complaint from a concerned team member who has been obstructed in attempting to apply current standards.


Decontamination Decontamination is still an emotive subject for general dental practitioners across the UK. Over the last few years there has been a gradual change in attitude from disbelief to a disgruntled acceptance that these requirements are not going to go away. When HTM 01-05: Decontamination in


dental care practices was finally published by the Department of Health in 2009, the same general principles were applied south of the border and in Northern Ireland. Te difference in the details of the guidance and differing timescale are contentious and are unlikely to be resolved soon. Compliance in decontamination is complex but the general principles are:


• A separate LDU facility •


Process documented and applied


• Decontamination equipment installed, validated, tested and maintained


• Quality management system • Documented training.


Te main focus has been on the need for


a local decontamination room outside the clinical area. In Scotland in 2007 the details of Local Decontamination Unit (LDU) design were set out in Scottish Health Planning Note 13. Although the general principle of the facility design was unchanged, the scale and the preferred option of the two-room models posed significant difficulties, particularly for those already challenged in terms of space. Te preference for a two-room LDU was based on a need for risk reduction as the one-room model risks clean and dirty instruments becoming mixed up. Tere appears to have been a slow


acceptance by the healthcare authorities that this may have been unrealistic for the majority of dental practices. Although two rooms remains the preferred option, recent discussions indicate a one-room model following the design principles of Health Facilities Scotland’s SHPN13 guidance will be acceptable.


Te critical requirement within the


one-room LDU is that processing must be carried out correctly and consistently by all staff. Te decontamination process includes transport, segregation, cleaning, inspection and sterilisation of reusable items. To achieve this, written policies and procedures must be in place and must be understood by all staff involved in decontamination. Training for the whole dental team is


essential to ensure decontamination processes are applied effectively and that each person knows their role and is competent to carry it out. Apart from the GDC requirement for all registrants to have five hours training in a five year CPD cycle, it is essential that decontamination is part of new staff induction, with regular updates for the whole team. Decontamination equipment, essentially


the bench-top steriliser, has been used for many years in dental services. But focus has shiſted more recently to the potential risk of prion contamination which requires a higher standard of instrument cleaning. Compliance requires the use of a washer disinfector while manual cleaning should only be used for items incompatible with automated processing. All decontamination equipment should


be installed and validated before use, with testing and maintenance carried out


compliant is not clear. Compliance is likely to be reviewed


through a new practice inspection document which is currently being developed. Tis will look at details of requirements for decontamination facilities, equipment and processes. It is hoped health boards will retain the responsibility for inspections as part of the requirements of current terms of service. Te role of other external organisations in this process is still not entirely clear. Aſter the significant changes introduced


in recent years it is clear that a period of consolidation would be welcomed. A need to review existing decontamination guidance in light of improving technology has been identified, as well as the need for a more risk-based approach to the requirements. Tis is unlikely to mean a relaxation in current standards but perhaps a more realistic approach to their application would be the best outcome for all dental professionals. Health boards and health protection


agencies take all potential breaches in infection control very seriously. If they are involved in investigating infection control errors or omissions this can result in the notification of all patients deemed to be at risk. Tese events are emotive and oſten create significant media interest which can be devastating for both patients and the


“ Recent discussions indicate a one-room model following the design principles of Health Facilities Scotland’s SHPN13 guidance will be acceptable.”


according to the manufacturer’s instructions. Audit is another essential element to assure both the practice and external agencies that all processes are being applied consistently and effectively.


The future One question frequently asked by dentists in Scotland is what will happen if they can’t/don’t/ won’t comply? By 31 December, 2012 all health boards will be required by the Scottish Government to report on decontamination compliance in dental services. Te fate of those who are non-


practice involved. Te best approach to infection control


and decontamination for all practices is to ensure the whole dental team are fully aware of their responsibilities and the potential pitfalls if it all goes wrong. Te need for policies, training and evidence of consistent good practice cannot be emphasised strongly enough.


 Irene Black is a general dental practitioner and assistant director (decontamination) with NHS Education for Scotland (NES)


AUTUMN 2012


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