Recommissioning Of Dental Clinics - Guidelines

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During this pandemic most practices would have experienced significant downtimes and closures. You can Rely on Us to assist you get back up and running safely.

It is highly recommended to return to work at least a week prior to opening as there are several health risks and issues you want to avoid before seeing your first patient again.

Many items within the dental clinic have moving parts and running water through them. Due to the period of stagnation there is significant health risks of biofilm* contaminated waterlines. It’s imperative, all dental chair waterlines are assessed prior to opening using an appropriate HCP water test system I.E. HS code ST-9MERHPCSAMP. If you are not intending to re-start your practice – we suggest that you put into place a process of running through the decommission and recommission process on a maximum 4 week cycle.

Production equipment that handles fluids whether air/water/treatment fluids/oils are designed for constant use, extended storage may have unexpected consequences. The process of cleaning, then running the equipment periodically will articulate/lubricate/actuate the various components. Our view is this use and testing will to help identify any deterioration of function that can be addressed in a timely manner.

Also consider when you first arrive disinfecting (using suction cleaning solution) your practice sinks. Reducing the flora and fauna growing in the ‘S Bend’ may reduce the aerosol contaminates from the traps under the sinks, (although this is a difficult to quantify phenomenon). This simple step may reduce non-specific odours and contamination.

*To appropriately assess your waterline quality, you must allow 7 days for a test to show the accurate CFU count. This time is required to allow valid test results and allow time to perform a shock treatment prior to seeing your first patient.

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Call your usual HS Equipment salesperson Call HS Equipment Service Hotline on 1300 360 328 Call your usual autoclave service provider for general service and possible

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Turn on all main power supplies to the clinic I.E. A/C, plant room Ensure that all clinical and sterilisation areas are cleaned as per the ADA guidelines Ensure that all bottle-fed treatment centres are refilled with water and flushed multiple times* Ensure that all treatment centres that are plumbed to town water, that the main tap supply at services is turned back on and dental unit is flushed multiple times* 5. If a central filtration system is used please ensure the filter is flushed through via bypass valve or similar 6. Once the lines have been thoroughly flushed you will need to test your waterlines to ensure the CFU count is within the legal drinking limits of <500CFU or <200CFU for immune compromised patients I.E. HS code ST-9MERHPCSAMP 7. For instructions and information on dental unit waterline testing, shock treatments and maintenance please refer to the Henry Schein waterline webinars for more information 8. Ensure all computers are turned on and possible software updates are recognized and loaded 9. Review all clinical surfaces are clutter free and cleaned/disinfected 10. Ensure that sterilisation/ surgery equipment is switched on and operational When recommissioning equipment such as chairs that produce aerosol, please be mindful of potential biofilm organisms spread by aerosol, this may affect nearby surfaces including your health. Potential management may include purging into a narrow-necked container using an HVE to create a negative pressure and PPE along with post purge surface cleaning.

*If you have the competency to do so you may choose to remove handpiece couplings, motors etc from the tubing before the first flush to allow an unimpeded flow in essence allowing a clean exit of any potential suspended materials away from the intricate water paths in these devices. After the initial purge they can be refitted for subsequent purges and ready for clinical use. If you are unsure how to remove, please leave them in place, rather than risk damage from unfamiliar processes.

Use disposable cloths or paper roll or disposable mop heads, to clean and disinfect all hard surfaces or floor or chairs or door handles or reusable non-invasive care equipment or sanitary fittings in the room, following one of the 2 options below: 1. Use either a combined detergent disinfectant solution 2. Or a neutral purpose detergent followed by disinfection 3. Follow manufacturerâ&#x20AC;&#x2122;s instructions for dilution, application and contact times for all detergents and disinfectants 4. Any cloths and mop heads used must be disposed of as single use items

You may want to regularly test all equipment items in your practice, to ensure functionally and to prevent possible â&#x20AC;&#x2DC;seizingâ&#x20AC;&#x2122; of items. If this is done, the above process should be undertaken each time, especially if water and solution are run through the treatment centre, dental unit water lines and/or vacuum system.

Note: The suggested broad guidelines are of general nature. If more specific questions are to be answered, please contact your usual supplier and their respective specialists or service support.

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Switch on power for plant room/suction unit Replace/clean in-line filters of suction unit If required, replace (as applicable) amalgam container Select closest dental chair to plant room Prepare vacuum lines cleaning detergent (E.G. Orotol) in appropriate container Carry out a usual daily cleaning of HVE and LVE hoses and systems on the dental chair Allow same liquid (Orotol) to be added to cuspidor bowl if available Review performance and if OK re-visit the plantroom to verify no leaks are evident Remaining dental chairs to be cleaned one by one

As your compressor and dental units have been drained previously your compressor will need to be filled again with air.

1. Release air and ensure the water draining valve is activated and release of any remaining water/moisture 2. Switch on power for plant room/compressor 3. Observe there are no visible/audible air leaks 4. Return to dental chair and check compressed air is coming through the air/water syringe#

# Note â&#x20AC;&#x201C; it will take some minutes for the compressor to build up pressure

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Connect ultrasonic bath to power Close outlet valve Refill with appropriate bath liquid as per standard procedures Conduct usual degassing and general preparation of bath Ensure either a Foil-test or Hendricks test is performed to ensure proper function of ultrasonic bath Re-assemble all accessories like jars, small cassettes etc. and prepare for use Return accessories to bath Perform a test run with a typical load Evaluate, confirm and accept the unit is ready for general use

If your autoclave or disinfector units are supplied with water from a central RO water treatment system, the following procedure (depending on brand and system) should be considered; 1. Turn on main supply valve to RO System 2. Switch on power supply to RO system 3. Flushing of system is necessary to remove any possible biofilm left while being in hibernation.

This is achieved in many ways and please ensure you check with User manual for proper procedure. In many systems, an automated flushing may be initiated via switch on the user interface. Please ensure a minimum of five minutes of water cleaning is run before normal operation is put in place

4. Following the flushing it is advantageous to ensure the autoclave water quality control* is within limits as per user manual. Alternatively, please used a TDS water meter (Total Dissolved Solids) is used on a water sample. Results should be < 10 TDS (PPM). For the disinfector, water quality should be < 20 TDS (PPM)**

*Not all autoclaves have an internal water quality meter **Depending on brand – consult you User Manual

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Reconnect autoclave to power supply Switch on autoclave and check date and general settings on user interface (GUI) Return rack and shelves to autoclave chamber Ensure wastewater line is connected to drain If water reservoir is connected to a RO system* with automated filling please turn on supply at main valve and verify the clean water chamber is filled 6. Alternatively, manually fill the clean water tank with demineralised water 7. Check autoclave validation is valid – if not, call your usual service company. In the event the validation is out of date and service is not immediately available please refer to the Office Based Sterilisation standard (AS 4815 2006 point 7.3.1.3) under which you can continue to use a non-validated autoclave using Class 5 or 6 indicators in every pack with every cycle 8. Follow manufacturer guidelines and initiate a standard vacuum test cycle followed by a standard Helix test 9. Double check all parameters are within expectations and that no errors are generated. If an error is experienced, you must not use the autoclave until the error has been rectified 10. Run a standard 134 C cycle B with a loaded chamber 11. Check performance date after cycle – if No errors – you are back in business!

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Reconnect autoclave to power supply Switch on autoclave and check all date and general settings on user interface (GUI) Ensure wastewater line is connected to drain Return cassette, heating plates (Treat interior surfaces of the cassette with STAT-DRI™ Plus) to autoclave chamber 5. Manually fill the clean water tank with demineralised water 6. Check autoclave validation is valid – if not, call your usual service company. In the event the validation is out of date and service is not available please refer to the Office Based Sterilisation standard (AS 4815 2006 in point 7.3.1.3) under which you can continue to use a non-validated autoclave using Class 5 or 6 indicators in every pack with every cycle 7. Follow manufacturer guidelines and initiate a standard Process Challenge Device (PCD) test using Statim emulators (SCI-99108332) 8. Double check all parameters are within expectations and that no errors are generated. If an error is experienced, you must not use the autoclave until the error has been rectified 9. Run three (3) normal wrapped cycles 10. No errors – you are back in business!

Disinfectors (all brands) are using various detergents. All pumps and supply lines must be refilled after an extended period of no use. Before a re-start, please refer to manufacturer’s operator manuals. The main objective will always to refill the detergents (replenish salts if required) and a general procedure will be as follows; 1.

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Reconnect disinfector to power supply Switch on disinfector and check all date and general settings on user interface (GUI) Ensure wastewater line is connected to drain Return racks, trolley and inserts to disinfector chamber As detergents may be caustic and very alkaline, ensure suitable PPE is secured before the next steps 6. Locate detergent bottles and relocate suction devices inside. Ensure the right suction hose is attached to appropriate type of detergents 7. Check salt supply and refill if required 8. There might be a detergent refill program available in your disinfector - please check and use if available 9. If no refill procedure is available, initiate and run a normal and preferred standard cycle with an empty chamber. During such cycle detergent lines and pumps will be refilled – wait until cycle has concluded. Open chamber and ensure racks are in correct position, the rotation of the cleaning arms is in order and that door seal is tight and no leaks observed 10. If a Soil Test” is part of your standard procedure, please prepare same and run another cycle 11. Following the second cycle, check soil test strip and if accepted - your disinfector is ready for use – if NOT, please call your service provider

If the milling unit indicates when turned on to proceed to the cleaning process, please follow the guidelines for cleaning. Otherwise fill the tank with water and appropriate cooling liquid. If indicated leave the milling chamber door open until use.

Printers make sure all resin has been replaced and tested prior to use.

For Planmeca’s decommissioning / recommissioning Guidelines: • https://issuu.com/henryscheinhalas/docs/planmeca_decommissioning__recommissioning_ guidelin?fr=sZTFhNTEwNTc2ODU

In line with daily/weekly practice infection control policy: • Conduct infection control the same as the new daily/weekly paradigm of intensive clean, disinfect, clean, rinse and dry protocol for surfaces. .

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Clean suction filters and disinfect suction system, lubricating O-rings and seals. Allow the suction to run on for a few minutes to dry out the chairs suction system and ducts.

Waterlines, the primary goal is to either dry out the unit or place a hibernation solution like Bilpron (if supported by chair maker) to prevent stagnation/biofilm creation and corrosion/deterioration of working components.

First step is to conduct long purge of waterlines, if you have the means conducting a Biofilm Removal process the cleaner it is the better.

The next step is to dry out the unit, if you’ve a bottle, connect it empty and run the all the instruments with water and cupfiller / spittoon until the unit runs dry.

Or Purge with a hibernation solution like Bilpron and switch unit off with once the waterlines are filled with the solution Or For mains connected units without bottle, contact a service person to disconnect and dry out the using compressed air through the water system.

Please be thorough; the last step before you switch off the lights is the final clean water and micro fibre cloth wipe down before you close the door.

Equipment, benches, floors and office fittings totally dry and clean of bioburden, disinfected and removed of all disinfection and cleaning chemical residues is your best protection strategy.

Please resist bombing the practices with ‘chemicals’ and closing the door on wet gear will do harm and not achieve what the idea proposes.

For Planmeca’s decommissioning / recommissioning Guidelines: • https://issuu.com/henryscheinhalas/docs/planmeca_decommissioning__recommissioning_ guidelin?fr=sZTFhNTEwNTc2ODU For Morita’s decommissioning / recommissioning Guidelines: • https://issuu.com/henryscheinhalas/docs/morita_decommissioning__recommissioning_ guidelines?fr=sY2E2YjEwNTc2ODU •

Preparing units bottle only

Long Purge

Long Purge

or

Purge to dry

Then empty bottle

Short purge

Switch unit off

Hibernation solution must have seal of approval from chair supplier

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

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Preparing Units | Bottle with Spittoon | Cup Fill

Preparing units bottle with spittoon / cup fill

Long Purge

Long Purge

or

Purge to dry

Then empty bottle

Short purge Hibernation solution must have seal of approval from chair supplier

Switch unit off Switch water off

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

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Preparing units | Town Water Connection Only

Preparing units town water connection only Long Purge

Switch unit off Switch off water

or Long Purge

Call service to arrange a technician to disconnect unit and dry unit out. If the unit supports use of hibernation solution we can optionally add.

Cost – call out fee and hourly rate, typical

Consider during surgery closed period ordering and having fitted a water bottle system to ensure forthcoming 20/21 compliance with water standards Hibernation solution must have seal of approval from chair supplier

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

Switch off unit Switch off air Switch off water Switch off suction

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

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Preparing Units With Technical Treatment

Preparing units with technical treatment Follow chair user instructions

Examples

KaVo Oxygenal 6 Planmeca PlanPure Metasys WEK Sirona Dentosept

Switch unit off Switch water off

Hibernation solution must have seal of approval from chair supplier – use only if manufacturer supports it

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

Note – these are generic instructions – please follow the manufacturers

Preparing units, suction cleaning

Preparing Units | Suction Cleaning

Follow chair and material instructions

Suction disinfection

Switch unit off Switch off suction

Clean Filters

rinse

Consider getting A suction service

Silicone lube the O-rings

Run system for Several minutes To dry

Note –the thesemanufacturers are generic instructions – please followand the manufacturers Note – these are generic instructions – please follow specific guides instructions. specific guides and instructions.

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Preparing units | Clean to Extraordinary Level Preparing units; Clean to extraordinary level - squeaky clean Follow chair surface cleaning instructions Follow ADA/Standards instructions Use approved solutions/detergents Use dampened medical cleaning cloths / micro fibre cloths

Clean – remove bioburden

Disinfect where contaminated

Removal all disinfectant residue

Rinse & dry to remove soap residue

Switch unit off Switch off water Switch off air Switch off suction Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

Note – these are generic instructions – please follow the manufacturers specific guides and instructions.

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We bina r Ser ies

Please find below some educational / instructional videos on how to keep your equipment maintained and compliant:

Webinar | Water Quality Issues in Dental Are Your Dental Unit Waterlines Safe (Part 1)

Webinar | Water Quality Issues in Dental Are Your Dental Unit Waterlines Safe (Part 2)

Webinar | Preparing Your Equipment For Decommissioning

Educational Video | Mocom Keeping your infection control equipment compliant

For more info, please contact our service team on 1300 360 328