Practice abstract
British Dental Journal 203, 395 - 401 (2007)
Published online: 13 October 2007 | doi:10.1038/bdj.2007.893
Subject Categories: Cross infection control | Infection control
Cleanability of dental instruments – implications of residual protein and risks from Creutzfeldt-Jakob disease
J. T. Walker1, J. Dickinson2, J. M. Sutton3, N. D. H. Raven4 & P. D. Marsh5
- Dental instruments such as endodontic reamers that are difficult to clean and should be considered as single use.
- Manual cleaning of dental instruments has a risk of puncture wounds, lacerations and cuts.
- Ultrasonic cleaners clean well, but the ultrasonic solution can become contaminated with debris.
- Washer disinfectors provide fully automated and validated cleaning but have yet to be taken up in large numbers of dental practices.
- Detailed cleaning instructions are required from instrument and washer disinfector manufacturers.
Abstract
Cleaning of dental instruments is the first line of control in reducing the adherent bioburden. The threat of vCJD and the difficulty in removing prion protein has provided a new challenge for cleaning surgical and dental instruments. Prion proteins are also more resistant to many disinfection and sterilisation techniques. A number of different methods are currently available in primary care for cleaning instruments including manual washing, ultrasonic cleaners and washer disinfectors. Manual cleaning of dental instruments is time-consuming, introduces operator error and the risk of puncture wounds, is not reproducible and does not completely remove debris from instruments. Ultrasonic baths are significantly more effective than hand cleaning alone and are currently used by the majority of dental surgeries (often as an adjunct to manual cleaning). Automated washer-disinfectors appear to provide a validated, reliable and reproducible procedure for disinfection and sterilisation of dental instruments to ensure both the safety of patients and dental staff. Dental instruments that are difficult to clean are frequently contaminated with tissue debris after routine reprocessing and cannot be excluded as a potential transmission risk for infectious agents, including prions. The transmission of vCJD via dentistry is considered to be low risk, however, the Department of Health (DoH) has recently advised dentists to ensure that endodontic reamers and files are treated as single-use as a precautionary basis in order to further reduce any risk of vCJD transmission.
- HPA Centre for Emergency Preparedness and Response, Porton Down, Salisbury, SP4 0JG
- HPA Centre for Emergency Preparedness and Response, Porton Down, Salisbury, SP4 0JG
- HPA Centre for Emergency Preparedness and Response, Porton Down, Salisbury, SP4 0JG
- HPA Centre for Emergency Preparedness and Response, Porton Down, Salisbury, SP4 0JG
- HPA Centre for Emergency Preparedness and Response, Porton Down, Salisbury, SP4 0JG; Leeds Dental Institute, Leeds, LS2 9LU
Correspondence to: J. T. Walker1 e-mail: jimmy.walker@hpa.org.uk
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