Decon Pete – manual or automatic cleaning?
Manual cleaning versus automatic cleaning – Pete explains why now is the time to make the leap to using washer disinfectors.
As a key part of dental infection control policy, the cleaning and sterilisation of dental instruments remains the cornerstone of practice compliance.
In the UK, local regulations provide guidance as to which cleaning methods are ‘Essential’ or ‘Best Practice’. And different guidelines apply various criteria about which cleaning is most suitable.
In England and Wales, Section 3.33 of (W)HTM 01-05 accepts that manual cleaning, in principle, is an ‘acceptable method’ of cleaning. Although this is accompanied by certain caveats, not least the inability to adequately validate this method.
The use of a washer disinfector is currently considered ‘Best Practice’. But as yet there is no specific timetable for implementation of this standard.
Scotland and Northern Ireland, on the other hand, have made it essential for practices to use WDs as part of the decontamination process.
Deciding on cleaning methods
The main considerations in selecting the most effective cleaning method include effectiveness, compatibility with the items that require cleaning and the occupational health and exposure risks posed to staff with each method.
HTM 01-05 (2013) states that manual cleaning is ‘acceptable within the essential-quality-requirements framework’.
However, as part of the move towards best practice, it further states that practices should consider manual cleaning only where the manufacturer specifies that the device is either incompatible with automation processes, or when the washer disinfector is temporarily unavailable. For example, when repairing or validating the washer disinfector.
When using a manual cleaning method, staff must have a written procedure to follow with full training.
Dental staff should control the critical parameters as far as possible to reduce the variability in cleaning performance. Use a low-foaming neutral detergent specifically for cleaning instruments in accordance with manufacturer’s instructions.
Water temperature should not go above 45 degrees and fully immerse items to minimise splashing.
The reason that we do not consider manual cleaning best practice is that the process is difficult to validate. This is due to variables and inconsistencies in individual’s cleaning styles.
Furthermore, this process can carry a greater risk of injury to decontamination staff compared with other methods.
It is, however, important that there are sufficient facilities and staff training in manual cleaning. This is necessary when other cleaning methods are not appropriate, or where other automated methods are temporarily unavailable.
If a practice uses manual cleaning methods, it is recommended that there should be systems in place to avoid recontamination of clean instruments, an agreed written procedure and a visual inspection should be carried out for cleanliness, wear and damage following cleaning.
In comparison, the use of a washer disinfector removes all variables from the cleaning process. It enables a fully audited and validated process for regulatory compliance.
Choosing a washer disinfector that has the capability to meet all your needs regarding space and capacity is important from the outset. For example, one with customisable storage trays that can accommodate a reasonable number of instruments. And one that can achieve a fast turnaround is essential in a busy practice. So choosing a machine with multiple programmes including a ‘fast wash’ is important in terms of maintaining practice efficiency.
An integrated data logger should also be used as it automatically records all the necessary data required for compliance documentation. This removes the need to keep manual records.
Automated processes have certain advantages over manual cleaning. Just as we prefer a domestic dishwasher over the manual task.
Instruments cleaned with automated equipment do not normally need presoaking (unless there is a considerable time lapse between used instruments entering the reprocessing cycle – in which case a pre-soak solution is useful).
Cleaning is generally more effective using an automated method. It also greatly reduces staff exposure to blood and body fluids.
Not least, the use of automated equipment can increase productivity and is therefore the most efficient method available, freeing up staff to deal with other surgery tasks.
The need for change
The case for using an automated rather than a manual process for cleaning instruments is strong.
The question of whether the use of washer disinfectors in dental practices will become mandatory is, in my view, ‘yes’. The only debate is around the timing.
Our increasing knowledge about disease transmission and the need to safeguard patients in every area of healthcare, including dentistry, makes this scenario inevitable.
Thirty years ago, a dental professional would not have routinely worn gloves when performing a procedure. Now we expect and accept the wearing of gloves as part of all treatment. Patients would react negatively were it not the case.
Decontamination remains an important aspect of dental care and is a top priority for regulators and inspectors.
As with other sections of the various infection control guidelines, it is compliance that will first create the need for practices to change.
But if a practice looks at the bigger picture now, they will find many advantages. Not just in terms of compliance, but also with regard to enhanced efficiency and health and safety. From which every practice is likely to benefit.
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