Dental compressed air and vacuum systems AN UPDATE OF HTM 2022 SUPPLEMENT 1

Dental compressed air and

vacuum systems
AN UPDATE OF HTM 2022 – SUPPLEMENT 1
Dental compressed air and
vacuum systems
AN UPDATE OF HTM 2022 – SUPPLEMENT 1

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First edition published 1996

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Executive summary

GENERAL dental department for dental surgical purposes,

provided that the existing system is capable of meeting
This Supplement provides advice and guidance on the the resulting increase in demand without detriment to
specific requirements for compressed air and vacuum the performance of either system.
systems for use in dental hospitals, dental teaching
schools, clinics and surgeries and primary care trusts QUALITY REQUIREMENTS
(PCTs).
Dental air is usually supplied via a compressor, which
The Supplement should be followed for all new should be fitted with an air-intake filter and a post-
installations and refurbishment; existing installations compression filtration and dryer system. This ensures
should be assessed for compliance with this that the air is clean and dry, minimising the risk of
Supplement. Where necessary, a plan for upgrading the contamination of the system by micro-organisms and
existing systems should be prepared, taking into improving the efficiency of dental instruments.
account the priority for patient and staff safety and
statutory requirements which may have become • The dryer system should be capable of producing air
effective subsequent to any existing installations. with an atmospheric dew-point not less than –20ºC.
Owners, occupiers, general managers and chief
• The filter system should provide dust filtration down
executives should ensure that the premises for which
to 1 µm with a DOP (aerosol) efficiency of not less than
they have responsibility and any activities carried out
99.97% and bacteria filtration down to 0.01 µm with a
therein comply with these statutory requirements. This
DOP (aerosol) efficiency of not less than 99.9999%.
compliance is obligatory.

Managers will need to liaise with dental and estates AIR COMPRESSORS
colleagues and take account of other guidance
Wet and dirty air will eventually lead to damage and
published by the Department of Health to assess the
corrosion of instruments. Oil-free compressors offer a
system for technical shortcomings.
simple, cost-effective solution to the problem of oil
The guidance given in HTM 2022 should generally be contamination. However, for larger installations, there
followed for these systems and plant accommodation, are implications of higher capital costs and noise levels.
except where modified in this Supplement.
Whatever compressor system is used, the importance of
This Supplement supersedes ‘HTM 2022 – Supplement properly conducted regular maintenance cannot be
1: Dental compressed air and vacuum systems’ first overstressed. Filters should be changed at least annually
published in November 1996. and more frequently if recommended by the
manufacturer.
USE OF MEDICAL GAS SYSTEMS
PIPELINE MATERIALS
Dental hospitals, clinics and surgeries require
compressed air to power dental instruments and a The pipework distribution system for dental air should
vacuum system to remove detritus from the operation be of a material technically suited to the application.
site. Copper and nylon are commonly used in pipework.

The performance requirements of dental compressed air Dental vacuum and exhaust line materials should also
and vacuum systems differ from those for medical air reflect current technology, with particular attention given
and vacuum, and they should be provided in addition to to minimising the harmful effects of any effluent which
the medical gas pipework systems (MGPS). To avoid pipework may carry. For example, copper pipe should
confusion they will be referred to as dental compressed not be used for wet vacuum systems, as it will be
air and vacuum systems (DAVS). Medical gas systems attacked by dental amalgam compounds.
should not be used for dental purposes. However, it
may be possible to extend a surgical air system into a
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

VACUUM EXHAUST FILTRATION companies certificated under BS EN ISO 9000 with a

defined scope of expertise. The Quality Assurance
The exhaust from the vacuum system should be sited Scheme 3720 1/206.1A for MGPS is currently under
outside, away from air intakes, opening windows etc review and will be revised to include dental installations
(preferably above roof level) and be clearly labelled. A and maintenance of both MGPS and DAVS.
bacteria filter with particle removal to 0.01 µm with a
DOP (aerosol) test efficiency of not less than 99.9999% COSHH
should be inserted in the system, preferably between
pipework and vacuum pumps. Small systems In areas where anaesthetic agents are in use, particular
exhausting into the work area should have such a filter attention should be paid to the requirements of the
fitted to the pump exhaust. COSHH Regulations 1999. However, it must be
remembered that these Regulations also apply to many
WATER SUPPLIES other compounds used in dentistry.

The design and installation of the surgery’s water supply OPERATIONAL POLICY
must take account of the Water Supply (Water Fittings)
Regulations 1999, in particular the need to prevent An operational policy covering the day-to-day
contamination waste and undue consumption. management and operation of the DAVS should be
devised. Its preparation will usually be the responsibility
To prevent contamination of the sewerage drainage of the senior partner/practice manager or the Authorised
systems, amalgam separators should be fitted to all Person (MGPS), if the latter has responsibility for the
dental vacuum systems. DAVS.

ACCOMMODATION PATHOLOGY DEPARTMENTS

Accommodation for dental compressor and vacuum Separate installations should be provided for pathology
pumps should be carefully controlled to prevent departments.
overheating of plant and contamination of dental air
supplies, or freezing of and subsequent damage to CE MARKING
drying systems and vacuum plant
All new plant should be marked with the appropriate CE
INSTALLATION, TESTING AND MAINTENANCE mark; plant which is not so marked should not be
installed. It should be remembered, however, that
Installation, testing and maintenance of these systems presence of a CE mark is no guarantee of conformity
should be carried out by competent authorities, that is with relevant standards.
Acknowledgements

Geoffrey Dillow (Main author), Consultant, Geoffrey Ian Pope Managing Director, Durr Dental (Products) UK
Dillow and Associates Ltd

Darryn Kerr (Chairman) and Committee Members Mike Siegfried Nafzger Product Management Equipment,
Ralph, Steve Goddard, David Peel, Alex Black, Durr Dental Germany
Mike Arrowsmith, Ian Fraser, Paul Jones, Medical
Gas Association Dr Frank Haines-Nutt (Chair), Paul Jones, Ian
Beaumont, Brian Midcalf, Ed Doyle et al, Regional
Clive Shakesheff Site Investigations Technician, Bristol Pharmaceutical Officers Quality Control Group (Medical
City Council gases)

Clive Bray Director, Device Technology and Safety et al, Steven Griffiths DEFRA
Medical Devices Agency
Richard Hurst Senior Account Executive, WRc-NSF
Mike Ralph Plant Operations and Maintenance Ltd.
Manager, Great Ormond Street Children’s Hospital
Dr M Thorpe General Dental Surgeon, Gateshead
Ian Cooper Senior Dental Officer et al, Dental Division,
Department of Health Dr H Thorpe Community Dental Officer, North Durham
PCT
Steve Goddard Training Consultant, Knowledge Pool
Staff Environment Agency, Exeter
Mike Arrowsmith Arrowsmith & Associates
Judith Reilly HM Inspector et al, Health & Safety
Steve Bailey Managing Director, Cattani ESAM UK Executive, Health Services Unit
Limited
Ian Beaumont, Director, Kay Witham, QA and Audit
Richard Orton, Technical Services Manager, KaVo Officer, Quality Control North West
Dental Ltd
Paul Jones, Ed Doyle, Richard Sutherland,
David Robinson Sales Manager, DentalEZ Dental Directors, Medical Gas Testing Services
Products (GB) Ltd
Mike George Managing Director, Dentalair UK
Peter Stanford Sales Director, Bambi Air Compressors
Ltd Garry Meager Building Services Engineer, Defence
Estates
Lyndon Saul Director Medical Architectural Systems,
Dräger Medical Russ Tebbs Director, Mossman–Tebbs Ltd

Henry Hicks Europe, Middle East and Africa Export Lee Kingston, Special Waste Business Development
Sales Manager, Penlon/East Healthcare Manager, Envirodent Ltd

Steve Parkinson R&D Manager, Hill-Rom MEDÆS Brian Elliott Higher Professional Technical Officer,
Estates Policy, Health Estates Northern Ireland
Andy Booth International pipeline systems designer,
Hill-Rom MEDÆS Jonathan Oakley Sales Engineer, Dominick Hunter
Filtration
Lynn Woods Health and Safety Advisor, Lesley Derry,
Head of Professional Services, British Dental Association M P Godden, Director, HVDS
Contents

Executive summary 6.0 Maintenance of dental air and

Acknowledgements vacuum systems (DAVS) page 21
6.1 Standards
6.3 Modifications – safety
1.0 Scope page 2 6.4 Insurance inspections
6.5 Maintenance schedules

2.0 Management responsibilities and

guidelines page 3 Appendix 1 Dental vacuum systems and
2.1 Compliance with statutory requirements amalgam separation page 22
2.3 Functional responsibilities
2.9 Use of the MGPS permit-to-work system
2.11 Operational policy Appendix 2 Water supply systems to dental
2.13 Training departments and practices page 24
2.16 Extent of systems and limitation of use

Appendix 3 COSHH – anaesthetic agents

3.0 Dental compressed air systems page 5 and other substances page 28
3.1 Statutory obligations
3.8 The need for high quality dental air
3.13 Dental air quality standard Appendix 4 Electricity supplies and fire
3.15 Air treatment required to meet the standard detection systems page 30
3.16 Air intake and pre-compression filtration
3.19 Compressor systems – siting
Appendix 5 Sample document for
3.29 Compressor systems – types and noise levels
control of work on plant and pipework
3.35 Post-compression air treatment
systems in dental practices page 31
3.49 Pipework system design
3.72 Plant monitoring and alarm systems
3.76 Emergency supplies
Appendix 6 Operational policy guidelines page 32

4.0 Dental vacuum systems page 13

Appendix 7 Glossary of terms page 33
4.1 System types
4.10 Plant siting
4.13 Plant types and noise References page 41
4.19 Filtration
4.30 Pipework system design
4.49 Plant monitoring and alarm systems About NHS Estates guidance
and publications page 44

5.0 Validation and verification page 18

5.1 General principles
5.3 Test gas for dental air systems engineering tests
5.4 Test equipment for engineering tests
5.8 Commissioning tests
5.25 Tests following repairs/modifications
5.28 Pharmaceutical testing

1
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

1 Scope

1.1 This Supplement to HTM 2022 covers the design, 1.5 The guidance given in this Supplement should be
installation, validation, verification, operational followed for all new installations and
management and maintenance of compressed air and refurbishment/extension.
vacuum systems for use in dental hospitals (including
dental teaching schools), surgeries and clinics. It 1.6 The guidance given in this Supplement should be
supersedes ‘HTM 2022 – Supplement 1: Dental implemented for patient and staff safety and to comply
compressed air and vacuum systems’ first published in with statutory requirements. Existing installations should
November 1996. be assessed for compliance with this Supplement.
Where necessary, a plan for upgrading the existing
1.2 Other guidance on the provision of medical gas systems should be prepared, taking account of the
pipework systems (MGPS) is also given in the Health priority for patient and staff safety and compliance with
Building Notes. Guidance on COSHH requirements is statutory requirements which may have come into effect
given in the Health & Safety Commission’s Health after any existing installations. Managers will need to
Services Advisory Committee publication ‘Anaesthetic liaise with dental and estates colleagues, equipment
Agents: controlling exposure under COSHH’. manufacturers and installers and heed other guidance
published by theDepartment of Health (DoH) to assess
1.3 The guidance given in HTM 2022 should generally the system for technical shortcomings.
be followed for these systems, except where modified in
this Supplement. 1.7 The requirements in respect of compliance with
statutory regulations apply to all premises where dental
1.4 Dental compressed air and vacuum systems (DAVS) procedures are carried out, regardless of whether they
are installed to provide safe, convenient and cost- are NHS or private premises.
effective systems for dental staff at the point of use.
Problems associated with portable cylinders and suction 1.8 Wherever possible, the appropriate British or
systems, particularly patient and staff safety, porterage equivalent European or international standards should
and storage are reduced. be used.

2
2 Management responsibilities and
guidance

COMPLIANCE WITH STATUTORY 2.4 For a private practice, the formal responsibility for
REQUIREMENTS these systems rests with the senior partner, partners or
principal(s) in the practice.
2.1 It is the responsibility of the owners and occupiers
of premises, general managers and chief executives to 2.5 In all cases where an MGPS is installed, an
ensure that their premises and the activities carried out Authorised Person (MGPS) [AP (MGPS)], as defined in
within those premises comply with all appropriate HTM 2022 ‘Operational management’, is responsible for
statutory requirements, some of which are listed below: the day-to-day management of the pipework system.

• Management of Health and Safety at Work 2.6 If an MGPS (or any part of it) extends to a dental
Regulations 1999. surgery, the AP (MGPS) should assume responsibility for
the DAVS.
• Workplace (Health, Safety and Welfare) Regulations
1992. 2.7 In the following cases, responsibility for the
management of the DAVS should be clearly defined in
• Provision and Use of Work Equipment Regulations the MGPS operational policy:
1998.
a. In dental schools which may be supported by an
• Reporting of Injuries, Diseases and Dangerous associated hospital’s MGPS.
Occurrences Regulations (RIDDOR) 1995.
b. In hospitals where the MGPS does not extend to an
• Manual Handling Operations Regulations 1992. on-site dental surgery.
• Personal Protective Equipment at Work Regulations c. In community-based clinics which may or may not
1992. have an associated MGPS.
• Electromagnetic Compatibility Regulations 1992. d. In a dental surgery, provided and maintained by a
Trust, but rented to a private practice.
• The IEE Wiring Regulations BS7671 2001.
2.8 In an independent private practice, responsibility for
• The Electricity at Work Regulations 1989.
the DAVS (and any associated MGPS) rests with the
• The Medicines Act 1968. senior partner, partners or principal(s) in the practice.

2.2 Particular attention is drawn to the following USE OF THE MGPS PERMIT-TO-WORK SYSTEM
documentation:
2.9 Where the AP (MGPS) has responsibility for both
• Pressure Systems Safety Regulations 2000 and dental and medical gas systems, the HTM 2022 Permit-
Pressure Equipment Regulations 1999. to-Work system should be used to control work on
these systems. The standard MGPS permit form may
• The COSHH Regulations 1999 (see Appendix 3). have to be amended (along with an appropriate
signature) to highlight procedural differences, for
• The Water Resources Act 1991 (see Appendix 2).
example in test routines. But this should not prevent its
• Advice Sheet A3: ‘Health and safety law for dental use, particularly in circumstances where a danger of
practice’ – BDA Advisory Service. cross-connection between systems exists. Sections of
the permit which do not apply should be clearly
• Advice Sheet A12: ‘Infection control in dentistry’ – annotated ‘N/A’ (not applicable).
BDA Advisory Service (under revision).
2.10 Where no AP (MGPS) is involved in work on the
FUNCTIONAL RESPONSIBILITIES system (for example in a private practice), it is especially
important for a nominated senior partner/principal/
2.3 Where dental care is provided within a hospital or practice manager to maintain concise records of
trust, the chief executive or general manager has the maintenance and modifications to the system. This is to
formal responsibility for the MGPS and the DAVS. comply with the requirements of the Pressure Systems

3
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Safety Regulations 2000. In these circumstances, use of should not be used to provide dental air or dental
the MGPS permit-to-work forms would encourage good vacuum. However, see the note below on extension of
practice but, ultimately, the form of documentation used existing surgical air systems.
is at the discretion of senior partner, partners or
principal(s) in the practice. Typical documentation is 2.19 DAVS may be extended to the dental laboratory,
shown in Appendix 5. provided the systems have been specifically designed to
cope with this demand.
OPERATIONAL POLICY 2.20 Very few dental chairs have their movement
operated by compressed air. If the dental chair is to be
2.11 In all areas where an MGPS is installed, an
operated by compressed air, a dedicated compressor
MGPS operational policy should be in place. Normally,
for this purpose must be provided.
this policy will be implemented and monitored by the
AP (MGPS). It is, therefore, logical to extend the scope 2.21 The dental air supply must not be used for this or
of this policy to encompass the DAVS, where the AP for any purpose other than clinical and dental laboratory
has a defined responsibility for these systems. procedures.
2.12 For DAVS that have no AP (MGPS) involvement, a 2.22 Where medical gas pipelines are installed in a
simple operational policy should be prepared by the dental surgery or clinic, the guidance given in HTM 2022
person(s) responsible for managing the system, detailing should be followed for their installation.
day-to-day operational requirements and arrangements
2.23 Separate installations should be provided for
for control and monitoring of modifications, maintenance
pathology applications.
and training. A typical operational policy data set is
shown in Appendix 6. Note: Extension of surgical air systems into dental
departments
TRAINING
There are many instances where an existing surgical air
2.13 Users of DAVS should have a sound general system has been extended into a dental department.
knowledge of the operating principles and safety From economic and air quality viewpoints, such an
procedures and should not attempt to operate extension offers obvious advantages and will, therefore,
equipment unless properly trained or supervised. continue to be considered as an alternative to separate
provision.
2.14 Installers and maintainers of DAVS should be able
to verify competence in appropriate techniques and While it is acceptable to extend a surgical air system
skills. (Proof of registration to BS EN ISO 9000, training into a dental department, a decision to do so should
records and current test equipment calibration take into account the following:
certificates constitute evidence that should be requested a. The extra demand on the existing system should not
by the AP (MGPS) or senior partner, partners or
compromise patient safety or operation of either the
principal(s) in the practice, when approached by a
existing system or its extension. In particular, the
potential installation and/or maintenance contractor.)
ability of an existing emergency supply system to
2.15 A training programme should be produced, and cope with potentially very high demands should be
records be kept of all training carried out. This should carefully assessed.
be subject to annual review. The training programme
b. An AP (MGPS) who is responsible for the existing
should be referenced in the operational policy.
surgical air system will automatically assume
responsibility for the whole of the DAVS.
EXTENT OF SYSTEMS AND LIMITATION OF USE
c. Both AP (MGPS) and Quality Controller (MGPS)
2.16 In a dental surgery or clinic, compressed air is
should be aware that extending a surgical air system
provided as the power source for the dental
instruments; vacuum is required to remove detritus from into a dental unit for dental instrument use will
the operation site. introduce “non-standard” pipework terminations, for
example crimped or compression fitted connectors in
2.17 The performance requirements of these systems addition to non-degreased components. Failure of
differ from those for medical air and vacuum, and they these non-standard components could lead to a
should be provided in addition to the medical gas serious depressurisation of the existing surgical air
systems. However, the guidance given in relevant system and, if provided from the same source, the
sections of HTM 2022 (in particular ‘Design, installation, associated medical air system.
validation and verification’) should generally be followed
for these systems, except where modified in this d. If the system is further extended into a dental
Supplement. laboratory, surgical air could be used to support the
operation of such devices as natural gas/air burners.
2.18 Ideally, dental air and vacuum should be supplied Cross-connection of these systems is unlikely but an
from separate sources via dedicated pipework systems assessment of the risk must be undertaken.
and the medical and surgical air and vacuum systems

4
3 Dental compressed air systems

STATUTORY OBLIGATIONS this could vary. Such an insurance inspection may mean
shutting down the compressed air system, unless
3.1 Reference to statutory guidance has been made in alternative provision is made.
Section 2. In this section, particular attention is drawn to
the Pressure Systems Safety Regulations (PSSR) and 3.7 For all pressure systems, the Regulations require
the Pressure Equipment Regulations (PER), as these that proper, documented maintenance is carried out in
apply to the provision of dental compressed air. accordance with the manufacturers’ recommendations.

3.2 A term ‘Competent Person’ is defined in the PSSR THE NEED FOR HIGH QUALITY DENTAL AIR
(usually the insurance company or its agent and NOT
the Competent Person (MGPS) referred to in the MGPS 3.8 A European Pharmacopoeia Standard is used to
permit-to-work system). Guidance is also given in HTM define the quality of medical air (Table 3.1). There is no
2022 ‘Operational management’. doubt that dental air needs to be ‘clean and dry’ to:

3.3 The Regulations require that a ‘written scheme of • minimise the risk of contamination of the system by
examination’ be prepared by the Competent Person, as micro-organisms;
defined by the Regulations, for each pressure system.
• improve the efficiency and working life of dental
3.4 This may include the compressed air system in instruments; and
dental surgeries, as the air receiver is a pressure vessel.
• maximise the efficacy of modern dental composites.
3.5 Periodic examination is a requirement of the PSSR
Even electric micromotor instruments will suffer damage
and is independent of any insurance arrangement. The
from the use of cooling air contaminated with high levels
time between each examination should be agreed
of oil and water.
between the user and the Competent Person. If doubt
exists about the need to insure a particular item of 3.9 Historically, many smaller installations, for example
equipment, advice should be sought from the up to three or four chairs, have used compressor
trust/hospital or practice insurer. systems which, in basic form, offer little by way of air
treatment. Additionally, poor siting of compressed air
3.6 Depending on quality of the maintenance, 24-
plant has led to instances of overheating, resulting in
monthly inspections may be deemed appropriate but

TABLE 3.1 MEDICAL AND DENTAL AIR QUALITY STANDARDS – COMPARISON

Content Medical air Dental air

Oxygen 20.9 ± 0.5% 20.9 ± 0.5%

Nitrogen 78.0% by inference 78.0% by inference

Carbon dioxide <500 ppm v/v <500 ppm v/v

Carbon monoxide <5 ppm v/v <5 ppm v/v

Oil <0.1 mg/m3 <0.1 mg/m3

Water <67 vpm (DPt –46ºC at atm p) < 1032 vpm (DPt –20ºC at atm p)

Particulate Free from visible particles in a 75-litre sample (taken at 150 litres/min)

Sulphur dioxide <1 ppm v/v <1 ppm v/v

Nitric oxide + nitrogen dioxide <2 ppm v/v <2 ppm v/v

5
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

gross oil contamination, excessive levels of carbon ventilation systems or other potential sources of
dioxide and carbon monoxide and plant failure. contamination.

3.10 All plant suppliers offer advice on plant siting and 3.17 For compressor protection, air-inlet filtration should
associated filtration and drying equipment to enable be fitted immediately upstream of the compressor. In
production of air to the standard recommended in this exceptional circumstances, additional screens, filters
Supplement. Users should discuss these requirements and silencers may be required.
with supplier so that suitable plant performance is
achieved. 3.18 A suitable intake filter would comply with BS ISO
5011: 2000 and be either medium filters or grade CA
3.11 The cost of instrument repair or replacement is paper element filters, with a 5 µm particle size removal
high and these costs, along with an increased danger of capacity. Intake structure will vary with the type of
infection and the inconvenience of system, equipment compressor.
and dental composite failure, should be carefully
weighed against the cost of installing the air treatment COMPRESSOR SYSTEMS – SITING
measures recommended below.
3.19 The importance of correct siting for compressor
3.12 Regardless of system structure, poor or absent plant cannot be overstressed. The following
maintenance is still a significant factor in the degradation requirements (which also apply to the siting of dental
of air quality and consequent premature failure of air vacuum plant) should be adhered to as closely as
driven equipment. A properly planned and administered possible.
maintenance scheme, carried out by a competent
3.20 The plant should have all-round access and good
organisation and meeting, in full, plant manufacturers’
lighting levels (200 Lux) for maintenance purposes.
requirements will very quickly recoup its cost against the
Allowance should be made for changing major
costs and inconvenience of equipment, plant and
components.
instrument repair or replacement.
3.21 The compressor and dryer plant should ideally be
DENTAL AIR QUALITY STANDARD
installed in a well-labelled, locked, dust-free, dry, cool,
3.13 It can be seen from Table 3.1 that dental air is the well-ventilated room.
same as medical air in all parameters except dew-point;
3.22 Most dental plant is rated for an operational
that is, it is not necessary to achieve a dew-point of
ambient temperature range of 10–35ºC; the optimum
–46ºC at atmospheric pressure – a dew-point of –20ºC
range is 10–15ºC. The performance of the compressor
is adequate.
and dryer may be seriously impaired if the ambient
3.14 A medical gas particulate content test is normally temperature rises above 35ºC, although some units are
conducted for 30 s at 150 l/min flow rate (see Table rated up to 40ºC (the HTM-specified maximum
3.1). This will not be practicable on all dental air operational temperature in a hospital plant room).
systems, especially small, for example single-chair,
3.23 An air compressor gives off approximately 70% of
installations. In these cases, purging of the system at full
its consumed power as heat energy; a compressor
flow should be sufficient to remove particulates.
system designed to develop 500 l/min at 5 bar
generates approximately 3 kW. This will need to be
AIR TREATMENT REQUIRED TO MEET THE
STANDARD taken into account when considering the room
ventilation.
3.15 Contaminants can enter the compressed air
systems from three sources: the atmosphere, the 3.24 Additional (forced) ventilation may be required if the
compressor and the pipework distribution system. Each ambient temperature exceeds 35°C.
potential source should be taken into account when 3.25 Some units are not installed in controlled plant
specifying the type and location of air treatment rooms and if the temperature is allowed to fall below
equipment. +5°C condensation may form inside the compressor
and dryer. In lubricated compressors, this could lead to
AIR INTAKE AND PRE-COMPRESSION
oil emulsification, with a subsequent reduction in plant
FILTRATION
life arising from excessive wear of moving components.
3.16 The air intake for the compressor plant should be
3.26 Considerable damage can be caused if water-
suitably located to minimise contamination from internal
contaminated plant temperatures fall below freezing.
combustion engine exhausts and discharges from
vacuum systems, anaesthetic gas scavenging systems,

6
 3 DENTAL COMPRESSED AIR SYSTEMS

Figure 3.1 Plant accommodation ventilation and working conditions

Ideal ventilation Good ventilation Poor ventilation

10

Difficult
working
Pipework distribution pressure (bar)

8 conditions
Very poor Normal working
Difficult

working conditions
conditions

–5 0 5 10 15 20 25 30 35

Ambient temperature (ºC)

3.27 Plant rooms constructed as part of a hospital A temperature sensor should be fitted, with suitable
should conform to the requirements of HTM 2022 controls, to cut off the power supply in the event of
‘Design, installation, validation and verification’. excessive temperatures.

3.28 All plant accommodation should be clearly labelled 3.31 Noise levels of plant obviously increase with the
as to its purpose. Details of emergency action capacity. The maximum free field noise level at 1 m
procedures and location of keys should be posted, as distance for unsilenced compressed air plant varies with
should “no-smoking” and other warning signs. the type and power of the plant (see Table 3.2). Many of
the figures in Table 3.2 apply to larger plant units that
COMPRESSOR SYSTEMS – TYPES AND NOISE are able to supply extensive compressed air systems
LEVELS and are normally housed in a specifically designed plant
room. Many dental installations require much smaller
3.29 Any type of compressor suitable for continuous
units. However, even larger dental installations may be
running on load and stop-start duty may be used.
based upon split systems, using multiple plant, rather
3.30 Oil-contaminated compressor condensate is than one large, centralised unit.
classed as trade effluent and should only be discharged
3.32 In many installations, for example in small dental
via an oil/water separator. Oil-free compressors have
surgeries, pumps may be situated close to the operating
been used successfully in dental surgeries and obviate
area; thus noise control becomes more significant. In
the need for oil separators and filters. Care should be
these circumstances, a maximum free field noise level of
taken to ensure that polytetrafluoroethylene (PTFE)
65 dB(A) at 1 m from the plant is recommended. Note
components do not become excessively hot.

7
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

TABLE 3.2 MAXIMUM FREE FIELD NOISE considerable. Much of this condensation, especially with
LEVELS AT 1 M FOR UNSILENCED smaller systems, will take place within the air receiver.
COMPRESSED AIR PLANT Therefore, to maintain air quality and reduce internal
corrosion and possible microbial contamination,
Noise level (dBA) Power (kW) particular attention should be given to regular draining of
Reciprocating receivers not fitted with automatic drains.
85 <7.5
89 7.6–15 3.36 Internally coated or stainless steel receivers offer
93 15.1–22 obvious advantages in terms of air quality when a dryer
97 22.1–60 system is not fitted before the receiver.
Screw
3.37 For large installations, where oil-lubricated
76 <7.5
compressors are installed, pre-filter, oil-coalescing and
78 7.6–15
80 15.1–22 activated charcoal filters will be required as part of the
92 22.1–60 air treatment process. A typical larger (duplex)
Vane
installation is shown in Figure 3.2.
76 <7.5 3.38 A duplex dryer system would not normally be
76 7.6–15
79 15.1–22 required for dental surgeries, although it would be
90 22.1–60 considered for a dental school or large department
where (a) downtime for maintenance or insurance
that some plant suppliers quote noise figures which are inspections or (b) examinations in accordance with the
referenced to a 38 dB(A) background noise level. Written Scheme of Examination would cause
unacceptable disruption.
3.33 There may be differences in noise levels between
oil-free and oil-lubricated plant offering similar air- 3.39 Each dryer and filter assembly must be rated for
delivery capacities and this should be taken into continuous use at the system demand flow.
account when considering installation in noise-sensitive
3.40 Some older units use refrigerant dryers to lower the
areas.
dew-point of the delivered air. These are unlikely to meet
3.34 The advice of manufacturers/suppliers should be the –20ºC dew-point requirement and, when upgrading,
sought when considering the merits of different plant should be replaced with desiccant dryers.
types for a particular location and the availability of
3.41 The dryer can be located either upstream or
acoustic screening.
downstream of the air receiver, depending upon the
design of the system.
POST-COMPRESSION AIR TREATMENT
3.42 For small installations, especially those in which an
3.35 The amount of water liberated following air
oil-free compressor is used, there may be advantages in
compression and subsequent cooling can be

Figure 3.2 A much larger (duplex) plant with duplex drying, filtration and pressure regulation equipment

B F
K
A C E G

8
 3 DENTAL COMPRESSED AIR SYSTEMS

Figure 3.3 A small simplex air plant with single column regenerative dryer

Pressure safety valve (PSV)

Filter/dryer
Air inlet filter Filter/Drye
column
P Pressure
Pressure
regulator
Plant
P
isolating
valve
Air
Air receiver
receiver

FilterFilter unit
Manual bypass
Test point
Test
Pre-filter/
Automatic point
separator
drain trap
Key:
A Air inlet with filter
B Compressor
C Air cooler with automatic drain, manual drain by-pass and pressure safety valve
D Air receiver with pressure gauge, fusible plug, pressure safety valve and drains, automatic drain, manual drain by-pass and
pressure safety valve
E Oil/water separator/pre-filter
F Desiccant dryer unit
G Dust filter
H Humidity sensor
I Bacteria filter (usually incorporating an activated charcoal element to remove odours)
J Pressure regulator
K Gas-specific test point
L Emergency supply system (cylinder manifold)

locating the dryer upstream of the receiver to ensure 3.48 Filtration to the above specifications may be
that the air receiver is not contaminated with moist air achieved via discrete or combined filter elements.
and to enable dry air from the receiver to be used to
regenerate the desiccant. A typical small installation is PIPEWORK SYSTEM DESIGN
shown in Figure 3.3.
3.49 Installation of a duplex compressor set, as seen in
3.43 If the dryer is located downstream of the receiver, many medical air installations, is not common practice in
the receiver acts as a secondary after-cooler and also dental air systems. Additionally, many small dental air
smooths out the pulsing effect of a reciprocating pump. systems are localised, for example to a single chair, with
This may be appropriate to larger installations. a compressor matched to the needs of the air
instruments. The pipework in such cases is a means of
3.44 There should be a dust filter downstream of the interconnection than rather a ‘system’. For small
dryer to remove particles down to 1 µm with a DOP surgeries, a single compressor system would supply a
(aerosol) efficiency of not less than 99.97%. maximum of about five chairs via a pipework system
comprising synthetic flexibles, for example nylon. A ten-
3.45 A bacteria filter should be fitted downstream of the
chair unit is often supported by two compressor
dust filter. The filter should provide particle removal to
systems, each feeding five chairs via a dedicated
0.01 µm and a DOP (aerosol) efficiency of not less than
pipework system, rather than a larger single plant. This
99.9999%. Modern monobloc air treatment filters offer
configuration has the added advantage of a degree of
the required degree of bacterial protection and combine
service protection, should one plant fail. (Emergency
odour, dust and bacteria removal elements.
supply manifolds are not often used to support dental
3.46 Micro-organisms can penetrate a bacteria filter if air systems.)
the material becomes wet. It is essential that the
3.50 The design of larger systems may also involve split
dryness of the dental air supplied to a bacteria filter is
installations; for example, in a dental hospital with an
checked at least annually to ensure that the filter does
integral dental school, a large number of teaching chairs
not become wet.
will be in use simultaneously. It is possible that the total
3.47 A filter incorporating an activated charcoal element flow requirement of the teaching school and hospital
will remove odours from the delivered air. would be supplied from separate compressor plant.

9
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

A combination of central and local provision, depending 70 chairs simultaneously will use 3500 l/min of air,
on the type of equipment in use, may be the preferred assuming 50 l/min delivered flow at each air
option. instrument connection point and no diversity.

3.51 Planning and design of DAVS, therefore, needs full In the dental hospital (200 outlets), a further
co-operation between user, supplier and installer to (diversified) flow of 6200 l/min will be required.
achieve the most effective design. The parameters
below will serve as guidelines when designing dental air Special cases
systems.
Dental schools
Flow and pressure requirements at the dental chair
3.58 For dental teaching schools it can be assumed that
3.52 A system should be able to provide a minimum all chairs in the teaching department will be in use
flow of 50 l/min at the instrument connection end of the simultaneously at a delivered flow of 50 l/min each. This
operating hose, with the system operating at design flow should be added to the diversified flow of any
flow. A typical pressure of 550 kPa at the floor-box associated system.
outlet connection will be required to achieve this.
Dental laboratories
Diversity factors and plant sizing
3.59 When the dental air supply is to be extended into a
3.53 To ensure that a minimum of 50 l/min is available at dental laboratory, additional flow capacity will have to be
each operating point, the dental air system should be designed into the system. Equipment manufacturers’
designed to offer a minimum plant outlet pressure of data will give the flow and pressure requirements for
600 kPa at design flow. individual items of equipment. No diversity allowance
should be made, unless agreed or specified by the user.
3.54 For surgeries with up to ten dental chairs, it can be
assumed that all chairs may be in use simultaneously, New technology
each requiring a flow of 50 l/min. For surgeries with
3.60 Occasions may arise when advances in technology
more than ten dental chairs, it can be assumed that
result in equipment requiring pressures or flows
60% of the remainder of the chairs will be using
considerably more than the current norms. Each such
compressed air simultaneously.
case should be treated individually and the advice of the
3.55 A maximum pressure drop of 50 kPa from plant to specialist manufacturer or supplier sought to achieve the
dental chair floor-box outlet connection can be tolerated full potential of the equipment. Under no circumstances
under design flow conditions, although it should be should the use of such equipment compromise the
borne in mind that commissioning routines do not integrity of the existing system. If necessary, a separate
include a full design flow test, unless specifically pressure source will have to be installed to cope with
requested by the user. the demands of the new equipment.

3.56 Compressed air receiver volume can be increased Pipework sizing

at the discretion of the plant supplier to meet higher
3.61 The pipework should be designed to produce a
short-term flow demands.
minimum of 550 kPa at each dental chair floor
3.57 For the purposes of plant sizing, the total system connection outlet, with plant operating at a nominal
demand (Q) will be as follows: delivery pressure of 600 kPa at total system design flow,
taking into account any allowance for diversity.
Q = 500 + [(n – 10)30l/min];
i.e. (10 × 50) + [(n – 10)(0.6 × 50)], 3.62 For the purpose of calculating pipework sizes/
where n = number of dental chairs. pressure drops, the following formula can be used:

Example 1. For a dental department with 30 dental

chairs, the system demand would be:  P  ( 0. 1152Q 2L ) 
2

∆p = P1 − 100  1  − .
 100  d5 
Q = 500 + [(30 – 10)30] = 1100 l/min.
where:
Example 2. For a dental teaching section of 70 chairs
integral to a hospital dental department fitted with a ∆p = pressure drop (kPa)
further 200 outlets: P1 = inlet pressure (kPa absolute)
Q = flow (l/min measured at 15ºC and 1013 mbar)
L = pipe length (m)
d = internal diameter of pipe (mm)

10
 3 DENTAL COMPRESSED AIR SYSTEMS

TABLE 3.3 PIPEWORK SIZING: ALLOWANCES FOR EQUIVALENT LENGTH OF FITTINGS

6mm 8mm 10mm 12mm 15mm 22mm 28mm 35mm 42mm 54mm 76mm

Ball valve 0.1 0.1 0.2 0.3 0.3 0.6 0.9 0.9 1.1 1.2 1.2

Tee (Thru’) 0.12 0.15 0.18 0.21 0.32 0.42 0.54 0.70 0.82 1.05 1.56

Tee (Branch) 0.46 0.52 0.70 0.80 0.95 1.26 1.6 2.10 2.45 3.14 4.67

90º Elbow 0.17 0.20 0.25 0.33 0.47 0.63 0.80 1.05 1.23 1.58 2.36

Allowances for equivalent lengths of fittings (see 3.69 Pressure safety valves protecting distribution
Table 3.3) should be included where appropriate. pipework should have a lifting pressure 25% above
nominal line pressure.
Test point
3.70 A certificate of conformity should be supplied with
3.63 To facilitate pharmaceutical testing of the dental air each pressure safety valve.
system, test points (e.g. 3/8" BSP male tapping with
integral isolating valve) should be provided at the plant 3.71 All pressure safety valves should be replaced as
and in each of the dental unit floor connection boxes. identified in the ‘Written Scheme of Examination’ (usually
every five years).
Pipework materials and jointing techniques
PLANT MONITORING AND ALARM SYSTEMS
3.64 All pipework should be of materials appropriate to
the demands of the system. Traditionally, synthetics 3.72 Small installations are not generally provided with
such as nylon have been used for smaller installations plant or pipework monitoring and alarm systems, failure
while copper has been used in larger installations. This of the service being considered sufficient indication of
is no longer the case, with synthetic pipeline systems plant or pipework failure. Indeed, attaching an alarm
being installed in units having considerably more than system to monitor, for example, line pressure would
two or three chairs. If synthetics are used, care should prove difficult, as it is good practice to turn off small
be taken to ensure that microbiological and fire safety compressors when the surgery is not in use.
are not compromised.
3.73 In systems where no alarms are fitted, particular
3.65 Copper systems should be installed using a attention should be paid to regular maintenance to
fluxless jointing technique in accordance with HTM 2022 ensure a continual high level of air quality and to avoid
‘Design, installation, validation and verification’. the inconvenience of plant or equipment failure.

3.66 Any appropriate method of jointing compatible with 3.74 Where provided, in small installations a simplified
the system operating pressure (for example operating and indicating system should signal any plant
compression fittings) may be used with synthetic fault conditions in the dental surgery.
materials.
3.75 In large (hospital) installations, where plant failure
Pressure safety valves would cause a major disruption in clinical services, the
following indications are recommended as a minimum:
3.67 Pressure safety valves should be provided on
pressurised vessels and pipework in accordance with • A simple alarm status indicator unit, forming an
the system requirements. integral part of the plant control unit, or a discrete
unit linked to plant via an interface unit, should be
3.68 All pressure safety valves should conform to
mounted in the plant room.
BS6759 Part 2: 1984 or equivalent. A receiver pressure
safety valve will typically have a nominal lifting pressure • Further repeater panels should be installed within the
10% above receiver working pressure. It should never dental department, telephone operators’ room etc as
be set to lift at a pressure higher than the maximum required.
allowable pressure of the vessel which it protects.
Furthermore, the normal working pressure in the vessel A schedule of indications is listed in Table 3.4.
should be below the pressure-safety-valve set pressure
by a suitable margin to protect against nuisance
opening and to permit the pressure safety valve to
reseat.

11
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

TABLE 3.4 SCHEDULE OF ALARM SYSTEM INDICATIONS

Normal condition Plant fault Pressure fault

At the plant Plant and system operating i) compressor unit: failed Line pressure ±20% of
within specified parameters – to start, overheated, nominal – signalled as a
signalled as a GREEN light overload-tripped or any RED light
other plant alarm as
determined by the plant
manufacturer – signalled
as a YELLOW light

(ii) dryer unit: dryer failure,

dew-point above –20°C
at atmospheric pressure –
signalled as a YELLOW light

In the dental
department or other GREEN YELLOW RED
specified location

Notes:
Yellow and red alarms should be accompanied by an audible warning (with 15-minute, user-operated MUTE facility).
Regardless of whether an alarm system is fitted, the departmental operational policy should detail staff actions in the event of
service failure.

EMERGENCY SUPPLIES emergency supply or installing a permanently piped

manifold system (manual or automatic) that is able to
3.76 If the user considers that sudden loss of, or come on line automatically (via a non-return valve) in the
interruption to, the dental compressed air system would event of primary system failure.
compromise patient safety, some form of emergency
supply should be available. For example, this could be a Warning: emergency supply capacity
cylinder of medical compressed air complete with
regulator and appropriate hose and instrument fittings. Very high flow rates are possible on dental systems,
However, this may not be viable, as difficulties with particularly if multiple chairs are in use. The capacity
cylinder handling and connection may preclude its use. of a cylinder supply may be severely limited in such
circumstances. Care should be taken when extending
3.77 In small surgeries this provision may not be MGPS surgical air systems into dental departments to
justifiable, if it is thought that the possible consequences ensure that these potentially high demands do not
of such an interruption would be insignificant. The chief pose unnecessary risks to the MGPS surgical air
executive, senior partner or principal should carry out a supply or any associated medical air or emergency
risk assessment to ensure that appropriate emergency reserve supplies.
provision is available.

3.78 For larger systems, consideration should be given

to providing an emergency inlet for connection to an

12
4 Dental vacuum systems

SYSTEM TYPES The merits of each system are not described here, as
installations will need to be assessed on an individual
4.1 Dental vacuum systems are classified as: basis to find the most effective solution.
a. dry systems in which, with an air separator, dental 4.2 A further classification, according to the air volume
detritus, sputa and cooling water from high-speed flow rate provided, is given in BS EN ISO 10637 as
drills and instruments have been removed from the follows:
air flow and passed to a drain before the air enters
the vacuum pump, and in which the separator and a. High volume systems: vacuum system with an air
vacuum pump are two different devices (see Figure intake of more than 250 l/min at each cannula
4.1). connector of the largest bore operating hose when
operated at full power and in accordance with the
b. semi-dry systems in which a similar separation takes manufacturer’s instructions.
place but the vacuum pump and separator are
combined into one device (see Figure 4.2). b. Medium volume systems: vacuum system with an
air intake between 90 and 250 l/min at the cannula
c. wet systems in which larger solids have been connector.
removed from the air/water/debris mixture by a filter
before air and liquid enter the vacuum pump, where 4.3 Medium volume systems are not generally specified
they are in turn separated (see Figure 4.3). in the UK and will not be considered further here.

Figure 4.1 Dry system

Cannula connector
Air outlet

Large particle
(>1 mm)
Co ense
Condense
filter sepa r
separator, Re moRemote
if, fitted te pump pumpuunit nitandan d
Separator alternative positions for
Sep
araunit tor if fi t ted alt ern
at ve p
osition
bacteria filter
s for
Drain uni t bacteriafilt er

Figure 4.2 Semi-dry system

Cannula connector
Air ou t le t
Air outlet

Bacteria filter
B acteri a fi lt er
La Large
geparticle
r(>1 mm)
parti cle Pump unit
combined with
>1
( filtermm ) separator
Drain
fi lter

13
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Figure 4.3 Wet system

Cannula connector
Air ou t le t
Air outlet

Separator
Sep
ara tor
La Large
r geparticle
parti cle unit
(>1 mm) Pump uni t Bacteria
>1
( filtermm ) ump
unit filter
fi lter (Protected twater
supply details
Drain
not shown)
Dra in

4.4 Low volume systems, that is those less than 90 systems which, if exposed to freezing temperatures,
l/min, are not used in dentistry. Medical vacuum is could suffer considerable damage.
typically 40 l/min.
4.12 Dry vacuum systems can suffer from excessive
4.5 In dry systems, the vacuum line is relatively dry and condensation if pipework is exposed to low
clean compared with a wet system, which helps temperatures and, if necessary, should be fitted with a
minimise bacterial contamination of the vacuum line, condensation separator, mounted as close as
However, some ‘dry’ systems are installed with the practicable to the pump units. This separator should be
separator unit relatively close to the pump(s), leaving a fitted with an automatic drain. A second separator with
considerable amount of the pipework to carry detritus. automatic drain will be needed at the bottom of a main
This should be taken into account when carrying out riser in situations where the pumps are mounted at a
maintenance on such systems. high level.

4.6 An amalgam separator should be included in all PLANT TYPES AND NOISE
systems, either as an integral part of the vacuum plant
or as a discrete recovery unit. Appendix 1 gives 4.13 Electrically driven, side-channel pumps are
guidance on amalgam separation. frequently used in dental vacuum systems and may
be combined with a separator unit. An amalgam
4.7 Special attention should be given to protecting separator may also form an integral part of the unit or
water supplies to dental units from cross-infection and be fitted as a discrete self-powered unit elsewhere in the
contamination arising from the use of dental vacuum system.
plant. Advice is given in Appendix 2.
4.14 Wet-ring pump systems usually employ water-
4.8 The operational policy should detail hygiene saving measures, for example a recirculation system,
procedures covering all work on vacuum systems to and may be fed from a reservoir or from the water mains
ensure staff and patient safety when, for example, via an air break system (see Appendix 2).
breaking into an existing system. The advice of the local
Control of Infection Officer should be sought. See also 4.15 For plant situated in a typical plant room, the noise
BDA Advice Sheet No 12 – ‘Infection control in dentistry’. levels below are considered as maxima:

4.9 In all systems, drainage of water from the Free field noise at 1 m Power
pumps/separators will pass into the normal foul 75 dBA <5 kW
drainage system. Efficient separation of 82 dBA 5.1–15 kW
detritus/amalgam will, therefore, help prevent pollution of 89 dBA 15 kW+
sewerage systems. Pipeline falls are not generally
required but may be incorporated, depending on the 4.16 Smaller plant will produce much lower noise levels;
system type and building structure. for example, a single chair unit combining pump,
separator and amalgam separator may produce a
PLANT SITING typical noise level of 64 dB(A).

4.10 The details given in paragraphs 3.19–3.28 on dental 4.17 Acoustic screening, giving (typically) 10 dB(A)
compressed air apply to the siting of vacuum plant. reduction in noise level, may be added if desired.

4.11 Maintaining a minimum temperature of 10ºC is 4.18 Vacuum plant should be fitted with a vacuum
particularly important in the case of wet vacuum gauge capable of displaying maximum system vacuum.

14
 4 DENTAL VACUUM SYSTEMS

FILTRATION charcoal filter to remove unpleasant odours arising from

the system.
4.19 In dry vacuum systems, it may be feasible and is
certainly desirable to fit a bacteria filter between 4.27 The filter should provide particle removal to 0.01
(condensate) separator and pump inlets. In wet systems µm with a DOP (aerosol) efficiency of not less than
this is not practicable. If upstream filtration is not 99.9999%.
possible, a bacteria filter should be fitted in the pump
exhaust line. All filters and their housings should be 4.28 The bacteria filter unit should be marked with the
capable of withstanding the maximum system negative legend ‘bio-hazard’ together with a description of a safe
pressure when installed upstream of the pump unit. procedure for changing and disposing of the filters and
emptying the drainage trap.
4.20 The exhaust pipe from the vacuum system should
be sited outside, preferably at roof level and away from 4.29 These filters should be changed in accordance
air intakes, opening windows etc. It should be clearly with manufacturers’ instructions. A procedure applicable
labelled ‘Dental vacuum discharge point – do not to the changing and disposal of filters is described in
obstruct’. Section 10 of HTM 2022 ‘Operational management’.
Vacuum filters are classified as clinical waste and they
4.21 The exhaust pipe should turn down to prevent should be treated accordingly. Filters containing waste
influx of rainwater and have a mesh to protect against amalgam should be disposed of via a specialist waste
ingress of insects, vermin, birds etc. contractor.

4.22 The exhaust pipe should be provided with a drain PIPEWORK SYSTEM DESIGN
valve at its lowest point.
4.30 Vacuum system design can be complicated by
4.23 A silencer should be fitted to the exhaust if various factors, for example:
required.
a. Flow resistance of a condensate separator on a
4.24 The exhaust from a duplex (or triplex) pump dry vacuum system. Condensate separators should
system may be manifolded together via non-return offer no more than 0.2 kPa resistance under design
valves to one external exhaust. flow conditions.

4.25 The vacuum pumps should be sized to take into b. The siting of the pump unit(s). Many dental suites
account the back-pressure of the exhaust system and use pumps mounted next to the chair as an
the resistance of any bacteria filter which may be fitted. extension of the floor-box system. In other suites, a
similar duty pump could be sited on a different floor
4.26 In the very few cases where it would be
of the surgery and use extended pipework.
impracticable to extend an exhaust line to the outside of
a building, a bacteria filter must be fitted in the exhaust c. The pipework arrangement. A ‘series’ (see Figure
line. This should be integrated with an activated 4.4) connection is often used for dry vacuum

Figure 4.4 Series connection of chairs to pump unit

Chair 1 Chair 2 Chair 3

Chair 4 Chair 5

15
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Figure 4.5 ‘Star’ connection for improved liquid flow

Chair 2

Chair 1 Chair 3

Chair 5

Chair 4

systems, as only air is aspirated through the pumps. 4.34 The detritus is aspirated through the suction hose
Wet or semi-dry vacuum systems additionally at a typical air speed of 15–20 m/s. A filter for larger
aspirate liquid through the pipework system which, if particles, that is >1 mm, fitted upstream of the air
installed in a series arrangement, could cause a loss separator/pump unit may be specified by plant
in performance at some of the chairs. A ‘star’ manufacturers. The air separator separates the residual
arrangement, in which all chairs drain back via particles and water.
individual pipework to the pump/separator unit, is
therefore quite common in these systems (Figure 4.35 For high volume systems (dry or wet), the system
4.5). performance should be based on a flow rate of 300
l/min at each dental chair cannula connector.
d. The type of pump/separation method employed.
Vacuum generation and separation functions are 4.36 For surgeries with up to ten dental chairs, it can
often driven by the same power source. The number be assumed that all chairs may be in use
of chairs such a unit is able to support will be simultaneously, each requiring a flow rate of 300 l/min
determined not only by the vacuum capability of the and, therefore, no diversity should be allowed.
unit but also by the maximum flow rate of liquid the
4.37 For systems with more than ten dental chairs, it
separator is able to process. Additionally, the
may be assumed that 60% of the remainder of the
specifications of a discrete amalgam separator
chairs will be in use simultaneously.
should be taken into account when defining the
number of chairs to be attached to a system. 4.38 The total system demand therefore will be:

4.31 For these reasons, it is especially important that full Qvac = (10 × 300) + [(n – 10)(0.6 × 300)];
consultation between designer, installer and user takes i.e. 3000 + (n – 10)180l/min
place to choose the most appropriate system.
n = number of chairs
4.32 The diversity factors here are presented for
guidance only. Each installation should be considered For example, for a 20-chair system, total flow will be
on an individual basis, as it is not unknown for users to 4800 l/min.
request a 60% diversity factor on a low number of
chairs. 4.39 The system should be designed to allow a
maximum pressure loss of 6 kPa for large systems
Performance requirements (>7000 l/min) and 3 kPa for smaller systems between
the plant and the cannula connector (including any loss
4.33 The system is designed to aspirate air, saliva,
across a condensate separator in a dry system). The
blood, amalgam, dust from tooth tissue and other
pumps should be capable of generating a maximum
materials using a high flow rate together with a specially
negative pressure of 25 kPa (65 kPa absolute) but
designed cannula.
systems are normally set to provide a maximum

16
 4 DENTAL VACUUM SYSTEMS

operating negative pressure of 18 kPa (82 kPa 4.44 Exhausts are chosen to match pump outlet port
absolute). size. However, if the length of the exhaust is greater
than 20 m, the next larger pipe diameter should be
Special circumstances used.
Dental schools Vacuum pipework materials and jointing techniques
4.40 For dental teaching schools it can be assumed that 4.45 The vacuum and exhaust lines should comprise
all chairs in the teaching department may be in use materials resistant to attack from substances carried
simultaneously at a delivered flow of 300 l/min each. and be so constructed as to withstand a negative
This flow will need to be added to the diversified flow of pressure of 25 kPa. Pipework made from ABS/ASA
any associated dental system. material are generally found to be unsuitable as they will
suffer chemical attack. Copper pipes will be attacked by
Dental laboratories
dental amalgam if used in wet systems.
4.41 An apparatus such as a dust extraction unit uses
4.46 Polyethylene, polypropylene and heat-welded
very high flow rates (typically >1000 l/min) and
uPVC have all been found suitable.
connection of such equipment to the dental vacuum
system could impose unacceptable loads. Equipment 4.47 Where non-metallic pipework pass through fire
manufacturers’ data will give the flow and pressure compartment walls/barriers they should be suitably
requirements for individual items of equipment. No sleeved.
diversity allowance should be made, unless agreed or
specified by the user. 4.48 Solvent, ultrasonic and heat welding are all suitable
as jointing techniques but any method which ensures
Safety – anaesthetic gas scavenging system integrity under vacuum may be used.
4.42 Dental vacuum systems operate at very high flow
PLANT MONITORING AND ALARM SYSTEMS
rates and, as a result, there will inevitably be some
scavenging of gases (via the cannula) exhaled by 4.49 The guidelines given in paragraphs 3.72–3.75 for
patients during surgery. Under no circumstances, dental compressed air plant monitoring and alarm
however, should the dental vacuum system be systems should be followed. The ‘pressure fault’ alarm,
considered an anaesthetic gas scavenging system. if fitted, should be activated when the system vacuum is
Scavenging systems are not generally applied to 20% less than its value under commissioning
patients undergoing relative analgesia and an accurate conditions.
risk assessment of residual levels of anaesthetic agents
must be made to establish appropriate measures for 4.50 When an amalgam separator is fitted, indication of
controlling staff exposure (see Appendix 3). (a) unit failure and (b) its reaching of separation capacity
should be provided and, if the amalgam separator is
Vacuum system pipework sizing remotely sited, relayed to the dental suite.

4.43 The formula for flow and pressure drop given in

paragraph 3.62 can be used to calculate pipework
pressure drops. Equivalent lengths for typical vacuum
fittings are shown below.

40mm 50mm 70mm 100mm 125mm

Tee (Thru’) 0.95 1.23 1.65 2.2 2.56

Tee (Branch) 2.76 3.38 4.57 6.12 7.68

90º elbow 1.25 1.71 2.44 3.08 3.84

17
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

5 Validation and verification

GENERAL PRINCIPLES COMMISSIONING TESTS

5.1 Installation and commissioning of DAVS differs from General principles

that of medical gas systems in that fewer tests are
performed, some to different parameters. Connection of 5.8 It is not necessary to purge out vacuum pipework
dental equipment (functional tests) is an essential part of but dental air lines should be purged using clean air
the validation and verification process. (from a cylinder or a fully tested dental compressor). A
particulate test, using an in-line (0.8 µm) filter at the
5.2 Each system will need to be examined in the light of floor-box connection point, will establish the air
these recommendations. Sometimes, it will be cleanliness.
unpractical to apply a test in full. For example, leaks on
a single-chair dental-air installation could easily be 5.9 For DAVS installed alongside medical gas systems,
discovered by application of leak detector fluid; it would the advice given in HTM 2022 ‘Design, installation,
waste unnecessary time to conduct a two-hour leak test validation and verification’ should be followed as far as
in these circumstances. is practicable.

TEST GAS FOR DENTAL AIR SYSTEMS 5.10 For labelling and marking, gas flow direction and
ENGINEERING TESTS identity labels should be in place. These should be
applied near valves, junctions, walls etc. Self-adhesive
5.3 The dental compressor may be used as the source or clip-on labels can be used. All colour-coded tapes
of test gas, particularly for smaller systems. For large applied by the pipework manufacturer should be
systems, a cylinder of medical air can be used as an removed.
alternative.
5.11 For sleeving and supports, sleeving/protection of
TEST EQUIPMENT FOR ENGINEERING TESTS pipework should be provided according to contract
specification. Pipework support separations for copper
5.4 For dental air:
pipework are given below.
a. A pressure gauge to BS EN 837-1: 1998, capable of
reading up to 10 bars full scale with a minimum Maximum separation
diameter of 100 mm. Alternatively, digital gauges of Pipework OD Vertical Horizontal
comparable accuracy can be used. (mm) runs (m) runs (m)
b. A flowmeter capable of reading up to 100 l/min full 12 1.2 1.0
scale and rated for pressures up to 10 bars.
15 1.8 1.2
5.5 For dental vacuum:
22 2.4 1.8
a. A vacuum gauge, analogue or digital, capable of
reading 30 kPa negative pressure (70 kPa absolute). 28 2.4 1.8

b. A flowmeter with a full scale reading up to 400 l/min 35 3.0 2.4

at the above vacuum.
42 3.0 2.4
5.6 Fittings for all the above equipment will be needed
to enable connection to instrument hoses, vacuum 54 3.0 2.7
cannula connectors and pipework test points.
76 3.6 3.0
5.7 All test equipment should be supplied by the
contractor and be calibrated to NAMAS (National
Accreditation of Measurement and Sampling) standards.

18
 5 VALIDATION AND VERIFICATION

5.12 Pipework supports for synthetic materials should Design flow and pressure drop test
be fitted such that undue mechanical stress is not
placed upon any part of the system. Manufacturers’ 5.20 This test, performed for medical gas systems, is
guidelines should be followed. not normally applied to dental air systems. By
agreement between user and installer, the flow test may
5.13 At this stage of the examination, methods of be extended such that the performance of the system
protection of the pipework from external damage should can be verified with a previously specified number of air
be checked, along with any fire protection measures. instruments operating.

Cross-connection test Safety valve test

5.14 If the system is in copper and installed 5.21 A visual inspection of the safety valve compliance
simultaneously and adjacent to an MGPS, all attempts certificate and the safety valve markings is carried out
should be made to prevent cross-connection of the and documented in the Written Scheme of Examination.
systems. In this respect, the cross-connection test It is advisable for the system user to keep a copy of the
applied to the medical gas pipework should be certificate for examination purposes.
extended to the dental air and medical vacuum
pipework, especially if the dental air pipework is copper, Vacuum system tests
or if the medical vacuum system comprises synthetic
Leak test
material.
5.22 The structure of most dental vacuum systems
5.15 Where systems are installed independently of (but
precludes the performance of the pressure test defined
possibly adjacent to) the medical gas systems, which
in HTM 2022 ‘Design, installation, validation and
remain pressurised during the installation, there is no
verification’. The pipework of a dry system installed in
need to depressurise the medical gas systems to effect
copper can be tested as described in HTM 2022 but
a full cross-connection test. However, care must be
leak testing of synthetic systems is limited by equipment
taken to minimise risks of cross-connection by
connections and characteristics. However, all
appropriate labelling of the new pipework and ensuring
practicable means should be taken to ensure that the
that no gas other than dental air is delivered from the
system is leak-tight. In its simplest form this test may be
dental air system.
limited to a water-leak test; that is, the system is
5.16 In circumstances where dental air and vacuum only examined for leaks during the flow of clean water.
are being installed, any cross-connection either will be
Cannula flow test
unlikely, due to differences in pipework materials and
structure, or will become immediately apparent on 5.23 With the vacuum pump(s) operational and all dental
pressure testing. chairs connected to the system, each cannula
connector should be tested in turn with the flowmeter. It
Dental air system tests
should be possible to generate the specified flow rate (a
Pipework pressure test minimum of 300 l/min) at the flowmeter. This test should
be performed using the largest diameter delivery hose
5.17 The test is performed on a complete system. It is but the user may specify other hoses at his/her
not usual to perform an initial carcass test, as the discretion. Again, a full diversity flow test will not be
dental-chair floor connections form an integral part of performed unless specifically requested by the user.
the system. Measurements should be taken at the floor-
box-to-chair connection point. Vacuum-limiting device test

5.18 With the pipework pressurised to working 5.24 With all other cannula connections closed and all
pressure and the source of compression isolated, the pumps operating, a vacuum gauge is attached to a
system should show no pressure loss over a two-hour selected cannula connection and the vacuum observed.
period. The gauge should not read more than 18 kPa negative
pressure (82 kPa absolute).
Flow test at working pressure
TESTS FOLLOWING REPAIRS/MODIFICATIONS
5.19 With all dental chairs connected to the floor-box
connections, each instrument hose should be tested in 5.25 All attempts should be made to ensure that system
turn with a flowmeter connected between the integrity and performance is maintained following repair,
instrument and the hose. It should be possible to deliver modification or replacement of system elements. Some
the specified flow rate (usually a minimum of 50 l/min) to or all of the above tests may need to be performed,
the instrument. Adjustment of the chair airline regulator depending on the degree of the work. Tests performed
(if fitted) may be necessary.

19
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

should be at the discretion of the maintenance 5.29 Further testing should preferably be performed
organisation. quarterly but at least annually and after major
plant/pipework repairs or modifications. Users and the
5.26 Confirmation of system performance should be QC (MGPS)/APTC should agree the test requirements
given to the user in the form of a service report and frequency, and a reference made in the operational
policy.
5.27 It may be necessary under the Pressure Systems
Safety Regulations to notify the Competent Person if 5.30 The user should keep records of pharmaceutical
repairs and modifications are made to the pressure tests for at least two years.
system. In addition, the Written Scheme of Examination
may need changing. 5.31 Details of pharmaceutical test procedures are given
in HTM 2022 ‘Design, installation, validation and
PHARMACEUTICAL TESTING verification’ and in the NHS Pharmaceutical Quality
Control Committee publication ‘Testing of piped medical
5.28 Pharmaceutical testing, by either the QC (MGPS)
gases’.
or an independent Air Purity Testing Company (APTC),
of the dental air to ascertain whether it complies with
the required standard (see Table 3.1) should be
performed on system commissioning.

20
6 Maintenance of dental air and vacuum
systems (DAVS)

STANDARDS further advice on infection control, see BDA Advice

sheet No 12: ‘Infection control in dentistry’.
6.1 Installation, testing and maintenance of DAVS
should be carried out by competent authorities, that is c. Daily: clean out large-particle filters. Do not dispose
companies certificated under BS EN ISO 9000 with a of waste down drains.
defined scope of expertise. The Quality Assurance d. Daily: switch off small compressor units at the close
Scheme 3720 1/206.1A for MGPS is currently under of surgery.
review and will be revised to include dental installations
and maintenance of both MGPS and dental systems. e. Weekly: empty the receivers of all air compressors
The manufacturer(s) of the plant and user equipment, that are not fitted with automatic drains.
the equipment installer, the pipework installer and the f. Weekly: check oil levels of lubricated plant.
maintenance company are frequently unrelated
g. At the specified frequency: change filter elements,
organisations. Therefore, care should be taken to
in traps, separators etc. Clean these units as
ensure that all systems are maintained regularly (see
specified. Filters should be treated as clinical waste
‘Maintenance schedules’ section below).
and disposed of accordingly. Maintenance personnel
6.2 All servicing/repairs should be documented in the should wear protective gloves and a face-mask
form of a service report, a copy of which should be left when changing filters/cleaning filter housings. Local
with the user or AP (MGPS) as appropriate. infection control procedures should be followed, or, in
their absence, the advice on bacteria filter changing
MODIFICATIONS – SAFETY given in HTM 2022 ‘Operational management’.
6.3 Special precautions are required when existing 6.6 Amalgam separators – at the specified frequency,
installations are to be modified or extended to ensure that or on a ‘full’ alarm indication: removal of the separated
the sections of the pipework systems remaining in use are amalgam and replacement of the amalgam container.
not contaminated or the supply compromised by (for The waste should be packaged and sent to a specialist
example) cross-connection. This is particularly important reclamation unit.
when MGPS are installed in the same room(s) as the
dental systems. In this instance, work should be controlled 6.7 Other servicing, carried out by specialist
by application of the MGPS permit-to-work system. organisations, will include:
a. Amalgam separators:
INSURANCE INSPECTIONS
i) Annually: a function test of the unit.
6.4 In addition to routine maintenance, examinations of
some pressure vessels are required under the Pressure ii) five yearly: a function and separation test. Note
Systems Safety Regulations 2000. Arrangements for that a full separation test as defined in BS EN
alternative provision of service may have to be made ISO11143 may be impossible to perform on site. In
during this inspection. such cases, an alternative method of validating
separation performance is acceptable.
MAINTENANCE SCHEDULES
b. Compressor and vacuum plant (general):
6.5 All plant and equipment should be serviced regularly function and performance tests and essential repair/
and in accordance with manufacturers’ procedures. replacement of specified components.
However, users can take some preventive measures c. Oil-free compressors: A regular check (to
regularly that will help maintain systems at peak efficiency: manufacturers’ recommendations) of the condition of
a. After procedures involving blood: a glass of cold the PTFE piston rings etc.
water to be aspirated through the hose or hoses used. d. Safety valves: in accordance with written scheme of
b. Daily: a suitable cleaning and disinfecting agent to examination; replacement with a certificated unit.
be aspirated through the system.
6.7 Pharmaceutical testing of air quality: to be
These measures are particularly pertinent to systems performed at least annually at all test points. Documenta-
which do not include an automatic irrigation system. For tion to be retained by the user for at least two years.

21
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Appendix 1 – Dental vacuum systems and

amalgam separation

INTRODUCTION However, once waste amalgam enters the wider

environment, it may present different and more significant
Dental amalgam is about 50% mercury by weight (other risks.
components include silver, zinc, copper, tin). Mercury is
on the UK ‘red list’ of dangerous substances that LEGAL ISSUES
represent the greatest threat to the aquatic environment.
This is because of their toxicity, persistence and capacity Both waste-water and waste are covered by laws
for bioaccumulation. It is a list 1 substance in EC Directive intended to protect human health and the environment.
76/464/EEC (the Dangerous Substances Directive) which
• The Water Industry Act 1991 (section 118)
obliges member states to take appropriate steps to
requires that anyone discharging trade effluents into
eliminate pollution by list 1 substances from the aquatic
the sewers gets permission first from the sewerage
environment.
undertaker. Breach of section 118 is a criminal
WASTE AMALGAM offence. The Environment Agency would expect to
use their powers (under section 132) to impose
This arises: conditions on such permissions, limiting how much
mercury goes into the sewers.
a. when new amalgam becomes surplus during
treatment and cannot be reused. A 1997 survey • Section 111 of the above Act makes it an offence to
suggests that, on average, perhaps 17% of amalgam discharge matter into a public sewer likely to ‘affect
once mixed is surplus; prejudicially the treatment and disposal of its
contents’. Waste amalgam released into drains might
b. when old amalgam fillings, or teeth with fillings, are in some circumstances be considered as having that
removed from patients’ mouths during treatment, or effect. For example, it might mean that sewage
during drilling, carving and burnishing; sludge is less readily incinerated or spread on
farmland because of difficulty in meeting pollution
c. when dental equipment is cleaned;
limits at the sites in question.
d. as residues in packaging, including used capsules;
• Section 33(c) of the Environmental Protection
and
Act 1990 makes it an offence to ‘deposit, recover or
e. as residues removed during cleaning or maintenance dispose of controlled waste in a manner likely to
of separators, sieves and traps. cause pollution of the environment or harm to human
health’.
AMALGAM IN WASTE-WATER
• Section 34 of the Environmental Protection Act
Particles of waste amalgam become mixed with water 1990 imposes a statutory duty of care on those
during treatment, rinsing and cleaning. If particles are not concerned with controlled waste, including everyone
separated out of waste-water, they will be carried into who produces it (except for householders’ own
drains and sewers, eventually ending up in sludge at refuse) and thus includes dentists producing waste
sewage treatment works and in effluent from those amalgam. Among other things, wasteholders must
works. Most will lodge in pipes and drains along the way make sure that it is transferred only to an authorised
and may be released much later. person, and parties to any transfer must complete,
sign and keep a transfer note. Breach of the duty is a
The mercury in dental amalgam is in a bound form and is criminal offence. Practical guidance for meeting the
not biologically available (not readily absorbed). The duty is in ‘Waste management: the duty of care – a
Department of Health advises that the use of dental code of practice’.
amalgam does not risk systemic toxicity (general rather
than localised toxic effect) and only a few cases of • The Special Waste Regulations 1996 impose
hypersensitivity (excessive reaction) occur in individuals. additional safeguards where waste meets the

22
 APPENDIX 1 – DENTAL VACUUM SYSTEMS AND AMALGAM SEPARATION

definition of special waste. At present, waste In summary, the six ‘good practices’ are:
amalgam and associated packaging, which typically
arise from dental practices, are not generally 1. Use amalgams effectively; this will reduce waste
considered to be special waste by the enforcing and cost.
authorities. However, the European Commission has
2. Install amalgam separators as soon as possible;
proposed that amalgam should be added to the EC
fit them either to existing equipment or when
Hazardous Waste List. If the EU agrees to this, waste
replacing equipment. Other traps and sieves may
amalgam would become special waste.
still be useful as supplements.
The UK, along with other countries, is committed to
3. Make sure that amalgam separators protect all
reducing the amount of mercury in the environment.
the normal routes such as spittoons, sinks or
‘Dental amalgam: an environmental code of practice’ (to
basins by which amalgam might enter the drains.
be published by DEFRA in 2002) aims to help dentists,
When working with amalgam, do not use any
practice managers and their staff minimise the
unprotected routes into the drains. This includes
uncontrolled release of mercury from dental surgeries,
the cleaning of instruments and utensils. Waste
including discharges to sewers. The code is non-statutory
amalgam must not be put directly down the drains
and relates to England. (Similar codes are envisaged in
and never flushed down the toilet. During
Scotland, Wales and Northern Ireland.) The code lists six
refurbishment or cleaning, care should be taken to
‘good practices’ and shows how to achieve them. Most
ensure that sediments in pipes are not flushed into
dentists already follow some or all of these practices or
drains.
are adopting them. Research published in 1997 by the
Department of the Environment, Transport and the 4. Keep waste amalgam separate from other waste.
Regions (DETR) entitled ‘Amalgam purchase, use, This will help with the recycling of its silver and
recovery and release’ shows that up to a quarter of mercury content; but if the recycling is not feasible,
dentists surveyed had already fitted separator systems. it will make disposal safer. Use only authorised
waste management firms – and remember the
duty of care. Specialised firms offer sealed
container systems and separate collection.
Dispose of packaging with amalgam residues
either in clinical waste containers or as normal
refuse, or through other general arrangements for
packaging waste.

5. Follow any regulatory advice from local sewerage

operators or other bodies, for example the WRAS
Guide highlighted elsewhere in this Supplement

6. Take stock of equipment in use now; operational

procedures and additional measures needed to
follow the code.

NB: The effectiveness of this Code will be reviewed in

January 2006. Amalgam separators should be fitted
before then.

Design and performance criteria for amalgam

separators are given in BS EN ISO 11143.

23
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Appendix 2 – Water supply systems to

dental departments and
practices

INTRODUCTION AND LEGAL RESPONSIBILITIES connection and also waste of water. It is also intended
to help those working for, and in, dental practices when
All owners or occupiers of premises are responsible for considering the design of new installations, modifying
the water systems within their premises. The extent of and maintaining existing systems, and implementing
these responsibilities is described in detail in Section 73 back-flow prevention and frost-protection measures to
of the Water Industry Act 1991 and comparable prevent burst pipes and fittings. It encourages good
Northern Ireland and Scottish Acts. The Act defines practice and water conservation and supports efforts to
responsibilities and penalties placed on water suppliers establish common procedures and installation criteria for
and customers. water supplies in the dental profession.
It is the duty of the water supplier to supply
CAUSES OF CONTAMINATION AND WASTE
‘wholesome’ water to the premises – that is, suitable for
normal domestic purposes and complying with the If back-flow occurs, water is drawn back from an
quality requirements of the Water Supply (Water Quality) appliance or fitting into the pipework supplying it. Any
Regulations. In addition, The Environment Act 1995 contamination present in the appliance could find its
requires water suppliers to promote efficient use of way into water used for drinking or food production,
water by their customers. with serious consequences for health. There are two
causes of back-flow – back pressure (where the water is
The customer (owner or occupier) should ensure that
forced in the reverse direction by an excess pressure)
there is no risk of deterioration in the quality of the water
and back-siphonage (where water passes back into the
from any cause whatsoever and must comply with the
pipework by siphoning under gravity). Within dental
Water Supply (Water Fittings) Regulations 1999 (and the
practices, there are many areas where a back-flow
equivalent Byelaws 2000 in Scotland), including taking
incident could present a major hazard to the quality of
responsibility for installing and maintaining fittings to
the water supply, thus placing both staff and patients at
ensure that they satisfy the Regulations. The
risk. With existing systems, it is therefore necessary to
Regulations apply from the point where the pipework
identify and modify any part of a water supply system
from the water main becomes the responsibility of the
which could give rise to such contamination. With new
owner of the premises. This is usually, but not always, at
systems, consideration should be given to this at the
the boundary of the property or the boundary of the
design stage.
road in which the water main is laid. The Regulations
apply from this point throughout the premises, for the WHERE THE RISKS ARE
purposes of preventing contamination, waste, misuse or
undue consumption of water. It is a criminal offence to Many of the situations regarded as ‘high risk’ (that is
commence most types of installation work without the having the potential to cause hazardous back-flow) that
local water supplier’s consent, which must be obtained are found in dental premises are identified in the
by notifying the details of the work to the water supplier. following schedule. This list is representative only and
should not be regarded as exhaustive.
The information given below is based upon the content
of ‘Water supply systems – prevention of contamination Each listed appliance or fitting is allocated a fluid
and waste of drinking water supplies’ a guide (due for category according to the risk of water contamination
release in 2002) prepared by the Water Regulations likely to exist. The category takes into account the
Advisory Scheme Technical Support Group in co- concentration and toxicity of the contaminant likely to be
operation with the dental profession. present.

The Guide is an aid to installing and maintaining water Installation protection options to ensure safe systems
systems in accordance with The Water Supply (Water are shown below.
Fittings) Regulations 1999 which are based on the
requirements of the 1991 Act and is aimed to prevent The Water Regulations classify contamination risks into
pollution by back-flow, back-siphonage, cross- five fluid categories, including wholesome water. These

24
 APPENDIX 2 – WATER SUPPLY SYSTEMS TO DENTAL DEPARTMENTS AND PRACTICES

fluid categories range from fluid category 1, wholesome SCHEDULE OF RISKS IN DENTAL
water, to fluid category 5, the highest risk to health. INSTALLATIONS

Fluid category 1 Facility Risk/fluid category

Wholesome water supplied by a water undertaker and Dental equipment

meeting the requirements of the Water Supply (Water 1. Drill turbine 5
Quality) Regulations 2000 for drinking water. 2. Syringe (air/water) 5
3. Descaler 5
Fluid category 2
4. Spittoon 5
Water which would be in fluid category 1 but whose 5. Cup filler 5
aesthetic quality is impaired owing to:
Waste systems
a. a change in its temperature; or 6. Aspirator (wet) 5
7. Automatic separator (wet) 5
b. the presence of substances or organisms causing a 8. Water powered aspirator 5
change in its taste, odour or appearance, including 9. Automatic separator (dry) 5
water in a hot water distribution system. 10. Saliva ejectors 5
Fluid category 3
Self-contained systems
Fluid which represents a slight health hazard because of 11. Bottled water Not applicable
the concentration of substances of low toxicity, including
any fluid which contains: Hygiene security
12. Injection dosing (auto/manual) 5
a. ethylene glycol, copper sulphate solution or similar 13. Autoclave 5
chemical additives; or 14. Backwash systems 5
15. Compressed air injection 5
b. sodium hypochlorite (chloros and common
disinfectants). X-ray equipment
16. Developers 4
Fluid category 4

Fluid which represents a significant health hazard Washing machines

because of the concentration of toxic substances, 17. Clothes washinga 5
including any fluid which contains:
Sanitary wares
a. chemical, carcinogenic substances or pesticides 18. Macerators 5
(including insecticides and herbicides); or
Miscellaneous
b. environmental organisms of potential health 19. Drinks dispenser 3/2
significance. 20. Hot-water heater 2
21. Water softenera 5/4/3/2
Fluid category 5

Fluid representing a serious health hazard because of Hose union taps

the concentration of pathogenic organisms, radioactive 22. Domestic areas 3
or very toxic substances, including any fluid which 23. Other risk areasa 5/4
contains:

a. faecal material or other human waste;

Notes:
b. butchery or other animal waste; or aRisk category to be determined by the water supplier.
c. pathogens from any other source.
The risk/fluid category should be viewed as the
potential contaminant. For example, if a supply is sited
within reach of a drugs or cleaning fluid storage area
they should be regarded as the risk/fluid category from
which the water system needs protection.

25
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Before commencing the water-supply design of any easily identified owing to the complexity of the
surgery, details should be obtained of all the equipment equipment. The units should therefore be regarded as
that is to be installed within the practice, whether it is to being in fluid category 5. Examples of units within which
be supplied with mains or stored water and if a back- such connections may exist are:
flow prevention arrangement or device is an integral part
(‘point-of-use protection’) of a unit or whether back-flow • injection disinfection dosing units (automatic or
protection has to be provided. manual);

In new multi-occupancy premises, it is a water-supply • back-wash systems;

industry requirement that, in addition to ‘point of use
• compressed-air injection units, water-powered
protection’, individual surgeries be:
aspirators.
• supplied by means of a separate, dedicated branch
MAINTENANCE OF AND REPAIRS/ALTERATIONS
supply or distribution pipe; and
TO WATER SYSTEMS
• provided with a fluid/risk category 3 protection device
Except for repairs and like-for-like replacements, it is a
at the point of entry to the surgery.
criminal offence to undertake installation, alteration or
A surgery should have its own stop-valve for isolating modification of plumbing systems in dental premises
the water supply. without the water supplier’s consent.

Before carrying out any remedial or new works in an Remedial plumbing work in any surgery should be
existing surgery, it is important that an installer makes a completed in accordance with the information set out
comprehensive survey of the water-supply system in the in the WRAS ‘Water Regulations Guide’ and in the
premises, as water-supply systems will vary forthcoming WRAS ‘Dental Premises Guide’. Always use
considerably from one dental practice to another. a reputable plumber. Many water suppliers now maintain
registers of Regulations-accredited plumbers.
It is recommended that all water that comes into
contact with patients during treatment should be of the Suppliers are not required by law to sell plumbing
quality provided by the water supplier. Where there is a fittings that comply with the Water Regulations, but both
fluid category 5 risk of potential back-flow, it may be the installer and user will be responsible if fittings do not
necessary to design or to modify an existing installation comply. Approved fittings may carry the WRAS mark
to include suitable protection, for example a type AB air and/or the BSI ‘kite-mark’ and the supplier should
gap and cistern suitably protected to maintain water confirm that fittings are of an appropriate quality and
quality. standard.

Note: No water used for domestic purposes shall Note: All mechanical back-flow prevention devices
be distributed from a cistern and any associated can fail and therefore need planned inspection and
pump delivery pipe used to protect dental maintenance or replacement. Back-flow of
equipment. contaminated water from the surgery to the mains
or to the domestic section of any surgery may be
Cistern temperatures should be kept below 20ºC to harmful to health.
minimise the growth of microbial organisms. Keep
cisterns and cold water pipes away from all sources of No pipe or fitting, particularly a plastic pipe or fitting,
heat, including sunlight. Where this is not possible, they may be installed in contact with contaminated material,
should be insulated to protect against heat. regardless of any protection given, to prevent
permeation and thereby contamination of the water
High risk back-flow protection (fluid category 5) should supply.
be provided for water-supply connections to separators
(dental air/liquid waste) and pumps which aid the Water meter readings should be checked regularly (high
induction of a vacuum or provide coolant to the motor readings can indicate a burst pipe or wastage).
bearings of aspirator/vacuum systems. However,
The use of new lead pipe or fittings in contact with
although this arrangement meets the water-supply
drinking water is now prohibited. Care should be taken
industry’s requirements, the risk of cross-contamination
to ensure that only approved solders, marked ‘lead free’
to the ‘hygienic water’ is reduced if a dedicated stored
are used for drinking water installations.
water system is provided for these types of apparatus.
Pipes located in roof spaces and any other unheated
In certain types of equipment or installations, ‘cross-
space need to be insulated for frost protection.
connections’ may exist between, or within, types of
water-using apparatus. In many cases, these are not

26
 APPENDIX 2 – WATER SUPPLY SYSTEMS TO DENTAL DEPARTMENTS AND PRACTICES

Type AF air gap with circular overflow. This provides back-

flow protection to fluid category 4. The dimension of the air
gap between the discharge point and the ‘critical water level’
(water level two seconds after closing the inlet) must meet the
minimum requirements for the standard.

Type AA air gap, with unrestricted discharge. This provides

back-flow protection to fluid category five. The discharge point is
located above the spillover level (SL) of the receptacle. The
minimum distance between the discharge and the spillover level
must meet the requirement for a type AA air gap.

Type AUK1 air gap with interposed cistern. This provides

back-flow protection to fluid category five. The air gap in the
cistern must meet the requirements for a type AG air gap
(British Standard BS6281: Part 2).

Key:
SgV = servicing valve
WP = warning pipe
SL = Spillover level

Some equipment may require an operating water pipes for earthing purposes. Installations must be
pressure that is higher than the incoming mains properly earthed in accordance with the latest edition of
pressure and a booster pump may be required. In such the IEE Wiring Regulations.
cases the water supplier should be consulted and its
consent gained for the installation of pumps which Manufacturers of some type of equipment for dental use
deliver more than 12 l/min. specify limits of water hardness and acidity. Water
treatment plant may be needed to achieve the required
It is potentially hazardous and unacceptable to connect limits. Any water treatment plant must be installed with
electrical appliances or electrical installations to water due regard to the above Regulations.

27
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Appendix 3 – COSHH: anaesthetic agents

and other substances

THE USE OF ANAESTHETIC AGENTS levels to assess staff exposure and establish what, if any,
additional control measures are required. If the risk
Before any Control of Substances Hazardous to Health
assessment shows that existing controls and procedures
(COSHH) assessment is carried out, all AGS/ventilation
are satisfactory, periodic review will offer compliance with
systems must meet performance standards established
COSHH. The length of period chosen will depend on the
at commissioning.
nature of the risk, the work and a judgement on the
The COSHH Regulations 1999 set out the legal likelihood of changes occurring, but in any case, the risk
requirements for protecting the health of staff in the assessment should be reviewed at least every five years.
workplace; anaesthetic agents are covered by these
When the risk assessment identifies inadequate control
regulations.
measures or work practices, improvement must be
COSHH requires employers to ensure that exposure of made to comply with COSHH.
their employees to substances hazardous to health is
Control measures may mean using active anaesthetic
either prevented or, where this is not reasonably
gas scavenging systems or increased local ventilation.
practicable, adequately controlled. There is a legal
The user should discuss such requirements with estates
requirement for the exposure of staff to anaesthetic
colleagues, where appropriate.
agents to be controlled by any assigned Occupational
Exposure Standard (OES) in accordance with the An operational policy for the management of the DAVS
requirements of COSHH. The Health and Safety and covering COSHH (specifically exposure to anaesthetic
Executive are empowered to enforce these standards. agents) should be in place. This policy should identify
those individuals responsible for the implementation and
In 1976, in response to concerns about exposure to
monitoring of the policy. Annual review of the policy is
anaesthetic agents, the Department of Health issued
recommended, but if work practices change significantly,
HC(76)38 advising health authorities on the need to
interim reviews will be needed.
install control measures in operating theatres. At that
time, no OESs had been set for anaesthetic agents. All staff should be reminded to reduce leaks from
equipment and medical gas systems to a minimum; for
In 1992 the Health and Safety Commission’s Advisory
example, flowmeters should be turned off when not in use.
Committee on toxic substances suggested that OESs
should be set for four anaesthetic agents, that is: GENERAL ANAESTHESIA
Anaesthetic agent OES (ppm)a Wherever this technique is used, a risk assessment should
be carried out as for a general operating theatre. Duration
Nitrous oxide 100
of exposure is particularly important in areas where the
Enflurane 50
ventilation system does not comply with HTM 2025.
Isoflurane 50
Halothane 10 RELATIVE ANALGESIA (RA)
aOver an 8-hour time-weighted average reference The risk assessment will need to take into account the
period number of patients to whom RA is administered, as
although short-term concentrations of nitrous oxide may
These OESs (published in 1995) apply to wherever these be high, exposure averaged over eight hours [time-
substances are used. This means that the OES for nitrous weighted average (TWA)] can be considerably less.
oxide will apply not only in hospital operating theatres but
also in small practices where the gas is used in relative In clinics where there is inadequate or no ventilation,
analgesia, rather than general anaesthesia. control measures will depend on the patient throughput.
Usually, some form of artificial ventilation will be needed.
ACTIONS TO BE TAKEN TO COMPLY WITH THE
REQUIREMENTS OF COSHH COSHH AND OTHER SUBSTANCES USED IN
A ‘suitable and sufficient’ risk assessment to identify the DENTISTRY
hazards (anaesthetic agents used), when and where they
Changes in technology mean that it is not possible to
are used and the staff most exposed is a legal
provide a list of all substances likely to be covered by
requirement. This will involve monitoring residual gas

28
 APPENDIX 3 – COSHH: ANAESTHETIC AGENTS AND OTHER SUBSTANCES

COSHH Regulations. BDA Advice Sheet A3 gives safety

advice on the use of methyl methacrylate, mercury and
glutaraldehyde. But where any element of uncertainty in
the use of a compound exists, the appropriate safety
data sheets, which detail OESs for that compound,
should be consulted.

29
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Appendix 4 – Electricity supplies and fire

detection systems

GENERAL When physical separation is impracticable, or where

there might be contact with extraneous metalwork, for
The installation should comply in all respects with example where the pipes are carried in metal partitions,
BS 7671 – ‘Requirements for electrical installations’, IEE the pipework should be effectively bonded to the
Wiring Regulations, 16th edition’ (and subsequent metalwork in accordance with Regulation 525-10 of the
amendments) and HTM 2007 – ‘Electrical services: IEE Regulations.
supply and distribution’.
Where piped gases and electrical wiring are enclosed in
Care is required when selecting pipework routes to a boom, gas control panel, dental pedestal or other
prevent pipes coming into contact with electric cables similar enclosure, the wiring should be carried in
and wiring and to minimise the risk of electric shock in separate conduit or trunking so that it cannot come into
the event of a fault on cables near to metallic pipework. direct contact with the piped gas installation. Where this
is not possible, the wiring should be secured in the most
The final connection to any equipment, for example
effective possible manner clear of the medical/dental
alarm panels or control panels, should be made via an
gas pipes, and the cables should comply with
unswitched fused connection unit. However, switching
Regulation 523-17 of the IEE Regulations.
facilities to enable isolation of all poles of the mains
supply to equipment should be provided to enable safe
ELECTRICAL WIRING IN PLANTROOMS
working on that system.
All electrical wiring in these rooms should be carried out
EARTHING using MICS cable or cable of the type indicated in IEE
Regulation 523-17 with adequate protection against
Metal pipework should be bonded to the consumer’s
mechanical damage.
earth terminal as required by BS 7671. This bonding
should be made as near as possible to the point at Fire-resistant cable to BS 6889, PVC armoured cables
which the pipework enters the building from the plant. and single insulated cables in conduit may also be used.
The size of the bonding conductor should be in
accordance with BS 7671. The pipework itself should Each compressor, vacuum pump and manifold should
not be used for earthing the electrical equipment. be supplied from a separate sub-circuit where
appropriate.
Flexible pipework connections between the
compressors or vacuum pumping plant and the fixed Metal-clad sockets, connection units and switches
pipework should be metallically bonded across to should be used in plantrooms; plastic fittings are not
comply with this requirement. Flexible connections in the appropriate.
fixed pipework should not normally be used, but if they
are specially approved they should be similarly bonded FIRE DETECTION SYSTEMS
across.
Smoke alarms or rate of change of heat detectors
INSTALLATION OF ELECTRICAL CABLES should be installed in the plantrooms in any health
building or practice having a fire detection system in
Distribution pipework should preferably be physically accordance with HTM 82 ‘Firecode: alarm and detection
separated from the metal sheath and armour of systems’.
electrical cables as well as from metal conduits, ducts
and trunking and bare earth-continuity conductors
associated with any electric cables which operate at low
voltage (i.e. below 1000 V a.c. or 1500 V d.c.) or above.

30
Appendix 5 – Sample document for
control of work on plant
and pipework systems in
dental practices
Dental air and vacuum systems
Control of work form

Practice name

Location
Permission is given by:
Name (print) Title

Signature Date

for the following work to take place on the dental air/dental vacuum system(s)

on Date between the hours of and

I accept responsibility for the work described above. No other work will be carried out
under this authorisation.

Name (Print) Company

Signature Date Time

The work described has been completed and tested in accordance with HTM 2022
Supplement No 1 (Dental Compressed Air and Vacuum Systems). A copy of the test
results/service report has been left with the Practice Manager.

Name (Print) Company

Signature Date Time

Following successful test results, I accept the above system(s) back into clinical use.

Name (Print) Title

Signature Date

31
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Appendix 6 – Operational policy guidelines

The purpose of this appendix is to offer guidelines to • start up/shut down procedures,
users/managers of DAVS which are not under the
authority of an AP (MGPS). Where the AP (MGPS) has • user maintenance routines.
responsibility for the DAVS, the MGPS operational policy
can be extended to include the DAVS. 3. Operational management

This section should contain details of paperwork

• It is wise to produce a policy that is looseleaf in
controlling:
format. This gives the greatest flexibility when
updates to personnel details, procedures etc are • maintenance;
required.
• installation;
• It is not wise to produce an unnecessarily bulky
document. The policy should be relevant, clear and • validation and verification;
concise.
• cylinder management procedures (where
• Details of personnel telephone numbers and appropriate);
emergency procedures can be inserted as
• COSHH-related statements, for example procedure
appendices. In this way, updating is made simpler.
for monitoring of waste anaesthetic gases;
• The content of the basic (four-section) structure
• bacteria-filter changing procedure;
below is not exhaustive but can be used as a starting
point for policy preparation. • a reference to fire-safety procedures;
1. Signatories and defined responsibilities
• statements appropriate to the use of maintenance
This section will contain the signature(s) of the senior contractors, for example permission to access
partner/partners or principal and will define the departments/equipment.
aims/objectives and scope of the policy. It will also define
day-to-day responsibility for the DAVS (including the 4. Appendices
control and recording of work on the systems) and
a. A list of personnel, contractors etc with contact
contain the signature of the person thus defined.
numbers and details of arrangements for cover in the
A small (schematic) plan of the installation can be added event of absence.
to this section.
b. A list of actions to be taken in the event of an
A reference to responsibility for user training should also emergency, for example loss of supply, fire.
be included.

2. System components

In this section, the DAVS should be defined in terms of

location, arrangements for system security, safety
procedures and routine operation. Nominated personnel
should be referenced to an appendix giving contact
details. Typical inclusions:

• security key control,

• actions in the event of system failure,

• use of protective equipment,

• safety hazard of equipment,

32
Appendix 7 – Glossary of terms

Activated carbon/charcoal filter: Activated charcoal is often used to remove odours from compressed air systems.
An activated charcoal element is often incorporated with the bacteria filter in a medical air system.

Adjustable pressure limiting (APL) valve: A user-adjustable valve that releases gases to the atmosphere or a
scavenging system and that is intended to provide control of the pressure in the breathing system. The volume of gas
above that which is needed to achieve the required patient pressure is vented.

After-cooler: A heat-exchanging device used to cool and hence release water by condensation from compressed air.
It is usually mounted in the output pipework from a compressor.

Alarm signal status unit: A small indicator panel affixed to all major plant items and displaying normal and fault
operating conditions.

Alarm system: A series of interconnected electronically operated units that continually monitor pipework pressure and
plant operating conditions and relay these to appropriate personnel via coloured indicator display panels.

Allowable pressure drop: The maximum permissible pressure drop when a medical gas system is delivering its full
design flow.

Amalgam: a mixture of mercury with another metal, dental amalgam consisting of about 50% mercury by weight (other
components include silver, zinc, copper, tin).

Anaesthetic agent: A drug used to reduce or abolish feeling.

Anaesthetic gas scavenging system (AGSS): A complete system which conveys expired and/or excess anaesthetic
gases from the breathing system to the exterior of the building(s) or to a place where they can be discharged safely, for
example to a non-recirculating exhaust ventilation system.

Anaesthetic vaporiser: A device used to facilitate the change of an anaesthetic from a liquid to a vapour.

Analgesic drug: A drug used to reduce or abolish pain.

Area valve service unit (AVSU): A valve assembly within an enclosure provided for maintenance or for connecting a
temporary supply or, in emergency, for shutting off the gas flow to a specific area or for the purging and testing of gas
supplies after engineering work.

As-fitted drawings: Scale drawings of a pipework system which shows the exact positions of pipework, valves etc
with respect to the layout of the building in which the system is fitted.

Authorised Person (MGPS) – AP (MGPS): A person who has sufficient technical knowledge, training and experience
in order to understand fully the dangers involved and who is appointed in writing by the executive manager on the
recommendation of a chartered engineer with specialist knowledge of MGPS. The certificate of appointment should
state the class of work that the person is authorised to initiate and the extent of his/her authority to issue and cancel
permits-to-work. The Authorised Person (MGPS) should have read, have understood and be able to apply the guidance
in HTM 2022, especially in relation to validation and verification, and should also be completely familiar with the medical
gases pipe routes, their means of isolation and the central plant. He/she should ensure that the work described in any
permit-to-work is carried out to the necessary standards.

Bacteria filter: The final stage of filtration in a medical air system, usually placed before the pipework pressure
regulator and often constructed with an integral activated charcoal filter which is used to aid odour removal. For a
medical air system, such a filter will be specified to an efficiency of 99.9999% according to the DOP (aerosol) test.

Back-flow: Flow in a direction contrary to the intended normal direction of flow.

33
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Batch number: A distinctive combination of numbers and/or letters that specifically identify a batch or lot and permit
its history to be traced, for example the batch number on a medical gas cylinder.

Bodok seal: A type of (high-pressure) gas seal featuring a (neoprene) rubber flat disc washer bonded to an outer alloy
ring. Such seals are commonly used in connections of medical gas cylinders to manifold systems.

Breathing system: A gas pathway in direct connection with the patient, through which gas flow occurs at respiratory
pressure, and into which a gas mixture of controlled composition may be dispensed. The function of the breathing
system is to convey oxygen and anaesthetic gases to the patient and remove waste gases from the patient.
Scavenging equipment is not considered part of the breathing system. Also referred to as breathing or patient circuit,
respiratory circuit or system.

Breathing system (semi-closed): This is a system that allows some of the expired gases to leave the circuit; the
remainder mixes with fresh gases and is rebreathed. A carbon dioxide absorber is used in this system.

Breathing tubes: Large bore, flexible tubes of rubber or plastic used in most breathing systems to convey gases to
and from the patient. They are usually corrugated to prevent obstruction and increase flexibility.

Buffer vessel: A reservoir used to smooth out variations in pressure caused by varying demands in a PSA system.

Bull nose valve: A type of cylinder valve in which connection of equipment is effected via a threaded valve outlet.

Cannula: A (usually) Hand-held hollow tube designed for insertion into a body cavity. It may be attached to a vacuum
system for purposes of fluid/detritus removal.

Cannula connector: Cartridge at the end of the hose part of a suction system, intended for fitting of cannulae and for
placement in a mobile support. Also called a suction handpiece.

Carbon dioxide absorber (Circle absorber): A device used to remove carbon dioxide chemically from exhaled
patient gas. Primarily used in closed or semi-closed circle breathing systems, which require carbon dioxide removal to
make rebreathing possible.

Check valves: Also known as unidirectional valves or one-way valves, these units allow passage of a gas or liquid in
only one direction.

Client's representative: The person, or that person's representative, as defined under the designated Standard Form
of Building Contract issued by the Joint Contracts Tribunal 1980 (JCT 98).

CCU: Coronary care unit.

Common (fresh) gas outlet: The port through which the mixture of gases and vapours dispensed by an anaesthetic
machine is delivered to the breathing system. Also referred to as the machine outlet.

Competent Person (MGPS) – CP (MGPS): A person having sufficient technical knowledge, training and experience
to carry out his/her duties in a competent manner and understand fully the dangers involved, and whose name is on
the register of Competent Persons (MGPS). The register should be maintained by either a specialist contractor or by
the Authorized Person (MGPS) as appropriate.

• He/she should be familiar with and be able to read the record drawings and should have received specific training
on MGPS.

• He/she should be able to identify all types of medical gases terminal units and should be familiar with all testing and
commissioning procedures referred to in HTM 2022. The person maintaining the register should assess a person's
competence, taking account of his/her training and experience.

Competent Person (Pressure Systems): As defined by the Pressure Systems and Transportable Gas Containers
Regulations 1989 and subsequently the Pressure System Safety Regulations 2000. A full list of the attributes required is
given in the Regulations, but in summary, minor systems require a Competent Person (Pressure Systems) of at least
Incorporated Engineer status while intermediate and major systems require Chartered Engineer status.

Compound: A term used to describe a usually locked, fenced area housing a VIE installation. In chemistry a
compound is a substance formed by the combination of atoms.

Contamination:

a. Of a water supply: Changes to the nature of the water and, or, deterioration of the quality of the water supplied by
the water supplier, whether it be harmful to health or not.

34
 APPENDIX 7 – GLOSSARY OF TERMS

b. Of a medical/dental gas supply: Changes in the physical or chemical composition of a medical gas or gas mixture
such that it no longer meets Pharmacopoeia specifications.

Contract: The agreement concluded between the trust and the contractor, including all specifications, contractor's
samples, plans, drawings and other documentation which are incorporated or referred to therein.

Contract supervising officer (CSO): The person authorised by the hospital authority to witness tests and checks
under the terms of contract. He/she should have specialist knowledge, training and experience of MGPS and HTM
2022.

Contractor: The contractor commissioned typically as a subcontractor for the installation of the MGPS under the
Standard Form of Building Contract issued by the Joint Contracts Tribunal 1980 (JCT 98). All contractors working on
MGPS and DAVS should be registered to BS EN ISO 9000 with scope of registration defined as appropriate.

Contractor’s Representative (CR): The person nominated by a contractor to oversee the installation of an MGPS.
This may be a contractor’s project manager. The CR should have received training appropriate to the work under
his/her control.

Control panel: A term usually applied to the pressure-reducing and monitoring unit used with a VIE. The term is also
attributed to the gas supply-switching unit of an automatic manifold system and to the electrical control units of
compressor and vacuum plants.

Control valve: An isolating valve mounted in a medical gas pipework and which is usually used for engineering
purposes. These valves are usually mounted in ceiling voids, ductwork and plantrooms. They may be locked in their
normal working position.

Cross-connection:

a. Medical gas: any connections between two or more medical gas services or between a medical gas service and any
other piped service.

b Water system: any connection between water supplied by the water supplier and a source other than from the water
supplier’s mains.

Cryogenics: The science of low temperatures; specifically, those below –40ºC.

Cryogenic liquid system (CLS): A source of supply containing liquefied gas stored under cryogenic conditions. See
also VIE (vacuum insulated evaporator).

Decanting: The act of transferring a gas (usually oxygen) under pressure, normally from a large cylinder to a smaller,
usually transportable, one. This procedure should only be carried out under controlled and documented conditions with
the sanction of the quality controller (QC).

Design flow: A calculated value of gas flow which allows for flow diversity factors and which is used in estimation of
primary gas source capacity.

Designated medical and nursing officer – DMO/DNO: The medical or nursing officer designated by the chief
executive to act as a focal point for communications related to MGPS in a specified department or departments. There
would ideally be a designated medical officer and a designated nursing officer in each department. The designated
officer gives permission for any interruption to the MGPS.

Designated Person: A suitably trained person who has been given responsibility for a particular operation involving
medical gas cylinders, for example responsibility for changing cylinders on the MGPS manifold. A role fulfilled by a
medical gas porter.

Diameter Indexed Safety System (DISS): A method of ensuring gas specificity by dimensional coding of connectors
etc.

DOP: Dioctylphthalate. A compound of accurately controllable particle size used in the efficiency testing of filter
media. This test has generally been replaced by a Dispersed Oil Particulate test (also using the DOP acronym!) which is
an aerosol test.

Diversity: When calculating medical gas flows from, say, a ward area an allowance is made for the fact that it would be
exceedingly unusual for all terminal units to be in use simultaneously. This allowance is called a diversity factor and, for
flow calculation purposes, will give a flow value for a particular area that is less than the mathematical (algebraic) sum of
the flows from all the terminal units.

35
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Dry vacuum system: A pump-driven dental vacuum system in which mouth washings are separated from the
pipework airflow (usually) at the dental chair. Only air will flow through the vacuum plant.

Duplex plant: Two identical plant items, for example vacuum pumps. One is the ‘Duty’ or working plant, the other is
the ‘Standby’ plant, which will come on line automatically in the event of failure of the duty plant.

Dynamic pressure: The nominal pressure in a pipework when gas is flowing through it.

Earth bonding (on an MGPS): A low resistance electrical connection between the copper pipework and an electrical
earth conductor. Also used to describe electrical continuity connection across flexible (non-conductive) couplings on
plant, for example between pump output port and copper exhaust lines on a medical vacuum plant or any electrical
connection to earth of parts of plant, alarm systems etc.

Emergency inlet port: A gas specific connector allowing connection of emergency gas supplies to medical air or
oxygen systems in the event of a major gas failure (e.g. primary and secondary supplies).

Entonox: BOC trade name for a 50/50 mixture of nitrous oxide and oxygen. Used for pain relief.

Equanox: Linde trade name for a 50/50 mixture of nitrous oxide and oxygen. Used for pain relief.

Equipment: A device, such as a pressure regulator and flowmeter, which is connected to a single cylinder for the
administration of medical gas to an individual patient or gas apparatus.

Equivalent length: The resistance to flow, in terms of a length of pipe of the same diameter, caused by insertion of a
fitting; for example, inserting a ball-valve into a 22 mm diameter pipe gives rise to a flow resistance equivalent to 0.6 m
of straight pipe: 0.6 m is the equivalent length of the valve.

Emergency supply/reserve manifold – ESM/ERM: A manual or automatic manifold used to supply gas in the event
of failure of the primary supply. A manual ESM is usually specified as support for an automatic manifold and a fully
automatic ESM for a medical air compressor, oxygen concentrator or cryogenic liquid system, where the latter is a
single vessel primary supply.

Essential supply: An electricity supply intended to be maintained in the event of failure of the main supply. It is usually
provided from an on site emergency generator. Medical gas systems and alarms should be connected to the essential
supply.

Evaporator: A heat-exchanging device in the cryogenic liquid output line from a VIE, in which the liquid boils under
constant pressure at atmospheric temperatures to produce gas.

First fix: The gas-specific back part of a terminal unit. It contains an automatic isolating valve.

Flammable: Capable of burning with a flame. (Analogous to inflammable.)

Floor box: A term frequently applied to the floor mounted distribution unit for compressed air vacuum and electrical
services in a dental surgery. It is usually adjacent to the dental chair.

Flow algorithm: A mathematical equation incorporating diversity factors, allowing the calculation of flow rates of gases
within a pipework system.

HTM 22: Hospital Technical Memorandum 22 - 'Piped medical gases, medical compressed air and medical vacuum
installations' (first published by HMSO for the Department of Health and Social Security as Hospital Technical
Memorandum 22 in May 1972, and as amended by HN(76)175), and last reprinted in 1978 with minor corrections.

HTM 2022: HTM 2022: 1997, began life as Health Technical Memorandum 22, published in 1974. Currently, the
document comprises two main volumes:

Volume 1 ‘Design, installation, validation and verification’ ISBN 0-11-322067-7

Volume 2 ‘Operational management’ ISBN 0-11-322068-5.

There are two Supplements to this publication; ‘Dental compressed air and vacuum systems’ ISBN 0-11-322040-5 and
‘Medical gas systems for ambulances’ ISBN 0-11-322052-9.

HTM 2022 (1997) is supported by Model Engineering Specification C11 and a Permit to Work System, published by the
Department of Health and HMSO, respectively.

36
 APPENDIX 7 – GLOSSARY OF TERMS

The objective of the guidance printed in HTM 2022 is to ensure the provision of medical gas pipework systems that
guarantee the safety of patients served by them.

Hyperbaric chamber: A medical treatment device in which a patient is subjected to (usually) elevated concentrations
of oxygen at a pressure above atmospheric. Blood oxygen levels and oxygen exchange rates are increased.

ICU: Intensive care unit (analogous to ITU).

ITU: Intensive therapy unit.

Inflammable: Capable of burning with a flame. The same as flammable.

Local area alarm: An alarm indicator unit sited in areas of (usually) high dependency and used to signal high or low
medical gas pipeline pressures to local staff.

Main cylinder storage area: The main area where all cylinders on a site are stored, excluding only those cylinders in
use in manifold rooms or in ready-to-use stores.

Manifold (automatic): A device that allows connection of high-pressure gas cylinders to a medical gas system. It
comprises a control panel which reduces the pressure to its working value, an automatic changeover facility (empty to
full cylinders) and alarm indicators. Automatic manifolds are designed such that they will continue to supply gas in the
event of an electrical supply failure.

Manifold (manual): A manifold that requires manual intervention to initiate a changeover from empty to full cylinders.

Manifold room: A purpose-built room designed to accommodate a cylinder manifold installation and reserve cylinders
as appropriate.

Maximum pressure drop: The maximum allowable pressure difference in a medical gas pipework between plant
room outlet and point of use. For example, the maximum pressure drop allowed in a medical vacuum system at a
nominal plant room outlet pressure of 450 mmHg is 50 mmHg between the plant room and the back of the most
remote terminal unit, under dynamic conditions.
Individual terminal units and flexible hoses will also have maximum allowable pressure drops at flow rates determined
by design parameters and defined in the appropriate design standard(s).

Medical gas: Any gas used in a regime of patient therapy and defined as a medicine under The Medicines Act 1968.

Medical gas pipework systems (MGPS): The fixed medical gases pipework and the associated supply plant or
pumping equipment and warning and alarm systems. This definition includes medical compressed air and medical
vacuum installations and anaesthetic gas scavenging systems.

Minimum leak device/low loss tee: A small orifice permanently fitted in a pipework and used as a connection point
for control devices, for example pressure switches. The device allows removal and repair/refitting of the switch without
supply interruption.

Molecular sieve: Any compound capable of selective adsorption of gas molecules, for example the Zeolites used in
PSA plant.

Muting: Silencing, on a temporary or permanent basis of the audible alarm on a medical gas alarm system.

NC: Normally closed. Usually used with reference to valves.

NO: Normally open. Usually used with reference to valves.

Nominal distribution pressure: The pressure in a pipework under design flow conditions. For medical gases in the
UK the nominal distribution pressure is 400 kPa, except for surgical air, which may have distribution pressures between
700 kPa and 1100 kPa. Medical vacuum has a nominal pressure of 450 mmHg (60 kPa) below atmospheric.

Non-flammable: Not capable of burning in air.

Octopus: A device comprising an assembly of suction cups and control mechanisms for restraining the heart during
surgery. It is operated from the medical vacuum system.

Oxygen-free nitrogen: A gas recommended for use as an inert shield purge during the hot jointing of copper medical
gas pipework. It obviates the need to use flux.

37
DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Passive system: A reference to a type of AGSS in which there is no active element, that is a pump. Waste gases are
propelled through the system by patient exhalation or the exhaust function of a patient ventilator.

Peak flow: The likely flow through a medical gas system under conditions of maximum demand.

Pendant: A mechanical device, usually ceiling mounted in an operating theatre and designed to facilitate easy access
to medical gas and electrical supplies. It may be a fixed unit (a ‘rigid pendant’), a telescopic pendant (a variation on the
rigid unit) in which some vertical movement (usually motor driven) of the pendant is possible or a complex unit in which
movement in all planes is possible. A single, ceiling-mounted hose is also often called a pendant.

Permit-to-work: A form of declaration, or certificate, in eight parts, for signature as appropriate. It states the degree of
hazard involved, defines all services to be worked on and the points where isolation of the affected sections are carried
out, describes the work to be done and requires a signature of a designated medical or nursing officer before work on
a MGPS is allowed to commence. It is not a permit for the use of the installation for clinical purposes until all parts have
been completed. A pro forma is given in the permit-to-work section of HTM 2022 ‘Operational management’.

Pin-Index(ed) Safety System (PISS): A method of ensuring gas-specific connections by the provision of interlocking
pin/socket combinations. The pin position is defined for each gas service. Pin-indexing is used on many medical gas
cylinder valves.

Pin-index valve: A medical gas (cylinder) valve constructed with an integral pin-index system: one or two sockets
drilled into the valve body in positions defined by the gas contained in the cylinder and into which a corresponding item
of pin-indexed equipment, for example cylinder yoke, will fit. Such an assembly offers a gas specific connection.

Pipework carcass: The pipework installation with terminal unit base blocks and area valve service units (excluding
pressure switches, flexible assemblies, etc).

Pipework manifold: A pipe to which cylinder tail-pipes are connected, which in turn is connected to the control
equipment by means of which medical gas is delivered to the MGPS.

Pipework odour: Any odour resulting from internal contamination of the MGPS copper pipework, for example by
residual cleaning agent or arising from the supply system. Odours may be detected when testing flexible hoses. These
arise from plasticisers in the hose material.

PPM: Planned preventive maintenance. A scheme of work contrived to attain maximum plant efficiency.

Premises: The premises should be the hospital site, healthcare building or other establishment where the MGPS is
installed and the services are to be provided, as defined in the contract.

Pressure gas: A term applied to gases that are delivered at pressures above atmospheric. In the case of medical
gases, pressure gases are oxygen, nitrous oxide, Entonox/Equanox, medical air, surgical air, nitric oxide and oxygen
carbon dioxide mixtures. With the exception of surgical air, which is distributed at pressures up to 1100 kPa, medical
gases are distributed at a nominal pressure of 400 kPa.

Pressure-reducing valve: A device used to control the operating pressure in a gas system

Pressure-regulating valve/pressure regulator: Same as pressure-reducing valve.

Pressure safety valve (pressure relief valve): A valve to limit pressure within a pipework or other pressurised
system. Medical gas pipework safety valves are usually set at 530 kPa on a 400 kPa system.

Pressure Systems Regulations (1989): (Now replaced by Pressure Systems Safety Regulations (2000) and the
Pressure Equipment Regulations (1999)). In the regulations three categories of pressure system are defined.

a. Minor systems: pressure less than 20 bar (2.0 MPa) and the pressure volume product for the largest vessel should
be less than 2 × 105 bar-litres (20 MPa · m3);

b. Intermediate systems: these include systems that do not fall into either of the other two categories;

c. Major systems: steam-generating systems exceeding 10 MW, pressure storage systems in excess of 106 bar-litres
(100 MPa · m3);

Most MGPS and dental air systems fall into the minor systems category. Systems with a largest pressure vessel ×
working pressure product of less than 250 bar-litres are exempt from some of the Regulations.

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 APPENDIX 7 – GLOSSARY OF TERMS

Pressure swing adsorber (PSA): Medical oxygen concentrator. System comprising compressor(s), nitrogen adsorber
unit(s) and reservoir by means of which oxygen-enriched, clean, dry, oil-free air is generated from atmospheric air.

Pressure switch: An adjustable electromechanical device in which varying pressures in a (medical) gas system
activate electrical contacts and hence an alarm system.

Probe: A gas specific connector used to connect equipment to a terminal unit. It is either attached to a hose (remote
probe) or to a piece of equipment, for example flowmeter (direct probe).

Procedure: A written method, which has been drawn up by a person familiar with the system and the requirements of
this HTM, and checked by the QC or Authorized Person (MGPS), as appropriate. It should be signed by both persons
and be dated, and include a review date.

Protective cover: A tamper-evident means of protection of the cylinder valve or valve gas-outlet which may be
achieved by a viscose seal, plastic cap or metal cover.

Quality controller (QC): A person appointed in writing by the executive manager on the recommendation of the chief
pharmacist. The QC should normally be a pharmacist or other suitably qualified person and should have specialist
knowledge, training and experience of MGPS and HTM 2022. The QC is responsible for the quality of the medical
gases; his/her duties include carrying out the quality tests in accordance with the procedures specified in ‘Validation
and verification’.

QC (MGPS): Current terminology used to identify a quality controller with MGPS testing duties.

Ready-to-use store: A local subsidiary to the main store for a limited number of medical gas cylinders, usually
cylinders for immediate use and one day’s supply for reserve purposes.

Receiver: A specially strengthened vessel used to store compressed air and smooth out variations in pressure caused
by compressor pumps and varying system demand.

Regulator: Same as pressure-reducing valve.

SCBU: Special care baby unit.

Scavenging: The collection of excess gases from a patient breathing circuit and removal of these gases to an
appropriate place of discharge outside the working environment.

Scavenging system: An assembly of specific components that collects and removes excess anaesthetic gases
released from a breathing circuit. There are three types; Active, in which a pump is used to create a flow which carries
the waste gases; Passive, in which the patient or patient ventilator provides the driving force for the gas expulsion;
Semi-active, in which a small amount of flow in the scavenging system is generated, for example, by the room
ventilation system.

Schematic drawing: A drawing of a pipework showing the general layout of the system. Exact positions of the
pipework and components with respect to building layout are not shown. Schematic drawings are not usually scaled.

Second fix: The gas specific front part of a medical gas terminal unit. It contains a self-sealing valve.

Semi-dry vacuum system: A dental vacuum system in which a separation similar to that of a dry vacuum system
takes place but the vacuum pump and separator are combined into one device.

Semi-passive system: A type of AGSS in which there is no integral active pump, but negative pressure is generated,
for example, utilising the venturi effect of the ambient-air conditioning system.

Services: The services and goods which the contractor is required to supply in accordance with the contract.

Shield gas: The gas used to provide an inert shield during the brazing of medical gas pipework (usually oxygen-free
nitrogen).

Simplex: A single plant item, for example one compressor, used as a primary supply.

Sodium flame test: A method of testing filter element efficiency using a cloud of known size-range sodium chloride
particles as the challenge medium.

Specialist fire safety advisers: This post is fully described in ‘Firecode: policy and principles’.

Static pressure: The pressure inside a pipework under zero flow conditions.

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DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

Suction device: A passive entity which can only induce an air flow when connected to a suction machine.

Suction system: Active entity of dental equipment, including a suction machine (vacuum pump) which enables a flow
to be induced which is designed to remove spray, liquids and solids from the mouth of a dental patient during
treatment.

Suitably Qualified Person (SQP): The HTM 22 nomenclature for the Quality Controller (MGPS) – (QC(MGPS)).

Synthetic air: Medical ‘air’ comprising a mixture of approximately 20% oxygen with 80% nitrogen. The air is
synthesised (mechanically mixed) from the gases vaporised from cryogenic supplies of liquid oxygen and liquid nitrogen.
A synthetic air system is able to provide a hospital site with synthetic air, oxygen and (surgical) nitrogen.

Tail-pipe: A flexible connecting pipe that connects a medical gas cylinder to a medical gas pipework manifold via a
gas-specific connector.

Telemetry: An electronic processing unit that relays to the gas supplier, via a telephone modem, information on the
contents and internal pressure of a VIE.

Terminal unit: A gas-specific socket, usually wall- or pendant-mounted, which is used as a connection point between
medical equipment and the medical gas pipework system.

Test point: A terminal unit and lockable control valve connected to all main plant items and used to facilitate
engineering and pharmaceutical testing of the plant.

Third means of supply: A term used to describe additional support for a medical gas (oxygen) system in the event of
failure of the primary system and its ESM. A typical example would be provision of a fully automatic manifold system,
permanently connected into the hospital end of a main pipework from a cryogenic liquid system installation. Hence,
failure of the primary plant or the pipework would not immediately deprive the hospital of oxygen, as the manifold (the
third means of supply) would take over in these circumstances.

Tracheal tube: Also called an endotracheal tube, intratrachael tube and catheter, it is inserted into the trachea and
used to convey gases and vapours to the lungs.

Training (gas cylinders): Formal instruction in the safe handling and storage of gas cylinders and associated
equipment to ensure that staff are aware of the dangers involved and will act accordingly.

Trap: A mechanical device that allows automatic drainage of (condensed) water from a pipework or compressed air
plant.

Trunking (also called bedhead/walling systems): Wall mounted plastic or metal ductwork, usually with some aesthetic
appeal, which carries services, such as MGPS, around a patient area.

Trust: Trust means an NHS Trust, Special Health Authority or other health authority as appropriate.

TWA: Time-weighted average (concentration). A way of expressing exposure such that the amount of time spent
exposed to each different concentration level is weighted by the amount of time a worker is exposed to that level.

Vacuum insulated evaporator (VIE): A source of supply containing liquefied gas stored under cryogenic conditions.

WAGS: Waste anaesthetic gas system/scavenger/scavenging – same as AGSS.

Wet vacuum system: A pump-driven dental vacuum system in which mouth washings are transferred via a pipework
system (and the pump) to a central reservoir for disposal.

White spot nitrogen: Another term for oxygen-free nitrogen. Used as shield gas when brazing medical gas pipework.
So called because of the white spot (or spots) painted on the black cylinder shoulder. Note that this cylinder colour
code is changing to meet the new European Standard (EN 1089-3) in which oxygen-free nitrogen is represented by a
grey-bodied cylinder with a black shoulder, that is no white spots.

Written Scheme of Examination: A document detailing frequency and degree of examination of a pressure system
by a Competent Person as defined by the Pressure Systems Regulations.

Yoke: A mechanical assembly usually having integral gas-specific components, for example the pins of a pin-index
system, for attaching a compressed (medical) gas cylinder to a piece of equipment, for example an anaesthetic
machine or a system supply manifold.

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References

NHS ESTATES PUBLICATIONS

Health Technical Memoranda

HTM 2007 Electrical services: supply and distribution. HMSO, 1993 (issued in 4 parts).

HTM 2022 Medical gas pipeline systems

Vol 1: Design, installation, validation and verification. HMSO, 1997.

Vol 2: Operational management. HMSO, 1997.

Supplements:

Piped medical gases in ambulance vehicles. HMSO, 1997.

Permit-to-work forms. HMSO, 1999.

HTM 2025 Ventilation in healthcare premises. HMSO, 1994 (issued in 4 parts).

Health guidance notes

The Pressure Systems and Transportable Gas Containers Regulations 1989. HMSO, 1993.

Model Engineering Specifications

C11 Medical gases. HMSO, 1996.

Firecode

82. Alarm and detection systems. HMSO, 1996 (new edition in preparation).

Policy and principles. HMSO, 1994.

ACTS AND REGULATIONS

SI 3246: 1994 SI 437: 1999 The Control of Substances Hazardous to Health (COSHH) Regulations. HMSO,
1999.

EC Directive 76/464/EEC: Water pollution by discharges of certain dangerous substances. European

Commission.

SI 635: 1989 The Electricity at Work Regulations. HMSO, 1989.

SI 2372: 1992 The Electromagnetic Compatibility Regulations. HMSO, 1992.

The Environment Act 1995. HMSO, 1995.

The Environmental Protection Act 1990. HMSO, 1990.

SI 3242: 1999 The Management of Health and Safety at Work Regulations. HMSO, 1999.

SI 2793: 1992 The Manual Handling Operations Regulations. HMSO, 1992.

The Medicines Act 1968. HMSO, 1968.

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DENTAL COMPRESSED AIR AND VACUUM SYSTEMS: HTM 2022 – SUPPLEMENT 1

SI 2966: 1992 The Personal Protective Equipment at Work Regulations. HMSO, 1992.

SI 2001: 1999 The Pressure Equipment Regulations. HMSO, 1999.

SI 2169: 1989 The Pressure Systems and Transportable Gas Containers Regulations. HMSO, 1989. Now
replaced by SI 825: 1996 Pipeline Safety Regulations (1996) and the SI 128: 2000 Pressure Systems Safety
Regulations 2000).

SI 2306: 1998 The Provision and Use of Work Equipment Regulations. HMSO, 1998.

SI 3163: 1995 The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR).
HMSO, 1995.

SI 972: 1996 The Special Waste Regulations. HMSO, 1996.

The Water Byelaws 2000 Scotland.

The Water Industry Act 1991. HMSO, 1991.

SI 3184: 2000 The Water Supply (Water Quality) Regulations. Amended by The Water Supply (Water Quality)
(Amendment) Regulations SI 2885: 2001.

The Water Resources Act 1991. HMSO, 1991.

The Water Supply (Water Fittings) Regulations 1999. HMSO, 1999.

SI 1148: 1999 The Water Supply (Water fittings) Regulations. HMSO 1999. Amended by The Water Supply
(Water Fittings) (Amendment) Regulations SI 1506: 1999.

SI 3004: 1992 The Workplace (Health, Safety and Welfare) Regulations. HMSO, 1992.

BRITISH AND INTERNATIONAL STANDARDS

BS 1780:1985(1992) Specification for bourdon tube pressure and vacuum gauges. Superseded by BS EN
837-1:1998, British Standards Institution, 1992.

BS 6281:Part 2:1982 Devices without moving parts for the prevention of contamination of water by
backflow. Specification for type B air gaps. British Standards Institution, 1982.

BS 6387:1994 Specification for performance requirements for cables required to maintain circuit integrity
under fire conditions. British Standards Institution, 1994.

BS 6759:Part 2:1984 Safety valves. Specification for safety valves for compressed air or inert gases.
British Standards Institution, 1984.

BS 6889:1987 Specification for generating racks for synchronous belt drive pulleys. British Standards
Institution, 1987.

BS 7226:1989 Methods of test for performance of inlet air cleaning equipment for internal combustion
engines and compressors. Withdrawn and replaced by BS ISO 5011: 2000, British Standards Institution, 1989.

BS 7671:1992 Requirements for electrical installations. IEE Wiring Regulations. Sixteenth edition. Withdrawn
and replaced by BS 7671:2001, British Standards Institution, 1992.

BS EN ISO 9000:2000 Quality management systems. Fundamentals and vocabulary. British Standards
Institution, 2000.

BS EN 837-1:1998 Pressure gauges. Bourdon tube pressure gauges. Dimensions, metrology, requirements
and testing. British Standards Institution, 1998.

BS EN 1089-3:1997 Transportable gas cylinders. Gas cylinder identification (excluding LPG). Colour
coding. British Standards Institution, 1997.

42
 REFERENCES

BS EN 60529:1992 Specifications for degrees of protection provided by enclosures (IP code). British
Standards Institution, 1992.

BS EN ISO 10637:2000 Dental equipment. High and medium volume suction systems. British Standards
Institution, 2000.

BS EN ISO 11143:2000 Dental equipment. Amalgam separators. British Standards Institution, 2000.

BS EN 21942-4:1994 Dental vocabulary – Part 4: Dental equipment. British Standards Institution, 1994.

BS EN ISO 7494:1998 Dental units. British Standards Institution, 1998.

BS EN ISO 9687:1996 Dental equipment – Graphical symbols. British Standards Institution, 1996.

BS ISO 5011:2000 Inlet air cleaning equipment for internal combustion engines and compressors.
Performance testing. British Standards Institution, 2000.

MISCELLANEOUS PUBLICATIONS

Advice Sheet A3: Health and safety law for dental practice. British Dental Association (BDA), 1993.

Advice Sheet A12: Infection control in dentistry. British Dental Association (BDA) (under revision for publication
late 2002), 1996.

Amalgam purchase, use, recovery and release. DETR, 1997.

Anaesthetic agents: controlling exposure under COSHH. Health & Safety Commission’s Health Services
Advisory Committee, 1995.

Dental Premises Guide. Water Regulations Advisory Scheme (forthcoming 2002).

Dental amalgam: an environmental code of practice. To be published by DEFRA in 2002.

Occupational exposure limits – EH40/96. Health and Safety Executive, Sudbury, HSE Books, 1996.

Occupational exposure standards for anaesthetic agents – EL(96)33. A ‘Dear Colleague’ letter issued from the
NHS Executive Headquarters to NHS Trust Chief Executives and FHSA General Managers on behalf of General
Dental Practitioners, March, 1996.

Standard Form of Building Contract. Joint Contracts Tribunal (JCT 98).

Testing of piped medical gases. NHS Pharmaceutical Quality Control Committee, 2nd edition, 1991.

Waste management: the duty of care – a code of practice. The Stationery Office.

The Water Regulations Guide. Water Regulations Advisory Scheme, 2001.

Water supply systems – prevention of contamination and waste of drinking water supplies. Water
Regulations Advisory Scheme Technical Support Group (due for release in 2002).

Water Fittings and Materials Directory. Water Regulations Advisory Scheme, 2002.

USEFUL ADDRESSES

The Water Regulations Advisory Scheme (WRAS), Fern Close, Pen-y-Fan Industrial Estate, Oakdale, Gwent, NP1
4EH. Tel: 01495 248454; Fax: 01495 249234.

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