Autoclaves only sterilise effectively if items are dealt with properly prior to being placed in an autoclave.
Cleaning of instruments is usually the role of the dental nurse and they must protect themselves sufficiently when dealing with the contaminated instruments and items.
Dental Nurse Protection
This list is a guide to what precautionary measures every dental nurse should take when cleaning surgical instruments.
- Thick rubber gloves – to protect from a sharps injury
- Glasses or a visor – to protect the eyes from spatter
- A uniform – this must only be worn in surgery, and also must be washed on a high temperature to minimise clothes becoming contaminated. Nurses may wear a disposable plastic apron while preparing instruments for sterilisation, further reducing the risk of contamination.
- A surgical face mask – to protect the face from splashes.
Prior to Sterilisation
Once sharps and other disposable items have been dealt with correctly, the re-usable instruments must be cleaned.
- Instruments must be scrubbed using soapy water (using washing up liquid for example as this leaves no residue on the instruments), and a brush (which must be possible to autoclave after use).
- All visible traces of blood and saliva are removed.
- Instruments are then placed into an ultrasonic bath or into a washer disinfector machine and are set to work for between 15 and 30 minutes, these pieces of equipment remove more debris than is visible to the human eye, and this is achieved by shaking the instruments in a specific detergent. This process disinfects the instruments.
- Once the instruments have been disinfected in these machines they must be rinsed thoroughly under running water.
- Instruments are then laid out on perforated metal trays and are placed in the autoclave.
Before an autoclave is used each day the operator must carry out several maintenance checks, this includes ensuring all door seals etc are working sufficiently, that the purified water used in the machine is changed daily, and importantly, that one cycle is completed without instruments in the autoclave, and a record is taken of temperature, pressure and the time taken to achieve the required conditions for sterilisation to begin.
When using any equipment in a dental surgery or hospital it is vital that equipment such as autoclaves are checked by a qualified engineer annually, and all maintenance records are kept. They must be used following manufacturer’s instructions and must be included in the practices insurance policy, in case of accident or emergency.
It is possible for dental surgeries and hospitals to buy some pre-sterilised items such as needles, gloves, syringes root canal treatment instruments and scalpels. These pre-sterilised items are sterilised by use of gamma rays which are similar to x-rays but are highly dangerous, there are many regulations in placed for gamma radiation, but this method of sterilisation is not used in dental practices.
