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Carmel Maher BSDHT Oral Health and Exhibition 2012.

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Presentation on theme: "Carmel Maher BSDHT Oral Health and Exhibition 2012."— Presentation transcript:

1 Carmel Maher BSDHT Oral Health and Exhibition 2012

2 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

3 Todays 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.

4 Routes of Cross Infection in the Dental Surgery

5 Hand Care & Hygiene

6 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

7 All hand products should be dispensed through wall mounted dispensers using disposable cartridges. Hand washing


9 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

10 Hand Emollients Colour free and perfume free for sensitive skin Keeps the pliability in the skin Helps counteract the effects of gloves

11 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

12 And its a No to......

13 And a no to....


15 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 At the end of a session, wash hands then apply moisturiser to maintain pliability of the skin

16 Personal Protective Equipment Gloves Eye Protection Masks Surgery Clothing

17 Properties of Gloves Well fitting Non powdered Good tactile qualities Low in residual chemicals Low in protein content

18 Before we wore gloves

19 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

20 Eye Protection

21 Masks Barrier against splatter Do not protect against aerosol inhalation Become moist and warm Change after every patient Single use only – limited life span

22 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 Non powdered Good tactile qualities Low in residual chemicals Low in protein content




26 Instruments and Decontamination Instruments MUST be clean to ensure the best possible chance of successful sterilisation Soiled instruments CANNOT be reliably sterilised

27 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

28 2

29 Processing of Instruments

30 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

31 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

32 Routine Testing of Ultrasonics Weekly protein detection test (ProTest Quick) Monthly / Quarterly Cleaning Efficacy (Standard PCD/ Brownes STF Load Check) Quarterly ultrasonic activity (foil ablation) Record results in logbook

33 Washer Disinfectors Favoured method If its not clean it cant be properly sterilised Clean reproducibly Safest method Can be validated

34 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

35 Processing of Handpieces

36 Routine Testing of WDs 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

37 Routine Testing of WDs Quarterly test – Standard PCD Pre- prepared coagulated blood test Machine efficiency test Test is processed in the unit in place £5 per typical cost

38 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

39 Helix Test

40 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

41 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

42 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

43 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

44 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.


46 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.

47 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

48 Dental Unit Water Lines

49 Issue of bacteria in DUWLs is one of dentistrys best kept secrets. Earliest paper referring to high level of bacteria in waterlines goes back to 1963 by Blake

50 Does contamination of DUWL matter? Has lead to infection of wounds Can cause infections in compromised patients Enteric infections One case of legionellosis Smell

51 Sterilox

52 Dip slide for water testing Call Optident on 01943 605050

53 Thanks for your attention!


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