Sterilization

Is Your Dental Clinic HIV-, Hepatitis-Proof?

Keeping an eagle eye on the sterilization process at the dental clinics can save you from fatal diseases like HIV/AIDS and Hepatitis. Instruments not properly sterilized can well be a source of life-threatening infections,writes Dr Sandeep Sharma, Senior Consultant, Axiss Dental, India’s leading multi-specialty chain of dental clinics

HIV/AIDS or Hepatitis — by the time people know the disease has gripped them it is too late. Both the diseases exhibit first signs five years down the line from when the person gets afflicted, mostly. It is too long a time to forget what actually caused it. Among the many possibilities could be the visit to the dentist. Well, maybe.

Dental clinics are a place where chances of acquiring HIV/AIDS and Hepatitis are very high. The instruments that are used are potential weapons to transmit the disease, if not properly sterilized. A place you visit for ensuring good oral health might just leave you with deadly HIV or Hepatitis, putting your life at major risk

HIV/AIDS and Hepatitis – both the diseases are slow killers. The pain is not just physical, but also psychological and mental, that puts huge pressure on the bearer of the disease. Battling the HIV stigma is far more traumatic than the disease itself, given the big social taboo it is considered in India.

The first case of AIDS was reported in 1986 in the country, and as per National AIDS Control Organisation (NACO), an estimated 1.48 lakh people died of AIDS-related causes in India in 2011. Likewise, World Health Organisation (WHO) estimates that around 2.4 lakh people succumb to Hepatitis B virus-related complications annually in the country.

Going by the figures, the situation pertaining to the two diseases is grim. Apart from curing the person, a lot of attention needs to be laid on prevention of transmission of the disease from the carriers of HIV and Hepatitis virus. Healthcare facilities, including dental clinics, where various instruments and equipment come into personal contact with patients make high-risk zones for spread of the diseases.

These are the places which demand special care to ward off infection transmission. Of the other healthcare facilities, dental clinics too have high prevalence of patient-to-equipment contacts. Sterilization of equipment and instruments thus gains a lot of importance at the clinics to keep infections at bay from cross-contaminating.

In India, when unorganized dental players rule 97% share of the dental market, to have a common guideline on sterilization is no less than a challenge. In the present scenario, having organised dental set-ups therefore becomes important, which could follow measures that are aimed at limiting cross-contaminations. Till the time India’s dental space is unorganized, dental chains could actively engage in processes that can minimize the chances of infection transmission.

    • Take stock of patients’ detailed health history: Prior to beginning the screening of patients, the first and foremost thing should be to take down the minutest details of patients’ health history. Knowing the patients’ health condition allows for taking extra caution in handling the patient as well as the medical instruments, post the dental treatment.
    • Sterilize instruments as per the category of instruments: The best way to achieve optimum result for sterilization and disinfection is by sticking to the process as per the usage of the instruments which are categorized in three criteria:
    • Critical instruments: These equipment penetrate tissues and come in contact with blood streams. It is highly critical to sterilize them after every use via autoclaving (steam heating),  dry heat or heat/chemical vapour. Critical instruments include forceps, scalpels, bone chisels, scalers and surgical burs.
    • Semi-critical instruments: Though these instruments, like mirrors, reusable impression trays, do not pierce through the tissues, they come in contact with the non-intact skin and so are a possible source of infections. They too need to be sterilized. However, instruments which cannot be sterilized should be exposed to high-level disinfectants to contain spread of infections.
    • Non-critical instruments: These equipment are not at high risk of transmitting infections as they barely come in contact with non-intact skin. X-ray heads, pulse oximeters, blood pressure cuffs, all these non-critical instruments should, however, be cleaned with disinfectants.
    • Pack instruments when not in use: Once sterilized, all the instruments should be packed in pouches and stored in UV chambers to avoid them from getting infected. The appropriate step is to open the pouches in front of the patients so that they too are convinced of the sterilization procedure being followed.
    • Use of maximum amount of disposables: Dental clinics should not reuse instruments which can be disposed of after a use. Needles, cartridges, glasses, drapes, gloves, among others should be dumped after a single usage. The more disposables are used the less are the chances of cross-contamination among patients.
    • Spore testing for optimum sterilization: Sometimes the autoclaves do not work properly, rendering the whole sterilization procedure fruitless. This also increases the chances of cross-contamination and spread of infections. Dental clinics must opt for spore testing to identify whether their autoclaves are working properly or not.

What is spore testing?

Under spore testing, living spores are run through an autoclave cycle, which is then sent to the laboratory that attempts to incubate it. If during the procedure, any spore is alive, it implies that autoclave has failed to achieve sterility. A properly working autoclave has the ability to kill pathogenic organisms, including HIV and Hepatitis. Dental clinics should every few months get their autoclaves checked through spore testing.

  • Spread word on sterilization: Dental clinics should spread awareness on sterilization procedures to the patients and provide them a quick yet thorough look of the process being followed. It is the duty of the healthcare providers to empower the patients about things which have high impact on their lives. Also while seeing a dentist, it is of utmost importance for patients to enquire about the sterilization process.

There is no denying the fact that –Prevention is better than cure’. If dental clinics in India start following the saying in letter and spirit by just following the sterilization process seriously, half the battle would be won in the fight against HIV and Hepatitis epidemic.