Keeping dental instruments clean and sterile is an important part of sound infection control practices in a dental practice. Proper sterilization protects your patients and dentists, prevents sharps injuries, and saves time, effort, and money.
Sterilization is an effective way to kill bacteria, but it requires thorough cleaning and follow-up procedures. Failure to sterilize dental instruments can result in infections, recontamination, and lowered patient safety.
Cleanliness
Proper cleaning and sterilization of dental instruments is essential to keep patients, staff members, and equipment free from infection. This is important because it prevents germs and bacteria from being transferred from one person to another.
When cleaning a dental instrument, the person who is doing the job should wear personal protective equipment (PPE) such as gloves, masks, and eyewear to reduce the risk of contamination from body fluids or other environmental factors. When PPE is not worn, the person could easily spread germs to other employees or patients in the dental office.
The most common types of dental instruments are made from metal, plastic, or wood. They can be cleaned by manual scrubbing or mechanical methods such as ultrasonic and instrument washers.
Hand scrubbing is relatively effective in removing visible debris but is time-consuming and not as efficient as mechanical methods. It is recommended that only a limited number of instruments are scrubbed by hand to minimize the risk of injury.
If it is necessary to scrub a dental instrument by hand, the person should use heavy-duty (utility) gloves and masks. They should also ensure that their cleaning brush is clean before use and does not leave behind residue.
Once the dental instrument is removed from the water, it can be rinsed thoroughly to remove any soap or detergent residue. Then, the item should be placed in an ultrasonic bath to further clean it.
During this process, microscopic bubbles are created in the liquid solution that collapses when they contact the surface of the instrument. The energy produced during this process kicks any soil particles that are on the surface of the instrument.
These bubbles are also able to create a vacuum that can hold onto soil particles and remove them from the instrument’s surface. This can be useful in removing soil from the interior of some dental devices, such as scalers or hatchets.
The effectiveness of this process depends on the design and texture of the instruments, as well as the type of detergents used in the ultrasonic bath. Some detergents help to suspend the soil removed from an instrument during the ultrasonic cleaning process, preventing it from reattaching to the instrument’s surface later.
Sterilization
Dentists should sterilize all instruments that they plan to use on a patient. The standard procedure includes a thorough cleaning to remove most bacteria, then using heat to kill any remaining microorganisms. This could be steam autoclaving, dry heat, or ethylene oxide gas.
After sterilization, the sterile instrument is rinsed in sterile water to eliminate any remaining bacteria. This process is repeated several times.
Once all instruments have been sterilized, they should be stored to prevent them from coming into contact with nonsterile items, dust, moisture, or other contaminants. Storing them in a clean, dry space helps maintain sterility until they are needed again in patient care.
Instruments that are used on soft or bone tissue, such as scalpels and scalers, must be sterilized to prevent infection. Other instruments that do not penetrate soft or bone tissue, such as dental mouth mirrors and impression trays, do not need to be sterilized.
To ensure sterility, dentists should select packaging materials approved by the U.S. Food and Drug Administration (FDA) and compatible with the sterilization method they use. Some options include paper wrap, nylon “plastic” tubing, and thin cloth.
Before running a sterilization cycle, practices should label each pack or cassette, indicating which autoclave it was run in and the date. They should also attach an external chemical indicator to the outside of each package.
Indicators on the inside of sterilization packs are also useful for confirming sterilization status. Some packages feature built-in indicators, while others include special markings that change color when exposed to heat.
The final step in the sterilization process is to store the sterile packs and wrapped cassettes to keep them from coming into contact with any nonsterile items, dust, moisture, or contaminants. Storage should be done in a clean, dry, and enclosed space where they will not come into direct contact with any nonsterile items or dust.
After storing instruments for several days, they should be checked to make sure they are still sterile. If sterile packs or wrapped cassettes appear compromised, they should be reprocessed before being returned chairside for use in patient care.
Disinfection
Proper disinfection of dental instruments is crucial to ensure the safety of patients and staff. It also helps to protect the investment that dentists have made in high-quality instruments.
The Centers for Disease Control and Prevention (CDC) states that dental equipment should be thoroughly cleaned before being subjected to sterilization procedures. Debris that remains on the instrument may interfere with microbial inactivation and compromise the effectiveness of the sterilization process.
In addition, the presence of bacterial spores on a device can result in contamination of the sterilizing environment. Biological monitoring can be performed using chemical indicator strips that change color upon exposure to heat or steam.
If a sterilizer does not pass these test strips, the machine should be inspected to ensure it is working properly and not compromising the safety of the instruments. This will allow the practice to correct any problems that may have occurred during processing and avoid the possibility of cross-infection.
It is recommended that contaminated dental equipment be separated from clean instruments in a separate area for washing and decontamination. This area should be equipped with heavy gloves and an ultrasonic cleaner to increase cleaning efficiency and reduce the risk of cross-contamination from unsterilized instruments.
Disinfection can be accomplished with a range of products that are effective against bacteria and viruses that can cause diseases in the dental field. However, the type of disinfectant that is used is crucial. Some products are harsher and can irritate the skin, eyes, or respiratory tracts. They can also require the use of personal protective equipment (PPE).
Choosing a disinfectant is important for efficiency and safety. It should be chosen carefully, avoiding products that have long contact times or high levels of alcohol.
The right product will be suitable for your specific instruments and devices, as well as the critical levels of infection. For example, stainless steel items should be sterilized with an EtO-based system.
For more thorough disinfection, thermal washer disinfectors are an excellent choice for many instruments and devices. These systems are highly efficient and provide significant savings in time as well as safety. They eliminate the need to manually scrub and reduce the bacterial load on instruments, thus ensuring less staff exposure to pathogenic microorganisms and sharps injuries.
Storage
Whether dental instruments are disposable or reusable, they must be properly sterilized and stored in a sterile environment before use. These steps are vital for reducing the risk of infection and improving the safety of patients.
1. Cleanliness
Before disinfection or sterilization, instruments should be cleaned to remove the blood and other organic contamination from the surface of the instrument. If visible debris is not removed, it will interfere with microbial inactivation and compromise the sterilization process.
2. Sterilization
Depending on the type of instruments used, they may be sterilized by either steam or chemical vapor sterilization. Both methods sterilize the instrument surface and are safe and effective for use in dentistry.
3. Drying
Before packaging, instruments should be allowed to dry completely. If not, they can become wet or warm, impeding the sterilization process and increasing the risk of cross-contamination.
4. Packaging
After cleaning, instruments should be packaged into sets or trays for wrapping. Alternatively, some small individual items may be placed into peel pouches or perforated cassettes for wrapping.
5. Load Log
Providing documentation of every load processed in a sterilizer helps ensure quality control. This can include the date and time of sterilization, temperature, cycle number, type of item (e.g., dental instruments), and other factors.
6. Monitoring
Before, during, and after sterilization procedures, it is important to monitor the sterility of the instrument package. This can be done by visually inspecting the packaging to ensure it is intact, not leaking, or showing signs of damage.
7. Reprocessing Procedures
When reprocessing instruments, following the manufacturer’s instructions for all steps of a sterilization procedure is critical. This includes sterilization times, temperatures, types of containers and wraps used, and any chemical or biological indicators required to verify sterility before removal from the sterilizer.