Dental Sterilization Process – SOLUTIONS FOR DENTIST

We had done many important things till now like NABH guidelines, personal safety, environment safety, etc.

Today we will talk about how to do actual sterilization. There could be many ways of sterilization like hot air oven, boiler, autoclave, glass band.

They all have their own advantages and disadvantages.

Today we will only look to the best practices. To understand the things let’s divide dental instrument into three categories.

CRITICAL INSTRUMENT

Those instruments are sharp and come in contact with blood. Like BP blade, scalars, curettes, probes, suture, elevator, extraction forceps.

SEMI-CRITICAL INSTRUMENT

Those instruments may or may not come in blood contact. Like mouth mirror, amalgam carrier, filling instruments, orthodontic instrument.

NON-CRITICAL INSTRUMENT

Those instruments that does not come in contact with body fluid. Like X-Ray Tube, BP Cuffs.

Some of the instruments could be confusing too. For example –

AIR ROTOR – Yes, air-rotor sometimes comes in contact with blood and sometimes not. So we will consider Air Rotor in semi-critical instrument but Air Rotor Bur in critical.

SCALARS – Scalar hand piece is semi- critical but scalar tips are critical.

ACRYLIC BURS – If you adjust denture then in which category you will put the Acrylic Burs. We will consider bur as a critical instrument.

IMPRESSION TRAYS – We consider impression trays in semi-critical.

IMPRESSION – We will consider impression as semi-critical.

Now let’s see how we should sterilize them.

CRITICAL INSTRUMENT – We just do autoclave of the critical instruments, there are no alternatives for autoclave. The things which we can dispose like needle, suture, and BP blade should be discarded in a rigid container.

SEMI CRITICAL – We have to autoclave the instrument which we can steam sterilize and clean with high level disinfectant which we cannot steam sterilize. This disinfectant should be EPA proved and before discarding these disinfectants, it should be neutralize various times so that there would be no harm to the environment. That’s why read the instructions given by manufacturer carefully.

NON-CRITICAL INSTRUMENTS – We can do the surface disinfect to them.

Now, as we have classified the instruments now let’s see how we actually do sterilization.

Process begins after we finish doing patients.
Discard all the barriers before removing gloves.
Then by wearing gloves take the instrument tray in the instrument cleaning area.

After that wear heavy duty gloves so that sharp instruments do not touch your skin.
Then separate the sharp instruments like needle, BP blade etc and throw them.
Then pick each of the instruments and put it in the sink.
At last, put the small ikm like burs files into the consette or holders.
Now, if the instruments are looking dirty then clean them with brush.
Now, put all instruments in ultrasonic cleavers.
Ultrasonic cleavers should be used with enzymatic solution so that enzymes can break the remaining debris and ultrasonic vibration can separate them.
You have to use ultrasonic cleavers for approx 10 minutes.
Then take out all the instruments and spread it on the paper towel and wait until they dry.
After they dry completely seal them in sterilization pouches.
Different sizes of pouches and sterilization rolls come in the market. You can purchase according to your need.
After making the pouches of instruments, mention the date on it because most of the time it may happen that a particular instrument has not been used since long time.
Suppose you have used cryer in any extraction and then it is needed after two months so will you consider it as sterilize.
You can only consider this pouch as sterilize till one month.
You should check your instruments regularly so that you can re-sterilize it time to time.
There are some sterilization pouches in the market in which chemical indicator is present and if it is not there then a tape of chemical indicator comes which you have to use on these pouches. These tapes are not so costly.
These chemical indicators are heat sensitive. When the particular temperature reaches then its color changes.
And we can consider that instruments are sterilized.
Now you have to autoclave all the instrument pouches.
How much instruments you have to autoclave together depends on the capacity of the autoclave.
As you know that the biggest reason for failure of autoclave is over packing. To put in a hurry, we put all the instruments together but think that if we do over pack then how the steam will reach to the instruments.
Autoclaves are mostly of three types.

Cooker type/gravity type
N class autoclave
B class autoclave

These whole three do the same type of autoclave steam sterilize.

First one is cooker/gravity type autoclave.

In this, steam is formed at first and that steam takes out the already present air. Then it starts the sterilization.

So, needs more time.

There is no dry cycle in this so the pouches of instruments become wet and we have to dry them in air before storing them.
Never store the wet instruments otherwise they will be damaged by rusting.

Second autoclave is N class autoclave.

This autoclave is front load.
Its mechanism is also like the first one, steam is formed and steam takes out the present air.
But additionally there is some automatic value which takes out the steam.
And then dry cycle is done so that instruments come out dry.
It takes more time in comparison to B class.

Third is B Class autoclave.

It also looks like N class autoclave.
But additionally vacuum is present in this which flushes out the air beforehand only.
So, overall this autoclave takes minimum period of time.
B class autoclave is supposed to be the best autoclave in dental field.

But during taking the autoclave you can look at your pocket also.

Remember these things while doing autoclave.

You have to use bacterial spore regularly to check out that the autoclave is working properly or not. Chemical indicator which we have applied on the pouch is not a correct method.
I use these bacterial spores in every three months because they used to be costly.
After autoclave, spores are sent to the lab for testing.
If lab gives you the positive report then you have to repeat this test and if again the results come positive it means that your autoclave is damaged and it needs repairing.

You should keep the daily report of your autoclave. Like – how much instruments are autoclaved? The reports of the chemical indicators are positive or negative.
You should check and monitor the autoclave report so that necessary adjustment could be done.

And lastly let’s see two more things.

Cleaning air-rotor and disinfecting dental impressions.

First cleaning air rotor.
First of all wipe and clean your air rotor.
If you can purchase air rotor cleaning system then buy them and use them. These systems runs the air rotor through lubricant so that debris comes out from inside.

If you don’t have then apply proper nozzle on normal lubricant and spray it for 30 seconds so that all the debris comes out from the air rotor cartridge.

Then wipe it, pack it in the pouch and autoclave them.

Next let’s see how to disinfect the impression.

First of all, plastic tray is single used. Throw it if it is looking clean also once it is used.

But nowadays autoclave plastic trays also come. You can ask to manufacturer about it.

You have to disinfect the impression before removing your PPE.
Disinfecting alginate infection.

Because the dimension of alginate can change that is why it is not immerged in the disinfectant solution.

We use the disinfectant spray and leave it for 3-5 minutes.

You can deep the impression in 1% hypo chloride.

Disinfecting rubber base and elastomeric impression.

We can immerge these impressions for at least 10 minutes.

We can use some of these types of materials for immerging: – like – Biophore, diluted hypochlorite solution, chlorine dioxide, glutaraldehyde, complex phenol.

Follow the guidelines of manufacturer for proper disinfection.

Then comes Zoe impression, wax bite.

Disinfect these too with spray.

You can get the spray and solution of Zhermack and DWE.

But to follow these in clinic is very tough.

So here are some tips to implement given by me

At first you have to understand the importance of these and you and your family should have the responsibility towards it to make it necessary.
You have to be an accountable person for sterilization.
You have to record and monitor everything. This is the necessity of NABH too.
You should do the surprise test in between because employees tend to take shortcuts.

SOLUTIONS FOR DENTIST

We had done many important things till now like NABH guidelines, personal safety, environment safety, etc.

Today we will talk about how to do actual sterilization. There could be many ways of sterilization like hot air oven, boiler, autoclave, glass band.

They all have their own advantages and disadvantages.

Today we will only look to the best practices. To understand the things let’s divide dental instrument into three categories.

CRITICAL INSTRUMENT

Those instruments are sharp and come in contact with blood. Like BP blade, scalars, curettes, probes, suture, elevator, extraction forceps.

SEMI-CRITICAL INSTRUMENT

Those instruments may or may not come in blood contact. Like mouth mirror, amalgam carrier, filling instruments, orthodontic instrument.

NON-CRITICAL INSTRUMENT

Those instruments that does not come in contact with body fluid. Like X-Ray Tube, BP Cuffs.

Some of the instruments could be confusing too. For example –

AIR ROTOR – Yes, air-rotor sometimes comes in contact with blood and sometimes not. So we will consider Air Rotor in semi-critical instrument but Air Rotor Bur in critical.

SCALARS – Scalar hand piece is semi- critical but scalar tips are critical.

ACRYLIC BURS – If you adjust denture then in which category you will put the Acrylic Burs. We will consider bur as a critical instrument.

IMPRESSION TRAYS – We consider impression trays in semi-critical.

IMPRESSION – We will consider impression as semi-critical.

Now let’s see how we should sterilize them.

CRITICAL INSTRUMENT – We just do autoclave of the critical instruments, there are no alternatives for autoclave. The things which we can dispose like needle, suture, and BP blade should be discarded in a rigid container.

NON-CRITICAL INSTRUMENTS – We can do the surface disinfect to them.

Now, as we have classified the instruments now let’s see how we actually do sterilization.

Process begins after we finish doing patients.

Discard all the barriers before removing gloves.

Then by wearing gloves take the instrument tray in the instrument cleaning area.

After that wear heavy duty gloves so that sharp instruments do not touch your skin.

Then separate the sharp instruments like needle, BP blade etc and throw them.

Then pick each of the instruments and put it in the sink.

At last, put the small ikm like burs files into the consette or holders.

Now, if the instruments are looking dirty then clean them with brush.

Now, put all instruments in ultrasonic cleavers.

Ultrasonic cleavers should be used with enzymatic solution so that enzymes can break the remaining debris and ultrasonic vibration can separate them.

You have to use ultrasonic cleavers for approx 10 minutes.

Then take out all the instruments and spread it on the paper towel and wait until they dry.

After they dry completely seal them in sterilization pouches.

Different sizes of pouches and sterilization rolls come in the market. You can purchase according to your need.

After making the pouches of instruments, mention the date on it because most of the time it may happen that a particular instrument has not been used since long time.

Suppose you have used cryer in any extraction and then it is needed after two months so will you consider it as sterilize.

You can only consider this pouch as sterilize till one month.

You should check your instruments regularly so that you can re-sterilize it time to time.

There are some sterilization pouches in the market in which chemical indicator is present and if it is not there then a tape of chemical indicator comes which you have to use on these pouches. These tapes are not so costly.

These chemical indicators are heat sensitive. When the particular temperature reaches then its color changes.

And we can consider that instruments are sterilized.

Now you have to autoclave all the instrument pouches.

How much instruments you have to autoclave together depends on the capacity of the autoclave.

As you know that the biggest reason for failure of autoclave is over packing. To put in a hurry, we put all the instruments together but think that if we do over pack then how the steam will reach to the instruments.

Autoclaves are mostly of three types.

Cooker type/gravity type

N class autoclave

B class autoclave

These whole three do the same type of autoclave steam sterilize.

First one is cooker/gravity type autoclave.

In this, steam is formed at first and that steam takes out the already present air. Then it starts the sterilization.

So, needs more time.

There is no dry cycle in this so the pouches of instruments become wet and we have to dry them in air before storing them.

Never store the wet instruments otherwise they will be damaged by rusting.

Second autoclave is N class autoclave.

This autoclave is front load.

Its mechanism is also like the first one, steam is formed and steam takes out the present air.

But additionally there is some automatic value which takes out the steam.

And then dry cycle is done so that instruments come out dry.

It takes more time in comparison to B class.

Third is B Class autoclave.

It also looks like N class autoclave.

But additionally vacuum is present in this which flushes out the air beforehand only.

So, overall this autoclave takes minimum period of time.

B class autoclave is supposed to be the best autoclave in dental field.

But during taking the autoclave you can look at your pocket also.

Remember these things while doing autoclave.

You have to use bacterial spore regularly to check out that the autoclave is working properly or not. Chemical indicator which we have applied on the pouch is not a correct method.

I use these bacterial spores in every three months because they used to be costly.

After autoclave, spores are sent to the lab for testing.

If lab gives you the positive report then you have to repeat this test and if again the results come positive it means that your autoclave is damaged and it needs repairing.

You should keep the daily report of your autoclave. Like – how much instruments are autoclaved? The reports of the chemical indicators are positive or negative.

You should check and monitor the autoclave report so that necessary adjustment could be done.

And lastly let’s see two more things.

Cleaning air-rotor and disinfecting dental impressions.

First cleaning air rotor.

First of all wipe and clean your air rotor.

If you can purchase air rotor cleaning system then buy them and use them. These systems runs the air rotor through lubricant so that debris comes out from inside.

If you don’t have then apply proper nozzle on normal lubricant and spray it for 30 seconds so that all the debris comes out from the air rotor cartridge.