Decontamination Continued » Brief advice from lessons learnt:


• Determine your required capacity and volume of devices to be processed before beginning to plan the facility. This can be done by simply auditing instrument usage on a typical week.


• Determine how many washer disinfec- tors and sterilisers the room will need to house to process required capacity


• Seek advice on workflow and design of the room, think practical application in order to accommodate staff working in the area


• Seek infection control advice with regard to the build requirements, design of sinks, floors and worktops etc.


Cleaning processes Manual cleaning has been the main method for cleaning of dental instruments for many years, however, deficiencies in this area identified within several studies is concerning when we consider that the effectiveness of subsequent processes may be compromised by the failure to remove all debris, soiling and prions9


. This process, when carried out using


correct protocols and well-trained, diligent staff, can be both effective in results and cost. However, it has been shown that this is very often not the case and there are a large degree of variables which exist in the process9


. These can range from untrained


or unmotivated staff and a lack of diligence in performing the task, such as the use of wrong or on occasions no detergentı


. Add


these to the potential hazards to staff and the inability to validate the procedure and record repeatable parameters, it identified a need for an automated process to be applied in the form of washer disinfectors. Washer disinfectors allow a validated cleaning process to take place, in that they perform the same task within the same parameters in every cycle. Each cycle is recorded by an independent data logger and, together with annual validation and a regular testing protocol, can provide us with a fully validated cleaning process. It has been shown that this cleaning process improves consistency in the cleaning of instrumentsıı


. However the studies showing this case


in dentistry are limited due to the small numbers of them in use within GDP. It


“Practical training and education has proved essential for compliance”


is important to highlight that the correct use and loading of the washer disinfector is also imperative to produce the required outcome. Overloading of the machine can prevent inadequate cleaning and also prevent contact of heat with the surface of the instrument during thermal disinfection. One lesson to learn from the north is


guidance on the purchasing of a machine that is both fit for your purposes and has the ability to be compliant with require- ments both now and in the future.


Validation and testing of sterilisers “Sterilisation is a process whose efficacy cannot be verified retrospectively by inspection or testing of the product. For this reason sterilisation processes should be validated before use, the performance of the process should be monitored routinely and the sterilisation equipment should be maintained in accordance with the manu- facturer’s prescribed schedule.”3 There are three key factors within steam


sterilisation: temperature, pressure and time; the parameters of these three factors most commonly used within dentistry are a temperature of ı34 to ı37°C at a pressure of 2.ı to 2.2 bar gauge for a holding time of three minutes. The absence of attain- ment of these three parameters results in a failure of the cycle and as a result the instruments cannot be considered steri- lised and therefore are not safe for reuse on patients. Smith et alı2


in surveying the sterilisa-


tion of dental instruments in GDP within Scotland identified a lack of educational and technical support for dental staff in this area. Considering the fact that we trust these pieces of equipment to kill or dena- ture viable micro-organisms like bacterial spores, it raises concerns of patient safety if it cannot be affirmed that the equipment is achieving the required parameters to achieve this. Practical training and educa- tion on the requirements and performing of periodical testing has proved essential in the pathway to compliance in NI.


Conclusions Decontamination of reusable medical devices is a complex procedure, the success of which is dependent on the inclusion of several correctly performed processes in order to complete the decontamination life cycle. This article has explored just some of the key elements of the process and looked at the difficulties they presented. The Department of Health guidance


HTM 0ı-05 (PEL (ı3) ı3) has gone some way to provide direction for GDPs in NI on the application of local decontamina- tion. However, published guidance without


crucial on site practical support and robust educational programmes supporting implementation could present difficulties in compliance. One very important lesson to be passed


on from the north is the crucial existence of robust educational and training programs for dental teams in the realisation of implementing a change of practice in this area. It is clear that poor practice in the area of local decontamina- tion has a significant impact on the safety of patients being treated in primary care dentistry and presents a challenge to the dental profession.


REFERENCES


1. Department Of Health. Getting ahead of the curve: a strategy for combating infectious diseases, 26346. London: 2002.


2. Scottish Government, S.A.H. Sterile Services Provision Review Group: Survey of Decontamination in General Dental Practice, B37786 11/04.Edinburgh: 2004.


3. Department Of Health Northern Ireland, Health Technical Memorandum 01-05: Decontamination in primary care dental practices, 13002. London: 2013.


4. Redd, J.T. et al. Patient-to-patient transmission of hepatitis B virus associated with oral surgery. The Journal of Infectious Diseases 2007; 195(9):1311-1314.


5. Kurita, H.et al. Nosocomial transmission of methicillin resistant Staphylococcus aureus via the surfaces of the dental operatory. British Dental Journal 2006; 201:297-300.


6. Smith, A.J. Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data. British Dental Journal 2003; 195: 701-703.


7. Frosh, A., et al. Iatrogenic vCJD from surgical instruments. British Medical Journal 2001; 322(7302):1558-1559.


8. World Health Organisation. Tables on tissue infectivity distribution in transmissible spongiform encephalopathies. Switzerland: 2010


9. Bagg, J. et al. Pre-sterilisation cleaning of re-usable instruments in general dental prac- tice. British Dental Journal 2007; 202(9):E22.


10. Smith, A.J. et al. A method for surveying instrument decontamination procedures in general dental practice. British Dental Journal 2007; 202:E20-E20.


11. Vassey, M. et al. A quantitative assessment of residual protein levels on dental instruments reprocessed by manual, ultrasonic and automated cleaning methods. British Dental Journal 2011; 210(9):E14


12. Smith, A.J., et al. Sterilisation of re-usable instruments in general dental practice. British Dental Journal 2007; E16:912.


Ireland’s Dental magazine 39


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