Instrument sterilization in general dental practices in Scotland

Effective sterilization of re-usable instruments is a key element of safe dentistry. Knowledge of the procedures employed is essential if dental practices are to function as local decontamination units. Objective: To assess, against current standards, the instrument sterilization procedures used by Scottish general dental practitioners. Methods: An observational survey of decontamination procedures in Scottish general dental practice was undertaken. As part of this study, a specific data acquisition tool was used by trained surveyors to record the equipment available for sterilizing cleaned instruments, the procedures used and the relevant quality control documentation. Results: Data were available from 179 surgeries. Most practices (88%) used a bowl and instrument (B&I) sterilizer, but 11% had a vacuum sterilizer. Overall, 51% of the sterilizers were tested on installation and 26% were commissioned. Little documentation was available to indicate whether daily, weekly and quarterly testing were undertaken. Many surgeries (65%) did not undertake sterilizer testing at the beginning of each day, but 39% used integrating chemical indicators in at least some loads. A maintenance contract was held for 90% of sterilizers. Pressure vessel insurance was available for 79% of B&I sterilizers and 60% of vacuum sterilizers. Written instructions for sterilizer use were available in 39% of practices and only 33% of practices maintained records of user checks on the sterilizer. More than 65% of practices used purified or distilled water in the sterilizer. The reservoir water was changed daily by 37% of practices, weekly by 29% and less frequently by the remainder. The reservoir water was never changed in 19% of practices. Packaging prior to sterilization was undertaken by 28% of practices operating B&I sterilizers. Conclusion: The survey has highlighted key deficiencies in sterilizer use in dental practice. Many of these issues can be resolved by inexpensive procedural changes. Funded by Scottish Executive Health Department.