Carmel Maher

BSDHT Oral Health 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

All hand products should be dispensed through wall mounted dispensers using disposable cartridges.

Hand washing

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

• 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

• At the end of a session, wash hands then apply moisturiser to maintain pliability of the skin

Personal Protective Equipment

• 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

• Non powdered

• Good tactile qualities

• Low in residual chemicals

• Low in protein content

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 01-05Essential 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 01-05Best 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.ukCall Optident on 01943

605050

Thanks for your attention!