13 Jul Behind the Scenes at Thackeray Dental Care

So, you’ve just been for your dental health check and you’ve passed with flying colours. You’re happy, and we’re happy too. We will warmly welcome you again in 6 or 12 months depending on what has been recommended. You’ve now gone home, back to work, shopping or out to paint the town red, but we thought you might like a little bit of insight into what happens here at Thackeray’s after you leave…

We’d like to tell you about how we process reusable dental instruments and how we prepare the surgery ready for the next patient.

At Thackeray Dental Care we pride ourselves on the highest standards of infection control and surgery cleanliness, which comply with our legal guidance and standards.

After seeing a patient in surgery all instruments and waste are cleared into a leak-proof, sealable container and are taken to our decontamination room ready for processing (which I will explain further in a little while).

One of our Dental Nurses will then clean & disinfect the surgery including the dental chair, headrest, over chair light, bracket table, work surfaces, handpiece/aspirator tubing and switches, and sometimes the Dentists face (only kidding 😉). The protective glasses & bib chain which we ask you to wear are also cleaned thoroughly after each patient.

 

The Nurse will then clean their hands by either washing or using disinfectant gel. Then they will prepare the surgery ready for the next patient, getting all the correct instruments and materials out ready for use. While the Nurse is doing this the freshly cleaned Dentist will be busy writing up the patient’s clinical notes on the computer!

Decontamination is the process by which reusable items are rendered safe for further use and for staff to handle. Wherever possible single use items are used within the practice and disposed of immediately after each patient.

^Image above shows a 3in1 tip which the Dentist will use to wash/dry your tooth also an aspirator tip used to remove the excess water/saliva during treatment (a.k.a the hoover). These are examples of single use items we use within the practice.

Decontamination of dental instruments is a complex process that involves several stages, including cleaning, inspection & sterilisation. All of this happens in our separate decontamination room (as mentioned earlier). This room has two zones, ‘Dirty’ and ‘Clean’. Starting in the dirty zone, one of our Dental Nurses will put on a mask, protective glasses, apron and heavy duty gloves. And then the following process will start:

● Firstly the waste is segregated. Any sharp items go into to the yellow sharps container, and cotton wool rolls, gauze, tissues etc. all go into clinical waste bins.

● The instruments are then fully immersed in a solution and scrubbed using a long handled scrubbing brush. They are fully immersed to prevent splashing and the long handled brush is used to help prevent inoculation injury. The solution we use is Gigazyme which is a enzymatic solution which breaks down proteins (aka blood & saliva to name a couple). It is important that the temperature of this solution is below 40 degrees because high temperatures can glue proteins to the instruments.

● The instruments are then rinsed in a separate sink.

● The next step is use of an ultrasonic cleaner. Again the ultrasonic cleaner has a Gigazyme solution in its bath and the instruments are fully immersed. The cycle runs for 6 minutes. The cleaner works by using cavitation bubbles induced by frequency pressure waves to agitate the solution. The agitation produces high forces on contaminants that have adhered to instrument surfaces enabling removal.

● After the 6 minutes the instruments are rinsed and then all instruments are inspected under an illuminated magnifier to confirm they are clean, functional and in good condition. We also check joints, hinges and any serrated surfaces which can be difficult to clean.

● If there is any residual contamination, the instrument will undergo another cycle of scrubbing and ultrasonic cleaning.

● Sterilisation can now occur. All instruments are placed onto trays, so that they are not overlapping or touching, and any hinges are left open eg. Forceps or Scissors etc. The autoclave works by using high pressure saturated steam. The cycle takes around 20 minutes, and must reach a temperature of 134 degrees and hold this temperature for at least 3 minutes. The autoclave prints a log of this out which we have to retain for our records, we also use TST (time, steam, temperature) indicator strips with every cycle which changes colour to confirm correct conditions have been attained.

● Personal protective equipment is removed and disposed of into the clinical waste bin. Protective glasses and heavy duty gloves are disinfected and stay in the dirty zone. Hands are washed using the hand washing only sink.

● The instruments are removed from the autoclave using forceps which clip onto the trays and placed into the clean zone. We then put on a clean pair of nitrile gloves from the box which is in the clean zone. Instruments are then dried using a lint free drying cloth and placed into sterilisation pouches and sealed. Every pouch is date stamped, and if not used within a year will need to be reprocessed as above.

● Instruments are stored in clean dry areas, away from any risk of contamination. Should a pouch become torn or damaged the instrument will not be used and will be processed again as above.

The autoclave is tested on a daily basis and weekly checks are carried out and it is serviced once a year by an engineer. The ultrasonic cleaner is tested weekly and every 3 months a foil efficiency test is carried out. All results are recorded and retained by the practice.

I hope this blog has given you an insight into the steps we take to make your care as safe as possible.

If you would like any further information or have any questions please free to contact me:    jen@thackeray.dental.

Written By Jen Porter
Lead Nurse