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COMPLIANCE OF STERILIZATION AND DISINFECTION PROTOCOLS IN

DENTAL PRACTICE -A REVIEW TO RECONSIDER BASICS

Article · April 2020

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 Available Online at http://www.recentscientific.com
International Journal of
CODEN: IJRSFP (USA)
Recent Scientific
International Journal of Recent Scientific Research Research
Vol. 11, Issue, 04 (B), pp. 38050-38054, April, 2020
ISSN: 0976-3031 DOI: 10.24327/IJRSR
REVIEW ARTICLE
COMPLIANCE OF STERILIZATION AND DISINFECTION PROTOCOLS IN DENTAL
PRACTICE - A REVIEW TO RECONSIDER BASICS
Sanjana Patil, Dr Mohammad Mukhit Kazi, Dr Asawari Shidhore*, Preeti More and Mitali Mohite
Sinhgad Dental College and Hospital Pune
DOI: http://dx.doi.org/10.24327/ijrsr.2020.1104.5232

ARTICLE INFO ABSTRACT

Article History: Microorganisms are ubiquitous. They're found within the surroundings, on inanimate objects and on
th the surface of the physical body. They are the primary source ofinfection and contamination;thus,it
Received 15 January, 2020 becomes mandatory to completely destroy them. This is the primary and foremost objective of
Received in revised form 7th sterilization. Although the mouth is contaminated with pathogenic bacteria, it's important that
February, 2020 dentists exercise measures of disinfection of hands, the sector of operation and therefore the
Accepted 13th March, 2020 instruments used for oral surgical procedures in an attempt to stop cross-infections. All invasive
Published online 28th April, 2020 dental procedures involve contact between a medical device or medical instrument and a patient’s
sterile tissue or mucous membranes. A serious risk of all such procedures is that the introduction of
Key Words: pathogenic microbes that would cause harmful infections. One such is the recently acquired
Biological monitoring, Dental practice, COVID-19 disease infection. Coronavirus disease (COVID-19) is caused by SARS-COV2 and
Disinfection, Infection control, Micro- represents the causative agent of a potentially fatal disease that is of great global public health
organisms, Sterilization concern. Dental care settings invariably carry the risk of 2019-nCoV infection due to the specificity
of its procedures. These risks can be attributed to the unique nature of dental interventions, which
include aerosol generation, handling of sharps, and proximity of the provider to the patient’s
oropharyngeal region. Thus, it is mandatory to follow appropriate infection control protocols by
dental professionals because in appropriate disinfection and sterilization practices can cause a
breach between the host and the infective agent. This review gives us an insight about the basic
practices of sterilisation and disinfection applicable in dental clinics and the need for strict
compliance of these practices in the current COVID-19 scenario.

Copyright © Sanjana Patil et al, 2020, this is an open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is
properly cited.

INTRODUCTION warmth tolerant dental instruments. These include use of

steam struggling (steam autoclave), dry heat or unsaturated
The field of dentistry deals with the various nature of oral chemical vapour. Generally, the time duration of sterilization,
flora which is rich in various aerobic and anaerobic bacteria. its temperatures and other operating parameters should be
Individuals undergoing treatment within the dental office followed as recommended by the equipment’s manufacturer.
could also be asymptomatic or could also be carriers of Additionally, instructions to be used of correct containers,
various diseases.1 The instruments utilized in medical also as wraps and chemical or biological indicators should be
dental field are contaminated with blood, body fluids etc followed.3 Heat sterilization methods (steam autoclave, dry
during clinical procedures, which when cleaned, disinfected heat and unsaturated chemical vapor) are preferred for all
and sterilized by different methods will reduce the equipment which will withstand high temperatures for several
probabilities of infection between patient-dentist, dentist- reasons. Liquid chemical disinfectants/sterilant should be used
patient and between patient-patient.2The definition of only heat will damage an item.4
Sterilisationstates that it is a process wherein all sorts of
microbial flora including bacterial spores are killed. Infection control protocols include all the cleaning and
Furthermore, it's a process by which a piece of writing, a sterilization of reusable dental instruments and devices. Care
surface or medium is freed from all micro-organisms either in must be taken by the dental healthcare professional to make
vegetative or spore form. The definition of Disinfection states sure that each one instruments are cleaned before sterilization,
that it is a process wherein the pathogenic organisms, but not which this is often administered during a safe manner to avoid
necessarily all the micro-organisms or spores are injury and puncture wounds.5,6 The practices of sterilisation
destroyed.1Variety of sterilization methods are available for and dis-infection are the essential components of any infection

*Corresponding author: Dr Asawari Shidhore

Sinhgad Dental College and Hospital Pune
 International Journal of Recent Scientific Research Vol. 11, Issue, 04 (B), pp. 38050-38054, April, 2020

control programme during a healthcare setting. With the Dry Heat Sterilization
utilization of a contaminated device or instrument it can cause
Dry heat is employed to sterilize materials which may be
infection acquisition. Effective and efficient infection control
damaged by moist heat (e.g. burs and certain orthodontic
within the dental office is important for the security of patients
instruments). Although dry heat has the benefits of low
and to make sure that productivity doesn't suffer.7,8
operating costs and being non-corrosive, it's a protracted
In addition, if adequate precautions are not taken, the dental process and therefore the high temperatures required aren't
office can potentially expose patients to cross contamination. suitable surely patient care items and devices with
As the understanding of this novel disease is evolving, it is temperatures starting from 300 degrees F (149 degrees C) and
important for the dental students and professionals to have an upward are often used for sterilization. Dry heat sterilizers
in-depth basic knowledge that should be reinforced and utilized in dentistry include static-air and forced-air types. The
updated regarding the sterilisation and disinfectionpractices. static-air type is usually called an oven-type sterilizer. The
Thus, this literature review was conducted to strengthen the forced-air type is additionally referred to as a rapid heat
fundamentals and protocols of sterilisation and disinfection for transfer sterilizer. At a high velocity, the heated air is
dental practitioners in current COVID-19 scenario and to circulated through the chamber which permits more rapid
assess the extent of monitoring of the same in dental office. transfer of energy from the air to the instruments and thus
reduces the time needed for sterilization as compared to oven-
Sterilization and Disinfection in Dental Clinics
type sterilizer.12
Primary goals of infection control in dental clinic are to lower
Unsaturated chemical vapour sterilization
the danger of contamination by reducing the extent of
pathogens, to correct any break in aseptic technique, to use This method of sterilisation includes heating a chemical
universal precautions with every patient (treat every patient solution of primarily alcohol with formaldehyde under a
and instrument as potentially infective) and to guard patients pressurized chamber. This method of sterilization is ideally
and personnel from occupational infection.9 Use of closed- suited to steel instruments (e.g. dental burs) because the low
system cassettes reduces the danger to dental healthcare level of water present during the cycle leads to less corrosion
professionals when executing infection control programs. than could be expected with steam sterilization. Instruments
Generally, while using sterilizers, washers and ultrasonic must be dry before sterilization. Follow the manufacturer's
cleaners, it is mandatory to always follow the manufacturer’s instructions.12
instructions. It's also important to consult the manufacturer of
Sterilization of Unwrapped Instruments
dental instruments and devices as required to make sure
complete sterilization and to avoid damage to those items.10It An unwrapped sterilization cycle (sometimes called flash-
is recommended that whenone of the several tests are being sterilization) may be a method of sterilizing patient care items
performed for gaining assurance of complete sterility of the for immediate use. Using aseptic technique,the critical and
instrument’s and devices, Moreover, these tests must be semi- critical items that are sterilized unwrapped should be
performed on a routine basis to analyse that the sterilizer transferred immediately to the workplace or storage place. The
isworking appropriately and sterilizing all instruments and unwrapped sterilization cycle in tabletop sterilizers is typically
devices which are then safe to be used on patients.11 pre-programmed by the manufacturer to a selected time and
temperature setting. Thorough cleaning and drying of
Sterilization Methods
instruments precede the unwrapped cycle. Mechanical
Steam Sterilization monitors are checked and chemical indicators are used for
every cycle12
Among sterilization methods, steam sterilization is that the
most generally used for wrapped and unwrapped critical and Other Methods of Sterilization
semi critical items that aren't sensitive to heat and moisture.
Other methods include liquid chemical germicides wherein,
When using an autoclave, the load must be placed in order that
theheat-sensitive critical and semi critical instruments and
steam can circulate freely around each item, because steam
devices are sterilized by immersing them in liquid chemical
must be ready to reach all instrument surfaces at a required
germicides. However, items sterilized during this manner can
temperature and pressure for a specified time so as to kill all
require approximately 12 hours of complete immersion.
microorganisms and achieve sterilization. make certain to
Moreover, these items sterilized during this manner must be
follow the autoclave manufacturer's operating instructions12
rinsed with sterile water to get rid of any toxic or irritating
Autoclave residues, handled using sterile gloves and dried with sterile
towels, delivered to the purpose of use in an aseptic manner
An autoclave may be a self-locking machine that sterilizes
then used immediately12.
with steam struggling, achieved by the heat. Autoclaves are
the universally accepted means for sterilization. it's generally Protocols of Sterilisation and Disinfection
accepted that an autoclave chamber must reach a minimum of
It is recommended that instruments that often penetrate oral
121°C at 15 Psi for a minimum of half-hour to make sure
soft tissue (the mucosa or skin) and even bone must be
adequate sterilization. Sterilization time may vary counting on
sterilized after each use or discarded. These things are termed
the number and density of things within the autoclave
critical items and have the best risk of transmitting infection,
chamber. Overloading must be avoided.12
for e.g. surgical instruments, periodontal knives and scaling
instruments.13 Instruments that aren't intended to penetrate oral
soft tissues or bone (such as amalgam condensers, dental
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Sanjana Patil et al., Compliance of Sterilization and Disinfection Protocols in Dental Practice - A Review To Reconsider Basics

handpieces, mouth mirrors) but are available contact with handling sterile items ready to be used and making sterile
mucous membranes or non-intact skin are termed semi critical transfer to a sterile field.22
items.14These things pose a lower risk of disease transmission;
Regular sterilizer monitoring during a dental office, when
however, because the bulk of semicritical items in dentistry
properly implemented, is a crucial a part of infection control
are heat tolerant, they also should be sterilized after each use.
verification, and includes a mixture of process parameters to
Reusable semi critical items unable to face up to heat (e.g.
gauge the sterilizing conditions and therefore the sterilizer’s
plastic impression trays, amalgam carriers, plastic
effectiveness. Biological monitoring is that the standard for
instruments) should be processed with high-level disinfection.
assuring proper sterilization of dental instruments. Both the
Non-critical patient-care items that are available contact with
Centre’s for Disease Control and Prevention (CDC) and
unbroken skin (e.g. radiograph head/cone, vital sign cuff,
American Dental Association (ADA) recommends that dental
facebow, pulse oximeter) in many cases need cleaning, or if
offices monitor sterilizers a minimum of weekly with
visibly soiled then cleaning followed by disinfection is
biological indicators.2
adequate (low level disinfection).15,16 If a non-critical item is
spattered with blood or touched with a contaminated glove or Biological Indicators–The standard for assuring proper
hand, it should be cleaned and disinfected. Non-critical items sterilization of dental instruments is Biological monitoring.
also can be protected with barriers. If contamination does Biological test strips with non-pathogenic bacterial spores are
occur, just remove the barrier and throw it away. Disinfection placed within the sterilizer and processed with a traditional
isn't necessary. load. If a sterilizer is working properly, the spores shouldn't
survive the sterilization process. To verify effective
Instrument and Area Sterilization
sterilization, the test strips are cultured to work out if the
The Instrument sterilization cycle begins with cleaning. Debris spores exhibit any growth. it's done by placing a test strip
like blood or saliva must be completely far away from the within the sterilizer consistent with the sterilizer
instruments, since it prevents the sterilization agent (steam or manufacturer’s instructions. If there are not any instructions, a
unsaturated chemical vapour) from contacting the instrument strip should be placed within a wrapped set of instruments
surface to kill any micro-organisms present.17 The foremost within the most difficult area to be sterilized, normally the
common methods for cleaning instruments are the utilization lower front area of the sterilizer.23 It’s an honest practice to put
of an ultrasonic cleaner or an automatic instrument washer. the spore test strip during a different location of the sterilizer
Hand scrubbing of instruments is discouraged since it presents hebdomadally to assist identify any “cold spots” within the
a risk of injury to dental health care workers from punctures sterilizer. Positive assurance that sterilization conditions are
during handling and from spatter of debris from the achieved are often obtained only through a biologic control
instruments. The sterilization area is split into three zones test. The biologic indicator detects non-sterilizing conditions
which be due dirty to sterile.18,19,20 within the sterilizer. A biologic indicator may be a preparation
of living spores immune to the sterilizing agent. These are
The Dirty Zone: this is often where the used dental
generally supplied during a self-contained systemin dry spore
instruments are located. These instruments have potentially
strips or discs in envelopes, or sealed vials or ampoules of
been exposed to blood or body fluids. Infectious waste
spores to be sterilized and an impact that's not sterilized.24
containers also are found during this area.
Chemical indicators- A chemical indicator on a package
The Disinfected Zone: this area is where items which have
verifies exposure to a sterilization process. An indicator
undergone a disinfection technique that kills most micro-
should be clearly visible on the surface of each on-site
organisms are placed.
sterilized package. This helps differentiate sterilized from
The Clean / Sterilized Zone: this is often where items that are unsterilized items. Moreover, it helps in monitoringthe various
through a sterilization process are kept and stored for future physical conditions within the sterilizer to alert personnel if
use. the method has been inadequate. A chemical indicator can
detect sterilizer malfunction or human error in packaging or
The central processing areas ideally should be divided into a
loading the sterilizer. If a reaction on the indicator doesn't
minimum of three areas: decontamination, packaging, and
show expected results, the item shouldn't be used. Several
sterilization and storage. Physical barriers should separate the
sorts of chemical indicators are available: Tape, labels, and
decontamination area from the opposite sections to contain
paper strips printed with an ink that changes colour when
contamination on used items18
exposed to at least one or more process parameters.23
Monitoring of routine sterilization
Physical indicators–Various parameters which include cycle
Monitoring of the sterilization process is important and time, temperature, and pressure are evaluated by checking the
significant to appropriately ensure that instruments and gauges and displays on the sterilizer. Correct readings don’t
supplies are sterile when used. Sterilization procedures should verify sterilization, but incorrect readings can help identify a
be monitored using biological, mechanical, and chemical drag with the sterilization cycle24
indicators.21 Procedures involved in administrative monitoring
are decontaminating, terminally sterilizing, and cleaning all Maintenance of Infection Control
reusable items; removing disposable items, packaging and
Cross-infection generally refers to the transfer of disease from
labelling of things, loading and unloading the
one patient to another within the dental clinic or hospital,
sterilizer,operating the sterilizer, monitoring and maintaining
whereas the transfer of disease to the dentist during dental
records of every cycle, adhering to safety precautions and
treatment is taken into account an occupational exposure to a
preventive maintenance protocol, storing of sterile items,
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 International Journal of Recent Scientific Research Vol. 11, Issue, 04 (B), pp. 38050-38054, April, 2020

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How to cite this article:
Sanjana Patil et al.2020, Compliance of Sterilization and Disinfection Protocols in Dental Practice - A Review To Reconsider
Basics. Int J Recent Sci Res. 11(04), pp. 38050-38054. DOI: http://dx.doi.org/10.24327/ijrsr.2020.1104.5232

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