Our longstanding understanding that sterility is one of the most important parameters of treatment, which is so important as the result of treatment, is expressed in high standards, which we advocate in our dentistry and beyond it as well.
In this article, we want to draw the attention of our Clients to how this sterility is achieved.
We do not have secrets from our Clients!
Our immutable principle No. 1:
to use maximum disposable instruments and materials.
These are gloves and napkins (photo 1), and versatile instruments for preparation, treatment, polishing of teeth, needles, systems for computer anesthesia (photo 3-4), saliva ejectors, rubber-dam and much more.
Photo 1-2. Sample of disposable consumables used in our clinic
All that can be used once, we use once (including materials for surgery and retrieval of canals).
Photo 3-4. The appliance of the computer anesthesia system Wand and a disposable system with a needle to it
Our immutable principle No. 2:
All reusable instruments undergo a thorough multi-step cleaning.
In the office of each dentist of our clinic there is an individual appropriately marked container for pre-soaking the used instruments (photo 5). Soaking is carried out using special disinfectants of the company “Lizoform”.
The exposure time of the solution is 30 to 60 minutes. Replacement of the disinfectant solution is carried out according to the regulations of the manufacturer’s documentation. This is the preliminary stage of processing the cleaning and disinfection of the used instrument. But this is only the first step …
Photo 5. Individual container for soaking instruments
At the next stage the doctor’s assistant delivers the container with a soaked and solution cured instruments to the sterilization room, where we have a thermal disinfector (professional washing machine MELAG MELAtherm 10) (photo 6-7) – the best professional equipment from the German manufacturer!
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Photo 6-7. The best professional thermal disinfector MELAG MELAtherm 10, exterior view, and instruments located inside the thermal disinfector
Despite the fact that the exterior of the machine is very similar to the usual dishwasher and the general principle of washing the instrument is the same as in a conventional dishwasher: the removal of all contaminants from the instrument due to repeated treatment with a stream of liquid under pressure, it has 2 important differences:
The machine uses special cycles, which vary depending on the type of instruments and the completeness of its loading. The average duration of the washing cycle is 1.5-2 hours. By the way, there are no more than 10 such machines in Ukraine, and one of them is installed in our clinic. * We do not save on safety!
As a result, we get a clean, dry, but not sterile instrument.
After the washing machine has completed the cycle of washing instruments, a mandatory test for the latent blood (azopiram sample) is carried out. For this, special tests are used (photo 9).
Samples are taken in different places of the machine and from different instruments. In case, if at least one sample was positive (until today, this case was not yet in our clinic), absolutely all the instruments in the thermal disinfector are washed again and after the washing cycle the follow-up samples are taken according to the procedure described above.
Photo 9. A set of reagents for the preparation of a test for latent blood
After that (and only under conditions the previous stage was successful), we remove the dry instruments from the thermal disinfector and pack them individually or with kits (depending on the type of instrument) in disposable bags that have a test for sterility (photo 10-11). The personnel, who extract the instruments from the thermal disinfector and pack them in disposable bags, are equipped to work with a sterile instrument (disposable gloves and masks).
Photo 10-11. Machine for packaging in sterile disposable bags, instruments packed in sets in disposable packages with a test for sterility
Individually wrapped washed instruments are sterilized in a steam autoclave (photo 12) at a temperature of 134°C. It should be noted that not all autoclaves are created equal. In our clinic we use the autoclave of the highest class MELAG class B +. Such an autoclave makes it possible to provide the highest level of sterilization of the instrument.
In case of unforeseen situations (for example, a sudden power outage), the autoclave will automatically restart for a re-sterilization cycle from the very beginning.
In a special journal, a strict account is taken of the work of autoclaves and examination on sterility (photo 13).
One of the autoclaves and the log book of its work and examination of sterility
The sterile instrument is placed for storage in the ultraviolet sterile box in the offices (photo 14). It is worth to note that modern packages allow storing a sterile instrument in a conventional drawer unit for up to six months.
One of the UV isolation wards for storage of a sterile instrument in our clinic
To ensure that each client of the clinic has an individual sterile hand-piece, the dentistry must have a sufficient supply of it. Taking into account that the individual hand-piece of the turbine is a close control and expensive equipment, and, moreover, each sterilization cycle takes at least 2 hours, it requires huge investments in the material and technical facilities of dentistry, and this is what we have in our clinic!
After the doctor has completed work with the patient, the assistant removes the dental engine hand-pieces and delivers them to the special appliance of the latest generation KaVo QUATTRO care PLUS (photo 15-16), where they undergo cleaning of the inner surface to remove residual organic substances (processed / blown by oil). This is necessary for the correct operation of the hand-pieces. At the end of this procedure, the hand-pieces, like the rest of the instrumentation, are packaged in the individual sterile bags and autoclaved.
The latest generation of KaVo QUATTRO care PLUS for cleaning the dental engine hand-pieces and hand-pieces are inside KaVo QUATTRO care PLUS
We use disposable systems of saliva ejectors (a pipe through which saliva is evacuated). The saliva ejector system (saliva ejector pipes) is cleaned with special disinfectants at the end of each working shift. In addition, 2 times a week we perform additional washing of the system with special disinfectants Oratol, MD 55 and OrtoCup, which we leave overnight (photo 16).
The assistant, who comes to work in the morning shift, rinses the entire saliva ejector system with water, thus, removing disinfectant.
Solutions and disinfectants for the cleaning of saliva ejector systems
All working surfaces in the doctor’s office are cleaned with disinfectant after each patient, and the corresponding treatment (washing) of the hands of all the personnel is carried out: the doctor and the assistant (photo 16-17).
Handling technique, a timer and rules for handwash in the offices of the clinic
Both the doctor and the assistant work exclusively in disposable gloves!
UV sterilisation of premises is focused, first of all, on the control of staphylococcal infection. Each office in our clinic is equipped with modern quartz lamps (photo 18) and quartz treated 3 times a day: in the morning (before the beginning of the working shift), in the shift turnover (approximately at lunch time) and at the end of the office operation (in the evening).
Gloves, used piercing and cutting disposable instruments, all materials that are blood stained (cotton swabs, gauze pads, etc.) and other material to be disposed of, are added to special containers (photo 19) and bags, where they are processed with a special disinfectant, and twice per week they are exported in a special container by a specialized (licensed) company for disposal (incineration).
A special container for collecting piercing and cutting instruments in one of the offices of our clinic
Specifically because we treat the entire sterilization procedure with special care, there are situations when we ask patients to wait in order to maintain the entire process of cleaning and disinfection from the beginning to the end (for the same reason, sometimes our customers note a specific odor in the doctor’s office).
We thank our customers for their understanding!
The logical continuation of our efforts in the field of cleanliness was gaining the honorable status “Clean hospital, safe for the patient” by our clinic on 26 April 2016 (ссылка сюда: https://stomatologia.com.ua/klinika-dubnovoji-stomatologiya-chistij-likarnya-bezpechna-dlya-paciyenta.html),which confirms the exemplary level of compliance with sanitary and hygienic standards in our medical institution.