Infection control: Revision of AS/NZS 4187

Dental practices with a concern about infection control should be aware that AS 4187 is being revised.

AS 4187 covers processing of Medical and Surgical instruments and is relevant to dental practices, although most of us use the more friendly AS 4815 for office base health care.

It is quite possible that AS 4815 will be dropped leaving dental practice to negotiate the difficulties in this hospital standard. I sympathise with the Royal Melbourne Dental Hospital where I act as a clinical supervisor.

Some of the more difficult aspect of AS 4187 will be:

  1. Validating cleaning of instruments in an objective manner rather than visual inspection (which could be objective!)
  2. Water quality testing
  3. Tracability of individual instruments to individual patients. This may mean each instrument is recorded in the patients records. That may mean over 500 instrument recordings per dentist per day.
  4. Validating and performance qualification  of wrapping, sealing and containment of instruments
  5. Collecting and documenting of all manufacturers reprocessing instructions and validating against practices procedures.

The reality is that dental practices have led the way in sterilisation of instruments and our practices are immensely safe (so safe that it is difficult to find any evidence based measures for improvements). This is because we are intimitely involved in our sterilisation processes – we do it ourselves. We talk to and know and work with the people who sterilise our instruments. Hospitals and doctors have removed themselves from these ‘grass roots’ processes so they require massive documentation to try and gain control over this critical part of your medical treatment.

Difficult decisions need to be made for this draft document.
Context is everything so hopefully the finished product will be one that allows for safety with common sense. The committee are doing a great job with a complex task!