NHSScotland: Sterile Services Provision Review Group: Survey of Decontamination in General Dental Practice
Executive Summary
Following the discovery in the UK in the 1990's of variant CJD (vCJD), much work has been done to reduce the potential risk of person-to-person transmission of vCJD via re-usable surgical instruments that have been inadequately decontaminated. The Glennie Group (tasked with reviewing and upgrading NHSScotland sterile services provision) was formed as a result of the recommendations contained in the Old Report (2001), and produced the Glennie Framework in 2001. Whilst dental procedures are categorised as low risk for vCJD transmission, there remains a risk for transmission of bloodborne viruses (e.g. HIV, hepatitis B and C) and other bacterial, viral and fungal infections.
It is estimated that in excess of 180 million instruments are re-processed in Scottish general dental practice per annum. This volume of material represents a substantial component of the instrumentation reprocessed within the NHS, for which only scanty technical data were available. Information was required to inform the Scottish Executive Health Department as it develops a framework for change to reduce the potential risks associated with decontamination of re-usable instruments in primary care. In order to provide a more robust evidence base of current decontamination practices within the general dental services of Scotland, a large-scale observational study was designed. This has now been completed, and represents the largest survey of decontamination ever to have been undertaken in general dental practice, incorporating actual visits to individual premises to view decontamination processes. This report describes the findings from surveys of 179 practices.
The results bear a striking resemblance to those from the central sterile service departments and acute sectors published previously. Central to these has been the observation of highly motivated staff attempting, often unsuccessfully, to comply with current infection control guidelines. The survey has highlighted that the cleaning of instruments has several shortcomings and is poorly controlled. This problem is compounded by the lack of clear instructions from manufacturers/suppliers on appropriate methods for the reprocessing of many dental devices. The findings of this study are relevant to the rest of the UK.
In conclusion, the key areas identified to maximise improvements in decontamination within dental practice and to further reduce risks associated with potential onward transmission of vCJD and other pathogens are:
Advice and training pertinent to instrument cleaning protocols.
Access to policies and procedures, such as SHTM 2010, presented in a meaningful and relevant manner.
Guidance on formal instrument procurement procedures.
Guidance on surgery design, layout and separation of clinical from decontamination areas.
Guidance on commissioning, testing and maintenance of cleaning and sterilizing equipment.
A re-appraisal of the role of regulatory bodies overseeing the compliance of instrument manufacturers/suppliers and equipment testing and maintenance sub-contractors with appropriate decontamination regulations.
Provision of appropriate documentation from suppliers, service and maintenance agents for decontamination equipment.
Revision of existing dental practice inspections.