In this article, I explain the background to decontamination, where to get guidance and advice and the difference between sterile and sterilised.

1. Dentistry SCOTLAND’s in practice
52 April 2012
Amanda Atkin explains the
background to decontamination
requirements and why dentists
in Scotland are on safer ground
than those in England
Defusing that infection
timebomb
Image: Thinkstockphotos.com

2. Dentistry SCOTLAND’s in practice
April 2012 53
Decontamination has become a
high profile subject in recent years
as a response to the possibility of
prion transmission through protein
contamination of dental instruments.
This resulted in the Department of Health
(DH) issuing HTM 01-05.
Guidance and advice
There are a number of sources of
guidance regarding decontamination.
The Health Facilities Scotland (HFS)
decontamination team sets the technical
requirements for all decontamination
facilities in Scotland. These are published
as a series of Scottish Health Technical
Memorandums (SHTMs) and guidance
on local decontamination units (LDUs).
It also publishes logbooks comprising
testing and validation templates covering
different types of decontamination
equipment.
Within HFS there is an LDU Support
Service to provide expert help and advice
to dentists setting up an LDU and buying
new decontamination equipment. Its
project management document was
published in January 2010 with a list
of preferred contractors following in
February. The CDO, Margie Taylor, has
recommended that equipment should
be sourced from the national framework,
which lists validated equipment.
Installation and commissioning should
be by the framework supplier and there
is a requirement for a maintenance
contract and for quarterly and annual
testing.
The Scottish Dental Clinical
Effectiveness Programme (SDCEP)
published Decontamination – Part 1
Cleaning of Dental Instruments in March
2007, with Decontamination – Part 2
Sterilization of Dental Instruments released
at the end of last year. Both documents,
together with a separate appendices and
references document, are available to
download from the SDCEP website www.
sdcep.org.uk.
Guidance, advice and information
relating to decontamination has
also been published by Healthcare
Improvement Scotland, the Health
Protection Scotland Infection Control
Team, the chief dental officer, the
Medicines and Healthcare Products
Regulatory Agency, and NHS Scotland.
Timebomb
In England, dental practices are
continuing to build their compliance
with HTM 01-05 without funding. Things
are being done rather more proactively
in Scotland as a precaution against an
infection timebomb – from, for example,
the viruses hepatitis B or hepatitis C
being transferred by instruments that
have not been properly decontaminated.
Transmission of Cruetzfeldt Jakob Disease
(vCJD) is another concern, although it
not known if this can take place through
instrument contamination.
Unlike in England, the Scottish
government has made funds available
for decontamination improvements
(although some PCTs have provided ad
hoc funding for washer disinfectors).
Over £80 million was given to NHS
Boards, with approximately £58m being
allocated to the provision of dental
services and training – decontamination
making up part of this. Each Board had
discretion as to how to use this funding,
which was made available via practice
improvement grants. Initially, the focus
was on equipment and instruments with
a switch of emphasis to LDU facilities
more recently. In 2011, further capital
funding was made available to Boards –
to be directed towards improvements in
decontamination facilities within primary
care and specifically in general dental
services.
In addition, the Scottish Dental Access
Initiative Scheme provides grants to
practices that need to relocate to better
quality or more suitable premises to
meet decontamination requirements.
This problem has affected many
practices in England that are located in
listed premises – they have had to cope
without central government funding.
In Scotland, funding is also available
for the (not inconsiderable) cost
of maintaining decontamination
equipment.
Sterile and sterilised
As the environment in which dental
instruments are used is not sterile, it
follows that dental instruments will not
be sterile at the point of use. They should,
however, be in a sterile state at the end
of the decontamination process when
the steriliser door is opened. Accordingly,
decontamination guidance accepts that
dental instruments may be defined as
‘sterilised’rather than‘sterile’at the point
and time of use (a somewhat different
approach compared to invasive surgical
procedures).
In some instances, the
decontamination process may not
generate full sterilisation, for example in
the reprocessing of dental handpieces;
however, the guidance will nevertheless
seek to raise standards and minimise
infection risk.
Training
Working with NHS Education Scotland (NES), HFS has developed an e-learning
decontamination training programme, which is available online at
www.decontamination.scot.nhs.uk.
NES also runs a number of different CPD courses on infection control and
decontamination in dental practices. These include two in-practice training sessions
covering (first session) hand hygiene, cleaning dental instruments and cleaning
the clinical environment. The second session includes operating and testing
decontamination equipment. More details are available from www.nes.scot.nhs.uk
The NES National Infection Control Dental Support has a team of support dental
nurses covering different geographical areas of Scotland.
Amanda Atkin
Runs Atkinspire Ltd and offers practices support, training and
consultancy on information governance, CQC compliance, national
minimum standards, decontamination and infection control. Her
bespoke service supports practices as they embed the required
standards within their daily routines – to ensure a high quality service
and patient safety at all times. For more information email amanda@
atkinspire.co.uk or visit www.atkinspire.co.uk.