Dental instruments have an affinity for acquiring debris and potentially pathogenic particles. This includes, but is not limited to, saliva, blood, plaque, soft tissue, and restorative materials such as cement or filling debris. Each is made from or can carry harmful microorganisms that, when transferred from patient to practitioner to another patient, can lead to illness.
Instrument decontamination is therefore essential for patient safety, preventing the spread of infectious bacteria. To be HTM 01-05 compliant,[i] decontamination requires cleaning, inspection and sterilisation before the dental instrument can be reused. But knowing the limitations of the two leading cleaning options and their possible challenges is vital for consistent infection control.
Cleaning options
Manual cleaning is a vital part of the daily workflow: wiping down surfaces like the dental chair, door handles, keyboards, computer mice and more ensures that the practice environment is safer for all. However, manual cleaning is less reliable for cleaning dental instruments decontamination which means that disinfection and sterilisation methods will fail if instruments are not cleaned effectively and debris remains.[ii]
Removing clinical soil should be done at the point of use. If not, materials may dry onto the surface and become more difficult to remove later. Incorrect cleaning protocols include leaving instruments to soak in water for extended periods (enabling biofilms to form and risking corrosion) and wiping or spraying instruments with ethanol (this can fix proteins onto instruments made from stainless steel).[iii] In cases where there is a delay in the end of the treatment, instruments can be placed in specific pre-soaking solutions.
When using correct disinfection products and following the recommended protocols, manual washing can be just as effective as washer-disinfector.[iv] However, manual cleaning is ultimately a human process that can extend patient waiting times, take up too much staff time and, in cases both build-up, can lead to rushed cleaning to stop the risk of falling behind. When this occurs, debris may still exist on the dental instruments prior to sterilisation.
A sound option
Ultrasonic baths are a viable alternative. Ultrasound energy has been found to be an efficient way to improve the performance of several different applications of analytical chemistry, including the removal of inorganic and organic compounds, slurry dispersion, homogenisation, and other applications.[v] For dentists, ultrasonic baths create consistency and lead to repeatable outcomes, unleashing high-frequency sound waves that cause microscopic bubbles to form, grow and collapse, dislodging stuck debris. Incorporating ultrasonic cleaning can elevate a practice’s infection control – providing due diligence in their use.
Best housed in a decontamination room, ultrasonic baths also reduce the incidence of splashes and sharps injuries that can occur with manual cleaning and give the dental team more flexibility in their workflow. The Care Quality Commission (CQC) states that decontamination rooms should have a setting down area for contaminated instruments, washing and rinsing sinks, an inspection area for cleaned instruments, and a separate hand washing sink.[vi] For dental practices without a decontamination room, it is important that instrument reprocessing occurs as far from the dental chair as possible and that, to reduce the risk of bacterial exposure, there should be no ultrasonic cleaning without a lid. For patient comfort, ultrasonic baths and autoclaves should not be operating during consultations or treatment.[vii]
Cleaning compliance
Whether manually cleaning or using ultrasonic products, the most important aspect of instrument decontamination is following the manufacturer’s instructions for reprocessing. Deviating from the decontamination instructions increases the risk of equipment failure, retained debris and incomplete sterilisation. The knock-on impact is compromised patient safety and the potential for legal action. This is avoided through diligent adherence to the manufacturer’s instructions, with close attention to ultrasonic baths and manual cleaning protocols.
A reliable product for removing instrument debris is DentiZyme Ultra from Dentisan. Featuring powerful detergent properties, the pH neutral solution is adept at removing proteins and other debris from dental instruments and can be used in ultrasonic baths and for manual cleaning. Crucially, DentiZyme Ultra is diluted to 5ml per litre of water and gives a superb cleaning result, covering stainless steel, glass, ceramic, plastic and soft metal materials.
Manual and ultrasonic cleaning are both HTM 01-05 compliant ways of removing debris,[viii] but identifying the best option for your practice helps optimise the daily workflow and achieve the best outcomes. Overall, this amounts to a more streamlined decontamination protocol that protects both patient and practitioner.
For more information about Dentisan, please visit https://dentisan.co.uk/
Book your in-practice CPD by emailing your request to the expert in your area:
For the Midlands, North Wales & North of England, contact Jenny: jenny.nixon@getinge.com
For the South of England, Wales & Channel Islands, contact Anne: anne.harris@getinge.com
For Scotland, Ireland & Northern Ireland, contact Holly: holly.dickinson@getinge.com
Author: Jenny Nixon – Business Development Dentisan
[i] Department of Health (2013). Decontamination Health Technical Memorandum 01-05: Decontamination in Primary Care Dental Practices 2 0 1 3 E D I T I O N. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf.
[ii] Walsh, L.J. (2024). Current Challenges in Environmental Decontamination and Instrument Reprocessing. International Dental Journal, [online] 74, pp.S455–S462. doi:https://doi.org/10.1016/j.identj.2024.08.016.
[iii] Walsh, L.J. (2024). Current Challenges in Environmental Decontamination and Instrument Reprocessing. International Dental Journal, [online] 74, pp.S455–S462. doi:https://doi.org/10.1016/j.identj.2024.08.016.
[iv] Oza, R.R., Sharma, V., Multani, P., Balsara, K., Bajaj, P. and Dhadse, P. (2022). Comparing the Effectiveness of Ultrasonic Instruments Over Manual Instruments for Scaling and Root Planing in Patients With Chronic Periodontitis: A Systematic Review and Meta-Analysis. Cureus, 14(11). doi:https://doi.org/10.7759/cureus.31463.
[v] Nascentes, C.C., Korn, M., Sousa, C.S. and Arruda, M.A.Z. (2001). Use of ultrasonic baths for analytical applications: a new approach for optimisation conditions. Journal of the Brazilian Chemical Society, [online] 12, pp.57–63. doi:https://doi.org/10.1590/S0103-50532001000100008.
[vi] www.cqc.org.uk. (n.d.). Dental mythbuster 18: Decontamination in the dental treatment room | Care Quality Commission. [online] Available at: https://www.cqc.org.uk/guidance-providers/dentists/dental-mythbuster-18-decontamination-dental-treatment-room.
[vii] www.cqc.org.uk. (n.d.). Dental mythbuster 18: Decontamination in the dental treatment room | Care Quality Commission. [online] Available at: https://www.cqc.org.uk/guidance-providers/dentists/dental-mythbuster-18-decontamination-dental-treatment-room.
[viii] Department of Health (2013). Decontamination Health Technical Memorandum 01-05: Decontamination in Primary Care Dental Practices 2 0 1 3 E D I T I O N. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf.
