www.dentisan.co.uk As UK dental practices return to practice, concerns for the wellbeing of staff and patients will be a high priority. In addition to the regular infection control measures, there are obviously heightened concerns about public health threats in reception and waiting areas. The measures required by HTM 01-05 should be carefully followed, together with any Covid-19 specific instructions issued by the UK Government.
MAINS WATER SUPPLY • Flush all mains water supplies to remove stagnant water that has been static during closure. This is particularly important where there are storage tanks. • Equipment used for water purification should also be cleaned and flushed in accordance with the manufacturer’s instructions before use.
DENTAL UNIT WATERLINES (DUWL) HTM 01-05 guidelines on recommissioning DUWLs need to be carried out before units are re-used. Recommissioning of DUWLs 19.12 In the absence of manufacturers’ guidance, flush the DUWL for at least three minutes, disinfect the DUWL with a suitable disinfectant (as recommended by the manufacturer for routine disinfection of the DUWL), then flush for a further three minutes. 19.13 Where in-line filters are used, these will require treatment using a cleansing solution that has been recommended by the manufacturer. This step should be performed after first flushing the DUWL.
Note Care should be taken to minimise the occurrence of splashing and aerosol formation. 19.14 If DUWLs have disposable filters, they should be replaced. 19.15 Self-contained water bottles (bottled water systems) should be flushed with distilled or RO water. Where visual contamination is present, flushing with a suitable disinfectant followed by thorough washing is necessary. The manufacturer’s instructions will specify which disinfectant to use. In instances where visual contamination is routinely detected, it will be necessary to decrease the interval between flushing operations. If good practice is followed, practices should not routinely detect evidence of visual contamination.
Note The self-contained water supplies used for dental care systems should be distilled or RO water (see Chapter 17). 19.16 As part of the recommissioning, dental equipment requiring protection against backflow should have the anti-retraction valves (incorporated on handpieces or waterlines) checked by the responsible person. They should ensure they are suitably decontaminated, refitted correctly and are operating in the correct manner. Examples of dental equipment requiring backflow protection are: dental spittoons; three-in-one syringes; ultrasonic scalers; wet-line suction apparatus; and
self-filling automatic radiographic processors (where still used).
• While virus contamination of waterlines is not expected, bacterial biofilms can develop very quickly. It is recommended that HTM 01-05 process is followed, using Bioclear to disinfect the DUWL before use. • DUWLs should be maintained in accordance with HTM 01-05 using Bioclear Daily to maintain water quality and Bioclear as a periodic purge cleaner and disinfectant to deal with any biofilm build-up in the system.
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MAINTAINING A HIGH LEVEL OF INFECTION CONTROL AFTER PRACTICE RE-START SURFACES AND EQUIPMENT • Biocleanse Ultra can be used to clean and disinfect medical device surfaces on a regular basis, in accordance with HTM 01-05. • Cleaning and disinfection of reception, office and waiting areas should also be undertaken. • Frequently touched surfaces should be frequently decontaminated.
Coronavirus is an enveloped virus and is likely to remain active on hard surfaces for days or weeks. Biocleanse Ultra has proven efficacy against enveloped viruses such as Vaccinia virus, HIV and HCV. Biocleanse Ultra is a single-stage cleaner and disinfectant. Wipes are wetted with a non-alcohol formulation so there is no concern of fixing protein to a surface, which is a significant issue with traditional alcohol wipes. Section 6.57 of HTM01-05 states “…the presence of protein will compromise the efficacy of alcohol-based wipes.
Note: Alcohol has been shown to bind blood and protein to stainless steel. The use of alcohol with dental instruments should therefore be avoided.”
BLOOD SPILLS AND CONTACT WITH A KNOWN OR SUSPECTED COVID-INFECTED PATIENT • After contact with a known or suspected Covidinfected patient, disinfection with a chlorine solution is recommended • The full guidance can be found here: https://www.gov.uk/government/publications/wuhannovel-coronavirus-infection-prevention-and-control/ wuhan-novel-coronavirus-wn-cov-infection-preventionand-control-guidance#decon • Chlorine solutions can be reliably generated using Dentichlor tablets (1 tablet dissolved in 1 litre of water produces a 1000ppm chlorine solution).
The same solution can be used for disinfection of impressions and prosthetics, following the guidance in section 7.1 of HTM 01-05.
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AEROSOL GENERATING PROCEDURES • If carrying out aerosol generating procedures (AGPs), respiratory PPE must be correctly used. • Additional measures may be considered such as forced room ventilation to ensure frequent air changes. • The use of disinfectant mouth washes prior to such procedures may be beneficial in reducing inhalation risk.
HAND HYGIENE • Good hand hygiene is a major part of any infection control regime. • Wash hands regularly, using correct technique • Use liquid hand cleanser from a wall mounted (preferably touchless) dispenser • Supplement hand washing with use of hygienic hand rubs, conforming to the EN1500 standard, between washes, on visibly clean hands. • While much attention has been placed on the use of alcohol-based hand disinfectants, other types, with proven efficacy against enveloped viruses, will be useful. • Adequate hand washing facilities should also be provided for patients.
BARRIER PRODUCTS AND PPE The PPE requirements specified in HTM 01-05 are an essential part of an infection control strategy. Correct use of gloves, masks, eye protection and aprons provides an effective barrier to potentially infective material. • Patient treatment activities • Handling and decontamination of used instruments - these are hazardous operations where infectious material may become airborne, as splashes or aerosols.
Remember that used PPE may be contaminated. Care is required to avoid the potential for transfer of infection from the PPE to the user when protective equipment is removed. Always observe the correct procedure for removal, dispose of items correctly and practice hand hygiene as appropriate.
• The use of impervious barrier products on items of equipment can also help to limit surface contamination and make cleaning and disinfection more effective.
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✓ CHECKLIST
When the time comes to re-open your practice you need to be ready. Infection control will play a very important role in ensuring your practice is fit for purpose and in reassuring patients that you are providing a safe environment. This simple checklist provides an aid to make sure you cover all the important areas.
SURFACE CLEANING & DISINFECTION
After being closed for a prolonged period every surface in the practice will need to be cleaned and disinfected and both of these are required processes. Importantly, cleaning must take place before disinfection to ensure that bacteria, proteins and other contaminants are removed from surfaces before disinfection takes place. An alcohol-free, all-in-one formulation with efficacy against bacteria, fungi and enveloped viruses will provide a fast and effective solution. Biocleanse Ultra has proven efficacy against bacteria, fungi and enveloped viruses, and cleans and disinfects in one solution and is compatible against all common surgery surfaces. RECOMMENDED PRODUCTS:
Biocleanse Ultra Wipes / Refills pk 200 Biocleanse Ultra RTU Spray 500ml Biocleanse Ultra Concentrate 5 litre
FLOOR CLEANING & DISINFECTION
Save time on cleaning floor surfaces by using a single stage cleaner and disinfectant. It is advisable to use colour-code mops and cloths according to the zone in which they will be used (kitchens/washrooms/offices/clinical and decontamination areas). This will reduce the risk of transmitting pathogens between areas. Dentifloor has proven efficacy against bacteria, fungi and enveloped viruses. Simply dilute with clean water to make a 20ml per litre solution. RECOMMENDED PRODUCTS:
DentiFloor 5 litre
FREE
when you buy the
BUNDLE
RECOMMISSIONING TREATMENT CENTRES
Your treatment centre is the most important equipment in the surgery and Dental Unit Water Lines should have been cleaned before closure by using a biofilm remover and the same process should be applied prior to use. Following guidance in HTM01-05 section 19.12, a suitable biocide that removes biofilm is particularly useful when chairs have been inactive for a period. This will help provide water of a quality that remains within guidelines (less than 200 cfu/ml). Testing of input and output water from DUWLs should be completed using dip slides and recorded prior to seeing patients. Bioclear should be left in DUWLs for 12 hours and ideally overnight, before flushing out with RO or distilled water. RECOMMENDED PRODUCTS: Bioclear box of 12 bottles Dip Slides pack 10
BUNDLE
DEAL
Buy Biocleanse Ultra wipes + Bioclear + a hand hygiene product + Dentichlor + Box of TST strips
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Get a 5 litre
Dentifloor
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BARRIER PRODUCTS
Once the practice is re-open and you are seeing patients, attention to infection control detail will be more important than ever. Disposable barriers for handles, control panels, headrests, 3-in-1, handpieces and turbines will be essential. Single use barriers should be placed firmly on clean, disinfected surfaces. After each patient, barriers should be removed and disposed of safely, before PPE is removed. The area should be decontaminated in the usual way. RECOMMENDED PRODUCTS: DentiShield A for control panels and handles pk 1200 DentiSield B for air motors and air/water syringes pk 250 DentiShield C for tubing, turbines & ultrasonic scaler heads pk 250 DentiShield D for headrests and x-rays pk 250 DentiShield E for low speed long handpieces pk 500
HAND HYGIENE
Hand hygiene will be one of the most obvious ways you can demonstrate infection prevention to patients and staff. Ensure hand wash, sanitiser and hand cream are available, ideally in touchless dispensers to reduce the risk of cross infection. An effective no-alcohol sanitiser is also available for those who cannot tolerate alcohol on the skin. DentiSure is specially formulated and microbiologically tested to BS EN 1500 RECOMMENDED PRODUCTS: Dentiwash 800ml pouch and 500ml pump dispenser Dentigel 800ml pouch and 500ml pump dispenser DentiSure 800ml pouch and 1litre pump dispenser Replenish 800ml pouch and 500ml pump dispenser Touchless Dispensers for liquid and foam
IMPRESSION DISINFECTION
Impression taking is a standard daily task and for patients having whitening or orthodontic treatment is essential. The disinfection of impressions before being sent to the lab is a vital decontamination process, particularly in the era of COVID-19. DentiChlor tablets provide a measured dose of chlorine and is suitable for disinfection of impressions, blood spills and for water storage containers. RECOMMENDED PRODUCTS: DentiChlor tablets x 200
TESTING & VALIDATION CHECKS
Check autoclaves, washer disinfectors and ultrasonic baths are working and to manufacturers’ specifications before you re-open. RECOMMENDED PRODUCTS: Wash checks (for washer disinfectors and ultrasonic baths) pk 25 Helix Test + 250 indicator strips TST Strips pk 200
DON’T FORGET…..
Check expiry dates on your sterilised instruments just to be sure everything is in date before re-opening
IN-PRACTICE CPD
Dentisan’s knowledgeable experts are available to give in-practice infection control refresher courses to the whole team, who can gain up 2 hours CPD. This is particularly useful so that all staff are fully aware of infection control procedures and are able to reassure patients of the processes you have in place. For more info call Jenny on 07741 314670 or Anne on 07741 312515 or visit https://dentisan.co.uk/education/in-practice-cpd/
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