NHS Practice Cross Infection Control Guidelines for Washer-Disinfectors

1. Question 1 You work in a large NHS practice and are responsible for maintaining cross infection control in your practice You are aware of HTM 01-05 and after reading this you want to aim towards best practice.

2. Why are washer disinfectors being introduced? • To reduce manual cleaning and associated risks • To remove as much soiling on instruments as possible prior to sterilisation • To give a means of recording cleaning • What are the stages a washer disinfector goes through? • Flush <45°C (to prevent protein coagulation and removes gross debris) • Wash (mechanical and chemical processes loosen and break up contamination) • Rinse (removes detergent) • Thermal Disinfection (80°C for 10 min or 90°C for 1 min) • Drying

3. How is the machine validated? • Data recorder showing completion of cycle • Weekly soil test to check for protein (based on NINHYDRIN) • Approved design meeting European EN 15883 • Cycle aborts if detergent level low • Quarterly and yearly validation according to manufacturers guidelines. • Should handpieces be lubricated before or after placing in the washer-disinfector and why? • After – if before oil can cause film buildup in washer, also bearings would have no protection from rusting/seizing during the autoclave

4. Where can the most up to date version of HTM 01-05 be found? • On Dept of Health Website • How long can wrapped and unwrapped instruments be kept? • Wrapped instruments may be stored for up to 1year • Unwrapped instruments in the clinical area 1 day (must be dry and protected from contamination eg in cupboard). These instruments should be reprocessed at the end of day or next morning even if not used • Unwrapped instruments in a non-clinical area 1 week • Wrapped instruments should be date stamped/marked

5. Describe what you see in the photo • What is the likely diagnosis? • Pseudomembranous candidosis – creamy white plaques that can be dislodged to leave raw bleeding mucosa. Can appear on any part of oral mucosa and pharynx. • How would you treat it? • Nystatin 100,000 units/ml QID for 7 days (or continue 2 days after lesions resolve) • Miconazole or mucosal gel 24mg/ml, 5-10ml QID for 7 days or longer (continue 2 days after lesion resolves) • Fluconazole 50mg once daily 7-14 days

6. Describe what you see in the photo • What is the likely diagnosis? • Chronic hyperplastic candidosis aka candidal leukoplakia. This is classically at the commissures of the lips, often bilaterally. It cannot be wiped away and the underlying candidal association is only apparent at biopsy as the white patches are clinically very similar to leukoplakias. • How would you treat it? • Antifungals • Smoking cessation • Generally considered premalignant – refer! • Although it may resolve following treatment with antifungals, it has a higher risk of malignant transformation than other white patches and consequently warrants excision.

7. Describe what you see in the photo • What is the likely diagnosis? • Denture Stomatitis/ Chronic Erythematous candidosis • Characterised by localised chronic erythema of tissues covered by dentures. • Diagnosis requires removal of dentures and careful inspection; swabs may be taken • Fairly common. • Treatment: local measures, oral hygiene, soak dentures in chlorhexidine, or sodium hypochlorite twice daily for 15 mins, leave dentures out as much as possible. • If drug treatment required- Fluconazole/Nystatin

8. Describe what you see in the photo • What is the likely diagnosis? • Median Rhomboid Glossitis A chronic symmetrical area on the tongue anterior to the circumvallate papillae. Most common 45-60year old males. Biopsy usually yields candida in 85% of cases. Associated with smoking and inhaled steroids. Treatment- antifungals if candidal, stop smoking, rinsing if use inhaler. Associated with HIV if seen in a younger person.

9. Describe what you see in the photo • What is the likely diagnosis? • Angular Chelitis/Stomatitis An erythematous fissuring at one or both corners of the mouth and is usually associated with an intraoral candidal infection(in denture wearers) Other organisms implicated are staphylococci and streptococci.(non denture wearers) Wrinkling at corners of mouth esp. in the elderly which is caused by decrease in face height- common in long term denture wearers Other factors in the aetiology are iron deficiency ,anaemia, and vit B12 deficiency. Treatment: Miconazole cream 2%, 20g tube. Apply twice daily to angles of mouth.. Unresponsive cases combine with hydrocortisone cream 1%