[Survey of methods of cleaning, decontamination, disinfection and sterilization in dental health services in tropical areas].

The International Aid for Ontology (IAO) carried out this survey of hygiene in the dental health services of 5 French-speaking African countries in 1994, in association with the Faculty of Pharmaceutical and Biological Sciences of Paris. This study received support from the World Health Organization (WHO), the French Ministry for Cooperation and the European Community and the Ivory Coast Oral and Dental Hygiene and Health Committee (CIHSBD). Twenty-nine dental services from Benin (3), Burkina Faso (6), Ivory Coast (12), Mali (5), Niger (3) participated in this survey which gives an insight into the daily hygiene routines of these services. The cleaning, decontamination, disinfection and sterilization procedures for premises, dental equipment, instruments, hands and disposable items were investigated. No individual protocols are reported. Bench tops were cleaned or disinfected daily in 73% of centers and floors were cleaned or disinfected daily in 59% of centers. Walls were cleaned once per week in 44% of the centers. Hands were always washed between patients, with 68% of dental surgeons using only solid or liquid cleansing soaps and the others using antiseptic or disinfectant solutions. The dentist's chair was cleaned or disinfected daily in 68% of centers, mostly with soap (43%) or diluted bleach (23%). Vacuum equipment was cleaned with soap (50%) or diluted bleach (57%), with some surgeries using a combination of the two. Hand pieces and turbines were cleaned and disinfected after each use with alcohol (35%) or diluted bleach (26%) and were sterilized in 9% of centers. Instruments were sterilized with a Poupinel (63%), unspecified sterilizer (26%), autoclave (7%) or low temperature disinfection procedure (4%). Instruments were regularly sterilized in all centers. Single-use disposable items were often reused: 88% of centers reused gloves, 64% anesthetic cartridges and 32% disposable needles. This survey demonstrates that dentists do attempt to achieve appropriate hygiene standards despite difficult practice conditions, exacerbated by supply problems. In all applications, hygiene involves a succession of closely-related, logical steps, which form an asepsis chain aimed at preventing the transmission of infection. Our survey shows that fundamental elements of hygiene require attention to achieve this aim. The cleaning, disinfection and sterilizing of floor surfaces and equipment should be improved and more widespread use made of disposable items. It is important to define the hygiene level required for particular treatments, taking into account the oral and dental micro flora and whether the equipment has been decontaminated, disinfected or sterilized. A piece of equipment is decontaminated if it has been mechanically cleaned and decontaminated. It is disinfected if these steps are followed by rinsing with sterile water, drying and conditioning. An item is described as sterilized if it is cleaned, decontaminated, rinsed, dried, conditioned and then sterilized. We found that a wide variety of chemicals were used to clean hands, surfaces and equipment. The nature and appropriate methods of use of these chemicals were not widely known. Understanding the chemical composition of these chemicals makes it possible to classify them into cleaning agents, detergents, decontaminating agents and disinfectants. The definition, choice and use of antiseptics and disinfectants should be strictly controlled. It is also vital that single-use disposable items are used only once and are never reused. Hygiene in the dental surgery is a chain of processes aimed at protecting the patient and the medical staff. There are many links in the chain, involving floor and surface hygiene, hand washing by dentists and dental assistants, washing of surgery linen and treatment of equipment. Dental practitioners should continually focus on ensuring that the chain of hygiene procedures is not broken, in their own interests as well as in those of their patients.