A revised HTM0105 document on
cross infection was released at the end of March. The revised document was
released by the English Department of Health with very little fanfare and publicity.
The very low-key launch of this document is in stark contrast to the original
launch of HTM 0105 which was launched in a blaze of publicity in 2008.
There are very many dentists out there at the
frontline who are not actually even aware that this document has been released.
I emailed five of my colleagues forwarding them the link and none of them had
even got the slightest idea that these major changes were coming through. When
the original document was released in 2008 there was a massive amount of
publicity given to it and it was supposed to be the new way forward for
dentists in promoting the highest standards of cross infection control and
decontamination. However the profession as a whole was very concerned about the
very weak and poor evidence base that supported some of the recommendations.
Many of the recommendations were put forward in response to concerns about CJD
and many of these concerns have now been demonstrated to be perhaps a little
unrealistic. It is pleasing to see that both ministers and civil servants have
actually listened to and taken on board the serious and justified concerns of
the dental profession and amended the document.
Our job as responsible professional dentists
is to ensure the highest standards of care for our patients. This is in all
aspects of treatment including decontamination and infection-control. However
these needs have to be balanced with the requirements of running a frontline
busy primary-care dental practice within in many cases a high street setting.
We are not able to send our instruments to a central reprocessing centre for
them to be sterilised like hospitals do. The original HTM 0105 document was
found to be extremely difficult to work with and had a poor evidence-base and
was criticised from many quarters of the profession for its poor evidence base.
From the outset many dentists were of the opinion that it was technically
flawed and over cumbersome and placed far too much burden on process rather
than outcome. The British Dental Association was at the forefront of lobbying
for change and I am pleased to say that it has been successful in reversing
many of the somewhat burdensome items of the original document.
The most important and
significant change to the document is the extension to the shelf life of
wrapped instruments from either 21 or 60 days to a maximum of one year. As
things stood we were going through cycles where we were repeatedly sterilising
and autoclaving instruments that were not being used on a regular basis purely
because of either 21 or 60 day deadline. Interestingly enough, prior to the
revision there were different deadlines for England Scotland Wales and Northern
Ireland. The twelve-month deadline is a very sensible and logical proposal and
helps in the efficient running of dental practices without compromising patient
safety. Another very important change is the fact that unwrapped instruments in
a clinical area can now be stored for one day and if they are in a nonclinical
area they can be stored for one week unwrapped. A non clinical area has been defined
as either a clean area of the practice decontamination room or a clinical area
not in current use. Another important change is the removal of the obligatory
requirement to have two separate sinks in a decontamination area in order to
wash and rinse instruments. Manual washing scrubbing and rinsing can be done
with one sink with a removable bowl that is contained within the sink just for
the purpose of holding instruments for watching and rinsing.
When I first took over Langley
Dental Practice in 1998 it was a very rundown building in a poor state that I
knew in a few years would not be fit for purpose. Therefore when I redesigned
Langley Dental Practice back in 2005 I knew that further and tighter and more
stringent cross infection rules and regulations would be coming. Therefore from
the outset I incorporated dedicated built-in cross infection areas into the
design of the building. We have always been praised when the practice has been
inspection expected whether by the local health trust or by the North West
deanery or by the Care Quality Commission (CQC). We regularly audit our cross
infection procedures and policies and the latest guidance from Department of
Health has now amended the requirements from 3 monthly audits to 6 monthly
audits.
The government and the dental profession need
to work together to ensure progress and ways forward for the best treatment for
our patients. Logic and common sense need to prevail over rigid fixed and
intransigent positions. I am really pleased that the government has
demonstrated that it is able to listen to the genuine concerns of the dental
profession and take them on board in order to promote the highest standards of
care and also the efficient running of dental practices.
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