Proposed changes to standards - infection control update

12 October 2018

Registered dental practitioners have an obligation to abide by the standards set out by the regulator (the Dental Board of Australia) and best practice as outlined by your professional association (the ADA) when it comes to infection control. 

So maintaining relevant and implementable standards for infection control in dental practices remains a key advocacy issue for the ADA with a focus on Australian and New Zealand Standards (AS/NZS) 4815 and 4187 which provide guidance on the reprocessing of reusable medical devices for dental practices and healthcare organisations. A key reference point for the Dental Board of Australia’s infection control guidelines and state and territory health department guidelines, they also form the basis for the ADA’s infection control resources. (Given the importance of the standards, the ADA has repeatedly advised that it would not be acceptable to add the key components of AS/NZS 4815 as an appendix on AS/NZS 4187.)

As with any standard, they should be reviewed on a regular basis, a process which is currently underway, initiated by lobbying by the ADA which commenced in 2015 following the alignment of AS.NZS 4187 with international standards in 2014 and an ADA proposal the following year to review AS/NZS 4815. While there was subsequent disagreement on the proposed approach within the HE023 Committee that oversees the standard, Standards Australia subsequently hosted a forum of interested stakeholders such as health professional peak bodies, members of HE023 and the Commission on Safety and Quality in Health Care in March this year. 

The forum canvassed a number of issues including; 

• The confusion surrounding which standard applies to which situations. 

• The current regulatory framework, including licensing and registration requirements set by different industry associations and regulators; 

• The difficulties in consistent (urban/regional/rural) and practical application of some requirements in AS/NZS 4187, for example, the water quality requirements; 

• The lack of guidance for the implementation of requirements in AS/NZS 4187; 

• The heavy use of jargon and lack of clarity in the requirements in AS/NZS 4187. 

• The group also discussed the use of industry training tool and resources to better communicate the positive nature of the Standard application in future. The development of any training materials or resources would be outside the scope of Standards. 

Emerging from this discussion was common agreement around the need for the standard to be: 

• Patient, healthcare and veterinary worker focused; 

• Clear and written in plain English while not removing technical detail; 

• Evidence-based in its approach; 

• Accessible by a range of users – including understanding the range of new industries using the standard and the ongoing commercial implications; 

• Workable and practical; 

• Containing clearer guidance for users; and 

• Futureproofed with an allowance for innovation. 

Standing firm on its position that it that it would not accept an appendix to AS/NZS 4187, the ADA contributed to a discussion on whether there is an ongoing need to maintain two different Standards, or if it would be preferable to move to a single document – a publication that would provide requirements that meet the needs of the entire industry. 

After a review of the similarities present in the two current documents and their intent, which is to deliver clean devices that are safe for patients and healthcare workers, it is being considered whether a single document should be developed as a new Standard, rather than one based on the existing AS/NZS 4187 & AS/NZS 4815. Furthermore, it would be supported by a set of complementary implementation guides that would explain the application of the standard to particular settings. 

Following a submission of a proposal by the ADA to Standards Australia to act on this determination, it’s expected that it will take two years to bring to fruition. 

In the meantime, you’re reminded of your ongoing obligation to comply with the current standards - either AS/NZS 4815 or AS/NZS 4187 depending on the type of healthcare setting. Responsibility for complying with Infection control requirements cannot be delegated to anyone else in the practice, with the responsibility for those processes always lying with every registered dental practitioner.