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

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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 (Pro. Test 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… “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

Sterilox ‘Dip slide for water testing’ carmel. maher@optident. co. uk Call Optident on 01943 605050

Thanks for your attention!