The Procedure of Dental Sterilization
Most dental offices have a designated area for instrument reprocessing that is separate from the dental treatment room. This is ideal, since cleaning, sterilizing by dental autoclave and storing instruments in the same room where the delivery of patient care is provided increases the risk of cross-contamination. The removal and disposal of single-use sharps such as needles, blades, orthodontic wires and glass must be done at the point of use, typically in the dental treatment room.
Some instruments and materials are single-use only. Single-use items should be segregated in the operatory, and those that are sharp or otherwise pose a risk of injury must be discarded into a sharps container. Items without risk, such as a saliva ejector, can be thrown into the trash. Finally, the tray or cassette of reusable instruments is taken to the cleaning and sterilization area for processing.
Using mechanical means of instrument cleaning rather than hand scrubbing should minimize handling of instruments. If procedures are used whereby hand scrubbing is necessary, heavy-duty (utility) gloves, mask, eyewear and gown should always be worn while cleaning. Minimize the risk of puncture injury by scrubbing only one instrument at a time while holding it low in the sink.
Use of a system utilizing locked cassettes eliminates the need to sort, handle and hand scrub individual instruments – reducing the risk of infection from contaminated instruments – and results in savings of, on average, five minutes during instrument reprocessing, as well as fewer damaged instruments, since the instruments are locked in position during reprocessing. As with any standardized procedure, a standardized instrument reprocessing protocol also results in easy staff training and cross-training.
In general, three classifications of mechanical cleaning devices are available for the dental office. They are the ultrasonic scaler, instrument washer and instrument washer/disinfector.
An ultrasonic scaler uses sound waves, that are outside the human hearing range to form oscillating bubbles, a process called cavitation. These bubbles act on debris to remove it from the instruments. Some manufacturers also use intermittent or sweeping sound waves to help improve the device’s cleaning ability and to decrease the potential for hot spots in the ultrasonic bath. Specialized detergent formulations are available for the solutions in ultrasonic machines. When selecting a cleaning agent to use in the ultrasonic scaler, always consider the effect on materials and instruments. Household products are inappropriate because they cause pitting, corrosion, rust or other damage to instruments, and potentially to the ultrasonic chamber.