HTM 01-05 Infection Control for Dental Nurses - Complete Guide 2025

What Is HTM 01-05 and Why Does Every Dental Nurse Need to Know It?

Health Technical Memorandum 01-05 (HTM 01-05), Decontamination in Primary Care Dental Practices, is the NHS England guidance that sets the standards for decontamination and infection prevention in every UK dental practice. Compliance is not optional: it is assessed on Care Quality Commission (CQC) inspection in England (and equivalent inspections in Wales, Scotland, and Northern Ireland) and is directly tied to a practice's registration status. Dental nurses are the team members most directly responsible for day-to-day HTM 01-05 implementation.

HTM 01-05 defines two tiers of compliance: Essential Practice, the minimum legal baseline every practice must meet, and Best Practice, the recommended standard that all practices should work towards. The document covers instrument decontamination, single-use item policies, waste management, water quality, clinical environment cleaning, personal protective equipment (PPE), sharps management, and staff training requirements. It was last substantially updated and republished in 2023 by NHS England following evidence reviews and pandemic learning.

Infection control is covered in depth in Unit 2 of the NCFE CACHE Level 3 Diploma (Contribute to Health and Safety in the Dental Environment). This guide expands on that curriculum coverage with the practical, clinical detail you need for both your portfolio of evidence and your career as a qualified dental nurse. See also the dental nursing glossary for definitions of decontamination terminology.

Sources: HTM 01-05 (NHS England) · Care Quality Commission · GDC Standards for the Dental Team · BADN

Essential Practice vs Best Practice, What's the Difference?

HTM 01-05 uses a two-tier framework to describe decontamination standards. Understanding the distinction between the tiers is essential for interpreting CQC inspection findings and for advising your practice on compliance improvements. Both tiers are legally significant, Essential Practice represents the minimum standard required to avoid enforcement action; Best Practice is the standard CQC inspectors use as a benchmark for rating a practice “Good” or “Outstanding” on the Safe Key Question.

Tier 1

Essential Practice

The minimum standard all dental practices must achieve and maintain. Failure to meet Essential Practice requirements is a regulatory compliance issue that CQC can act upon. Essential Practice standards require:

Separate dirty and clean zones for instrument processing
All multi-use instruments washed, inspected, packaged, and autoclaved
Autoclave validation records maintained
Single-use items never reused
PPE worn during all clinical procedures
Sharps containers correctly labelled, stored, and collected
Clinical waste segregated and correctly disposed of
Dental unit waterlines flushed according to the manufacturer's schedule
Staff have basic IPC training and a signed training record
An infection control lead is designated

Tier 2

Best Practice

The recommended standard that all practices should work towards and that CQC uses to benchmark “Good” performance. Best Practice builds on Essential Practice by adding:

Automated washer-disinfector (AWD) for instrument cleaning, replacing manual scrubbing
Pouch or cassette packaging with chemical indicator strips confirming sterilisation
Type B (vacuum/pre-vacuum) autoclave for hollow/porous instruments
Documented decontamination log for every autoclave cycle, every day
Regular microbiological testing of dental unit waterlines
Quarterly instrument decontamination audits with records
Named Infection Prevention and Control Lead with formal IPC training
Annual IPC policy review with written records of sign-off by clinical lead
Patient decontamination cycle information available on request

Area	Essential Practice	Best Practice
Instrument cleaning method	Manual scrubbing with brush + detergent OR ultrasonic bath	Automated washer-disinfector (AWD), preferred
Packaging before sterilisation	Pouches or cassettes required	Pouches/cassettes with validated process indicator strips
Autoclave type	Type N (non-vacuum) acceptable for solid instruments	Type B (vacuum) for all instrument types including hollow/porous
Autoclave validation	Annual validation by a competent person	Annual + quarterly performance qualification
Decontamination records	Minimum log of cycle completion	Full electronic or paper log of every cycle, print-outs retained
Dental unit waterlines (DUWL)	Flush at start of day and between patients	Flush + regular microbial sampling + anti-stagnation treatment
IPC training	Induction + documented annual update	Formal IPC lead training, competency assessments, audit programme
Single-use items	Must not be reused; must be correctly disposed of	Expanded single-use policy; regular audit of compliance; clear SUI marking on all relevant items

CQC and HTM 01-05: The Care Quality Commission uses HTM 01-05 as a key reference document when inspecting dental practices in England under the Health and Social Care Act 2008. Inspectors assess decontamination standards as part of the Safe Key Question. A practice that does not meet Essential Practice standards risks being rated “Requires Improvement” or “Inadequate” and may receive a Warning Notice requiring urgent remediation. Dental nurses who understand HTM 01-05 thoroughly are invaluable to practice compliance and are often the primary point of contact for CQC inspection evidence on decontamination. See also: GDC Standards for the Dental Team Standard 4 (maintain and develop knowledge and skill).

The Decontamination Cycle, 4 Stages Every Dental Nurse Must Master

HTM 01-05 structures instrument decontamination as a four-stage cycle. Each stage must be completed in the correct sequence, skipping or combining stages compromises the outcome and constitutes an HTM 01-05 breach. Dental nurses are responsible for all four stages in most primary care dental practices.

Stage 1

Cleaning

The removal of organic matter (blood, tissue debris, biofilm, saliva) and inorganic contamination from instrument surfaces. This is the most critical stage, sterilisation cannot overcome inadequate cleaning. HTM 01-05 recommends:

Automated washer-disinfector (AWD), Best Practice; validated cycle, temperature-controlled wash with enzymatic detergent followed by thermal disinfection (93°C for ≥1 min or 80°C for ≥10 min, achieving A0 600)
Ultrasonic cleaner, acceptable at Essential Practice level; instruments submerged in enzymatic solution and ultrasonicated for the manufacturer's recommended time (typically 10-15 min); followed by rinsing under running water
Manual scrubbing, last resort only; instruments scrubbed with a long-handled brush under running water (never in a sink full of water); PPE essential including heavy-duty gloves and eye protection

Key rule: Always clean in the designated dirty zone. Never move uncleaned instruments to the clean zone.

Stage 2

Inspection & Packaging

After cleaning and drying, every instrument must be inspected under magnification (illuminated magnifier or loupe) to confirm it is visually clean, undamaged, and functional. This stage is often undervalued but is essential for two reasons:

Residual organic matter defeats sterilisation, proteins coagulate under autoclave temperatures, protecting microorganisms beneath. Any instrument with visible contamination must return to Stage 1.
Damaged instruments are a cross-infection and injury risk, instruments with chips, cracks, or damaged hinges should be removed from service and reported.

Clean, inspected instruments are then packaged in:

Self-sealing sterilisation pouches with process indicator strips/prints
Cassettes (metal trays) placed inside pouches or wrapped in sterilisation paper
Packaging labelled with the date of sterilisation and batch number

Stage 3

Sterilisation

Sterilisation destroys all forms of microbial life, including resistant bacterial endospores (e.g. Clostridium and Bacillus species). In dental practice, sterilisation is achieved by autoclaving. The key autoclave types are:

Type B (vacuum/pre-vacuum): Best Practice for dental practice; removes air from the chamber before steam entry, allowing steam penetration into hollow and porous loads (handpieces, cannulated instruments); cycles at 134°C/2.2 bar for 3 minutes
Type N (non-vacuum): Suitable for solid, unwrapped instruments only; relies on gravity displacement of air by steam; cheaper but less versatile than Type B
Type S (specific): Manufacturer-defined, validated for a specific instrument range; may be used where validated

Documentation: HTM 01-05 requires a print-out or electronic record of each autoclave cycle including date, time, temperature, pressure, and cycle duration. Dental nurses must check the record against the expected parameters and sign/initial the daily log. Cycle failures must be reported immediately and affected instruments re-processed.

Stage 4

Storage

Sterility is event-related, not time-related, a correctly packaged and stored sterile instrument remains sterile until the packaging is breached, wet, or visibly damaged, regardless of the date. HTM 01-05 storage requirements include:

Store in a clean, dry, dust-free dedicated cabinet (not in an open tray on the worktop)
Store instruments in sealed pouches/cassettes, unopened until point of use
Use a first-in, first-out (FIFO) rotation to prevent old pouches accumulating
Keep away from potential contamination sources (sinks, clinical waste bins)
Inspect pouches before use, discard any with compromised seals, moisture ingress, or torn packaging
Single-use instruments stored separately, clearly labelled, and never mixed with reusable stock

An instrument removed from sterile storage and not used must be re-processed (not simply returned to the cabinet) if it has been taken to the chairside.

1. Clean → 2. Inspect & Package → 3. Sterilise → 4. Store

The decontamination cycle must always run in this order. No stage can be skipped. Any instrument failing inspection at Stage 2 returns to Stage 1.

PPE, Sharps Safety, and Surface Disinfection

Beyond the decontamination cycle, HTM 01-05 sets standards for three additional infection control domains that dental nurses manage directly every working day: personal protective equipment, sharps safety, and clinical surface decontamination.

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Personal Protective Equipment (PPE)

PPE protects both the dental nurse and the patient from cross-contamination. Under HTM 01-05 and the Health and Safety at Work etc. Act 1974, the employer must provide appropriate PPE free of charge, and the dental nurse must wear it correctly during all clinical procedures. Standard clinical PPE comprises:

Gloves, single-use nitrile or latex-free gloves for all patient contact; heavy-duty utility gloves for decontamination work; gloves are changed between patients and must not be worn outside the clinical area
Face mask, Type IIR fluid-resistant surgical mask (or equivalent) covering nose and mouth during all aerosol-generating procedures (AGPs) and during decontamination; FFP2/3 respirator for confirmed/suspected airborne risk patients
Eye/face protection, visor or safety glasses protecting against splatter of blood, saliva, or chemicals; visor required during AGPs (bur work, ultrasonic scaling, air-water syringe use)
Clinical gown / scrubs, appropriate clinical attire covering arms; changed if visibly contaminated; not worn outside the practice

Hand hygiene: the single most important infection control measure. Dental nurses must perform the WHO 6-step hand wash technique with soap and water, or approved alcohol hand rub, before donning gloves and after glove removal. Bare-below-the-elbows policy applies.

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Sharps Safety

Sharps injuries are among the most significant occupational hazards in dental nursing, carrying the risk of transmission of bloodborne viruses including Hepatitis B, Hepatitis C, and HIV. The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 place obligations on employers and workers to prevent sharps injuries. Key principles:

Never re-sheath needles by hand, use a one-handed scoop technique or a needle resheathing device if recapping is clinically necessary
Use safety-engineered devices (auto-retractable syringes, safety scalpels) where available
Never pass sharps directly hand-to-hand, use the neutral zone technique
Dispose of sharps immediately into a correctly assembled, UN-approved sharps container at the point of use
Never overfill sharps containers beyond the fill line (typically 2/3 full)
Seal and correctly label full containers for collection by a licensed clinical waste contractor
In the event of a sharps injury: encourage bleeding, wash the wound with soap and water (do not suck), report immediately to the designated person, complete an incident form, and seek urgent occupational health / A&E assessment for post-exposure prophylaxis (PEP) if indicated

All dental nurses should have confirmed Hepatitis B immunity (titre ≥10 mIU/mL), a requirement of GDC-compliant placement practices and a condition of starting clinical work.

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Surface Disinfection

Clinical contact surfaces, those touched during patient treatment, must be decontaminated between every patient and at the end of each clinical session. HTM 01-05 requires a two-stage clean:

Clean, wipe with detergent solution to remove visible contamination
Disinfect, wipe with an appropriate disinfectant (e.g. 1,000 ppm sodium hypochlorite solution, or a combined detergent-disinfectant wipe where validated)

Key surfaces requiring between-patient decontamination include:

Dental chair headrest, arm rests, and adjustment controls
Light handle and switches
Spittoon and bracket table
X-ray tube head and timer (if not covered with barrier film)
Computer keyboard and mouse in the surgery (use keyboard covers or barrier film)

Barrier film (disposable covers on surfaces/handles) is an acceptable alternative to between-patient wipe decontamination for hard-to-clean or electronic surfaces, provided the cover is changed after every patient. End-of-session cleaning must still address all covered surfaces.

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Clinical Waste Management

Dental practices produce several categories of clinical waste that must be correctly segregated, stored, and collected under the Environmental Protection Act 1990, the Hazardous Waste Regulations 2005, and HTM 01-05. Dental nurses manage daily waste segregation. Key categories:

Yellow/orange bags (offensive/clinical waste), contaminated PPE, impression materials, patient bibs; collected by a licensed waste contractor
Yellow sharps containers, needles, scalpel blades, bur fragments; never into standard clinical waste bags
Amalgam waste, into designated amalgam waste containers (not the drain); collected by an approved amalgam recycling service; mercury-containing waste is a COSHH hazard
Medicinal waste, expired or unused medicines; collected via a licensed medicinal waste disposal service; never into general waste
Domestic waste, unwrapped packaging, paper, non-contaminated items only

Clinical waste must be stored securely in a lockable area awaiting collection. Consignment notes must accompany hazardous waste movements. CQC inspectors check waste segregation and documentation routinely.

Zoning, the physical basis of HTM 01-05 compliance: HTM 01-05 requires practices to establish a physically separate dirty zone (where contaminated instruments are received, manually cleaned, and put through the AWD/ultrasonic) and a clean zone (where inspected instruments are packaged and autoclaved). In small practices a dedicated instrument processing area (IPA) can fulfil both functions if there is a clear workflow from dirty to clean, with a physical barrier (e.g. a wall, a clearly marked countertop divide) separating the two sides. Clean instruments must never pass back through the dirty zone after sterilisation.

Dental Unit Waterlines, Hand Hygiene, and Staff Health

Three additional HTM 01-05 areas that dental nurses must be familiar with and actively manage: waterline hygiene, effective hand decontamination, and occupational health standards for the clinical team.

Dental Unit Waterlines (DUWL)

The small-bore tubes supplying water to the air-water syringe, turbine handpiece, and ultrasonic scaler can harbour Legionella pneumophila and other opportunistic pathogens in their biofilm lining. HTM 01-05 requires:

Flushing handpieces and the air-water syringe for at least 2 minutes at the start of each clinical session
Flushing for 20-30 seconds between patients
Never using DUWL water for irrigation of open surgical wounds (use sterile saline instead)
At Best Practice: regular microbiological testing of DUWL output (target: ≤200 CFU/mL total viable count; ≤1 CFU/100 mL for Legionella)
Use of anti-stagnation treatments and chemical dosing systems where installed
A documented DUWL maintenance log

Hand Decontamination

Effective hand hygiene remains the single most important measure to prevent cross-infection. HTM 01-05 specifies three levels of hand decontamination for different clinical contexts:

Social/routine hand wash (soap and water, 20 seconds WHO technique), before and after patient contact
Hygienic hand rub (alcohol-based gel/rub, 6-step technique, 20-30 seconds), between patients if hands are not visibly soiled; effective for bacteria and enveloped viruses but NOT for Clostridioides difficile spores or norovirus (use soap and water instead)
Surgical hand scrub (antiseptic scrub, 2 minutes minimum with chlorhexidine gluconate or povidone-iodine), required before surgical procedures

Nail varnish, false nails, and rings (except a plain wedding band) are not permitted in the clinical area per the bare-below-elbows policy under HTM 01-05.

Staff Health and Occupational Requirements

HTM 01-05 and the GDC jointly require all dental team members to maintain specific occupational health standards:

Hepatitis B vaccination, all dental nurses must have completed a full course and have confirmed immunity (anti-HBs titre ≥10 mIU/mL). Required by GDC-compliant placement practices before clinical work begins
BBV status, dental nurses who perform exposure-prone procedures must comply with the relevant HSE/DH guidance on bloodborne virus transmission
DBS check, an Enhanced DBS (Disclosure and Barring Service) check is required for all dental nurses working with patients
Exclusion from work when ill, dental nurses with active diarrhoea, vomiting, skin infections affecting the hands, or respiratory infections should be excluded from clinical work until symptom-free per HTM 01-05 and occupational health guidance
Up-to-date immunisations as per Green Book recommendations (MMR, Varicella, seasonal flu)

GDC Standards connection: Standard 4.2 of the GDC Standards for the Dental Team requires all registrants to “make sure that the environments in which you work are safe for patients, staff, and visitors.” Failure to follow HTM 01-05 may therefore constitute a fitness-to-practise concern for an individual dental nurse, not just a regulatory issue for the practice employer. This is why a thorough understanding of HTM 01-05 is part of the NCFE CACHE Level 3 Diploma curriculum and assessed in the synoptic MCQ papers.

HTM 01-05, Frequently Asked Questions

HTM 01-05 is technically guidance rather than legislation, but compliance is effectively mandatory because: (1) CQC uses it as the benchmark for assessing the Safe Key Question during inspections under the Health and Social Care Act 2008, and non-compliance can result in enforcement action; (2) NHS England contracts with dental practices require compliance; (3) professional indemnity insurers may consider non-compliance a material fact. The underlying legal duties (COSHH, Health and Safety at Work Act, sharps regulations, waste regulations) are statutory. In practice, every regulated dental practice in England is expected to comply.

CQC dental inspectors assess infection control under the Safe Key Question, looking at: the physical decontamination environment (clean/dirty zone separation), equipment validation records (autoclave logs, AWD cycle records), instrument processing policies and procedures, staff training records, PPE availability and use, sharps management, waste segregation, DUWL flushing records, and staff immunisation records. Inspectors may observe decontamination procedures being carried out and interview staff. A dental nurse who knows HTM 01-05 thoroughly is a significant asset to a practice undergoing CQC inspection. Request a callback from a learndirect adviser to discuss how the diploma prepares you for this aspect of professional practice.

Pregnant dental nurses face specific occupational health considerations. Under the Management of Health and Safety at Work Regulations 1999, employers must carry out a specific risk assessment for pregnant workers. Key considerations include: avoidance of X-radiation (notify the RPS immediately), avoidance of mercury/amalgam where possible, avoidance of nitrous oxide sedation atmospheres, and careful management of exposure to disinfectants and sterilisation chemicals. Dental nurses do not need to stop working during pregnancy, but a risk assessment should result in reasonable adjustments. The employer must implement those adjustments or, if not reasonably practicable, offer suitable alternative work or paid leave.

Dental handpieces (turbines, slow-speed motors, and contra-angle heads) are classified as critical instruments under HTM 01-05 because they contact mucous membranes and penetrate tissue indirectly via instruments they hold. They must undergo the full decontamination cycle between every patient use: (1) remove the bur/attachment; (2) lubricate the handpiece using the manufacturer's specified oil/lubricant; (3) run the handpiece to distribute lubricant and expel excess; (4) wipe externally with a detergent wipe; (5) bag and autoclave (Type B cycle). Handpieces cannot be chemically disinfected instead, autoclaving is mandatory. Handpieces that are not heat-tolerant must be replaced with heat-tolerant alternatives. The internal water channels of handpieces must be flushed before removal from the patient and before decontamination.

Yes, extensively. Unit 2 (Contribute to Health and Safety in the Dental Environment) of the NCFE CACHE Level 3 Diploma is dedicated to health, safety, and infection prevention in the dental setting, covering COSHH, sharps regulations, the full HTM 01-05 decontamination cycle, PPE requirements, waste management, and staff health obligations. It represents 35 Guided Learning Hours of the diploma and is assessed through a portfolio of evidence demonstrating practical competence in your placement, as well as the synoptic MCQ papers. Familiarity with HTM 01-05 at Best Practice level will also strengthen your portfolio evidence.

Under GDC Standards for the Dental Team (Standard 8: raise concerns if patients are at risk), dental nurses have a professional obligation to speak up if they observe practices that put patients or colleagues at risk. This includes witnessing failures to decontaminate instruments correctly, failure to use PPE, or unsafe sharps handling. In the first instance, raise concerns with your line manager or the practice's infection control lead. If concerns are not addressed, escalate to the practice owner, and if still unresolved, you have the right to report to the CQC (in England) or equivalent regulator. GDC Standards protect registrants who raise concerns in good faith.

Next Steps, Dental Nursing Faculty

HTM 01-05 compliance is a core competency for every dental nurse. The NCFE CACHE Level 3 Diploma equips you with the theoretical knowledge and, through your placement portfolio, the practical evidence you need to demonstrate this competency to the GDC and CQC. To start your qualification journey, request a callback from a learndirect adviser today.

Enrol on the Diploma

£29.99 deposit · £100.58/mth · 24-month access

Course Units

Unit 2: Health & Safety, full detail

Dental Radiography Guide

Radiography IPC requirements

GDC Registration Pathway

Post-diploma next steps

Dental Nursing Glossary

Decontamination terms defined

Placement Guide

Finding a GDC-compliant practice

Key external references: HTM 01-05 (NHS England) · Care Quality Commission · GDC Standards for the Dental Team · HSE Sharps Regulations · BADN · NCFE CACHE Qualification Specification

HTM 01-05 Infection Control in Dental Nursing