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Carmel Maher

BSDHT Oral Health and Exhibition 2012. Carmel Maher. Health Technical Memorandum 01-05. Decontamination in primary care dental practice. Wide-ranging document –attempts to raise the standard of Infection Control Procedures

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Carmel Maher

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  1. BSDHT Oral Health and Exhibition 2012 Carmel Maher

  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. 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.

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

  8. 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

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

  10. 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

  11. And it’s a ‘No’ to......

  12. And a ‘no’ to....

  13. 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

  14. Personal Protective Equipment • Gloves • Eye Protection • Masks • Surgery Clothing

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

  16. Before we wore gloves

  17. 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

  18. Eye Protection

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

  20. 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

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

  22. Disposable Items and Instruments • Local anaesthetic needles • Part used local anaesthetic cartridges • Rubber Dam • Bibs • Tray Liners • Gloves • Polishing Disks • Endodontic instruments • Steel burs • Scalpel Blades • Aspirator Tips • Saliva Ejectors • Matrix Bands • Impression Trays • Plastic Cups • Paper Towels • Three in One Tips

  23. 2

  24. Processing of Instruments

  25. 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

  26. 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

  27. 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

  28. Washer Disinfectors • Favoured method • If its not clean it can’t be properly sterilised • Clean reproducibly • Safest method • Can be validated

  29. 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

  30. Processing of Handpieces

  31. 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

  32. 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

  33. 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

  34. Helix Test

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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.

  40. ‘Complying’ with HTM 01-05Essential 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.

  41. ‘Complying’ with HTM 01-05Best 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”

  42. Dental Unit Water Lines

  43. 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

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

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