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Thompson : Henry Schein Demo
14 To find out more about Treatment Centres, contact us today... 14 For specialist advice on the issue of decontamination or for more information on Dr Richard Mitzman Cabinetry products, contact us today... The design planning implications of HTM 01- 05: de Dr Richard Mitzman and Geoffrey L Ridgway discuss the impact that HTM 01-05 will have on the design of dental practices HTM 01 - 05 is designed to give not only comprehensive guidance on the whole of the instrument decontamination cycle, but also on the provision of an optimal environment where this exercise can be safely carried out. HTM 01-05 is designed for use by the dentist, the clinical staff, the servicing engineer and the surgery designer. HTM 01-05 recognises that many practice premises in England are within buildings that were never intended for use as clinical dental units. However, there is no doubt that, in many cases, there is an urgent need to upgrade standards of instrument decontamination to at least a basic level of acceptability. It is for this reason that HTM 01-05 allows for a period of transition. Initially, all premises will be required to achieve the essential quality requirements within 12 months of publication of the hard copy version and accompanying audit tool. The essential quality requirements require the practice to have written validated policies for infection control and instrument decontamination. Practices will also be required to demonstrate how they intend to proceed to the requirements for achieving best practice, along with some indication of timescale. Best practice will require the environment for decontaminating instruments to be clearly separate from the clinical treatment area. Essentially, this will require separate rooms for ‘dirty’ and ‘clean’ instruments. Use of a mechanical washer/disinfector will be necessary, and instruments will need to be stored away from the clinical treatment area. Ideally, the air direction in the decontamination suite should flow from the ‘clean’ and storage areas to the ‘dirty’ area. ‘STERILE’ AND ‘STERILISED’ The document Sterilisation, disinfection and cleaning of medical equipment: guidance on decontamination, from the Microbiology Advisory Committee to the Department of Health (known as the MAC Manual Part 1, 2002), defines sterilisation as a process used to render an object free from viable infectious agents, including bacterial spores and viruses. In order to maintain an article in a sterile condition, it cannot be exposed to the room air until immediately before use. In the surgical setting this means that the article must have been processed whilst wrapped, and stored in the original wrapping until required. Unwrapped instruments cease to be sterile as soon as they are exposed to the room environment. Therefore, unwrapped instruments sterilised in a type N, gravity feed autoclave cannot be maintained in a sterile state once removed from the autoclave. Pre-wrapped instruments processed in a type B autoclave, which has a pre-vacuum phase, or instruments contained within the cassette of a type S autoclave specifically programmed for dental instruments can be stored sterile if kept in the original wrapping/cassette. An important point that underpins the guidance in HTM 01-05 is the concept of instruments having been ‘sterilised’ when available at the point of use, compared with the more usually accepted surgical standard of being ‘sterile’ at point of use. This is to acknowledge that most work in general dental practice will not take place in a sterile environment (the oral cavity). Whilst this guidance allows for the wrapping and storage of sterilised, unwrapped instruments after they have been autoclaved, such storage is for a limited period under optimised conditions. However, although these instruments are not sterile as defined above, this is not a reduction in standard of re-processing, which (with few exceptions) requires reusable instruments to be sterile at the completion of the decontamination process. SUMMARY OF IMPLICATIONS OF HTM 01-05 TO THE DESIGN OF DENTAL PRACTICES The overall aim is that the instrument should be: • Clean and sterile at the end of the decontamination process • Maintained in a clinically satisfactory condition up to the point of use. With a vacuum steam steriliser (types B), instruments will be pre-wrapped using purpose-designed materials that are compatible with the steriliser. Wrapping should take place with a dry product shortly after washing and disinfection. Once the wrapped instruments have been sterilised satisfactorily, the product may be stored for up to 60 days. Similarly, instruments processed in a cassette in a type S steriliser designed for re-processing dental instruments can be stored in the sealed cassette for 60 days. Instruments processed in a type N steriliser (gravity or downward displacement steriliser) should either be used in the current session, or immediately placed in suitable view packs for storage for up to 21 days. Regardless of the choice of location used for the reprocessing facilities, a dirty to clean workflow should be maintained so that the used instruments are at a lower risk of coming into contact with decontaminated instruments. This requires a well-developed routine for surface cleaning/decontamination within the facilities: • One room for dirty activity (cleaning instruments) • One room for clean activity (inspection, sterilisation and wrapping instruments (pre-wrapping for processing in type B or S sterilisers and post-wrapping for instruments processed in a type N steriliser). Where possible, air movement should be from clean to dirty areas. A wash-hand basin should be provided for use by staff at the completion of each stage in the decontamination process. This guidance recognises that, because of physical limitations on space, it may take longer for some practices to meet the best practice requirements. In areas where building alterations to existing premises are restricted and/or purpose-built premises may be difficult or impossible to acquire, best practice may not be achievable. MINIMUM REQUIREMENTS NOW: 1. Processing of contaminated instruments in a separate space from treatment areas 2. Decontamination area separated into dirty and clean zones 3. Dirty zone has sinks with draining for scrubbing and rinsing instruments and another designated solely for hand washing and designed for that purpose 4. Dirty zone has instrument washer/disinfector (W/D) (ultrasonic cleaner is an optional item in addition to a W/D) 5. Clean zone has sink designated solely for hand washing and designed for that purpose 6. No contaminated instruments or personnel pass through clean zone 7. A dirty to clean workflow should be maintained 8. Where possible, air movement should be from clean and storage areas to dirty area 9. Adequate uncluttered worktops 10. Ample clean storage Below is a plan (Figure 1) of the absolute minimum necessary for a decontamination area. It needs 5.25sqm (54sqft), about 11 x 5 feet. Figure 1: Minimum decontamination room to be compliant now The easiest way to explain what has to be done is to describe what the decontamination areas should include to be: a. Compliant for mandatory guidelines, now (Figure 2) b. Compliant for ‘best practice’ in five years time (Figures 3 and 4). Figure 2: Single decontamination room compliant now Figure 3: Double decontamination room ‘best practice’ Figure 4: Elevation of double decontamination room, best practice At the moment, very few existing practices have an instrument washer/disinfector, let alone a pass-through model. The instrument washer/disinfector should always be in the dirty area; the steriliser in the clean area. The washed instruments then have to be carried through to the clean area to be inspected and packed. The biggest difference for the ‘best practice’ decontamination areas is that the dirty and clean areas have to be divided into separate rooms each with a door and individual air supply and extraction. J001-01-11HSEQ Focus:Layout 1 20/1/11 11:44 Page 14