New SanPin in dentistry: requirements for a dental office, sanitary and epidemiological regime, general cleaning

Dental services are classified as medical services, therefore special requirements must be met in institutions. Compliance with SanPin in dentistry is not only the implementation of the law, but also the protection of the health of each patient and employee.

Before opening a private dentistry office, you need to make sure that it complies with existing standards and get confirmation of this from the bodies of Rospotrebnadzor, Fire Inspection by obtaining from them the appropriate documents. Since 2009 began to operate SanPiN 2.1.3.2524-09, in connection with which rules 28.12.83 N 2956A-83 have ceased to be in force.

General rules and regulations of SanPin

General rules:

1. Requirements apply to state clinics and legal entities that plan to open dentistry.
2. New clinics are being built and equipped based on current rules and guidelines.
3. New objects are accepted and allowed for operation by the state commission, which can issue the conclusion of the SES.
4. Each dental organization must have an officially published copy of SanPin.
5. Legal entities, their heads and other officials are responsible for the fulfillment of the requirements of the sanitary and anti-epidemiological regime.
6. In the process of construction and operation of dentistry, only those materials, products and devices are used that are allowed in Russia.
7. It is the responsibility of all dental workers to perform work places and carry out sterilization cleaning.
8. The existing SanPin also belongs to the dentistry in which the hospital operates.

Basic requirements by category

To the placement of a dental organization

Requirements:

1. Dental clinics, their premises and laboratories are located separately from nearby facilities, however, it is allowed to place them in ordinary clinics, subject to the relevant rules.
2. Dentistry is allowed to be organized in residential buildings if the current requirements are met. In particular, a separate street entrance is set up in such dentistry. If it is planned to supply devices with radiation in the arsenal of clinics located in residential buildings, the rules must be followed.
3. Dental clinics should be equipped with sewerage, plumbing, heating and electricity systems.
4. In the basements, it is allowed to equip a wardrobe, a room for employees and a toilet, but ventilation systems must be installed.
5. Dentists take children in separate rooms that are not intended for the treatment of adult patients. It is recommended to organize a children's reception in a separate section with a bathroom and a waiting room.
6. You can provide first dental care to expectant mothers in regular offices.
7. Each dentist's office must have an area for a working installation in the form of 14 square meters (not less), and for an additional installation of 10 square meters (if a drill is not used, then 7 square meters). The minimum height from floor to ceiling is 2.6 meters.
8. Operations requiring anesthesia and resuscitation are allowed only in the operating room.
9. The work of dentists is divided into purulent and clean (planned) interventions, cannot be used together. The latter are held on the days allotted for this with the advance implementation of the gene. cleaning.

To finishing from the inside

Primary requirements:

1. It is possible to decorate dental premises from the inside only with those materials that are approved for use for these purposes.
2. The walls should be smooth. They can only be finished with materials that lend themselves well to processing with antiseptic solutions.
3. The walls of the dental laboratory are allowed to be treated with paints and revetted with smooth panels. Seams must be sealed tightly.
4. For processing ceiling surfaces, it is allowed to use water-based emulsion and other paints. It is not forbidden to install false ceilings, but the height obtained must not be allowed to be lower than the norm. If overhead equipment is chosen, you need to use smooth plates that tolerate treatment with antiseptic solutions well.
5. The floors should also be smooth, made from materials that can be used in dentistry.
6. You cannot choose bright colors for walls. We need neutral light tones that do not interfere with the clear distinction of skin tones, mucous membranes, dental materials, etc.
7. To decorate cabinets in which amalgam is used, you need to:
   • walls and canvas are plastered with the addition of sulfur and treated with paint;
   • the floor is covered with a solid roll, all seams are welded, the plinth fits snugly to the walls and floor;
   • tables are protected from mercury by special materials; bumpers are installed at the edges;
   • only amalgam is used, produced in the form of a sealed capsule.

To equipment

Equipment requirements:

1. If the lighting is only on one side, the chairs should be installed along the light-carrying wall.
2. When installing more than one chair in one office, you need to make sure that they are separated by partitions that are not transparent, and their minimum height is 1.5 meters.
3. If the clinic has less than 3 chairs, it is not necessary to equip a separate sterilization room. In this case, it is possible to install sterilization equipment in the rooms themselves.
4. A sink must be installed in every office in order to wash hands and dental instruments.
5. Employees working with plaster, there is a special equipment for the precipitation of gypsum from wastewater before being flushed down the drain (gypsum trap).
6. Any office should have an air disinfectant that kills bacteria. But you can only install equipment approved for dentistry. If open irradiators are used, the switches are removed from the work areas.

To microclimate, heating, ventilation

Not unimportant requirements are those that are imposed on the climate, heating in dentistry:

1. Heating and air conditioning systems must be equipped in accordance with current standards and microbiological data.
2. Heating devices must not be dangerous. It is allowed to use only smooth heating equipment that is resistant to processing agents.
3. In offices where doctors work constantly, a certain temperature is set. During the cold season and during the transition period, the optimal temperature is 18-23 ° C, in the warm period, 21-25 ° C. Air speed 0.2 m / s and humidity 60-40% remains unchanged at any time.
4. In the offices where employees do not stay constantly, the temperature during the cold season is 17-25 ° C with a humidity of no more than 75% and an air speed of 0.2-0.3 m / s. In the warm period, no more than 28 ° C, humidity up to 65% and 0.2–0.5 m / s air movement.
5. In any room in dentistry, the air is conditioned using special equipment. In this case, clean and dirty air masses should not be combined.
6. There may be particles of drugs and even harmful substances in the air, but at the same time a certain norm is observed, which is unacceptable to exceed.
7. You need to change the filter in cleaning and air conditioning systems once every 6 months or as recommended by the manufacturers in the instructions for the equipment.
8. If there are no more than three chairs in the office, ventilation can be carried out using conventional ventilation through a window. Natural exhaust ventilation can also be used.
9. If more than three seats are in operation, the installation of an extractor hood is a mandatory requirement. If dentistry operates in a residential building, you cannot use shared ventilation. Ventilation equipment should be separate, not connected to the air from the dwelling.
10. In rooms where operations, sterilization, x-ray, as well as in bathrooms and laboratories, a separate ventilation system is installed.
11. If there is no autonomous ventilation in the office, it is allowed to remove the spent air masses from the general exchange exhaust systems. ventilation on the outer wall of the building using devices that purify the air from harmful chemicals and odors.
12. Offices that belong to dental technicians are allowed to be equipped in residential buildings, but only if no more than two employees work. It is allowed to equip air exchange through a window or natural exhaust ventilation with 2-fold air exchange through an independent ventilation channel with access to the roof or to an external wall without light openings.
13. In any room there should be transoms that can be opened without difficulty, the only exception is the room where the operations are carried out.
14. It is necessary to monitor the microbial contamination so that it does not exceed the established indicators.
15. The equipment providing ventilation in dental premises is checked by special companies that have permission to carry out their activities.
16. If ventilation, heating and other equipment breaks down, it is necessary to eliminate all problems immediately.

To natural and artificial lighting

These requirements are divided into several points:

1. Every dental office should be naturally lit (no special devices).
2. Recommended orientation of windows is north, northwest, northeast.
3. The main offices and laboratories of dental technicians should be oriented in lighting only to the north.
4. If the windows in dentistry rooms are not oriented to the north, it is important to use sun protection devices. Where operations are carried out, blinds need to be installed between window frames.
5. It is allowed to install patient chairs one behind the other, but if the lighting from the window with only one hand, in the process of work, doctors must use artificial light and change from time to time places.
6. Places where dentists work are illuminated only on the left.
7. Dentistry offices are illuminated not only naturally, but also with fluorescent lighting and incandescent lamps.
8. Luminescent equipment in laboratories dental technicians best used with a non-color-distorting emission spectrum.
9. The light should not shine into the eyes of the dentist handling patients.
10. The offices are equipped with:
    • special lamps;
    • a specialized reflector at each surgeon's workplace;
    • a lamp at every workplace of the dental technician.
11. The level of individual light should not exceed the total by more than 10 times;
12. It is important to equip luminaires with protection that can be treated with solutions. Such protection is aimed at protecting the eyes from glare.

To radiation safety

Radiation safety refers to the protection of a person from exposure to harmful rays. There are such requirements in dentistry:

1. It is necessary to equip the rooms in which the radiation will be, based on the size of the room, its type.
2. X-ray equipment can only be installed on the basis of a special project. It is drawn up by a specialized organization that has permission.
3. The floors can be finished with artificial and natural materials, the main thing is that they do not conduct electricity.
4. The microclimate can be maintained using equipment that is approved for use in dentistry.
5. Employees of offices with X-ray equipment are assigned to group A if they perform X-rays. This means that they fulfill special requirements. Those who are just in the office are group B.
6. All types of X-ray equipment, only certain ones, cannot be placed in the room. The restrictions also apply to the workload per week.
7. Before installing the equipment, radiation is necessarily calculated, and the protection of all employees who deal with X-rays is organized.
8. If, when using an X-ray, a person is present who does not take any part in the diagnostic procedure, he must be protected from a large dose of radiation.

Sanitary and anti-epidemic measures

Disinfection

Requirements:

1. Responsible for the implementation of sterilization is the manager, whose actions are based on regulatory documents.
2. Products that can be used several times when working with patients must be cleaned in strict accordance with the following stages: disinfection, pre-sterilization cleaning, sterilization and further storage where there is no risk of exposure to pathogenic microorganisms.
3. If a disposable product is used, after use it must be disinfected and disposed of.
4. For the implementation of disinfection measures, chemicals, special materials and equipment are used.
5. The means by which products, offices and workplaces are processed must be stored in the manufacturer's packaging, which has a label, as well as in special places.
6. There should be separate containers with working disinfectant solutions that are used to treat various objects.
7. Compliance with sanitary standards is monitored by SES.
8. Sterile products can be laid out on the doctor's work table (for this, a special clean tray or sterile napkin is used) only before the treatment of a particular patient.
9. Chest wipes are clean for each patient. If they are disposable, then after the first use, which becomes the only one, they must be thrown away. Reusable wipes are washed after each patient.

On the sanitary maintenance of premises

Rules:

1. Wet cleaning is carried out in dentistry offices at least 2 times a day. Windows are processed at least once a month from the inside and at least once every 3 months outside.
2. It is important to carry out antiseptic treatment of surfaces located near the treatment site after each patient.
3. General cleaning is carried out at least once a month in the surgical, opera house. block and in the sterilization room.
4. Cleaning requires special clothing and protective equipment.
5. When carrying out the gene. cleaning the walls are irrigated with a solution or wiped to a height of 2 meters. After decontamination, workers change their clothes and wash everything with clean cloth napkins, which are moistened with drinking water. Only after these actions can the air be disinfected.
6. Cleaning equipment is soaked and dried well after use. Different types of inventory are used for different surfaces.
7. Cleaning equipment is kept in a special locker.

Cleaning products

Requirements:

1. All instruments must be processed.
2. For disinfection, agents are used that have a wide spectrum of antimicrobial action.
3. During processing, the products are immersed in the solution until all channels and cavities are filled. Detachable products are immersed in disassembled form, models with locking elements are soaked open (with such products, several working movements must be made in the solution).
4. The minimum thickness of the mortar layer over the products is 1 centimeter.
5. You can only wipe only those products that do not come into contact with the patient. Also, this method is allowed in cases where it is impossible to carry out the immersion treatment in the solution.
6. After processing, each container is washed.
7. Special impressions are disinfected after use on the patient.
8. The treatment of suction systems is carried out by filling with a special solution, which must be kept for some time.
9. Nozzles and glasses, as well as replaceable physiotherapy electrodes should be disinfected.
10. If there are 3 or more chairs, a separate room is required where processing is carried out.
11. Check the cleanliness of the instruments using an amidopyrine test.
12. Medical devices are sterilized by physical and chemical methods.
13. In sterilizers, it is allowed to process several items.
14. The infrared method is used for metal products.
15. Chemical methods are used to process products that do not contain heat-sensitive materials.
16. Germicidal chambers with UV lamps are used for storing instruments.
17. The formation of a sterile napkin and the unfolding of the instrument must be carried out in specialized clothing.
18. Each product processing is recorded in a special journal.

Hand processing

Rules:

1. Regardless of the position held, the staff carries out the processing of hands.
2. For the absence of bacteria, you must follow simple rules: nails are cut short; there are no jewelry on the hands.
3. All disinfectants must be correctly selected and harmless.
4. The staff have their own soap and napkins.
5. You can use both hand treatment with soap and water, and an antiseptic.
6. The soap should be in a container and in liquid form.
7. For disinfection, antiseptics containing alcohol are used.
8. Hand rubbing with alcohol is performed both before and after the patient.
9. Hands are treated with rubbing alcohol until completely dry.
10. In the offices, access to the water is provided with a foot or an elbow in order to leave hands clean after washing.
11. If bio-material gets on your hands, it is necessary to remove the contamination, treat the hands, wash them with soap and water and dry them, and then process them again.
12. Treatment and examination of patients can be carried out only with gloves, which are changed after each patient.
13. Surgeons working in dental operating rooms should treat their hands in two steps:
    • wash hands under running water for several minutes, then dry thoroughly.
    • treat with an antiseptic.

Personnel hygiene

Requirements:

1. Working conditions should not be dangerous for employees.
2. Employees have special work clothes.
3. Dentistry employees change their clothes every day, if there is blood contamination - immediately. Each employee has at least 3 sets of clothing.
4. Clothes are processed in the laundry, it is forbidden to do this at home.
5. Where operations are performed, employees carry out their activities in sterile gowns, gloves and masks. Non-woven footwear is used.
6. Staff should be alert to patients as potential sources of blood-borne infections. This obliges them to use personal protection methods during any manipulations with patients.
7. During examination and treatment, do not touch other objects (cosmetics, telephone, etc.).
8. If skin damage has occurred, it is necessary to process and apply a patch.
9. If there is a high likelihood of contracting HIV, it is important to visit centers that deal with such problems for chemoprophylaxis.