You are here

Plymouth Orthodontics Limited

All reports

Inspection report

Date of Inspection: 13, 28 February 2014
Date of Publication: 20 March 2014
Inspection Report published 20 March 2014 PDF

People should be cared for in a clean environment and protected from the risk of infection (outcome 8)

Meeting this standard

We checked that people who use this service

  • Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 13 February 2014 and 28 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We sent a questionnaire to people who use the service, talked with people who use the service, talked with carers and / or family members and talked with staff. We reviewed information given to us by the provider.

Our judgement

People were protected from the risk of infection because appropriate guidance had been followed and were cared for in a clean, hygienic environment.

Reasons for our judgement

Everyone we spoke with who used this service told us the premises were always clean and tidy. No one we asked had any concerns about risk of infection or poor hygiene practices from the dental staff.

We saw in annual staff performance reviews that staff objectives included infection control training in 2014. We also saw evidence showing the dentist and dental nurses were vaccinated against Hepatitis B. This ensured the safety of the people using the service.

In November 2009 the Department of Health published a document called Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01- 05). It set out in detail the processes and practices essential to prevent the transmission of infections and clean safe care.

The practice had a dedicated decontamination room where all the dental instruments were cleaned and the dental nurses were responsible for decontamination of instruments on a rotational basis. The dental nurse on duty showed us the decontamination procedures, including the packaging and storage of clean instruments. There was a separate sink for hand washing with liquid soap and paper towels. Before starting the decontamination process the dental nurse put on their protective gloves, apron, mask and visor. There was a flow of work from dirty to clean. Boxes were labelled to ensure dirty and clean instruments were stored separately. The boxes used to transport instruments were leak-proof, rigid and closed securely to protect instruments from damage and to protect the handler from injuries.

Dental nurses brought dirty items from the dental surgery in covered boxes, immersed in water with an enzyme cleaner. Any disposable instruments were disposed of in the clinical waste bin or bin provided for anything sharp. The reusable items were scrubbed under cold water with detergent to remove any visible debris. The temperature of the water was monitored to check it was not above 45 degrees Celsius. This was not recorded after each load however the dentist agreed to add this to the decontamination check lists. The instruments were rinsed in plain water before they were inspected under a magnifying glass to check they were clean. Any instruments still showing debris were returned to the sink for a second scrub. The cleaned instruments were laid out on trays and these were loaded into the autoclave that was used to sterilise the instruments. Any hand-pieces were cleaned and lubricated before sterilisation. This is because hand pieces are hollow and require a different method of cleaning. A log was maintained of each use of the autoclave and the ultrasonic cleaner.

The clean instrument trays were removed from the autoclave and checked for damage or wear. The clean instruments were bagged and stamped with the expiry date by which they had to be used or processed again in accordance with revised HTM01-05 guidance issued in May 2013 in the clean area of the decontamination room. This process was carried out as it was needed throughout the day. Pouches were checked to ensure they were still in date. Any instruments that had not been used and were past the expiry date were returned to the decontamination room to be put through the decontamination process again. The pouched cleaned instruments were put into “clean” boxes and transported to the dental surgery where they were stored ready for use. We saw in the dental surgery trays with instruments not in pouches. The dental nurse explained there were always less instruments than would be required for each sessions however if any of the trays and instruments were not used, these were sterilised and pouched at the end of each day.

The dental nurses told us that anything being sent away to a laboratory, for example, dental impressions were rinsed, disinfected, date stamped and sealed before they left the surgery. Prostheses and appliances were subject to decontamination on their arrival at the practice from the laboratory.

One of the dental nurses told us