Dental National Decontamination Survey 2010
(Limited Text - Ministerial Extracts only)
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The Minister of State, Department of Health (Mr Simon Burns)
In recent years we have gained a better understanding of the risks of transmission of infectious diseases like hepatitis from poorly maintained health care premises and instruments which have not undergone effective decontamination. The risk to individual dental patients is small but, with 1.5 million people undergoing dental treatment each week and some 500,000 people infected with blood-borne viruses many of whom may be unaware of their infection, we cannot afford to be complacent.
Because of this risk and evidence that some dental practices might not be achieving adequate standards, the Department issued health technical memorandum 01-05 “Decontamination in primary care dental practices” in November 2009. In implementing the HTM we have sought to strike a balance between protecting patients and the constraints imposed by the layout and structure of dental practices which, while being easily accessible in the high street, may have limited scope for expansion and upgrading.
I am today publishing the report of the dental national decontamination survey which was undertaken at the start of the year. The primary aim of this, the first national survey of current standards of decontamination in primary care dental practices, was to provide a baseline to compare standards in general dental practice at the time of issue of the HTM 01-05 with those set in the guidance. The HTM is intended to encourage continuous improvement in local decontamination by giving dental practices a range of options to achieve the essential quality requirements (EQR) identified in the HTM and progress to best practice.
EQR is a level of decontamination which will achieve significant risk reduction, while best practice offers an optimum level of protection. The main features of best practice are the provision of a dedicated room for decontamination away from where clinical care is delivered and the use of an automated washer-disinfector, for the cleaning of instruments.
All practices are expected to be operating at EQR by the end of this year; no timeframe has yet been set for the achievement of best practice because of the need for further information to be obtained about the constraints imposed by the design and structure of some dental practices.
I am very grateful to the primary care trusts (PCTs) and the dental practices which participated in this voluntary survey, and to the Health Protection Agency which worked with the Department in bringing it to completion. In total 75 PCTs participated in the survey which involved nurses with training and experience in infection control visiting 487 randomly selected dental practices. Practices were assessed in relation to essential quality requirements and best practice at the time that the HTM was published.
The results of the survey showed that around 70% of practices were already working at EQR with some 20% of practices already achieving best practice. Approaching 20% of practices were very near EQR with the remaining minority operating at an unsatisfactory standard.
These results show that the majority of practices were meeting EQR and it is likely that this figure would have increased over the year as practices began to implement the HTM.
I was very encouraged to learn that well over two thirds of practices were already meeting EQR. As to the remainder, the survey data show a number of practices need to improve their cleaning of instruments which is a critical part of the decontamination cycle. The Department is encouraging practices to acquire automated washer-disinfectors, whose use is a feature of best practice, to achieve a uniformly high standard of cleaning of dental instruments.
The Department has, in collaboration with the Infection Prevention Society, produced a self-assessment audit tool to allow all dental practices to assess their level of compliance with the quality standards in the guidance. By applying the audit tool, practices will be able to compare their standards to those included in the sample survey.
The quality of local decontamination will be one of the factors the Care Quality Commission (CQC) will take into account in monitoring standards when dental practices are brought within its remit from April 2011. The CQC will wish to ensure that it only registers practices that can demonstrate local decontamination is carried out to acceptable standards.
The dental national decontamination survey report has been placed in the Library. Copies are available for hon. Members in the Vote Office and for noble Lords in the Printed Paper Office.