1. Health Technical Memorandum 01-05 Section 2 Tuesday 17 th May 2015, Lecture Theatre, 6 th Floor, School of Health Studies, St Bernard’s Hospital

2. The concise educational aims, objectives and outcomes of this meeting are: To understand and take steps to implement the requirements of HTM 01-05 Section 2

3. “Essential Quality Requirements” Vs “Best Practice” 1.7 Every practice should be capable of meeting the essential quality requirements: 1. Regardless of the technology used, the cleaned instruments, prior to sterilization, should be free of visible contaminants wen inspected. Instruments should be reprocessed using a VALIDATED decontamination cycle including: i. Cleaning/washing (in terms of manual cleaning, this includes having a written protocol). ii. A validated steam sterilizer. iii. At the end of the reprocessing cycle they should be in a sterilized state. 2. Reprocessed dental instruments should be stored in such a way as to ensure restraint of microbiological recolonisation. These measures should be backed by careful controls on the storage times to which instruments that are less frequently used are subject. 3. Practices should audit their decontamination processes every 6 months. 4. Practices should have in place a detailed plan on how the provision of decontamination services will move towards BEST PRACTICE... if possible.

4. “Essential Quality Requirements” Vs “Best Practice” All dental practice should have an infection control policy that includes: 1.A written policy regarding the minimisation of blood borne virus transmission. 2.A policy on decontamination and storage of dental instruments. 3.Procedures for cleaning, disinfection and sterilization of dental instruments. 4.A policy for the management and disposal of clinical waste. 5.A policy for hand hygiene. 6.A policy for decontamination of new reusable instruments. 7.Local policies and procedures for the use of personal protective equipment. 8.Procedures for the management of dental instruments in context of infection control. 9.Recommended disinfectants. 10.Spillage procedures. 11.Environmental maintenance and cleaning. Practices may consult with local infection control specialist advisers for further support.

5. “Essential Quality Requirements” Vs “Best Practice” 1.8 To demonstrate BEST PRACTICE, further improvements are required in three main areas: 1. Using a validated automated washer-disinfector. 2. Improve separation of decontamination processes from other activities and enhance the distinction between clean and dirty workflows. 3. Provide suitable storage for instruments, which reduces exposure to contamination.

6. Cleaning instruments The principal methods of cleaning reusable dental instruments are: 1.Cleaning using a washer-disinfector. 2.Manual combined with ultrasonic cleaning. 3.Manual.

7. Cleaning instruments Automated cleaning: washer-disinfectors 1.Flush 2.Wash 3.Rinse 4.Thermal disinfection 5.Drying

8. Cleaning instruments Automated cleaning: ultrasonic cleaning Aerosol production Technique sensitive Avoid heavily contaminated solutions Ensure full immersion of instruments Thorough rinsing

9. Cleaning instruments Manual cleaning Simplest method, hard to validate Greater risk of inoculation injury Not considered best practice Visual inspection for cleanliness, wear and damage

10. Sterilization Saturated steam under pressure delivered at the highest temperature compatible with the product is the preferred method for the sterilization of most instruments used in the clinical setting. Records are required for every sterilization cycle. It is recommended that records be maintained for not less than two years.

11. Sterilization 1.Type N: air removal in type N sterilizers is achieved by passive displacement with steam. They are non-vacuum sterilizers designed for non-wrapped solid instruments. 2.Type B (vacuum): type B sterilizers incorporate a vacuum stage and are designed to reprocess load types such as hollow, air-retentive and packaged loads. A number of different cycles may be provided. Each cycle should be fully validated. 3.Type S: these sterilizers are specifically designed to reprocess specific load types. The manufacturer of the sterilizer will define exactly which load, or instrument, types are compatible.

12. Sterilization Use and testing of benchtop sterilizers: 1.Use clean distilled or filtered water 2.Validation 3.Testing – i.Steam penetration test (Helix or Bowie-Dick) ii.Automatic control test iii.Record of the temperature and pressure achieved at the daily test to ensure that this is satisfactory before the autoclave is used for sterilizing instruments 4. Date by which instruments should be used/cleaned by

13. Sterilization Storage of sterilized instruments/devices: 1.Control of storage of wrapped instruments 2.Restraint of recontamination 3.Decontamination flow from dirty to clean 4.Unwrapped instruments transported carefully 5.Sterilized instruments to be stored in dedicated areas 6.Storage area designed to allow rotation of stocks 7.Cupboards capable of being easily cleaned in conjunction with sealed view packs or covered/sealed trays 8.Products stored away from floor level, sun light, water in cool, dry environment 9.Air flow from clean to dirty areas

14. Setting up a decontamination area 5.3 Regardless of the choice of location used for the reprocessing facilities, a dirty-to-clean workflow should be maintained so that used instruments are at a lower risk of coming into contact with decontaminated instruments. This requires a well-developed routine for surface cleaning/decontamination within the facilities.

15. Setting up a decontamination area 5.18 This guidance recognises that, because of physical limitations on space, it may take longer for some practices to meet the best practice requirements. In areas where building alterations to existing premises are restricted and/or purpose-built premises may be difficult or impossible to acquire, best practice may not be achievable.

16. General hygiene principles Hand hygiene: See Appendix 1 for diagrams and details of how best to perform Before and after each treatment session Before and after the removal of personal protective equipment Following the washing of dental instruments Before contact with instruments that have been steam sterilized After cleaning or maintaining decontamination devices used on dental instruments At the completion of decontamination work

17. General hygiene principles Facilities and procedures for hand washing: 1.The basin should not have a plug or an overflow 2.Basin should be fitted with a remote running trap 3.Sensor or lever operated mixer tap 4.Taps should not discharge directly into the drain aperture as this might generate aerosols 5.Wall-mounted liquid hand-wash dispensers 6.A cleanable poster depicting a six or eight step method should be displayed above every clinical wash hand basin

18. General hygiene principles Personal protective equipment for decontamination processes: 1.Gloves 2.Disposable plastic aprons 3.Face and eye protection 4.Fully enclosed foot wear 5.Clothing

19. General hygiene principles Environmental conditions Ventilation and air quality Surfaces and equipment Cleaning protocols- special measures

20. General hygiene principles Decontamination of treatment areas 1.Between each patient, e.g., chair 2.After each session, e.g., taps 3.Weekly intervals, e.g., window blinds Use of disposable single-use covers Covers for keyboards or “easy-clean” waterproof keyboards

21. General hygiene principles Dental unit water lines (DUWLs) Legionnaires’ disease- the control of Legionella bacteria in water systems (HTM 04-01) Microbiological monitoring using dip slides for total viable counts is not considered essential 6.80 No currently available single method or device will completely eliminate biocontamination of DUWLs or exclude the risk of cross-infection.

22. General hygiene principles Dental Unit Water Lines (DUWLs) DUWLs should be flushed for at least two minutes at the beginning an end of the day and after any significant period when they have not been used. In addition, they should also be flushed for at least 20-30 seconds between patients. For dental surgical procedures, surgical flaps or other access into body cavities involving irrigation, the use of sterile water or sterile isotonic saline provided form a single use source is recommended.