BSDHT Oral Health
Carmel Maher
and Exhibition 2012
Health Technical Memorandum
01-05. Decontamination in primary care dental
practice
• Wide-ranging document –
attempts to raise the
standard of Infection
Control Procedures
• It can present challenges to
the dental professional
when trying to implement
all of its recommended
procedures
Today’s Focus
• Measures and procedures we use to
prevent the spread of micro-organisms Hand Hygiene & PPE.
• Equipment , prior to use, must go through a
validated decontamination process.
• Responsibility of the user to ensure
equipment used is ‘fit for purpose’ and
required tests are recorded.
Routes of Cross Infection in the
Dental Surgery
Hand Care & Hygiene
When should we wash our hands?
• At the start of session
• After contamination with blood, saliva or
other bodily fluid
• After contact with contaminated dental
equipment
• After cleaning up blood or body fluid spills
• After handling waste
• At the end of a session
Hand washing
All hand products should
be dispensed through wall
mounted dispensers using
disposable cartridges.
When to disinfect our hands
• After a patient episode, once gloves
have been removed and discarded,
providing hands are not visibly soiled.
• If hands are soiled, repeat hand
wash procedure
• Alcohol rub should not be applied to
the surface of gloves
Hand Emollients
• Colour free and perfume free for
sensitive skin
• Keeps the pliability in the skin
• Helps counteract the effects of
gloves
Other handy hints!
• Nails should be short
• No artificial nails or nail varnish
• No rings or wrist jewellery
• All cuts & abrasions covered with
water-proof adhesive dressing
And it’s a ‘No’ to......
And a ‘no’ to....
Dividing up the audit tool
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•
•
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Decontamination
Environmental design & cleaning
Hand hygiene
Management of dental medical devices –
equipment and dental instruments
• Prevention of blood borne virus exposure
• Personal protective equipment
• Waste management
Personal Protective Equipment
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•
•
•
Gloves
Eye Protection
Masks
Surgery Clothing
Properties of Gloves
• Well fitting
• Non powdered
• Good tactile qualities
• Low in residual chemicals
• Low in protein content
Before we wore gloves
Eye Protection
• Eye protection is vital
• Protection against foreign
bodies, splatter and aerosols
• Discourages touching of the
face with contaminated gloves
• Patients must wear eye
protection
Eye Protection
Masks
• Barrier against splatter
• Do not protect against aerosol
inhalation
• Become moist and warm
• Change after every patient
• Single use only – limited life span
Surgery Clothing
• Should only be worn in the practice
• Changing facilities should be
provided
• Freshly laundered uniforms should be
worn each day
• Change before if soiled with splatter
• Plastic aprons useful & should be worn
during decontamination processes
• Wash at 60 degrees
Instruments and Decontamination
• Instruments MUST be clean to ensure the best
possible chance of successful sterilisation
• Soiled instruments CANNOT be reliably
sterilised
Disposable Items and Instruments
•
•
•
•
•
•
•
•
•
Steel burs
Scalpel Blades
Aspirator Tips
Saliva Ejectors
Matrix Bands
Impression Trays
Plastic Cups
Paper Towels
Three in One Tips
• Local anaesthetic
needles
• Part used local
anaesthetic cartridges
• Rubber Dam
• Bibs
• Tray Liners
• Gloves
• Polishing Disks
• Endodontic instruments
2
Processing of Instruments
Manual Cleaning
• Acceptable under essential requirements
• Not preferred method
• Not reproducible
• Difficult to validate
• Risk of sharps injuries
• Advisable to soak in enzymatic solution prior to cleaning
• Protocol for manual cleaning
Ultrasonic Cleaning
• Ultrasonic cleaning in a well maintained machine
enhances removal of debris
• Can be used as extra stage prior to a washer disinfector
• Follow manufacturers recommendations
• Process should be validated
Routine Testing of Ultrasonics
• Weekly protein detection test (ProTest Quick)
• Monthly / Quarterly Cleaning Efficacy
(Standard PCD/ Browne’s STF Load Check)
• Quarterly ultrasonic activity (foil ablation)
• Record results in logbook
Washer Disinfectors
• Favoured method
• If its not clean it can’t be properly sterilised
• Clean reproducibly
• Safest method
• Can be validated
Factors to consider
• Correct loading of the machine
• Baskets or Cassettes
• Effective process of logging cycles using a printer or a
data logger
• Should be compliant to EN 15883 and HTM 2030
• Optional irrigation system for handpieces
Processing of Handpieces
Routine Testing of WD’s
• Weekly test-protein detection test
• Swab type test with colour indicator
• Results in 10 mins
• Record results in logbook
• Protest Quick- Pyromol, Pro Tec - Biotrace, –
Clean Trace
• £5 per test typical cost
Routine Testing of WD’s
• Quarterly test – Standard PCD
• Pre- prepared coagulated blood test
• Machine efficiency test
• Test is processed in the unit in place
• £5 per typical cost
Sterilisation – Factors to consider
• Size and speed of the machine
• N, B or S Type
• Drying facility
• Effective process of logging cycles using a printer or
data logger
• Should be compliant to EN 13060 and HTM 2010
• Daily testing using Helix or Bowie –Dick type test
Helix Test
Sterilisers – N, B or S type
• N type – passive displacement, non vacuum,
traditional machines
• Designed for unwrapped and non hollow loads
• 01-05 states that the use of an N type steriliser is not
suitable for wrapped instruments
Sterilisers – N, B or S type
• B type vacuum sterilisers
• Suitable for wrapped hollow and air
retentive loads including handpieces
• Built in electronic storage of cycles
• Typical cycle time 20 – 40 minutes
• Typical cost £3500 - £5500
Sterilisers – N, B or S type?
• S type specific load sterilisers
• Manufacturer will define which load the unit
is compatible with – usually includes hollow
loads and handpieces
• Data logger for electronic storage of cycles
• Typical cycle time 8 -12 minutes
• Typical cost £3000 - £5000
Sterilisation
• Reservoir to be filled daily using RO or freshly distilled water
• Daily tests – steam penetration test Helix or Bowie Dick (vacuum only)
• Automatic Control Test (ACT) - all small steam sterilisers
• Outcomes to be recorded in a log book (One book for each machine)
along with date and signature of operator
• At end of day chamber should be drained after water has cooled
• Device should then be cleaned, dried and left empty with the door kept
open
Logbooks
• Accurate and dedicated logbooks compiled for each
piece of equipment must record all servicing and
validation information
• Cycle parameters must be recorded unless using a data
logger or a printer
• All scheduled tests (daily, weekly, monthly, quarterly or
annually) must be recorded, signed and dated by the
appointed individual.
‘Complying’ with HTM 01-05
Essential Quality Requirements
•
The practice should have a nominated lead member of staff
• Appropriate policies and protocols
• Instruments must be free of visible contaminants
•
Validated decontamination (manual or ultrasonic)
• Instruments sterile at the end of cycle
• Safe storage with stock control – 21/60 days
•
Documented training scheme for staff engaged in decontamination
• A plan to move towards best practice.
‘Complying’ with HTM 01-05
Best Practice
•
All of essential quality requirements and in addition:
•
All decontamination must take place in a separate, dedicated room
•
Install a validated washer disinfector to remove manual cleaning
•
Provide suitable storage for instruments (ideally in clean area of
decontamination room)
•
Ensure stock rotation of stored devices with effective record keeping
•
The practice should have a procedure for the safe transfer of
devices
•
Consider the environment i.e. air flows from clean to dirty
•
Audit, audit, audit… “A strong emphasis on self-audit”
Dental Unit Water Lines
Dental Unit Water Lines
• Issue of bacteria in DUWL’s is one of dentistry’s best
kept secrets.
• Earliest paper referring to high level of bacteria in
waterlines goes back to 1963 by Blake
Does contamination of DUWL matter?
• Has lead to infection of wounds
• Can cause infections in compromised patients
• Enteric infections
• One case of legionellosis
• Smell
Sterilox
Accepted for publication BDJ
Jan 2004
Published March 2005
Sterilox
‘Dip slide for water testing’
carmel.maher@optident.co.uk
Call Optident on 01943 605050
Thanks for your attention!