Decontamination in primary care dental practices - Gov.uk

Decontamination: Health Technical Memorandum 01-05 – Decontamination in primary care dental practices (2013 edition)that staff are aware of the need to assess when achange of solution is necessary as advised in theoperational requirements.m. After ultrasonic cleaning, rinse and inspectinstruments for cleanliness, and where possiblecheck for any wear or damage beforesterilization.3.31 Instruments cleaned in an ultrasonic cleaner (orby hand) should be rinsed thoroughly to removeresidual soil and detergents. A dedicated sink orbowl (separate from the one used for the originalwash) should be used, and the instrumentsimmersed in satisfactory potable water or, wherethis is not available, in RO or distilled water. Washhandbasins should not be used. (This step may beomitted if the local policy and procedure involvesthe use of a washer-disinfector as the next stage inthe decontamination process.)NoteHard-water contamination of wet instruments, whichthen go on to sterilization, can compromise the properfunction of a small steam sterilizer. Advice should besought from the manufacturers. When potable water isused, a water softener device may be needed (seeparagraphs 17.8–17.10).3.32 Instruments should be sterilized as soon as possibleafter cleaning to avoid air-drying (which canresult in corrosion and/or microbial growth). Forinstruments processed in a vacuum sterilizer, beforebeing wrapped, instruments should be dried usinga disposable non-linting cloth.Manual cleaning3.33 In principle, manual cleaning is the simplestmethod to set up, but it is hard to validate becauseit is difficult to ensure that it is carried outeffectively on each occasion.3.34 Compared with other cleaning methods, manualcleaning presents a greater risk of inoculation injuryto staff. However, despite the limitations of manualcleaning, it is important for each practice to havethe facilities, documented procedures and trainedstaff to carry out manual cleaning as a backup forwhen other methods are not appropriate.3.35 For dental services that are working to the bestpractice requirements outlined in this document,manual cleaning (acceptable under the essentialquality requirements) should only be used forequipment that cannot be cleaned by automatedmethods.3.36 This method should have systems in place to avoidrecontamination of clean instruments.3.37 An effective system for manual cleaning should beput in place, as outlined in Section 3, and all staffshould follow an agreed written procedure. A visualinspection for cleanliness, wear and damage shouldbe carried out.3.38 Consider routinely using an automated method(for example a washer-disinfector). Aim to phasein instruments that can be cleaned in a washerdisinfector.Avoiding instrument damage3.39 Most dental instruments are made of high-qualitymaterials designed to minimise corrosion ifreprocessed correctly. The corrosion resistance isbased on their alloy composition and structure,which forms a protective passivation layer on thesurface. The ability of the instruments to resistcorrosion depends on the quality and thickness ofthis layer.3.40 It is important to avoid damage to the passivationlayer during cleaning. Accordingly, methods suchas the use of wire brushes, which may give rise tosurface abrasion, should be avoided.3.41 Any instruments that have rust spots should beremoved.Cleaning procedure summary3.42 Effective cleaning of dental instruments beforesterilization is of the utmost importance to reducethe risk of transmission of infectious agents.3.43 Research suggests that instruments cleaned as soonas possible after use are more easily cleaned thanthose left for a number of hours beforereprocessing.3.44 Instruments should be transferred from the pointof use to the decontamination areas as soon as ispractical to ensure that processing takes place assoon as possible after use. Evidence indicates thatkeeping instruments moist after use and prior todecontamination improves protein removal andoverall decontamination outcomes.3.45 It should be noted that certain solutions arecorrosive to stainless steel instruments and willcause pitting and then rusting if allowed to remainon instruments for any length of time. Dental20