Keeping out of harm's way

The importance of automated and validated infection control protocols

Who can forget ‘Hands, Face, Space’? The coronavirus pandemic has given the entire population a crash-course in epidemiology. And still today, a greater awareness of the need and responsibility around ‘spreading germs’ persists. That’s why even in a highly sanitised environment like a dental practice, infection control remains top of everyone’s mind. 

There are two possible ways of patients acquiring a blood-borne virus during a visit to the dentist: one, a minor cut through a protective glove could lead to direct exposure of the patient’s blood with that of the dentist; and two, exposure of the patient’s blood to instruments that have been contaminated with blood from a previous patient and not decontaminated correctly before re-use.[i]

Look sharp

For practice staff, there is the added hazard of a potential sharps injury (and eye splash incidents) particularly for those involved in the decontamination of the surgery’s instruments. Also known as reprocessing, it can be a complex operation that involves several stages including cleaning, disinfection, inspection and sterilisation.

As you know, there are various routes to cleaning instruments: manual cleaning, manual cleaning combined with ultrasonic cleaning and the use of a washer disinfector.

According to HTM 01-05, best practice cleaning should be undertaken using an automated and validated process. This means that the entire cleaning and disinfection process is verified, tested and documented, as well as consistently reproducible.[ii] Something of an impossibility when it comes to manual cleaning. Washer disinfectors from leading manufacturers, on the other hand, have a cycle validation feature which can give dental professionals peace of mind that instruments have been thoroughly processed.

While not mandatory in England and Wales, but in pursuit of best practice, HTM 01-05 recommends the installation of a washer disinfector to remove the need for manual washing. It also suggests the separation of decontamination processes from other activities to enhance the distinction between clean and dirty workflows.ⁱⁱⁱ

Process progress

So, what does a washer disinfector offer? Apart from the benefits of being a validated and more time-efficient than manual cleaning, the machine itself features a five-stage cycle: flush, wash, rinse, thermal disinfection and drying.

Firstly, cold water is used to remove contaminants (such as blood, proteins and fluids); then a detergent temperature wash loosens up and breaks down any remaining contamination; this is followed by a detergent rinse and then a thermal disinfection (whereby the temperature of the load rises and is held for the required time, for example, 90^oC for one minute). Finally, the load is dried to remove any residual moisture. It is then ready for inspection prior to sterilisation.ⁱⁱⁱ 

HTM 01-05 emphasises the need for the machines to be loaded correctly, as
incorrectly loaded instruments will not be cleaned effectively.ⁱⁱ It is also crucial not to overload or overlap instruments.

Accurate records of the process must be kept so that they can be produced during an audit. Certain washer disinfectors are able to keep precise processing and validation records with the use of data logging devices. Again, HTM 01-05 recommends their use as a way to demonstrate best practice.ⁱⁱ Not only does this give an additional level of security but also saves the dental team time by not having to manually transfer data.

North of the border

In Scotland washer disinfectors are mandatory.[iii] At Gunning Dental in Annan, South West Scotland, lead dentist Andrew Gunning recently replaced his old washer disinfector with the Miele Professional PG8581 under bench washer disinfector/s? from Eschmann.[iv] “The Miele Professional washer disinfectors are not only cost effective and easy-to-use, but they also give staff the peace of mind that instruments are thoroughly cleaned and disinfected,” he says.

“We have been working with Eschmann for decades and the ongoing support they provide makes life easier. The installation process went ahead without any issues and Eschmann also delivered ECPD User training to staff, meaning the machines were ready to use in no time at all.”

Infection prevention is a critical aspect for the dental practice and the effective cleaning of instruments and equipment plays a key role in infection control to help prevent pathogens and microorganisms being transferred to patients and staff. Washer disinfectors give dental practitioners peace of mind that their instruments have been cleaned and thermally disinfected in a validated and automated process. They help to protect patients as well as staff, ultimately safeguarding the provision of quality dental care.

[i] Professor David Evans, University of Warwick’s School for Life Sciences, https://warwick.ac.uk/newsandevents/expertcomment/exposure_to_viruses/

[ii] Department of Health, Decontamination in primary care dental practices, https://www.england.nhs.uk/estates/health-technical-memoranda/ [Accessed September 2023]

[iii] Scottish Dental Clinical Effectiveness Programme https://www.sdcep.org.uk/published-guidance/decontamination/ [Accessed September 2023]

[iv] Eschmann case study https://www.eschmann.co.uk/news/eschmann-and-miele-case-study-gunning-dental-practice/