Q. I am always been given old equipment in my surgery and I have recently inherited the old Little Sister steriliser, as it is being replaced by new fully computerised one. I have been told that I cannot use the central sterilising facility because my surgery is on the fourth floor and I will waste too much time moving from the ground floor room to my surgery. I am not sure that this steriliser is even fit for purpose. I am sure that we are supposed to be conforming to HTML0105 for central sterilisation. Where do I stand legally on this?
This is a most extraordinary set of circumstances and raises a considerable number of issues. It is certainly true that under HTML0105 central sterilisation facilities are recommended, but for obvious reasons the implementation very much depends on the layout and distribution of surgeries to say nothing of the available space within the practice. It may not always feasible or practical to undertake. I would have been logical if the practice could have thought through the problem more fully before starting any building work or alterations.
Having a steriliser within the surgery can, at first sight, be extremely helpful, although it can also have its drawbacks. Most of the older sterilisers were quite noisy when in operation which can make communication difficult particularly for those patients that are hard of hearing. In addition the steriliser, by its very nature, produces a great deal of heat and this can make the surgery uncomfortable at times.
There is no legal reason why such a steriliser should not be used, provided that it conforms to the current guidance. Consequently many older sterilisers have been confined to the scrap heap even though they appear to be working perfectly well. Continuing to use the steriliser that does not conform to the current regulations and guidance would leave the clinician and the practice open to criticism.
Offering a hygienist old and well used equipment can also be a little short sighted in that the equipment may be more prone to break down. Many practices prefer to have a regular renewal programme to ensure that equipment meets with the appropriate standards and to ensure the reliability of the machines.
A fourth floor surgery brings with it a whole new set of problems. It could well be a problem in the event of an emergency particularly if the waiting area and reception are on the ground floor. Patients would no doubt be expected to climb four floors to obtain their treatment. This means that access to the hygienist is likely to be denied to any patient who is not fit and mobile. This could rules out some of the patients that would normally see a hygienist and does not make good business sense.
Access to a medical team in the event of an emergency may also be more difficult, particularly if it is necessary to transfer the patient to an ambulance. It may also discriminate against certain groups protected by the Disability Discrimination Act 1995 unless alternative arrangements can be made, such as a lift - but that would be unusual finding in the average UK dental practice.
Finally the questioner implies that the principal has barred access to the central steriliser as s/he would waste too much time carrying instruments up and down stairs. That suggests that the hygienist might be working alone and would be contrary to paragraph 3.7 of the GDC guidance - Principles of Dental Team Working. This paragraph clearly states that clinicians should work with another registered or emergency qualified team member present.
A hygienist working on their own on the fourth floor of a practice is possibly at an increased risk of something going wrong and so the hygienist concerned needs to think very carefully about the situation and decide whether it is in their best interest to continue to work in the practice. It can be very easy to ignore the short comings until of course a problem occurs.