Home' News Bulletin : ADA News Bulletin November 2015 Contents 13
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sterilised, under what conditions and who checked off the printout
of physical parameters and status of the chemical indicators prior
to releasing the load for use. The printouts for the cycles of interest
are checked, and are found to show correct processing and the
signature of the staff member who unloaded the chamber for
those cycles (load release authorisation). The performance test
results for the steriliser are then checked, including the details
of the verification of the cycle parameters as being suitable for
wrapped loads using spore tests (biological indicators), the daily
tests for air removal effectiveness (process challenge devices),
and the weekly tests for integrity of the door seal. All are found
to be recorded in the logbook, in line with AS/NZS 4815:2006,
and showing satisfactory performance. Details of the instrument
cleaning process are then checked, looking at the records for
aluminium foil tests for the ultrasonic cleaner.
A site visit to the dental practice by the investigator confirms
the consistent approach used in the practice to check for
proper cleaning and correct use of chemical indicators. In this
instance, the practice demonstrated that as well as meeting the
requirements under the Australian standard for verification of
cycle parameters, they also routinely used internal indicators inside
all packages of oral surgery instruments and had a consistently
applied protocol for checking these internal indicators whenever
surgical packages were being opened, prior to instruments being
used. Service records for the steriliser show details for the initial
commissioning and annual calibration of the thermocouple
sensors. The investigator notes the thorough and systematic way
that surgical instruments in the practice are cleaned, packaged
and sterilised and by reviewing past years finds that recording
performance data has been done consistently, reflecting the
training of the staff and their level of awareness of infection
The investigator is satisfied that everything possible has been done
to ensure that surgical procedures in the practice give optimal
patient safety and concludes that the hepatitis B infection has
resulted from an event other than the surgical dental procedure.
If the situation had been the patient themselves presenting
to the practice making claims they had acquired the infection
there, the demonstration of the chain of evidence would have
followed exactly the same path as it did for the investigator
from the public health unit. Without an understanding of the
Spaulding classification system, Batch Control Identification and
steriliser validation, reassurance of the patient would not have
been possible in this situation. Patients whose latent herpes
virus infections reactivate in the mouth following local trauma
to the soft tissues (e.g. raising a flap or placing a rubber dam
clamp) often believe they have contracted herpes from the dental
instruments used in their treatment. As above, the same chain of
evidence can be followed, guiding the patient through the aspects
so that they can be reassured of the many steps taken to achieve
and document quality outcomes for instrument reprocessing.
Brendan White and Laurence Walsh
On behalf of the Infection Control Committee
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