Best practice for infection control

Christine Bowness from Prestige Medical explains how you can improve efficiency and make cost savings by embracing best practice

It is encouraging to see that the number of practices choosing to move to “best practice” in decontamination standards is on the rise again. More and more dentists are realising that there are significant business benefits to be gained, in addition to providing patients and staff with the highest infection control standards and reassurance that their safety and comfort is a top priority.

Instrument cleaning is the first step

For a number of years, it has been generally accepted that the best method of cleaning and preparing instruments for sterilisation has been the use of a washer disinfector. While some practices had, perhaps understandably, held back from making such a big investment, the increased risk of cross-infection – from HIV, Hepatitis C, Herpes and even from those diseases we thought we had eradicated such as TB and Polio – together with an increasing resistance to antibiotics, will continue to drive cross-infection control standards ever higher.

In addition, evidence exists to show that sharps injuries to staff are significantly lower or completely eliminated in those practices using a washer disinfector to replace the manual processes involved in either scrubbing or using an ultrasonic bath.

A wide choice of machines means that there are now sizes and capacities available to suit the needs of most practices, while advances in technology have enabled the process to be completed much faster – in the past, one of the main reasons given for delaying purchase.

Most dentists now recognise that a washer disinfector can provide valuable time and throughput efficiencies in the practice and many have already made room to accommodate them but still there are those who remain to be convinced!

Let us consider how cost-effective a washer disinfector could be in your decontamination process.

Save time and money

The starting salary for a dental nurse will be around €11/£8.50 per hour. Once qualified, this will rise to between €12/£9.75 and €14.29/£11.50. These costs don’t, of course, take into account insurance and pension contributions etc.

Manually scrubbing

The protocol is arduous to say the least. It includes constant monitoring of water temperature using a non-mercury thermometer, monitoring of detergent concentration, scrubbing of each instrument below the water level for two minutes, and full inspection of each instrument under a magnified illuminated source. To prevent inhalation of, or contamination from, an aerosol spray of contaminated water, full personal protective equipment (PPE) should be worn. Even if all of these protocols are observed, which often they are not, the risk of sharps injury is high, especially if such procedures are performed regularly over a long period of time during a nurse’s career.

Taking the starting salary as the minimum cost then, a dental nurse will take at least two minutes to clean an instrument. It would take four hours to clean 120 instruments – at a cost of €42.26/£34 in terms of labour. Throughput – 30 instruments per hour.

A washer disinfector will cost around €4,900/£4,000 and will clean those same 120 instruments in around 35 minutes. Using instrument cassette trays (that can then be transported directly from the washer disinfector into the autoclave) and allowing time for loading/unloading, in four hours it could clean 823 instruments. Throughput – 205 instruments per hour.

On a seven-hour day, therefore, the cost for manually scrubbing is seven hours multiplied by €11.00/£8.50 which works out at €77.00/£61.25.

Washer disinfector purchase price €4,900/£4,000 divided by €77,00/£61.25 means that it is recovered in around 64 days.

Ultrasonic bath

Ultrasonic cleaning is a very effective method of removing contamination from instruments. It is particularly useful when trying to remove hardened on substances or protein-rich contamination such as dried blood. Ultrasonic cleaners use a process called cavitation, where bubbles are specially formed in a solution of water and detergent. The bubbles implode on contact with contamination on instruments placed in the solution, and these implosions release a surprising amount of energy in the process, sufficient to forcibly remove even stubborn contamination on instruments.

However, ultrasonic cleaners are not the complete answer to instrument cleaning, because even though contamination can be removed from the instruments, the instruments themselves will still be immersed in a toxic soup of contaminated water within the ultrasonic cleaner. When instruments are removed from the ultrasonic cleaner, they still need to undergo a washing process before being ready for inspection and sterilisation in the autoclave.

An ultrasonic bath will take a maximum of 45 instruments per load. A cycle takes around 10 minutes, following which the instruments still need to be thoroughly rinsed and then dried manually. Conservatively, this will take another 10 minutes. Throughput – 135 instruments per hour.

On a seven-hour day, therefore, based on the time saved compared with using an ultrasonic bath, a washer disinfector will pay for itself in around 150 days.

So, it is clear that whatever method you are currently using and even taking into account running costs and detergent, a washer disinfector will have easily paid for itself in less than six months – and it doesn’t need to take a holiday!

A word about handpieces

Handpieces, particularly, are difficult to effectively clean, inspect and sterilise due to their intricate nature and their inability to be easily dismantled. Laboratory tests show that sterilisation can only be effective following adequate cleaning. Efficient cleaning and lubrication will also determine handpiece functionality, reducing wear and tear and therefore the need for costly ongoing maintenance and premature replacement. Dental hand pieces present a particular challenge because they have both external and internal surfaces which become contaminated during use. When the air and water is switched off, the negative pressure is also likely to result in contaminated fluid and air being drawn into the air and water lines within the hand piece.

The majority of good quality handpieces can be safely cleaned in a washer disinfector – look for the shower symbol which is located on the body of the instrument. The UltraClean 3 range of washer disinfectors from Prestige Medical incorporate special connectors for hand pieces with irrigation channels which enable the hand pieces to be cleaned and disinfected both externally and, critically, internally – forcing water up through the internal tubes and channels. The addition of forced air drying, which eliminates the need to dry with paper towels or leave to air dry, means that at the end of the process the handpiece is clean and ready for lubrication before sterilisation, as recommended by the handpiece manufacturers themselves.

Instrument sterilisation

A validated cleaning process, coupled with the appropriate lubrication of the internal components would then be followed by sterilisation. The majority of instruments used by dentists are classed as ‘hollow’ devices. For example, given their design, for effective hand piece sterilisation, it is necessary for the air to be removed from the lumens and hollows to allow steam penetration by using a ‘B Class’ vacuum autoclave. This is especially important if the hand piece is to be pouched before sterilisation. The Prestige Medical Advance B Class autoclave also features a non vacuum cycle for maximum flexibility in use and, with a capacity of six trays, can process more instruments per cycle than most other autoclaves.

In summary

There is a wide range of decontamination equipment on offer from a variety of manufacturers, both from the UK, Europe and further afield. Inevitably, there can be a temptation to go for the cheapest option. However, as with the purchase of handpieces, it is wise to look for a reputable manufacturer who can not only provide you with a good quality product at a competitive price, but can also offer full ongoing service and technical support, including access to spare parts.

In summary, then, with the current generation of equipment, the whole decontamination process to meet best practice standards can actually reduce the time you spend on processing instruments in the practice. Most reputable manufacturers will offer a range of decontamination solutions and should be able to provide you with sensible advice on choosing the best type of equipment to suit your needs.

About the author

Christine Bowness is the business manager – UK and Ireland for Prestige Medical. For more information, visit http://www.prestigemedical.co.uk