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Decontamination Into Practice: Part 1 - Cleaning of Dental Instruments

Dental toolsThe Scottish Dental Clinical Effectiveness Programme (SDCEP) first published guidance on the Cleaning of Dental Instruments in March 2007. The aim of this guidance is to facilitate improvements in decontamination practice and compliance with the relevant mandatory and statutory standards. The guidance provides advice on organising the local decontamination unit, cleaning methods and equipment testing. This guidance was updated in October 2014.

Diagnostic Analysis

A diagnostic analysis was conducted during the guidance consultation period and comprised two stages:

1. Semi-structured Telephone Interviews

General Dental Practitioners (GDPs) took part in interviews prior to publication and dissemination of the guidance. A semi-structured interview schedule followed a standardised format to identify the barriers and facilitators to the implementation of the SDCEP guidance. Interview findings were mixed, however all participants commented that in general if would be too difficult for them to implement best practice as detailed in the guidance and suggested they would benefit from outside help, financial and or advice, to facilitate implementation.

2. Pre-guidance Publication Survey

A theory based postal questionnaire was developed, informed by the findings of the qualitative interviews. The questionnaire was designed to assess current decontamination practice and beliefs about implementing the guidance. It was sent to a random sample of 200 GDPs approximately six weeks prior to the publication of the guidance. Questionnaire findings highlighted the need to enhance the implementation of the SDCEP guidance and that a tailored approach would be most likely to succeed [1].

Evaluation

In order to explore strategies to improve the implementation of the SDCEP guidance, a pragmatic, practice based, two-arm randomised controlled trial (RCT) was conducted. This trial explored two educational strategies and their influence on best decontamination practice. These educational strategies were a didactic style postgraduate training course and an in-practice decontamination training session delivered by NHS Education for Scotland’s (NES) Infection Control team.

Trial results highlighted that very few practices were fully compliant with the recommendations in the guidance. While all participating practices showed a trend towards performing more of the key recommendations, there was a significant increase in compliance by those who received the in practice training, compared with those who attended the postgraduate training alone.

Following the results of this trial NES’s Infection Control team have continued to deliver in-practice training in this area and have rolled out further in-practice training to support the implementation of SDCEP guidance recommendations to facilitate best practice.

Publications and Presentations

1. Bonetti D, Young L, Black I, Cassie H, Ramsay C, Clarkson, J. Can’t do it, won’t do it! Developing a theoretically framed intervention to encourage better decontamination practice in Scottish dental practices. Implementation Science 2009; 4:31.

2. Bonetti D, Clarkson, JE, Young L, Ramsay C, Cassie H, Black I, Tailored action planning improved decontamination best practice when providers were greatly variant in implementing guidance Poster presented at the 30th Conference of the European Health Psychology Society and the British Psychological Society Division of Health Psychology, Aberdeen (2016, August)