Procedure to be carried out: Alginate impression taking for partial removable

prothesis (LL6,LL5,LL4,LR3,LR4)

Patient details: 53 years, male,

Social habits: no smoking, drinking occasionally,

Medical history: no health issues, no allergies of any kind

Last visit: 15th June for Routine Examination

Clinical area: NHS Dental Practice

Preparation of the clinical area for alginate impression taking for partial removable
prothesis

I am wearing my scrubs, I have short nails, I am not wearing any jewellery, I washed
my hands in line with HTM 01-05 regulations, as stated in the handwashing poster
found above each handwashing sink and after that I used rinse-free hand
disinfection gel on my hands and wrists. I am wearing Personal Protective
Equipment (PPE) that I put in the following order: first I put on the plastic apron and
tied at the waist, second, I put on the disposable face mask and made sure it covers
my nose, mouth and chin, then I got the visor and lastly the disposable nitrile
powder-free examination gloves.

I made sure that surgery is 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, and ventilations 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. Approximately

I switched on and visually checked all the equipment required for the procedure
according to the manufacturer’s guidelines:

 Air compressor, which is located downstairs, I switched on the power by

pressing the switch button on the wall, and then pulled on the safety valve to
test it which released a hiss of escaping air. After I had done that, I watched
the pressure gauge, waiting for the needle to stop moving. This signifies that
the air inside has reached optimum pressure.
 X-ray Machine, I switched on the power by pressing the red switch button on
the wall, and visually checked if the equipment works within diagnostic
reference levels (DRL), checked if warning lights and alarms functioning
correctly, checked if isolation switch is working, and I checked if the arm is not
loose and moving, and if the head is in good working condition with the
collimator on, recording the findings in the Log in record sheet.
 Dental chair- I switched on the power by pressing the green switch button
from the bottom of the dental chair unit, and I filled a reservoir bottle with
freshly made distilled water and water lines decontamination solution
 ( tosylchloramide sodium solution), in a concentration of 10ml solution to
990ml distilled water, according to manufacturer guidelines, for preventing the
biofilm in dental unit waterlines I attached it to the chair securely and flushed
all dental unit water lines (DUWL) like 3 in1 syringe, slow and fast speed hand
pieces and scale and polish, for 2 minutes and flushed again for 30 seconds
between each patient (HTM01-05). This is done to remove stagnant water
and to also reduce the microbiological count within the water lines and to
prevent cross contamination. I am aware that Legionella and Pseudomonas
bacteria can be spread through the handpieces to the patient or staff and can
cause mild to severe illness.
 The Suction line was switched on together with the dental chair, and now
used my finger to completely cover the Regulator Port to check the suction
strength.
 Amalgamator- I switched on the power by pressing the switch button on the
wall, hearing the beep sound confirming that the amalgamator is on.
 Light cure- I switched the power on and checked it was working by removing
the light cure and placing it back on the charging unit watching the charging
light come on.
 switched on the computer from the plug and pressed the on/off button at the
bottom of the screen which then brought power to the computer and logged
into the system.

All the equipment was in good working condition for the day.

All staff in our practice are responsible for checking and setting up the
Decontamination room every morning, by turning all the equipment on - the lights
pressing the swich on, the fun extractor, that is very important because ensures a
good ventilation taking out the air from the room and bringing in fresh air, the
illuminated magnifier by pressing the switcher on, and the Autoclave type N that I
filled with freshly distilled water and I run an autoclave test cycle using TST strip to
test the sterilising conditions. Before the cycle starts, I do the safety checks looking if
the door seal is intact and checking for the door pressure interlock and door closed
interlock. During this cycle the air is sucked out of the vacuum chamber which
creates a steam which allows it to contact all surfaces, including any hollow
instruments. The autoclave heats to 134 degrees Celsius and holds a bar pressure
of 2.25 for 3 minutes. A full cycle length is 15 minutes, and I knew the test was
successful when the yellow circle present on the TST strip had turned to purple once
the cycle had complete. I write down all the findings in the Log sheet, and signed
with my initials, together with the cycle number, the Autoclave model and serial
number. There are no other automatic cleaners in my practice. I scrubbed the dirty
instruments washing sink and the instruments rinsing sink with cream cleaner paste,
the taps as well, making sure there is no limescale deposits, and then I cleaned them
with warm water. I sprayed all the flat work surfaces with disinfectant spray 2 in 1
anti -microbial non- alcoholic surface cleaner and wiped them with paper towels.

Back in surgery room, I sprayed all the flat work surfaces with disinfectant spray 2 in
1 anti -microbial non- alcoholic surface cleaner and wiped them with paper towels.
For the dental chair, dental light, control panels and for the bracket table that holds 3
in 1, slow and faster speed hand pieces and scale and polishing handle, I used anti-
microbial surface cleaning pre-saturated and alcohol-free wipes following
manufactures guidelines (we don’t apply disposable covers to the dental chair
handles and headrest in the surgery room I worked this day, but we do it in other
surgery rooms were the dental chair have any sign of wear or tear, and I am aware
that the best practice according to HTM 01-05 guidelines Best Practice there should
be disposable covers applied to the aspirator tubes, control panels and handles
dental light). Computer keyboard is covered with protective silicone cover. I clean
these areas in between each patient with anti-microbial cleaning wipes following
manufactures instructions. I prepared the dirty instruments box, which is lockable,
rigid and puncture proof by spraying it with disinfectant spray 2 in 1 anti -microbial
non- alcoholic surface cleaner and wiped it with paper towels.

The patient is an existing patient, and I opened his file records, where I could see
that his last visit was on 15th June for routine examination, and I opened patient's
medical history to check for any allergies or red flag warnings, to inform the dentist
accordingly. Any change in patient's medical history was documented and
electronically signed and dated at the reception, as for each patient. The patient has
no medical issues and no allergies of any kind.

The planned procedure of alginate impression taking for partial removable prothesis
for LL6,LL5,LL4,LR3,LR4 is confirmed with the dentist. I made sure I have got the
consent from the patient as a trainee dental nurse to use the information about the
treatment for my RoE records. Patients consent was gained for a trainee dental
nurse to assist the clinician prior to treatment.

On the dentist side I placed the tray with mouth mirror, straight probe, disposable 3
in 1 tip. On the nurse side I placed a disposable aspirator tube, a cup of fresh mint
mouthwash and a box with soft tissues, several sizes of disposable upper and lower
perforated impression trays (the right size to be decided by the dentist) and tray
handles, mixing bowl, mixing spatula, measuring scoop, measuring water cup,
alginate material, adhesive spray for impression trays, shade guide, laboratory ticket
and mirror. A disinfecting bath been prepared prior to procedure. I changed my
gloves and prepared PPE for the dentist and for the patient, as follow: for the dentist
prepared disposable nitrile powder-free examination gloves, plastic apron,
disposable face mask and visor, and for patient prepared the safety googles and bib.

I politely invited the patient into the surgery room and asked them to have a seat on
the dental chair. I provided the safety googles and covered her with the bib, always
making sure and asked if the patient is comfortable to start the procedure. The
dentist informed the patient about the procedure and asked me for the shade guide,
to check what teeth shade the new denture will have. Together with the patient,
decided that the best match will be shade A3.5. Then, I passed to the dentist a
selection of impression trays, enabling the correct ones, for both the upper and lower
arch, and after the correct tray sizes been identified, I started to prepare the material
for impressions. First,to save time I sprayed both disposable trays internal surface
with adhesive spray to provide a strong adhesion between the tray and alginate, than
I shaken the alginate box before open, to loosen the powder, and for the upper tray I
got 3 scoops of alginate powder and put them into the mixing bowl, and filled the
correct amount of water into the measuring cup, and when the dentist allowed me to
mix, I started by mixing the water from the cup with the alginate, in the mixing bowl,
and using the mixing spatula I vigorously mixed the alginate to a smooth
consistency. When the right consistency was achieved, I loaded the perforated upper
tray with the material and passed it to the dentist. After impressions material had set
in patient mouth, the dentist passed me back the tray, asking me to prepare the
lower tray as well. The lower tray I only used 2 scoops of alginate powder, and water
accordingly. I mixed with the mixing spatula, and when the right consistency been
achieved, I loaded the material on the tray, and passed it to the dentist. After the
dentist gave me the trays from patient’s mouth, those been disinfected accordingly,
and both impressions been covered with wet paper tissue, and sealed in an air tight
plastic bag. The lab ticket was filled with Dentist's name, patient's name and age,
patient's id number, shade, dental practice address, additional features, date of
delivery for fitting and disinfected, and the ticket was attached to the front of the
sealed bag.

The patient was constantly monitored and reassured through the entire procedure.
After the alginate impression was taken, I helped the patient to clean his face with
paper tissue and after I checked that the patient was clean and tidy, without water or
alginate traces on his face, I asked him to rinse their mouth, and after that I asked
him if I can remove the bib and have the googles back. When the patient left, I
escorted him to the Reception, and ensured he is having three more appointments
booked for Bite, Try in and Fit stages.