Dental Tribune UK Edition, September 13-19, 2010, Vol. 4 No. 21

‘I feel the profession is quite right to ques- tion the science behind the guidance, given that other industries where cross infection may occur, such as tattooists, belly-button piercers and even restaurants, are subject to comparatively ‘light touch’ regulation.’ September 13-19, 201014 Infection Control Tribune United Kingdom Edition and dental pulp tissues’. WHO consultants agreed that for procedures not involving neu- rovascular tissues, the standard cross infection policies were suf- ficient, but they did not come to a consensus on major dental treat- ments. Now of course, as a minimum standard, patients should expect to be treated in a safe and clean environment, but are our current procedures broken and in need of fixing? If they are then of course measures to protect patients need to be introduced, but given the potential cost and burden of ad- ditional bureaucracy, are these policy measures based on sound evidence and is there any proof that patients are actually better off as a result? The real question we must ask in relation to our cross infection policies is just exactly when is enough, enough? After all, there seems to be a real difference in cost and burden between get- ting instruments ‘clean’ and get- ting instruments ‘sterile’. As yet, it remains to be seen whether it is truly realistic to work in a ster- ile field when an aseptic field is more easily achievable; after all, regardless of any measures de- signed to get instruments super, super clean, the most bacteria- ridden area in any dental operat- ing field is likely to be in the pa- tient’s mouth. Further red tape? Over the past few years, I think we have all seen the burden of bureaucracy imposed on us by the tsunami of policy change de- signed to improve our profession. While a drop in access figures, complex treatment items and rise in tooth extractions seem to be among the main outcomes of the 2006 contract, it seems that what central Government has intro- duced is further red tape through the introduction of cross infec- tion policies fit for complex brain surgery rather than general den- tistry. We are yet to see the stance our new coalition Government will take. It seems that the profession is deeply sceptical about the scale of the standards demanded by HTM 01-05. Barring manufacturers, in my opinion, it’s not yet clear who else benefits from these chang- es. I would like to think that the overwhelming reasons to intro- duce these changes are evidence based, rather than merely to pro- vide the Department of Health (DH) some form of legal cover, but I guess without objective ex- ternal assessment the policies imposed will continue to remain questioned by GDPs like myself. Carrying the burden While many recent policies have acted to standardise cross-in- fection guidance for many areas within the NHS, if this is merely a legal exercise rather than a prac- tical one the issue of funding is also raised; unlike the hospital sector, GDPs are left to carry the financial burden themselves. I feel the profession is quite right to question the science be- hind the guidance, given that other industries where cross in- fection may occur, such as tat- tooists, belly-button piercers and even restaurants, are subject to comparatively ‘light touch’ regu- lation. Surely no one would sug- gest that pubs and restaurants must have washer-disinfectors or steam autoclaves, would they? And if they did, how would their trade organisations react? In my opinion, dental prac- tices across the UK can be proud to embrace cross-infection meas- ures based on available evidence as science has progressed over the past few decades. We have developed Joseph Lister’s early work, to a point where it is now considered ‘bad practice’ not to have simple barrier protection measures, such as disposable gloves and masks. The challenge introduced by Prions clearly needs special attention, given its potentially lethal consequences. Another hurdle? However, history has shown that dentists have a clear willingness to embrace change when that change has a sound evidence base. Clearly the DH has an im- portant role in regulating prac- tices that currently have less than satisfactory cross-infection poli- cies. But will introducing cross- infection measures filled to the seams with bureaucracy actually raise the standards from the bot- tom up, or merely add another hurdle for those already imple- menting good cross-infection procedures? We are yet to see whether our new coalition Government will also bring a new direction to den- tistry, but for the time being, it seems the age of austerity is upon us. While the NHS budget has been ring-fenced, this does not mean that the coffers will be over- flowing – all departments must demonstrate ‘value for money’. Of course patient protection must be paramount for any Government, but before new measures are im- plemented, let us hope the new coalition is absolutely sure that the old measures are in need of fixing. DT About the author Neel Koth- ari qualified as a dentist from Bristol Uni- versity Dental School in 2005, and currently works in Cambridge as an associate within the NHS. He has completed a year-long postgraduate certificate in im- plantology at UCL’s Eastman Dental Institute, and regularly attends postgraduate courses to keep up-to-date with cur- rent best practice. Immedi- ately post graduation, he was able to work in the older NHS system and see the changes brought about through the introduction of the new NHS system. Like many other den- tists, he has concerns for what the future holds within the NHS and as an NHS dentist, appreciates some of the dif- ficulties in providing dental healthcare within this widely criticised system. page 13DTß GDPs are facing the challenges of providing safe care and managaing cost effectiveness