Features / July 11, 2024

Errors in dental instrument decontamination

Jane Renehan identifies 10 weak spots that frequently occur in dental instrument decontamination processing.

The question – Dear Jane…

Our practice infection prevention and control (IPC) protocol on decontamination of dental instruments is due for an annual review. We would be grateful for any advice that you can offer.

From your experience, what are the most common errors in the decontamination of dental instruments?

Answer

The Dental Council Code of Practice Relating to Infection Prevention and Control (2015) states that all dental practices must establish and maintain a formal, written infection prevention and control policy document, which is site-specific.

The Code of Practice Relating to Infection Prevention and Control places additional obligations on practice owners with regards to practice protocols and procedures, organisational governance, education, and training of dental team members.

Your site-specific practice protocol on the decontamination of dental instruments is one of a number of protocols that should be audited annually.

There are five steps in the process for the decontamination of dental instruments. Within each of these steps there are a number of individual tasks. An error during any one of these tasks or steps can disrupt the decontamination process, resulting in failure to sterilise.

When I visit dental practices to provide practice-specific staff training, there are some avoidable errors that I repeatedly find.

Here are my top 10 most frequently observed weak spots in instrument decontamination processing.

Weak spot one

Steps must be taken to ensure that contaminated instruments do not dry out prior to cleaning. If instruments cannot be decontaminated within 30 minutes of use, they should be kept moist. Proprietary products are available from dental suppliers that will commence the breakdown of proteins, while keeping the instruments moist in their transportation container.

Weak spot two

Ultrasonic baths must not be overfilled with contaminated instruments. As the size and capacity of ultrasonic baths can vary, the manufacturers’ instructions must be followed.

In summary, the enzymatic solution must make full contact with all of the instruments in the basket for the length of the cleaning cycle. Hinged instruments should be opened prior to placing in the basket.

Weak spot three

Overdependence on manual cleaning of dental instruments may expose staff to an increased risk of a sharps injury. Manual cleaning of instruments is the least acceptable method of cleaning instruments and should be kept to a minimum.

Where manual cleaning of instruments is practised, staff must be made aware of the risks and a detailed written protocol must be followed.

Weak spot four

A number of errors can occur at the packaging step. Instruments should be packed in sealed autoclave pouches prior to being placed in the autoclave. Wet, damp, or soiled instruments will not achieve sterilisation. The pouches must not be overfilled, otherwise the steam cannot reach each item for the appropriate length of time during the sterilisation cycle.

When sealing the autoclave pouch, it must be sealed as per the manufacturers’ directions along the adhesive strip, sealing it with no gaps or creases.

Weak spot five

Dental handpieces must be cleaned, decontaminated and sterilised after each patient. Manufacturers’ instructions should be followed in relation to their cleaning, lubrication and sterilisation. Correct technique at this stage will prolong the life of the handpiece.

Common errors routinely found are inadequate or over oiling, and oiling at an inappropriate stage in the process. Handpieces are expensive items. Their care and maintenance must be in accordance with the user manual.

As a practice may have handpieces from more than one manufacturer, it is essential that handpiece-specific instructions are understood by staff and are documented in the decontamination protocol.

Weak spot six

Overpacking or incorrectly loading the steriliser may lead to some autoclave bags/pouches not being fully sterilised. Load trays loosely, allowing air to circulate around the pouches and between the trays.

Pouches should not overlap. Solid trays should not be used as they block airflow. Directional placement of the pouches should be in accordance with the autoclave manufacturer’s instructions. The most usual placement is paper side faced downwards, but it can differ based on the type of autoclave. When using a pouch rack, it should be placed on the bottom section of the autoclave.

Weak spot seven

Unwrapped instruments must be used on the day of sterilisation. Storage of unwrapped instruments beyond the working day is not good practice. Wrapped instruments should be stored in a clean and dry location such as a drawer or in an enclosed area.

Stored instruments should have the dates of sterilisation on them to facilitate traceability and instrument turnover. Stored packs should be regularly inspected to ensure they are in good condition with no damage to the integrity of the pouches.

When the process is correctly followed, storage of up to a year is permitted by the code of practice.

Weak spot eight

Governance failure is probably the most frequent error I observe during my practice visits, with the main failing being the absence of a nominated decontamination lead. The Code of Practice Relating to Infection Prevention and Control requires this role to be assigned to an individual who has the experience and authority to perform the task and who is accountable to the practice owner.

In the absence of a nominated decontamination lead, the responsibilities assigned to this role are frequently overlooked (eg, staff training, and ongoing monitoring of infection prevention and control systems).

Weak spot nine

A written protocol for the decontamination of dental instruments is a Dental Council requirement. It is essential that each member of the clinical team is aware of this document, understands what is individually expected of them, and agrees to abide by the procedures set out in the protocol.

Everyone must understand that the protocol is ‘how we do it here’ in this practice. There must be no deviation from the agreed practice procedures.

Weak spot 10

Without exception, all dental healthcare professionals must comply with the Dental Council Code of Practice Relating to Infection Prevention and Control. Dentists are professionally and ethically responsible for the standards of infection prevention and control undertaken by staff. To achieve consistent processes and quality standards, regular staff training is essential.

Team effort

Finally, in my opinion, infection prevention and control is a team sport. To succeed, every member of the team must know their role and play their part in maintaining robust infection prevention and control processes.

Great dental teams work together to raise the overall performance of their practice.