Four years ago, The Department of Health decided that it would publish a new Health Technical Memorandum on Infection Control in Dental Practices - HTM01-05 - Decontamination in primary care dental practices. Up until this point, the accepted document on decontamination was produced by the British Dental Association - Advice booklet A12. This had been produced in consultation with the Department, and had been the document I had used since the 1980s (It was reviewed and republished every couple of years).
At one swift stroke, the Department cast aside the A12, which had been produced and adapted as more evidence based advice became available, and produced it's own HTM. There was consternation within the profession at the time, as there were massive sweeping changes, and massive inconsistencies compared to the standards for other healthcare environments, and no published evidence to back-up the changes. One example was the storage of bagged sterilised instruments. In hospitals this has been set at 1 year - instruments must be used within 1 year of being sterilised, but in dental practice it was 21 days - yes hospitals have 365 days to use a bagged sterilised instrument, and we got 21 days. After 21 days, the bag has to be opened and the instrument re-sterilised and re-bagged in a new bag.
The HTM was so suspiciously non-evidence based, the BDA and other dental organisations put pressure on them to release the evidence that had been used to make the sweeping changes. After many months, the Department finally, reluctantly, released the list of evidence they had used. Funny old thing. Hardly any published, refereed research; mostly opinions, committee decisions, and other department documents. This evidence would not have been taken seriously by anyone with an enquiring mind. The evidence was flimsy at best.
It was promised by the Chief Dental Officer that it would be reviewed after 2 years, but we would be stuck with these changes for at least 2 years, and the changes have been extensive requiring expensive changes to surgeries and procedures with no evidence it would improve patient safety.
In the meantime, research was conducted by the Scottish Department of Health (Yes there are different standards for different parts of the UK!), and others. They soon found that the assumptions made by HTM01-05 were just that - the evidence showed they were wrong, and the HTM needed re-writing. Well 2 years came and went; Then 3 years: then 4 years; and nothing; Then very quietly, with no fanfare, no press release, NO NOTIFICATION TO DENTISTS, NO APOLOGY, they quietly published the 2013 version of the HTM on 3rd April (3 days ago). In fact the majority of Dentists will still be unaware there have been changes, as there has been no notification by the Department of Health, and it was only a partial review, but a number of important changes had been made. A full reveiw will now not happen until the end of 2014 - 6 years after to original 'living' document - if it is a living document, it must be a walking dead zombie.
So we made all these expensive changes (£1000s), with no evidence, and now it has changed again, and lots were conpletely unnecessary in the first place - and from the DH - NO APOLOGY.