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DECONTAMINATION TRAINING. Brent PCT Dental Decontamination Tracey Miller Authorising Engineer (Decontamination). Why do we need to disinfect and sterilize?. Medical devices (where appropriate) require a disinfection and sterilization process prior to being used on a patient
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DECONTAMINATION TRAINING Brent PCT Dental Decontamination Tracey Miller Authorising Engineer (Decontamination)
Why do we need to disinfect and sterilize? • Medical devices (where appropriate) require a disinfection and sterilization process prior to being used on a patient • The disinfection process for surgical instruments is undertaken thermally using water at specific temperatures • Various methods of sterilization – however, within the PCT benchtop high-temperature steam sterilizers are the preferred method • The complete process requires regular testing and monitoring to comply with current standards and regulations
Decontamination • Decontamination is a combination of processes • Cleaning • Disinfecting • Inspection • Sterilizing • In order to achieve complete decontamination all aspects of the process must be adhered to and these must be monitored and checked throughout • In order to achieve sterility all items MUST be clean before being processed
Standards & Regulations Health Technical Memorandum 01-05 (HTM 01-05) – Decontamination in primary care dental practices, re-published November 2009 ‘Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment’ To support and advance good practice – by the end of the first year all practices will be working at or above the essential requirements A registration process will be introduced - audited by Care Quality Commission Follows the principles introduced in the Health & Social Care Act, 2008
Standards & Regulations • HTM 01-05 defines ‘best practice’ • Validated, automated washer-disinfector • Preferable to manual decontamination – difficult to validate • Re-producible cycle • Dedicated decontamination areas • Removing the decontamination process from the patient treatment area • Good workflow • Storage of processed instruments • Ensuring that there is no potential for re-contamination of items • Dating packages – encouraging good stock rotation
Disinfection • Automated washer-disinfector cycle • Flushing – initial stage to remove gross contamination, water usually < 45° to prevent coagulation • Washing – removal of remaining soil, specified detergents with a wash temperature as specified by manufacturer • Rinsing – removal of detergent • Thermal disinfection – water should be of a good quality (reverse osmosis or distilled) – temperature usually 80° or 90° • Drying – to remove residual water • Printouts should be retained
Disinfection • Recommendations • Clean instruments as soon as possible after use • Transferring to decontamination quickly aids the cleaning process • Remove any amalgum, cement etc as soon as possible • Loading baskets • Dismantle instruments where appropriate • Open all hinged forceps • Attach lumened items to irrigators where appropriate • Do not overload the basket • Do not ‘shadow’ items
Inspection • Inspection process • Visually check all items to ensure cleaning process was successful • Remove any items requiring repair • Replace any broken items • Use of a light / magnifier recommended • Any item found to have residual soil should be re-cleaned
Sterilization • All sterilizers must be used in accordance with manufacturers instructions • It is a legal requirement for sterilizers to be tested by a Competent Person (Pressure Vessels) – Pressure Systems Safety Regulations 2000 • Safety requirements must always be followed • Sterilizers should be drained of water at the end of the day, cleaned and dried • Re-filled with water (reverse osmosis or distilled) daily • Serviced and tested by a Competent Person (Decontamination) • Failure to carry these out could compromise safety and have legal / insurance implications for the registered manager
Sterilization • Benchtop sterilizers • Vacuum • Can be suitable for wrapped goods and lumened equipment • Have an air removal stage • Longer cycle time • Items can be wrapped, dated and stored (HTM 01-05 now states 60 days) • Non-vaccum • No air removal stage • Not suitable for wrapped goods or lumened items • Can be wrapped and stored for up to 21 days
Servicing and Validation • All decontamination equipment should be serviced • Usually by the manufacturer or independent company • Prior to validation • All decontamination equipment should be validated • HTM defines the periodic test requirements • Daily Operator / User • Weekly Operator / User • Quarterly Competent Person (Decontamination) • Annually Competent Person (Decontamination)
Logbooks • Logbooks are required for all equipment • Should be specific to a machine, retained in office or by machine • Must be filled in and signed • All data should be recorded, all signatures legible, no liquid paper • Can be used in a Court of Law • Printouts should be attached (where appropriate) • Must be retained – HTM states ‘not less than 2 years’ – however, sterile service departments within Acute Trusts – 11 years – may be 20 • Provide a complete ‘history’ of the machine • Failed cycles should be noted • When machine fails – should be removed from service
Storage • Protect against aerosols, contact with environment, other instruments • Reduces the risk of re-contamination • Stored away from sunlight and water • Secure, dry, cool environment • Good stock rotation required • HTM 01-05 states up to 60 days from date of sterilization if items are sterilized in a vacuum benchtop – this may change as further research occurs
Operator A person with the authority to operate decontamination equipment Includes noting required instrument readings and completion of the necessary housekeeping duties (i.e. records) Competent in required duties and training record maintained User Responsible for the management of the sterilization and disinfection procedures Responsible for the ‘day-to-day’ running of the equipment Responsible for ensuring operators adequately trained Management Chief Executive or similar authority -ultimately accountable Roles and Responsibilities
Competent Person (Decontamination) Person delegated / contracted to carry out validation He / she should:- be qualified to HNC in engineering or a microbiological science have completed an accredited course for Test Persons been recently employed in a hospital with responsibility for validation and periodic testing on one or more processes Authorising Engineer (Decontamination) Provides independent auditing on sterilization and disinfection procedures within the organisation Reviews / witnesses validation documentation Advice and help on all decontamination issues Roles and Responsibilities
Summary of Operator responsibilities • To undertake daily / weekly tests • To record / sign all tests in logbook • To follow written procedures • Use equipment safely • Report all defects / failed cycles
Summary of User Responsibilities To certify that the sterilizer is fit for use. To hold all documentation relating to the sterilization equipment. This will include the names of key support personnel. To ensure the equipment is subjected to periodic testing and maintenance. To appoint operators (where required) and ensure that they are adequately trained. To maintain production records. To establish procedures for product release.
Why? “Why is all of this necessary?” “It’s so time consuming” “We never had to do this before” “No-one ever checks the records anyway” “Why does the machine always break down after the engineer has been” Well ……………
So why do we have to do it? … because ‘Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment’ HTM 01-05 We all have a ‘duty of care’ We are all responsible for our actions One day, we or our loved ones, will be the patient
