1. Infection control
Practices require registration with CQC. Cleanliness and inf control requirement
Decontamination processes should be audited every 6 months (DH audit tool) (prev 3/12)
Aim to achieve reprocessed device fully compliant with medical devices regs 2002
Special precautions for prion transmission not necessary
Training essential (5 hours per CPD cycle)

2. Infection control policy
Written policy updated every 2 years
Blood borne transmission and sharps
Decontamination and storage
Procedures for cleaning, disinfection and sterilization of instruments
Management and disposal of clinical waste
Hand hygiene
Reusable instruments and single use
PPE
Disinfectants-use, storage, disposal
Spillage procedures and COSHH
Environmental cleaning
training

3. Transport of instruments
ASAP to avoid risk of drying (can immerse in water or gels/sprays)
Containers should be
Leak proof
Easy to clean
Rigid
Able to be closed securely
Robust to prevent instrument damage
Clearly marked
Transport outwith surgery for decon. requires noted consignment
Domiciliary visits require record of date and vehicle used

4. Cleaning instruments Essential prerequisite before sterilization
Best practice with WD
ASAP after use
New instruments cleaned & sterilized before use, unless supplied as sterile
Cleaning practices should be validated

5. Washer disinfector Flush –remove gross contamination <45oC
Wash-detergent
Rinse-remove detergent
Thermal disinfection-80oC for 10 mins or 90oC for 1min
Drying
Crucial to load correctly-open hinges, no overlapping, attach to irrigation
Inspect afterwards under lighting and magnification

6. Ultrasonic cleaning
Can be used prior to WD esp. for hinged instruments
Should be immersed in cold water with detergent first
Place instruments in basket, fully immersed
Do not overload, overlap or place on floor
Close lid and set timer
After cycle drain basket before rinsing in a dedicated sink or bowl
Change solution when visibly contaminated or at end of every session

7. Manual cleaning Wash hands Wear PPE
Prepare sinks, equipment and setting down area
Fill the sink to level (marked on edge of sink) with water and detergent
Ensure temp <45oC
Fully submerge and keep under water to prevent aerosols
Scrub using long handled brush with soft plastic bristles
Drain water
Rinse in separate sink (potable/RO/distiller water)
Drain (and dry if to be wrapped)
Visually inspect

8. Sterilization
Saturated steam under pressure at the highest temperature compatible with the product
Records required for every cycle
These should be copied as print outs fade over time
All steam sterilizers subject to Pressure Vessels Systems Safety Regulations 2000-must be examined periodically by a competent person

9. Sterilizers Type N: non-vacuum Type B: vacuum Type S: specific load
Must be:
Compliant with safety requirements
Installed, commissioned , validated and maintained
Operated according to manufacturers instructions

10. Sterilizers
Reservoir should be filled at least daily with distilled or RO water
Should be cleaned, drained and left empty with door open at end of day
Testing required to ensure performance
Each sterilizer should have a logbook in which the following are recorded:
Maintenance
Validation
Faults
Modifications
Routine tests

11. Sterilizers Before carrying out tests the user should: Clean door seal
Check chamber for cleanliness
Fill reservoir
Turn power source
Daily tests consist of
Automatic control test
Steam penetration (vacuum) helix or Bowie-Dick

12. Packaging Instruments should be cleaned and dried before wrapping
With steam displacement (type N) instruments should be wrapped after sterilization
With Type B instruments should be wrapped prior to sterilization
Instruments should be dried using disposable non-linting cloths
Instruments can be stored for up to 12 months
First in - first out principle helpful
Date should be marked on package

13. Storage Wrapped instruments may be stored for up to 1year
Unwrapped instruments in the clinical area 1 day (must be dry and protected from contamination eg in cupboard). These instruments should be reprocessed at the end of day or next morning even if not used
Unwrapped instruments in a non-clinical area 1 week
Wrapped instruments should be date stamped/marked

14. LDU Dirty to clean workflow, clearly separated Decluttered
Sealed, easily cleaned work tops
Should be wiped down after each decontamination cycle
Air flow from clean to dirty
Dirty zone receives instruments
Washing sinks should be next to receiving area.
Ultrasonic cleaner next and then WD
After the cleaning/disinfection area should be an inspection area
Sterilizer should be well away from other activities
Set down clean area adjacent to this
Separate wash hand basin for hand washing

15. Hand hygiene
Crucial to prevent spread of infection and decontamination
Should be carried out:
Before and after each treatment session
Before and after removal of PPE
Following washing of dental instruments
Before contact with instruments that have been steam sterilized
After cleaning or maintaining decontamination devices
After toilet visits
Before and after contact with food

16. Hand hygiene Mild soap should be used, not bar soap.
Apply soap to wet hands
Dry with disposable paper towel
Hand cream (water based) should be used at the end of session
Rings, bracelets and watches should be removed
Fingernails should be kept clean and short with no polish
The basin used should not have a plug or overflow
It should have a mixer tap-lever or sensor operated
Taps shouldn’t discharge directly into the drain (to prevent aerosols)
A cleanable poster dictating hand wash method should be displayed above every clinical wash hand basin

17. PPE
Infection control policy should specify when PPE should be worn and changed
Gloves:
Protect hands from contamination, chemicals and to minimise cross infection risk
Glove integrity can be damaged by isopropanol or ethanol, therefore alcohol rubs shouldn’t be used with gloves
Domestic household gloves, if used should be washed with detergent and hot water and left to dry

18. PPE
Plastic single use aprons should be worn during all decontamination processes
Face masks are single use
Visor or face shield should be worn
Footwear should be enclosed
Clinical clothing should not be worn outside the practice
Short sleeves should be used (can wear disposable sleeves)
Uniforms should be washed at hottest temperature suitable for fabric
Clean uniform should be worn every day

19. Removal of PPE Items should be removed in the following order
Gloves first
Plastic apron
Face and eye protection
Face mask
Wash hands thoroughly

20. Maintenance and testing Sterilizer
DAILY
Steam penetration B
Automatic control test B & N
WEEKLY including daily tests plus
Air leakage B
Residual air test N
QUARTERLY (by engineer)
Thermometric tests
ANNUALLY (by engineer)
Thermometric tests - Small load, Large load
Dryness tests - Small load, Large load

21. Maintenance and Testing WD
Validation is needed for new equipment at installation and annually thereafter. Also after any repairs
DAILY
Remove and clean strainers and filters - Ensures filters and strainers are clean
Cleaning efficacy - Visual examination of all load items
WEEKLY including daily tests plus:
Protein residue test - Confirms that cleaning process retains the capability of removing protein
Safety checks - Check condition of door seal
QUARTERLY
Safety checks
Automatic control test
Cleaning efficacy test
Chemical dosing
Thermometric disinfection test
ANNUALLY
Completion of all validation tests above

22. Maintenance and Testing Ultrasonic
Validation is needed for new equipment at installation and annually thereafter. It will also be necessary to validate equipment after any major repairs have been carried out
DAILY
Remove and clean strainers and filters - Ensures filters and strainers are clean
Drain machine at end of day/ session
Cleaning efficacy - Visual examination of all load items
WEEKLY
Safety checks - Check condition of door-seal
Protein residue test
QUARTERLY
Automatic control test
Verification of calibration
Cleaning efficacy test
Ultrasonic activity test
ANNUALLY
Completion of all validation tests above

23. Blood spillages
The use of hypochlorite at 1000 ppm available chlorine is recommended. Hypochlorite should be made up either freshly using hypochlorite-generating tablets or at least weekly in clean containers. Contact times should be reasonably prolonged (not less than five minutes).
A higher available chlorine concentration of 10,000 ppm is useful, particularly for blood contamination. The process should be initiated quickly and care should be taken to avoid corrosive damage to metal fittings etc. The use of alcohol within the same decontamination process is not advised.

24. Sharps Regulations Needles must not be recapped after use unless
the employer’s risk assessment has identified
that recapping is itself required to prevent a risk (eg to reduce the risk of contamination of sterile preparations). In these limited cases, appropriate devices to control the risk of injury to employees must be provided. For example, needle-blocks can be used to remove and hold the needle cap and so allow safe one-handed recapping.