Today’s busy dental practices face a serious challenge to maintain or increase productivity while ensuring that patient safety remains a top priority. At times, these may seem like incompatible goals. Advances in dental processing equipment, however, have empowered practices to develop safer processes while realizing efficiencies and ultimately.
1. Follow an appropriate process for the segregation, cleaning and sterilization of re-usable items, and for the appropriate disposal of single-use items.
2. Understand the various cleaning and sterilization devices available in the United States, as well as the various methods by which they sterilize and clean instruments.
3. Select the correct materials used in preparing instruments prior to sterilization, package instruments appropriately for sterilization and ensure correct storage of sterile instruments.
4. Understand the various tests that are available to ensure the sterility of instruments, and what these tests can be used for and will show.
The decontamination of reusable dental instruments includes:
• thermal disinfection, if a washer-disinfector is available
• inspection for dryness, functionality and cleanliness
• wrapping before sterilization when using a vacuum sterilizer
• wrapping after sterilization when using a non-vacuum sterilizer
Sterilization is an essential step in the reprocessing of reusable dental instruments that have become contaminated, or are potentially contaminated, with saliva, blood or other biological fluids. This includes dental handpieces. The aim of sterilization is to break the chain of potential cross-infection between patients by killing micro-organisms, including spores. However, prion proteins are not fully deactivated by the sterilization process. Therefore, effective instrument cleaning is particularly important to physically remove contamination, including prion proteins, prior to sterilization.
Sterilization using a steam sterilizer is recommended as the most efficient, cost effective and safe method of sterilizing dental instruments in primary care dental practices. The sterilization process must be validated to ensure that instruments are reliably and consistently sterilized using predetermined and reproducible conditions. To kill microorganisms, the instruments need to be exposed to steam at a specified temperature for a specific holding time. Although other options exist, the preferred temperature-pressure-time relationship for all small steam sterilizers is 134–137°C, 2.1–2.25 bar guage pressure for at least a 3 minute holding time. It is preferable to use reusable instruments that can withstand both an automated cleaning/ disinfection process and steam sterilization or to use single-use instruments. Reusable instruments that cannot withstand steam sterilization must be decontaminated as recommended by the instrument manufacturer.