DECONTAMINATION PROCESS
Sterile - no viable cells or viral particles present in the environment
or on an item of equipment
Disinfection- is a process which is intended to kill or remove
pathogenic microorganisms but will not kill spores.
- not adequate/appropriate for instruments used in dent
- for environmental items
Decontamination - as the application of a range of appropriate
processes that will render an item safe for use during dental
procedures.
Classification according to risk (Spaulding, earle H 1957)
Critical instruments—these are defined as instruments that will
penetrate soft tissues, contact bone or will enter into or contact the
bloodstream or other normally sterile tissues. Examples of this type
of instrument are surgical instruments, periodontal scalers, scalpel
blades and surgical burs.
Semi-critical instruments—these are defined as instruments that
will contact mucous membranes or non-intact skin but will not
normally penetrate soft tissues, contact bone or enter into or
contact the bloodstream or other normally sterile tissues. Examples
of this type of instrument are dental mouth mirrors, restorative
hand instruments, reusable impression trays and dental handpieces.
Noncritical instruments—these will only contact intact skin.
Examples of this are radiography head/cone, blood pressure cuff,
pulse oximeter, operating light handles and bib chain.
-Noncritical instruments can be decontaminated by disinfection
- preferred to use a disposable barrier on a noncritical piece of
equipment to reduce the need to disinfect the item
Sterile – (in instruments) state at the point of use
Sterelised - refers to the fact that an item has been subjected to a
sterilisation process after it has been used but may not be stored
inside sterile packaging.
CLEANING METHODS FOR DENTAL INSTRUMENTS
chromium-rich layer - prevents corrosion occurring (passivation
layer)
When selecting methods for cleaning instruments, the following
factors should be considered:
 Effectiveness—Will the method remove the materials that
are likely to soil the instrument, particularly bioburden?
 Safety—Is the method inherently safe for the operator?
Are there risks that can be avoided?
 Cost—Is the relative cost of the method within the
resources available to the practice?
 Reliability—What is the likelihood that the method will
give consistent results? Can a system of quality assurance
be devised to measure the reliability of the method?
Methods used to clean reusable instruments prior to sterilization:
Manual cleaning- oldest and traditional way
- least effective way of reliably cleaning instruments.
- is a low capital cost method but is very labour intensive and is very
operator dependent and difficult to quality assure meaningfully
- risk of sharps injury is high (biggest cause of injuries in dent)
45 degrees above- proteins coagulate
-submerged below the level of detergent
- non foaming to see what they’re doing
- scrubbed while kept submerged
- sterilized in a vacuum type sterilizers
Ultrasonic cleaning baths - ultrasonic waves generated by
transducers fitted to the base of the chamber.
Acoustic cavitation - sound waves that travel through the cleaning
solution can remove soil from the surface of objects
- formation of cavities in the solution, As these cavities in the
solution collapse, they generate high temperatures (up to 5000 °C) =
disruption of soil
- ensure that there is no air trapped within the object.
- detergent sol should be changed at the end of each working
session
Hollow instruments – (air trapped) should not be cleaned in an
ultrasonic bath.
2 main methods to validate;
foil ablation test - most commonly used method
- uses strips of foil that are suspended in a fresh detergent solution
that has been degassed
Degas - entails running a cycle with no instruments present in order
to drive off any dissolved air that might interfere with cavitation
use of probe or wand designed to measure ultrasonic energy - e
placed in different but consistent locations in the chamber to
measure activity across the whole area of the chamber.
- expensive, not often used
ADVANTAGE:
- inherently safer than manual cleaning as the contaminated
instruments require less handling, and therefore the risk of ‘sharps’
injury is reduced.
DISADVANTAGE:
- cleaning solution is usually used several times for successive
batches of instruments, and therefore there is a risk of carryover of
soil from one batch of instruments to the next.
Automated cleaners - usually in the form of an automated
washer/disinfector.
- similar in form to a domestic dishwasher

- begins with a cold rinse that is designed to remove any gross

soiling.

- is the most consistent method for cleaning dental instruments as

the control system is very accurate and each phase of each cycle has
the parameters accurately measured and recorded.

Cold water - is used to prevent the coagulation of proteins onto the

surface of the instruments

hot wash- (next step) using a detergent that has been specifically
developed to effectively remove biological soil.

final rinse -to remove any residual detergent and loosened soil.

drying phase-(final part) that can be either a passive phase relying

on the residual heat in the machine or an active phase using filtered
hot air generated by the machine.

Diff between dishwasher: sophistication of the control and

monitoring systems for each phase of the cycle and the type of
detergent used.

Validation: testing for residual protein

- a swab contained in a tube that has a reagent which when it

detects traces of protein changes colour.

Disadvantage: s the most capital expensive method of cleaning

-energy and water volume requirement is also greater