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Dental Office Sterilization Guide

DENTAL OFFICE STERILIZATION

The Definitive Guide

This is a Simplified Guide to Dental Office Sterilization.

So if you want:

  • Ways To Improve Air Quality
  • An Infection Control Checklist
  • A Sterilization Training Guide For Dental Assistants
  • A Simple Recommendation For:

Designing A Dental Office Sterilization Room Plus … Size Requirements

Then you’ll love the information in this guide.

Let’s dive right in

A Simple Recommendation For:

Designing A Dental Office Sterilization Room Plus … Size Requirements

Then you’ll love the information in this guide.

Let’s dive right in

CONTENTS

Chapter 1

Dental Office Aerosols

Chapter 2

Infection Control Checklist

Chapter 3

Dental Assistant – Basic Training

CHAPTER 1

Dental Office Aerosols

In this chapter I am going to walk you through the basics of controlling aerosols.

Including:

  • Extraoral Vacuum Aspirators
  • Energy Recovery Ventilators (ERV’s)
  • High Volume Suction (HVE) Gauges to insure outstanding suction
  • Disinfectant Solution used for High Speed Handpiece Spray
  • Ultraviolet Lighting
  • Fogging Treatment Rooms
  • Ozone

Dental Office Aerosols

The current world health situation is drawing attention to aerosols. Aerosols have always been a problem. There are new ways to address the problem.

ExtraOral Vacuum Aspirators (EOVA)

Extraoral Suction Dental Suction System (Burkhart Dental

Supply)

Extraoral Vacuum Aspirators (EVAs) have been demonstrated to be effective in the dental setting. (American Association of Oral and Maxillofacial Surgeons)

Extraoral Vacuum Aspirators have HEPA filters and some have UVC lighting.

Extraoral Vacuum Aspirators do not collect liquids. They pass the aerosol spray through filters. They shine UVC lighting on the filters. Then clean air comes out of the Extraoral Vacuum Aspirator. In theory, liquids from aerosols could pass out of an Extraoral Vacuum Aspirator, but it would be clean.

It is important to check the electrical requirement for an Extraoral Vacuum Aspirator, Some require dedicated electric lines because of the electrical (Amp) requirement.

It is very important to follow the manufacturer recommended maintenance and cleaning instructions. The debris inside an extraoral vacuum aspirator can be highly toxic!.

Extraoral Vacuum Aspirators take up floor space. Therefore considerations need to be taken when planning treatment room setups.

Extraoral Vacuum Aspirators are additional tools for aerosol mitigation.

No study has demonstrated 100% effectiveness for the capture of aerosolized particles.

The following chart is from the American Association of Oral and Maxillofacial Surgeons

Energy Recovery Ventilators (Contaminated Air Out – Fresh Air In)

Today buildings are built to be very tight. They don’t breathe. In other words, there is a lack of fresh air inside many new buildings.

Energy Recovery Ventilators (ERV) are like big exhaust fans that continuously change the air in rooms.

Energy Recovery Ventilators help take aerosols out of the air.

Your Heating and Ventilating Professional may recommend a Heat Recovery Ventilator.

They do basically the same thing. The choice is based upon the climate.

(Air Venting Solutions)

The size of an energy recovery ventilator determines how many air changes per hour you will have.

This is an Energy Recovery Ventilator in the process of being installed. Ductwork is connected to the 2 black circles to bring fresh air into a building.

ERV’s are part of the Heating, Ventilating and Air Conditioning system of buildings.

They are used in surgical suites in hospitals.

They are not super expensive. Often they are part of Residential Heating and Air Conditioning Systems.

You need to check with your Heating and Air Conditioning professional to determine if your building can have an Energy Recovery Ventilator.

If you are not able to get an Energy Recovery Ventilator, open a window. It ‘s not great, but it’s better than nothing.

The Center for Disease Control has calculations for air changes per hour (ACH). Air Changes Per Hour is the number of times per hour all the air in a room is changed.

Air Filters

Air filters are used to mitigate aerosol. The problem with air filters is that they may not be killing pathogenic bacteria and viruses. They may only be collecting and trapping the bacteria and viruses. If that is the case, you need to be extremely careful when cleaning and changing filters.

HEPA Filters collect bacteria and viruses. They do not kill bacteria or viruses

Some filters have ultraviolet lighting that does kill bacteria and viruses. Filters need to be kept clean and properly maintained.

Before purchasing Air Filters, check room dimensions.

Measure the height, length, width of the room where Air Filtration will be used. You need to calculate the cubic volume of a room.

Check the capacity of an air filter before purchasing it

Dental Office Aerosol – High Volume Suction

Occasionally our suction would seem inadequate.

We’d clean out our lines with a cleaning solution.

We’d use a heavy duty cleaner that “Shocked the Lines”.

We still were not sure that our suction was operating at peak performance.

We’d call our service technician. He would do something and say, “I think it’s better”. “It sounds Okay”. But it never seemed to be good as new.

Subjectively addressing suction line problems is dangerous and “It sounds Okay” is not a risk we wanted to take with our patients .

We knew there had to be a better way.

USE A VACUUM GAUGE

Vacuum Gauge

Attach HVE hose to gauge

Attach hose to HVE tip.

Turn on (Open) suction. The vacuum gauge checks the strength of your suction.

Vacuum gauges can be purchased from plumbing supply stores or from plumbing departments in retail stores.

Check with the manufacturer of your suction system for the recommended suction (vacuum) strength numbers. Suction or vacuum is normally measured in “Inches Hg” (Inches of Mercury) (Fluid Power Journal #)

Line capacity should be checked daily using a vacuum gauge. It’s super simple and takes less than a minute. Check each room separately. If they pass the suction test – Great.

Now check multiple rooms at the same time.

If you normally work out of more than room … If you work with a dental hygienist …

Open all suction lines that would normally be open at the same time.

Take a vacuum gauge reading in all rooms. If your vacuum level drops, then you need to consider getting additional vacuum units to properly control aerosols.

The maintenance and positioning of all aspirators (Intraoral and Extraoral) are critical to their effectiveness.

Disinfectant Solution used for Water Lines

Traditionally distilled water has been used in treatment room water lines. This allows a biofilm to form.

When a high speed drill is being used to prepare a tooth, a distilled water plume is generated that is laden with bacteria and viruses.

When an air/water syringe is used, distilled water is mixed with bacteria and viruses.

Fill Water Bottles With A Disinfecting Solution

When water bottles are filled with a disinfecting solution like hydrogen peroxide, a disinfecting

plume is generated.

Other solutions such as chlorine dioxide can be used in water bottles. You need to choose the solution that you feel will be most appropriate.

The chemical formula for hydrogen peroxide is H2O2. Hydrogen peroxide has an extra oxygen molecule compared to water. It will not cause water lines to become clogged. When hydrogen peroxide degrades, it degrades into water.

Patients need to be instructed not to drink or swallow the liquids coming from the drill or air/water syringe. This is no different than having a patient rinse with mouthwash.

Bacteria and viruses are associated with dental sensitivity and failed root canals et cetera. Ideally before seating restorations or sealing root canals the patient’s tooth is disinfected.

Reducing the intraoral bacterial and viral load has the added benefit of improving treatment results.

Dental Office Sterilization – Disinfecting Treatment Rooms

Ultraviolet Lighting

For years people have used Ultraviolet Lighting(UV) to disinfect objects and areas. There are different wavelengths for Ultraviolet Lighting.

Ultraviolet Lighting covers a wavelength spectrum of 100 to 400 nm.

nm = Nanometer. Nanometer (nm), an SI unit of length, equal to 10 * 9m (a thousand-millionth of a meter)

Ultraviolet Lighting is divided into three categories based upon wavelength.

  • UVA = 320 – 400nm
  • UVB = 280 – 320nm
  • UVC= 200 – 280nm

Ultraviolet Lighting C (UVC) has the strongest germicidal effect and would be used in a healthcare setting. People should not be in a room when Ultraviolet Lighting is turned on. You should not look directly at Ultraviolet Lighting.

Ultraviolet bulbs are readily available online or at many retail stores.

Germicidal UV Sanitizer Light Bulb. 25W 254nm. Ozone Free $17.99 + 6.23 shipping. (Amazon)

Ultraviolet lights can be used in overhead lighting as well as being used in heating systems (Furnaces) and Air Filters.

Fog Treatment Rooms

Treatment rooms can be fogged after patients are seen.

This is especially important after treatment involving high speed drills, ultrasonic scalers or any kind of treatment that creates an aerosol.

Foggers help to disinfect difficult to reach surfaces.

With the proper fogger, entire areas and offices can be fogged and disinfected very quickly.

Foggers have valves that allow you to choose the particle size of the mist. Depending upon the particle size you choose, the floor, furniture and equipment may become damp.

Carefully choose the liquid to use in the fogger. There are many options available. Hydrogen Peroxide can very effectively be used in a fogger. (The Journal of Hospital Infection p 385-386)

You want to be dressed appropriately when using a fogger. You must be careful not to inhale any of the fogged mist or get it in your eyes.

https://www.amazon.com/s?k=fogger+machine+disinfectant+cordless&crid;=1VC33JWMBP6RG&sprefix;=fogger%2Caps%2C195&ref;=nb_sb_ss_ts-doa-p_11_6

Ozone

Ozone generators are advertised as ways of purifying the air. According to the California Air Resources Board, Ozone Generators should be avoided because of health risks and because of the lack of effectively killing or removing air contaminants. (California Air Resources Board.)

CHAPTER 2

Infection Control Checklist

In this chapter I am going to give you a Downloadable

“Sterilization Checklist”

You will be able to change and adapt the “Sterilization Checklist” to best fit your needs.

Let’s now look at the “Key Areas of Concern”.

1. Dental Infection Control Checklist – The Need

Dr. Atul Gawande MD. MPH. is a surgeon who was honest about problems that were occurring during surgeries.

Errors were occurring because team members lost their focus for a split second.

The Bottom Line: ERRORS WERE COSTING LIVES.

In a massive effort to prevent mistakes and save lives, Dr. Gawande developed a surgical checklist.

Dr. Gawande said that most first attempts at checklists do not work.

Ultimately his research resulted in super practical checklists and led to his book “The Checklist Manifesto.”

You can say you don’t need a checklist.

That’s like a pilot saying he does not need a checklist.

I can 100% guarantee that if pilots did not use checklists, many pilots would crash and burn.

You owe the highest level of safety to your patients and staff.

I made it easy to start using a checklist. I included a downloadable checklist that you can alter to best fit your needs.

Dental Office Sterilization

Key Areas of Concern

  1. Administrative
  2. Training
    1. Education & Training
    2. Hand Hygiene
    3. Personal Protective Equipment
    4. Sharps
    5. Injections
  3. Office / Facility
    1. Entrance
    2. Patient Reception Area
    3. Reception Desk/Business Area
    4. Rest Rooms – Patient and Staff
    5. Staff Lounge
    6. Clinical Areas
      1. Treatment Rooms
      2. Water lines
      3. Lab
    7. Sterilization Lab
    8. In – Office Lab
    9. Off Premises Lab
    10. HVAC
    11. Waste

Administrative

Insuring Proper Disinfection and Sterilization

Audit Your Disinfection and Sterilization Procedures

During the day the clinical staff will make thousands and thousands of movements. Auditing and supervising the clinical staff has nothing to do with whether or not they are good. It has to do with …

There is no room for error!

When people hurry they tend to get sloppy. They tend to make mistakes. By the end of the day people are tired and more prone to mistakes.

When performing your office audit you are looking for cross contamination. You are looking at the entire process. You are looking to see if people are taking extra steps. You are looking to see if people are wasting motions. You are looking to see if things are neat and organized.

Downloadable Checklist

You can change the checklist to best fit your needs.

Dental Office Sterilization Checklist

Put annual and quarterly checklist items on your calendar.

❏ Annual – Review and update “Standard Operating Procedures” (SOP) Manual for Infection Control. Review of written infection prevention policies, procedures and protocols.

❏ Annual – Staff “Infection Prevention Training & Testing”.

❏ Annual – Current immunizations and vaccinations up to date for all staff members.

Follow CDC Guidelines.

❏ Annual – Assign at least one person responsibility for coordination of the program.

❏ Annual – Exposure Control Plan – Review of Office System for detection and management of potentially infected Person. Referral and Follow Up protocol in place

❏ Annual – job/task specific training completed.

❏ Annual – Training records and files up to date for state or federal requirements

❏ Annual – Policies and procedures in place for using sterile water as coolant/irrigant when doing surgical procedures

Annual – Policies and procedures for handling Implants, Grafting and Surgeries.

❏ Quarterly – Heating Ventilating Air Conditioning (HVAC) Inspection and Servicing. Filters and Ultra Violet Bulbs changed as needed

❏ Weekly – All Logs properly completed

❏ As Needed – New or temporary employee training

❏ As Needed – Office Cleaning Personnel properly trained in safe cleaning and disinfecting procedures.

Daily Checklist

❏ COVID: Temperature taken for all patients and employees

❏ COVID: Symptom Screening

Personal Protective Equipment (PPE)

❏ Proper fit and wearing of Personal Protective Equipment (PPE) by all staff members

❏ Proper inventory of PPE

Entrance/Exit Doors

❏ Entrance/Exit Doors properly disinfected.

❏ Hand Scrub Dispensers working and filled by Entrance/Exit Doors

❏ Hand wipes available at Entrance/Exit Doors

❏ Trash receptacle at Entrance/Exit Doors

Patient Reception Area

❏ Chairs/Furniture properly disinfected

❏ Hand Scrub Dispensers filled and working

❏ Hand Wipes available

❏ Trash Receptacles available

❏ Keyboards and iPads/Tablets properly disinfected

❏ Remote controls properly disinfected

❏ No food or drinks in the area

❏ No trash or debris in the reception area. Floors Clean

Reception Desk/Business Area

❏ Keyboards, phones, copy machines and office equipment properly disinfected

❏ Chairs/Furniture properly disinfected

❏ Hand Scrub Dispensers filled and working

❏ Hand Wipes available

❏ Trash Receptacles available

❏ No food or drinks in the area

❏ Floors clean

❏ If the office has water dispensing machines, it needs to be cleaned and maintained.

Follow manufacturer’s instructions.

Clinical Areas

❏ Observe Hand Hygiene Procedures

❏ Observe Set Up Procedures for patient treatment

❏ Floors, walls, work surfaces and sinks clean and properly disinfected before and after treatment

❏ Trash receptacles clean, disinfected and not overflowing

❏ Water lines properly cleaned and disinfected

❏ Treatment Room water filters cleaned and maintained. Ultrasonic Scalers have filters that need to be maintained.

❏ Vacuum lines cleaned, disinfected and working properly

❏ Vacuum strength checked using vacuum gauge

❏ Dental Chairs – patients and clinicians – Disinfected and properly covered including controls for operating chairs.

❏ Properly covered/wrapped equipment

❏ Bonding lights

❏ Intraoral Cameras

❏ Suctions – HVE, Saliva Ejectors

❏ Water Syringes

❏ Extraoral Lighting Handles

❏ Electrosurges/Lasers

❏ Sharps Containers not overflowing

❏ All syringes properly recapped after injections

❏ All needles properly disposed

❏ All scalpels properly handled. Blades properly removed and disposed of in Sharps Containers

❏ Logs completed for all Implants and Grafts (Needed in case of product recalls)

❏ CAD/CAM (CEREC etc.) Scanning Units properly cleaned and disinfected between all patients

❏ X-rays – properly cleaned, disinfected and sheathed

❏ Intraoral X-ray heads

❏ Panoramic/3D Cone Beams

❏ Handheld X-rays

❏ Sensors

❏ Lead Aprons

❏ Extraoral Suction Machines working properly and being maintained properly

❏ Waste from Extraoral Suction Machines properly handled and disposed of

❏ Treatment Rooms Air Filters being maintained and working properly

Sterilization Lab

❏ Staff people working in the sterilization lab wearing gloves, gowns, eye protection and masks.

❏ No Food or drink in lab

❏ All equipment checked for proper functioning and proper maintenance (Autoclave, Ultrasonic Cleaners, Handpiece Lubricators)

❏ Lid always in place when ultrasonic cleaner is turned on

❏ Sterilization process observed for possible errors and cross contaminations

In – Office Lab

❏ All impressions properly cleaned, disinfected and handled with gloves

❏ Lab Work (Crowns, Dentures etc) properly cleaned, disinfected and stored to insure cleanliness.

❏ People working in lab wearing proper PPE: gloves, gowns, masks and eye protection

❏ No food or drink in lab

❏ Floors, walls, work surfaces sinks clean and properly disinfected

❏ Lab Burs and Lab Handpieces properly cleaned, disinfected and sterilized

❏ Lab knives and instruments properly cleaned, disinfected and sterilized

❏ Lathes and polishing hoods properly cleaned and disinfected

❏ Lathe burs properly cleaned, disinfected and sterilized

❏ Vacuum, air and water lines properly disinfected

❏ Air Filters properly cleaned and maintained

❏ CAD/CAM (CEREC) milling equipment properly cleaned, disinfected and maintained

❏ Trash receptacles clean, disinfected and not overflowing

❏ Buff Wheels being properly cleaned and disinfected if being used for more than 1 patient. Ideally singe use Buff Wheels being used.

❏ Pumice, plasters, polishing compounds properly handled to avoid cross contamination

Off Premises Lab

❏ Impressions and Lab Work properly disinfected and packaged

Rest Rooms

❏ Touch Free Soap Dispensers adequately filled

❏ Touch Free Hand Wipes

❏ Touch Free Faucets working properly

❏ Hand Sanitizing Dispensers properly maintained and filled

❏ Trash Receptacles cleaned, disinfected and not overflowing

❏ Mirrors, Faucet and Sinks spotlessly clean

❏ Toilet paper

Staff Lounge

❏ Touch Free Soap Dispensers adequately filled

❏ Touch Free Hand Wipes

❏ Touch Free Faucets working properly

❏ Hand Sanitizing Dispensers properly maintained and filled

❏ Trash Receptacles cleaned, disinfected and not overflowing

❏ Mirrors, Faucet and Sinks spotlessly clean

Waste

❏ Sharps and Bio-Hazardous properly disposed of (Regulated Waste) with proper logging.

❏ Trash, Sharps and Bio-Hazardous materials handled with gloves, masks, gowns, eye protection and properly disposed

Below is a link to the Center For Disease Control. They have a great checklist. The real question will be … whether you will be able to implement it.

https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care-checklist.pdf (Center For Disease Control)

CHAPTER 3

Dental Assistant – Basic Training

Training is the most important thing that you can do.

What good are checklists if you can’t get them implemented? In this chapter I’ll discuss:

  • Definitions
  • Infection Control And Sterilization
  • Dental Sterilization Equipment
  • Sterilization Room Design And Recommended Room Size
  • A Sterilization Protocol
  • How To Sterilize Dental Instruments
  • Proper Autoclave Use
  • Spore Testing

How To Sanitize And Disinfect A Dental Clinic

Dental Office Sterilization

Dental Assistant – Basic Training

DEFINITIONS

Autoclave (au-to-clave) – An autoclave is a machine used to carry out industrial and scientific processes requiring elevated temperature and pressure in relation to ambient pressure / temperature.

Dental autoclaves sterilize instruments by subjecting the instruments to pressurized saturated steam at 121 degrees Centigrade (250 degrees Fahrenheit) for around 15 to 20 minutes depending upon the size of the load and the contents. (Wikipedia)

When needed, there are high speed autoclaves that will sterilize instruments within minutes.

Bioburden – Bioburden is normally defined as the amount or number of pathogenic agents living on a surface or within an organism. (Mosby”s Dental Dictionary (2nd Ed) 2008 and Elsevier #)

Cross Contamination – The process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another with harmful effects.

Disinfection (dis-in-fec-tion) – The process of cleaning something, especially with a chemical. This infection is not the same as sterilization. Disinfection will kill bacteria but generally not the same degree is sterilization.

Immune System – A complex network of cells, tissues, organs and the substances they make that helps the body fight infection and other diseases. The immune system includes white blood cells and organs and tissues of the lymph system, such as the thymus, spleen, tonsils, lymph nodes, lymph vessels and bone marrow. (National Cancer Institute – cancer.gov)

Infection (in-fec-tion) – The state produced by the establishment of one or more pathogenic agents such as a bacterial virus or protozoan in or on the body of a suitable host.

Personal Protective Equipment (PPE) – is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. (OSHA) It is critical that masks be properly sized and fitted. Non vented N95 masks should be worn in all clinical areas.

Sanitize (San-i-tize) – Make clean and hygienic

Clean, sanitize, and disinfect are often used in overlapping contexts.

Cleaning is done with water, a cleaning product, and scrubbing. Cleaning does not kill bacteria, viruses, or fungi, which are generally referred to as “germs.” Cleaning products are used to remove germs, dirt, and other organic material by washing them down the drain.

Sanitizing and disinfecting products are chemicals that work by killing germs. These chemicals are also called antimicrobial pesticides…Disinfectants kill more germs than sanitizers. In most cases, a cleaning product is used first. Then the surface is either sanitized or disinfected when it is necessary. (Merriam Webster)

Six Sigma – a set of management techniques intended to improve business processes by greatly reducing the probability that an error or defect will occur.

With Six Sigma, reducing waste and streamlining processes is central to the core of its principles.

Wasted motion is considered one of the seven wastes when evaluating work processes.(Kettering Global)

Spores – a minute, typically one-celled, reproductive unit (microorganism) capable of giving rise to a new individual without sexual fusion, characteristic of lower plants, fungi, and protozoans. Spores are often very resistant to heat and very difficult to kill.

Sterilization (ster-i-li-za-tion) – The process of making something free from bacteria or other living microorganisms.

Infection Control and Sterilization

Who is at risk for exposure to infectious materials? EVERYONE!!!

What are the methods of disease transmission?

  • Airborne
  • Contact with body fluids
  • Instruments and surfaces.

Treat blood and all body fluids as if they are infectious. Treat all patients as if they are high-risk!

Click Here To Watch “If Saliva Were Red”. 

How do you protect yourself?

  • Meticulously follow sterilization standards.
  • Heat sterilization
  • Chemical sterilization
  • Surface disinfection
  • Single-use items when possible.
  • Have patients rinse with a mouthwash before treatment.

Have Patients Rinse For At Least 1 Minute

Watch the clock and time when patients rinse. Rinsing for 1 entire minute will seem like a very long time for most people.

BEWARE …

“Cross Contamination” Is Always The Problem!!!

  1. Dental Sterilization Equipment

Ultrasonic Instrument Cleaner

A special Ultrasonic Cleaning Solution (the blue liquid) is used to maximize the cleaning efficiency.

The controls for the ultrasonic cleaner have different power settings based upon how dirty the instruments are. The liquid in the ultrasonic cleaner is heated.

Dental Handpiece Cleaner & Lubricator

The picture below shows a handpiece cleaner and lubricator. A handpiece cleaner and lubricator is used to clean and lubricate high-speed and low-speed drills before they go into an autoclave.

Instruments

Before instruments are used, they must be cleaned and scrubbed.

Proper Autoclave Use

After instruments have been cleaned and scrubbed, they are placed in an ultrasonic cleaner.

Next, they are placed on instrument trays or in autoclave bags.

The properly prepared trays or bags will then be sterilized in an autoclave.

Autoclave bags have dots on them.

The dots on the bags are temperature sensitive. The dots change colors when exposed to the heat from an autoclave.

Unused autoclave bag. Note the pink dot. A pink dot means the bag has not gone through an autoclave.

An autoclave bag with instruments that has a black dot. The black dot indicates the bag has gone through an autoclave.

Offices typically dispense instruments in autoclave bags or use tray set-ups. Metal trays can be placed in autoclaves while plastic trays will melt.

A stainless steel instrument tray sitting on blue autoclave wrap

Instrument trays are sealed with special autoclave tape.

Un- sterilized instrument tray

Sterilized Instrument tray. Tape gets black lines after being exposed to the the heat of the autoclave.

Autoclave for sterilizing instruments

  1. Dental Office Sterilization Room – Design

There are four main areas when designing a dental office sterilization room.

Each area is used to perform a specific function in the sterilization process.

Think of sterilizing instruments like a production line. You want instruments flowing smoothly, efficiently, and effectively down the line from one end to the other.

The goal is to be precise and quick without hurrying.

  1. Dental Office Sterilization Room – Recommended Size

Frequently the sterilization areas are forgotten about places. Not enough space is allocated to the site. They become bottlenecks to traffic. You can have two or three clinical staff members in the sterilization area, and it becomes difficult to move around and get the needed supplies.

Typically you want to allow at least 100 square feet for every four treatment rooms.

If you have eight treatment rooms, you would want to have at least 200 square feet for the sterilization area. The sterilization area is separate from the lab area. Usually, the more space you have for the sterilization area, the better.

  1. Dental Office Sterilization Protocol

Dental office sterilization protocol involves the following:

  1. Instrument Sorting and Cleaning
    1. Loose Instruments
    2. Burs and Bur Blocks
      When possible, it is best to use “single-use” burs. This helps to avoid the possibility of cross-contamination.
  2. Disinfection
  3. Bagging and wrapping instruments and tools
  4. Sterilization
  5. Storage of Sterile Instruments

Single Use Sterile Burs

When possible, it’s best to use root canal files on only one patient. This helps to avoid the possibility of cross-contamination.

Avoid touching sterile files to anything other than sterile gauze or the inside of the patient’s tooth.

Our root canal success rate skyrocketed years ago when we ensured that anything touching the inside of a patient’s tooth was sterile.

I have seen Doctors put lubricating agents on the back of a non-sterile glove and then touch a sterile file to the back of that glove. I have seen Doctors bend root canal files with their non-sterile gloved hands.

DO NOT DO THAT!!!

You are cross-contaminating the patient and possibly creating holes in your glove.

FYI: Sterile gloves come in packets individually wrapped. They are not typically used in a dental office.

The box of gloves you typically see is clean but not sterile.

Buff Wheel For Polishing Acrylic

Buffing wheels are inexpensive.

They become dirty and packed with debris and bacteria.

The debris and bacteria become deeply lodged within the wheels. Generally, the steam from most autoclaves is not capable of adequately penetrating and sterilizing a buff wheel.

It is best always to use new buff wheels for each patient.

Removing a bur from a handpiece

Use a 2 x 2 gauze when removing a dental bur!!!

Dental burs are sharp. If you touch a dental bur while wearing a glove, you are most likely creating microscopic holes in your gloves. And if that is the case, then why even bother to wear gloves.

It is very easy to test what is happening. Put on a pair of clean gloves. Place a new, unused bur on a handpiece. Then remove the bur. Do this several times.

Carefully remove your gloves. Do not turn your gloves inside out when you remove them. Take the glove that you used to remove the bur. Fill it up with water. You will see tiny drops of water on the outside of your glove. You have holes in your glove. End of story!

  1. How To Sterilize Dental Instruments

It is good to have photos in the sterilization area showing how you like your instruments grouped and prepared.

Proper Dress 

You must be appropriately dressed when sterilizing instruments.

It is necessary to wear a face shield, hair cover, mask, puncture-proof gloves, and a puncture-proof apron, gown, or lab coat.

The Dirty Zone

The dirty zone is where instruments are placed after seeing a patient.

The instruments in this area will have blood, tissue, and organic matter on them.

If you’re using instrument tray setups, there may be extracted teeth on the trays.

Extracted teeth must be disposed of properly.

Extracted teeth cannot be thrown out in normal trash. They must be disposed of in a biohazard container.

The Disinfecting Zone

You will start to clean your instruments in the disinfecting Zone.

Instruments will be scrubbed with soap and water and rinsed in this area. It’s good to use a steel brush as part of the cleaning process.

After the instruments have been cleaned and disinfected, they are placed in a hot ultrasonic bath. The ultrasonic bath generates an aerosol when turned on. Therefore, it is always necessary to have the lid on the ultrasonic bath before turning it on.

Once the instruments come out of the ultrasonic bath, they are rinsed and transferred to the clean zone.

The Clean Zone

This Clean Zone is where instruments are placed after having undergone a disinfection process.

The initial disinfection process killed most microorganisms.

Instruments are then bagged and wrapped before you place them in an autoclave.

When instruments are bagged, the bag has a chemical indicator that changes colors after the bag has been appropriately autoclaved or sterilized.

When instrument trays or cassettes are used, they are wrapped with a unique autoclave wrap.

Autoclave tape is used to seal the wrapped tray.

Autoclave tape changes colors after it has been properly autoclaved and sterilized.

  1. Proper Autoclave Use

It is important not to overload your autoclave so that it can properly sterilize instruments.

If too many instruments are placed in your autoclave, the steam and pressure may not be adequate to completely sterilize instruments.

If you have unclean instruments with debris on them, it is referred to as a “Bioburden”. Steam may not be able to penetrate the bioburden or debris. As a result, instruments may not be sterile.

In theory you could have sterile debris/dirt however that may not always be the case. If the steam and heat are not powerful enough to penetrate the debris on the instruments, you will have contaminated instruments.

Follow the manufacturer’s instructions for the capacity, proper operation, cleaning and maintenance of your autoclave.

It is a good idea to keep an autoclave maintenance log.

  1. Spore Testing Log

Make PDF for people to print out.

“Spore Testing” should be done regularly. How often and how many patients you see will determine the ideal schedule for spore testing.

You can do the spore testing yourself or you can use an outside independent lab. The purpose of the “Spore Test” is to make sure that your autoclave is reaching the proper temperature and pressure to kill all pathogenic organisms.

Using an outside lab helps to limit your personal liability.

If a spore test ever comes back positive, IMMEDIATELY STOP USING YOUR AUTOCLAVE!

  1. How To Sanitize And Disinfect A Dental Clinic

“Disinfection is a process that eliminates most or all pathogenic organisms, except bacterial spores. Disinfection is usually accomplished with liquid chemicals.

  • High-level disinfection is capable of killing bacterial spores, when used in sufficient concentration for the required contact time.
  • Intermediate-level disinfection destroys all vegetative bacteria (including tubercle bacilli), lipid viruses, some non-lipid viruses, and fungi; but not bacterial spores.
  • Low-level disinfection kills all vegetative bacteria (except tubercle bacilli), lipid viruses, some non-lipid viruses, and some fungi; but not bacterial spores.” (Texas Dental Association)

Clinical staff must wipe down all touched surfaces. Always wear gloves, masks, eye protection, gowns, and hair coverings when sanitizing a clinical area.

Disinfectants can be used alone or in combinations.

  • alcohols
  • chlorine compounds
  • formaldehyde
  • glutaraldehyde
  • Ortho-phthalaldeyde
  • hydrogen peroxide
  • Iodophors
  • peracetic acid
  • Phenolics
  • quaternary ammonium compounds.

Read the labels carefully to make sure that you are using the correct product for the correct situation.

Wipes

These wipes are for hands and not for wiping down clinical areas. (Purell – Chemtrec, Gojo Industries)

These wipes are for clinical disinfection.)
These wipes are NOT FOR USE ON HANDS!!! (PDI)

I have seen assistants not wearing gloves when using clinical strength wipes or spraying clinical strength disinfectants. You must read the labels. You must wear gloves, masks, eye protection and gowns when using professional strength wipes and sprays.

Below is an example of a warning statement on professional strength wipes.

Precautionary Statements: Keep away from heat, hot surfaces, sparks, open flames and other ignition sources. No smoking. Keep container tightly closed. Avoid breathing vapors. Wash thoroughly after handling. Use only outdoors or in a well-ventilated area. Wear eye protection per facility protocol. IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. If eye irritation persists: Get medical attention. IF ON SKIN (or hair): Take off immediately all contaminated clothing. Rinse skin with water or shower. IF INHALED: Remove person to fresh air and keep comfortable for breathing. Call a POISON CENTER or doctor if you feel unwell. In case of fire: Use water fog,

alcohol-resistant foam, carbon dioxide and dry chemicals to extinguish. Store in a well-ventilated place. Keep cool. Dispose of contents and container in accordance with local and national regulations. (PDI)

Sprays

Sprays are more penetrating and offer a higher level of disinfection compared to wipes.

Use Barrier Wraps after sanitizing and disinfecting.

Dispose Of Contaminated Waste Properly

Bibliography

  1. Air Venting Solutions.http://www.airventingsolutions.com/.
  2. Amazon.com
  3. American Association of Oral and Maxillofacial Surgeons. Intraoral vs. Extraoral Suction Devices, 2020,https://www.aaoms.org/docs/COVID-19/Intraoral_vs_Extraoral_Suction_Devices.pdf.Accessed 02 06 2020.
  4. Burkhart Dental Supply. “ADS Extraoral Dental Suction System 04000100.”https://www.burkhartdental.com/equipment-technology/operatory-room/suction-air-filtration/ads-extraoral-dental-suction-system/.
  5. California Air Resources Board. Hazardous Ozone – Generating Air Purifiers,https://ww2.arb.ca.gov/our-work/programs/air-cleaners-ozone-products/hazardous-ozone-generating-air-purifiers.
  6. Center For Disease Control. “Infection Control: Appendix B. Air.” Center for Disease Control and Prevention, https://www.cdc.gov/infection-control/hcp/environmental-control/appendix-b-air.html
  7. Center For Disease Control. “Infection Prevention Checklist for Dental Settings – Basic Expectations for Safe Care.” https://www.cdc.gov/dental-infection-control/hcp/summary/index.html
  8. Fluid Power Journal. “Vacuum Measurement: Basic Guide.” Fluid Power Journal, 12/19/2016,https://fluidpowerjournal.com/vacuum-measurement-a-basic-guide/#:~:text=When%20a%20vacuum%20is%20applied,or%2027%20inches%20of%20mercury.
  9. The Journal of Hospital Infection. Hydrogen Peroxide Fogging/Fumigation. vol. 62 Issue 3 – pages 385 -386, Healthcare Infection Society, 2006,https://www.journalofhospitalinfection.com/article/S0195-6701(05)00382-8/abstract.Accessed 01 March 2006.
  10. Kettering Global. “Lean Six Sigma: The Expensive Cost of Waste.”https://online.kettering.edu/news/2016/05/24/lean-six-sigma-expensive-cost-waste.
  11. Merriam Webster.https://www.merriam-webster.com/words-at-play/clean-vs-sanitize-vs-disinfect-usage.
  12. Mosby”s Dental Dictionary (2nd Ed) 2008, and Elsevier.
  13. National Cancer Institute – cancer.gov. “Publications – NCI Dictionaries.”https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immune-system.
  14. OSHA. “Personal Protective Equipment.”https://www.osha.gov/personal-protective-equipment.
  15. PDI. “Sani-Cloth Prime Germicidal Disposable Wipe (Canister) 02/12/2020.”
  16. Purell – Chemtrec, Gojo Industries.
  17. Texas Dental Association. “Environmental Surface Disinfection: CDC Guidelines for Dental Offices – Simplified.”https://tdaperks.com/environmental-surface-disinfection-cdcs-guidelines-for-dental-offices-simplified/.
  18. Wikipedia. “Autoclave.”https://en.wikipedia.org/wiki/Autoclave.
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