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!

Dental practice accreditation – in a market driven healthcare world

NSQHS Standard 10.3  says “Organisational clinical service capability, planning, and scope of practice is directly linked to the clinical service roles of the organisation”.

What does this mean in a consumer-driven free market healthcare service?
In our dental practice we do what we do! For me this means that I do the things I love, that I think I am pretty good at and I redirect people when I think that something has gone beyond my ‘comfort’ zone. Is this definable in a meaningful way in a policy document or business plan? Of course not.

Would attempting to define it improve standards of quality and safety in our practice. No! Each situation and person that comes under our care is a unique individual who requires their own unique attention. Flow charts are not the answer to all healthcare needs.

Recently I heard a singer on TV say that she does what she loves; ignores reality; and hope someone pays her for it. I loved what she said.

This Standard is one of the oddities that shows that “one size fits all”  health care organisation standards leads to incredibly frustrating and time wasting bureaucracy. We understand where this standard requirement comes from. In public hospital health patients are NOT realistically the consumer. It is incredibly hard to get up and walk out of a hospital that fails to deliver.

But this is not true of private dental practices and the risks and quality and safety of patients can not be seen to be improved by trying to make evidence of this statement.

Is it time for the ACSQHC to recognise situations where “patient centred focus” is market driven and moves from artificially imposed(by the NSQHC Standards) to an everyday business reality? Allied health practices need recognition for the problems we DON’T have. Perhaps the focus should be to look at us and follow the way we do things! (Rather than make us appear like mini-hospitals)

Barriers in infection control

Should I be using barriers? What are the ‘rules’?

This is the most common question I get from Dental Assistants. It is also one of the most controversial aspects of practice protocols, especially when a new staff member comes into a practice.

At our practice we use barriers extensively. Why? Well we philosophically believe that this is must be the superior system because we do it(:))… but basically we do it because that’s what we were taught…it’s what we have become familiar with…and it’s what we therefore are setup to do and we find it quickest. But it is not necessarily necessary.

What does the ADA Inc guidelines say…What is the DBA ruling?…If you don’t know then perhaps it is time to do SmartDentist’s latest CPD /training exercise for dental practitioners and dental assistants on Barriers and infection control.