BSDHT Oral Health Carmel Maher 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 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 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 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 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 01-05 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 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’ [email protected] Call Optident on 01943 605050 Thanks for your attention!