Cross infection

1. Cross infection The transfer of harmful microorganisms. Bacteria and viruses are among the most common. The spread of infections can occur between people, pieces of equipment, or within the body. • What is it?

2. Infection control and HTM • Practices require registration with CQC. Cleanliness and inf control requirement • HTM 01-05. (updated 2013) Found on department of health website • Decontamination processes should be audited every 6 months (DH audit tool) IPS audit (infection prevention audit

3. Infection control • Sets out essential requirements and best practice. • For new practices best practice should be adopted • States special precautions for prion transmission not necessary • All practices need to have an infection control policy

4. Infection control policy • Written policy updated every 2 years • Blood borne transmission and sharps • Decontamination and storage • Procedures for cleaning, disinfection and sterilization of instruments • Management and disposal of clinical waste • Hand hygiene • Reusable instruments and single use • PPE • Disinfectants-use, storage, disposal • Spillage procedures and COSHH • Environmental cleaning • Training • Nominated lead for decon

5. Surface Cleaning • For floor and general surface cleaning, the national colour coding scheme for cleaning materials and equipment in primary care medical and dental premises may be useful: • red – for wash-rooms; • blue – for offices; • green – for kitchens; • yellow – for clinical and decontamination areas. • Surgery surfaces with detergent wipes – no alcohol or sprays

6. Single use • Marked with 2 • Encouraged to use single use where possible • Endo files are either single use or single patient (only where marked as reusable) • Can be placed with other instruments in WD but if manual washing should be cleaned separately

7. Transport of instruments • ASAP to avoid risk of drying (can immerse in water or gels/sprays) • Containers should be • Leak proof • Easy to clean • Rigid • Able to be closed securely • Robust to prevent instrument damage • Clearly marked • Transport outwith surgery for decon. requires noted consignment • Domiciliary visits require record of date and vehicle used

8. Cleaning instruments • Essential prerequisite before sterilization • Best practice with WD • ASAP after use • New instruments cleaned & sterilized before use, unless supplied as sterile • Cleaning practices should be validated

9. Washer disinfector • Flush –remove gross contamination <45oC • Wash-detergent • Rinse-remove detergent • Thermal disinfection-80oC for 10 mins or 90oC for 1min • Drying • Crucial to load correctly-open hinges, no overlapping, attach to irrigation • Inspect afterwards under lighting and magnification

10. Ultrasonic cleaning • Can be used prior to WD esp. for hinged instruments • Should be immersed in cold water with detergent first • Place instruments in basket, fully immersed • Do not overload, overlap or place on floor • Close lid and set timer • After cycle drain basket before rinsingin a dedicated sink or bowl • Change solution when visibly contaminated or at end of every session

11. Manual cleaning • Wash hands • Wear PPE • Prepare sinks, equipment and setting down area • Fill the sink to level (marked on edge of sink) with water and detergent • Ensure temp <45oC • Fully submerge and keep under water to prevent aerosols • Scrub using long handled brush with soft plastic bristles • Drain water • Rinse in separate sink (potable/RO/distiller water) • Drain (and dry if to be wrapped) • Visually inspect

12. Inspection • Instruments should be inspected after cleaning • Using magnification and light • If damaged - repair or replace • If dirty – manually scrub Things inspectors look out for……. No Lamps Lamps in cupboards Dusty lamps Bulbs out Lamp broken

13. Sterilization • Saturated steam under pressure at the highest temperature compatible with the product • Records required for every cycle • These should be copied as print outs fade over time • All steam sterilizers subject to Pressure Vessels Systems Safety Regulations 2000-must be examined periodically by a competent person

14. Sterilizers • Type N: non-vacuum • Type B: vacuum • Type S: specific load Must be: Compliant with safety requirements Installed, commissioned , validated and maintained Operated according to manufacturers instructions

15. Sterilizers • Reservoir should be filled at least daily with distilled or RO water • Should be cleaned, drained and left empty with door open at end of day • Testing required to ensure performance • Each sterilizer should have a logbook in which the following are recorded: • Maintenance • Validation • Faults • Modifications • Routine tests

16. Sterilizers • Before carrying out tests the user should: • Clean door seal • Check chamber for cleanliness • Fill reservoir • Turn power source • Daily tests consist of • Automatic control test • Steam penetration (vacuum) helix or Bowie-Dick

17. Packaging • Instruments should be cleaned and dried before wrapping • With steam displacement (type N) instruments should be wrapped after sterilization • With Type B instruments should be wrapped prior to sterilization • Instruments should be dried using disposable non-linting cloths • Instruments can be stored for up to 12 months • First in - first out principle helpful • Date should be marked on package

18. Storage • 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

19. LDU • Dirty to clean workflow, clearly separated • Decluttered • Sealed, easily cleaned work tops • Should be wiped down after each decontamination cycle • Air flow from clean to dirty • Dirty zone receives instruments • Washing sinks should be next to receiving area. • Ultrasonic cleaner next and then WD • After the cleaning/disinfection area should be an inspection area • Sterilizer should be well away from other activities • Set down clean area adjacent to this • Separate wash hand basin for hand washing

20. Hand hygiene • Crucial to prevent spread of infection and decontamination • Should be carried out: • Before and after each treatment session • Before and after removal of PPE • Following washing of dental instruments • Before contact with instruments that have been steam sterilized • After cleaning or maintaining decontamination devices • After toilet visits • Before and after contact with food

21. Hand hygiene • Mild soap should be used, not bar soap. • Apply soap to wet hands • Dry with disposable paper towel • Hand cream (water based) should be used at the end of session • Rings, bracelets and watches should be removed • Fingernails should be kept clean and short with no polish • The basin used should not have a plug or overflow • It should have a mixer tap-lever or sensor operated • Taps shouldn’t discharge directly into the drain (to prevent aerosols) • A cleanable poster dictating hand wash method should be displayed above every clinical wash hand basin

22. PPE • Infection control policy should specify when PPE should be worn and changed • Gloves: • Protect hands from contamination, chemicals and to minimise cross infection risk • Glove integrity can be damaged by isopropanol or ethanol, therefore alcohol rubs shouldn’t be used with gloves • Domestic household gloves, if used should be washed with detergent and hot water and left to dry

23. PPE • Plastic single use aprons should be worn during all decontamination processes • Face masks are single use • Visor or face shield should be worn • Footwear should be enclosed • Clinical clothing should not be worn outside the practice • Short sleeves should be used (can wear disposable sleeves) • Uniforms should be washed at hottest temperature suitable for fabric • Clean uniform should be worn every day

24. Removal of PPE • Items should be removed in the following order • Gloves first • Plastic apron • Face and eye protection • Face mask • Wash hands thoroughly

25. Maintenance and testing Sterilizer DAILY • Steam penetration B • Automatic control test B & N WEEKLY including daily tests plus • Air leakage B • Residual air test N QUARTERLY (by engineer) • Thermometric tests ANNUALLY (by engineer) • Thermometric tests - Small load, Large load • Dryness tests - Small load, Large load

26. Testing • Log books for each machine • Automatic control test • Helix/Bowie Dick (vacuum)

27. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

28. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

29. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

30. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

31. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

32. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment

33. Infection control and decontamination Practice compliance • Testing and Validation of Decontamination Equipment