Whether you are predominantly an NHS or private dentist, or a mix of the two, high standards of infection control are critically important to your practice. The effective cleaning and sterilisation of dental instruments is an essential part of this process. The equipment needed can represent a significant investment and choosing the right products to fit best with the way you work can be a daunting task.
As with any purchase, it should be apparent that the cheapest option is not always the best route to take. Whilst the upfront purchase price might be lower, if there is a lack of after sales support, reliability is poor or spare parts are difficult to obtain,
then it might actually cost you more in the long term.
When looking for new or replacement equipment, let’s consider the instrument decontamination process itself.
Firstly, it’s all about cleaning the instruments. It’s important to understand that, unless an instrument is clean, it will not be sterilised – even when it has been autoclaved. This is because it is necessary to remove blood and other material from the surfaces of instruments prior to sterilisation. Sterilisation is achieved in an autoclave by subjecting the instrument to steam at 134°C for at least three minutes (or at 121°C for 15 minutes). It is the contact of steam on the surface of the instrument that causes sterilisation, hence the need to remove material from the surface of the instrument in the cleaning stage of decontamination.
The most common form of instrument cleaning is manual washing in a sink by a dental nurse. The problems with this method are that it tends to be ineffective, is difficult to validate and subjects the nurse to potential infection from sharps injuries. A recent study showed that people who experience such injuries can suffer persistent and substantial psychiatric trauma or depression in addition to the physical health effects. This is because of the length of time the injured person has to wait for blood test results. A sharp contaminated with infected blood can transmit more than 20 diseases, including Hepatitis B, C and HIV. This is what causes stress and worry to the estimated 100,000 people in healthcare settings who experience a needle stick accident every year. Fortunately, the increased use of washer disinfectors has made an important contribution to reducing
the risk of sharps injuries to members of the dental team who manually handle contaminated instruments. It is also the most effective method of cleaning. The second edition of HTM 01-05 states that progress towards achieving best practice should
include the installation a validated washer disinfector to remove the need for manual washing. The latest generation of washer disinfectors feature much faster cycle times than those of the past. In fact, if you take into account the time saved by not having to manually scrub instruments, they can actually pay for themselves within just a few months.
After cleaning, the next stage is instrument sterilisation for which an autoclave (steam steriliser) is used. A dental autoclave is capable of a vacuum and/or a non-vacuum cycle. The former is referred to as a B cycle and the latter an N cycle. B cycle autoclaves operate by using a vacuum pump to remove air from a sealed chamber in to which steam is introduced. The evacuation of air from the chamber enables the
steam to permeate all surfaces of an instrument, especially surfaces in internal hollow spaces. An N cycle uses the steam to displace air from the chamber. It is as effective as a B cycle in sterilising solid instruments, but not hollow or wrapped instruments, nor porous materials. The European standard for small steam sterilisers, EN13060, categorically states that a B cycle should be used for hollow and lumened instruments.
Historically, dentists have preferred to use N type rather than B type autoclaves because the cycle time was much quicker – something considered very important in a busy practice. However, with advances in technology, there are now full B Class (vacuum) autoclaves available with sterilisation cycles just as fast as an N Class but which are not constrained by the type of
instrument which can be sterilised effectively. This completely eliminates the need to sort instruments prior to sterilising.
In summary, then, with the current generation of equipment, the whole decontamination process to meet best practice standards can take less than one hour from start to finish and, at the same time, minimise the handling of instruments. Most reputable manufacturers will offer a range of decontamination solutions and should be able to provide you with sensible advice on choosing the best type of equipment to suit the needs of your practice. Just as importantly, they should be capable of providing you with a high standard of ongoing service and technical support after purchase and be up front about what the
price includes – with no hidden extras.