When it comes to dentistry, the patient’s safety and health are paramount. The sterilisation of surgical instruments is a critical aspect of dental care that cannot be ignored. A dental clinic must maintain hygiene and avoid contamination. Dental instruments used in daily dental practice get contaminated with blood, saliva, and other bodily fluids. They are not advisable to use in other patients until completely sterilised. So you can just imagine how much responsibility is given to the one who sterilises surgical instruments – the dental personnel. Let us explore why proper sterilisation is essential and discuss the characteristics dental personnel must possess to ensure maximum safety.
Dental Sterilisation: Its Importance
The primary reason why sterilisation of surgical instruments is essential is the potential transmission of infectious diseases through contaminated instruments. Dental procedures like root canal therapy involve using sharp instruments that can cause direct injury to the patient’s tissues, exponentially increasing the risk of infection. Moreover, contaminated instruments can lead to erroneous results of diagnostic tests, faulty measurements of dental structures, and affect the accuracy of the diagnosis, which ultimately impacts the treatment plan.
Preventing the spread of any disease
Remember: the main aim is to protect a healthy patient from infection and provide quality treatment in a germ-free environment. It should come as a comfort that the dental profession is accustomed to maintaining high infection control and sterilisation levels, even in normal times. Responsible dental teams follow the most stringent sanitation standards the Centers for Disease Control and Prevention (CDC) set out. This includes sanitation best practices for general dentistry and official guidelines to prevent the spread of any virus, like the recent coronavirus.
Protecting our patients and ourselves
Proper sterilisation practices in dentistry protect both patients and dental professionals. They prevent bacteria from growing on instruments and surfaces throughout the dental practice. They also ensure that germs cannot be transmitted from one person to another.
The concept of “clean” means something quite different to the dentist than it does to the general public. For a dental practice, being clean means reducing the number of microorganisms to avoid transmission from the environment or dental personnel. The next level up is sterile, which means removing ALL microorganisms. That’s why dentists and dental assistants take many precautions throughout a single visit.
Steps in Dental Sterilisation
The Australian Dental Association (ADA) has recommended some guidelines for dental professionals, which involve properly following the steps of sterilisation of instruments and handpieces that lead to an improvement in infection control, risk assessment & disease management.
A sequence of processes has to be maintained to have an effective way of sterilisation. The processes include proper cleaning of instruments, wrapping, sterilisation, and keeping in the UV chamber to maintain the sterility of the instruments for a longer period of time.
We wear personal protective equipment (PPE), including eyewear, face masks, and gloves, to prevent any exposure to germs from each patient. This also keeps patients safe by preventing the passing of germs from one patient to another. With COVID-19 as a new, constant concern, we take special care to replace our PPE between patients.
Sterilisation requires a careful, multi-step process that is more detailed and complex than we can fully explain here. Before the sterilisation of dental instruments occurs, the instruments are thoroughly cleaned. This means removing any visible debris from the device by scrubbing with a surfactant, detergent, and water or using an automated process with chemical agents. After cleaning, instruments are rinsed with water to remove chemical or detergent residue. Before final sterilisation, instruments are handled with the utmost care to avoid contamination.
The CDC recommends several ways to clean instruments:
- Ultrasonic cleaning
Sound waves pass through a solution to shake any debris loose from the instrument.
- Automated instrument washers
These washers save time by eliminating the need to manually rinse each instrument.
- Manual scrubbing
Instruments are soaked in a detergent or enzymatic cleaner if they cannot be cleaned immediately. Manual cleaning must be performed in a highly controlled environment.
Three types of sterilisers are commonly used in dental offices:
- Steam sterilization (autoclave)
- Dry heat sterilisation
- Unsaturated chemical vapour sterilisation
Steam sterilisation (autoclaves) puts each item into direct steam contact with a specified temperature, pressure, and time to kill microorganisms. Autoclaves reach approximately 250-273 degrees Fahrenheit. Sterilisation times may range from four to 30 minutes, depending on whether instruments are wrapped or unwrapped. The drying cycle may take between 25 and 40 minutes.
Dry heat sterilisers use either static or forced air. In the static air option, heating causes hot air to rise inside an oven-type chamber using natural convection. With forced air, heated air is circulated throughout the chamber at high speeds. The combination of high heat (300-375 degrees Fahrenheit) and extended time (12-150 minutes) achieve sterilisation.
Unsaturated chemical vapour sterilisers combine alcohol, formaldehyde, acetone, ketone, and water to create a vapour that sterilises instruments. This chemical vapour is applied at high pressure, hot temperature (270 degrees Fahrenheit), and an extended time (20-40 minutes).
The Characteristics of Dental Personnel Responsible for Sterilization
The process of sterile processing of surgical instruments cannot be taken lightly, and dental personnel responsible for this task must have certain characteristics to ensure it is done correctly.
Firstly, they must comprehensively understand the sterilisation process and its implications on patient care. They should be aware of the difference between sterilisation methods, the classification of dental and medical instruments based on their criticality, and the consequences of improperly sterilised instruments.
Abides by CDC protocols
Adherence to written protocols and guidelines is non-negotiable. Dental personnel responsible for sterilising surgical instruments must follow the manufacturer’s instructions for each instrument, including the type of solution and the level of temperature to be used to ensure maximum sterilisation efficacy.
A sterile processing technician must also be able to record the procedures followed in a log book to trace the sterilisation process and identify the reason for suspected instrument damage or contamination.
Skilful and adept in using the instruments
In addition to knowledge and adherence, dental personnel must have high technical expertise in instrument sterilisation. They must be familiar with various types of sterilisers, such as steam, chemical vapour, and dry heat sterilisation, and their correct operation. They should also know when to test and monitor the sterilisation equipment and employ validation methods to ensure it functions correctly.
The last characteristic we will discuss is the importance of communication and teamwork skills. Dental personnel and sterile processing technicians who sterilise surgical instruments must work collaboratively with other team members to ensure that the instruments are processed, stored, and managed following the appropriate protocols. Good teamwork and communication among dental personnel responsible for instrument sterilisation can enhance the efficiency of the entire sterilisation process, making it less time-consuming and ensuring maximum hygiene and safety.
In conclusion, proper sterilisation of surgical instruments is vital for ensuring patient safety and well-being in dental procedures. Dental personnel responsible for sterilising surgical instruments must possess knowledge, technical expertise, adherence to protocols and guidelines, and the ability to communicate and work as a team. By following these characteristics, dental personnel who sterilise surgical instruments can guarantee the safety of patients, prevent disease transmission, and adhere to standard sterilisation procedures to ensure the accuracy of diagnoses and treatment, thus fostering a healthy and safe practice.