CHANGES TO HTM Decontamination in primary care dental practices By Sandra Holt – Infection Control Specialist Nurse

Health and Social care act 2010 – Code of practice. The 2010 revision to the Code of Practice establishes a duty to provide and maintain a clean and appropriate environment for healthcare within which a specific requirement for effective arrangements for the appropriate decontamination of instruments and other equipment is given. HTM01-05 is designed to assist all dental providers in meeting these requirements.

KEY CHANGES TO HTM (2013) Instrument storage Shelf life of wrapped instruments has been extended from 21 and 60 days to a maximum of one year. Unwrapped instruments in the clinical area can be stored for 1 day. Unwrapped instruments in a non-clinical area can be stored for 1 week.

SINKS Guidance on manual cleaning and rinsing of instruments has been amended to allow the use of a removable bowl. Manual washing and rinsing of instruments can be achieved by either: Two dedicated sinks or One sink with a removable bowl that can be contained within the sink for instruments to be rinsed. (this is least preferred option) The room design example has been amended to indicate a second wash hand basin is optional.

AUDITS The frequency of audits has been relaxed from every 3 months to now only every 6 months. The use of the Infection Prevention Society/ DH audit is strongly recommended.

HANDPIECES Guidance clarified on this Practices can “seek the advice on the decontamination of hand pieces from the hand piece manufacturer. The use of a validated washer-disinfector may be successful provided that the hand piece and washer-disinfector are compatible. Where this is established, sterilisation using a type B or S steriliser is likely to be useful, although it should be accepted that it is unlikely that sterility will be achieved, whatever steriliser is used, due to the presence of lubricating materials”.

ENDODONTIC REAMERS AND FILES “Where endodontic reamers and files are designed reusable they should be treated as single patient use or single use to reduce the risk of prion transmission. Practices must have effective procedures in place to exclude errors. Care must be taken in the cleaning of these if reusable. If an automated washer disinfector used the risk of cross contamination to other instruments would be low, can be put in with other instruments. If manual washing the file/reamers should be washed separately from other instruments.

STERILISER DAILY TESTS AND VALIDATION Daily tests – Can follow manufacturers advice on whether a steriliser`s daily tests can be conducted whilst instruments are being reprocessed. Equipment validation – Manufacturers instructions can be followed in relation to the validation of all decontamination equipment.

MICROFIBRE CLOTHS/REFILLING SPRAY BOTTLES States “ it is not good practice to refill spray bottles used to apply cleaning or disinfecting solutions. Bacteria can contaminate the bottles and become adapted to these solutions and grow in the sprat mechanisms. Such bottles, whether supplied pre-filled or empty, should be single use”.

UNIFORMS Guidance has removed regarding reference to 60 degree C washing for uniforms. Now states “wash uniforms and work wear at the hottest temperature suitable for the fabric to reduce any potential microbial contamination.

BLOOD SPILLAGES AND HEPATITIS B VACCINE Guidance amended to require sodium hypochlorite to be available in tablet form. It now states “hypochlorite should be made up either freshly, using hypochlorite-generating tablets or at least weekly in clean containers”. Occupational health has been amended to concentrate on Hepatitis B and subject to local policy, tetanus.

TOWARDS BEST PRACTICE Every practice should be capable of meeting essential quality requirements. To demonstrate best practice : 1.A cleaning process that should be carried out using a validated automated washer disinfector. 2.Decontamination facilities clearly separate form the treatment area. 3.Storage of instruments in a simple but carefully designed facility clearly separate from the clinical treatment area.