Sterilization methods and storage rules
Preparation of surgical dental instruments involves several physical and chemical methods. The most common is dry heat sterilization, which is carried out in dry heat ovens. For processing dental handpieces, the steam method in an autoclave is used, while glass bead sterilizers (with glass beads) may be used for small endodontic and surgical instruments. In some cases, the chemical method is applied, in which items are immersed in containers with strong-acting solutions.
Special attention is paid to maintaining sterility after processing is complete. There are several acceptable storage formats:
- On a sterile table: instruments are covered with a sterile sheet, and the required item is retrieved exclusively using dressing forceps.
- In ultraviolet cabinets: special shelves maintain an aseptic environment.
- In packaged form: instruments are sealed in kraft paper pouches using laminating devices.
- Dressing material: is stored in metal drum sterilizers (bixes), which must be labeled with the sterilization date.
Infection safety and PPE
The high-risk infection group includes any procedures involving sharp instruments: scalpels, injection needles, burs, and separation disks. Before starting the appointment, the medical worker must be equipped with personal protective equipment (PPE), including a protective mask, safety glasses or a plastic face shield, and disposable gloves.
Hygienic hand hygiene with soap and running water is mandatory after examining each patient, upon completing any procedure, and after contact with infectious media. If there is a high risk of HIV transmission, all interventions must be performed using double gloves. Their reuse is strictly prohibited, and during work, they must be periodically wiped with 70% ethanol or another antiseptic. Medical personnel with skin lesions (scratches, wounds, weeping dermatitis) are temporarily suspended from clinical work.
Emergency response protocol
In case of a breach of barrier protection means or direct contact with biological fluids, it is necessary to act according to strict protocols.
In case of glove puncture and skin injury:
- Wipe gloves with a disinfectant.
- Remove torn gloves.
- Express blood from the injury site.
- Wash hands with soap under running water.
- Treat the skin with 70% ethanol.
- Apply 5% iodine tincture spot-wise to the wound.
If blood gets on intact skin:
- Immediately (within 30 seconds) wipe the contaminated area with an antiseptic swab. The use of 70% ethanol, 3% chloramine solution, as well as chlorhexidine, actiniderm, or actinesept preparations is permitted.
- Thoroughly wash hands twice with warm water and soap.
- Dry hands thoroughly with a personal towel.
In case of splashes onto mucous membranes:
- Eyes: rinse thoroughly with water or 1% boric acid solution.
- Nasal passages: instill 1% protargol solution.
- Oral cavity: rinse intensively with 70% ethanol, or 0.005% potassium permanganate solution, or 1% boric acid solution.
Impression disinfection and sanitation
Dental impressions act as a hazardous reservoir for pathogenic microflora, making their disinfection a critical prevention step. During manual processing, the impression is first rinsed with running water and then treated with a 2% glutaraldehyde solution. Modern clinics also use automated disinfection, employing devices such as Hygocid (specifically for impressions) or universal systems like Nebucid.
An additional measure to reduce microbial load is patient preparation: a routine mouth rinse with water before the procedure clears the aerosol cloud by 75%, while using special formulations clears it by 98%.
Daily cleaning is carried out in the surgical office itself, along with mandatory general cleaning. Disinfectants are used for this purpose, such as a 1% chloramine solution or a 0.05% septodor solution.
Briefly: answers to topical questions
Which chemical solutions are used for the disinfection of dental impressions?
Various chemical solutions and antiseptic agents are used for the disinfection of dental impressions. These include:
- Glutaraldehyde — 2% solution.
- Chlorhexidine — 0.5% solution.
- MD-520 — an agent containing 50% glutaraldehyde and 50% alkylbenzyldimethylammonium chloride.
- Deoxon — 0.1% solution.
- Hydrogen peroxide — 6% solution.
What are the temperature and time regimens for dry-heat sterilization in a hot-air sterilizer?
The main and several additional temperature-time regimens are used for dry-heat sterilization in a hot-air sterilizer. The following parameters exist:
- Main regimen — temperature of 180 °C for 60 minutes.
- Regimen at 160 °C — sterilization time is 150 minutes.
- Additional regimen — temperature of 180 °C for 40 minutes.
- Additional regimen — temperature of 200 °C for 30 minutes.
Which disinfectant solutions are used for general cleaning in a surgical dental office?
Special chemical disinfectants that provide the required sanitary and epidemiological regimen are used for general cleaning in a surgical dental office. Specifically, the following are used for surface treatment:
- Chloramine — 1% solution is used.
- Septodor — 0.05% solution is used.
This cleaning using the specified solutions must be performed in the office once a week.
What chemical tests are used to monitor the quality of pre-sterilization cleaning (PSC) of instruments for hidden blood?
Quality control of pre-sterilization cleaning (PSC) of instruments for the presence of hidden blood residues is carried out using the following chemical tests:
- Azopiram test — includes azopiram and 3% hydrogen peroxide solution in a 1:1 ratio.
- Amidopyrine test — consists of alcohol, amidopyrine, 3% hydrogen peroxide solution, and 30% acetic acid.
A positive result indicating the presence of blood is the appearance of a blue-violet coloration.
The algorithm for blood contact with mucous membranes can be remembered by the first letters: Eyes — Boric acid (1%), Nose — Protargol (1%), Mouth — Alcohol (70%).
Class and exam questions
How should sterile dressing materials be stored?
After autoclaving, dressing materials must be stored exclusively in metal drums (bixes), which must bear a label indicating the date of sterilization.
What to do if the patient turns out to be HIV-positive and the doctor accidentally pricks themselves with a needle?
In addition to local wound care, it is necessary to immediately start antiretroviral drugs for post-exposure prophylaxis, register at the AIDS center for follow-up for 12 months, and undergo blood testing at 3, 6, and 12 months.
How to properly retrieve instruments from a sterile table?
Instruments are kept under a special sterile sheet. Lifting this sheet and taking the required item is permitted only using special holders — surgical forceps (councils).
What else to study on this topic
- Chemical method of sterilization: concentrations and types of potent antiseptics
- Operating principles and design of glass bead sterilizers
- Hardware disinfection systems: technical features of Hygodjet and Nebucid devices
- Regimens of specific antiretroviral therapy for post-exposure prophylaxis
- Organization and algorithms for general cleaning of the surgical dental office
Master the entire topic in the course "Surgical Dentistry"
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Asepsis and Antisepsis in Oral Surgery" and 866 more pages on the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 28 video lessons on the subject
Other topics in "Chapter 2. Organization and Equipment of the Dental Surgery Office (M.M. Pozharitskaya)"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.