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 Infection control and HTM ID: 915012
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Slide1
What is it?
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.
Slide2Infection control and HTM
Practices require registration with CQC. Cleanliness and inf
control requirementHTM 01-05. (updated 2013) Found on department of health websiteDecontamination processes should be audited every 6 months (DH audit tool) IPS audit (infection prevention audit
Slide3Infection controlSets out essential requirements and best practice. For new practices best practice should be adoptedStates special precautions for prion transmission not necessary
All practices need to have an infection control policy
Slide4Infection control policyWritten policy updated every 2 yearsBlood borne transmission and sharps
Decontamination and storageProcedures for cleaning, disinfection and sterilization of instruments
Management and disposal of clinical wasteHand hygieneReusable instruments and single usePPEDisinfectants-use, storage, disposalSpillage procedures and COSHHEnvironmental cleaningTrainingNominated lead for decon
Slide5Surface CleaningFor 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
Slide6Single use Marked with 2Encouraged 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
Slide7Transport of instrumentsASAP to avoid risk of drying (can immerse in water or gels/sprays)
Containers should be
Leak proofEasy to cleanRigidAble to be closed securelyRobust to prevent instrument damageClearly markedTransport outwith surgery for decon. requires noted consignmentDomiciliary visits require record of date and vehicle used
Slide8Cleaning instrumentsEssential prerequisite before sterilizationBest practice with WDASAP after use
New instruments cleaned & sterilized before use, unless supplied as sterile Cleaning practices should be validated
Slide9Washer disinfector
Flush –remove gross contamination <45oCWash-detergent
Rinse-remove detergentThermal disinfection-80oC for 10 mins or 90oC for 1minDryingCrucial to load correctly-open hinges, no overlapping, attach to irrigationInspect afterwards under lighting and magnification
Slide10Ultrasonic cleaningCan be used prior to WD esp. for hinged instruments
Should be immersed in cold water with detergent first
Place instruments in basket, fully immersedDo not overload, overlap or place on floorClose lid and set timerAfter cycle drain basket before rinsing in a dedicated sink or bowlChange solution when visibly contaminated or at end of every session
Slide11Manual cleaningWash handsWear PPE
Prepare sinks, equipment and setting down areaFill the sink to level (marked on edge of sink) with water and detergentEnsure temp <45oC
Fully submerge and keep under water to prevent aerosolsScrub using long handled brush with soft plastic bristlesDrain waterRinse in separate sink (potable/RO/distiller water)Drain (and dry if to be wrapped)Visually inspect
Slide12Inspection
Instruments should be inspected after cleaning
Using magnification and lightIf damaged - repair or replaceIf dirty – manually scrub
Things inspectors look out for…….
No Lamps
Lamps in cupboardsDusty lampsBulbs outLamp broken
Slide13SterilizationSaturated steam under pressure at the highest temperature compatible with the productRecords required for every cycleThese 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
Slide14Sterilizers
Type N: non-vacuum
Type B: vacuumType S: specific loadMust be:Compliant with safety requirementsInstalled, commissioned , validated and maintainedOperated according to manufacturers instructions
Slide15SterilizersReservoir 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:MaintenanceValidationFaultsModificationsRoutine tests
Slide16SterilizersBefore carrying out tests the user should:Clean door sealCheck chamber for cleanliness
Fill reservoirTurn power source Daily tests consist of
Automatic control testSteam penetration (vacuum) helix or Bowie-Dick
Slide17PackagingInstruments 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 clothsInstruments can be stored for up to 12 monthsFirst in - first out principle helpfulDate should be marked on package
Slide18StorageWrapped 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 usedUnwrapped instruments in a non-clinical area 1 weekWrapped instruments should be date stamped/marked
Slide19LDUDirty to clean workflow, clearly separated
Decluttered
Sealed, easily cleaned work topsShould be wiped down after each decontamination cycleAir flow from clean to dirtyDirty zone receives instrumentsWashing sinks should be next to receiving area.Ultrasonic cleaner next and then WDAfter the cleaning/disinfection area should be an inspection areaSterilizer should be well away from other activitiesSet down clean area adjacent to this
Separate wash hand basin for hand washing
Slide20Hand hygieneCrucial to prevent spread of infection and decontamination
Should be carried out:
Before and after each treatment sessionBefore and after removal of PPEFollowing washing of dental instrumentsBefore contact with instruments that have been steam sterilizedAfter cleaning or maintaining decontamination devicesAfter toilet visitsBefore and after contact with food
Slide21Hand hygieneMild 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 removedFingernails should be kept clean and short with no polishThe basin used should not have a plug or overflowIt should have a mixer tap-lever or sensor operatedTaps 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
Slide22PPEInfection control policy should specify when PPE should be worn and changedGloves: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 glovesDomestic household gloves, if used should be washed with detergent and hot water and left to dry
Slide23PPEPlastic single use aprons should be worn during all decontamination processes
Face masks are single use
Visor or face shield should be wornFootwear should be enclosedClinical clothing should not be worn outside the practiceShort sleeves should be used (can wear disposable sleeves)Uniforms should be washed at hottest temperature suitable for fabricClean uniform should be worn every day
Slide24Removal of PPEItems should be removed in the following orderGloves firstPlastic apron
Face and eye protectionFace maskWash hands thoroughly
Slide25Maintenance and testing Sterilizer
DAILY
Steam penetration BAutomatic control test B & NWEEKLY including daily tests plusAir leakage BResidual air test NQUARTERLY (by engineer)Thermometric tests
ANNUALLY (by engineer)Thermometric tests - Small load, Large load
Dryness tests - Small load, Large load
Slide26TestingLog books for each machineAutomatic control test
Helix/Bowie Dick (vacuum)
Slide27Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyAutoclave
(All types)Automatic Control TestDaily
Autoclave (Non Vacuum)Cycle Test StripsDaily
Autoclave (Vacuum only)Steam
Penetration TestDaily
Slide28Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyAutoclave (All types)
Engineer ValidationAnnually
Slide29Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyWasher
DisinfectorProtein Residue TestWeekly
Washer DisinfectorManufacturer Soil Test
weekly or monthlydepending on which manufacturer
Slide30Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyWasher Disinfector
Cleaning Efficacy Visual CheckDaily
Washer DisinfectorEngineer Validation
Annually
Slide31Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyUltrasonic
Cleaning Efficacy Visual CheckDaily
UltrasonicProtein Residue Test
Weekly
Slide32Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyUltrasonic
Manufacturer Soil TestWeekly or Monthly depending on which manufacturer
Slide33Practice compliance
Infection control and decontamination
Testing and Validation of Decontamination Equipment
Equipment
Test
What it looks likeFrequencyUltrasonic
Ultrasonic Activity TestQuarterly
UltrasonicManufacturer Validation
Annually