From water temperatures to dress codes, Decon Pete continues to answer all of dentistry’s biggest decontamination questions.
Carrying on from last month’s article, I wanted to continue covering of some of the most common FAQs that we receive through various channels.
I have a digital thermometer for testing water temperatures but what is the correct procedure for this?
Every practice must have a legionella risk assessment carried out in accordance with the L8 ACOP document.
The risk assessment involves an external company inspecting the practice and identifying the path of water throughout, the number of sentinels, how water is stored, heated etc. Then, a complete risk assessment is provided which outlines any potential risks of legionella.
The CQC in England also states: ‘All premises are required to have a written waterline management scheme and legionella risk assessment. These schemes should be written by experienced and competent people. A competent person is someone with the necessary skills, knowledge and experience to carry out this function.’
In conjunction with this the practices must carry out hot and cold water testing on a monthly basis to ensure that any risks are mitigated. This is carried out using the thermometer as follows:
- The cold tap is run for two minutes and the temperature must not go above 20°c
- The hot tap is run for one minute and the temperature must not go above 55°c.
These temperatures should then be stored on a suitable spreadsheet or logbook. If any of the sentinel’s temperatures go above or below these readings, it won’t automatically indicate the presence of legionella but it will indicate that the temperatures are desirable for the potential growth of the pathogen and remedial action can be put into place. Any records need to be kept for five years.
From an infection control point of view, when laying out the surgery drawer, should everything be placed in boxes with lids?
When I carry out any pre-inspection audits or decontamination training days this is what I would suggest. Have small lidded containers, which you can write the contents on for easy identification.
This helps to minimise any aerosol droplets landing on everything should the draw be opened during a procedure.
What is the current dress code for dental teams as I am getting different information?
The National Examining Board for Dental Nurses (NEBDN) in its national diploma in dental nursing guidance outlines the following dress code that should be adopted:
- Uniform (as determined by practice policy) should be clean and smart
- Sleeves should allow staff to be bare below the elbows
- Hair should be short or tied back and off the collar
- Tattoos should ideally be discreet and inoffensive
- Small stud earrings (and other piercing to be discreet)
- No other jewellery should be worn although a wedding band may be permitted
- Shoes should be comfortable and protective ie not heels and not canvas
- Facial hair should be kept short and neat
- Nails short and free of any nail varnish. Our policy includes acrylics/gel but, as long as they are secure and gloves are worn, then practice policy may differ.
If a trainee nurse hasn’t completed their course of hepatitis B vaccinations, can they still work chairside?
It’s a difficult question as there is no definitive answer. The HSE guidelines (www.hse.gov.uk/biosafety/blood-borne-viruses/immunisation.htm) state: ‘Pre-exposure immunisation against HBV is strongly advised for all workers who may be exposed to blood, body fluids or tissues as part of their work activity.’
Based on this guidelines, in an ideal world the answer would be no as it is important to have received the antibody titre result to ensure full protection and to have completed the course. But how realistic is this particularly if staff members have no seroconversion?
Each practice should discuss a thorough risk assessment with any individual when making the decision, following this guidance, documenting everything and reducing the risks wherever possible.
This should be done through use of safety devices, clinician dismantling matrices, needles etc to avoid the trainee having to do it, and providing decontamination equipment such as ultrasonic baths or washer disinfectors that remove debris and bioburden before staff handle them for inspection and cleaning.
It should also be highlighted the importance of what and when to wear all available personal protection equipment (PPE) along with effective hand hygiene at all times.
Help and support
Next month, I will carry on outlining some more of the FAQs that are received along with answers to them.
We have created a testing and validation guidance handbook to support the wider dental team who are looking for answers to questions such as these.
The handbook has been developed to provide help and support with all things around the decontamination process including what to do if tests fail. You can also find a hot and cold record book on the website for the storing of all temperatures along with RO TDS readings.
Catch up on previous Decon Pete columns:
- Answering the biggest decontamination questions – part one
- Breaking down safer sharps procedures
- Updates to waste management legislation
- Hints and tips for purchasing washer disinfectors
- Hints and tips for purchasing benchtop autoclaves.
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