Decon Pete – the role of UK decontamination and interpretation of the guidance
With confusing and subjective guidance on decontamination in dentistry, Decon Pete tries to clarify how practices can interpret the documents.
The UK guidance documents relating to decontamination within primary care dentistry have been with us since 2004, with the SDCEP document, then HTM01-05 in 2009 and WHTM01-05 in 2010.
These documents are all underwritten by the Health and Social care Act 2008. And I have worked with all of these documents since inception.
I consider all these documents a valuable contribution to the subject by bringing together previously published guidance to define what ‘best practice’, in terms of infection control, should consist of.
Since the early 1990s, practices have been aware of the need for strict infection control and decontamination procedures. But the need for additional clarification in guidance is now driven by the increasing mobility of the population. This has given rise to the prevalence of diseases such as Hepatitis B, C and newly Sars-Cov2.
Infection and decontamination confusion
The aim of guidance is to develop awareness amongst dental professionals regarding how cross infection can reduce and ultimately eradicate the transmission of diseases in a clinical environment.
There is an acceptance by the Department of Health that this area of microbiology is subject to constant modifications. This results in an evolving document (which has helped maintain its credibility). The changing document reflects clinical advances in terms of knowledge and discovery of new viruses.
In general, knowledge about infection control and decontamination is improving. But UK Guidance Documents (UKGD) remain open to individual interpretation. So it is difficult for dental professionals to work out exactly what actions they must take in order to comply.
Dental practices understand what they need to do, but because so much of the documents are advisory, many find it difficult to understand which parts they should prioritise and whose rules they should follow.
Service, maintain and validate
UKGD requires that equipment receives servicing, maintenance and validation. But in itself this is the cause of some confusion for dentists.
I like to explain the differences by thinking about ‘service’ as making sure the equipment is operating efficiently and ‘validation’ as ensuring the equipment is fit for purpose and that it is operating within safe parameters.
I always advise practitioners to pay particular attention to testing procedures and the accurate recording of evidence.
- How is each member of staff trained to test equipment?
- What aspects of the equipment need testing and how often should this be undertaken?
- How is testing recorded?
- How does a practice deal with equipment that fails to pass the test?
The equipment in surgeries are medical devices. The practice must produce a report that confirms the equipment is operating according to the pre-set parameters at the point of manufacture. This is validation.
According to UKGD, validation of equipment should take place once a year. But this process must be manufacturer led.
There are certain inconsistencies in terms of the validation UKGD requires and those from manufacturers. In the same way there are also some contradictions in terms of the frequency of validation.
In these cases I always recommend that a practice gets written confirmation from the manufacturer that the validation achieved is in line with their recommendations.
Validating your efforts
Washer disinfectors are in HTM01-05 and WHTM as the ‘preferred’ method of cleaning instruments. This is because it is the only method that can be validated.
Manual washing, although acceptable, is inconsistent in terms of temperature of the water, amount of cleaning fluids used etc. In the same way, ultrasonic baths have variance every use.
It is difficult to validate either method, although HTM 01-05 does refer to the specifications required when purchasing a new ultrasonic bath to ensure that validation is possible.
Validation of surface decontamination is a more complex and subjective issue.
The guidance states using alcohol wipes with caution; surfaces require cleaning before disinfecting. The frequency of both cleaning and disinfecting should be in line with what is indicated in the practice’s cross-infection policy.
Every practice is required to have a cross infection policy and if they are unsure how to create one, their PCT or manufacturers are an excellent source of template policies.
Naturally, I am able to review policies and give general advice. But I always recommend practices seek guidance from their decontamination ‘partners’ with regard to specific help in this area.
Recording of evidence and complying with the laid down procedures is the cornerstone of meeting the regulations. It is vital because if there is a complaint against the practice, it is this information that would demonstrate the strict adherence to policies.
The CQC requires accurate recording. It is now this body that is really driving the observation of regulations.
The interpretive nature of UKGD some see as an obstacle who would prefer to have clearer regulations.
But the flexibility of the guidelines is of benefit; I recommend that practitioners use all available resources to help with their compliance needs and adhere to the manufacturers’ guidance when it comes to equipment validation. In this way they can feel certain that the wellbeing of their patients and staff, which UKGD is there to safeguard, is assured.
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