The ultimate essence of dentistry is that all patients should be guaranteed the best possible health care, with the best possible quality and safety to reasonable costs and as few side effects as possible. Quality assurance also includes the evaluation and use of innovative technology. The following products and instruments can ensure that this is achieved.
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1. Type-B sterilization cycles
Saturated steam under pressure is by far the quickest, safest, most efficient and most reliable medium for sterilization. Steam sterilizers providing B-type cycles, in accordance with EN 13060, are very advanced medical devices.
Through a series of powerful pre-vacuum pulses, virtually all air is evacuated from the chamber and therefore from the goods to be processed, which guarantees the exposure of all internal and external surfaces of the items to saturated steam and thus their full sterilization.
Post-vacuum drying removes all residual moisture from the load, which means that the water boiling temperature drops making drying faster and more efficient.
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2. Washer disinfectors
Medical devices must be thoroughly cleaned to reduce the bioburden before sterilization. Automated washer disinfectors (thermodisinfectors), fulfiling the requirements in EN 15883, offer the safest, most reliable option. The massive flow of water spraying all items in the washer disinfection process will result in a very effective physical (mechanical) cleaning.
In smaller bench-top washer disinfectors the water flow through the circulation pumps is at least 100 litres per minute. For a complete cycle, this is the equivalent of the water content in 15–25 bath tubs being flushed over the instruments.
In a normal sized hospital washer disinfector, the flow of water through the circulation pumps is at least 400 litres per minute, or 120 bath tubs in a 60 minute cycle. Try to achieve this in manual cleaning!
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3. Ultrasonic cleaners
Dental instruments can be very difficult to clean, especially burs and endodontic files. Ultrasonic cleaners, operating in the 35–55 kHz wavelength, can actually tear the biofilm away from the instruments. The low pressure bubbles formed by the high frequency sound waves cause the water to boil at low temperatures and in a microscopic area. The sudden growth and collapse of these vapour cavities cause extreme pressure forces. The lifespan of ultrasonic cleaners is relatively short, lasting anything between 3–5 years.
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4. Multipurpose cleaning devices
To clean, disinfect and lubricate hollow instruments, a special device is required. Apart from the primary aim to prevent crosscontamination, another major reason for cleaning is to maintain the instruments. Debris from enamel, dentine, amalgam, composite mixed with oil, saliva and blood can form a grinding smear that will destroy the instruments, causing vibrations that can lead to a risk of bur fractures (which can be inhaled or swallowed by the patient), poor quality treatment and loss of sensitivity in the dentist’s finger-tips.
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5. Waterline cleaning systems
There are recent studies showing that bonding strength is negatively affected by the amounts of bacteria in the dental unit waterline and toxins produced by bacteria in the biofilm are known to cause asthma and allergies — which is proven to be three times as common in dental personnel. The system must clean and disinfect effectively and not being toxic or causing damage to patients, personnel, environment and equipment, the active agent must therefore be lethal to microorganisms yet safe.
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6. Compressors
Air supplied to the surgery must be clean, dry and free of particles and oil. Using ‘contaminated water’ or ‘impure air’ to spray out over the dentine surface before using highly costly composite filling materials can not be considered as high quality dentistry.Modern compressors therefore have sophisticated systems and filters to remove all moisture and particles from the air.
7. Evacuation Systems
The system used should be appropriate for dentistry and able to effectively reduce aerosols created during preparations. In a good suction system the airspeed in the middle of the suction-tip will be approximately 180 kmph. Biofilm in the evacuation system will significantly reduce the airflow and can also retain large amounts of amalgam waste since organic particles are ideal carriers of mercury.
8. Smart tray systemsThe logistics of cleaning instruments is time consuming, and the manual handling of instruments during cleaning will cause damage and shorten their lifespan. The use of solid or non appropriate cassettes in washer disinfectors may impair proper washing and cleaning. It is therefore critical to adopt the correct methods to ensure proper maintenance and efficient cleaning. Instruments should be free yet secured on trays so that ultrasonic waves, water jets and steam can reach every part to clean and sterilize the instruments.
Smart tray systems with ‘everything needed for treatment’ on the tray facilitates the handling of instruments through the whole cycle. Evaluations of effective tray systems have shown reduced time for handling the instruments at disinfection and sterilization.
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9. Face visors
Dental personnel should protect their eyes, noses, mouths and skin of the face from splatter. Paper face masks only protect the nose and mouth for a limited period of time, 5–30 minutes depending on quality. Face visors are a better alternative than face masks and will also reduce waste handling.
10. Alcohol based hand disinfection solutions
There is clear evidence that hand disinfection with alcohol based disinfectant is significantly superior in reducing the bacterial flora to washing with soap and water. To avoid the dehydrating effects on the skin a rehydrating agent is added, usually 1–3% glycerol.
If only one single measure were to be recommended to significantly reduce cross infection — proper hand disinfection is by far the most important..
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