Law & Ethics

Law, ethics & infection control - brief overview

It would be fair to assume that as you are reading this article, you either have a key interest in law and ethics, or that the recent GDC changes on CPD which stipulate increased awareness and adherence to this core area has triggered a sudden panic attack. Don't panic, most legislation within infection control and health and safety is based upon some very fundamental and common sense principles / responsibilities. These responsibilities exist simultaneously and when potential conflicts arise between them, knowledge of the underlying principles can help to resolve them.

The Law; Some of these responsibilities exist under the provisions of Common law (for example, the principle of a duty of care), others are defined by specific Laws and Statutes and various sets of Regulations made under them (for example, the Health and Safety at Work Act 1974 and the Environmental Protection Act 1990). and some are ethical principles.

An important case defined the principles of negligence (Tort Law) in this country, and something called "the neighbour principle" was established. In summary, the Judge said:

"you must take reasonable care to avoid acts and omissions which you can reasonably foresee would be likely to injure your neighbour."

A great deal of today's legislation the field of infection control and Health and Safety at Work generally, flows directly or indirectly from the "neighbour principle", established in 1932, which subsequently founded TORT LAW. A "tort" is essentially a "wrong".

In order to be found negligent, three requirements must all be satisfied:

You must have a duty of care to the other party (in the case of a dentist who is treating a patient, this is automatically established);
You must have failed in this duty of care in one or more ways; and
The second person must have suffered some kind of harm as a direct result of these failings in the duty of care.

A Dentist's Responsibilities

The fact that any of the above people (and many others) could bring a negligence claim, reflects the "neighbour principle" described above; dentists have responsibilities - the "duty of care" described above - to a wide range of different "neighbours" in the area of infection control:

These obligations are continuous and inter-related; for example, when choosing an infection control product that will ensure the safety of patients, care must also be taken to use products that are safe for members of staff to use.

It will also be seen that the legal basis for these various obligations arises from several sources, and a dentist could face challenges from two or more of them simultaneously, arising from the same incident. For example, a single incident could result in a criminal conviction, a referral to the General Dental Council and a separate civil (negligence) claim from the injured party.

What are ethics?

Ethics is essentially the voluntary framework of guiding principles, which brings order, and purpose into what would otherwise be a void between laws, on the one hand, and a free-for-all on the other. Because ethics are different from laws, ethics have been described as "allegiance to the unenforceable". In the case of dentistry, however, this is not strictly true because the General Dental Council (GDC) has the power to suspend or remove a dentist from the Dentists' Register.

What is clinical governance?

Clinical Governance is "the framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish".

Key Issues in clinical governance are:

Accountability
Quality and Standards
Encouraging the pursuit of excellence

This is designed to be achieved by:

Involving every member of staff
Identifying areas for improvement, planning and implementing strategies, setting standards, measurement and monitoring (audit)
Demonstrating the achievement of standards
Effective management - managing people, systems and processes, time and financial resources, to create a culture in which targets can be achieved consistently.

How does infection control fit into law and ethics?

Infection control is not an optional area of practice expenditure, but a fundamentally important professional obligation. It forms a central part of the quality of care. It is meaningless and hypocritical for dentists to state their commitment to quality and excellence in dental care, when they are paying no more than lip service towards quality issues in the field of infection control.

There is no room for short cuts or half measures in infection control and no choice as to whether or not to implement the necessary procedures.

Dentists must carry out appropriate infection control procedures because they have:

Specific legal obligations (e.g. Health and Safety at Work Act)
Professional obligations (standards)
Ethical obligations (General Dental Council)
Civil obligations (e.g. Duty of Care)

Failure to implement appropriate standards of infection control can result in:

Disciplinary procedures
GDC action and possible suspension/erasure from the Register
Civil action claiming negligence
Damaging publicity for the practice
Loss of patients and/or potential patients

Alongside the implementation of an appropriate infection control policy, a strategy should be developed for making patients aware of the steps that are being taken (visibly and invisibly) to ensure their continuing safety. This can turn any expenditure on infection control into a positive investment in the marketing of the practice, the retention of existing patients, and the flow of new patients to the practice.

What key areas do I need to learn / understand?

Greater understanding; It is important that taking the GDC's new requirements for education within this field, dentists do need to have an appreciation of the key areas, facts and responsibilities:

Basic legal and ethical principles in healthcare
Clinical governance and infection control
Professional guidelines and accreditation; what do they mean?
Standards; a practical tool or a practical dilemma?

2. What you need to know

Essential legislation
Legal penalties and professional consequences
General Dental Council guidelines
NHS Regulations
Directives and European standards
Peripheral legislation and other issues
The power to inspect and enforce. Who, when, why and how?

3. Practical implications

Reading up and learning from real life case studies.

4. Bringing the dental team together

Addressing under-performance relating to infection control
Apathy, economics and motivation
The importance of the team approach
Training and continuing professional development

Where do I go to get this training?

Our best advice is to contact any of the following:

Your local PCT or deanery
BDA
GDC
Your legal indemnity organisation
schülke UK (Other commercial organisations may also offer training in this field)

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