All dental professionals today should be very familiar with HTM 01-05. First published in 2008 these guidelines have the principle aim of making the dental practice a safe and clean working environment to protect both patients and staff alike. However, although most DCPs know they must follow these protocols, do they really understand why they need to? There is a constant balancing act of trying to achieve what HTM 01-05 is saying must be done and what the practice is actually trying to do on a daily basis. So, we need to know why we are being asked to incorporate certain processes , understand the risks and learn how to deal with them.
The basic route of infection within a practice is similar to lighting a fire. A fire needs three things in order to burn; oxygen, fuel and an ignition source. Take away any one of these and the fire will go out. Similarly, the spread of infection starts with an infective agent, which on its own is not a risk, unless it is able to infect a target. The target is the patient or member of staff and so the third key part is the route of infection, which can take a number of different directions. It is not possible to eliminate the target for obvious reasons, but there are many ways of removing infective agents and preventing their spread with the use of rigorous infection control procedures and correct cleaning agents.
The biggest potential infection route within a surgery is hand to surface/hand to patient contact. A patient presenting at the practice with a cold, for example, can easily spread the virus by hand onto the reception desk, posing a potential infection risk to the next person who touches it. However dental surgeries are not dangerous places to visit or work in as long as good hygiene practices are in place. Unlike in hospitals, where infections being carried are usually identified, dental practices in general have to be reliant on patient disclosure, meaning that every patient should be considered and treated as a potential infection risk.
The infective agents that need to be dealt with are bacteria, viruses and prions. Bacteria can be found in every environment and vary greatly in size and shape, but in general most are not pathogenic. They reproduce by simple cell division and in ideal conditions can multiply at a very rapid rate. Some of the most serious bacterial infections are MRSA, cholera, diphtheria and typhoid, but the greatest risk today is tuberculosis (TB), once thought to be have been virtually eliminated from these shores, but which now experiencing a worrying rise in cases.
Viruses are smaller than bacteria and, strictly speaking, are not a living thing, as they require a host cell in order to replicate. Amongst the most serious viruses are hepatitis B and C, commonly referred to as the blood borne viruses and the highly contagious Norovirus (or winter vomiting bug), especially common at this time of year.
Prions are the least understood of infective agents, proteinaceous infectious particles that are responsible for transmissible spongiform encephalopathies (TSE) that are fatal to man. Although to date there have been no cases of TSEs linked to dentistry, it is essential to follow best practice guidelines in thorough cleaning, hand hygiene and instrument decontamination at all times.
Another crucial factor often overlooked in dental surgeries is water quality. It is important to remember that the quality of DUWLs output water entering a patient’s mouth is limited by the quality of the input water, so this should be regularly monitored and results logged to ensure compliance. A simple dip slide test should be made on the input water entering the surgery as well as the output water, coming through the treatment centre. Incubating the slides for 36 hours and checking if any pink dots appear will give a clear and accurate indication as to the level of any harmful bacteria present.
If bacteria are found in the output water it indicates the presence of biofilm that readily builds up in the tubing of DUWLs. Biofilms are tenacious and difficult to remove with conventional cleaners or by simple flushing of the unit with water, and one treatment alone is normally ineffective. It is important that DUWLs are treated on a weekly basis with a proven commercially available biofilm remover, as if biofilm is left to develop it becomes a risk to human health as well as potentially blocking the tubing, leading to costly repairs.
For many dental professionals, understanding the compliance requirements of CQC standards and (in England), HTM 01-05, can be difficult to integrate with the everyday pressures of running a busy dental practice. However, help is at hand. Companies such as Dentisan understand these problems and are committed to helping dental professionals get to grips with the training and education requirements in infection control. A nationwide programme of decontamination and HTM 01-05 seminars, suitable for the whole practice team is scheduled to run again in 2014 to underline this important aspect of practice functionality. These programmes have been highly successful since they were first introduced three years ago and I believe this sort of training is vital to get the infection control message across. During the course we take the audience on a step by step journey through infection control and detail all the requirements made on a practice, with recommendations about how best to comply. The feedback we have received has been excellent and demonstrates the value of good, independent education, in this core CPD area.