Best practice in dental decontamination – David Gibson

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  Posted by: The Probe      2nd February 2018

David Gibson, Marketing Manager for Eschmann reviews the minimal requirements for infection prevention and control, as well as best practice recommendations that can be implemented to achieve higher standards.

 

Learning objectives:

  • To understand the importance of decontamination processes in reducing cross-contamination.
  • To review the basic principles of instrument decontamination in the dental practice.
  • To review best practice recommendations for higher standards.

 

Introduction

Since the rollout of the Health Technical Memorandum, it has been a legal requirement for all primary care dental practices to work at or above the essential quality requirements. Despite this, compliance remains an issue. Indeed, a report by the Care Quality Commission (CQC) shows that 10 per cent of the practices observed between April 2015 and November 2016 failed their inspection, many of which were due to shortcomings in infection prevention and control.[i]

This article serves as a reminder of the basic standards expected by the CQC when it comes to decontamination of used dental instruments, and what improvements could be made to move towards best practice. While not all practices will have the facilities to adopt these preferred procedures, clinical teams should endeavour to implement these changes wherever possible, as well as be able to provide a statement on plans for future development.

 

Cleaning, disinfection and sterilisation

Decontamination of reusable instruments through cleaning, disinfection and sterilisation is an essential part of infection control. Failure to carry out these processes efficiently and correctly is not only a breach of requirement, but puts patients and practice staff alike in harm’s way of dangerous pathogens.

To minimise the risk of cross-contamination, practices must always begin the decontamination process by using a validated cleaning and disinfection process. There are three approved options: washer disinfector, manual combined with ultrasonic cleaning, or manual. For best results and the optimal removal of all proteins and contaminants, a washer disinfector is the most favourable choice, as it’s reproducible, automated and validated. It must be noted that an additional handpiece cleaning machine is required if the washer disinfector can’t be adapted to clean handpieces. It is always wise to confirm suitability with the manufacturer first otherwise you could end up damaging both your equipment and your tools. Where an ultrasonic bath is in use, it must be adequately covered to restrict the release of aerosols. At the end of the reprocessing cycle, all instruments should be sterilised. The most popular, widely used method for this is saturated steam under pressure at a high temperature as it can destroy microorganisms effectively using a rapid and non-toxic technique.

 

Decontamination area design

The gold standard design according to HTM 01-05 is a two-room solution, but in the majority of practices this is impossible due to a lack of space. Where it is a possibility, reprocessing procedures must be separated from all other clinical activity, whether by physical or temporal means.

The most likely set-up is the single room decontamination solution. A ‘dirty’ to ‘clean’ workflow is essential to minimising cross-contamination, so where a single room is in use professionals must always stick to the allocated area for each task. Once instruments have left the ‘dirty’ area and undergone thorough decontamination, they should then be packaged and held in the ‘clean’ area for re-use. What’s more, airflow must be designed to move from ‘clean’ to ‘dirty’, never the other way round otherwise you run the risk of airborne recontamination of clean instruments.

If the in-surgery solution is the only option – in other words the treatment room is the only space available to carry out all aspects of the decontamination process – clever and effective use of existing space within the surgery is essential to meeting decontamination standards without impacting the patient. The same principles applied in a single-room setup must also be applied here, though particular consideration must be paid to the spatial relationship between the decontamination areas and the patient. Furthermore, any uncontrolled procedures where there is a risk of exposure to aerosol dispersion or splashes should always take place after the patient has left the surgery.

In addition to the best practice two-surgery solution, practices should strive to provide suitable storage for instruments that is protected in the appropriate clean room against the risk of contaminated aerosols. Through this combination, a high standard of infection control can be guaranteed day in, day out, ensuring complete compliance and safety.

 

Training and maintenance

Of course, none of this is possible without the correct training and education or ongoing care and maintenance. All staff members should have a thorough understanding of infection prevention and control – taking care to complete at least five hours of CPD in every CPD cycle – as well as a sound awareness of their own practice’s individualised infection control policy. For ongoing training and help with maintaining, servicing, testing and validating your decontamination equipment, you will need a dedicated, reliable and experienced manufacturer with an unrivalled knowledge of dental infection control and prevention. Together, with the implementation of best practice strategies, you should then be able to guarantee the highest level of compliance.

[i] Care Quality Commission. CQC’s new approach to dental regulation shows positive findings. Published 28 November 2016. Accessed online 21 September 2017 at http://www.cqc.org.uk/content/cqcs-new-approach-dental-regulation-shows-positive-findings

 

For more information on the highly effective and affordable range of decontamination equipment and products from EschmannDirect, please visit www.eschmann.co.uk or call 01903 753322

 

[1] Care Quality Commission. CQC’s new approach to dental regulation shows positive findings. Published 28 November 2016. Accessed online 21 September 2017 at http://www.cqc.org.uk/content/cqcs-new-approach-dental-regulation-shows-positive-findings

 

 


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