Sarah Bain, Director of the Bristol School of Dental Care Professionals, Bristol University, highlights the benchmarks by which compliance with essential quality requirements and Best Practice can be achieved regarding hard surface decontamination.
The 2013 edition of HTM - 01-15 states that, "patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment.
This article will highlight the specific benchmarks by which compliance with essential quality requirements and Best Practice can be achieved regarding hard surface decontamination. By implementing these suggestions it will help the Practice demonstrate to patients that it is capable of operating in a safe and responsible manner with respect to their health and safety. It will not cover the other essential topics regarding the same aspects for personal protection and hygiene for the whole Dental Team or decontamination and sterilisation of dental instruments and other medical devices.
The information provided here also follows the essential principles given in the Health and Social Care Act 2008: Code of Practice and its 2010 revision on the prevention and control of healthcare associated infections. These principles require that effective prevention and control of healthcare-associated infections be embedded in everyday practice. Clean, safe care – reducing infections and saving lives – demands the need for high-quality environmental cleaning and decontamination as vital components in reducing rates of infection. Every practice should be capable of at the very least meeting, but preferably exceeding, the essential quality requirements. These include, among other things:-
Auditing their decontamination processes at least every six months using an appropriate tool.
Having in place a detailed plan on how the provision of decontamination services will move it towards Best Practice.
Having an infection-control policy in place and available for external inspection. This policy should indicate full compliance with the essential quality requirements. In addition, a written assessment of the improvements the Practice needs to make in order to progress towards meeting the requirements for Best Practice should be available together with an implementation plan too.
What does this mean within the practice generally?
All work surfaces where clinical care or decontamination is carried out should be impervious and easily cleanable. They should be jointless as far as it is reasonable; where they are jointed, such joints should be welded or sealed. It should be ensured that all surfaces within these areas can be easily accessed and will dry quickly.
Similarly, all flooring in clinical care and decontamination areas should be impervious and easily cleanable. Carpets, even if washable, should never be used. Any joints should be welded or sealed. Flooring should be coved to the wall to prevent accumulation of dirt where the floor meets the wall.
The practice should have a local protocol clearly outlining surface- and room-cleaning schedules. The cleaning process will be most effective if the more contaminated areas are cleaned first. Materials and equipment used to clean clinical areas and other higher-risk areas should be stored separately from those used for general and non-clinical areas. Simple records should be maintained in accordance with the Code of Practice.
The use of disinfectant or detergent will reduce contamination on surfaces. The HTM - 01-15 Guidelines say that, if there is obvious blood contamination, the presence of protein will compromise the efficacy of alcohol-based wipes because alcohol has been shown to bind blood and protein to stainless steel. However, because alcohol containing disinfectants and wipes need in excess of 10 minutes’ contact time before alcohol binds proteins to stainless steel, this may not be such a problem in reality. Consequently, the use of alcohol-based disinfectants and wipes may be the best option in certain clinical situations, depending upon the nature of the surface being disinfected and personal preference.
Decontamination of treatment areas
The patient treatment area should be cleaned after every session using disposable cloths or clean microfibre materials – even if the area appears uncontaminated.
Areas and items of equipment local to the dental chair that need to be cleaned between each patient visit include work surfaces, chairs, curing lights, inspection lights and handles, hand controls including replacement of covers, trolleys/delivery units, spittoons, aspirators and x-ray units.
Areas and items that need to be cleaned after each session include taps, drainage points, splash backs and sinks.In addition, cupboard doors, other exposed surfaces (such as inspection light fittings) and floor surfaces (including those distant from the dental chair) should be cleaned daily.
Items of furniture that need to be cleaned weekly include window blinds, accessible ventilation fittings and other accessible surfaces such as shelving, radiators and shelves in cupboards. Purpose-made, disposable, single-use covers are available for many of the items mentioned above; however they should not be taken as a substitute for regular cleaning. Such covers should be removed and the underlying surfaces still cleaned after each patient’s visit.
For infection-control purposes, in clinical areas covers should be provided over computer keyboards, or conventional keyboards should be replaced with ‘easy clean’ waterproof keyboards. If covers or conventional keyboards are used, care should be taken to ensure that the covers are changed or that washing is performed at frequent intervals.
This cleaning should centre on simple techniques, using disposable cloths wetted with clean water and an appropriate detergent. Dry cleaning should be avoided wherever possible as this may result in a bacteria-laden dust suspension being distributed around the surgery.
ChairSafe - alcohol-free surface disinfectant and surface disinfectant wipes
According to the manufacturer, Kemdent’s ChairSafe range of alcohol-free hard-surface disinfectants, foam and wipes have been specially formulated to clean sensitive surfaces and equipment, including the leather and synthetic facings of dental chairs. The wipes are available as single-use dry wipes for use with ChairSafe Spray or Foam, pre-impregnated economy wipes and pre-impregnated microfibre wipes.
Used in combination with the dry wipes, the spray delivery of ChairSafe Spray is recommended for use on large surfaces where you want to cover a large area quickly and easily, for example: work surfaces, chairs, cupboard doors, shelves in cupboards, sinks and splash backs etc. The foam, which is non-drip and remains exactly where you apply it, is said to be more suited to smaller items for example curing and inspection lights.
The pre-impregnated economy or microfibre wipes can be used as an alternative to the dry wipe / foam or spray combination. As well as being suitable for use on trolleys and shelving, they are particularly useful for disinfecting small and fiddly items for example curing lights, inspection lights, aspirators and spittoons, x-ray units, taps, draining points, window blinds, ventilation fittings and radiators.
Compared with economy wipes, microfibre wipes are larger and more heavy duty, which makes them even better for use when cleaning larger surface areas. Available as either dry wipes, for use with ChairSafe Spray or Foam, or pre-impregnated for even greater economy, microfibre wipes are designed to provide superior removal of dust, dirt and micro-organisms because they are able to attach themselves and thereby lift up even the smallest and most microscopic dirt particles.
Whichever option is chosen they are all effective against bacteria including MRSA, Pseudomonas Aeruginosa, Staphylococcus Aureus; viruses including BVDV, Vaccinia, H1N1, Hepatitis B, Hepatitis C; and Fungi. Used as recommended ChairSafe hard surface disinfectants are effective against the above pathogens in one minute.
Table 1, above, contains a summary of the surfaces that need to be disinfected either between patients, daily or weekly. It also contains our recommendations for the best combination of ChairSafe products to use for each surface.
During our recent assessment of the complete ChairSafe range within the department we were impressed with the heavy-duty microfibre wipes. They were very easy to use, had a pleasant smell and one wipe went a long way. They spread well and did not leave a foamy residue, unlike some other products we have used. We would recommend the pre-impregnated microfibre wipes as the first product of choice for all applications, with the added benefit that you do not need to have different options for different surfaces.
The next best option for most applications was the spray with a single-use dry wipe. The spray was great to use on larger surface areas in particular because it covered the surface area the best, but we still preferred using a pre-impregnated wipe rather than a spray and wipe combination because it was easier. For smaller items we still preferred to use microfibre wipes to avoid excess aerosol use.
Having evaluated the ChairSafe range, we believe it contains everything required to enable dental practices to fulfil the requirements of the 2013 edition of HTM - 01-15 and Best Practice. In most cases our first choice of product is the pre-impregnated microfibre wipe, which is suitable for all surfaces and is quick and easy to use.
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The ChairSafe range of surface disinfectants is manufactured in the UK by Kemdent Ltd.
For further information contact Kemdent on 01793 770090