View source for Hygiene in the dental office

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== Asepsis ==

* a set of precautions and procedures to prevent microbial contamination of the sterile environment (e.g. including the operating theatre)
* disinfection of the hands of the operating team
* sterile clothing of the operating team (gown, gloves, surgical caps, mouth and nose drapes, surgical gowns...)
* patient skin disinfection
* protection of the operating field with sterile drapes
* preparation of sterile instruments and materials for operating tables
* treatment of feeding cords and hoses with sterile cloth sleeves
* disinfection of operating theatre rooms and air disinfection

== Disinfection ==

=== Physical ===
==== Boil in water ====
: atmospheric pressure, exposure 30 minutes, distilled water under pressure (Papin pot principle) - 0.1-0.15 [[MPa]], exposure 20 minutes
: objects - metal, glass, rubber, ceramics, stoneware, porcelain, textiles, thermostable plastics

==== Boil in oil ====
: silicone lubricating oils, 150&nbsp;°C, 30 minutes (!!! steam explosive !!!)
: then centrifugation (removal of excess oil)
: dental handpieces and elbows (must be disassembled and cleaned first)
: turbines - steam sterilisation up to 135&nbsp;°C (contains plastic parts)
: other handpieces - hot air sterilisation up to 180&nbsp;°C (all metal) 
==== Washing and steaming appliances ====
: temperatures above 90&nbsp;°C, follow the procedures specified by the manufacturer
* '''UV radiation'''
: germicidal emitters - direct and indirect irradiation of space for air disinfection
: bactericidal action - wavelength 253.7-264 nm
: only on the surface of objects
: mercury vacuum silicon lamps
: long-term (overnight) exposure
* '''other methods''' 
: filtration, annealing, incineration, pasteurisation (heating to 60-65&nbsp;°C for 30 minutes, then heating to 85-90&nbsp;°C or 134&nbsp;°C for a few seconds and rapid cooling)
: hot air flow in dryers (110&nbsp;°C for 30 minutes)

=== Chemical ===
: solutions or aerosols of chemical disinfectants of a specified concentration
: specified duration of action - spectrum of effectiveness
: often toxic substances (limited concentration only)
* spray disinfection
:foam, aerosol
* disinfection by wiping, washing or immersion in a disinfectant solution for a specified time (usually 30 minutes) or until dry

=== Physico-chemical ===
:simultaneous action of physical and chemical processes
* paraformaldehyde disinfection
* disinfection by boiling - in water, 60&nbsp;°C, disinfectant additive in washing, washing and cleaning machines

'''Substances used for chemical disinfection:'''
* '''inorganic acids''' – HNO3, HCl, H2SO4
: exceptionally for disinfection of glass and porcelain (more in industry and veterinary medicine)
* '''alkalis''' 
: NaOH, KOH 5–10% – cleaning and disinfection of drill bits (they dissolve detritus)
: Ca(OH)2 – wall bleaching, gross disinfection 
* '''organic acids''' – citric, acetic, lactic, benzoic (food preservatives)
* '''peroxyacids''' – peracetic, perpropionic, permravenic - vapours, solutions, aerosols
: wide spectrum of action - microbes including mycobacteria, spores and viruses
: 40% peracetic acid = Persteril
* '''''oxidizing agents''''' 
* '''[[hydrogen peroxide]]'''
: 3% - disinfection of wounds
: 6–10% - periodontal rinsing in periodontology
: 30% - endodontics (Perhydrol) 
* '''potassium manganate''' (hypermanganese) – 0,1–0,3% - mouth rinses, treatment of skin lesions
* '''soaps''' – solid (sodium), oily (potassium) - emulsification and dissolution of fats
: mechanical cleaning of instruments and body surface
: bactericidal action - penetrate the body of microorganisms
: disinfectant soaps - from naphthenic acids, addition of disinfectants (hexachlorophenone) - for surgical hand washing
* '''alcohols''' – degreasing, poultices, sometimes hand disinfection
* '''halogens''' – chlorine and iodine products
* '''chlorine products''' – chlor lime, chloramines, chlorseptol
: salt content HClO - decomposes in water - oxygen in the nascent state
: efficiency decreases rapidly (no longer effective after 60 minutes)
: disinfection of laundry and containers, in powder for sinks, aerosol for air disinfection
: chloroseptol - 0.25-0.5% - hand disinfection, disinfection of rubber gloves and drains
* '''''iodine products'''''
: iodine tincture - 5% alcohol solution
: iodophores - complex compounds, large spectrum of effectiveness, less allergies
:: Iodisol - disinfection of skin and mucous membranes, 1:20 for gargling and mouth rinses
:: Iodonal - surface and coarse disinfection
* '''metal compounds''' – Hg and its compounds, Ag, Sn
* '''mercury''' – inorganic compounds are not used (toxicity)
* '''''organic compounds''''' – less toxic but also less effective
: Famosept Super 
:: 1% solution of phenylhydrargyrum boricum
:: storage of sterile instruments, mucous membrane disinfection, wound flushing, hand disinfection 
* '''aldehydes'''
:wide spectrum of effectiveness - bacteria, fungi, viruses, spores (in sufficient concentration)
:disadvantages - irritation, pungent odour
* '''formaldehyde''' – colourless gas with a characteristic pungent odour
: 36-40% aqueous solution = formalin
: 2-20% - coarse disinfection
: part of instrument storage solutions and surface disinfection solutions
: vapours - disinfection of textiles, plastics, instruments (in closed chambers)
: tablets, gels - for small instrument cartridges (release CH2O gas)
* '''glutaraldehyde''' – 2% – good and rapid effect on vegetative forms of microbes
:longer exposure - even spores
: 3% - also effective against hepatitis virus
: decontamination of endoscopes and other instruments
: 1-2% solution + Na2CO3 - disinfection of fingerprints at 10 minutes exposure (alginates)
* '''cyclic compounds''' – phenolic and cresol preparations, halogen and diphenyl derivatives
: the effect can be increased by combining with alcohol, certain organic compounds, soap
* '''phenol''' – part of instrument storage solutions
: Chlumsky's solution (solutio fenoli comphorata) - disinfectant inserts into root canals, it is used to fill mule drains
* '''''surfactants'''''
:: anioactive (carboxyl soaps, sulphonate detergents)
:: cationic (quaternary ammonium compounds)
:: amphoteric
:: non-ionogenic
: germicidal, non-virucidal and sporocidal
: not to be combined with soaps and strong oxidizing agents
* '''Ajatin''' – quaternary ammonium base with high phenol coefficient
: supplied as a 10% solution and diluted accordingly
: 0.5-1% - surface disinfection of skin, rinses and instrument storage
: Ajatin tincture = 1% alcohol solution
: disinfection of the operating theatre
* '''Septonex'''
: sodium carbonate is often added during chemical disinfection
:: facilitating the penetration of disinfectants into the body of microorganisms
:: speeds up the disinfection process
:: increases the bactericidal effect of soapy water and sublimate in particular
: used in a 2% solution

== Sterilization ==

=== Physical ===
==== Steam sterilization ====
: sterilization with saturated steam under pressure, the most reliable, the most used today
[[File:Melag Autoclave 11.JPG|thumb|289x289px|autoclave]]
* '''Autoclave'''
: pressure boiler with double wall, tight, screw-closable lid
: connected via a pressure reducing valve to the central steam supply or to the steam generating plant itself (for electric or gas heating)
: thermometer, pressure gauge, vent valve
: internal compartment connected to vacuum extraction
: measuring recording device - operation control
: preparation of instruments to be sterilised: 
:: containers and cassettes with perforated walls or lids (the openings are closed with a sliding cuff after sterilisation)
:: Lukasterik - low-pressure polyethylene or paper packaging
:: instruments are sealed or wrapped in it
: operation:
::heating time
:: equilibration time - steam is introduced into the sterilisation compartment with simultaneous air extraction
:: sterilisation (exposure) time - determined for each instrument for the respective pressure and temperature values and for the different materials
:: drying time
: temperature pressure overpressure exposure
°C	kPa	bar	kPa	bar	min
121	205	2,05	105	1,05	20
134	304	3,04	204	2,04	10

==== Hot air sterilisation ====
: exploits the effects of hot dry air at certain parameters
: simplicity of installation and operation
: safe results
: higher temperatures must be achieved
: longer exposure
: instruments:
::metal, glass, porcelain, ceramic, stoneware
::cannot be sterilised - textiles, rubber, pulp (heat damage) 
* Hot air sterilizers - well insulated thermal cabinets with a volume of 30-400 l
: built-in fan for controlled air circulation
: indoor - electric heating (controlled by adjustable thermostat, external control by thermometer located outside the unit)
: temperature - 50-200 °C
: exposure - inversely proportional to temperature
:: dependent on the quality and quantity of sterilised material
:: empirically determined for each type of apparatus
:: includes the time required for instruments to cool down to 80&nbsp;°C
  	
exposure temperature (min)
160&nbsp;°C	60
170&nbsp;°C	30
180&nbsp;°C	20

: mainly used after working hours (time consuming)
: less used today, replaced by autoclaves

==== Radiation sterilisation ====
: uses the effects of ionizing radiation (cold sterilization)
: electromagnetic waves, gamma rays, ultra-hard X-rays
: radiation source = cobalt isotope 60Co
: products may be sealed in plastic packaging
: no need for air extraction
: economically costly
: demanding safety precautions
: mainly in industry - sterilisation of disposable items (needles, syringes...)

==== Sterilisation by plasma ====

=== Chemical ===
:use - sterilization of plastic materials that do not tolerate high temperatures (implant prostheses...)
* formaldehyde sterilization
: formaldehyde in a vacuum device under given parameters, temperature 60-80&nbsp;°C
* ethylene oxide sterilization
:ethylene oxide - in liquid (below 10,7&nbsp;°C) and gaseous form


== Hand hygiene ==
: the hands are the most important agent in the transmission of infection !!!
: microbial flora
:: transient - adheres to surfaces when touching infected objects
:::eliminated by normal handwashing
:: resident (permanent) - deep in the skin, at the mouth of sebaceous and sweat glands
:::only partially eliminated by normal hand washing

=== Hand washing ===
: removal of dirt using liquid soap and water for 30 seconds
: drying - disposable towel
=== Hygienic hand washing ===
: removal of impurities and partly of the transitory flora before surgical hand disinfection
: washing hands including forearms with liquid soap and disinfectant for 1-2 minutes
: alcohol disinfectants, rinse with drinking water
: drying with a sterile towel
: washing hands including forearms with liquid soap without disinfectant 2 x 5 minutes using sterile toothbrush, rinsing with drinking water, drying with sterile towel
=== Hygienic hand disinfection ===
: elimination of transient flora 
: performed after microbial contamination of the hands
: immersion of hands in disinfectant, rinsing with drinking water after a specified time, drying with a sterile drape
: alcohol preparation - rubbed into dry hands for a specified time, do not rinse
: after repeated disinfection, treat hands with regenerating cream
=== Surgical hand disinfection ===
: elimination of transient microflora, blocking of resident flora in the inner layers of the skin
* '''classical procedure''' (surgical hand washing)
: the hands, including the forearms, are washed for 2 × 5 minutes using a sterile brush, rinsed with drinking water during the washing
: drying of the hands with a sterile drape
: washing hands with 70% alcohol for 3 minutes (Sterilium Sagrosept, Deladerm...)
: immersion of the hands for 1 minute in a disinfectant solution (Iodonal, Chloramine...)
: drying with a sterile drape
* '''quick procedure''' (abbreviated hand washing)
: hands including forearms are washed with warm water and soap for 1 minute using a sterile toothbrush, rinsed with potable water and dried with a sterile drape
: immersion of hands in disinfectant solution for 2-3 minutes
: rinsing hands with distilled water
: immersion of the hands in the disinfectant solution again for 2-3 minutes
: drying with a sterile cloth
* '''procedure for the use of alcoholic disinfectants'''
: hygienic washing of hands and forearms with disinfectant liquid soap and water for 1-2 minutes (or use a sterile toothbrush on the nail beds)
:: disinfectant soaps - C40, Triformin Mehaso, Primasept M, Lamyderm...
: dry hands thoroughly with a sterile drape
: treatment with an alcohol disinfectant containing a residual substance recommended for surgical hand disinfection
: the amount of solution recommended by the manufacturer is repeatedly rubbed into the skin of the hands and forearms for a specified time (usually 2 x 2,5 minutes)
: the hands should be kept moist for the entire duration of the application (i.e. 5 minutes)

'''Gloves'''
: necessary to change gloves with each patient (examination, treatment)
:: this is preceded by hygienic hand disinfection
: surgical procedures - surgical hand washing, putting on sterile gloves

== General principles of operational hygiene in dental establishments ==
The dental workplace is a place with a significant risk of infection transmission due to contact of unprotected hands of the doctor with the patient's mouth, inhalation of infectious aerosol, etc.

=== Decontamination of surfaces and environments of surgeries and operating theatres ===
* thorough mechanical cleaning and disinfection
* two-stage
* one-stage – cleaning and disinfecting agents, or combination of disinfectants with detergents (Persteril, Chloramine B - combination with Jar, Pur, Corona, Sapon...)
* disinfectants - effectiveness against bacteria, yeasts, viruses
* '''Surfaces''' – decontamination - wiping with a cloth, rinsing, spraying
** in records - area (section) treated, method of treatment, disinfectant, frequency of decontamination
** painting - once a year outside the facility
** construction work - prohibited during operation
* '''Air'''
** physical methods (ventilation, UV radiation (germicidal lamps), air conditioning...)
** chemical methods (formalin, Persteril) - not recommended - toxicity, irritation, odour 
* '''Extraction equipment'''
** for extraction of saliva, blood, aerosol... + narcosis devices
** flushing hoses and equipment with warm water and detergent after each patient

=== Cleaning ===
* frequency according to the workplace (nature of procedures) – [[Decree of the Ministry of Health of the Czech Republic No. 440/2000 Coll.]].
* daily in all areas, in a humid manner
* rooms for invasive procedures (operating theatres) - before the start of the surgical programme and after each patient
* equipment separately allocated for this purpose only, storage in a designated place
* disinfectants in combination with detergents

=== Treatment of used linen ===
* put used linen into containers made of impermeable materials
* laundry - program adjusted
* thermo-disinfection (washing at 90&nbsp;°C for 10 minutes)
* chemodisinfection (washing with disinfectant)
* drying - minimum 140&nbsp;°C 
* ironing - minimum temperature 150&nbsp;°C
* storage - dedicated areas protected from contamination (mainly aerosols)

=== Waste management ===
* is regulated by the Waste Act No. 125/97 Coll.
* '''specific''' (category N - hazardous waste)
** disposal in incinerators with combustion chamber and flue gas cleaning
** decontamination in approved equipment, then disposal as non-specific waste
* '''non-specific''' (municipal and other waste category O - waste not contaminated with pollutants)
** collect and sort on site into suitable containers - sealable and leak proof
** disposable syringes and needles - dispose of whole without manual separation, after deterioration place in a rigid plastic container - labelled with place of generation and type of waste
** medical waste - disposed of daily
** disposal of amalgam !!! - amalgam separator must be used
*** sedimentation - waste water flows through a multi-chamber vessel with filters made of glass beads or ceramsite (increasing the sedimentation area), efficiency - over 95%
*** centrifugal - in a two-stage system, the heavy amalgam mass is centrifuged and deposited in a collection container, efficiency - 97 %, signalling device (operation, container filling, faults...)
*** dry amalgam waste (surplus, waste after mixing before application), placed in containers with disinfectant solution

=== Hygienic treatment of tools and instruments ===
* all instruments intended for manipulation in the oral cavity must be sterile !!!
* when treating, storing and handling instruments in the office
* '''pre-sterilization preparation''' – removal of microorganisms that have adhered to objects:
** disinfection - immersion in a disinfectant with virucidal activity, observing the specified concentration and exposure time
** mechanical cleaning - water, detergents, soaps, brushes
** rinsing - under running potable water
** drying - a place where there is no risk of airborne contamination
** picking and packing - packing kits and sets, disposable paper, polyamide and combination packaging (+ processor test)
* '''sterilization''' 
** most often sterilisation with hot saturated steam under pressure (autoclaves)
** small capacity sterilizers (Larioclave, Euroclave, Statim, Omega, Instaclave, Faro...)
** shorter exposure time, lower sterilization temperatures → more dentist-friendly. more gentle on dental instruments
** modern equipment - post-sterilization drying - sterilization of packaged instruments, printer output - monitoring of sterilization cycles, digital panels - easy control and monitoring of the cycle
* '''higher degree of disinfection'''
** thermolabile devices, devices with optics (cannot be sterilized at high temperatures)
** decontamination - as pre-sterilization preparation
** disinfection - immersion of the instrument in a virucidal preparation of a given concentration for a given time, rinsing with sterile distilled water
** storage in cassettes or other packaging
** observe aseptic conditions during handling (do not expose to the risk of airborne contamination)
** products - Sekusept forte, Cidex, Gigasept FF, glutaraldehyde + 0.3% NaHCO3...

'''Dental instruments and their treatment:'''
* After use, instruments are immersed in disinfectant tubs and jars with disinfectant solution (usually 2-3%, exposure 30-60 min - depending on the manufacturer).
* Rinsed under running water or mechanically cleaned.
* Re-insert into the disinfectant solution for 15 min.
* Rinse under running water and dry.
* Lubricate the locks of the pliers with oil, sharpen sharp tools, curettes, scalers...
* Wrap them in sterilization bags or cassettes.
The expiration time of instruments in cassettes or tubs is 24 hours, that of instruments stored loose (in a bag) is 6 days. Protected material (in sealed bags) has an expiration time of 12 weeks.

'''Cleaning of preparation handles''':
* immediately after treatment - external disinfection of the end cap
* external cleaning with mule and brush
* disassemble the tip, clean the inside - cleaning and lubricating sprays
* turbines and quick-acting handpieces - after 30 minutes of operation (2-3 times a day)
* normal and reduction handpieces - after 60 min of operation (1 × per day)
* operating test - displacement of excess oil, gradual lowering of the end cap from minimum to maximum operation (5-10 s)
* drills, grinders, root tools
** after use - 10-15 minutes in undiluted disinfectant solution
** rinse under running water
** mechanical cleaning - UZ cleaner, soft brush
** rinse under running water
** drying
** packing in sterilization bags, trays...

== Overview ==
: after decontamination
: strictly observe civil cleanliness in all operating rooms of the dental facilityclean all rooms once a day with water and disinfectant - sanitary cleaning
: wipe equipment and tools with a cloth soaked in disinfectant solution - furniture, chair, unit, at the end and especially at the beginning of the surgery
: removable tips – disinfect, clean, sterilise in a suitable way in the apparatus.
: non-removable tips - mechanically clean, disinfect
: spittoons, sinks, siphons of washbasins to be filled with disinfectant solution or sprinkled with Chloramine or Chlorseptol
: clean the unit, chair and adjacent working environment (suction hoses and hoses to the end-pieces) between patients during surgery hours
: decontaminate used instruments in two steps (pre-disinfection, mechanical cleaning, rinsing, drying, assembling, or packing in sterilisation containers)
: storage of sterile instruments - sealed cassettes, assembly into purpose-made sets sealed in packaging or cassettes
: handling of sterile instruments - they are removed from the cassettes only with sterile feeding forceps - in a quiver with disinfectant solution, administered to the attending on a sterile tray covered with sterile pulp
: sterile forceps are also used to remove drills, root instruments...
: elbows and handpieces (including turbine handpieces) - sterilise in oil sterilisers, change after each use (only surface disinfection is not allowed !!!)
: interaction between doctor, nurse and patient - protection of the patient's clothing with disposable paper or washable drape, disposable plastic water cup, doctor and nurse wearing disposable gloves, use of goggles or face shield, hygienic hand washing
: sterile protective mask and gloves - procedures that violate the integrity of the skin and mucous membranes, communicating with body cavities
: equipment must be individualised for each person
: put away instruments immediately after the procedure
: interweaving with the ethical principles of the protection and treatment regime
: aim - to eliminate or minimise physical and psychological trauma to the patient during medical treatment
<noinclude>

== Links ==
=== References ===
* {{Cite
|type = article
|surname1 =Ďulíková
|name1 = Josefa
|article = Dezinfekce a sterilizace
|journal = Urologie pro praxi
|year = 2004
|volume = 4
|pages = 173-174
|issn = 1803-5299
|url = http://www.solen.cz/pdfs/uro/2004/04/09.pdf}}
</noinclude>

[[Category: Dentistry]]
[[Category: Hygiene]]