All dentists and their teams have a responsibility to protect their health and the health of patients from the risk of infectious diseases. Failure to comply with the Code of Practice Relating to Infection Prevention and Control may result in fitness to practise proceedings being taken under the Dentists Act, 1985.

Dentists and their teams are advised to review the new Code and to assess their current procedures and any changes they need to implement to enable them to comply with the document.

Although it is not yet clear how the Dental Council intends to review a Registrant’s compliance with the Code, all Registrants now have a good reason to ensure that they can demonstrate compliance.

Some points to note:

The practice principal or manager must nominate a Decontamination Lead to ensure that:

• All staff involved in infection prevention and control are suitably trained;
• The infection prevention and control system is established and monitored;
• All roles and responsibilities are clearly defined. (para 7.1)

All practices must establish and maintain:

• Safety Statement;
• IPC policy document. (para 7.2)

All dental staff involved in patient care must receive appropriate and ongoing training in infection prevention and control. Details of this training must be kept on record. (para 5.1)

All dental practices must have written protocols which establish and help maintain a safe, healthy working environment for all staff. (para 1.3.2)

These protocols should include practice policies that must address the following separate and distinct elements:

• Immune status 
• The prevention of injuries that may expose those working in a dental environment to blood borne diseases. All dental practices must have a protocol for dealing with exposure prevention and post-exposure management.

All dental practices must have a formal, written infection prevention and control policy document which is site-specific and which reflects European Union and national legislative requirements and practice guidelines. The policy should reflect the recommendations developed by Expert Groups and Competent Authorities (e.g. the Health Protection Surveillance Centre (HPSC) and the Health Service Executive (HSE)). It should address IPC education and training for all DHCWs. The written policies and procedures must include reporting, risk assessment and medical follow-up following occupational exposures (eg. percutaneous or needlestick injuries). (para 2.2)

All current dental practices must have a suitable local decontamination area (LDA), while best practice requires that dental practices should have a separate local decontamination unit (LDU). (para 3.1.1)

The LDA must allow for the separation of clean and dirty instruments, must be clearly zoned and must be as far as possible from the patient.

All new dental premises opened after 1 January 2016 must have a separate decontamination room (LDU) and must at least be fitted out to provide for a washer-disinfector; also a separate decontamination room (LDU) must be included in the plans for the extension of any existing dental premises into a larger area.

All existing practices should, where possible, have a plan to progress towards the establishment of an LDU.

All practices must maintain the following documents for eight years:

• Validation and service reports for decontamination equipment;
• Log book for each autoclave, recording daily and weekly tests and, preferably, the cycle number and date of sterilisation of each load;
• Waste transfer forms;
• Staff training log;
• Audit reports;
• Pressure vessel tests.

Read Dental Protection’s briefing document on the Sharps Regulations 2014 for more information.

It is becoming common for patients to ask to record discussions about their dental treatment using a mobile phone. Dental Protection is also aware of cases where the patient has made a covert recording without telling the dentist. In a recent case in the USA, a clinician was sued after a patient’s mobile phone recorded him making unprofessional comments about the patient whilst he was under anaesthesia.

It is common courtesy that somebody wishing to make a recording should ask permission. If you feel uncomfortable at the prospect then you should express that discomfort and tell the patient that you would prefer your conversation not to be recorded.

If you would prefer not to be recorded, but the patient is insistent, it would be inadvisable for you to refuse to proceed with a consultation simply because the patient wishes to record it. A patient may have their own reasons for wishing to record a consultation and it would be worth exploring this further with them. Reasons could relate to the complexity of the consultation, the significance of the diagnosis, the patient’s memory, or the patient’s potential dissatisfaction. A little careful questioning could be helpful in discovering the patient’s thought process. Often patients simply wish to record consultations to ensure that they do not forget important information and/or because they want to share it with a friend or relative. There may be other ways of communicating this information (for example, by writing down the relevant information, or recording a summary of the relevant points at the end).

If your consultation is recorded, it would be sensible to ask for a copy so that it can be placed in the patient’s notes to form a permanent record. Medical records already incorporate a variety of formats, including text messages and emails to and from patients, and recordings could become part of this mix.

Secret recordings

Technology makes it increasingly easy for patients to secretly record conversations. Most mobile phones and smartphones have record functions which can easily be activated without the dentist or dental nurse realising. Even hand-held games consoles can record conversations.

A patient does not require your permission to record a consultation. The content of the recording is confidential to the patient, not the dentist so the patient can do what they wish with it. This could include disclosing it to third parties, or even posting the recording on the internet. So what does this mean for dentists?

The content of the recording is confidential to the patient, not the dentist so the patient can do what they wish with it.

Protection

Smartphone use in the dental surgery should not affect the way you deliver treatment. Dentists and hygienists should always behave in a responsible and professional manner when working with a patient and consequently, any recording will provide concrete evidence of that. Such a record would inevitably be more complete than a traditional note and Dental Protection’s experience is that detailed record keeping is an invaluable tool in protecting the dental team against unsubstantiated complaints or legal action.

A recording would potentially provide even more detail to demonstrate the professional management of your patients. There should be no reason therefore why you should have anything to fear from such a recording.

Whilst you may understandably feel that being recorded may impair the professional relationship, this may well simply be a matter of adapting to current cultural and societal norms where it is becoming commonplace for the public to record and publish on the internet all sorts of pictures, recordings, etc, relating to their private lives.

The future?

Technological advances will undoubtedly bring further changes and it may well be that in 20 years’ time, recording of consultations, with copies being held by both doctor and patient, will be commonplace.

An adverse comment placed on a website, be it WhatClinic.com (or similar) or the practice’s own website, can be upsetting, especially as it sits in the public domain for anyone to see.

With regard to an adverse post left on a review website, most such websites have the advantage of allowing the practice to post a response. Whilst there is no requirement to respond to website posts, indeed it would be inappropriate to respond to a complaint in this way, and it is advisable that a practice responds to such posts with a simple acknowledgement of the comments made and an invitation to the patient to make contact with a named person to discuss their concerns directly. This reassures both the patient who made the post and any other patients, potential patients and any others reading it that the practice takes patient feedback seriously and is keen to learn from patient experiences and to improve the service they offer. A suggested response is:

Many practices have protocols for routinely reviewing website posts and see them as an opportunity to improve services. Some practitioners also wish to thank those who have left positive feedback.

A similar approach could be taken to comments placed on practice owned websites which have facilities for this, and sites such as Facebook. Practitioners could also consider inviting satisfied patients to leave positive reviews. These may be helpful in themselves and can also have the effect of balancing out and indeed outweighing any negative comments.

In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.