Cleaning and disinfection protocols in dental offices

Even though dental offices most often operate outside of classic healthcare facilities, this does not mean that the attention given to sanitation is at a lower level. Dentists have direct and indirect contact daily with saliva, blood, and instruments, dental impressions, and surfaces that could be contaminated, potentially making the dental office a place for the spread of viruses, bacteria, and fungi, including SARS-CoV-2. Numerous studies have shown that the dental unit can be colonized by pathogenic microorganisms in the form of fungi, bacteria, or protozoa. Taking into account the danger of contamination with pathogens, a risk to which both medical staff and patients are exposed, it is necessary that sanitation and disinfection protocols in dental offices be strictly followed. The use of professional disinfectants is mandatory to ensure a sterile work environment.

Due to the way infections are transmitted, critical points in dentistry are numerous and stem from the multitude of microbial agents, the variety of possible infection routes, the type of instruments used, the rapid turnover of patients, and the invasive nature of the procedures performed.

Infections can be transmitted in four different ways:

• Blood – through blood-borne diseases.
• Air – through diseases transmitted by microorganisms in human secretions carried through the air.
• Water – through microorganisms transmitted by water.
• Contact – through direct transmission between host and infection.

The dental unit's water circuit, which supplies water to the instruments and eliminates residual substances, constitutes a vehicle for infection transmission. This is due to the presence of biofilm, a complex aggregation of microorganisms that develops inside water networks: communities of bacteria in the water flow that feeds the unit adhere firmly to the limescale layer and proliferate due to various factors that favor their growth and adhesion.

The suction circuit is also an ideal breeding ground for pathogenic microorganisms due to the removal of solid and liquid compounds during dental procedures.

This makes strict adherence to the cleaning-disinfection protocol a vital part of dental practice. It is also important to use exclusively compliant products approved by the Ministry of Health, through the National Commission for Biocidal Products.

Steps of the disinfection process in dental offices

To drastically reduce the accumulation and proliferation of bacteria and other pathogenic microorganisms, a maintenance protocol for the dental unit must be followed daily.

At the beginning of the day:

• Flush the suction lines with a high-level disinfectant for two minutes.
• Flush each instrument with water for no less than 2 minutes.

Between patients:

• Clean surfaces.
• Decontaminate surfaces.
• Rinse each instrument with water for 20-30 seconds.
• Flush the suction cannulas with a high-level disinfectant for two minutes.

At the end of the day:

• Flush the suction lines with a high-level disinfectant, leaving it to act overnight, if possible.
• Rinse each instrument with water for at least 2 minutes.
• Remove and clean the suction system filter.

How to choose disinfectants for dental offices

Cleaning, disinfection, and sterilization are essential for preventing the transmission of infectious pathogens in medical offices. It is important to keep in mind that these three steps represent different and mandatory stages of the sanitation protocol.

Cleaning is an essential first step before sterilization and disinfection. Cleaning is defined as the removal of visible dirt, blood, proteins, microorganisms, and other debris from surfaces, cracks, serrations, joints, and lumens, or from instruments, devices, and equipment. This stage prepares items for safe handling and/or subsequent decontamination. The removal of debris is usually accomplished by using a detergent and water or an enzymatic detergent and water, through a manual or mechanical process.

Disinfection is a process that eliminates many or all pathogenic organisms, except for bacterial spores. It is usually performed with the help of liquid chemical substances.

A disinfectant is defined as a physical or chemical agent that removes, inactivates, or destroys pathogens on a surface or object to the point where the surface or object is no longer capable of transmitting infectious particles, thereby making the surface or object safe for handling, use, or disposal. GLUTANOL® RTU – Disinfectant for surfaces and instruments

Important: However, unless a disinfectant is also labeled as a cleaning agent, it cannot be used for the cleaning stage. Only consider using products approved by the Ministry of Health, through the National Commission for Biocidal Products, labeled for both cleaning and disinfection – but ensure that both stages are performed separately.

Sterilization is a process that kills all forms of microbial life.

Many liquid disinfectants and sterilizers are used alone or in combinations in the healthcare environment. These include alcohols, chlorine compounds, formaldehyde, glutaraldehyde, ortho-phthalaldehyde, hydrogen peroxide, iodophors, peracetic acid, phenols, and quaternary ammonium compounds. Commercial formulations of these chemical mixtures are considered unique products and are not interchangeable. Misuse can lead to excessive costs and/or safety risks. Users should carefully read labels to ensure that the correct product is selected for a specific use and that it is applied appropriately. PEROKLIN® – Hydrogen peroxide-based disinfectant

Sanitization and disinfection of instruments

It is important to mention that special attention must be paid to transporting contaminated dental instruments to the central processing area. They should be packed in containers, and personnel should never place their hands into containers containing contaminated instruments or handle the instruments with their hands.

Single-use instruments

If disposable needles need to be recapped, either the single-handed scoop technique or a proper recapping device must be used. Disposable sharp objects must be discarded in a sharps container. Single-use items labeled for one-time use – such as high-velocity suction tips and saliva ejectors – must not be used on more than one patient.

Reusable instruments

Instruments that come into contact with intact skin must be cleaned and disinfected. Otherwise, reusable instruments must go through three stages before reuse: cleaning, packaging, and sterilization.

1. The cleaning process

Reusable instruments must be cleaned before sterilization. Debris can prevent heat or chemical vapors from coming into contact with the surface of the instrument and can prevent sterilization. Reusable instruments must be cleaned with automated cleaning equipment. If manual scrubbing is required, a long-handled brush must be used to keep hands at a distance from sharp, contaminated instruments. If instruments cannot be cleaned immediately, presoaking them can improve the cleaning process. Enzymatic disinfectant detergent

2. Instrument sterilization

The disinfection protocol classifies reusable dental instruments as critical, semicritical, or noncritical.

• Critical instruments penetrate soft tissues or bone (e.g., scalpels, scalers, and burs).
• Semicritical instruments come into contact with oral tissue without penetrating it (e.g., dental mirrors and dental impression trays).
• Noncritical instruments come into contact with intact skin.

Critical and semicritical instruments require sterilization after use. Sterilants used to process these types of instruments must be approved by the Ministry of Health. Noncritical instruments do not need to be sterilized and can be wiped down with a professional disinfectant.

     3. Instrument storage before sterilization

After cleaning, all instruments must be packaged or wrapped before sterilization, unless they are to be used immediately after being sterilized. Packages/wraps must remain sealed until the day they are to be used and must be stored in a way that avoids contamination.

Packaging materials include: wrapped perforated instrument cassettes, plastic or paper pouches, and woven or non-woven sterilization wraps. Materials must be compatible with the type of sterilization process used. To maintain the integrity of the package, follow only the manufacturer's instructions for sealing it. Do not use staples, pins, or paper clips to seal packages.