Answering the biggest decontamination questions

Do I need an ultrasonic cleaner? What tests do I need to be carrying out? This month Decon Pete answers frequently asked questions about decontamination and infection prevention and control.

I get asked a lot of different questions on social media or by email about a variety of different subjects on infection prevention and control (IPC) and contamination. With this in mind, I thought I would produce a series of articles addressing these questions.

Last month we took a recap of the safer sharps regulation 2013 and the main implications of this on dental practices. This month I wanted to carry on with some of the frequently asked questions that are asked by many members of the dental team.

Do we need an ultrasonic cleaner?

There is no requirement to have an ultrasonic cleaner. However, they can be useful as an additional pre-cleaning stage prior to manual cleaning or the washer disinfector.

They also aid with the reduction in possible sharps injuries. If your practice is not using a washer disinfector then I would certainly advise the use of an ultrasonic bath as a way of helping to reduce the need to manually clean.

Why do I need a vacuum autoclave?

Many dental instruments have internal lumens or are air retentive. Due to the nature of these instruments, the air must be removed before full sterilisation can take place.

Class N autoclaves are only suitable for solid, non-air retentive instruments. EN13060 outlines the different classifications of small bench top sterilisers and what load types they are suitable for.

As a non-vac or passive displacement, autoclaves have no vacuum pump. This means these units have no way of evacuating air from hollow or air retentive instruments.

The only way to remove the air from such instruments is with the use of acClass B (vacuum) or suitable class S autoclave. By being able to fully remove the air steam, it is then able to fully penetrate all areas thus guaranteeing sterility.

Why do we need to use a washer disinfector?

Moving to an automated process is the recommended method for cleaning re-usable medical devices.

The reasons for this are:

To increase safety for staff who process the instruments
Automated systems can be validated and tested to ensure they are consistently effective.

Washer disinfectors usually incorporate up to five cleaning stages before they then thermally disinfect which renders instruments safe to handle. Once these stages have been completed, they will then dry them ready for processing through the autoclaves.

Due to washers being consistent in their cleaning, there is only a requirement to inspect instruments with an illuminated magnifying lamp at random rather than the entire load as is required with manual and ultrasonic cleaning. As a result, this saves extra time.

When manual cleaning, do I need to have two sinks?

If possible, it is desirable to have two sinks for washing and rinsing. This ensures complete separation of the instruments.

If space is an issue, it is acceptable to have one sink with a removable bowl which is used for the rinsing. However, it is important to ensure that this is followed with a written protocol.

The sinks that are made available need to:

Be fitted with surgical style taps
Have no overflows fitted
Have a tap spout not discharging directly into the plug hole
Have a trap/u-bend not directly under the plug hole.

Could you please clarify what tests are required on ultrasonic baths?

The tests that are required are manufacturer led and will vary from bath to bath.

Typically, according to UK guidance, the tests required would be the weekly protein test, the quarterly cleaning efficacy test (soil) and the ultrasonic activity test (Foil). The frequency of the tests depends on the manufacturer requirements.

In the absence of any manufacturer guidance, you should always follow the tests outlined in the guidance.

Next month I will outline some more of the FAQ’s that are received.

We have created a Testing and Validation Guidance Handbook to support the wider dental team who are looking for answers to questions such as these.

The handbook has been developed to provide help and support with all things around the decontamination process including what to do if tests fail.

If you need any help or support with anything outlined in these articles then please do not hesitate to get in touch with me by email at [email protected] or visit the website www.deconpete.co.uk.