An adverse outcome can affect a patient’s quality of life, but an infection control breach has the potential to affect the wider community – often impacting on thousands of individuals and families. Dr Annalene Weston, dentolegal adviser at Dental Protection, goes through the steps that can be taken to prevent, or resolve, such breaches
- This article is in conjunction with Dental Protection’s Sliding Door seminar, which explores commonly occurring infection control breaches
What’s the standard?
The lead Australian document is the Dental Board of Australia’s Guideline on Infection Control,1 which should be read in conjunction with other Dental Board documents that outline infection control obligations of dental practitioners.2
The guideline on infection control mandates that each practice has hard or soft copies available of the following documents, which essentially instruct you on how to undertake appropriate infection control and instrument processing in your practice:
- The Australian and New Zealand Standard AS/NZS 4815: (current edition) Office based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment (unless you work within an organisation that operates under AS/NZS 4187)
- Australian Guidelines for the Prevention and Control of Infection in Healthcare – National Health and Medical Research Council (NHMRC)
- The current Australian Dental Association Guidelines for Infection Control
- A practice-specific infection control manual.
What’s the problem?
Complaints against dental practitioners are on the increase, and are made disproportionately when compared to complaints against other healthcare providers. Naturally, many of these complaints are rooted in clinical dentistry itself, specifically the quality of the work provided and whether the patient has received the outcome they were expecting; but it can be surprising to some that many complaints also arise as a result of our behaviour and conduct.
Infection control complaints can relate to issues with a practitioner clinically or with their conduct. While seemingly self-evident, many practitioners fail to meet these obligations for a variety of reasons including being busy, distraction, being unaware of the standards they are meant to be meeting, or being unable to meet the standard altogether, sometimes for reasons outside their control.
As well as our professional obligations regarding infection control, many would argue that we have a moral and ethical obligation to protect the public as healthcare workers, with the Dental Board taking the position that:
“Dental practitioners must practice in a way that maintains and enhances public health and safety by ensuring that the risk of the spread of infectious diseases is prevented or minimized.”3
The Board expands on this further in the Code of Conduct to state that:
“Practitioners have a duty to make the care of patients or clients their first concern and to practice safely and effectively.”4
What are the consequences?
Infection control breaches are often more far reaching than an adverse outcome affecting one patient, as they have the potential to affect many. They can also affect the practitioner, the team at large and the organisation/practice.
When considering the consequences, they can be divided into physical, emotional and reputational (with the spectre of the regulator ever-present for a dental practitioner).
While the only demonstrated transmission of HIV from a dental practitioner to a patient(s) is the infamous ‘Florida Case’ with multiple other look backs failing to make the connection, the risk of contracting a blood-borne virus through an infection control breach is legitimate and real, and needs to be taken seriously.
Not only can there by physical repercussions, but the emotional impact of the fear that many feel when they believe themselves to have been exposed to a blood-borne virus must not be underestimated. Speculation regarding the potential mechanism of contraction of a blood- borne virus commonly leads to reputational damage within the community.
What can I do?
DO follow infection control protocols.
DO keep up to date with your requirements through regular CPD.
DO train your staff, and attend regular updates together.
DO be honest with your patients if you suspect and infection control breach, and consider blood-borne virus testing when appropriate.
DO contact your indemnifier in the event of an infection control breach.
DO take infection control seriously.
DO check to ensure that any equipment affected by the breach is removed from circulation immediately to ensure that more patients are not affected.
DON’T try to cover the breach up.
- For more on managing and preventing infection control breaches, attend our Sliding Doors Seminar Friday 28 September 2018, Hotel Grand Chancellor, Tasmania.