Decontamination Sciences Flashcards
GDC requirement
1.5 Treat patients in a hygienic & safe environment
- Health & Safety
- Decontamination
- Medical Devices
Important for patient perceptions
operator
defined as any person with the authority to operate a sterilizer/washer disinfector including the noting of device readings and simple housekeeping duties
record keeping for decon
If it is not documented it did not happen
Audit been through decontamination and sterilisation practice and quality check
shortcomings in dental practice decon before addressing
Several shortcomings
- Combined with eating area, storage for staff
Potential mix up of clean and dirty
dental practices scotland now
among the best as of high standards and continued training
Packaged sterilised equipment – how they are stored
standardised way equipment stored in dental hospitals and practices
Package sterilised instruments have standard in hospital and in practice
- equal level
3 levels of spaudling classifications
critical - needs to e sterile
semi-critical - sterile preferable/high level disinfectant
non-critical - disinfectant/clean
Critical spaudling classification
– devices that enter tissue that is usually sterile or enters the vascular system
- STERILE
non-critical spaudling classification
– Instruments have contact with intact skin only
– Disinfectant/ clean
semi-critical spaudling classfication
– Instruments have contact with intact mucous membranes but does not penetrate sterile tissue
– STERILE preferable/ high level disinfectant but these have no place in dental practices
eg dental semi-critical instuments
mirror (sterile preferable)
e.g. dental critical instruments
handpiece
water irrigator
what does the rise of ‘surgical’ dentistry mean
increased demand for sterile instruments
- more invasive
mucoperiosteum flaps etc
4 reasons why we need sterile instruments
reduces probability of infection transmission
International standard for surgical instruments.
Legislative and professional standards.
Maintaining high quality of care for patients
invasive surgery needs
Any invasive surgery need sterile instruments
- Wrapped before going into steriliser
- When receive from steriliser will remain sterile until unwrapped
all dental surgical instruments
issue with type N non-vacuum sterilisers
evidence non-vacuum sterilizers (type N) fail to achieve sterilization conditions inside dental handpieces
sterile means
For a terminally-sterilized medical device to be designated “STERILE”, the theoretical probability of there being a viable micro-organism present on/in the device shall be equal to or less than 1 x10^(-6)
life cycle of re-useable surgical instruments
acquisition - purchase/loan
cleaning ->
disinfection ->
inspection ->
(disposal - scrap/return)
packaging -> sterilisation -> transport -> storage -> use -> transport -> cleaning again
operator level of decon sciences
Keep it simple - Single use devices where practical - Automated washer-disinfectors - Inspection - Pouch it (paper or clear bag) & sterilize it (type B process)
Record Keeping
Additional resources SDCEP – decontamination in practice
BBVs
HIV Hep B Hep C vCJD Herpes Simplex
HIV transmission dental concern
Aware of HIV transmission in dentistry
- news report from the USA about patient Kimberly Bergalis experience
There are many publications about this “Acer” Florida dentist case & HIV transmission in dentistry.
little evidence of HIV and dental transmission link
hep B and C infection transmission in dental practice
concerns (recent as 2009)
large press converage
more common BBV dental transmission with
herpes simplex
improvements in decon dental transparency
Improvements prompted most recently by
2007 DOH risk assessment for vCJD & dentistry
- Press influence public perception need to be transparent and active about dental decontamination procedures
why worry about vCJD?
Prions more difficult to inactivate on surgical devices
Infectivity can survive steam sterilization at 134°C for 18 minutes
dental relevance of prion research
This study provides evidence that in animal models;
Infectivity was found in both dental pulp and the gingival margin within 3 weeks of challenge with infectious prion
Exposure to deliberately contaminated dental files, 68 of 70 mice (97%) of mice developed clinical disease – worst case scenario
cases of vCJD
Cases are low (n=178 UK) but asymptomatic carriage may be relatively high
Suspected asymptomatic vCJD carriage in UK = approx. 1 in 2,000 (but wide confidence intervals)
risk of bacterial cross infection in dentistry
Post operative treatment or complication of dental surgery
- Need investigated and monitored
- better documentation needed for post op
Infection transmission in dental practice
- An implant periapical lesion leading to acute osteomyelitis with isolation of Staph aureus
S.aureus and oral infections
This study provide evidence that S. aureus can cause dento-alveolar infections.
- N= 1,986 from 11,312 specimens (18%)
But what is the source & how did cross infection occur?
- endogenous or exogenous ?
what bacteria can be recovered from inside dental hand-pieces (after use, before decon)
Oral streptococci,
Pseudomonas spp &
Staphylococcus aureus.
Need to get sterilisation in dental practice – type B or vacuum
