup and decontamination. Disposables also solve the problem of decontaminating hard-to-clean items such
as the saliva ejector.
• Identify equipment and surfaces that will become contaminated during treatment. Use a barrier to prevent
contamination of these surfaces and items or to disinfect them after treatment.
• The decision to use barriers or chemical disinfection should be based on individual circumstances.

Barriers are quick and easy to use, and can be readily changed, but may be more expensive than
chemical [Link] are generally less expensive and are easy to use on flat surfaces,
but they may stain or corrode some materials, may be toxic and are difficult to use effectively on
rough and odd-shaped surfaces.
If barriers are chosen, a number of readily available materials can be used. These include plastic wraps,
aluminum foil, impervious backed paper and commercially available polyethylene sheets and tubing.

Some examples of the use of barriers are as follow

Cover light handles with plastic wrap or aluminum foil. These are available commercially and some
manufacturers offer removable light handle attachments that can be disinfected easily.

26
 Cover the back of chair with a polyethylene bag to protect the headrest, protect the control buttons
with plastic wrap and the arms of the chair with polyethylene tubing.
Cover counter tops with plastic laminated paper.
Protect the hoses to the air-water syringe, saliva ejector, high- speed evacuator and handpieces with
polyethylene tubing.
• Set up radiographs for viewing and reviewing patient records before initiating the treatment. Entries into the
record should be made before putting the gloves on or after they have been removed and hands have been
washed. Do not make computer entries during treatment unless the equipment has been barrier protected.
• Follow manufacturer's directions for care and maintenance of water lines. Patient material (e.g. oral
microorganisms, blood, saliva) can enter the dental water system during patient treatment. Dental devices
connected to the dental unit water system should be operated to discharge water and air for a minimum of 20-
30 seconds between patients. This procedure flushes out any patient material that might have entered the
turbine, air and waterlines.
• All personnel involved in patient care should prepare themselves for the incoming patient. This includes the use
of personal protective equipment (gown, eyewear, mask, gloves) and hand washing.

PROCEDURES DURING TREATMENT

Infection Control practices for use during clinical activities will help reduce the exposure to infectious agents.
Infection Control Practices-Chair side:
• Use care when receiving, handling or passing sharp instruments. Many dental instruments can easily cut gloves
and skin.
• Take special precautions with syringes and needles. Needle stick injuries are a major cause of infection in health
care personnel. Needles should not be recapped, bent, broken or otherwise manipulated by hand.
• Never recap a needle using a two-handed technique. Instead, use one of the commercially available sheath
holders or the "scoop" technique. In this technique, the cap is scooped up from the tray with the needle tip using
only one hand. As an additional protection against needle sticks, do not allow uncovered needles to remain on the
instrument tray. It is far safer to dispose of them immediately after use in a puncture- proof container.
• Disposable needles should not be bent or broken after use.
• Needles should not be removed manually from disposable syringes or otherwise handled manually.
• Forceps or other appropriate instruments may be used to handle sharp items.
• Disposable syringes, needles, scalpel blades and other sharp items should be discarded into puncture -resistant
biohazard (sharps) containers that are easily accessible.
• Use a rubber dam whenever possible. Rubber dams limit the splash and spatter of blood and saliva and should be
used whenever possible .
• Avoid touching unprotected switches, handles and other equipment after gloves have become contaminated. If
objects are touched or handled, they should be carefully cleaned and disinfected at the end of the procedure.
• Avoid opening drawers or cabinets once gloves have become contaminated.
• If it becomes necessary, you may simply ask another person for assistance; or you may use another barrier, such
as pre-packaged aluminium foil squares or plastic gloves, to grasp the cabinet or drawer handle.

27
 • However, if these options are not available, you must remove the contaminated gloves, wash hands before
opening a drawer or cabinet, and then reglove before resuming patient treatment.
• Extracted teeth should be considered as potentially infectious material and should be disposed in medical waste
containers.

Pre-procedural Mouth Rinses

Anti-microbial mouth rinses (e.g. chlorhexidine gluconate, essential oils, or povidone- iodine) used by
patients before a dental procedure are intended to reduce the number of microorganisms the patient
might release in the form of aerosols or spatter that subsequently can contaminate dental practitioner
and equipment operatory surfaces.

POST-TREATMENT PROCEDURES
• Continue to wear personal protective equipment during cleanup. Begin the cleaning and disinfection process by
removing contaminated gloves used during treatment.
• Next, wash your hands and put on a pair of utility gloves before beginning clean-up. Continue to wear protective
eyewear, mask and gown.
• Remove all disposable barriers. All barriers placed before treatment, including light handle covers, polyethylene
tubing and counter-top barriers, should be removed. These should be placed into a leak-proof waste bag inside a
trash container.
• Dispose of blood and suctioned fluids that have accumulated in the collection bottles during treatment.
• Identify a utility sink, drain or toilet connected to a sanitary sewer that can be used solely for the disposal of blood,
liquid wastes and suctioned fluids.
• After the blood and suctioned fluids are poured into the sink, use a 1 : 100 dilution of household bleach (or other
appropriate intermediate-level disinfectant) and tap water to disinfect the dental unit collection bottle.
• The bottle should be completely filled and the solution should be kept in the bottle for 10 minutes (or according
to manufacturer's instructions) before emptying and rinsing with fresh water.
• Clean and disinfect all items not protected by barriers. All clinical contact surfaces that were not protected by
barriers must be cleaned and then disinfected with an intermediate-level surface disinfectant- for example
iodophor, phenolic solution, or diluted household bleach (sodium hypochlorite).
• Remove personal protective equipment. The proper method of removing a mask is to grasp it only by the cloth or
elastic strings, not by the mask itself.
• Reusable protective eyewear and face shields should be cleaned with soap and water as necessary and, if visibly
soiled, disinfected between patients according to manufacturer's instructions.
• Remember not to touch the eyewear or face shield with ungloved hands, because it may have become
contaminated with spatter of blood and saliva during patient care.
• Protective clothing should be changed when it becomes visibly soiled and as soon as feasible if penetrated by
blood.
• Soiled protective gowns should be placed in a soiled linen container.
• Gowns may be washed using the normal laundry cycle.

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 • Utility gloves should be washed with soap before removal.
• Finally, thoroughly wash your hands for at least 15 seconds, using soap or anti microbial hand wash.
• Clean the instruments and prepare them for sterilization. Remove the tray with all instruments to the receiving
and clean-up section of the central processing area.
• Instruments should be picked up individually. Never pick up a handful of instruments because this greatly
increases the risk of cuts or punctures.
• Special care should be used when handling double-ended instruments. Don't reach into trays or containers holding
sharp instruments that are not clearly visible. Use strainer- type baskets to
• Dental instruments should be scrubbed carefully using a long- handled brush with soap and water and rinsed
thoroughly. As an alternative, instruments may be cleaned in an ultrasonic cleaner or washer- disinfector. After
drying, the clean instruments are ready for sterilization.
• Sterilize devices connected to the air or waterlines of the dental unit between each patient. Any device connected
to the dental unit air or water system that enters the patient's mouth (e.g., handpieces, prophylaxis angles, air
abrasion devices) should be run to discharge water and/or air for 20-30 seconds after each patient.
• Follow the manufacturer's recommendations for proper flushing of devices and for the use and maintenance of
waterlines and check valves as appropriate.
• An ultrasonic cleaner should be used to remove any adherent material, but only if recommended by the device's
manufacturer.
• Otherwise, scrub devices thoroughly with a detergent and hot water and dry. Finally, sterilize it according to the
manufacturer's instructions.
• Disposal of any general medical waste (e.g. gloves, masks, lightly soiled cotton balls, protective barriers) classified
as non-regulated medical waste and can be disposed of along with ordinary waste.
• A single leak-resistant biohazard bag is usually adequate for non-sharp regulated medical waste. Sharp items, such
as needles and scalpel blades, should be placed intact into puncture- resistant biohazard containers and disposed.
• Disposal of regulated medical waste. (e.g. solid waste soaked or saturated with blood and saliva, surgically
removed hard and soft tissues, and contaminated sharp items). A single leak- resistant biohazard bag is usually
adequate for non-sharp regulated medical waste. Sharp items, such as needles and scalpel blades, should be
placed intact into puncture- resistant biohazard containers and disposed.
• Appropriate procedures for handling sharp instruments include the following:
• Wear sturdy utility gloves when cleaning contaminated instruments or other sharp items.
• Dispose of needles and other sharp items promptly and appropriately.
• When handling sharp instruments, avoid any quick motions that would bring one hand toward the other or the
instrument across any part of your body.

PREPARATION OF OPERATOR BETWEEN PATIENT/CLINICAL SESSION

The infection control process continues after the patient leaves the office. Although effective pretreatment
planning will simplify your task, there are a number of tasks that should be done following patient care to further
reduce the risk for transmission of infectious agents.

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INFECTION CONTROL DURING RADIOGRAPHIC PROCEDURES
Dental Radiology
• When taking radiographs, the potential to cross-contaminate equipment and environmental surfaces with blood
or saliva is high if aseptic technique is not practiced.
• Gloves should be worn when taking radiographs and handling contaminated film packets.
• Other modes (e.g. mask, protective eyewear and gowns) should be used if spattering of blood or other body fluids
is likely to occur.
• Heat-tolerant versions of intraoral radiograph accessories are available and these semicritical items (e.g. film-
holding and positioning devices) should be heat-sterilized before patient use.
• After exposure of the radiograph and before glove removal, the film should be dried with disposable gauze or a
paper towel to remove blood or excess saliva and placed in a container (e.g. disposable cup) for transport to the
developing area.
• However, care should be taken to avoid contamination of the developing equipment.
• Protective barriers should be used, or any surfaces that become contaminated should be cleaned and disinfected
with a disinfectant (intermediate-level).
• Radiography equipment (e.g. radiograph tubehead and control panel) should be protected with surface barriers
that are changed after each patient.
• If barriers are not used, equipment that has come into contact with dental practitioners gloved hands or
contaminated film packets should be cleaned and then disinfected after each patient use.

For Digital Radiography

• Digital radiography sensors and other high-technology instruments (e.g. intraoral camera, electronic periodontal
probe, occlusal analyzers and lasers) come into contact with mucous membranes and are considered semicritical
devices.
• They should be cleaned and ideally heat-sterilized or high- level disinfected between patients.
• Semicritical items that cannot be reprocessed by heat sterilization or high- level disinfection should, at a minimum,
be barrier protected to reduce gross contamination during use.
• To minimize the potential for device-associated infections, after removing the barrier, the device should be
cleaned and disinfected with a disinfectant (intermediate-level) after each patient.
• Manufacturers should be consulted regarding appropriate barrier and disinfection/sterilization procedures for
digital radiography sensors, other high-technology intraoral devices and computer components.

General Recommendations for use of Clinical Instruments

• Heat sensitive endodontic material (Gutta Percha) should be sterilized with 5% sodium Hypochlorite for 10
minutes
• No instrument that is Critical or Semi critical ( eg : endodontic Instruments and surgical burs ) should be used
directly from the packages (unsterile). They should be subjected to the usual sterilization process and stored
properly before use on patients.

30
 • Although considered non critical, items like Orthodontic pliers used for wire bending and tools used extra -orally
in Prosthodontics are but should be disinfected with a ILD to HLD type disinfectant or sterilized due to the potential
of cross infection.
• Air rotor hand pieces, low-speed hand pieces, rotary components which are heat sensitive may be disinfected.
• Sterile packages/wraps are considered sterile unless an event, such as packages getting opened, wet, or damaged,
causes the barrier of the package to be breached.
• Instruments, items, and devices processed by high-level disinfection (cold sterile) can be packaged or wrapped
This keeps instruments clean and dust-free but not sterile.
• Clinic personal should be trained in the correct handling of packaged sterile instruments.
• To resterilise the proper procedure would be to re-clean, dry, and rewrap the instruments in new sterilization
packaging, or wrap and resterilise in a working sterilizer.
• When clearing away waste products, all surgery waste products are to be treated as clinical waste EXCEPT the
following items which must be placed in the appropriate waste containers:
o partially used or used local anaesthetic syringes / cartridges – in their own special waste container after
destroying the needle and syringe using Needle burner.
o needles, scalpel blades, orthodontic wires or accessories, broken or discarded endontic instruments
or other sharp objects – in the sharps bin.
• Care should be taken to avoid the common mistakes that can lead to improper sterilization.
1. Interrupting the sterilization cycle, or inadequate time, temperature, or pressure
2. Inadequate pre-cleaning of instruments
3. Overloading of sterilizer
4. Inadequate drying cycle (autoclaves)
5. Faulty gaskets or seals
6. Improper packaging
7. Bulky packaging
8. Inadequate spacing of instruments
9. Faulty or Improper operation of unit
CHECK LIST

• Keep operatory free of unnecessary items.

• Set up all supplies and instruments for a procedure in advance.

• Use disposable items whenever appropriate.

• Use individualized, sterilized bur blocks preferably.

• Set up radiographs and review patient records before treatment.

31
• Flush waterlines between patients. Wear gown, protective eyewear, masks and gloves during
procedures involving spatter.

• Use proper handwashing techniques.

• Use rubber dams where ever possible.

• Use high-volume evacuation.

• Use barriers to protect equipment (including digital radiographic equipment) from contamination
whenever possible.

• Keep radiographs and records protected during treatment.

• Use a safe method for recapping needles.

• Disinfect all unprotected clinical contact surfaces in dental operatory.

• Use appropriate methods of handling and passing sharp items.

• Use safe procedures for exposing and developing radiographs.

• Wear protective gear during post treatment clean-up.

• Proper disposal of regulated medical waste.

32
 ANNEXURE – 4
Bio Medical Waste Disposal

33
 ANNEXURE – 4

Biomedical Waste Management

Biomedical waste ( BMW ) in a dental clinic means any waste, which is generated during the diagnosis or treatment. It
shall be the duty of every occupier of, clinic, to take all steps to ensure that such waste is handled without any adverse
effect to human health and the environment.

It is advisable that all clinics join a common waste disposal scheme for the effective management of BMW. Bio-medical
waste shall not be mixed with other wastes and shall be segregated into containers/bags prior to its storage
transportation, treatment and disposal.

The Management of Biomedical waste is governed by the The Biomedical Waste Management & Handling Rules, 1998.
Every clinic that treats more than 1000 patients per month should obtain an authorization from the Kerala State
Pollution Control Board. The State Pollution Control Board is the prescribed Authority for supervision and
implementation of the grant of Authorization.

Kerala has only one BMW service provider as of December 2012 , which is managed by Indian Medical Association
Kerala Chapter ( IMA IMAGE ).

Every Dental clinic should submit an annual report to the prescribed authority in Form II by 31 January every year, to
include information about the categories and quantities of bio-medical wastes handled during the proceeding year. (This
filled up form is issued by IMA Image authorities for all clinics and establishment affiliated to it.)

CATEGORIES OF BIO-MEDICAL WASTE

Human Anatomical Waste incineration@/deep burial*

Category

(human tissues, organs, body parts)

No. I

Category Waste sharps (needles, syringes, scalpels, disinfection (chemical treat- ment@01/auto
blades, glass, etc. that may cause puncture and claving/micro-waving and multilation /shredding"
cuts. This includes both used and unused
No. I sharps)

Solid Waste (Items contaminated with incineration@autoclaving/microwaving

Category blood,and body fluids including
cotton,dressings, soiled plaster casts,lines,
34
 beddings, other material contaminated with
blood)
No. I

Category Liquid Waste (waste generated from laboratory disinfection by chemical treatment@@ and
and washing, cleaning, housekeeping and discharge
disinfecting activities)
No. I

*Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be
ensured that chemical treatment ensures disinfection.

* Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.

COLOUR CODING, SEGGREGATION AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTES

Biomedical waste should be segregated and placed in specific colour coded bags as specified

Red Bag
Yellow Bag
(Infected material that can be re-cycled)
1) Teeth
2) Plaster of Paris, die-stone etc
3) Cotton Syringe without needle (Hubs Cut )
4) Impression material
5) Disposable Aprons
6) Disposable used Paper cups Gloves
7) Mouth Masks
8) Tissue paper Head caps
9) Tips of light body Suction tips
10) Acrylic material
11) Amalgam restoration particles &
Other filling materials Plastic Impression material bags
12) Ortho appliances
13) X-ray lead sheets and covers
Saline plastic bottles

Ortho elastics

35
Glass Container : Injection solution bottles, any other glass items

Metal Container : Destroyed Injection needles, scalpel, endo files , suture needles, metal crowns, Ceramic
crowns, ortho wires, ortho pins,hand instruments,mouth mirror tip,burs

GENERAL WASTE not to be given to BMW service providers

1) Syringe & Needle covers 5) Newspaper & Cartons of material purchased

2) Letter covers 6) Soft drink & mineral Water Bottles bottles

3) Biscuit & Sweets, Milk cover 7) Disposable plates `

4) Uninfected Instrument pouches 8) Any waste food items

36
TERMS & CONDITIONS

37
IDA Policy regarding use of IDA Logo

The use of the IDA logo will be controlled by Indian Dental Association. Observe the following guidelines when
using the IDA logo

• Reproduce the logo in the proportions and the colours indicated in appendix `?”. The logo must
retain the same format. It may be printed as a coloured image or in black and white as given in appendix
“?”

• The logo may be resized to suit the organization’s needs but no amendments will be permitted to its
design or the relationship of the items within the design.

• The certified dental clinics can only use the logo for services of healthcare that are included in the
certification.
• The logo must not be used to advertise p r o d u c t s and services o r in connection with
c o m m e r c i a l purpose without the prior written permission of IDA. The logo must not be used to
suggest complete approval or sponsorship by IDA, of all its activities, products or services.

• The logo shall not be used to mislead the reader about the certification status of the clinic.

• The logo is not transferable and is to be used only by the certified facility.

• The accredited body upon suspension or withdrawal or expiry of its certification, shall discontinue use
of the IDA Logo and certification status.

• The IDA reserves the right to terminate use of the logo by giving notice in writing if the organization
breaches any of the above-mentioned terms and shall take appropriate actions as laid down in IDA's
policy.

• These guidelines for printing the logo apply for use on all print and electronic materials and promotional
items such as organization’s letterhead and prescriptions and business cards.

TERMS AND CONDITIONS

The dental clinic that has been granted IDA certification shall be required to fulfill the following terms and conditions.

• It should provide services and carry out functions in accordance with IDA standards.

38
• Certification shall be initially granted for a period of three years and shall be subject to an on-site surveillance
during second year and a reassessment before the end of three years. The Clinic shall apply for certification six
months before it's expiry.

• The dental clinic shall offer to the IDA or its representative, co- operation in:

o All service areas.

o Various patient care areas and other departments.

o Relevant information and documentation.

o Records and relevant personnel.

• On grant of certification, the dental clinic shall

o Claim certification in only those premises, services, for which it has been accredited (applicable for dental
clinic having more than one branch).

o Not state its certification in a manner as to be considered misleading or unauthorized and bring IDA to
disrepute.

o Not use IDA certification symbol or certificate for promotional or publicity purposes in any way that IDA
may consider to be misleading.

o Use certification only to indicate that it has met the relevant IDA standards and does not imply that a
product or service is approved by IDA.

o Make reference to certification in its documents, brochures or advertising only in compliance with the
requirements of IDA.

• The certified IDA clinic shall pay all the applicable dues such as application fees for renewal; annual certification
fees; expenses towards travel, boarding & lodging of assessment team for assessment, surveillance, re-
assessment, verification etc. as shall be determined by IDA from time to time.

• The dental clinic shall inform IDA within 15 days of significant changes affecting the operation such as

39
 o It's legal, commercial, ownership or organizational status.

o The organization, top management and key personnel.

o Main policies.

o Resources and premises.

o Scope of accreditation.

o The clinic shall continuously keep in touch with IDA to keep itself updated with the latest versions of IDA
documents.

• The certified clinic shall respond promptly to the changes initiated by IDA in its certification criteria, policies and
procedures. The dental clinic shall be given sufficient notice and time, to carry out adjustments.

• IDA may occasionally give provisional extension of accreditation beyond the normal cycle of three years where:

o Re-assessment has been completed, but on the recommendation of the certification committee, the
approval is pending.

o There is delay in conducting re-assessment for reasons beyond control of IDA.

o A subsequent verification visit has become necessary leading to delay in decision.

• IDA may suspend or withdraw certification of a dental clinic, on one or more of the following grounds:

o Dental clinic is found not complying with the accreditation requirements.

o Non-payment of certification expenses like assessment or surveillance or reassessment charges and

annual certification fees.

o Not applied for certification six months before its expiry.

o Non-cooperation with IDA.

40
 o Refusal to permit examination of relevant documents and records by IDA and its assessors.

o Denial of access to IDA and its assessor to its services and patient care areas.

o Wrong representation of scope of certification.

o Misuse of logo or its use after expiry of certification.

o Misleading reporting of facts.

o Activity bringing disrepute to IDA.

o Result of complaint analysis or any other information, which indicates that the dental clinic no longer
complies with requirements of IDA.

• The certified dental clinic upon suspension or withdrawal of its certification or expiry of validity of certification
shall forthwith discontinue displaying matter that contain any reference to the certification status.

• The certified dental clinic can relinquish certification by giving three months notice in writing to IDA.

• The dental clinic is required to inform IDA, if any of the proposed assessor(s) happens to be their consultant or
associated with the dental clinic in any other capacity, since the IDA cannot appoint these consultants as assessors.

• IDA absolves itself of any legal or financial liability arising out of any act involving any accidental or
consequential damages to personnel/equipment at any time.

• All disputes, if any, arising out of IDA decisions that remain unresolved are subject to the exclusive jurisdiction of
the Courts where the State office exists and none other.

I agree to comply at all times with all above mentioned Terms and Conditions for Maintaining IDA Certification.

Name & Signature of Dental Surgeon:

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41
Name & Address of the Dental clinic:

Date & Place:

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