Hygiene and sterilisation

Highly technological sterilisation room in Forte dei Marmi

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Hygiene and sterility are the watchwords at Versilia Dental Institute.

Caring for the needs of each patient with passion and commitment: this is what we all expect from a healthcare professional, and even more so from a dentist. Therefore, if you are looking for a place where the future is already present, where cutting-edge techniques are part of daily routine, and where patient consideration is genuinely a top priority, then look no further than the Versilia Dental Institute run by Dr Francesco Ciucci, just a stone's throw from the centre of Forte dei Marmi.

The Institute represents the most modern and rigorous facility in Italy in terms of adopting protocols for the sanitisation of operating environments and sterilisation of instruments. "For us, it is crucial that every clinical action on the patient, from the visit to the procedures, is carried out in adherence to strict guidelines to minimise risks," explains Dr Ciucci, the founder and head of the facility. "That is why I have also sought the advice of an infection specialist, Dr Antonella Vincenti."

In addition to the dental hygiene room, with a dedicated hygienist, we have the operating rooms (equipped with air purifiers), one for check-ups and fillings, a surgical room for major procedures, where two assistants work and where we conduct strict intraoperative monitoring, and a room for prosthetic management, featuring a laboratory bench that allows us to prepare prosthetics on the spot if necessary.

But the pride of the facility is undoubtedly the instrument sterilisation room, with three bespoke machines, where the material, traceable, is each time sealed in sterile kits. Of significant importance is also the use of the operating microscope, which, due to its strong magnification capabilities, enables long-lasting interventions, prevents recurrences, and allows for thorough prevention by addressing even the slightest imperfections in the tooth before they become serious issues (T.C.). Additionally, to reduce the introduction of dirt carried by footwear, each patient is given shoe covers during their brief wait in the waiting room, which also has an air purifier. A crucial part of every clinical procedure at Versilia Dental Institute is washing hands not just with soap but using specific disinfectants.

Each patient can see the care we take in managing sterility and the sterilisation of every instrument they will come into contact with. The area dedicated to instrument sterilisation, the sterilisation room, is visible, so patients can see it as they walk down the corridor. Moreover, the Institute uses a sterilisation log and a reference code for the sterilisation of instruments used in each individual treatment for greater meticulousness.

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Protocols for preparing environments

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The practice is disinfected with bactericidal, fungicidal, tuberculocidal, and virucidal solutions.

Every surface that is touched is covered with disposable protections which are removed at the end of each session, the area is disinfected, and new protections are put in place.

Rotating instruments such as drills are used for single treatments and then sterilised and sealed; indeed, we have numerous drills that allow us to always have them ready, sealed, and sterile. Drill covers are also replaced after each treatment. All instruments used are sealed and sterile.

Path of used instruments and sterilisation room

As previously mentioned, at the end of each session, the assistant removes all used or touched instruments and takes them to a designated room for the disinfection and sterilisation procedure, known as the sterilisation room. The practice is then sanitised and disinfected as described.

The sterilisation room is divided into three zones:

Zone for infected instruments;
Zone for disinfection;
Sterile zone.

By maintaining this order, sterile instruments follow a path ensuring that clean instruments never come into contact with infected ones.

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1. Instruments are first decontaminated by immersing them for a minimum of 10 minutes in a solution of water and peracetic acid (also used for surgical instruments in hospitals).
2. They are then rinsed and manually cleaned.
3. They are subsequently dried and given a final check before being sealed and placed in the autoclave. The instruments are now ready to be sealed and put into the autoclave where actual sterilisation occurs.

We use Class B autoclaves, i.e., steam sterilizers compliant with European standard UNI EN 13060, following the sterilisation activity guidelines: collective protection in healthcare facilities (July 2005) published by ISPESL. Once the autoclave has completed its cycle, each bag is stamped with the sterilisation date. We leave no detail overlooked, as our priority is to ensure a safe environment for the patient, which can only be achieved by performing periodic tests to verify the effectiveness of sterilisation. All tests are dated, signed, and archived annually. Each autoclave cycle includes three tests that guarantee the load is completely sterile:

The first test involves the autoclave producing a printout indicating that the cycle has been completed correctly, showing parameters of cycle time (20 minutes), temperature (135°C of steam), and pressure (2 atmospheres) for each sterilisation cycle.
The second test consists of process indicators printed on the bags used for sealing the instruments, which change from pink to brown and are checked after each sterilisation cycle.

At the beginning of each week, a Vacuum Test is performed to check the autoclave’s vacuum integrity, essential for sterilisation. At the end of the test, the machine provides a report with the results which are then archived in a dedicated register. Once a month, there are two additional checks: the Bowie&Dick and Helix Tests.
The Bowie&Dick Test involves a package containing sheets (simulating a porous load) made of paper but resistant to high temperatures, with a printed sheet in the middle. At the end of the cycle, the central sheet turns black, ensuring the autoclave's effectiveness in creating a vacuum and verifying that steam and temperature parameters are correct.

The Helix Test further guarantees the previously mentioned parameters, ensuring complete steam penetration in hollow and porous items (such as tissues or handpieces). It consists of a coiled tube with an end cap containing an indicator that starts off blue and turns green/black at the end of the test.

The final test, performed every 90 days as required, is the Biological Control. This test demonstrates the autoclave's ability to destroy all microorganisms, including spores. We use vials containing Bacillus Stearothermophilus (ATCC7953), one of the most heat-resistant microorganisms with pathogenic characteristics. A vial is placed in the autoclave, and a normal cycle is run. Once complete, we check if the chemical indicator on the label has changed, then break the vial to mix the liquid inside with the indicator. This is also done with an unautoclaved vial for comparison. Both vials are then placed in an incubator at 57°C for 48 hours. The test is passed if the liquid in the processed vial turns purple, while the unprocessed vial remains yellow.

Resources of materials, equipment, and personnel

To ensure the use of sterile instruments, it is essential first to have a sufficient number of tools and assistants to manage proper sterilisation processes and studio management.

We believe that meticulous management of disinfection and sterilisation is crucial for patient safety. Generally, patients trust healthcare providers but do not see how these processes are carried out.

The clinical path

Meticulousness and safety

We wish to emphasise that we maintain a sterilisation log available to every patient. For each procedure, the sterilisation code for the instruments used is recorded in the patient’s clinical file.

Air purification

The Versilia Dental Insitute is equipped with air purifiers that filter and disinfect the air, capable of eliminating all types of bacteria and viruses.

The air purifier is a tower model, suitable for small spaces, childcare facilities, residential areas, clinics, and other areas with a low number of occupants.

The dental institute provides this technology to its patients to ensure safety and peace of mind.

How SHU technology works

The UVC germicidal lamp destroys germs that pass through UV light rays.
The UV rays from the UVC lamp react with the nano Nickel HCT™ catalyst, producing catalytic molecules.
The catalytic molecules identify and destroy carbon-based molecules, converting them into carbon dioxide and harmless water.
Features

Easy to use
Extremely quiet
Acoustic alarm - AHPCO cell replacement
No maintenance for 3 years
Components guarantee long-lasting use
Made in the USA
3-year warranty
What harmful substances does it reduce?

Odours caused by VOCs (volatile organic compounds)
Cigarette smoke
Mould
Bacteria
Viruses
Other allergens

SHU PDF - COVID-19 Prevention

Air purification benefits for allergy sufferers

Respiratory allergies (such as bronchial asthma and allergic rhinitis) are the most common forms of allergic disease. Recent statistical studies show that these conditions account for at least 75% of all clinically manifest allergic diseases and are on the rise.

In cases of respiratory allergies from dust mites or other environmental allergens, it is not possible to eliminate exposure to the responsible allergens. To significantly reduce symptoms, it is advisable to improve the hygienic conditions of the environment.

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The Versilia Dental Institute has implemented the use of completely latex-free devices for patients with latex allergies.

Specific latex-free devices provided for patients with this allergy include: latex-free gloves used during initial visits and treatments; latex-free rubber dam, used in most dental treatments to maintain a sterile field, as saliva and contact with the oral cavity are filled with bacterial strains.