The importance of cleaning of re-usable instruments prior to sterilization has been re-emphasised by the emergence of prion diseases. No detailed information on the methods of cleaning used by dental practices is currently available.
Objectives: To assess, against current standards, the cleaning methods presently used during the decontamination cycle in primary dental care in Scotland, in order to inform the development of a framework for change to reduce the potential risks associated with decontamination of re-usable instruments in primary care.
Methods: A large-scale observational study of decontamination procedures in Scottish dental practice was undertaken. As part of the study, trained surveyors recorded data on the methods used for cleaning re-usable instruments and viewed directly the processes undertaken
Results: Data were available from 179 dental surgeries. Virtually all cleaning of re-usable instruments was undertaken by dental nurses. Most surgeries (96%) used manual washing as the sole method (6%) or in combination with ultrasonic cleaning (92%). No surgeries used a washer disinfector. The majority of surgeries did not have a dedicated sink for instrument cleaning (57%) and in general the manual washing process was poorly controlled, with 41% of surgeries using no cleaning agent other than water. Most staff undertaking manual washing wore gloves (99%) but many (51%) did not use eye protection. Most surgeries (92%) had access to an ultrasonic bath, but often the solution was not changed frequently enough (80%) nor was the efficacy of the ultrasonic generator checked (96%). Handpieces were generally cleaned either by wiping the external surface with a cloth (66%) or scrubbed manually (31%).
Conclusion: The survey has highlighted that the cleaning of re-usable instruments in general dental practice is poorly controlled, with significant health and safety risks for staff. Improvements to instrument cleaning procedures must be a priority.
Funded by Scottish Executive Health Department.