Decontamination in primary care dental practices - Gov.uk

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Decontamination: Health Technical Memorandum 01-05 – Decontamination in primary care dental practices (2013 edition)(Ehrenkranz et al., 1980; Sautter et al., 1984). Suchbottles, whether supplied pre-filled or empty,should be single use.6.59 Local provision of steam cleaning from practiceresources is unlikely to be economical. Instead theuse of a contractor may be advantageous.6.60 Cleaning equipment should be stored outsidepatient care areas.Decontamination of treatment areas6.61 The patient treatment area should be cleanedafter every session using disposable cloths or cleanmicrofibre materials – even if the area appearsuncontaminated.6.62 Areas and items of equipment local to the dentalchair that need to be cleaned between each patientinclude:• local work surfaces;• dental chairs;• curing lamps;• inspection lights and handles;• hand controls including replacement of covers;• trolleys/delivery units;• spittoons;• aspirators;• X-ray units.NoteDental chairs should be free from visible damage (forexample rips and tears).6.63 Areas and items of equipment that need to becleaned after each session include:• taps;• drainage points;• splashbacks;• sinks.In addition, cupboard doors, other exposed surfaces(such as dental inspection light fittings) and floorsurfaces, including those distant from the dentalchair, should be cleaned daily.NoteSpittoons and aspirating units need to be washedthrough at the end of a session according tomanufacturers’ instructions.6.64 Items of furniture that need to be cleaned at weeklyintervals include:• window blinds;• accessible ventilation fittings;• other accessible surfaces such as shelving,radiators and shelves in cupboards.6.65 Purpose-made disposable single-use covers areavailable for many of the devices mentioned above,including inspection light handles and headrests.The use of these is encouraged but should not betaken as a substitute for regular cleaning. Coversshould be removed and surfaces should be cleanedafter each patient contact.6.66 For infection control reasons, in clinical areas:• covers should be provided over computerkeyboards; or• conventional keyboards should be replacedwith “easy-clean” waterproof keyboards asrecommended in the Department of Health’s(2008) ‘Clean, safe care: reducing infections andsaving lives’.Where covers or conventional keyboards areprovided, care should be taken to ensure thatcovers are changed or that washing is performed atfrequent intervals. This should be regarded as auseful priority.6.67 Cleaning centres on simple techniques usingdisposable cloths wetted with clean water and adetergent.6.68 Dry cleaning should be avoided wherever possibleas this may result in dust suspension.6.69 Care should be taken to keep water well away fromelectrical devices, even though many of thoseprovided in dentistry will have water-resistanthousings.6.70 After some clinical procedures, it is necessary tostart cleaning as soon as care of the individualpatient is complete. In these cases, staff should notwait until the end of the session to start cleaningthe area.38
6 General hygiene principles6.71 Portable aspirators with reservoir bottles are notrecommended. They are not fitted with filters andpose a considerable hazard when disposing of thecontents.6.72 Intra-oral radiology film and devices used in digitalradiology imaging are potential sources of crossinfection.Accordingly, where reusable devices areused, they should be decontaminated in accordancewith the manufacturer’s instructions. For intra-oralholders, this will require the use of steamsterilization following washing and disinfection.6.73 Soft toys are often difficult to clean and shouldaccordingly not be provided within practices.6.74 For blood spillages, care should be taken toobserve a protocol that ensures protection againstinfection. The use of hypochlorite at 1000 ppmavailable chlorine is recommended. Hypochloriteshould be made up either freshly usinghypochlorite-generating tablets or at least weekly inclean containers. Contact times should bereasonably prolonged (not less than five minutes).A higher available chlorine concentration of 10,000ppm is useful, particularly for bloodcontamination. The process should be initiatedquickly and care should be taken to avoid corrosivedamage to metal fittings etc. The use of alcoholwithin the same decontamination process is notadvised.Dental unit water lines (DUWLs)NoteIn view of the expertise required in this specialisedfield, practices (through the Registered Manager)should engage with an external specialist to assist inmeeting the recommendations given in Section 3 ofthis guidance. This may be a locally-based engineeringconsultant with specialist knowledge of Legionella andother water-borne organisms.General6.75 Best practice guidelines on the control of Legionellaare provided in the Health & Safety Commission’s‘Legionnaires’ disease – the control of Legionellabacteria in water systems. Approved Code ofPractice & guidance’ (also known as L8) andHealth Technical Memorandum 04-01 – ‘Thecontrol of Legionella, hygiene, “safe” hot water,cold water and drinking water systems’.NoteThe Health & Safety Commission’s Approved Code ofPractice L8 gives practical advice on how to complywith UK health and safety law with respect to thecontrol of Legionella bacteria. This Code is importantin that it has a special legal status. If a healthcareorganisation is prosecuted for a breach of health andsafety law, and it is held that it did not follow therelevant provisions of the Code, that organisationwould need to demonstrate that it had complied withthe law in some other way, or a court would find it atfault.6.76 The use of water in dentistry must comply with aseries of regulations which are designed to ensurethe safety of patients, staff and the public. Theapplication of these regulations and codes iscovered in detail in Chapter 19 of this guidance.6.77 The Registered Manager (see paragraph 9.3) shouldensure that arrangements are made such that thepractice can continuously achieve compliance withthe requirements of these regulations. Registrationwith the Legionella Control Association or otherrecognised body is recommended.Microbiological monitoring6.78 Apart from situations where there are indicationsfrom taste or odour, microbiological monitoringusing dip slides for total viable counts (TVCs) isnot considered essential. However, some companiesand other institutions offer comprehensive waterpurificationservices that include periodicmicrobiological sample monitoring. Such services,provided they are quality-controlled, maycontribute usefully to risk reduction in this area.6.79 Where monitoring is undertaken, the TVC shouldbe expected to lie in the range 100 to 200 colonyforming units per millilitre (cfu/ml). In general,incubation should be at 22oC. These measurementscan be carried out by commercial microbiologicalservices or by Public Health England. (Somecommercial water-purification services offermicrobiological control such that TVC values maybe maintained below 10 cfu/ml.)NoteThis is a complex procedure and the use of in-housetest kits is not recommended.39
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Decontamination in primary care dental practices - Gov.uk

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