DTUK1010

April 19-25, 2010United Kingdom Edition I nfection control is an essen- tial element of any modern dental practice. It is also part of the duty of care: there is a legal obligation to ensure that when a patient consents to dental treat- ment they receive a standard of care that puts them above any reasonable risk of contamination. As practice managers will be aware, staff have a statutory duty of care to ensure that all instru- ments and equipment are safe for use, have undergone a thor- ough process of cleaning/disin- fection, sterilisation and storage, and that any instrument is free from contamination from blood or other body fluids. The practice’s infection con- trol policy, which all staff should be familiarised with and guided by at all times, forms the basis of a training and reference guide for staff, particularly during their inductions. There should also be a nominated lead member of staff responsible for infection control and decontamination. If the practice has yet to draft their Infection Control policy, it is ad- vised to consult with an expert provider of decontamination services who can help formulate the document correctly. Follow the rules Within the policy, the correct procedure for decontamination of instruments should be record- ed. There is the need for a clearly defined cycle that ensures reus- able items are rendered safe for further use and for staff to han- dle: this method of reprocess- ing is detailed in the HTM 01- 05 document. It is essential that there is a systematic approach to this process by having clear ‘dirty’ and ‘clean’ zones in the surgery to avoid the cross con- tamination of used instruments with clean ones. HTM 01-05 states that, wher- ever possible, disposable items should be used. Single use items will be clearly marked as such, and reusing such items can seri- ously affect their safety, perform- ance and effectiveness. Instru- ments that are difficult to clean, such as matrix bands, saliva ejectors, aspirator tips and three- in-one tips should be considered for replacement by single-use items if appropriate. Where single-use items are not practical, instruments and appliances must be processed using the correct procedure. This is the only way of ensuring the equipment is free of any possible contamination and therefore safe to use. The decontamination process Any instrument contaminated with blood or saliva must be completely clean before it can be sterilised. Manual cleaning is considered to be unsuitable, primarily because of the lack of reproducibility of the conditions. There is, however, still the need for manual inspection after the decontamination process has been completed, to ensure the instruments have been success- fully reprocessed. Washer disinfectors are con- sidered to be the best solution to the cleaning process because they offer a validated, controlled and efficient process of clean- ing instruments compared with manual cleaning and most ul- trasonic baths. These machines are fully automated and provide a reproducible and validated cy- cle of cleaning and disinfection. Always consult with a reputable manufacturer on type, require- ment, installation etc to ensure you have the right machine and that you and your team fully un- derstand how to gain the most from their use. Careful loading of the instru- ment is required, as incorrect loading will inhibit the machine’s ability to clean effectively: • Do not overload instrument carriers or overlap instruments. Open instrument hinges and joints fully. Attach instruments that require irrigation to the ir- rigation system correctly, ensur- ing filters are in place if required • The sterilisation process can only take place once the instru- ments have been successfully disinfected. A record needs to be kept of the temperature (op- timally 134° 137°c) and pressure achieved during the cycle and modern machines will do so au- tomatically; there is one solution to storing data, with a wireless data logger that can be connect- ed directly to the practice’s com- puter system. • For dentistry, the two standard types of autoclaves are Type N (non-vacuum) and Type B (vac- uum). There is one UK manu- facturer who has developed a “hybrid” B and N steriliser, giv- ing practices greater flexibility in their decontamination options. Safe storage Once satisfied that the instru- ment has been successfully cleaned, storing it safely is vital in preventing the recontamina- tion by pathogens. This is an area of instrument decontamination that must be rigorously control- led and a dedicated storage area, separate from the clinical area, is required to meet ‘best practice’ standards. There needs to be a clear rotation system of ‘first-in first-out’ so instruments are used within the time limit stated in HTM 01-05. Using trays covered with lids is a practical way for storing and transporting instruments, while pouches are useful for instruments that are used less frequently. By organising instru- ments into treatment bundles, it is possible for the surgery to identify the cost of decontami- nation for specific services. This could become a useful method of business cost diagnostics. The reprocessing of instru- ments is an integral part of the decontamination procedures of a surgery. Naturally, the new reg- ulations that apply to dentistry will entail a greater burden of administration upon an already busy management team. One so- lution is to delegate the manage- ment of the process to a company dedicated to providing a guaran- teed decontamination service to the dental profession that covers all aspects, from supplies to sur- gery design. DT One way of making sure infection control procedures are carried out properly is to delegate the management of the process to a company dedicated to providing a guaranteed decontamination service. Ken Turley explains Cleaning up About the author Ken Turley is the founding director of the YoYo Dental Group, following a 17-year military career, Ken worked globally in the mo- bile telecomms in- dustry until 2003 when he became the managing di- rector of Salpharma, a 35-year old hospital autoclave company providing decontamination equipment which he later acquired and re-branded as YoYo in 2006. ‘The HTM 01-05 document states that, wherever possible, disposable items should be used’