Decontamination in primary care dental practices - Gov.uk

1 Policy and foreword (Barry Cockcroft, Chief Dental Officer)of a dental service is capable of operating in asafe and responsible manner with respect todecontamination of instruments and dentalequipment. Where new practices arecommissioned or new premises contemplated, itis advised that the full best practice provisions ofthis guidance be utilised wherever reasonablypracticable.1.4 The guidance provided here follows the essentialprinciples given in the ‘Health and Social CareAct 2008: Code of Practice on the prevention andcontrol of healthcare associated infections andrelated guidance’ (the Code of Practice). Thisrequires that effective prevention and control ofhealthcare-associated infection be embedded ineveryday practice. For this reason, the guidance iswritten with emphasis on practical and readilyimplemented measures. Appendix B of the Code ofPractice refers specifically to the requirements fordental practices.1.5 The 2010 revision to the Code of Practiceestablishes a duty to provide and maintain aclean and appropriate environment for healthcarewithin which a specific requirement for effectivearrangements for the appropriate decontaminationof instruments and other equipment is given.This guidance is designed to assist all primary caredental providers (including salaried dental services)in meeting these requirements.1.6 ‘Clean, safe care – reducing infections andsaving lives’ refers to the need for high-qualityenvironmental cleaning and decontamination asvital components in reducing rates of infection.“Essential quality requirements” and“best practice”1.7 Every practice should be capable of meeting theessential quality requirements, that is:• Regardless of the technology used, the cleanedinstruments, prior to sterilization, should befree of visible contaminants when inspected.Instruments should be reprocessed using avalidated decontamination cycle including:cleaning/washing (in terms of manual cleaning,this includes having a written protocol – seeChapter 16); a validated steam sterilizer, and atthe end of the reprocessing cycle they should bein a sterilized state.• Reprocessed dental instruments should bestored in such a way as to ensure restraint ofmicrobiological recolonisation. These measuresshould be backed by careful controls on thestorage times to which instruments that are lessfrequently used are subject.• Practices should audit their decontaminationprocesses every six months using an audit tool(the use of the Infection Prevention Society/DHaudit tool is strongly recommended). This canbe downloaded from www.ips.uk.net at the“resources/dental audit tool” section of thewebsite.• Practices should have in place a detailed plan onhow the provision of decontamination serviceswill move towards best practice.An expanded list of essential quality requirementsis given in paragraph 2.4.1.8 To demonstrate best practice, furtherimprovements are required in three main areas:• A cleaning process that should be carried outusing a validated automated washer-disinfector.• The environment in which decontamination iscarried out should be such as to minimise therisk of recontamination of instruments and thepossibility of generating aerosols, which mayreach patients or unprotected staff. For bestpractice, the decontamination facilities shouldbe clearly separate from the clinical treatmentarea. This implies the use of a separate room orrooms for the accommodation of clean (output)and dirty (input) work. In these facilities, theroom(s) should be used for this purpose onlyand access should be restricted to those staffperforming decontamination duties. However,plant and equipment not necessarily used fordecontamination may be located in these rooms(but preferably in the dirty room) provided itcan reasonably be shown that the devices donot conflict with the requirement for a cleanenvironment.• The storage of reprocessed dental instrumentsin a simple but carefully designed facility clearlyseparate from the clinical treatment area is animportant best practice improvement. Thefacility should take account of the need toreduce recontamination of sterilized instrumentsand also make the identification/selection of3