In the realm of dental practices, maintaining proper air ventilation is critical for infection control and ensuring the health and safety of both patients and staff.
But there’s quite a topical debate as to whether this is mandatory, regulatory, gold standard or even good practice. So we’ve extracted (excuse the pun!) the information available as best as possible to simplify the requirements….hopefully !?
While the Care Quality Commission (CQC) does not specify exact air changes per hour (ACH) as part of its regulations, dental practices must comply with several key national guidelines and legal requirements. These regulations outline the expected ventilation standards, particularly in high-risk areas such as treatment rooms where aerosol-generating procedures (AGPs) are performed and in decontamination rooms where instruments are sterilized. In this guide, we will examine the required air changes per hour, specific regulations for decontamination rooms, and the mandatory guidelines that practices must follow.
1. General Areas in Dental Practices (Non-Aerosol-Generating Procedure Areas)
In dental practices, the majority of areas, such as reception areas and non-AGP treatment rooms, require a sufficient level of ventilation to mitigate the risk of airborne infections and maintain general air quality.
Air Changes Per Hour (ACH) Requirement
For general areas in a dental practice where aerosol-generating procedures are not performed, the recommended number of air changes per hour is 6 ACH. This ensures a consistent turnover of air, reducing the concentration of airborne pathogens that may be present in the room.
Guidance Sources
The primary guidance document used to determine ventilation standards in dental practices is the Health Technical Memorandum (HTM) 03-01: Specialised Ventilation for Healthcare Premises. Although this guidance is aimed more at hospitals and specialized healthcare facilities, dental practices are advised to adhere to these standards as best practice. HTM 03-01 recommends 6 ACH for rooms where AGPs are not being performed, which would include many general treatment areas and waiting rooms in dental practices.
Additionally, Public Health England (PHE) and the Faculty of General Dental Practice (FGDP) provide supplementary guidance on infection prevention, supporting the recommendation of 6 ACH in non-AGP dental practice areas.
Mandatory Compliance
While HTM 03-01 itself is not a mandatory regulation for dental practices, the CQC expects dental practices to follow this guidance as best practice to meet infection control requirements under CQC Regulation 12 (Safe Care and Treatment). Regulation 12 mandates that dental practices must have effective systems in place to prevent, detect, and control infections. This includes ensuring proper ventilation in areas where staff and patients may be at risk of airborne infections.
2. AGP Areas (Aerosol-Generating Procedure Rooms)
In dental practices, aerosol-generating procedures (AGPs) are common, involving high-speed drills, ultrasonic scalers, and other equipment that can generate aerosols that may contain infectious agents. Due to the high-risk nature of these procedures, rooms where AGPs are performed require significantly more stringent ventilation standards.
Air Changes Per Hour (ACH) Requirement
For rooms where AGPs are performed, the recommended number of air changes per hour is 10-12 ACH. This increased ventilation rate helps to quickly clear airborne particles generated during these procedures, reducing the risk of airborne transmission of infectious agents.
Additionally, achieving 10-12 ACH allows practices to reduce the fallow time—the period required between patients to ensure the air is cleared of potentially infectious aerosols. A higher ACH reduces fallow time from 20-30 minutes (for lower ACH rates) to as little as 15-20 minutes with 10-12 ACH, improving the efficiency and safety of patient care.
Guidance Sources
The PHE COVID-19 Guidance and the FGDP both recommend 10-12 ACH in AGP areas of dental practices to control the spread of aerosols. These recommendations became widely adopted during the COVID-19 pandemic to reduce transmission risks and are now considered a key part of infection control in dental practices.
The Health Technical Memorandum (HTM) 03-01 also provides similar ventilation guidance for healthcare premises, including dental practices, ensuring that rooms with a high risk of aerosol transmission meet adequate ventilation standards to prevent the spread of airborne infections.
Mandatory Compliance
While the PHE and FGDP guidelines are advisory, the CQC requires dental practices to follow them to meet infection control standards under CQC Regulation 12 (Safe Care and Treatment). The CQC expects dental practices to assess their risk of airborne transmission and implement appropriate control measures, including ventilation. Failure to provide sufficient ventilation in AGP areas could result in non-compliance with CQC regulations.
3. Decontamination Rooms (Sterilisation Areas)
Decontamination rooms, where instruments are cleaned and sterilized, are critical in dental practices. Ensuring proper ventilation in these rooms is essential to managing airborne contaminants, heat, and humidity generated by sterilisation equipment, such as autoclaves.
Air Changes Per Hour (ACH) Requirement
For decontamination rooms, the recommended number of air changes per hour is 10 ACH. This ensures that airborne contaminants, including fumes and vapours from cleaning chemicals and sterilization equipment, are removed effectively.
Airflow Direction
In addition to the required number of air changes, airflow direction is crucial in decontamination rooms. Air should flow from clean to dirty areas to prevent cross-contamination. Maintaining this directional airflow ensures that any contaminants generated during the sterilization process do not flow into clean areas where sterilized instruments are stored or handled.
Guidance Sources
The primary guidance for decontamination rooms in dental practices comes from HTM 01-05: Decontamination in Primary Care Dental Practices. This document outlines the decontamination process in detail and emphasizes the need for sufficient ventilation to manage the heat and humidity generated by autoclaves. While HTM 01-05 does not specify an exact ACH for decontamination rooms, HTM 03-01 provides a best practice recommendation of 10 ACH for similar healthcare settings.
Mandatory Compliance
For NHS dental practices, HTM 01-05 is mandatory and must be followed to ensure that decontamination processes are conducted safely and effectively. In private dental practices, HTM 01-05 is considered best practice and should be adhered to, particularly in relation to ventilation and infection control in decontamination rooms.
Additionally, compliance with COSHH (Control of Substances Hazardous to Health Regulations 2002) is mandatory in decontamination rooms. COSHH requires employers to control hazardous substances, including chemicals and fumes, which may be present in decontamination areas. Adequate ventilation is a key control measure under COSHH to reduce exposure to these substances.
The CQC also requires dental practices to maintain safe and effective decontamination processes under CQC Regulation 12 (Safe Care and Treatment). This includes ensuring that ventilation systems in decontamination rooms are sufficient to protect staff from exposure to airborne contaminants.
4. Mandatory Guidelines and Regulations
a) Health and Safety at Work Act 1974 (HSWA) – Mandatory
The HSWA requires employers to ensure the health and safety of employees and anyone affected by their work, including through adequate ventilation to prevent airborne disease transmission.
b) Control of Substances Hazardous to Health (COSHH) Regulations 2002 – Mandatory
COSHH regulations require control of harmful substances, including airborne pathogens and chemicals. Proper ventilation, especially in decontamination rooms, is a control measure under COSHH to reduce exposure to hazardous substances.
c) CQC Fundamental Standards – Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Mandatory
CQC Regulation 12 (Safe Care and Treatment) requires dental practices to have systems in place to manage infection risks. Adequate ventilation (e.g., appropriate ACH rates and airflow direction) is a critical part of these infection control measures.
d) HTM 01-05 (Decontamination) – Mandatory for NHS Dental Practices
This document provides mandatory guidance for NHS dental practices on decontamination procedures, including best practices for ventilation. Private practices are encouraged to follow it as best practice.
e) HTM 03-01 (Specialised Ventilation for Healthcare Premises) – Best Practice
HTM 03-01 provides best practice ventilation standards for healthcare premises. While it is not mandatory for dental practices, adherence is expected by the CQC for maintaining proper infection control.
Summary of ACH Requirements
– Non-AGP Areas: 6 ACH (recommended based on HTM 03-01).
– AGP Areas: 10-12 ACH (recommended for reducing aerosol transmission, based on PHE and FGDP guidance).
– Decontamination Rooms: 10 ACH (recommended based on HTM 01-05 and HTM 03-01).
While these ACH rates are primarily advisory, compliance with broader regulations like COSHH and CQC Regulation 12 makes it mandatory for dental practices to ensure their ventilation systems meet infection control and health safety standards. Ensuring proper ventilation is crucial for minimizing the risk of airborne infections and providing a safe environment for both patients and staff.
At Excel Building Contractors we have a wide experience in designing and building fully compliant dental surgeries. To discuss your dental project whether it’s a refurbishment, new build or building renovation, call us today on 020 8820 0853 or contact us.