Dentisan takes a look at the new National Standards of Healthcare Cleanliness 2021, that come into force for NHS dental practices in April.
The National Standards of Healthcare Cleanliness become mandatory in April 2022 and apply to all primary care NHS healthcare establishments in England, including those providing NHS dental care and regardless of the way cleaning services are provided. The new regulations replace the National specifications for cleanliness in the NHS 2007 published by the National Patient Safety Agency, and the Healthcare cleaning manual revised by the Association of Healthcare Cleaning Professionals (AHCP) in 2013.
The National Standards of Healthcare Cleanliness (NSoHC) combine mandates, guidance, recommendations and good practice, all designed to reflect modern methods of cleaning and other changes since the last review and includes important considerations and assurances for cleaning protocols during a pandemic. The NSoHC outline a separate compliance framework designed to work alongside existing CQC regulations.
The NSoHC aim to provide all NHS healthcare organisations with a way to measure their performance and provide an opportunity for managers to benchmark themselves against similar healthcare environments. It states that the standards, “reflect modern methods of cleaning, infection prevention and control (IPC)”.
The NSoHC stipulate a series of new responsibilities for every dental practice with an NHS contract and a strong recommendation for private practices to also comply. The regulations include a new three stage audit process – technical audit, efficacy audit and external audit – designed to provide assurance that a practice is delivering safe standards of cleanliness and to ensure the new standards are met.
To show how cleaning and infection prevention are intrinsically linked, the audit scores are represented in two ways:
- a percentage score for internal verification and scrutiny that a safe standard has been achieved.
- a star rating score for external verification of this.
The star system is something widely used by industries such as hospitality and retail. The idea is that this familiar system, clearly showing the cleanliness of a practice and displayed in patient-facing areas, will be instantly recognisable and easy to understand for patients, as well as staff.
The NSoHC also introduces a Commitment to Cleanliness Charter to promote the ethos of the 2021 standards. Signing up to and displaying the charter in public areas underlines that a practice is committed to providing a safe and clean environment by referencing the new star system and by using the most appropriate and up to date cleaning methods and frequencies.
Providers are being asked to designate a “functional risk” rating between 1 and 6 to all areas in the practice, based on the activity carried out and whether they are patient accessed, or accessed by clinical or non-clinical staff. Once designated practices need to compile a list of elements within each area, which need to be cleaned, and specify the frequency and who is responsible.
Cleaning and disinfection
Underpinning the NSoHC is the need for all staff to understand the general principles of cleaning and disinfection. Section 2.1 states; “The terms cleaning, disinfection, decontamination and sterilisation are not interchangeable, and their differences need to be understood.”
Cleaning usually involves a liquid detergent and water for the physical removal of organic material including dirt, blood and bodily fluids, leaving a surface or equipment visibly clean. However, micro-organisms are only removed rather than killed. Cleaning is a pre-requisite to achieving effective disinfection, which is the process of eliminating or reducing harmful micro-organisms from inanimate objects and surfaces.
In the context of the environment and non-critical equipment, the term decontamination refers to both cleaning and disinfection, either using a separate cleaning and disinfection agent in a two-step process or a ‘2 in 1’ product that cleans and disinfects in one step.
Local policy should outline where and when detergent and water is enough (ie low-risk areas such as foyers and corridors) and where a detergent and disinfectant, or combined cleaning and disinfecting solutions are required, for example clinical areas.
Proven and regulated products
As a leading dental infection control product manufacturer, Dentisan, has been at the forefront of providing clinically proven decontamination products created specifically to help the profession comply with local and national regulatory guidelines in infection prevention.
These include surface cleaners that clean and disinfect in one step with proven efficacy against viruses including coronaviruses, bacteria including mycobacteria, fungi, yeast and enveloped viruses such as HIV, HBV and HCV. All Dentisan cleaning and disinfection products for use on medical devices, also conform to the requirements of the Medical Device Directive 93/42/EE and are HTM 01-05 compliant.
The way ahead
For dental nurses, maintaining a safe and clean environment to protect staff and patients from the spread of infection is nothing new. However, compliance with all the necessary mandates, audits and cleaning processes in the NSoHC is likely to become a significant but essential challenge for every member of the dental team.
Every dental practice should already be well used to following rigorous infection control procedures, therefore complying with the NSoHC should be seen not as a hindrance but as a vital step forward in the safe practice of dentistry.
The full NSoHC document can be accessed and downloaded at: www.england.nhs.uk/publication/national-standards-of-healthcare-cleanliness-2021/