Q. I am interested in knowing if all practices follow the procedures below for cross infection control. If you do have you been obliged to allow in your day additional time or staff for these procedures to be carried out. If you do not allow additional time, how long does it usually take to complete the procedure? I would be eternally grateful for any feedback. I am desperate.
Cross Infection Control
At the beginning of the day after putting on uniform wash hands with soap and water following the procedures outlined in the hand washing guide.
Put instruments and handpieces in a box which is some moisture, but not overly wet. Put the cover on the box.
Remove mask and gloves. Do not put masks or gloves in your uniform pocket. Be sure that they are placed in the clinical waste bin.
Carefully transport the instruments to the decontamination room
Upon entering the decontamination room wash hands again with either soap or hand disinfectant following the procedures outlined in the hand washing hygiene guide.
Put on face mask, eye protection (goggles or visor), If you wear the visor, you still have to wear the mask, apron, gloves and heavy duty (black) gloves.
Take the lid off of the instrument box. Place instruments in the disinfection solution. HAND PIECES DO NOT GO INTO THIS SOLUTION. The instruments may stay in the solution for a random period of time.
Remove instruments from the disinfectant solution and place in the ultra sonic bath for a minimum period of ten minutes.
While the instruments are in the ultrasonic bath run clear plain water into the blue plastic bowl which should be located above the sink.
Place the instruments into clean blue bowl filled with warm water. Rinse them and inspect them one by one under magnifying light before you place them on metal autoclave tray. If you find dirty instruments at this stage you must place them back in the ultrasonic bath or clean them manually in the metal sink with water temperature below 45 degreesC using appropriate disinfectant and long handle brush. Scrub them under water to avoid splashing.
Handpieces do not follow this procedure
They must first be wiped with disinfectant and oiled before going through the auto clave process
Place instruments in the autoclave. On the required cycle.
When cycle has finished remove instruments from the autoclave.
Wash the now empty box with water and spray with disinfectant. This box should be transported back to the surgery with lid on and empty. Disinfect the blue bowl by spraying. Wash and disinfect gloves with spray. Wash brushes in hot water and store upright on the clip provided.
Remove PPE in this order. Gloves, plastic apron, face mask, eye protection. Wash hands again either with soap or disinfectant.
A. We employ 2 decontamination nurses to ensure the unit is fully covered, and the nurses can concentrate on their job.
A. We broadly follow this procedure but have employed an additional nurse as scrubs nurse in the decontamination room!
A.I have had to employ a person to run the decontamination room, it doesn’t work if you have your nurses doing it in between patients there isn’t enough time. I don’t know how many surgeries you have we have roughly 7 so with all the guidelines etc we took the decision to man it. We don’t use a qualified nurse as this is not cost effective but employed a person who works the room and as long as they are fully covered with Hep B etc and are learnt what to do then this will be the most cost effective way.
A.We have a member of staff working within the decon room every session (barring staff shortages when everyone chips in), so all these jobs are done within the session, it works very well for us, we are very busy and couldn’t manage without an allocated person
A.With the changes to cross infection control and the subsequent timing issues, we have now contracted a start time 30 mins prior to the start of the practice opening times, to give us all an opportunity to get set-up without too much stress. We do the same at the end of the morning session we close at 12.30pm to give 30 minutes or so for the end of session procedures. (It gives me a chance to bother the dentists with admin!!!). Of course, we do the same at the end of the afternoon session which ends around 5.30pm allowing 30 minutes clean-up (end of day admin as well). If you would you like a copy of my infection control policy/hand cleaning policy etc., just let me know.
We have a designated member of staff working in the decon room full time – not sure how you’d be expected to work this into your daily routine and maintain seeing the same amount of pts?
A. Yes all of this apart from the soaking.
We have a central decon room for the processing as to do this in surgery between each patient would have taken up a lot of surgery time. I believe that it is still the case that a patient should not be in the room for certain sections of the decontamination process so again this lengthens the turn around time between patients.
I am under the impression that now the guidance has moved away from “Soaking the instruments” as this can cause prions to harden to the instruments. The spraying option with a specific product is the preferred method of use before the instruments go into the ultrasonic bath.
Once the patient has been treated the nurse should place the dirty items safely in the box and then change her gloves and wipe down the surgery.
Is one of your dentists a BDA member? If they are you may have a source of telephone contact to the BDA for advice. This would be recommended. Are you or one of your nurses indemnified? If so you will have access to advice via this route too.
Do you have an NHS contract? If so it will not just be what the HTM01-05 dictates but also NICE guidelines and any quirks by the PCT will be applicable.
A.Every day one of the nurses is the assigned decontamination nurse and all our nurses are given an extra (paid) 20 minutes at the start of the day to ensure cross infection procedures are carried out and surgeries prepared for the day’s patients.
A.We pay the girls 15 mins in the morning overtime for setting up, and also if needed 15 mins at end of day overtime to do end of day duties, bearing in mind they usually have 30 mins after the dentist has left to complete all tasks, and it seems to be working. All end of day jobs are listed for them, so they just need to tick off and sign when done.
It might be an idea just to provide each surgery an extra secure lidded box to transport clean instruments, they are not very expensive. We label our tubs, CLEAN/ DIRTY.
A.Our practice has 3 surgeries running at one time and we have a designated nurse to carry out all the decontamination procedures.
A.We do not have a decontamination room at the moment but I would envisage employing a member of staff to work in there as we will not block off time in the dentists book for this. I think it is more economical to employ someone else and run 3 full surgeries and on a rota basis have someone to cover all these extra duties.
A.I am practice manager in a large NHS Surgery.
We found the only viable solution was to employ an extra nurse to enable us to have a full time ‘scrub nurse’. Each nurse takes a turn to do this which means all the staff have a really good knowledge of the infection control routine.
Our procedures differ slightly to yours but are tailored to our practice.