Rely On Us - October 2017 - SS3
Recent developments in the regulatory
framework for infection control
Professor Laurie Walsh
The second half of 2017 is an important timepoint as several
processes which affect the regulatory environment for infection
control converge. The national law which established AHPRA
and uniform regulation of health practitioners will be going
through two series of amendments. One can expect the
opportunity to empower rapid responses by the national
boards when faced with situations of risk to public health will
be strengthened through these amendments. In mid-2017
changes were made to the Public Health Act in Queensland in
a similar vein, and subsequent changes in Qld and NSW which
have co-regulatory arrangements are likely to occur or have
already been set in motion.
A common point for such amendments is to allow the operation
of dental practices with significant infection control concerns
to cease until such issues are addressed. There would be
an expectation of further audits and monitoring for any dental
practice so identified. The types of breaches which can trigger
such events may not necessarily occur in the dental operatory.
History has shown that issues in
instrument reprocessing are commonly
found when dental practices are
audited, and the dental practitioner
running the practice may not be aware
of these, despite being held legally
responsible for them.
Examples include packages of sterilized instruments with
inadequate seals, or which have been stored incorrectly, as
well as incomplete records for the sterilization processes, such
as deficits in cycle records or in batch control identification
(tracking) records for surgical instruments.
Over the next 3 years one can expect to see a transition for
dentistry into a uniform approach for instrument reprocessing
where there will be one rather than two Australian standards, in
this case AS/NZS 4187:2014. This document is used currently
as the benchmark for large dental practices as well as for
hospitals, and it will need to be expanded from its current form
to address the level of detail needed for smaller, office-based
dental practices where mechanical cleaning uses ultrasonic
cleaners rather than washer-disinfectors. Having said that,
many dental practices undergoing renovations are now moving
to include washer-disinfectors, which is entirely sensible as
they can clean a larger range of items than ultrasonic cleaners.
Likewise, the concept of clear segregation of working areas
within the sterilizing room, which is stressed in AS/NZS 4187,
is becoming the norm in new dental practices and renovated
sterilizing rooms, with the use of colour schemes and coloured
Orders
1 3 0 0
lighting to highlight the transition
from contaminated through
to clean. Any dental practice
considering a major renovation
or a new build would be wise
to draw on the experience of
those who have been through
this process many times, and
appreciate the principles of optimal design, and can factor in the
best positioning of water and compressed air services, lighting,
and ventilation to make the room function at its best.
A revised version of the national health service safety
standards has been produced by the Australian Commission
on Safety and Quality in Health Care, and will launched
publicly in late 2017, to become active from January
2019. This new set of 8 standards will be the platform for
accreditation of dental practices, and surveyors involved
in accreditation will need to be trained to understand
its differences from the earlier set of 10 standards. The
Commission is of the view that processes for tracking should
extend from critical items such as surgical instruments to
also include semi-critical instruments such as those used in
routine non-surgical dentistry, which is beyond what the ADA
Guidelines and the Australian standards require. Nevertheless,
many large dental clinics already follow this best-practice
approach, with packaging and tracking of all items for all
procedures. To do this well requires greater sterilizer capacity
to handle the volume of wrapped items, as well as efficient
procedures for entering the batch data into patient records.
There has been a significant revision to the Communicable
Disease Network of Australia guidelines on blood-borne
viral infections, and when released in late 2017 these will
give advice around exposure-prone procedures and set
expectations for the frequency of blood tests for viral hepatitis
B and C and for HIV which dental practitioners should
undergo, according to the nature of their clinical work. Those
who do mostly surgical dentistry will be performing exposureprone procedures at a higher frequency and so more frequent
testing is logical when one considers the issues of potential
transmission of infection from skin penetrating injuries during
surgical procedures which may not be noticed at the time.
There is a revision of the NHMRC guidelines underway, and
this will be accompanied by the release of the next edition of
the ADA Guidelines. Both are expected in late 2018. One can
anticipate in both documents an expansion of advice in areas
such as environmental cleaning, and the implementation of
transmission-based precautions, as well as reference to the
recently revised Australian standards on disposable non-sterile
gloves and disposable surgical masks. Both the latter set the
benchmark for gloves and masks made available for dentistry.
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Table of Contents for the Digital Edition of Rely On Us - October 2017
Contents
Rely On Us - October 2017 - 1
Rely On Us - October 2017 - Contents
Rely On Us - October 2017 - 3
Rely On Us - October 2017 - 4
Rely On Us - October 2017 - 5
Rely On Us - October 2017 - 6
Rely On Us - October 2017 - 7
Rely On Us - October 2017 - 8
Rely On Us - October 2017 - 9
Rely On Us - October 2017 - 10
Rely On Us - October 2017 - 11
Rely On Us - October 2017 - 12
Rely On Us - October 2017 - 13
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Rely On Us - October 2017 - 21
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Rely On Us - October 2017 - 46
Rely On Us - October 2017 - SS1
Rely On Us - October 2017 - SS2
Rely On Us - October 2017 - SS3
Rely On Us - October 2017 - SS4
Rely On Us - October 2017 - SS5
Rely On Us - October 2017 - SS6
Rely On Us - October 2017 - SS7
Rely On Us - October 2017 - SS8
Rely On Us - October 2017 - SS9
Rely On Us - October 2017 - SS10
Rely On Us - October 2017 - SS11
Rely On Us - October 2017 - SS12
Rely On Us - October 2017 - SS13
Rely On Us - October 2017 - SS14
Rely On Us - October 2017 - SS15
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