Introduction
Effective decontamination of dental instruments is very critical for the safety of patients as well as management of infections within the premises of dental clinics. The decontamination is essential to ensure that all dental instruments reflect the highest quality for usage as well as reflecting modern day standard for decontamination in general dental practice.
It is essential to realise that there is laid down procedures in health practice to ensure that all the equipments used for the dental service are decontaminated for adequate protection against infections, and for the proper management of facilities used for dental service. Thus, it is essential to realise that prevention of hazardous is very essential, and it is through the minimisation of hazardous cases that compliance with decontamination procedure can be achieved.
Despite the essential importance of decontamination, there are standard technical devices attached to current best practice guidance of medical devices of decontamination that make it to be quite complex occasionally. (Department of Health, 2005, National Electronic Library Infection, 2004, Godfrey, 2007).
Meanwhile, the complexity associated with the current best practice guidance of medical devices decontamination in general dental practice make some medical professionals to call for audit against current best practice of decontamination in a general dental practice.
The objective of this report is to provide an audit report against current best practice guidance of medical devices decontamination in a general dental practice.
The structure of this report is as follows:
- First, the report provides overview of current best practice guidance of medical devices decontamination in a general dental practice.
- Next, the report provides audit report against current best practice guidance of medical devices decontamination in a general dental practice.
- The final part of this report provides necessary recommendation to ensure that there are adequate devise to enhance decontamination in order to ensure absolute safety of dental instruments.
Overview of current best practice guidance of medical devices decontamination in a general dental practice
Decontamination is the process of ensuring that all the dental instruments are rendered safe for handling by the dental staff, and for further use. It is essential to realise that decontamination is to minimise the risk of cross-infections in the dental hospitals that might have occurred between the patients and the dental staff. Typically, current best practise of decontamination involves several stages that include disinfection, cleaning, inspection, and sterilization. According to Department of Health in England, there are processes by which the best practise of decontamination of dental instruments is carried out for the safety of the patients and the dental staff.
First, there is a need for installation of modern process of disinfection, which involves using a washer-disinfector (WD) to make the instruments safer to be used in order to reduce the number of viable microorganisms. Typically, disinfection after cleaning produces very good results on the reduction of microorganisms.
Moreover, there is need for the provision of storage for instruments in order to ensure reductions of air exposure
In addition, sterilisation is carried out after cleaning and disinfection in order to ensure that there is absolute decontamination of instruments for the minimisation of cross-infection between patients and dental staffs. (Godfrey, 2007).
Despite all the procedures described above to ensure current best practice guidance of medical device decontamination in a general dental practice. There is still call for audit against current best practice guidance of medical device decontamination. For example, the results of survey carried out in 1999 on all NHS hospitals about the decontamination of surgical instruments on all medical, and dental hospitals in England revealed that application of decontamination in these hospitals were fell short of current best standards. From the survey, some practise of decontamination was poor, and there is need for substantial improvement on the current decontamination standards of dental practice. (Department of Health, 2005).
Audit against current best practice guidance of medical device decontamination in a general dental practice
The audit is the process of carrying out independent evaluation of a study in order to ascertain whether it meets the criteria laid down. It is essential to realise that to ascertain the validity of a service, there is need for independent auditing to ascertain the reliability of service provided
In the decontamination of the dental practice, there is best practice guidance of medical device decontamination laid down for general dental practice. The British Dental Association, and Health Technical Memorandum have general procedures that all dentists should follow in best practice decontamination process, and to ascertain that these laid down procedures are followed, there are occasional audit of the dental practice to ensure that the decontamination procedure are followed.
Typically, to ensure the control of cross infection, the correct decontamination is extremely important, it is essential to realise that vast number of instruments are used everyday that range from basic to heavy surgical instruments. Typically, these instruments are exposed to number of contamination materials such as saliva, and blood. The findings from this audit will identify the needs for changes in the current best practice guidance of medical device decontamination in a general dental practice. (Department of Health, 2008).
In carrying out audit procedure to ascertain whether current best practice guidance of medical device decontamination in a general dental practice is followed, Department of health carried out audit control on the current decontamination procedure in dental practice in 2004. The technique the Department of Heath used for audit control was by carrying out series of survey on general practice of the decontamination procedure in the dental practice to ensure safe infection control standard.
However, from the result of auditing by the Department of Health, it was revealed that many dental hospitals did not follow the decontamination standard with correct dental equipments.
In addition, it is revealed that in the current dental practise, there is no recognised process that can be used to deactivate prion protein. It is essential to realise that prion protein has been found in the dental instruments, and their contact with dental tissues can have effect on transmission of disease. It is noted that deactivation of prion protein is essential to comply with Health Technical Memorandum. However, as indicated by Godfrey, (2007), “currently there is no sterilization process which can inactivate prion protein whilst not affecting instrument quality. It is the cleaning process and its ability to remove protein that has become the process targeting prion protein. It is essential, therefore, that cleaning processes in dental decontamination are no less rigorous than those cleaning processes used in acute Trusts”.(p 6).
However, the only suggested technique to remove protein is validated steam sterilization procedure, which at least reduces risk of prion transmission. (Department of Health, 2009).
Moreover, in compliance with best practice guidance of medical device decontamination in a general dental practice. The dental instrument that are not used frequently should not be stored for long period of time because storing these instrument for longer period may lead to occurrence of pathogenic recolonisation. However, audit results by Department of Health revealed that many dental hospital stored dental instrument for more than 30 days, which exceed maximum of 21 days stipulated for best practice of decontamination procedure in a general dental practice. (Department of Health, 2008).
In addition, the survey carried out by Department of Health in 2001 to ascertain whether NHS complied with Decontamination of surgical instrument in 249 NHS private dental hospitals in England revealed that 109 hospitals did not meet the best practice standard of dental practice. (Department of Health 2001).
In addition, comprehensive data analysis on several dental hospitals in 2001 revealed that 27% of sterilizers used in these hospital hospitals were more than 16 years old, and 22% of sterilizers were between 11 and 15 years old. There are also deficiencies in several in the washer-disinfectors, and sterilizers.
For example, the critical analysis carried out at Mid Yorkshire Hospitals NHS Trust to examine the hospital’s compliance with best practise of dental practise revealed that three of the departments in the hospital had non-compliant decontamination equipments, and there were poor facilities that may lead to cross-infections.
Moreover, the analysis of Darlington Memorial Hospital also revealed that many of the decontaminated equipments were outdated that needed to be replaced. (Department of Health, (2005).
Added to this, the survey carried out by the Scottish government to ascertain the compliance with best practice on decontamination dental practice revealed several interesting results, which are contrary to the best practice.
Thus, In compliance with BDA standard, the total numbers of 373 dentists were recruited for survey in 2004. Meanwhile, total numbers of 179 dentists were available for survey.
Thus, the findings from survey revealed that 96% use manual washing as method of cleaning process. In addition, most of the responses use cleaning agent for surgical instruments, however many of them did not use standardisation cleaning agents.
In addition, the management of decontamination is solely word of mouth to communicate with various member of dental team. 57% of the dental practice had no record document or documented procedures. It is essential to note that in the dental practice, there should be documentation with regard of control of infection. With regard to procurement of reusable instruments, 86% did not review current decontamination procedure before purchasing the dental equipments for the first time.
Thus, from the audit finding of dental practice in Scotland, it is revealed that many dental practices were not aware of SHTM 2010 guideline on dental practice. Meanwhile, the effort of staff of general dental practice was misdirected because of lack of clear guidance for the decontamination. It is essential to realise that decontamination of instruments required high level of technical knowledge to be carried out. (The Scotland Government, 2004).
To ascertain this argument, there was application of Failure Mode and Effect Analysis (FMEA) to conduct the decontamination assessments among the dental practise. The programme took place for the period of four years between 1999 and 2003. During the assessment, there were survey, and comprehensive review. In the analysis, Department of Health selected total 29 hospitals SSDs. The overall findings revealed that 20% has poor decontamination procedures, between 21% and 40% need improvement in order to meet the best practice of dental practice. Between 61% and 80%, record good results, 81%, and 100% had very good compliance value. Although, the result over the four-year period revealed that there have been improvement in the compliance to the best practice in the dental practise in the UK.
As being indicated by department of Health “Whilst this indicates that there have been significant improvements in the application of standards for cleaning and sterilization, there are still sites where further improvements are required to achieve a fully compliant status”.(p5, 2005).
Conclusion
This report carries out the audit of current best practice of medical devices decontamination in a general dental practice. The report carried out several audit process following the Health Technical Memorandum, and the British Dental Association procedures. The audit tools used in these report are survey and questionnaires. Meanwhile, from the findings of these report, it is revealed that the best practice of decontamination process in general dental practice are not been followed in totality. It is also revealed from the report that many NHS UK hospitals still lack the necessary facilities in order to follow the best practice. There are cases where sterilization process does not follow the best practice of decontamination. However, the report further reveals that over the years, there is improvement in the compliance process of best practice by dental practice.
Despite the improvement in the compliance. There is still shortcoming in the decontamination dental practice in certain regions in the UK.
Meanwhile, with these shortcomings in the best practice, this report provides the following recommendations.
First, there is need for further research to develop new method of decontamination. It is essential to realise that there are some dental instruments difficult to sterilize, and there is need to develop methods where these instruments will be easy for the dentist to carry out the decontamination.
In addition, there is need for more funding of some NHS hospitals. The report reveals that there are some dental hospitals that lack essential materials to carry out the decontamination in accordance with best practice due to insufficient of materials. Thus, if government could provide more funding, there will be improvement of decontamination of dental equipments.
Finally, there is need for training of dental practitioners in order to develop their knowledge on the management of decontamination in the dental practice.
References
Department of Health (2001) Review of Decontamination of surgical instrument in NHS in England, NHS Estates.
Department of Health, (2005), The Decontamination of Surgical Instruments in the NHS in England Update report “A Step Change”, the Department of Health Gateway number: 4625, efm Standard.
Department of Health (2007), Decontamination Health Technical Memorandum 01-01: Decontamination of reusable medical devices, TSO (The Stationery Office), UK.
Department of Health, (2008), HTM 01-05: Decontamination in dental practice: Decontamination care Dental pratices, UK.
Department of Health, (2009), Decontamination Health Technical Memorandum 01-05: Decontamination in primary care dental practices, UK.
Godfrey, B, (2007), Decontamination in General Dental Practices Dhssps General Dental Services Quality Improvement Scheme Technical Guidance, Health Estates.
National Electronic Library Infection, (2004), Decontamination of Re-Usable Medical Devices, Health Protection Agency.
The Scotland Government, (2004), NHSScotland: Sterile Services Provision Review Group: Survey of Decontamination in General Dental Practice, NHSScotland: Sterile services provision review group: 1st Report.