Case Studies in Infection
Training in Infection Control
The Bug Blog
Page updated 9 October 2006
Studies undertaken in GP and GDP surgeries have shown evidence of failure to adequately clean and sterilize medical and dental equipment. As a consequence, the prevailing view from Department of Health Estates & Facilities Directorate is that Sterile Services Department ( SSD) provide a superior service for the reprocessing (cleaning, sterilisation and packaging) of re-useable instruments compared to local decontamination units in surgeries. Local reprocessing should be the exception rather than the norm for the reprocessing of reusable surgical instruments in primary and acute care. However, if the use of central processing units (SSD) is not achievable, then all reprocessing of surgical instruments should be undertaken outside of the clinical environment wherever possible, and that automated washing methods (e.g. thermal washer disinfectors) are preferred to manual cleaning.
The overarching aim of the Government is to raise and harmonise the standards of decontamination and infection control across the whole spectrum of primary and acute care in order to reduce the associated infection risks to patients and healthcare workers. Recommended protocols based on those published by Department of Health Estates & Facilities Directorate , MHRA and the BDA are described in the following section of the Guidelines.
Therefore the Chief Dental Officer has recommended that local decontamination of instruments should continue in dental practice, but that dentists should implement high quality standards in line with national recommendations for good practice (National Standards, Local Action 2004, www.dh.gov.uk/publications).
In essence good practice comprises:
According to advice from the Department of Health Estates & Facilities Directorate whenever possible decontamination should be carried out in a separate dedicated room, although it is appreciated that many practices do not have sufficient space to build or house a dedicated local decontamination unit. Under those circumstances an area in the surgery should be specifically designated for decontamination.
This is to ensure quality standards and enhanced staff safety in line with:
Layout of Decontamination room /area
The decontamination area or dedicated decontamination room should be divided into two physically separate sections so that there is a one- way flow through of traffic from the "dirty- scrub section" to the "clean" section for handling of sterile instruments. There should be a dedicated deep sink for cleaning instruments that is not used for hand hygiene. Automated methods are recommended as these are safer and can be validated, so the use of a thermal washer disinfector rather than manual cleaning is preferred .
One way flow from dirty to clean with a single run of sealed, easily cleaned worktop with (in order):
Dirty zone contains :
Clean zone contains :
Air flow should be from the clean zone to the dirty zone.
If you are planning a major refurbishment or new build then you should comply with the requirement for a dedicated decontamination room or local decontamination unit (LDU) designed with a hand-through hatch ( for the delivery of dirty sets of instruments and equipment). Instruments should be transported to and from the clinical area in a clean box with a secure lid.
Like the dedicated decontamination area there should be a one-way flow of instruments from the "dirty zone"- reception and instrument cleaning area, which is separated from the clean zone that contains the instrument inspection area, sterilizer and storage areas. The clean zone should be physically separated from the dirty zone and fitted with readily cleanable shelving and cupboards. In the clean zone sterile instruments and equipment that are sterilized unwrapped can be packaged and stored. The room should be well ventilated ( 8-10 air changes per hour) and any extraction ventilation should be sited in the dirty zone so that the air flows from the clean to the dirty area i.e. the reverse traffic flow to that of the instruments.
Sterilizer purchase, use, validation and maintenance: