BSDHT Oral Health
Carmel Maher
and Exhibition 2012
Health Technical Memorandum
01-05. Decontamination in primary care dental
• 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
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
• After cleaning up blood or body fluid spills
• After handling waste
• At the end of a session
Hand washing
All hand products should
be dispensed through wall
mounted dispensers using
disposable cartridges.
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
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
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
Personal Protective Equipment
Eye Protection
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
Eye Protection
• Barrier against splatter
• Do not protect against aerosol
• 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
• 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
Instruments and Decontamination
• Instruments MUST be clean to ensure the best
possible chance of successful sterilisation
• Soiled instruments CANNOT be reliably
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
• Part used local
anaesthetic cartridges
• Rubber Dam
• Bibs
• Tray Liners
• Gloves
• Polishing Disks
• Endodontic instruments
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
• 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
• 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 01-05
Essential 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 01-05
Best 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
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
Accepted for publication BDJ
Jan 2004
Published March 2005
‘Dip slide for water testing’
[email protected]
Call Optident on 01943 605050
Thanks for your attention!

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