Infection prevention and control audit-feedback instrument for oral health care in South Africa

Abstract

This study reviewed national and international literature to develop an audit-feedback instrument (AFI) to monitor adherence of South African oral health care facilities with compliance to infection prevention and control precautions. In a multi-phased literature search, existing infection prevention and control recommendations, guidelines and audit-feedback instruments were reviewed and broadened to include “dental audit tools”, as well as audit tools from other health care disciplines. Audit-feedback instruments were scrutinised for user friendliness, the use of simple language, electronic calculations and feedback possibilities. A new South African AFI was proposed, considering the differences between public and private oral health care facilities and also the diversity of training levels of oral health care personnel employed. Eleven focus areas supporting all aspects of infection prevention and control in oral health care facilities, including administrative controls; personnel protection controls; environmental- and work controls; surface contamination management; equipment maintenance, service or repair; air- and waterline management; personal protective equipment usage; personal and hand hygiene practices; sterilisation practices; safe sharps handling and waste management were included. The AFI was tested in a sample of 50 oral health care facilities. None of the participating facilities demonstrated 100% compliance. Personal- and hand hygiene practices and waste management performed the best, at respectively 75% and 63%, while administrative controls and air- and waterline management scored the lowest mean values; 31% and 36% respectively The general lack of compliance with infection prevention and control precautions in the participating oral health care facilities clearly poses a safety hazard to both patients and oral health care workers. Results indicate that adherence of South African oral health care facilities with compliance to infection prevention and control precautions need to be improved. The AFI should go a long way towards improving safety and the high expectations about providing quality infection prevention and control outcomes in oral health care.