Optimising safety with comprehensive decontamination protocols

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  Posted by: Dental Design      12th April 2024

A high-quality, systematic approach to decontamination promotes the highest standard of patient and professional safety.

Patients must be treated in a safe and clean environment – this is a primary tenet of every dental practice. The importance of a meticulous decontamination workflow therefore cannot be overstated and is always worth revisiting, reviewing and optimising. By meticulously following high-quality procedures, the dental team can ensure that all surfaces and equipment are cleaned and disinfected, and all reusable instruments are sterilised. In doing so, professionals minimise the risk of cross infection[i] and help to maintain a safe environment for both patients and colleagues.

The effective decontamination of reusable instruments comprises of several stages including cleaning, disinfection, inspection, sterilisation and storage.

Fast out of the blocks

Before starting the decontamination process, it is crucial to ensure that the work area is clean and organised. Any clutter should be cleared, waste correctly disposed of and all necessary supplies arranged in an orderly manner. It is advisable that the process begins as soon as possible post-procedure to prevent contaminants on reusable instruments from coagulating, as this makes the items more difficult to clean.

Appropriate personal protective equipment should be worn, including gloves, masks, and protective eyewear, to minimise exposure to potentially infectious aerosols and materials.[ii] Reusable dental instruments should then be disassembled, where applicable, to allow for thorough cleaning and disinfection.

Clean machines

The next step in the decontamination workflow is cleaning, which involves removing visible debris or biofilms from the instruments. This can be achieved using a combination of manual scrubbing and ultrasonic cleaning.[iii] An enzymatic cleaner, specific to dental instruments, may be used during this process to help break down and remove organic matter.

However, the issue with manual cleaning is that it’s unvalidated – there’s no way to test whether the cleaning has been completed to an acceptable standard. That’s why best practice guidelines within the HTM 01-05 document[iv] recommend the use of a washer disinfector in England and Wales, which ensures automated and validated cleaning of instruments. In Scotland, SDCEP regulations mandate automated washer disinfectors in the dental practice, providing the necessary thermal disinfection of reusable instruments to ensure effective pre-sterilisation cleaning.[v]

Washer disinfectors operate with a five-stage process: flush, wash, rinse, thermal disinfection and drying. No matter where you are located in the UK, all regulations require that the equipment is correctly installed, validated and maintained in accordance with the manufacturer’s instructions.

After cleaning and disinfection, instruments should be inspected using an illuminated magnifier to ensure they are visibly clean, functional and in good condition.

Sterile steps

Sterilisation is the next critical step in the decontamination workflow to ensure that all instruments are free of infectious microorganisms. Depending on the dental practice’s specific sterilisation methods, this may be achieved through moist heat (steam autoclave), chemical (ethylene oxide or hydrogen peroxide plasma), or a combination of both.[vi] However, autoclave sterilisation is considered the elected procedure.[vii]

An ’N’ type, non-vacuum autoclave is used to sterilise unwrapped, reusable solid instruments. These are placed on suitable autoclave trays prior to placement in the autoclave. However, the instruments lose their sterile status, from the moment that the chamber door is open and they are exposed to the air.

Another option commonly used in dentistry is the ‘B’ type vacuum autoclave, which can sterilise hollow instruments, implant kits, unwrapped solid instruments and wrapped/pouched instruments. For the latter, a post-sterilisation drying phase is required. Upon a successful cycle, these instruments can be removed from the autoclave and either used immediately, or securely stored in a suitable storage cupboard – for later use. Those in pouches can be safely stored for up to a year and should be organised in a way that prevents confusion between sterilised and sterile instruments.v

Keeping the record straight

Documentation is an essential component of the decontamination workflow in a dental practice. Records should be maintained to track instrument usage, cleaning and sterilisation cycles. These records serve as evidence of compliance and can be used for audits or CQC inspections.iv It is also important to regularly test the effectiveness of the decontamination equipment to ensure that it is functioning correctly.

Selecting a service provider that can assist in ensuring the maintenance of its decontamination equipment is a real advantage. Eschmann Care & Cover gives dental professionals peace of mind that their decontamination equipment is fully compliant with HTM 01-05 and SDCEP guidance, while providing full technical support through a nationwide team of 50+ specifically trained Eschmann engineers. Eschmann also offers a helpful decontamination guidance poster on its website that dental teams can download free of charge.

Implementing a comprehensive decontamination workflow in the dental practice is crucial for maintaining a safe environment for both patients and staff. By following the correct steps, dental teams can create a systematic approach to promoting the highest standard of care for their patients.

For more information on the highly effective and affordable range of

decontamination equipment and products from Eschmann, please visit

www.eschmann.co.uk or call 01903 753322

[i] Upendran A, Gupta R, Geiger Z. Dental Infection Control. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470356/

[ii] Bergmann N, Lindörfer I, Ommerborn MA. Blood and saliva contamination on protective eyewear during dental treatment. Clin Oral Investig. 2022 May;26(5):4147-4159. doi: 10.1007/s00784-022-04385-1. Epub 2022 Feb 14. PMID: 35165772; PMCID: PMC8853203. [Accessed December 2023]

[iii] Murakami K, Hirata D, Haraguchi K, Arai N, Inoue K, Miyazaki Y, Funase K, Nakashige T, Teramoto A, Iwatate M, Hattori S, Fujita M, Sano W, Sano Y. Ultrasonic cleaning is effective in removing carbonized clots and tissue from the insulation-tipped diathermic knife-2. DEN Open. 2022 Mar 6;2(1):e101. doi: 10.1002/deo2.101. PMID: 35873510; PMCID: PMC9302054. [Accessed December 2023]

[iv] Department of Health. Health Technical memorandum 01-05: Decontamination in primary care dental practices. https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf [Accessed January 2024]

[v] NHS National Health Services Scotland. Scottish Health Memorandum 01-05. https://www.scottishdental.org/wp-content/uploads/2022/11/Draft-SHTM-01-05-Part-C-V2.00-Consultation-20221031.pdf [Accessed January 2024]

[vi] Smith, A., Bagg, J., Hurrell, D. et al. Sterilisation of re-usable instruments in general dental practice. Br Dent J 203, E16 (2007). https://doi.org/10.1038/bdj.2007.912 [Accessed December 2023]

[vii] Laneve E, Raddato B, Dioguardi M, Di Gioia G, Troiano G, Lo Muzio L. Sterilisation in Dentistry: A Review of the Literature. Int J Dent. 2019 Jan 15;2019:6507286. doi: 10.1155/2019/6507286. PMID: 30774663; PMCID: PMC6350571. [Accessed December 2023]

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