23 February 2010

Q. As a DCP I have experienced a couple of issues recently regarding infection control protocols in the practice (sterilising toothbrushes for demonstration in patients mouths, wearing of clinical dress outside of the surgery a practice that all the staff members seem to adopt). On approaching the senior partner about these issues, I was told that the infection control practices in the workplace were his responsibility and that whilst he recognised the infection control guidelines issued by the BDA, they were just that, ‘guidelines' and as such could be interpreted as he saw fit. Where do I stand here?I have had a couple of issues recently regarding infection control protocols in the practice. The senior partner says he recognises the BDA infection control guidelines but because they are ‘guidelines' they can be interpreted as he sees fit. Where do I stand here?

In some respects what the senior partner says here, is correct. The BDA guidelines on cross-infection control are exactly that - guidelines, and nothing more. He is also correct in that it is up to the individual to interpret those guidelines as they see fit. However, there is no guarantee that the individual's interpretation will be correct, or that the dentist would be able to defend that stance, particularly if the rest of the profession did not agree with that interpretation.

In many situations, the BDA guidelines are not really open to interpretation. It would be a foolish dentist, for example, who would interpret the requirement to sterilise all instruments between patients to mean they could simply be left to soak in disinfectant. If that dentist subsequently indicated to the staff and the other clinicians in the practice that in future they were no longer permitted to use the steriliser, it would not be long before the staff refused to work on patients and the Health and Safety Executive were knocking at his door.

The BDA guidance represents good clinical practice and demonstrates a standard that would be regarded as appropriate. Generally speaking, the guidelines are realistic and take account of the difficulties that most clinicians face in their practices. They are by no means fixed, and indeed the guidance is regularly updated.

The difficulty that this hygienist faces is not unusual and situations of this nature often demonstrate a failure of the practice principal to keep up-to-date. The DCP, of course, has a duty to discuss his or her concerns with the principal and try to persuade that dentist to comply with the guidance. This can be very difficult. When the DCP feels that the safety of patients is compromised within the practice, their duty extends somewhat further.

The GDC guidance clearly indicates that a clinician must place the best interests of a patient first; ahead of any business or professional loyalty. If patients are perceived to be at risk, and the principal will not agree to alter the cross infection procedures then the DCP would have to think carefully about whistleblowing. Indeed to fail to do so might well mean that criticism would be levelled against the DCP, particularly if a complaint was received from a patient about standards of cross infection control in the practice. By that stage it would be too late to act.

The decision to raise concerns is a personal responsibility. It is not something that any other clinician can make for them. It can be extremely hard to whistleblow, even in the most obvious of circumstances. There is a genuine fear that the whistleblower will subsequently be scrutinised themselves, particularly if the case against the first clinician could not be proved.

For this reason most clinicians, when faced with a similar situation, vote with their feet and simply look for another job, arguing that they cannot work with the individual. Although this is disappointing and effectively ducks the issue, it also reflects the reality of human nature.

Before making any decision it is best for the DCP to speak with a defence society and ask for their guidance. Every case will be different and there is no single answer that will fit every occasion. Doing nothing, however, is not an option.

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