It is the responsibility of the Practice Director, Neil Phillips, in consultation with the Clinical Director, Joanne Giddy, to select and purchase appropriate equipment when required.
In particular, we will ensure that:
- Equipment bears appropriate CE marking where necessary;
- Where possible, single-use items are introduced as an alternative to reusable items (eg triple-spray tips and large bore suction tubes were switched to single use many years ago);
- Where possible, equipment can withstand automated cleaning processes, such as ultrasonic and autoclave cleaning; otherwise that the recommended decontamination processes can be carried out within the practice;
- Where the manufacturer recommends specific cleaning agents, that these are adequately covered by our COSHH procedures and are compatible with other instruments already in use and with ultrasonic baths, autoclaves, etc.;
- When selecting new hand instruments, we avoid serrated handles and hinge mechanisms that are difficult to clean and that where instruments need to be dismantled before cleaning, the manufacturer supplies instructions on how this is to be done;
- In the case of dental chair and work surface coverings, that these can be regularly decontaminated without deterioration;
- Where relevant, the new equipment is compatible with existing equipment (eg that dental motors and handpieces will fit the outlets on the over-the-patient delivery system);
- The equipment is easy to use and maintain;
- When routine maintenance is required for a device, that this is added to the Testing, Maintenance and Audit Schedule with appropriate time intervals;
- Wherever possible, electrical devices for use in the surgery have foot controls;
- Where a device has a limited life cycle specified by the manufacturer, this is identified and added to the Testing, Maintenance, Audit and Compliance Schedule (eg the defibrillator power pack);
- Where training is required, this will be provided by the supplier or manufacturer where it cannot be satisfactorily carried out within the practice;
- That commissioning and validation requirements, where necessary, are complied with (eg new x-ray equipment – refer to Radiography Risk Assessment);
- Where specialist repair, servicing and testing is required, that response times are acceptable.
Records of equipment purchased (in the form of invoices, delivery notes and other purchase documents) are kept in the office. These office records are archived after 5 years.
The Practice Director must review the instructions that accompany new equipment, ensure that important matters are drawn to the attention of the team members who will be using the equipment, ensure that training is provided (if necessary) and that, where appropriate, the equipment is installed by suitably qualified persons.
decontamination of new reusable instruments
The Practice Director must ensure that new equipment is sterilised or decontaminated (as appropriate) wherever it is not clearly marked as a sterile item on arrival:
- Instruments that can withstand cleaning using automated cleaning processes, such as ultrasonic or autoclave cleaning, should be cleaned in this manner.
- Instruments that cannot be immersed in water (for example, electrical equipment) should be cleaned in accordance with the manufacturer’s instructions. If recommendations include wiping with a detergent solution, a clean non-linting cloth should be used. Then a damp non-linting cloth should be used to remove residues of detergent and the instrument dried.
- If disinfection with alcohol is recommended, the instrument or equipment should be cleaned with detergent first, as described above before applying the alcohol to disinfect the item.
- Instruments that can be disassembled should be dismantled before cleaning (following the manufacturer’s instructions).
- Training will be provided to ensure that all staff involved in decontamination are competent to decontaminate new instruments and equipment introduced into the practice.
A library of instructions and operating manuals is kept in the office.
single use items
It is essential that single use items are used only once and are disposed of in an appropriate manner. Refer to the Infection Control Policy for a list of those items we treat as single use (regardless of whether the manufacturer designates them as such – some potentially re-usable items are treated as single-use anyway, eg if we are unable to effectively clean them in a general practice setting). Single use items will be classed as clinical or special waste and must be disposed of accordingly – refer to Waste Disposal Policy.
testing and maintenance
A Testing, Maintenance, Audit and Compliance Schedule is kept in the hygeia document database. This prompts the testing and maintenance of practice equipment. It is the responsibility of the Practice Director, Neil Phillips, to check that all necessary actions have been carried out.
- portable electrical appliances are tested by a qualified electrician biennially,
- the wiring in the building is tested by a qualified electrician every five years,
- the compressor is checked and drained of condensate every month,
- small surgery equipment is checked at least every 6 months (and ad-hoc repairs are carried out as required),
- the autoclaves are tested and certified every year by a qualified engineer,
- the autoclaves have their data loggers checked each week,
- the ultrasonic baths are tested for cleaning efficacy with a protein residue test every week,
- the ultrasonic baths are tested for cleaning efficacy with a Brownes test every month,
- the ultrasonic baths are tested with an ultrasonic activity meter every 3 months,
the compressor is tested and certified every two years by a qualified engineer,
- mechanical ventilation systems are tested every week,
- emergency oxygen cylinders are checked and/or replaced annually by a BOC engineer,
- emergency oxygen cylinders are checked daily by surgery personnel,
- the defibrillator is checked every day,
- other resuscitation equipment (eg Res-Q-Vac, Ambu-Bags, etc) are checked weekly,
- the emergency drugs kit is checked weekly,
- fire fighting equipment is checked monthly,
- fire fighting equipment is tested/serviced annually by an engineer,
- the alarm system is tested and serviced by an engineer every 6 months,
- smoke detectors are cleaned every 6 months,
- x-ray viewing screens are checked every 3 months,
- x-ray sensors are tested every 3 months,
- x-ray generating equipment undergoes routine surveillance checks every 6 months,
- x-ray generating equipment is serviced annually by a qualified engineer,
- x-ray generating equipment undergoes a radiation safety assessment every 3 years,
- emergency lighting is tested every month;
- indoor lighting is tested every month;
- outdoor lighting is tested every week;
- the pharmacy refrigerator’s temperature performance is checked every day.
equipment failure and routine checks
While equipment undergoes essential tests and maintenance on a regular basis, the persons best placed to observe its function and condition are the team members who routinely use it. Team members are required to ensure that all equipment appears safe and functional before they attempt to use it. For example, surgery staff are best placed to know if a plug has become loose or casing has been damaged on a piece of clinical equipment.
If a piece if equipment appears damaged or ceases to function as it should, team members must report this immediately to the Practice Director, Neil Phillips, and must not use the equipment until it has been tested, repaired or replaced, as necessary.
It is the responsibility of the Practice Director, Neil Phillips, to carry out regular risk assessments and, where necessary, to arrange for:
- removal and disposal of unsuitable equipment;
- repair or replacement of equipment;
- additional training.
reporting of incidents
If there is any adverse incident involving the failure or malfunction of equipment, particularly if this affects treatment outcomes or results in harm to a patient or a team member, this must be reported immediately to the Practice Director, Neil Phillips, and recorded in the Accident and Incident Report book kept at reception. He will investigate the matter and arrange for the repair, replacement or modification of the equipment in question.
The Practice Director must also make reports to the MHRA, CQC, HSE and other relevant bodies where appropriate.
All staff receive training in the use of equipment that is essential for the conduct of their duties as part of their induction programme and also on an ad-hoc basis as new equipment is purchased. If any team member feels they are not sufficiently familiar with the operation of any piece of equipment, they must report this immediately to the Practice Director, Neil Phillips, who will make arrangements for training, as required.
safety alerts and bulletins
Where relevant safety alerts and bulletins are received from competent authorities (such as the MHRA or equipment supplier or manufacturer), it is the responsibility of the Practice Director to consider these and to ensure that any necessary action is taken (refer to Health and Safety folder in office document database). The practice subscribes to email alerts and RSS feeds from the MHRA and NPSA to ensure that we are kept up-to-date with all relevant bulletins that may affect us.
Where an emergency situation (such as power failure, flood or fire) prevents dental equipment from being used, team members must not attempt to carry out any dental treatment at all until the situation has been satisfactorily resolved and it is safe to do so. If treatment is already underway when the emergency arises, it should be ceased immediately and action taken to ensure that the patient undergoing treatment is placed into a safe and comfortable condition until treatment can be safely completed.
If a patient is in need of urgent treatment and it is not possible to provide this as a consequence of an emergency situation that prevents safe use of dental equipment, the Practice Director, Neil Phillips, or Clinical Director, Joanne Giddy, will make arrangements for care to be provided elsewhere. In the first instance, they will contact other practitioners who provide holiday cover for our practice and make arrangements for treatment to be carried out at one of their practices instead.
disposal/recycling of equipment
Where equipment is removed from service, it must be disposed of in an appropriate manner.
Many electrical wastes including refrigerators, freezers, fluorescent tubes, televisions, computer monitors, and certain batteries (lead acid or nickel-cadmium) are hazardous and a consignment note must be obtained when they are disposed of.
New regulations on the disposal of waste electrical and electronic equipment (WEEE) mean that when new equipment is purchased there is an opportunity to make arrangements with the supplier to remove the old one. The supplier may not mention this, so we must ensure that we ask.
Where equipment needs to be disposed of and there is any doubt as to the appropriate method of disposal and documentation required, the Practice Director may liaise with our specialist waste disposal contractors (currently Devon Contract Waste and Peake GB) to ensure that correct disposal procedures are followed.
Web version 8: 1.9.2017 (reviewed 11.11.2018)
Previous web versions: 15.2.2011, 6.2.2011, 26.1.2012, 8.9.2012, 18.12.2012, 12.3.2013 (reviewed 19.6.2014 & 5.6.2015), 1.8.2016