Advertisement

Sterilization of dental handpieces

      To the Editor,
      We read with great interest the recent report by Pinto et al.
      • Pinto F.M.
      • Bruna C.Q.
      • Camargo T.C.
      • Marques M.
      • Silva C.B.
      • Sasagawa S.M.
      • et al.
      The practice of disinfection of high-speed handpieces with 70% w/v alcohol: An evaluation.
      The authors correctly point out that dental handpieces should be steam sterilized between patient use and provide evidence that external disinfection of dental handpieces with alcohol is unsafe. However, there is a possibility that readers may wrongly assume that there is an ongoing search for a way to safely disinfect these instruments, when surface disinfection or immersion in disinfectant are not acceptable reprocessing methods for dental handpieces.
      The U.S. Centers for Disease Control and Prevention 2003 guidelines state the following: “Manufacturer's instructions for cleaning, lubrication, and sterilization should be followed closely to ensure both the effectiveness of the process and the longevity of handpieces.”
      • Centers for Disease Control and Prevention
      Guidelines for infection control in dental health-care settings—2003.
      In 2016, further clarification was made,Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high level or surface disinfected. Although these devices are considered semi-critical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.
      • Centers for Disease Control and Prevention
      Summary of infection prevention practices in dental settings: basic expectations for safe care.
      The authors paid meticulous attention to the surface disinfection protocols. However, they neglected to test the internal components when assessing the level of contamination of the disinfected handpiece. Surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection, mainly because their internal complex designs may restrict access to cleaning and sterilization agents.
      • Deshpande A.
      • Smith G.W.
      • Smith A.J.
      Biofouling of surgical power tools during routine use.
      Indeed, after surface disinfection of these dental instruments, the internal turbine mechanism retains blood and saliva, as well as viruses and bacteria.
      • Mills S.E.
      • Kuehne J.C.
      • Bradley Jr, D.V.
      Bacteriological analysis of high-speed handpiece turbines.
      • Epstein J.B.
      • Rea G.
      • Sibau L.
      • Sherlock C.H.
      Assessing viral retention and elimination in rotary dental instruments.
      • Chin J.
      • Miller C.H.
      • Palenik C.J.
      Internal contamination of air-driven low-speed handpieces and attached prophy angles.
      • Herd S.
      • Chin J.
      • Palenik C.J.
      • Ofner S.
      The in vivo contamination of air-driven low-speed handpieces with prophylaxis angles.
      Viable microorganisms could therefore be expelled during subsequent patient treatment, making strict adherence to dental handpiece sterilization a professional imperative.
      Instrument sterilization is a cost-effective, evidence-based practice for patient safety. It is true, however, that contrary to the highest safety standards, compliance with handpiece sterilization remain a major challenge for dental education and professional practice worldwide. In a recent survey (2013-2014) among 207 dentists recently graduated from 43 schools of dentistry in Latin America, only 35% declared that they were trained to sterilize handpieces between patients.
      • Osegueda-Espinosa A.
      • Sánchez-Pérez L.
      • Perea-Pérez B.
      • Labajo-González E.
      • Acosta-Gío A.E.
      Dentists survey on adverse events during their clinical training.

      References

        • Pinto F.M.
        • Bruna C.Q.
        • Camargo T.C.
        • Marques M.
        • Silva C.B.
        • Sasagawa S.M.
        • et al.
        The practice of disinfection of high-speed handpieces with 70% w/v alcohol: An evaluation.
        Am J Infect Control. 2017; 45: e19-22
        • Centers for Disease Control and Prevention
        Guidelines for infection control in dental health-care settings—2003.
        MMWR Recomm Rep. 2003; 52: 1-61
        • Centers for Disease Control and Prevention
        Summary of infection prevention practices in dental settings: basic expectations for safe care.
        2016 (Available at:)
        • Deshpande A.
        • Smith G.W.
        • Smith A.J.
        Biofouling of surgical power tools during routine use.
        J Hosp Infect. 2015; 90: 179-185
        • Mills S.E.
        • Kuehne J.C.
        • Bradley Jr, D.V.
        Bacteriological analysis of high-speed handpiece turbines.
        J Am Dent Assoc. 1993; 124: 59-62
        • Epstein J.B.
        • Rea G.
        • Sibau L.
        • Sherlock C.H.
        Assessing viral retention and elimination in rotary dental instruments.
        J Am Dent Assoc. 1995; 126: 87-92
        • Chin J.
        • Miller C.H.
        • Palenik C.J.
        Internal contamination of air-driven low-speed handpieces and attached prophy angles.
        J Am Dent Assoc. 2006; 137: 1275-1280
        • Herd S.
        • Chin J.
        • Palenik C.J.
        • Ofner S.
        The in vivo contamination of air-driven low-speed handpieces with prophylaxis angles.
        J Am Dent Assoc. 2007; 138: 1360-1365
        • Osegueda-Espinosa A.
        • Sánchez-Pérez L.
        • Perea-Pérez B.
        • Labajo-González E.
        • Acosta-Gío A.E.
        Dentists survey on adverse events during their clinical training.
        J Patient Saf. 2017;

      Linked Article