Infection Prevention Planning

Carefully establishing, planning for, carrying out and assessing the mission’s infection prevention protocol will help ensure that patients and team members remain safe.

Prepare before leaving and assess upon return. Use Appendix A - "Main Checklist for Oral Healthcare Missions" and Appendix K - "After-Action Mission Report Template" as a basis for planning the team’s infection prevention protocol and for assessing its effectiveness at the end of the mission trip. Such follow-up provides valuable information to help you improve the process on future trips.

Setting out the site. Working in a nontraditional setting presents its own set of challenges; making the area as comfortable and safe as possible helps the team stay focused and protective. Patient positioning, adequate lighting, access to supplies, freedom from excessive dust, insects and noise and other factors should be considered in selecting the set-up for patient treatment.

Basic set-up. First, consider where the team can best define the operating area, particularly the exact position in which patients’ heads should be with regard to natural or artificial light. Arrange everything else around this position.

The treatment area must have controlled access. It is undesirable and potentially unsafe to allow onlookers to be present.

Next, determine the traffic flow to and from the operating area to ensure that those who have been treated do not exit through a crowd of waiting patients.

Identify a location offering a place with a suitable writing surface where patients can register, provide a short medical history, and have vital signs recorded. Position this area away from others, so conversations cannot be overheard.

Organize safe, adequate instrument and supply storage to protect these valuable items from contamination, accidental loss and theft. They also need to be conveniently placed so that when stocks in the operating area are low, replenishments are easily accessible.

Figure 2.
Image: The Principles of Infection Action.
The Principles of Infection Action.

Instrument storage. Protect stored instruments from moisture or contact with a contaminated object. Keep wrapped sterile instruments in their packaging until they are ready for use. Store unwrapped instruments in a covered container that is clearly marked to indicate that the instruments have been sterilized or high-level disinfected. Ensure that contaminated instruments are never stored in the same manner as those that are ready for use.

Treatment area. The operating area in many mission situations bears little resemblance to a modern dental office. Sites are usually informal and may not have the same protection from the elements that the team is used to. Whenever possible, locate a building such as a community hall or church that allows the use of indoor space for treating patients.

First clean the floor and remove any obstacles that might cause operators or patients to trip. Sweep up obvious dust. Clean all flat surfaces, particularly those that will come into contact with instruments or devices that will be used intraorally. If possible, cover surfaces with surgical drapes or other clean material that can be changed between patients.

Clearly establish the boundaries between the areas intended for “clean” items (such as supplies, sterilized instruments and dental materials) and the area designated for “dirty” items that have been contaminated through contact with blood or saliva.

Figure 3.
Image: Flow Process for Instrument Management.
Flow Process for Instrument Management

Instrument processing area. Instrument processing requires planning to help ensure that instruments are safely moved from the location of use through cleaning, sterilization, and storage. Whenever possible, set up a specific area for instrument processing that clearly separates contaminated items from those that have been processed for reuse with patients. When processing sharp instruments, heavy-duty puncture and chemical-resistant gloves should be worn. Instruments should be cleaned individually rather than by the handful, which reduces the risk of glove puncture and contamination. A directional flow that allows instruments to sequentially move from receiving in the "dirty" area through cleaning, packaging, sterilization, to the "clean" area and storage is ideal.