Dentistry, due to the nature of the intraoral workspace and the procedures performed in this environment, requires the complete implementation of sterilization rules. It is essential that the surfaces that our doctors and patients come into contact with are disinfected and the instruments and materials used are sterile.
This is both an important factor affecting our treatment success and a vital fact that protects our patients, physicians and auxiliary staff against cross-infections. For this very reason; Sterilization is an indispensable rule for us.
In our clinic; all our hand tools and other treatment instruments are pre-disinfected in ultrasonic cleaners in the clinical rooms and taken to a special sterilization room where they are individually packaged and sterilized in a reliable autoclave. All non-sterilizable products (gloves, masks, patient gowns, cups, aspirator tips, etc.) are disposable. They are discarded after use on only one patient. The packages of sterile instruments are opened in front of our patients. Patient chairs and other contact surfaces are disinfected by our trained staff after each patient.
In addition, disinfection of the mains water connected to our working tools with filters, supporting mouthwashes with anti-septic tablets, and ensuring that all the tools we use have the ability to enter the autoclave are other details we pay attention to.
Our medical awareness and humanitarian responsibility have made it our principle to comply with all sterilization rules, to keep our patients away from possible infection risks and to provide healthcare services in a safe environment, as if we were sitting in that chair ourselves.
To be worthy of the trust you have placed in us, we think of everything for you down to the finest detail…
Sterilization of dental materials to be used in dentistry with appropriate techniques and monitoring with materials in accordance with standards play an important role in controlling infections. Nosocomial infections continue to be a problem not only in developing countries but also in developed countries.
In both inpatient treatment institutions and oral and dental health centers, the goal is single and clear. It is to provide optimal health care to people who have applied for treatment. Although patient anamnesis is one of the most important diagnostic and treatment steps in oral and dental health practice, unfortunately it is not a valid step in terms of infection control. For this reason, the Centers for Disease Control and Prevention (CDC), an official organization headquartered in the United States, has announced a concept called “universal precautions” in infection control. This concept is based on the assumption that body fluids such as human blood and saliva are contaminated with Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and other pathogens known to be infectious. Universal precautions mean that the same infection control and sterilization methods are applied to all patients. The American Dental Association (ADA), in a report prepared by its own committees, recommends that oral and dental health professionals apply universal precautions. In addition, the ADA organizes written and visual events throughout the country to inform both employees and patients about the introduction and implementation of universal precautions.
STERILIZATION PROCESS STAGES
- Cleanup-control.
- Packing-loading.
- Sterilization process.
- Unloading-recording.
- Storage-distribution.
A. Cleanup & Supervision
The first step in the process is cleaning, which must be done effectively and in accordance with the principles. It has been reported that 95-97% of microorganisms are eliminated by effective washing. Cleaning is done manually or with devices (disinfectors-ultrasonic washing devices). Washing disinfectors and ultrasonic washing devices, which are now slowly being seen in dental treatment centers, aim to minimize the human workload. “The Food and Drug Administration (FDA) has categorized these devices into two groups. Washing machines and washing/disinfection machines. Washing machines clean and dry instruments. Washing/disinfection machines clean, decontaminate, disinfect and dry. If disinfectant is to be used, a suitable disinfectant is applied according to the manufacturer’s instructions. If thermal disinfection is to be performed, five minutes at 90°C to 95°C is the desired time. The controls and prints of these devices should be kept in the logbook with their dates. It presents details such as whether it performs appropriate disinfection, how many minutes of thermal disinfection, temperature range, etc. on the graph.
B. Packaging & Loading
The material to be sterilized should be stored in a package until the time of use. The packaging should provide an effective barrier to protect the material from possible contamination. It should also not interfere with the penetration of the sterilant. The wrapping paper should be compatible with the material and the sterilization method chosen.
Disposable packaging material should not be reused. Large packages may cause problems in sterilization by preventing sufficient drying. Packages that come out wet at the end of the sterilization process should not be considered sterile and should not be used. If gas plasma method is to be used, non-woven, cellulose-free packaging papers should be used. During loading, large packages must be placed on the lower shelf and small packages on the upper shelf. The bundles should be placed vertically with 5 cm between themselves and the device.
C. Sterilization
While it was defined as the process of removing all viable forms of microorganisms, including bacterial spores, this definition was changed in 1995 by the Association for the Advencement of Medical Instrumentation (AAMI) to “the removal of microorganisms from the environment to the extent that it provides an acceptable level of sterility assurance”. Sterility Assurance Level (SAL) is the probability of the presence of viable microorganisms in the environment after sterilization. This definition change has made the sterilization process measurable and controllable in practice. For the sterilization process, the amount of microorganisms and spores on the object must decrease by at least 10-6 log.
Bakteri sporları dahil olmak üzere mikroorganizmaların tüm canlı formlarının ortadan kaldırılması işlemi olarak tanımlanırken, 1995 yılında “Association for Advencement of Medical Instrumentation (AAMI)” tarafından bu tanım “kabul edilebilir sterilite güvencesi düzeyini sağlayacak ölçüde ortamın mikroorganizmalardan arındırılması” şeklinde değiştirilmiştir. Sterilite güvence düzeyi [Sterility Assurance Level (SAL)] sterilizasyon işleminden sonra ortamda canlı mikroorganizma bulunması ihtimalidir. Bu tanım değişikliği sterilizasyon işleminin pratikte ölçülebilir, kontrol edilebilir olmasını sağlamıştır. Sterilizasyon işlemi için cismin üzerindeki mikroorganizma ve spor miktarının en az 10-6 log azalması gereklidir.
D. Recording
Let to be returned on all stages when desired. Evidence of work done and tests, biological, chemical and physical performance tests are kept as records. Tests showing the effectiveness of the decontamination process, repair, breakdown or routine maintenance records must be kept.
E. Storage
All materials should be transported in closed transfer vehicles and placed in shelved systems. Suspected contaminated materials should be processed again from the beginning. The storage area should be close to the sterilization area. Shelves should be at least 30 cm from the floor, 40-50 cm from the ceiling and 5 cm from the wall in line with AAMI guidelines. Unnecessary touching should be avoided and the date should be observed during use.
Disposable instruments
A new pair of gloves is used for each patient.
At the end of the session, the used gloves are discarded and hands are washed with antiseptic soaps. A new pair of gloves is used for the next treatment. For local anesthesia, a new syringe is used each time, removed from its original sterile bag in front of the patient. All other disposable materials such as saliva absorbers, patient gowns, masks, etc. are disposed of at the end of the treatment according to the medical waste procedure.
Other instruments
We perform the sterilization process in 3 stages as stipulated by the international sterilization protocol.
- All instruments are washed with disinfectant solution.
- All instruments are kept in peracetic acid disinfectant solution, a new generation high level disinfectant, for 45 minutes. Peracetic acid solution has bactericidal, fungicidal and virucidal effects (kills bacteria, fungi and viruses).
- Cold sterilized instruments are placed in sterile bags, one bag for each patient. The instruments in the bag are sterilized with a computer-controlled autoclave operating with vacuum, steam, pressure and drying cycle. There are indicators in each bag indicating that the sterilization process is complete.