Following the updates to decontamination guidance in Scotland, Decon Pete looks at how the instrument decontamination process is changing.
In the final part of the SHTM 01-05 document mini-series, this month we are going to explore the key highlights and changes to Part C of the document.
Just to recap, unlike the English, Welsh and Northern Irish variant, this document is made up of three bite-size publications as outlined:
- Part A: management – this section focuses on the management of the decontamination process within the local decontamination units (LDU) and applies to dental instruments that are processed by the User or a third party to be made ready for use
- Part B: decontamination equipment and test methods – this covers decontamination equipment used to carry out processing of dental instruments. It details the maintenance, periodic testing, and test equipment requirements for decontamination equipment in line with the chief dental officer (CDO) letter (2010) and current guidance
- Part C: process – this section provides practical guidance on the whole instrument decontamination process, presented in a form designed to be readily understandable by members of the dental team and has been written in collaboration with the Scottish Dental Clinical Effectiveness Programme (SDCEP). For 10 years Scottish dentistry has been working with SDCEP however the new SHTM 01-05 Part C now replaces this.
Part C is based on and now replaces the widely used SDCEP, which was completed and came into practice in 2014.
Similar to the English and Welsh edition, the new document breaks down the process of each area within decontamination, from acquisition to reuse, including single use instruments. In general terms, nothing has significantly changed from the previous SDCEP, however it focuses on up-to-date procedures and also outlines very clear action plans for dental practices to follow.
The key plans taken away from the update are as follows, and broken down into each section of the document.
Section two: general considerations
Section two of part C outlines the things to consider regarding the LDU, equipment purchasing, instrument storage, equipment installation Health and Safety requirements with the key action plans being:
- Ensure instrument storage is clean, orderly, enclosed (for example in trays, cassettes or pouches), and is not on open shelving:
- Ideally, instruments are stored in an area that is separate from the decontamination unit and clinical area, as during surgery, the formation of contaminated aerosols could contaminate processed instruments. The storage area should be well lit, secure, dry, and away from direct sunlight
- Ensure storage is arranged so that sterile and sterilised instruments are stored separately and cannot be confused.
Health and safety requirements for steam sterilisers
- Following installation and before use, obtain a written scheme of examination for each steriliser from the manufacturer, supplier or insurer that has been prepared by a Competent Person (Pressure Systems) (CP(PS))
- Obtain third-party liability insurance that specifically covers risks associated with the operation of pressure vessels. Such risks may not be covered by practice insurance
- The current national contract now includes type S sterilisers (see paragraph 4.5 to 4.7) with type N and/or type B cycle profiles as required. Further items are added periodically and, therefore, it is important to check the contract for the latest information
- Ensure the steriliser carries the UKCA mark (CE currently acceptable for purchases up to 30 June 2028, subject to change). This indicates that the manufacturer claims compliance with the essential requirements of the Medical Device Directive
- Check with the supplier that:
- They can install the steriliser to be consistent with SHTM 01-05 part B requirements and provide certification of this
- They can supply a contract for maintenance and testing in accordance with the manufacturer’s instructions
- Remove wrist and hand jewellery, including wrist watches, before working in the clinical environment or the decontamination unit. A plain metal finger ring is permitted but should be removed (or moved up) during hand hygiene to ensure the area under the ring is cleaned and dried thoroughly.
Section three: cleaning of dental instruments
Section three outlines the requirements for all aspects of the cleaning process including the use of single use and the relevant waste streams for items considered ‘high risk’. Key action points are:
- Any dental substance that can solidify on reusable instruments (for example cements), should be wiped immediately using a lint free swab:
- To avoid risk of sharps injuries, it is the clinician’s responsibility to ensure that residues are removed from sharp hand instruments used in the patient’s mouth, such as scalers
- Identify and dispose of single-use sharps, matrix bands, used and partly used local anaesthetic cartridges in yellow stream waste-disposal containers (sharps bin) close to the point of use
- Dispose of extracted teeth not containing amalgam into a rigid yellow waste stream container that is clearly labelled
- For manual cleaning use a thermometer, monitor the temperature of the water throughout the cleaning procedure to ensure the temperature is maintained within the range recommended by the detergent manufacturer.
Section four: sterilisation of dental instruments
Section four outlines all the steps and considerations with regards to the sterilisation process. It outlines the different types of steriliser along with the recommended load types:
- Type N: solid, unwrapped instruments – cannot assure sterilisation of hollow instruments
- Type B: wrapped or unwrapped, sold or hollow instruments – widest range of load types
- Type S: suitable for load types as specified by the manufacturer – typically sold, hollow, wrapped and unwrapped
Actions after sterilisation:
- Record that the cycle was satisfactory:
- If using a printer, sign and retain it as a record. Some practices choose to keep an electronic record by scanning signed printouts in batches, thus avoiding the need to store large quantities of printouts
- If using a data logger, ensure that the data is downloaded and checked at least weekly
- If a wrapped item or pack is wet, is dropped on the floor, is torn, or has broken seals, it is no longer sterile. Unwrap the instruments and return them to the start of decontamination process.
The document also covers off all aspects of maintenance and periodic testing in accordance with European guidance and the manufacturers. The outlines here are the same as the previous SDCEP with the exception of how long records are required to be kept. These records must be kept for the lifetime of the equipment (25 years or more).
All records must be accessible for inspection.
These are the key take aways from Part C and the primary areas that I feel should be highlighted. If you require any help or assistance, please do not hesitate in getting in touch with me, either via email [email protected] or by visiting the website www.deconpete.co.uk
Catch up on previous Decon Pete columns:
- New Scottish decontamination guidance: Part B
- New Scottish decontamination guidance: Part A
- Decoding updated decontamination guidance in Scotland
- How can dental waste management be more sustainable? Part four
- How can dental waste management be more sustainable? Part three.
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