Coming Clean
As Professor of Clinical Bacteriology at Glasgow Dental School, Andrew Smith has some sympathy with the extra demands on dentists to ensure dental instruments are decontaminated to recognised International and European standards.
However, although the “buck stops” with dentists to ensure patient safety, the increasingly technical knowledge required to purchase and run decontamination equipment takes the profession outside areas they were trained to undertake.
As one of the UK’s international experts on infection prevention and medical device decontamination, Prof Smith is concerned at the technical expectations placed on dental surgeons and the level of support available to them.
He wonders whether the public would find it acceptable if surgeons from other specialities, such as ENT, were responsible for the technical aspects of decontaminating their surgical equipment rather than perfecting their surgical skills.
However, the big question in the sector is not the need for decontamination of surgical instruments to the required standards – that is a given – but for a consensus on how best to implement the standards to which dentists should be working to.
This debate has now been taken up by the Association for European Safety & Infection Control in Dentistry (AESIC), which has appointed Professor Smith as its chairman.
Professor Smith explained the role of the organisation: “AESIC (http://www.aesic.eu) was set up to be the leading European source of information on safety, instrument decontamination and infection prevention for everyone involved in the dental field, ranging from academia and decontamination equipment manufacturers to policy-makers and clinicians.
“As we are a relatively new organisation, our first objective is to review the different European norms the EU has produced regarding hygiene, disinfection and sterilisation and assess how these have been implemented throughout the EU. We intend to use this information to define a common EU set of recommendations concerning hygiene and infection control in dentistry, and learn from examples of good practice that could be more widely adopted throughout Europe.”
As a qualified dentist whose interest in microbiology has taken him to the top of his specialism in academia, Professor Smith understands the demands placed on dental practices to ensure adequate decontamination and infection prevention.
He said: “Dentists naturally want to undertake dental treatment on patients and be freed from administrative and technical roles not directly linked to hands-on treatment.
“Infection prevention is high on every dentist’s agenda, however, it is becoming increasingly frustrating trying to tackle the maze of technical requirements and more support rather than additional guidance is desperately needed.”
Professor Smith thinks this situation has its roots, at least partly, in the education and training previously undertaken in UK dental schools.
He added: “I don’t think decontamination training has been very high up on the agenda for teaching student dentists or dental nurses in the past, so it is no wonder that the current technical requirements are proving challenging.
“How can we expect people to have compliant instrument decontamination processes in dental practice if they have never received the quality of training they need?”
That is certainly not the case with students at the University of Glasgow’s Dental School which has one of the most up-to-date and fully equipped local decontamination unit training labs in Europe.
This allows the 90 students studying at the school each year to get hands on experience of the different decontamination technologies – something that never happened in the past – and understand the logistics of employing them in general dental practice.
He added: “It doesn’t matter if you have the best equipment available, if you don’t have the staff training or quality management systems in place then you won’t be able to maintain high standards in operating and managing the instrument decontamination process.
“I believe education and training is key to improvements in infection prevention and that’s why I’m delighted to be working with AESIC. This collaborative venture between industry and academia will help to make improvements in this area and help obtain more evidence to support instrument decontamination standards.”
Prof Smith believes it is this collaborative approach that has given Scotland a significant lead in developing high standards of infection control in dentistry and other healthcare specialties.
He explained: “Scotland has taken the lead in Europe in obtaining an evidence base for change and improving surgical instrument decontamination practice because of the pro-active and collaborative approach it has taken to this issue which started with the Glennie Group in 2000.”
Prof Smith, who served as a member of the group for nearly a decade, added: “There was a real willingness on the parts of all healthcare workers in the NHS to respond to challenges quickly and effectively as a group across Scotland. I served as a member of the Glennie Group for nearly a decade and it was inspiring to see the various groups and individuals working together as a real multi-organisational taskforce with a cohesive approach – although I did witness a few heated debates!”
Professor Smith’s work with collaborators from the Health Protection Agency on the biology of prion disease in the oral cavity and instrument contamination has demonstrated the potential for cross infection of variant CJD.
He said: “Dental surgical procedures continue to advance in complexity, especially in the field of implantology which increasingly resembles orthopaedic surgery. That is why there continues to be pressure for dental instrument decontamination processes to provide the same degree of sterility assurance as that found in other surgical specialities.
“I’m excited by the work we are embarking on with AESIC as it will provide us with an overview of the European standards and show us examples of good practice that can be more widely adopted. I hope this will help AESIC become the leading forum for promoting a European consensus on these issues.
“Who knows, considering the significant advances Scottish dentists have made in improving decontamination standards and our models of education and training, the rest of Europe might learn a thing or two from us.”
Biography
Professor Andrew Smith is one of the UK’s foremost experts on infection prevention and medical device decontamination.
1987: Qualified BDS from the University of Wales College of Medicine in 1987.
1988: Worked briefly in general dental practice in Bristol.
1993: PhD from Cardiff Dental Hospital.
1993: Lecturer in the Department of Adult Dental Care, Glasgow Dental Hospital
2000: MRCPath in Microbiology from the Royal College of Pathologists. Promoted to Senior Lecturer in Microbiology and Honorary Consultant in Microbiology NHS Glasgow & Clyde.
2005: Head of the Diagnostic Oral Microbiology laboratory and lead Microbiology Consultant for Decontamination in NHS Glasgow & Clyde.
He is also co-author of two text books, several book chapters and over 90 peer-reviewed publications.
Research interests: Infection prevention (iatrogenic CJD from contaminated medical devices and the biology of prion proteins); Microbial virulence factors (evolution of pathogenic traits in the pneumococcus and its implications for pneumococcal vaccine design); Diagnostic Oral Microbiology (pathogenesis of oral mucosal infections).
He also sits on several local and national committee’s looking at decontamination of medical devices.
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