Risks to staff and patients from poor sterilisation procedures

The infection risk to dental staff and patients from incorrect sterilisation procedures has been highlighted by renowned Swedish infection control expert, Dr Mikael Zimmerman.

Dr Zimmerman was in Australia for the first time as a guest speaker at the Australian Dental Congress in Adelaide thanks to the sponsorship of dental equipment companies, W&H and A-dec Australia. He was also a guest speaker at a private function of dental infection control professionals hosted by A-dec Australia in Sydney on March 1.

Dr Zimmerman is an Associate Professor and former Lecturer Of The Year at the famous Karolinska Institutet in Sweden which each year awards the Nobel Prize for Medicine. He has also performed dental work with AIDS patients in the United States and has worked with other infectious diseases patients in Sweden.

Significantly for dentists, Dr Zimmerman wrote the regulations on infection control for the Swedish Board of Health and assisted in the drafting of the British standards. He is also a member of the steering committee for the European Centre for Disease Control in Stockholm.

Dr Zimmerman told delegates at the Sydney and Adelaide events that even the greatest steriliser can be let down by basic hygiene procedures - especially lack of basic cleaning of instruments prior to sterilising or re-contamination of instruments afterwards by improper handling.

This was because certain heat-stable endotoxins on improperly cleaned surgical instruments could survive the autoclave process - causing severe inflammatory reactions in the immediate postoperative period.

Even greater infection risks were presented by inadequate sterilisation from substandard sterilisers, insufficient vacuum pulses or short sterilisation cycles - especially on small autoclaves.

"The most commonly used sterilisers in clinical dentistry today are not in accordance with the needs and demands of current dental procedures. Only accredited Class B sterilisers can achieve the same level of sterilisation as steriliser units used in hospitals," Dr Zimmerman said.

Apart from the immeasurable health risks and emotional stress posed to patients and staff from inadequate sterilisation procedures, Dr Zimmerman's take-home message is simple: "the lifetime cost of effective infection control is far less than one malpractice suit."

According to Dr Zimmerman, the risk of infectious diseases has never been greater, with viruses being spread rapidly around the world by increased international travel. This has changed the ecology of the diseases so that bacteria and viruses are adapting and becoming more potent and more resistant to antibiotics.

"Increased travelling equals increased risk. For example, index cases of the corona virus or so called SARS epidemic in China and Southeast Asia have been traced back to the same hotel in Hong Kong," Dr Zimmerman said.

Even more concerning was the recent development of antibiotic resistance including Vancomycin-resistant staphylococcus which had set back treatment of the disease by 70 years - not to mention risks from blood borne diseases such as HIV, Hepatitis B and Hepatitis C.

So what does all of this have to do with dental surgeries?

"Without effective antibiotics we can say good bye to modern medical procedures like open heart surgery, organ transplants and dental surgery like dental implants, endodontics and periodontal work," Dr Zimmerman warned.

This called for a 'back to basics' approach to hygiene in the dental clinic to control infection risks to staff and patients alike. "The big question you might ask is 'who is contagious?'. The simple fact is we don't know, so we must take universal precautions and treat every patient as if they are infected."

Dr Zimmerman illustrated his point with the following scenario:

At YOUR OWN next dental appointment: YOU know that the patient before you is an active drug user, infected with HIV, Hepatitis B and Hepatitis C... YOU will be the NEXT patient in the same chair.... Will you sit down comfortably?

Fortunately with the right equipment and procedures, Dr Zimmerman said infection risks in dental clinics can be controlled. "Studies from around the world show moist heat in the form of saturated steam under pressure is by far the most reliable medium known for the destruction of all forms of microbial life.

"Simply put, steam sterilization using a Class B vacuum steriliser is the most economical and effective method for sterilization. However, the equipment must be used properly - including pre-cleaning and wrapping of instruments, sufficient vacuum pulses to a predetermined level, and the autoclave must be regularly monitored for effectiveness."

Keith Mentiplay, General Manager of dental supply company, A-dec Australia, said A-dec will once again run a series of infection control seminars with Australian dentists following Dr Zimmerman's presentations at this year's Australian Dental Congress.

"We are most concerned that some brands of sterilisers can be used on a 'flash cycle' to save time. We would encourage all clinic staff to use the longest cycle on older and non-Class B autoclaves or better still, use only properly accredited Class B sterilisers in their practices."

A-dec exclusively supplies W&H 'Lisa' sterilisers which are designed to perform only at the full Class B cycle - ensuring effective sterilisation of all instruments including porous loads, hollow handpieces and dental turbines.