SOP of Post Extraction Haemorrhage

SOP of Post Extraction Haemorrhage

Post extraction haemorrhage is the most common complication after extraction.

●        If the patient is calling from the home:

➢  Advice the patient to clear the mouth of any blood clot using sterile gauze piece /cotton.

➢      Tell him to rinse his mouth with warm salt water.

➢     Then instruct the patient to bite firmly on to sterile gauze piece /cotton or alternatively he can bite a tea bag (which has been placed on cold water) for a period of twenty minutes.

➢   If the bleeding persists at the end of this period advise him to report to the dental department.

●        When the patient has reported in the dental department

➢       Separate him from his anxious relatives and guide him to the dental chair.

➢       Cover him with the drape and make him comfortable and reassures him.

➢       Examine the site and amount of haemorrhage.

➢       Remove the excess blood clot by grasping it with a piece.

➢       If  the  site  of  bleeding is from surrounding  soft  tissue  then  apply  gauze  pack  soaked  with  adrenaline  and   tell  the patient  to bite  on it.

➢       If  bleeding  persists  and / or a tear is present in the  gingiva  then  do suturing across the socket ( tension suture  to apply  pressure  to the area) under local  anesthesia  over  a  pack of   gelatin.

➢       If  the  bleeding  is  from  the  bony  socket  (which  occur less frequently)  apply pressure  at  the  bleeding  site  using  or  blunt  instrument  (e.g.  dull side  of or curette)  to  crush  the  bony  channel containing   the  vessel.  Then  apply  haemostatic  agent  in the socket  and  patient   instructed  to  bite on or gauze pack  for 5 minutes  following  insertion  of a suture.

➢       Re examine the patient before discharging him.

SOP of Digital X-Rays

SOP of Digital X-Rays

Desired outcome

To promptly take quality x-rays the first time and to limit exposure to the patient.

Measurement

●        Minimal exposure to patient and staff by consistently achieving quality radiograph.

●        Number of times x-rays to be repeated.

Procedure for taking x-rays

●        If the female patient then ask whether she is pregnant or not and place the lead apron on the patient.

●        Staff should wear the lead apron at the time of X-ray exposure.

●        Enter the patient’s particular in the computer and select the tooth/teeth for which x-ray to be taken.

●        Adjust the arms of the RVG (Digital x-rays) and switch on and ready it with appropriate setting.

●        Put the sensor which is covered with cling film into patient’s mouth with gloved hand with appropriate position.

●        If the patient has gagging sensation topical anesthesia can be used.

●        Then press the indicated button (as per manufacturer’s instructions) and observe the digital x-ray on the window screen.

●        If desired view has not come, repeat.

●        Remove the lead aprons both from the patient and self.

●        Remove the cling film from the sensor and make it ready for the next X-ray.

SOP of Dental Procedure In General

SOP of Dental Procedure In General

Desired out come

Successful carrying out of the planned procedure with minimal patient discomfort / trauma.

Measurement

●        Response of the patient & doctor.

●        Inspection of the room

●        No of times the assistant must live the room to obtain supplies or instrument.

Setting up of the trey

●        Mouth mirror

●        Twizer

●        Explorer

●        Oral surgical pack

●        Extra gauze and cotton rolls

●        Topical anesthesia

●        Lignocaine with and without adrenaline

●        Syringes with needle (appropriate size)

●        Elevators and dental instruments & materials as per requirement of the dentist.

●        Patient drape

●        Surgical gloves

●        Needle & suture

Procedure

●        The patient to be greeted warmly and professionally and made to sit on the dental chair.

●        The patient to be draped by the dental assistant.

●        Appropriate personal protective equipment to be put on by the staff.

●        Reassess and review the scheduled treatment plan and health history from the patient and make any necessary change to the treatment plan.

●        Arrange the dental chair to the appropriate position as per the required procedure.

●    Apply topical anesthesia to the proposed surgical site followed by the appropriate injectable anesthesia (Lignocaine 2% with or without adrenaline as per the requirement) when required.

●        Once the expected anesthesia effect has been obtained, carry out the procedure.

●        Use the saliva ejector as and when required.

●        If it is a tooth extraction or surgical procedure, follow post extraction / post surgical instruction.

●        Once the procedure is over clearly communicate the post-operative instructions to the patient, give him the prescription and guide him to the reception.

●        Clearly communicate about the follow-up visits both to the patient and the receptionist.

●        Complete the necessary documentation in the patient’s file before and after the procedure as per hospital guideline.

SOP of Safety For Dental Staff

SOP of Safety For Dental Staff

Desired Outcome

To Prevent The Staff Being Affected By Professional Hazards.

Measurement

How Often The Staff Is Affected By The Work Environment

●        Controlling Occupational Exposure To Blood Borne Pathogens

➢        Adequate History Taking Should Be Carried Out At The First Appointment Of The Patient To Find Out Whether The Patient Is Suffering From Contagious Or Communicable Diseases Such As HIV/Aids, Hepatitis-B Etc. By Taking The Patient Into Confidence.

➢              Vaccination Of Staff-  Should Be Adequately Vaccinated Against Hepatitis-B

➢      Barrier Technique-The Staff Should Stringently Follow The Barrier Technique As Described In 

➢               Optimum Waste Disposal Method- To Be Followed 

➢               Prevention Of Needle Stick Injury

●        Personal Protective Equipment

➢         Lead Apron-Should Be Worn By The Staff As Well As By Patients During X- Ray Exposure

➢               Mask, Apron, Gloves, Protective Eye Wear- To Be Worn During Procedure

●        Controlling Exposure To Chemical Hazards

➢    In Case Of Exposure To Chemicals Wash With Plenty Of Water Or Follow Manufacturer’s Instruction , If Irritation Persists Report To The Concerned Department

                 

●        Work Place Emergencies

➢             Fire 

➢             Electrical Short Circuit

SOP of Dental Hospital Infection Control

SOP of Dental Hospital Infection Control

Desired Outcome

To prevent cross infection among the patient, belongings & the staff.

Measurement

In a dental clinic, the patient’s saliva, dental plaque, blood, pus, and crevicular fluid are aerosolized and spattered. Microorganisms are always mixed with these body materials and they cause infectious and transmissible diseases, starting from the most common, i.e common cold ,to hepatitis, and AIDS.

By adhering to some basic procedures, the dental staff can safe guard their own health as well as patient’s health and prevent cross infections.

PROCEDURE  

Barrier techniques

●    Gloves must be worn when skin contact with body fluids, mucous membranes or contaminated items and surfaces is anticipated. Between patients, the gloves must be removed and hands must be washed and re-gloved. Latex or vinyl gloves should be used for patient examinations and procedures.

● Heavy rubber (utility) gloves are meant to be used while cleaning instruments and environmental surfaces.

●      Hand washing.

●    Hands should be washed at the start of the day, before gloving, after removal of gloves and after touching any contaminated surface.

●      Hand washing with water and plain soap is adequate for patient examination and non surgical procedures.

●        For surgical procedures, an anti-microbial hand scrub should be used

●   Face masks protect the oral and nasal mucous from body fluid spatters. They should be changed when visibly soiled or wet.

●        Protective eye wear is indicated to shield the eyes from spatters.

●      Protective clothing. Aprons, either reusable or disposable, must be worn in the dental clinic. They should be changed when visibly soiled or penetrated by fluids and they should not be worn outside the work area.

Limiting contamination can be done by three methods

●        Proper patient positioning

●        Use of high volume evacuation

●        Use of rubber dam. Sterilization and disinfection are the basic steps in instrument processing

Decontamination of instruments and equipments

●        All instruments contaminated with oral and other body fluids must be thoroughly cleaned and sterilized after use.

●      The three stages towards decontamination process ie pre sterilization cleaning, sterilization, and storage to be followed.

●        Hand cleaning of instruments should be done by dipping in detergent and water or only water and using a kitchen type brush, which is to be autoclaved at regular intervals.

●        After removing from water put it in D-125 solution followed by ultrasonic cleaning.

●        For Sterilization, the method of choice is AUTOCLAVING.

●        The instruments should be placed in the autoclave to allow free circulation of steam.

●        Avoid overloading of autoclave chamber.

●        The instruments such as hand pieces which should not come in contact with steam should be wrapped properly or kept in pouches.

●   Single used or disposable items like saliva ejectors, needles, cartridges matrix bands, impression trays etc to be discarded strictly after single use.

Instrument storage

●        Sterilized instruments should be stored in dry and covered condition for ex in trays with lid.

●        Pouches to be used for storing infrequently used instruments

Decontamination of impression materials and appliances

●        Immediately on removal from the mouth the impression should be rinsed under running water to remove saliva, blood and debris till it is clean.

●        Then it should be disinfected as per the manufacturer’ instructions.

●        It should be rinsed again in water before sending to the laboratory.

Surface cleaning and disinfection

●        Surfaces of the dental units and its parts, x’ray assembly etc to be wrapped with cling films and changed between procedures.

●        Uncovered surfaces to be wiped clean with disinfectant after every procedure.

●        Aspirators, drains, spittoons should be cleaned after every session with detergent / disinfectant.

Cleaning and disinfection of work surface

Work surface to be cleaned regularly with detergent and wiped with disinfectant regularly in between procedures.

Cleaning of floor

This is done with the help of disinfectant before and after the procedure.

Disposal of clinical waste

●        All wastes to be segregated into clinical and non clinical waste.

●        Sharp wastes like needles and blades etc are to be stored in puncture proof container before disposal. Needles should be destroyed with help of needle destroyer at the end of all procedures.

●        Blood spillage if occur should be handled immediately by covering with a disposable towel which is then treated with sodium hypochlorite solution. 

SOP on Patient Management

SOP on Patient Management

Desired Outcome

To have a smooth functioning in the department within the desired timeframe.

Measurement

●        After the patient’s arrival he should be registered at the front desk /reception fill the "patient registration form" for New Patients and after that confirm the appointment, directed to the waiting area or concern consultant OPD.

●        At the appointed time the patient to be directed to the procedure room, made to sit on the dental chair.

●        The patient to be draped by the assistant, made to rinse his/her mouth and then examined by the dentist.

●        Then the detail treatment plan is carried out.

●      Financial obligations are explained clearly to the patient and procedures are carried out (if any) with patient’s consent.

●        After the chair side procedure is over, the details of the procedure needs to be entered in the patient file /software. 

●    The patient is given the prescription, and directed to the front desk again to complete the formalities of payment, to be informed about the next appointment, and any other queries to be met.

●   If he is a new patient then detail treatment planning should be carried out in the first appointment by the dentist and financial obligations are explained in detail. Consent forms should be signed where applicable.