Wednesday, 1 May 2013

Dr Tariq Drabu Affairs Around Update Cross Infection Guidance

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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