The Decontamination Room

A prime requirement of a decontamination room is the segregation of clean and contaminated activities to minimise the risk of contaminating clean or sterile product.

The Decontamination Room

One of the main requirements of decontamination guidance and standards is that decontamination takes place in a dedicated room or rooms away from all clinical activity. This is the requirement for HTM 01-05 Best Practice.

In the past, all decontamination was carried out in the clinical environment. Even theatre instruments were manually washed and sterilised in bench top autoclaves in theatre – with the patient present.

It was recognised that this was not providing any assurance of quality or the consistency of the process. Staff training was inadequate, as was the equipment in use. There was a clear risk of cross infection of the patient undergoing surgery.

Decontamination was moved into a dedicated area with dedicated staff. Standards and guidance were developed, improved equipment, environment and processes were introduced. Eventually the modern Central Sterile Services Department (CSSD) became the norm in hospitals.

As legislation and standards continued to evolve, non-theatre decontamination also moved into the CSSD until the ward and department based decontamination facilities were removed from hospitals.

In the past ten years an increasing number of community and primary care activities have also abandoned local decontamination, opting to use either a certified CSSD or single use surgical instruments.

Because of the nature of dentistry, with some very high value instruments and large patient throughput, very few dental practices send their instruments to a dedicated CSSD and instead opt to install a decontamination room on their premises. The application of single use instruments and devices is also increasing as new products become available.

HTM 01-05 is the Department of Health’s pragmatic solution to bring decontamination standards in dentistry as close as practicable to those of the modern CSSD, whilst also recognising the space limitations present in some practices that may prevent the use of dedicated rooms.

A prime requirement of a decontamination room is the segregation of clean and contaminated activities to minimise the risk of contaminating clean or sterile product.

This could be achieved by the use of two dedicated rooms, one for the cleaning of instruments and one for inspection packaging and sterilisation. This is the standard achieved in a CSSD.

More typical in a dental practice would be a single dedicated room. In this case the segregation can be achieved by a combination of contaminated to clean workflow and temporal segregation, with clean and contaminated activities not taking place at the same time, and with surfaces cleaned and disinfected between the activities. Further improvement in segregation may be achieved by means of a clean to contaminated airflow. This can be achieved by using mechanical ventilation systems. At its simplest this may be extraction fans at the washing zone and the air inlet at the sterilisation zone.

Where decontamination can only take place in the surgery, temporal segregation must be implemented and decontamination activities must not take place when a patient is present.

HTM 01-05 provides a number of suggested simple layouts for decontamination room(s).

One of the most important elements of installing a decontamination room is the design. Properly constructed plans will ensure that your practice ends up with a room that is fit for purpose. Once an installation is complete it would be extremely difficult to change, therefore before work begins ensure that the design fits with the requirements of meeting Best Practice.