Transmission of infection in a dental clinic setting is rare, particularly when guidelines are followed, but it can happen. Much depends on the sterilisation procedures put in place in the clinic, whether staff members are adequately trained to follow guidelines, and potential DHCP (dental health care personnel) breaches of infection prevention procedures.
Proper handpiece maintenance procedures are paramount in ensuring patient safety, as these instruments are widely used in everyday settings. Sterilisation and cleaning processes will destroy all present microorganisms, which prevents disease transmission between patients and staff.
Critical Instruments and Sterility
Medical devices such as dental handpieces are considered critical items, as they are in frequent contact with fluids and/or body tissues during procedures. Other critical instruments include bone chisels, forceps, scalpels and dental burs.
Sterilisation of dental handpieces is achieved through a multi-step maintenance process, which can be quickly summarised:
Clean and flush. Using a soft brush and neutral detergents, remove all obvious signs of debris. It is important that visible debris is fully removed, as it will otherwise interfere with disinfection and the microbial inactivation process. Flush the handpiece thoroughly following this process.
Cleaning fibre optics. Using a cotton tip, you can remove oil and debris remnants in the optics.
Lubrication. Apply a lubricant after each and every cleaning cycle to optimise performance. Take care that the lubricant does not interfere with the sterilisation process. Replace deionised water in your steam steriliser weekly, as an example. Automatic over manual systems are advised, as the lower oil dosing rates are generally safer.
Sterilisation. Following manufacturer guidelines to the letter, and ensuring the use of an autoclave steam steriliser. Steam sterilisation is the most effective cleaning procedure for heat-resistant instruments, and has the highest margin of safety. Allow the handpiece to dry naturally and fully before the next use.
Of course, the definition of sterile is not absolute. It is simply a measure of the probability of sterility, based on the item, risk and sterilisation method. In an industry setting, this is usually marked as the sterility assurance level (SAL). This is the existing probability of the presence of a viable single microorganism on an item following a strict sterilisation procedure.
Debate still exists about the most effective decontamination process for dental handpieces. However, generally speaking, most experts agree that an effective cleaning and subsequent processing using a steam steriliser is an acceptable process for general dental procedures.
Implementing Effective Infection Control
Ensuring your practice has effective infection control procedures in place includes not only handpiece maintenance but an overarching strategy and understanding of the transmission of bacteria, fungi and viruses.
Successful dental practice infection control involves the following:
Having an in-depth understanding of the principles of transmission.
Creating effective systems for your dental practice, including the maintenance of dental handpieces according to ADA (Australian Dental Association) and manufacturer guidelines.
Following the latest information on infectious diseases, e.g. avian and human influenza outbreaks or multiple resistant organisms. This will allow your practice to implement additional precautions, should they be necessary.
Ensuring modified procedures according to the setting, e.g. in a nursing home or portable dental clinic.
Case Study: Transmission of Pathogens in Dental Care Clinic, West Virginia
Perhaps the most impactful method to highlight the importance of handpiece maintenance is not simply covering the theoretical basis, but illustrating an example where this did not happen and the resultant transmission of infection.
In 2003, the Centers for Disease Control and Prevention in the United States published a set of guidelines for infection prevention in dental healthcare settings. Since then, infection transmission rates have markedly decreased. In the last twenty years, the CDC has reported just three (3) instances of transmission of HCV and HBV, for example.
In 2009, however, a 2-day portable dental clinic in West Virginia witnessed the outbreak of 5 acute HBV infections. All infected patients received treatment, including extractions, restorations, and dental prophylaxis. One of the cases included a DHCP involved in the maintenance of dental equipment during the clinic and reported handling blood-contaminated equipment.
Further, dental handpieces were cleaned with disinfectant wipes but did not go through a heat-sterilisation process, as per existing guidelines. Volunteers involved in the dental health clinic were also not given proper training about BBVs.
This unfortunate incident highlights the importance of ensuring sterilisation procedures for dental handpieces are followed to the letter, and that all staff members must be given proper training to ensure patient safety.
In Australia, the ADA (Australian Dental Association), has published similar guidelines for infection control. Dental practitioners are legally bound to comply with these recommendations, ensuring that guidelines are employed in their practices.
The Importance of Training Procedures and Record Keeping
Staff training is an essential part of ensuring effective dental handpiece maintenance. In the first instance, this involves creating clear procedures that all staff members must follow.
Training should also be provided to all staff members on a regular basis, ensuring everyone is kept up-to-date on any potential changes to regulation or outbreaks that require additional procedures.
It is also worth considering providing funding for training off-site. Many organisations exist that provide industry-standard training for dental healthcare professionals. It is an additional cost, but definitely worth considering.
Further, dental practitioners are advised to keep records of the sterilisation process, including maintenance, regular tests of performance (e.g. the steam sterilisation process), and daily steriliser cycle records.
Record-keeping is not just advisable to ensure quality standards are kept, but it is also a legal requirement. The exact records your practice must possess varies depending on your state or territory. In general, records must be kept for a total of seven years before they can be discarded.
Review Handpiece Maintenance Processes
Dental health care professionals are advised to regularly review existing processes, checking whether procedures can be optimised and that standards are maintained when it comes to cleaning and sterilising handpiece equipment.
Handpiece maintenance not only ensures that patients are kept safe from viral, bacterial, and fungal transmission, but also guarantees that instruments perform to an adequate industrial standard. This improves patient outcomes, and in turn customer satisfaction for your dental practice.