Sterilization and Biologic Monitoring in Private Dental Clinics in Lebanon

Abstract

The aim of the present study was to evaluate sterilization practices and effectiveness in the Lebanese private dental sector and identify potential factors contributing to sterilization failure. A 13-item questionnaire consisting of four demographic/professional questions and nine questions related to sterilization practices along with self-contained biologic indicators (SCBIs) were delivered to a representative sample of Lebanese private offices. Univariate statistics and bivariate analyses were performed to compare sterilization failure rates according to demographic, professional, and sterilization-related conditions. Out of the 560 dentists contacted, 205 dentists returned the completed questionnaires and undamaged processed SCBIs. The tested autoclaves (n = 134) were mostly dynamic air removal (69.4%) and had a mean age of 10.5 ± 6.9 years. The dry heat ovens (n = 71) were all static air and had 12.9 ± 8.1 years. The dental assistants performed the routine sterilization procedures in nearly 62% of the practices and sterilization cycles were run 4 to 6 times per week in 75% of the offices. Correct temperature/time ratios were applied in 97% of the autoclaves and 80.3% of the ovens. Few dental practices reported having preventive maintenance (17.9% for the autoclaves and 14.1% for the ovens). Routine monitoring of sterilizer efficacy was infrequently performed and was mostly conducted using physical indicators. Sterilization failure rate was higher for the ovens (16.9%) than for the autoclaves (7.5%). Incorrect temperature/time ratio was the main significant factor associated with sterilization failures. The present study demonstrated a relatively high rate of sterilization failures in the Lebanese private dental sector and identified the human error in setting sterilization cycle parameters as the predominant cause of failure. These findings should prompt actions toward increasing knowledge of the sterilization processes and their monitoring among dental professionals and improving the quality control of sterilization through collaborative efforts among health authorities, dental schools, and associations. This study presents the first published data relative to sterilization practices and effectiveness in private Lebanese dental offices and provides a rationale to implement biologic monitoring protocols in Lebanon as long practiced in developed countries.