There are a number of publications written by experts in the field of microbiology and infection control which are dedicated solely to this subject. There is very little point in restating that which is already written. Therefore, this chapter is intended to provide practical guidance on the implementation of the Department of Health’s Decontamination Health Technical Memorandum 01-05, Decontamination in Primary Care Dental Practices (HTM 01-05); the HTM forms the basis of this chapter. By 2011, it is expected that all dental providers will be registered with care quality commission. In order to meet the requirements of registration compliance with HTM is essential. The policy and guidance provided in the HTM is aimed at establishing a programme of continuous improvement in decontamination performance at a local level.
- Health and Safety at Work etc. Act 1974:
Employers must identify and provide, so far as is reasonably practicable, safe materials and substances and safe systems of work without risks to health.
- Health and Social Care Act 2008:
Service providers must, so far as reasonably practicable, ensure that healthcare workers, patients and others are protected against identifiable risks of acquiring an infection.
- Management of Health and Safety at Work Regulations 1999:
Employers to make suitable and sufficient assessment of risks to the health and safety of employees and anyone else who may be affected, and implement the necessary control measures.
- Control of Substances Hazardous to Health Regulations 2002:
Employers are required to make an assessment of the risk of exposure to biological substances and where there is a risk to the health of employees or others, this risk must be controlled.
- Hazardous Waste Regulations 2005:
Producers of healthcare waste have a duty of care to ensure that waste is managed appropriately from the point of production to the point of disposal.
- Department of Health – Health Technical Memorandum (HTM) 01-05:
Healthcare providers have a duty of care to ensure that appropriate governance arrangements are in place and are managed effectively.
Advancements in disease identification have led to a recent review of health-care-associated infections and, as such, infection control requirements have altered. Up to date infection control procedures should be in place in dental practice to minimise the transfer of infections from person to person. It is essential that patients receive treatment in an environment that is as safe as possible and that all foreseeable risks are minimised.
The terms ‘essential quality requirements’ and ‘best practice’ are used within the HTM to define a level of compliance which is expected when the decontamination requirements are implemented. The HTM is intended to provide authoritative guidance to help dental practices identify areas for improvement, maintain acceptable standards and continuously develop their infection control systems and procedures.
Essential Quality Requirements
Essential quality requirements necessitate practices to provide a development plan which states how they will improve their decontamination processes. This will assist in demonstrating compliance to external bodies, for example, Care Quality Commission, Primary Care Trusts (PCTs) and Strategic Health Authorities.
- Instruments should be free of visible contaminants when inspected prior to sterilisation.
- At the end of the processing, cycle instruments should be sterilised.
- Instruments should be stored in such a way as to ensure that the risk of recolonisation is minimised.
- Practices should audit their decontamination processes at least quarterly using an audit tool compliant with local PCT policies.
- Practices should have in place a detailed plan on how the provision of decontamination services will move towards best practice.
Best practice refers to the full level of compliance that may be achieved immediately or via a documented improvement from essential quality requirements.
- The cleaning process should be carried out using a validated automated washer – disinfector.
- The decontamination facilities should be clearly separate from the clinical treatment area.
- Instruments should be stored in a facility clearly separate from the clinical treatment area.
All dental practices should have an infection control policy in place which indicates full compliance with the essential requirements of HTM 01-05 and identifies a lead person responsible for infection control in the workplace. In addition, a written assessment of the improvements that the practice needs to make in order to progress towards meeting the requirements for best practice should be available together with an implementation plan.
The policy should be updated as legislation requires, or at two-yearly intervals, whichever is shorter.
- Training and education in the processes included in HTM 01-05 should be part of staff induction programmes.
- Records should be kept of training and competency, and infection control should form part of the continuing professional development cycle required by the General Dental Council.
- Prior to cleaning, reusable instruments to be cleaned should be segregated from items for disposal.
- Single-use device should only be used during a single treatment episode and then disposed of.
- Dentists should ensure that endodontic reamers and files are treated as single use regardless of the manufacturer’s designation – in order to reduce the risk of prion transmission in dentistry.
- Reusable instruments can be cleaned using a washer – disinfector. For details of all operational aspects of using a washer – disinfector, follow the manufacturer’s instructions.
- Hand-pieces should be lubricated according to the manufacturer’s instructions.
- Hand-pieces that have not been processed in a washer – disinfector may require lubrication again before going into the steriliser.
- A separate canister should be used for cleaned hand-pieces and labelled accordingly.
Manual Combined with Ultrasonic Cleaning
- It is important to ensure that the water/fluid is maintained, cleaned and changed at suitable intervals.
- The bath should also be kept free of dirt released during the cleaning process; good maintenance is also essential.
- Instruments should be cleaned in water at a temperature of 45°C or lower.
- Items should be fully submerged (if permitted in manufacturer’s instructions) and scrubbed using a long-handled brush under the surface of the water.
- Water should be drained from the sink and instruments rinsed in a clean sink.
- Brushes should be single use. Where they are reusable, after each use, the brushes should be washed in hot water using the manufacturer’s recommended detergent, in order to remove visible soil, and be stored dry and head up.
- To meet the requirements of best practice, practices should plan for the introduction of washer – disinfectors.
- At the end of the cleaning process, instruments should be inspected to ensure that the standards of cleaning achieved are visually satisfactory, that is, instruments are free from contamination, salt deposits or marked discoloration. The use of a simple magnifying device with task lighting may prove invaluable at this stage of the process.
- Instruments that cannot be cleaned should be discarded.
- Instrument processing should take place in an area separate from the clinical environment.
- Decontamination equipment including sterilisers should be located in a designated area with clearly identified dirty and clean zones.
- To comply with the essential requirements the designated area for decontamination may be in, or adjacent to, a clinical room.
- For best/>