Getting decontamination right – Kate Scheer

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  Posted by: Dental Design      10th January 2018


More than 2.5 million cases of healthcare-associated infections occur each year in the EU/EEA resulting in high numbers of morbidity and mortality.[1] The risk of infection associated with contamination in dentistry is still unknown. However, cross-transmission of viruses and bacteria is believed to be significant and often under-reported among dental practices.[2] Prevention and control of infection through effective decontamination is essential for the safety of both personnel and patients.

The dental setting provides a unique environment that exposes staff and patients to a number of major risks of cross-contamination. The oral cavity alone offers a natural habitat for a large number of microorganisms, such as fungi, bacteria and viruses, as well as saliva and blood that are known vectors of infection. The ecological niche provides a reservoir for opportunistic and pathogenic microorganisms that have the potential to cause infection. This is particularly important in cases of routine dental practice, where procedures are open and invasive.2

There are a number of possible means by which transmission of viral and bacterial pathogens can occur. Pathways of contamination can be bidirectional from a patient to a member of the dental team, or vice versa. Moreover, pathogens can be transferred from patient to patient through a surface located in the dental practice, or a device or instrument used during treatment. This can apply in the case of inadequate sterilisation of the dental instruments or disinfection of the dental unit.2

Saliva, blood and plasma are all major vectors of cross-transmission. Blood-borne pathogens can expose staff to dangerous and potentially lethal infectious diseases such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Contamination can arise by exposure to the infectious material through non-intact skin and mucosal lesions. However, the highest risk of this type of infection is associated with accidental punctures by contaminated needles or injuries by sharp instruments. Various studies have shown that the proportion of injuries from sharp instruments is 53%[3] to as high as 72%.[4] The other possible device-borne means of pathogen transmission can occur through insufficient cross-contamination control, such as improper decontamination of dental instruments.[5]

Stringent standards are required in order to meet legislations and provide a safe environment for staff and patients. When it comes to decontamination of instruments, the dental team must follow a strict cross-infection regime in accordance with HTM 01-05. Instruments must be cleaned, lubricated and then correctly sterilised. It is worth regularly reviewing the most effective methods of improving these in order to meet current guidance and improve the work-flow. For example, the use of thermo-washer disinfector dryers, such as the ThermoKlenz from W&H is considered to be ‘best practice’, for a number of reasons.

Accredited thermo-washer disinfectors are manufactured for purpose and are sophisticated medical devices: thorough cleaning is achieved by very high water flow rates at high pressure, these machines use formulated and validated solutions for the particular machine cycles, developed to take into account cleaning efficacy balanced with the necessity to minimise damage to instruments. They ensure a reproducible, valid and medically effective washing process is achieved every time, reducing the risk of cross infection amongst patients and team members.

Following effective cleaning, dental handpieces require lubricating with manufacturer recommended service oil prior to sterilisation. The majority of dental handpieces do not require disassembly prior to decontamination, although some specialist instruments are able to be disassembled. The manufacturer’s instructions should always be adhered to, whether lubricating manually or using an automatic system such as the Assistina from W&H. Bagging and sterilisation then follows in accordance with manufacturer instructions, HTM 01-05 and/or other appropriate guidelines. The autoclave is a key piece of equipment in any dental practice and clean saturated steam under pressure is by far the most reliable medium for the sterilisation of medical devices. For unrivalled sterilisation, W&H offers dental practices the new Lisa steriliser with Class B automatic cycles and a fast cycle. The user-friendly touch screen and menu structure supports easy navigation, while performance is second to none with advanced Eco Dry technology, saving practices time and power consumption.

Dental instruments, including handpieces should be sterile when used in order to prevent cross-contamination. Decontamination equipment provides fast and effective sterilisation to ensure dental practices meet the current legislations. It is also worth remembering that in accordance with HTM 01-05 recommendations, decontamination equipment should be validated at the point of installation and then revalidated annually thereafter.

Decontamination is an important concern for all dental professionals, as procedures are carried out in an environment that exposes staff and patients to significant risk. Correct sterilisation, hygiene and maintenance are essential if patients and staff are to remain safe from cross-contamination.


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[1] Cassini A, Plachouras D, Eckmanns T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13(10):1-16.

[2] Laheij AM, et al. Healthcare-associated viral and bacterial infections in dentistry. Journal of Oral Microbiology 2012;4:1-10.

[3] Porter K, Scully C, Theyer Y, Porter S. Occupational injuries to dental personnel. J Dent 1990;18(5):258-262.

[4] Shimoji S, Ishihama K, Yamada H, et al. Safety among dental health-care workers. Adv Med Educ Pract 2010;1:41-47.

[5] Ramich T, Eickholz P, Wicker S. Work-related infections in dentistry: risk perception and preventative measures. Clin Oral Invest 2017;21:2473-2479.

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