NEBDN NATIONAL DIPLOMA IN DENTAL NURSING

PRACTICAL EXPERIENCE RECORD SHEET

Unit 1.1: Preparing & Maintaining the Clinical Area

Student Dental Nurse Name: DT

Date of Activity: 22/04/2020
Range: Restorative Procedure
1. Clinical area details
Guidance Notes:
• Students should state the procedure to be carried out.
• Students should detail the clinical area, the equipment switched on, and the preparation of the area
for the procedure.
• Students should state the particular instruments and materials (where relevant) set out, as well as
the relevant patient records.
Procedure: Amalgam procedure. Amalgam filling replacement on UL6 MOD

Beginning of the day. Preparation of the clinical area

Surgery must be kept dry and adequately ventilated at all times to eliminate exposure of airborne
materials, toxic hazards and improve the comfort of dental staff and patients.
Temperature, humidity air-conditioning, and ventilation systems are regularly
maintained/checked following HTM 03-01 specialised ventilation for healthcare premises
guidance.
Natural light combination with Ambient lighting is used to establish a comfortable environment in
a way that helps the patients feel confident and calm and helps to reduce their nervousness.

Clinical area equipment: all required equipment is turned and prepared for the
treatment/procedure: compressor, X-ray Machine, dental chair, amalgamator, and the computer.

Decontamination room equipment

I turned on the autoclave, the distilled water filter, the ultrasonic Bath and the
extractor fan.

Clinical/surgery room

I disinfected flat surfaces, the dental chair and applied disposable covers/protective barriers to
the dental chair handles and headrest, light handles, dental chair control panel and X-ray machine
head cover. Disposable syringe sleeves are used to cover High-speed handpiece, Contra-angle
handpiece and 3 in 1 syringe. Computer keyboard, mouse are covered with disposable cling film.

Disposable covers/protective barriers are changed between patients to control and to reduce viral
cross-contamination.

DUWLs Water lines

Water quality in dental premises is regulated under the:

• HTM 01-05
• HTM 04-01

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 • Code of Practice: Legionnaires disease
• The Control of Legionella Bacteria: Bacteria in Water Systems (L8)

In the morning I turned the dental chair unit on. I fitted a reservoir bottle back with freshly made
distilled water and removed instruments handpieces and placed all water consuming instruments
into the flushing holder; syringes into their specific openings and flushed water lines for 2 minutes
in order to reduce the level of micro-organisms and bacteria growth in DUWLs lines (Dental Unit
Waterlines) following manufacturer’s instructions The contaminating bacteria are able to multiply
and form a biofilm on the inner surface of the waterlines. Biofilms form rapidly, and within a week
start shedding large numbers of bacteria into the waterline. Contaminated aerosols can
be inhaled by both the dental team and patients during treatment.

I am aware that Legionella and Pseudomonas Aeruginosa bacteria, non-tuberculous mycobacteria,

fungi, protozoa that can be spread through the handpieces to the patient or staff and can cause
mild to severe illness. The longer a pathogen persists on a surface, the longer it may be a source
of transmission, therefore endangering patients and/or dental staff.
DUWLs must comply with drinking water standards and bacteria levels should not exceed 100 to
200 cfu/ml.
Under the Health and Safety Act and associated regulations e.g. The Control of Substances
Hazardous to Health (COSHH) Regulations 2002 (as amended), a risk assessment must be carried
out in order to identify favourable conditions for bacteria proliferation within the water systems.

Three in one syringe

There are no suck-back concerns when using disposable/plastic air & water syringe tips. Metal tips
can cause problems with cross-infection; metal tips can become clogged, as the internal surface
corrode during use. Metal tips are no longer used in our dental surgery. In the morning three
syringe in one must be checked by releasing air and water from it.

Reservoir bottle

I fitted the reservoir bottle filled with distilled water and Alpron (10ml Alpron solution to 990ml
distilled water) using manufactures instructions onto the dental chair for routine decontamination
to prevent the formation of biofilm in dental unit waterlines. Following HTM 01-05 6.86 guidance.
At the end of the day, I disconnected the reservoir bottle emptied, rinsed and stored inverted
clean and dried overnight.

Transporting box

Transporting box, is prepared for transporting amalgam instruments after procedure safely from
clinical area to the decontamination room. The Transporting box is colour coded in RED (for
dirty/contaminated instrument).

Patient details: male NHS/Private mix surgery, patient 26, medical history form is up to date,
Patients attends for check-up regularly, once a year (every 6 months). Patient medical history was
rechecked to make sure that the patient was not taking any kind of medicines or have any kind of
allergic reaction (also latex allergy) which will affect the dental treatment and also helped the
dentist to enter the dental charting, periodontal charting and BPE. Then I confirm the treatment
with dentist. I put the treatment plan and consent form next to the computer.
The planned amalgam procedure is confirmed with the dentist/clinician. All required patient
radiographs are prepared for the treatment.

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I made sure I have got the consent from the patient as a trainee dental nurse to use the
information(s) for my RoE.

Before the procedure: I Washed hands using the hand washing instructions/techniques.
I made sure, when I came into the clinic that my hair is tied back and my nails were plain, short
and clean. I wore my uniform PPE (i.e. tunic, trousers covering my toes and black flat shoes before
entering into the surgery.

Dental Staff PPE: Protective gloves, mask, visor and tunic.

Patient PPE: Safety Glasses (Googles) and bib is ready for patient to use.

Prior to the treatment, the dentist taken the consent from the patient and Patient was happy to
let a trainee dental nurse to assist in the treatment being provided.

Treating nervous patient:

I suggested listening to his music on headphones during the dental procedure.

Amalgam procedure instruments:

Check-up instruments: Mouth mirror, Right angle Probe and College tweezer
Self – aspirating syringe and anaesthetic cartridge, Long needle, Rubber dam kit: Rubber dam
stamp, Rubber sheet, Rubber Dam Punch, Forceps, Clamps, the metal frame (Youngs) and dental
floss.

Siqveland matrix band, Wooden wedge, High-speed handpiece, Contra-angle handpiece, Dental
burs: high speed and larch grip, Spoon excavator, amalgam carrier, Amalgam well, Plugger, Carver
and Ball ended burnisher, high speed and larch grip burs.
Disposable 3 in 1 syringe, high-volume evacuator tip, and cotton rolls

Dental Amalgamator: is used to mix silver with mercury. The manufacturer’s instructions for
trituration time is followed.

Mercury spillage kit: is used in the event of a spillage in order to quickly and safely recover
mercury spillages.

Materials require:
Anaesthetic LA cartridge, Amalgam capsules

After the restorative/amalgam procedure I helped patient to remove PPE safely: Safety Glasses
(Googles) and bib. I disinfected Safety Glasses (Googles) using disposable alcohol-free wipes. The
bib and patient’s plastic cup I disposed of in an orange clinical bag.

2. Details of how clinical procedure managed after procedure

Guidance Notes:
• Students should explain how instruments, sharps, equipment, surfaces were decontaminated and
sterilised after the procedure.
• Students should give details of all relevant waste disposal techniques used.

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Clinical area

After the procedure I carried out effective decontamination procedures using zoning techniques
on the surgery equipment e.g. flat surfaces/table, dental chair, bracket table, aspirator unit,
suction unit and spittoon using disposable alcohol-free wipes, and sodium hypochlorite based
disinfectants (up to 10% fresh solution to clean blood spillages within the surgery) to remove
blood traces from non-metallic surfaces. Bactericidal/viricidal surface cleaning spray Dettol is used
to reduce any viral contamination of work surfaces between patients. Disinfected flat surfaces,
the dental chair and removed disposable covers from the dental chair, headrest, light handles,
control panel, X-ray machine.

Also flushing of water lines is carried out between patients for 20-30 sec. after each patient to
reduce backflow of microorganisms (bacteria from the mouth of a patient, due to a ‘suck-back’
effect) into the water lines following HTM 01-05 cleaning of DUWLs recommendations.

I used Puli-Jet Plus aspirator cleaning product to flush through all suction lines end of the day
followed by manufacturer’s instructions. I filled the Pulse Cleaner Bucket up to halfway between
the second and third line 2.5 litre of 40 C warm water and added 30ml Puli-Jet Plus solution. Puli-
Jet leaves a residue on the inside pipes and suction tubes in order to stop grows on these DUWLs
surfaces and helping to maintain a safer work environment.

I removed my PPE, washed my hands using the hand washing instructions/techniques following by
HTM 01-05 instructions.

I took the transporting box securely from the surgery to the red zone ‘dirty zone’ of the
decontamination room.

PPE: heavy duty apron, rubber gloves, visors.

Decontamination: The items should be then autoclaved as soon as possible before they can dry in
the air; as this can result in corrosion or recontamination.

Area designated Red ‘dirty’ and green ‘clean’ zones:

RED ‘dirty’ zone: instruments transported from the surgery into red zone.

Sharps: The dentist safely removed the long needle and an empty anaesthetic cartridge from the
self-aspirating syringe, I disposed wooden wedges, Siqveland matrix band metal strip (exception:
if matrix bands contaminated with amalgam then it should be disposed of in the waste amalgam
pot, not the sharp container), high-volume suction tip and 3 in 1 syringe tip.

Clinical waste-hazardous- Orange sack/bin: surgical gloves, face masks, patient bib, disposable
covers/protective barriers, cotton rolls, patient plastic cup, tray lining, low volume saliva ejector.

White colour Cap Guard Chairside: Amalgam capsules were segregated into Cap Guard Chairside
container.

Manual cleaning with ultrasonic decontamination:

To avoid indirect and indirect cross infection following sequences Debride, inspect, rinse, and
scrub are used before preparing reusable instruments for sterilisation procedure following HTM
01-05 decontaminating reusable instruments in primary care dental practices guidance.

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Ultrasonic bath: An ‘Instrument Safe’ disinfectant and cleaning agent is used to remove debris
from items by vibrating at an ultrasonic frequency. ‘Instrument Safe’ is a concentrated liquid
which is diluted in water to following manufacturer’s instructions. 10ml makes 1 litre of 1%
solution. The solution is changed daily or when it has become visibly contaminated.

Hinged items such as amalgam carrier must be disassembled. All items are placed on the bath tray
and fully immersed into distilled water with solution and time set followed by manufacturer’s
instructions. When the cycle is finished the basket with instruments was lifted and allowed to
drain, then instruments was rinsed in a dedicated sin/bowl of distilled water. The items were
visibly inspected by using illuminated magnifier to ensure debridement has occurred, and put
through the process again if debris remains.

Manual Debride: I used cold water which I checked with a thermometer to ensure that it is below
45 C and diluted in water ‘Instrument Safe’ detergent 1 litre of 1% solution to following
manufacturer’s instructions in a dedicated instruments cleaning sink/bowl; HTM 01-05

My practice is following HTM 01-05 requirements, advising that ideally a decontamination room
should be equipped with two dedicated sinks for manual cleaning; however, this is not a
requirement. One sink/bowl is to be dedicated to the cleaning of instruments and the other is to
be dedicated to the rinsing of instruments. HTM 01-05

I used nylon-bristled autoclavable scrubbing brushes to remove difficult contaminants.

The instruments should be scrubbed while under the water surface to avoid spraying/splashing
contaminants.

Dental burs are manually cleaned using the same sequences in decontamination: debride, inspect,
rinse and scrub.

Debride – remove blood traces, debris from instruments

Inspect – The items should be visibly inspected using an illuminated magnifier.

Rinse - A separate sink/bowl of distilled water should be used to rinse the items after cleaning to
remove any detergent and loose contamination.

Scrub – to ensure that all contamination has been removed; if any is found the item should be
recleaned and rinsed again.

Handpieces: High-speed handpiece, Contra-angle handpiece were disinfected using disinfectant

wipes 70% V/V Isopropanol and used handpiece lubricant spray (to protect instruments from
corrosion)

Magnifying glass was used to check instruments.

All instruments were placed on the metal tray and prepared for the sterilisation process. I made
sure that instruments are not overloaded/overlapped on the metal tray.

Sterilisation:

Autoclave: Type N (Non-vacuum). In the beginning of the day an autoclave is filled with distilled

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water and tested using TST (Time, Steam and Temperature) control indicators for steam
autoclaves. These are three critical parameters which must be achieved to guarantee the
effectiveness of the sterilisation process. The bright yellow indicator will change to a deep
purplish blue upon completion of a successful sterilisation cycle 134 C -3.5 Mins. Then I filled up
the autoclave with distilled water and placed a Helix test strip to check whether steam
penetration is working properly.

Autoclave cycle: 134C 15-20 min.

TST strip is used to record autoclave cycle and kept in the records book. Cycle sterility printout is
checked after each cycle.

Green area ‘clean’ area is used only for packing sterilised instruments:

Dental Staff PPE: clinical gloves, mask, visor and tunic.

Lint-free cloth:

After sterilisation Instruments are dried thoroughly first using single-use Lint-free cloth,
pouched/bagged and sealed.
Pouched bags storage: I wrote my name, surname, today’s date and expire date 1 year. Signature

Handpieces: High-speed handpieces and Contra-angle handpieces are oiled after sterilisation
according the manufacturer’s guidelines.

Decontamination room:
After each reprocessing activity, the decontamination room must be kept clean/disinfected at all
times.

3. Reflective Account

Guidance Notes:
Students should identify their strengths and weaknesses during the procedure and describe any action they
would take to address weaknesses in the future, if required.
Strengths: I have achieved effective team working throughout treatment, I managed/prepared the clinical
environment before/after treatment following current standards and guidelines.

Weaknesses: I am still familiarising in clinical decision making and clinical procedures.

Aims: Follow GDC standards in sterilisation and decontamination and cross infection control. Indirect cross
infection.

4. Witness assessment
This Section should be completed by the GDC (or other) registrant who witnessed the activity of the student
and is assessing their competence. Constructive feedback will help the student to develop their performance
in the workplace
Not Yet
Criteria Competent
Competent
Surgery Preparation
Student turned on all equipment required for the procedure ☐ ☐
Student donned appropriate PPE (gloves, mask, eye protection,
☐ ☐
clinical dress)

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Student cleaned work surface using viricidal disinfectant or
☐ ☐
detergent solution
Student flushed through all water lines ☐ ☐
Student applied disposable covers to required areas of the dental
☐ ☐
surgery e.g. light handles, control panel etc.
Student made all required patient records and radiographs
☐ ☐
available
Student identified the planned procedure and confirmed with the
☐ ☐
clinician
Student prepared all instruments, materials and equipment for
☐ ☐
the procedure in their order of use
Clearing Away
Student removed all sharps safely from the clinical area ☐ ☐
Student disposed of all sharps appropriately ☐ ☐
Student disposed of all clinical waste appropriately ☐ ☐
Student disposed of all special waste appropriately ☐ ☐
Student transferred dirty instruments to the decontamination
☐ ☐
zone safely transporting box
Student carried out effective instrument decontamination
☐ ☐
procedures
Student carried out effective decontamination procedures on the
surgery equipment e.g. work surface, dental chair, spittoon dental ☐ ☐
chair, spittoon
Student carried out procedure with consideration for the patient’s
☒ ☐
condition e.g. latex allergy
Professionalism
Student demonstrated professionalism throughout the procedure ☒ ☐
Student demonstrated effective team working throughout the
☒ ☐
procedure
Student demonstrated effective clinical decision making
☐ ☐
throughout the procedure
Student managed themselves and the clinical environment in line
☐ ☐
with current standards and guidelines:
5. Witness feedback
Student managed themselves and the clinical environment

I confirm that the performance of the student demonstrated competence as indicated in the table
above.
Witness Name: Dr. Green
Date: 08/10/2020
GDC Number: GDC Dr. Green
6. Tutor feedback
This section should be completed by the GDC registrant who is assessing all sections of the completed PER
and is normally based at the Training Centre. Constructive feedback will help the student to develop their
performance in the workplace.

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Satisfactory ☐ Not Yet Satisfactory ☐
Tutor Name:
Date: Click here to enter a date.
GDC Number:

Internal Moderation
Internal Moderator Name:
Date Sampled: Click here to enter a date.
GDC Number:
Meets NEBDN Requirements: Yes ☐ No ☐