Best practice for the best tools
Product specialist Ian Creighton shares Pier Luigi Martini’s invaluable guidance on disinfecting and sterilising procedures for dental instruments in the new normal.*
Monitoring biological risk is extremely complicated. If we take into consideration the environment in which the dental team works, the oral cavity, and the complex medical devices used.
In their daily work, the dentist, hygienist or therapist in charge of the surgery, as well as the nurse, of course, need follow procedures and protocols created to safeguard the health of all patients and the dental team.
For both patients and clinicians, surgical instruments used for any treatment represent the possibility of disease transmission.
With that in mind, especially given the extra anxieties some are experiencing in these challenging times, it seems worthwhile to revisit disinfection and sterilisation protocols of instruments in the dental practice.
Preparation is key
Disinfection and sterilisation involve many phases. They begin with potential exposure to biological agents when instrument handlers collect materials following treatment.
Therefore, when doing this, the operator (often the dental nurse) must wear appropriate personal protective equipment; rubber gloves, special visors or protective eyewear, water-repellent gown, and cap.
The decontamination phase must be carried out in a suitable area. Possibly with good air ventilation. The decontaminant solution may produce vapours.
Before placing tools in an appropriate container, which is specific for that use, rigid with handles at the side, and have a removable grill to reduce the possibility of accidental injury and fluid leaks, certain precautions need taking.
For example, to avoid marks and corrosion, contaminated instruments must be separated according to the materials of which they are made.
In addition, instruments with removable components should be immersed in the decontamination bath as a whole. Disassemble only after the decontamination phase. While jointed or hinged instruments must be opened before soaking.
Pre-sterilising cleaning and disinfecting
These phases aim to remove organic and inorganic residue from medical devices. We can achieve this in several ways.
For instance, we can carry out decontamination cleaning manually. Instruments must be immersed in a disinfectant solution, or using a thermo-disinfector machine. This provides washing, disinfecting, rinsing and drying for medical devices through standard programmes. This latter method reduces the risk of injures and cross contamination.
Furthermore, it is important to note that washing in an ultrasonic bath is an additional procedure to manual washing or using an automatic thermo-disinfector; it is not a substitute.
Returning to manual methods. As already mentioned, we must disassemble any tools made of several parts. Every surface of the various components must come into contact with the disinfectant solution.
Once completed, clean all the instruments using a brush to eliminate any organic residuals that were not eliminated by the detergent’s action.
It is important to use gentle brushes to avoid scratching the instruments. An instrument with rough spots will get dirty more easily and oxidise. This compromises the outcome of subsequent sterilisation in the damaged areas.
Pay special attention to elements such as joints, ridges or grooves, as well as cavities. In the case of cavities or very narrow lumens, use a compressed air blow gun.
Drying the instruments
After cleaning and disinfecting, rinse the instruments thoroughly before drying to eliminate any residual detergent. Irrespective of whether washing was manual or ultrasonic.
Moisture could compromise the outcome of sterilisation. This would lead to the formation of marks on the surface of instruments.
Dry the instruments manually, preferably with a disposable cloth that does not shed fibres. Or with compressed air to eliminate any water in cavities, joints and narrow lumens, etc.
Before packing for sterilisation, check equipment to ensure it is clean, undamaged, and corrosion- and rust-free. Plus reassembled if disassembled, and lubricated where needed.
Saturated steam sterilisation is the most commonly used procedure for dental equipment. It is practical, cost-effective, efficacious, and traceable.
The protocol serves to kill all microorganisms that are still present after washing and disinfecting.
Dental practices use class B autoclaves. They ensure the sterilisation of shallow and porous items. They can therefore process, for example, all rotating and high-speed ultrasonic instruments.
To use an autoclave correctly, there are a few simple rules to follow; do not stack the pouches; do not cover the filter area of the basket valves; the pouches should not stick to the walls of the sterilisation chamber.
Sort the instruments into pouches. For each pouch, indicate the sterilisation and expiry date and the operator performing and verifying the process. All pouches must also have a chemical process indicator and sterilisation integrator.
Next, place the pouches in a position that enables them to stay parallel to the steam stream, with the porous side facing upwards.
You could possibly place the pouches one next to the other but not overlapping. Use perforated sterilising trays to contain the pouches.
Preferably, place heavy and hollow items in the lower tray. To achieve a complete and correct sterilisation cycle, it is important to avoid overloading the autoclave.
To sterilise surgical instruments, follow the manufacturer’s instructions carefully. Wait for the drying cycle to complete. Any water left in the pouch could, over time, lead to corrosion and oxidation of the instruments and generate bacterial formation.
Once the sterilisation cycle finishes, it is very important to consider the possibility of humidity residuals. Place on a dry and clean surface, protected from air shifts, covered with a clean and dry drape for at least 10 minutes.
At the end of the process, keep the pouches containing the sterile instruments in a dry, dust-free atmosphere, away from sources of light and heat.
Medical devices in pouches stored correctly normally remain sterile for at least 30 days.
The best tools for the job
Of course, not all dental tools are equal. You want to be sure the equipment you use will not only stand up well to infection control protocols but also feel comfortable in your hands.
Consider, for example, Italian-based Medesy. It has been supplying dental instruments of unrivalled quality, supporting clinicians in achieving outstanding results for their patients, for an incredible 600 years!
In fact, encompassing six centuries of Maniago blacksmiths’ expertise, this market leader’s prestigious, certified, stainless teel instruments are streets ahead of the competition.
Within the ranges available are an incredible 3,000 items for diagnostics, periodontal care, surgical treatment, orthodontics, restorative work and implantology.
Myriad accessories are also available, as are lab items. In addition, order bespoke kits, to meet specific needs.
With an established evidence base, proven efficacy, and a knowledgeable team at Quintess Denta fully prepared to discuss and meet your needs, using Medesy instruments combined with disinfecting and sterilising your instruments correctly will guarantee safety and efficiency for your team and your patients.
* Original wording kindly shared by Medesy. Please also refer to HTM 01-05 and guidance relevant to your practice’s location, to ensure your protocols meet any regional infection control requirements.