Effective Sterilisation in Dentistry

Disinfection is generally less lethal to pathogenic organisms than sterilization. The effectiveness of any disinfection procedure is influenced by several factors, including the type and number of micro-organisms present, the concentration and length of exposure to the disinfecting agent and the amount of organic matter or other debris present on the item being disinfected.

A normal infection becomes much more likely to occur if pathogens in another person’s blood or saliva come into contact with any soft tissue on any person’s body. Be it a dental appointment or even a simple cleaning, It involves the risk of blood or saliva from the mouth getting on instruments or furniture. Moreover, dental instruments come into contact with the soft tissue inside the mouth all the time. Because most people don’t know that they have an illness until they have already been contagious for several days.

The major factor determining whether an item must be sterilized, disinfected or simply cleaned is how it is used.

ITEMS TO BE STERILIZED OR DISINFECTED

• Instruments that penetrate oral soft tissue bone must be sterilized after each use or discarded.
• These items are termed critical items and have the greatest risk of transmitting infection, for e.g. surgical instruments, periodontal knives and scaling instruments.
• Instruments that are not intended to penetrate oral soft tissues or bone (such as amalgam condensers, dental handpieces, mouth mirrors) but come in contact with mucous membranes or non-intact skin are termed semi critical items.
• These items pose a lower risk of disease transmission; however, because the majority of semi critical items in dentistry are heat tolerant, they also should be sterilized after each use.
• Reusable semi critical items not able to withstand heat (e.g. plastic impression trays, amalgam carriers, plastic instruments) should be processed with high-level disinfection.
• Non-critical patient-care items that come in contact with unbroken skin (e.g. radiograph head/cone, blood pressure cuff, face bow, pulse oximeter) in many cases need cleaning, or if visibly soiled then cleaning followed by disinfection is adequate (low level disinfection).
• If a non-critical item is spattered with blood or touched with a contaminated glove or hand, it should be cleaned and disinfected.
• Non-critical items can also be protected with barriers. If contamination does occur, just remove the barrier and throw it away. Disinfection is not necessary.

6 CRITICAL STEPS FOR CLEANING AND PROTECTING YOUR DENTAL INSTRUMENTS

1. Protect Yourself- Personal protective equipment (PPE), including safety eyewear, face masks, and gloves protect you from microbial contamination as you clean and organize instruments.
2. Pre-Soak Your Instruments- you may not always be able to clean your instruments immediately after using them. This can be a problem, because biological debris (blood, for example) left on instruments may dry out and harden. When it comes time to clean the instruments, this hardened material can be difficult to remove. Infection control experts recommend spraying soiled instruments with a solution to keep organic build-up moist. Enzymatic spray gels are an effective option that can easily break down any build-up until you’re ready to properly clean the instruments.
3. Clean Before You Steam- If debris remains on instruments before they go into the autoclave, the superheated steam may not be able to contact the full surface of the instrument. For this reason, CDC guidelines require you to clean any visible material from instruments before you sterilize them.
4. Dry Your Instruments- Prior to sterilization in an autoclave, it’s critical to dry your instruments thoroughly. If you put your instruments into a sterilizer wet, they will emerge wet. As a result, the packaging will also get wet.
5. Package the Instruments- The last step before placing your instruments in the sterilizer is to package them with wraps or pouches. The package should be sealed to prevent exposure to the air when you remove your instruments from the sterilizer.
6. Load the Instruments carefully- It can be tempting to try to squeeze as many instruments into each autoclave cycle as you can, however, overloaded sterilizers are the main cause behind failed sterilizations. Overloaded sterilizers take longer to reach the optimum temperature, and when items are packed too closely together, they may not come in contact with a sufficient amount of the sterilizing agent.