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NHSScotland: Sterile Services Provision Review Group: Survey of Decontamination in General Dental Practice
Appendix II: AD
3 Forms
Dental surgery - administrative information: this form collects details of the dentist, practice and surveyors. These data are stored securely and separately from the main database.
Dental practice - summary: data on this form provide a summary overview of the practice infrastructure, staffing, clinical service provision and decontamination procedures.
Management of infection control: data on this form provide details of infection control policies, staff communication and staff training in decontamination.
Procurement: this form gathers information which describes the methods of procurement and the control over the acquisition of reusable medical devices.
Environment and work flow: this form gathers information which describes the facilities available for the decontamination of instruments and examines the movement of both used and sterilized instruments within the surgery and practice.
Summary of decontamination: this form summarises the equipment and chemicals used in the decontamination process.
Manual cleaning: this form gathers information on the extent to which manual cleaning is employed and how manual cleaning is carried out.
Automatic washer disinfector: this form gathers information concerning automatic washer disinfectors.
Ultrasonic cleaner: this form gathers information concerning ultrasonic cleaners.
Chemical disinfection: this form gathers information about the chemical disinfectants used in the surgery.
Post cleaning inspection: this form collects data about the procedures used for inspecting cleaned instruments prior to their being sterilized.
Packing and tray assembly: this form gathers information about packaging of cleaned devices, before and after sterilization.
B&I benchtop sterilizers: this form gathers information about bowl and instrument benchtop sterilizers, including testing.
Vacuum benchtop sterilizers: this form gathers information about vacuum benchtop sterilizers, including testing.
Hot air sterilizers: this form gathers information about hot air (dry heat) sterilizers, including testing.
Sterilization process control: this form collects information about the procedures in place to ensure appropriate monitoring and quality control of sterilization of instruments used in the surgery.
Storage: this form collects information on the storage sites available for sterile and sterilized items.
Transit - on site: this form collects information on the methods for movement of contaminated and sterilized items both within the surgery and within the practice.
Transit - off site: this form collects information on the methods for movement of contaminated and sterilized items between the surgery / practice and an external decontamination facility.
Instruments and devices: this form collects information on the types and numbers of instruments in the surgery.
Staff and health & safety: this form collects data relating to the measures taken to protect the health and safety of staff undertaking decontamination and the training received by staff in respect of decontamination.
Dental handpieces: this form collects data on dental handpiece purchase, decontamination and servicing.
Loan equipment: this form examines policies and procedures linked to the borrowing and lending of equipment associated with the surgery.
Subcontractors and maintenance: this form collects information about contractors employed to carry out maintenance and testing on decontamination equipment.
Validation and testing of washer disinfectors: this form examines the validation studies and periodic testing carried out on an automatic washer disinfector.
Domiciliary care: this form records information linked to decontamination of instruments used for domiciliary visits.
Reference documents: this form collects information on the availability of reference documents on decontamination to the staff within the surgery.
Surgery layout: this form collects information on the physical layout of the dental surgery and decontamination areas being surveyed.
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