Dental Instrument Management and transportation made an appearance as an “Area for improvement” in a recently published CQC report. The practice in question had been using open trays to transport instruments and sharps via the reception area to the decontamination room…..
While many practices are aware of the risks this type of protocol exposes staff and patients to, some may not be. Dental Instrument Management is an area I have been doing some research in, and thought a blog might be useful to shed some light on the topic and prompt discussion. The following measures may help you to build a robust and safe protocol for transporting your dental instruments.
Dental Instrument Management – The Risks of Transportation
Protocols for transportation should include measures that detail how dental instruments are safely moved from their point of use, to the point at which they can be re-processed. The object of the measures put in place should be to reduce the risk of cross contamination between instruments, and to protect patients and staff from exposure to pathogens and dangerous instruments.
Lets consider the risks of transporting dental instruments in open trays from the Surgery to the Decontamination room via a reception or waiting area:
- Sharps injury to staff or patients
- Tripping or falling and dropping contaminated instruments
- Airborne contamination
- Leaking fluids onto the floor creating a slip hazard and bodily fluid spill
- Contaminants and soil drying onto the instruments.
Do your current measures mitigate the risks identified above, does your practice have any different risks?
Can I use any box?
In all cases, a secure, clearly labelled transport box should be used as part of your dental instrument management protocol. This reduces several of the risks identified above at once.
Lets be clear – open trays are not fit for purpose and should not be used.
The HTM01-05 (Section 2.25) provides guidance on what the transport container should look and feel like.
HTM 01-05 SUMMARY
Transport containers should be:
- easy to clean
- capable of being closed securely
Boxes should not be used interchangeably, so therefor should be colour coded or labelled for each function – Dirty, Clean and Storage. Boxes should be large enough to fit instrument trays in, resulting in reduced Dental nurse exposure to handling contaminated instruments. The box it seems, is central to removing to majority of risks associated with dental instrument management and should be the first place you start when reviewing your protocol.
Wet or Dry – does it matter?
The majority of risks identified are covered with the use of an adequate box, however, drying time is a risk that can be too easily ignored.
Cleaning instruments is the most basic element of decontamination and is the stage at which instruments are removed of soil and contaminants and made ready to be sterilised. It is critical that instruments are clean before they are sterilised as you cannot sterilise a dirty instrument. Decontamination is usually carried out using an Ultrasonic bath or washer disinfector, in some cases manual cleaning is relied upon despite its shortfalls and risks.
Cleaning can be made more difficult, in fact severely hampered, if contaminants are left to dry onto instruments for any length of time. The HTM01-05 makes clear that if instruments are not immediately processed, they should be held in moist conditions using water or a pre-treatment spray.
“Instruments for decontamination should be transferred as soon as possible after use to avoid the risk of drying. Water Immersion or use of commercial sprays may be considered if a delay is unavoidable” HTM01-05 2.12
This is because clinical research into the effects of drying time show that moist conditions prior to processing can significantly reduce protein contamination levels (Lipscomb et al 2007). Allowing soil to dry onto instruments by delayed decontamination makes the process of trying to remove it much more difficult. A number of options and products are available to help you on this.
|The golden rules of instrument transportation|
Don’t transport anything you don’t need to
Disposable sharps items should be placed in sharps bins by the USER directly after use. Needles and other items should be re sheathed and placed in conveniently located sharps bins by the Dentist.
Design your protocol around your drying time
Do you re-process immediately or do you have to delay for operational and practical reasons? If so add a step to your protocol that ensures instruments are kept moist. If your delay is less then an hour a liberal spray of InstruClean IC100 Pre-cleaner onto the tray placed in the Transport box closed will reduce the risk of drying and begin to break down the proteins. If the delay is longer, add a InstruPak Instrument Pouch to your protocol to keep your instruments moist with just water.
Choose the right box range
Transportation is the point at which all the risks become real so your choice of box is your last level of protection in case contaminated instruments do get dropped accidentally. Is it robust and lockable, is it easily identifiable, does it meet HTM requirements, does it fit a full instruments tray within it?
Get your current Instrument Transport protocol out and consider your risks, consider if your process protects your staff and patients against them and identify the gaps. Make a note that you have done a Risk assessment, review of process and gap analysis and what action you plan to take (CQC love this!). Then implement the changes and ensure full training is given to staff.
Check out our blog on the brand new InstruBox range for a simple transport box solution.
Lipscomb, I.P., Pinchin, H.E., Collin, R. and Keevil, C.W. (2007) Effect of drying time, ambient temperature and pre-soaks on prion-infected tissue contamination levels on surgical stainless steel: concerns over prolonged transportation of instruments from theatre to central sterile service departments. Journal of Hospital Infection, 65, (1), 72-77. (doi:10.1016/j.jhin.2006.09.025).
Originally posted 2016-01-12 09:27:57. Republished by Blog Post Promoter