Mr H was an employee dental hygienist working in a busy group practice of six dental practitioners: four dentists, one OHT and himself.
A typical day for Mr H included a full day of patients every 45-50 minutes with a lunch break, providing appointments went to plan. Mr H arrived early each morning to review his patient records prior to commencing treatment for the day, and exited the practice after treating his last patient in the evening. Essentially Mr H spent his day treating patients and authoring contemporaneous notes, while delegating the day-to-day running and, to that end, the infection control compliance requirements to the practice management and practice owner. Mr H viewed himself primarily as a clinician responsible for patient treatment, and trusted that the practice’s infection control policies and procedures undertaken were in compliance with the Dental Board of Australia (DBA) Infection Control Guidelines and DBA Code of Conduct.
Unbeknown to Mr H, a complaint had been made about one of the dentists in the practice. Within certain states of Australia, a complaint can trigger an infection control audit of the practice, regardless of the reason for the initial complaint.
An infection control audit of the premises was undertaken and, regrettably, it identified a number of deficiencies. While Mr H was aware that the audit had taken place, he was unaware of the audit outcome and was not provided with any follow-up information.
To Mr H’s surprise each practitioner working within the practice received notification from the regulator a week or so later, advising they were required to attend Section 150 proceedings to determine if any action should be taken, including possible suspension from practice or conditions placed on their registration. A copy of the audit was provided.
The infection control audit identified the following deficiencies:
- Lack of access to two of the four required infection control documents outlined in the DBA Guidelines
- No validated process for reprocessing of Nickel-Titanium (Ni-Ti) endodontic files
- Non-compliant instrument packaging and storage of critical extraction instruments
- Incomplete sterilisation log – no record of content for every sterilisation load
- No protocol in place in the event of infection control breach, such as a recall procedure and incident review and assessment.
Following the findings, practitioners were required to submit a written response regarding the audit within three days and attend a hearing shortly after.
Mr H sought advice from Dental Protection, and immediately reviewed his recent CPD log, realising it had been two and a half years since his last infection control update. While there is no specific guidance regarding the frequency of infection control CPD, it is expected an update or refresher course be completed every two years. Additionally, Mr H reviewed the four required documents outlined in the DBA Infection Control Guidelines alongside the DBA Code of Conduct, and realised that while the emphasis placed on his clinical treatment was important, so were his responsibilities and duty of care as a health practitioner.
While Mr H viewed his primary role as a clinician, the regulator looked further, measuring the practice’s ability to preserve public health and safety in the context of risk minimisation and prevention of infectious disease. In effect Mr H was being held accountable for the deficiencies identified in the audit, and while Mr H, as a dental hygienist, did not complete critical treatment procedures or have direct oversight into processes undertaken in the sterilisation room, the regulator held that the accountability sat with every practitioner in the practice due to the duty of care that governs a practitioner’s role. In effect risk sits with all registered practitioners, irrespective of their division of practice or who holds operational accountability.
During Mr H’s practitioner registration renewal he had declared that he was aware of the DBA guidelines on infection control, and by admission indicated he was compliant with these guidelines in his practice. Upon review, Mr H recognised that the DBA Infection Control Guidelines were very clear: their application in daily practice is a requirement for all dental practitioners (dentists, dental prosthetists, dental hygienists, dental therapists, dental specialists and oral health therapists). Furthermore, all practitioners are expected to act in accordance with the requirements set in all four documents referred to in Section 1, “Documentation”, of the DBA Infection Control Guidelines.
During Mr H’s hearing he was able to demonstrate his understanding and compliance with DBA Guidelines on Infection Control and their application in practice. The practice staff as a collective were able to discuss and action the changes required to rectify the deficiencies identified in the audit, and Mr H was able to speak to these changes in his hearing with the regulator. Mr H was able to prove that he was not a threat to public safety and this was reflected in his knowledge and understanding of the DBA infection control guidelines, DBA code of conduct and his recent completion of CPD. This was further supported by the action taken to address the regulator’s concerns. Pleasingly in Mr H’s case, no further action was taken, and Mr H determined the experience had reaffirmed his duty of care and responsibilities as a registered dental practitioner. Mr H was able to see this stressful event as a learning opportunity that would inform and guide his future practice.
Learning points
- Practitioners have a duty to ensure the care of their patients is their first concern and to practise safely and effectively.
- Practitioners must ensure the premises in which they practise are in compliance with the Dental Board of Australia infection control guidelines.
- Practitioners cannot delegate their responsibilities or duty of care and must ensure their practice is safe, appropriate and to the standard expected.