Decontamination in primary care dental practices - Gov.uk

1 Policy and foreword (Barry Cockcroft, Chief Dental Officer)“Sterile” and “sterilized”As the environment in which dental instruments areused is not sterile, it follows that dental instrumentswill not be sterile at the point of use. (They should,however, be in a sterile state at the end of thedecontamination process when the sterilizer dooris opened.)Accordingly, this guidance accepts that dentalinstruments may be defined as “sterilized” rather than“sterile” at the point and time of use (a somewhatdifferent approach from that in invasive surgicalprocedures).In some instances, the decontamination process maynot generate full sterilization, for example in thereprocessing of dental handpieces; however, theguidance will nevertheless seek to raise standards andminimise infection risk.Noteand reamers (see paragraph 2.18). Otherinstrument or device types for which a reliablecleaning regime is not available should also beconsidered for replacement by single-use typesor by the single use of reprocessible instruments.Information regarding risk in this important area iscontained in ‘Potential vCJD transmission risks viadentistry: an interim review’ (December 2007).Where patients indicate that they are in a high-riskgroup, guidance provided by the Advisory Committeeon Dangerous Pathogens – Transmissible SpongiformEncephalopathy Working Group (ACDP-TSE WG)should be followed (http://www.dh.gov.uk/health/2012/11/acdp-guidance). The guidancesuggests that special precautions beyond fullinstrument decontamination will not be necessary.1.13 This guidance is based upon a principle ofcontinuous improvement in the quality ofdecontamination practices and the environmentused. Where dental practices use the same room forpatient treatment and decontamination (essentialquality requirements), they should have a plan inplace that facilitates a separate and controlleddecontamination room. This plan will normallyalso contain statements on staff training anddevelopment to suit work in a dedicateddecontamination room or suite.1.14 In addition, the plan should realistically outlinethe way forward in relation to best practicerequirements, for example:• measures to purchase and incorporate a washerdisinfector;• the separation of decontamination processesfrom the patient treatment area.Prion decontamination1.15 Recent research has indicated that a low level ofprion contamination may theoretically be presenton some instruments following contact with dentaltissues. This applies if these instruments havepreviously been used in the care of a prion diseasecarrier who may exhibit no symptoms and mayindeed not go on to develop the disease. For thosetissues where evidence suggests this risk is mostpronounced, the Chief Dental Officer for Englandhas published requirements for endodontic files1.16 For all other instruments used in dentistry, the riskof prion transmission will be usefully reduced bycompliance with the decontamination proceduresdescribed in this Health Technical Memorandum.This statement is based on various studies(conducted on behalf of DH) that examined theeffect of steam sterilization on prion infectivity.These studies showed that the steam sterilizationmethods described in this guidance provide a usefullevel of deactivation of prion infectivity. While thiswould not be significant in high-risk tissue surgery,the effect is large enough to be of significance indentistry (excluding, that is, endodontic proceduresas mentioned in paragraph 1.15). In addition,there is a risk of prion transmission through proteincontamination of instruments, hence the measuresoutlined in this guidance to improve washing anddisinfection of dental instruments.1.17 Currently there is no recognised process thatcan fully deactivate prion protein in the sense ofremoving any foreseeable level of contamination. Inthis Health Technical Memorandum, the cleaningprocess and its ability to remove protein in tandemwith a validated steam sterilization procedure isemphasised, as this is known to at least reducethe risk of prion transmission through dentalinstruments.5