Essential cleaning

Although the cleaning and  sterilisation of instruments is not considered the most exciting aspect of a dental practice’s work, it is one of the most important, since the inability to adequately clean and sterilise instruments should in theory cause the closure of the practice. According to the CQC, over 10 per cent of practices inspected during the first year of regulation failed to comply with Department of Health guidance, with some practices disregarding even the most basic levels of hygiene and cleanliness.

With the increasing visibility of compliance, practices not only face the real possibility of having to close their doors but also have to consider the impact of the negative publicity caused by a poor CQC inspection. However, most of the infection control guidance is relatively easy to follow, given the right cleaning products and systems.

The cleaning of soiled dental instruments prior to sterilisation is the first essential part of the daily routine in order to reduce the risk of transmission of infectious agents and to remain compliant with HTM 01-05 or other local regulations. The detergents used to clean instruments in practice contain surfactant molecules that have two important components: one end of the molecule repels water (hydrophobic), while the other end attracts water (hydrophilic). When these molecules come into contact with soiled instruments, the hydrophobic end becomes attracted to the soil and surrounds it, whilst the hydrophilic end draws in the solution. This soil is suspended, by the right blend of surfactants and other cleaning components, preventing re-deposition on the cleaned surface. One of the challenges faced by many practices when cleaning instruments is having the ability to clean them quickly after use. As we all know from our own domestic experiences, if soiled equipment is allowed to dry out prior to washing, any remaining material can become difficult to remove. The same is true of the residual protein left on instruments after use in the surgery, the longer instruments are left before cleaning, the more difficult the process is. However, depending on the size of the practice and number of surgeries, it is not always possible to clean instruments immediately and this can make the removal of contamination extremely difficult. A further problem is highlighted by the fact that oral tissues contain salts that can both discolour and cause instruments to rust, thereby increasing the likelihood of mechanical failure.