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NHSScotland: Sterile Services Provision Review Group: Survey of Decontamination in General Dental Practice
SECTION 2: REVIEW OF CURRENT DECONTAMINATION PRACTICE IN GENERAL DENTAL PRACTICE
2.1 Objectives
The objectives of this survey were:
to develop a process assessment tool for decontamination procedures used in general dental practice;
to assess, against current standards, the procedures presently used during the decontamination cycle in primary dental care in Scotland. This encompasses all the components involved in the decontamination cycle, including the physical environment, equipment, management processes, knowledge and training undergone by the dental team; and
to provide an evidence base for the development of future measures to ensure compliance with recognised decontamination procedures in primary dental care.
2.2 Methodology
2.2.1 Study population, sample size determination and selection of surgeries
Determination of number of sites for review
The study population comprised all general dental practitioners in Scotland with an NHS list number. Details of the number of practices in Scotland offering NHS services were obtained from NHS National Services Scotland, Practitioner Services, previously known as the Dental Practice Division of the Common Services Agency. Data generated during the inspection of the twenty dental practices reviewed as part of the original NHS Estates Decontamination Review
17 and the Scottish audit
5 indicated that the majority of the practices had scope for considerable improvement in their instrument decontamination processes. This information was used to determine the number of practices required to be surveyed to validate these initial findings. Assuming an expected, conservative, percentage of 75% of practices requiring improvement in the decontamination process, then from the finite population of 837 dental practices in Scotland a target sample size of 215 and a minimum of 175 surgeries was set. A target of 215 would allow the estimation of the percentage of practices requiring improvement in the decontamination process (with a corresponding two sided 95% confidence interval) to within 5%. A minimum of 175 practices would allow estimation to within 6%.
Selection of surgeries for surveying
A list of dental practitioners and dental practices for Scotland was obtained from the NHS National Services Scotland, Practitioner Services (previously the Dental Practice Division of the Common Services Agency). This list was the basis for randomly selecting practitioners to survey.
A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there were more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey.
2.2.2 Liaison and support within the dental profession
Prior to implementation of the study protocol, the project group liased closely with representatives from the dental profession, which included the Scottish Branch of the British Dental Association, regional general dental practitioner sub-committees and local dental committees.
2.2.3 Funding
Following a review of the study methodology by the Chief Scientist's Office (CSO) for Scotland, the study was funded by the Scottish Executive Health Department. Additional financial resources were provided by the Chief Dental Officer for Scotland and the Dental Postgraduate Dean at NHS Education for Scotland. Dental practitioners were reimbursed at the Dental Guild rate for participating in the survey
.
2.2.4 Survey method
The survey was a joint project between the Infection Research Group at Glasgow Dental School and the Scottish Centre for Infection and Environmental Health
(SCIEH). A project co-ordinator was appointed to oversee the running of the site surveys. Technical consultation from SCIEH provided consistent interpretation in the assessment of the decontamination standards.
Development of the data acquisition tool
The data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination, for example the BDA Advice Sheet A12 and the Glennie Technical Requirements
7. The data collection forms were designed on Cardiff Teleforms to permit automatic data recognition. The refinement of the data acquisition tool and corresponding guidance notes took place over several months and involved 17 pilot visits to dental surgeries. A set of 28 standardised reporting forms, referred to as AD
3 (automatic data acquisition documentation for assessment of decontamination), was developed to ensure a consistent approach to the data collection. The subject areas that each form covered are summarised in
Appendix II.
Training of survey teams
Training of the survey team members was undertaken over three days in May 2002. The training provided an overview of decontamination guidance designed to ensure a common standard of interpretation.
Data collection
Each surgery survey was undertaken by a team of surveyors. This team comprised one infection control/decontamination expert and one experienced dental practitioner. On the morning or afternoon of the visit, the surgery was closed to patients. The survey team interviewed the dental practitioner and surgery nurse, reviewed documentation relevant to the survey and recorded the physical layout of the premises. The decontamination processes undertaken by the surgery nurse were viewed directly by a member of the survey team. All relevant data were recorded on the AD
3 forms. The survey visits ran from January 2003 until the end of March 2004
.
Data quality, entry and analysis
All returned forms were submitted to an initial visual quality check, to ensure compliance with the instructions for surveyors contained within the guidance notes.
The completed AD
3 forms were scanned using an electronic scanner and downloaded to a database using a software package called Cardiff Teleforms. The forms were designed with internal verification, including a serial number on each form, multiple selection boxes, mandatory responses and range values. These checks were run automatically once the forms were scanned. In addition, the responses to a number of critical questions were required to be checked on screen. Forms could be flagged for validation when the verifier was unsure of the surveyor's entry. Once the form had been reviewed, the data were then committed to a Standard Query Language (SQL) Server 2000 database. The practice location information was held separately from the main data to ensure secure data protection.
Data were exported from the database into Minitab (version 13) for analysis. Data analysis comprised both tabulated and descriptive statistics.
2.2.5 Technical requirements and guidance
The findings of the survey were assessed against published technical requirements and guidelines. These are summarised under "key indicators of good practice" in the text and are based on principal references contained in
Appendix III, including the
BDA Advice Sheet A12 and the recommendations of
NHSScotland: Sterile services provision review group: 1
st Report.
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