Decontamination Continued »


requirements, of HTM 0ı-05, or as it is referred to in NI PEL (ı3)ı3, by November 20ı0 followed by full compliance with best practice by November 20ı3. A summary of some key elements of best practice in local decontamination included: • Separate local decontamination facilities incorporating correct workflow (LDU)


• The use of a washer disinfector as a main cleaning process


• Validation and periodical testing of all decontamination equipment


• Clear processes and procedures.


What are the risks? It is difficult to produce a strong evidence base for transmission of infection by the reuse of instrumentation in dentistry. However, anecdotal evidence would suggest transmission of viruses such as Hepatitis B and bacteria such as Staphylo- coccus aureus can take place as a result of dental treatment4,5,6


. It is also important to


highlight that within dentistry, post-oper- ative infections are not always cultured and, as no surveillance takes place, it is therefore difficult to define the frequency of s.aureus-related infections, leaving open the possibility of the rate of MRSA-related post-operative infections. This may be an area for future research. The emergence of variant Creutzfeldt-


Jakob disease (vCJD) presented another challenge within decontamination and, although there has been no evidence of vCJD being spread through the practice of dentistry, there is a possibility that gingival tissues and dental pulp of patients who are carriers could carry the infective agent7 However, this risk is often questioned by


.


the dental profession in that this evidence is based on the significant levels of infec- tivity in the gingival tissue of mice and rats whose oral anatomy differs from humans. Considering also that there has been no trace of infectivity found in the gingival tissue or dental pulp in vCJD patients8


it


raises the debate as to whether dentists are justified in questioning this risk. When evaluating risk, one must take into


consideration all of the possible theoretical outcomes and consider the restrictions which may have had a bearing on results, such as in tissues infectivity the tests were of limited sensitivity and the amount of samples available to test from humans were extremely limited. As a result of this paucity of scientific


evidence and remaining unknowns about the disease, advice to dentistry from the DOH had to adopt a worst case scenario based approach to risk assessment in this area. It seems rational, given our duty


Equipment Validation etc


of care to protect our patients should we encounter a degree of uncertainty regarding their safety, we must err on the side of caution rather than be regretful if the worst should happen.


The road to compliance The lonely and thankless task of evaluating and inspecting compliance in this area fell to the dental regulator in NI, the Regula- tion and Quality Improvement Authority (RIQA) during the year April 20ı3 to April 20ı4. When we consider the term ‘fully compliant’, it brings with it some prob- lematic ideas in as much as it is not one measure but a combination of interrelated elements which, when combined, present the concept of compliance (see Figure ı). An early objective in NI was to commu-


nicate to general practitioners that simply fulfilling the requirement to develop a shiny new LDU would not render them compliant. Elements highlighted above such as staff knowledge and training, correct processes being applied, correct use and maintenance of equipment and finally ensuring quality management throughout would need to be evidenced for compliance to be demonstrated.


Developing an LDU The development of a separate decontamination facility presented a significant challenge for many


Training ABOUT THE AUTHOR


Elaine has worked as a dental care profes- sional for 25 years and recently gained her postgraduate diploma as an advanced infec- tion control practitioner from the University of Dundee. She currently works as a regional DCP tutor with the Belfast postgraduate dental deanery and has been involved in the development of educational programs to aid implementation of infection control stand- ards in NI. She is also owner and director of Dental Infection Control providing training and consultancy to dental teams. Contact Elaine at dentalinfectioncontrol@hotmail.com


practitioners on several levels. Available space was a major problem, with many practices located in older residential build- ings and the capital outlay for the initial development together with the recognition of new ongoing consumable costs. A further stumbling block was guidance


and advice on the design, size and capacity of the facility to enable it to efficiently fulfil the needs of the practice. Some front running practitioners who went ahead and developed a facility without guidance and advice, consequently found themselves in a position either where the room was not compliant with recommendations or it was not fit for purpose to accommodate the demands of the practice.


Continued » Ireland’s Dental magazine 37 Compliance


“The term ‘fully compliant’, it brings with it some problematic ideas”


Facilities Quality Management Processes


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