Cleaning and Sterilising

THE FIRST RULE FOR TREATMENT: STAY CLEAN!

No matter what problem you are treating, be sure that your workplace, your instruments, and you are always clean. For example, prevent infection by always washing your hands before you examine or treat someone.

Wash your hands in front of the person, in the same room. You will show that you are a careful and caring health worker. Also, you will demonstrate just how important cleanliness really is.

The mouth is a natural home for germs. They usually do not cause problems because the body is used to them. In fact, many germs are helpful. For example, when we eat, some germs break down chewed food into parts small enough for the body to use.

There are problems when the number of these ordinary germs increases greatly, or when strange, harmful germs come into a healthy body from outside. Fever and swelling follow. It is an infection.

When we regularly clean the mouth, the number of germs stays normal. You can teach others to clean teeth and gums, but cleaning is each person's responsibility.

However, dental workers have one serious responsibility. You must not spread germs from a sick person to a healthy person. You must do everything you can to make sure your instruments are clean.

Germs hide inside bits of old food, cement, or blood on an instrument. There they can continue to live, even in boiling water.

This is why you must be sure to scrub the working end of each instrument carefully with soap and water. Rinse, and then look carefully to see that it is clean and shiny.

Remember that 'clean looking' is not necessarily 'clean'. Truly 'clean' means free of germs. Unless you sterilize, that instrument may still have germs, the kind that cause infection in the next person that it touches.

Sterilizing means killing germs. The best way to sterilize is with heat. High heat kills almost all harmful germs-especially those that cause hepatitis, tetanus, and mouth infections. Wet heat (steam) is always more effective than dry heat from an oven.

Here is a simple rule to use in deciding when to sterilize:

Boil any instrument that has touched blood.

That means always sterilize with steam all syringes, needles, and instruments you use when scaling teeth (Chapter 8) or when taking out a tooth (Chapter 11).

Instruments left in boiling water need 30 minutes to become sterile. A pot with a cover to trap the steam can act faster. The inside becomes hotter and 20 minutes is enough. But remember that water can rust metal instruments. To prevent rust:

• Add 5 spoonfuls (20 ml.) of oil to every litre of water you boil.
• Then lay the hot instruments on a dry, clean (sterile, if possible) cloth, so the water can evaporate.

Never put an instrument away while it is wet.

Be safe: When in doubt, sterilize!

Sterilizing with steam under pressure is the fastest and surest method. It kills harmful germs in 15 minutes. You need a strong pot with a tight fitting lid. But be sure to make a small hole in the lid so steam can escape when the pressure becomes too great.

A special pot called a pressure cooker is perfect for this. It even has a safety hole on it to release extra steam.

1. Put 2 cups of water and 2 spoonfuls of oil into the pot.

Place the handles together. Put on high heat until a loud hissing noise begins.

3. Put on lower heat. Begin timing now. Leave the hissing pot on the low flame for 15 minutes.

DO NOT LET THE COOKER BOIL DRY!

4. Cool the pot under water, open, and lay the instruments on a clean towel to dry.

The next time you use the pot, you can use the same water that was left inside it.

Sterilizing with heat is not necessary for instruments that do not touch blood. For example, after you examine a person or place a temporary filling, you can clean your instruments and then soak them in a solution of alcohol or bleach.

Alcohol solution

1.  Mix in a large container each week:

7 parts alcohol (95%) and 3 parts clean water. Keep the container tightly covered to prevent evaporation.

2.  Keep a covered pan half filled with this mixture. You will have to add some more of the mixture frcm the large container (#1) to the pan each day.

3.  Leave your clean instruments in the pan, completely covered with the liquid, for 30 minutes.

Bleach (sodium hypochlorite) solution

Find the cheapest brand name in your area for bleach. Examples are Javex, Clorox, Purex, and Cidex. Make 1 litre of solution with a mixture of 1/2 cup (100 ml) of bleach and 3 1/2 cups (900 ml) of clean water.

BLEACH & WATER

Unfortunately, bleach rusts metal instruments. To reduce rust, add 1 large spoonful of baking soda (sodium bicarbonate) to the solution, and leave your instruments in the solution for only 30 minutes

Wipe each instrument with alcohol to remove the film of bleach. Then store it dry inside a clean cloth or in another covered pan.

Change the solution each week.

CLEANING INSTRUMENTS

If your instruments are dirty, they can pass on germs that cause tetanus or hepatitis (see page 172 in Where There Is No Doctor).

Germs on dirty instruments can also go into the socket and start an infection.

Dental instruments must be not only clean, but also sterile. This means they need to be bot!. scrubbed and then boiled before they can be used again. See pages 82 to 85.

Use a brush and clean each instrument with soap and water.

Be careful to scrub away all bits of old dried blood.

Then kill the germs by placing the instruments into a covered pot of boiling water for 20 minutes.

Keep your sterile instruments together in a clean place.

Wrap them in a  clean cloth OR Leave them in disinfectant.

Mark with tape the names of the instruments inside.

Before you use any instrument again, wash it with clean water-to remove the taste of the disinfectant.

Germs living in dirty cotton can easily go inside the socket and start an infection. It is important, therefore, to keep the cut pieces in a container that is clean and has a cover. Use clean tweezers to remove the cotton gauze when you need some.

Also, keep your room and work area clean. Sweep the floor every day, and wipe down the chair and tables as often as possible.

Staying clean is a part of staying healthy.