Clean cut area?
Decontamination is still a fairly emotive subject for general dental practitioners in Scotland. However, during the last six years, I have seen a gradual change in attitude from anger and disbelief to a disgruntled acceptance that these requirements are not going to go away.
It did look for a time that Scotland was on its own as far as the application of the guidance was concerned. Now, with the publication of HTM 0105 by the Department of Health, the same principles will be applied south of the border and in Northern Ireland, although the detail will differ.
Scotland was just a bit ahead of the game. The fact that general dental practices in Scotland have had the benefit of some funding to enable these changes should be appreciated. I agree, it may not be enough, but it is certainly the envy of our colleagues in the rest of the UK.
Compliance in decontamination is complex. The general areas for compliance are facility, processing, quality management, training and equipment. The focus often has been on facility as this has been the most challenging element.
As the previous deadline for compliance of December 2009 approached, practices received a letter from the Chief Dental Officer (CDO) detailing the new timescales. The information used to determine this timescale was collated using the responses from the Dental Decontamination Facilities and Equipment Questionnaire (DDFEQ) carried out early in 2009.
The letter asked practitioners to report progress towards compliance and any future plans to their health boards by 30 December.
The new timescales meant that those who considered themselves able to accommodate a separate local decontamination unit (LDU) facility, and had not done so, would be expected to complete by 2011. Those who had no potential for an LDU in their current setting were given until December 2012 to investigate their options and complete their plans.
The CDO’s dental subgroup was aware that there were still significant challenges ahead. The need for more support and advice in relation to developing facilities and buying suitable equipment was identified as a major requirement.
Practitioner’s responses to the DDFEQ highlighted the need for practical help and support in relation to developing LDU facilities. Some were grateful for the help they had received from their health boards via dental practice advisers. Others, particularly those who had space constraints, would have welcomed some dedicated expertise.
Health Facilities Scotland (HFS), which is now the lead organisation for decontamination, has produced a list of surveyors and contractors that practices may contact. HFS has provided these companies with some training as to the guidance requirements. The list has been posted on the NHS information website (http://www.scottishdental.org). It would still be advisable to keep in touch with your health board as arrangements for support may vary from are to area.
There is some news in relation to those who own more than one practice and have a branch practice unable to accommodate an LDU. The latest response from HFS stated that, as long as the two sites are the same ‘legal entity’ and the instruments are transported as per the requirements of the Carriage of Dangerous Goods Act, moving instruments to and from the site with an LDU would be allowable.
Progress has been made in relation to the National Procurement Contract NP143/09 for decontamination
Last year, manufacturers and suppliers were invited to tender to have their products included. The equipment was rigorously tested to the full guidance requirements. The manufacturers and suppliers were asked to provide evidence in areas of product quality, performance, cost and technical support. Those who scored most points were included on the contract.
A list of equipment now on the NP143/09 can be accessed via the home page of http://www.scottishdental.org
For details on how to access the full contract list, including costs, go to the decontamination link on that site. Purchases should be made directly from a contracted supplier.
Full compliance requires that all decontamination equipment should be installed and commissioned. Contracts should also be in place for quarterly testing, annual revalidation and maintenance. The ongoing cost implications of this aspect of compliance could make the capital outlay look insignificant.
At the moment, there is some discussion around the potential for reducing the frequency of these testing requirements. This has been raised, as some manufactures believe this frequency may be unnecessary due to the technological improvements of the newer equipment.
HFS does not fully agree with this proposal at present but have agreed to consider it? Have they not?
Reviewing this situation would undoubtedly be a welcome step and could lead to significant cost reduction. It is hoped this can be explored further.
Quality management systems are a somewhat alien concept for general practices at present. Some work is being progressed by HFS in relation to developing a suitable quality management tool. A few practices and their staff have been involved in piloting the system. They have fed back and modifications are being considered.
This is still a work in progress.
The infection control support team at NHS Education has been delivering in-practice training across Scotland for two and a half years. It has been well received by dental teams and around 550 practices across Scotland have accessed the service.
As part of the requirement for compliance, the CDO determined that all practices should undertake this training. Naturally, this has increased demand and stretched the support team’s staffing capacity. This has resulted in practices having to wait longer for training than they would have liked. It is hoped that the staffing situation will be resolved in the near future as recruitment is in progress.
At present, the support team are prioritising those who haven’t accessed the training previously. They hope, in the near future, to be able to offer those who have already accessed training a second session, which will include operating and testing of decontamination equipment. Information on the training is available from http://www.scottishdental.org
In the last few years most dentists and their teams have made significant progress in working towards compliance. There are also people working hard in an effort to support practices. There is no doubt there are still lots of questions and issues to resolve as far as decontamination is concerned, however I believe that the principles involved in compliance will not change – the devil is undoubtedly in the detail.
The most hopeful phrase I heard used at a recent CDO sub group meeting was that consideration had to be given to ‘reasonable practicability’.
Perhaps there is some hope after all.
IRENE BLACK qualified from Glasgow University in 1980.
- She is in General Dental Practice in Eaglesham where she has worked in partnership with her husband for the last 24 years.
- She gained her Membership of the Faculty of General Dental Practitioners in 1999 and the Certificate in Effective Dental Management in 2005.
- She has worked as a Dental Practice Adviser for Greater Glasgow Health Board for nine years and has also been involved with the Care Commission on an advisory basis. Her most recent post is with NHS Education where she is an Assistant Director with the remit for Infection Control and Decontamination, providing information and education for dental teams throughout Scotland. She has been part of the Chief Dental Officer’s advisory group on dental decontami
- Her interest in the thorny subject of decontamination came about through her involvement in the Survey of Decontamination in Dental Practice in 2003.