Hesperian Health Guides
The First Rule for Treatment: Stay Clean!
HealthWiki > Where There Is No Dentist > Chapter 7: Treating Some Common Problems > The First Rule for Treatment: Stay Clean!
Wash your hands with soap and water 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.
 Wear glovesLatex or plastic gloves protect the people you touch from germs that may be stuck under your fingernails or on your skin, even after you wash your hands. They also protect you from getting infections. Wear clean gloves whenever you touch someone’s mouth or any blood. If you are filling or removing a tooth, or if you are touching any instruments that have been sterilized, you must wear sterile gloves.  If you do not have gloves, use plastic bags that have been washed in disinfectant soap instead. Bags are harder to use than gloves, but they are better than nothing. |
Sterilizing means killing germs that could cause hepatitis, tetanus, and various mouth infections. Unless you sterilize, an instrument may still have germs and cause infection in the next person it touches.
Clean and sterilize any instrument that has touched blood or cut into the body.
That means cleaning and sterilizing all syringes and needles, and any instruments you use when scaling teeth (Chapter 8) or when taking out a tooth (Chapter 11).
To clean and sterilize tools:
- Take apart your tools, if they come apart, so that all surfaces can be cleaned and then sterilized.
- Clean your tools with clean water, soap or detergent, and a brush to remove any blood, mucus, food, cement, or dirt. Remove rust and get rid of tools that are dull or damaged. Wear gloves to protect your hands from cuts and from detergent.
- Sterilize your tools to kill germs.
- Sterilize by baking
Baking can be used to sterilize metal and glass tools. Do not bake tools made of rubber or plastic–they will melt!
Take your tools apart and clean them (see steps 1 and 2, above). Then wrap them in 4 layers of clean cloth or heavy paper and tie the packet shut. Put the packet into a container or on a pan.
Bake at 170°C (340°F) for 1 hour or 150°C (305°F) for 2 ½ hours. Then let the packet cool and store it in a clean, dry place. Do not open the packet until you are ready to use the tools, and then touch them only when wearing sterile gloves. Once a tool is exposed to the air or touches anything (like a table or your skin), it is no longer sterile and the germs on it can cause an infection when it is used.
- Sterilize by pressure steaming
Pressure steaming can be used to sterilize metal or rubber tools and some plastic equipment. Some clinics have a machine called an autoclave for sterilizing by pressure steaming. A pressure-cooking pot can sterilize tools in the same way an autoclave does.
Take your tools apart and clean them (see steps 1 and 2, above). Then wrap them in 2 layers of non-woven paper or crepe paper and close with autoclave tape (see Resources). If you do not have paper and tape, place your tools in a heat-safe container with a lid. Put a steamer basket and water in the pressure-cooking pot. Put your packets or container into the steamer basket, making sure they are above the water surface. Close the pot lid so the gasket seals and put the pot on to boil.
After it comes to a boil, cook at 15 to 20 pounds of pressure at 121°C for 20 minutes.
Then let packets cool and dry. Store in a clean, dry place. Do not remove tools from the packet or container until you are ready to use them, and then touch them only when wearing sterile gloves. If you sterilized tools in a heat-safe container, seal the lid with tape and do not open the container until you are ready to use the tools. Once a tool is exposed to the air or touches anything (like a table or your skin), it is no longer sterile and the germs on it can cause an infection when it is used.
Keep your sterile instruments together in a clean place.
Instruments that do not touch blood or cut into the body do not need to be sterilized. After you examine a person’s mouth or place a temporary filling, you can clean these instruments and then disinfect them.
To clean and disinfect tools:
- Disinfect by boiling
You can use boiling to disinfect metal tools, rubber or plastic equipment, and cloth.
Take your tools apart and clean them (see steps 1 and 2, above). Then place in a pot, cover with water, and boil for 20 minutes.
Start counting the 20 minutes when the water starts to boil. After 20 minutes, pour the water from the pot and let the tools cool and dry. Then use disinfected tongs, chopsticks, or spoons to remove the tools from the pot. Move them directly to a disinfected container with a lid. Remember, anything you touch with your hands is no longer disinfected. And do not put tools away wet.
- Disinfect with chemicals
Some people use chemicals to disinfect metal, rubber, or plastic tools and equipment. When possible, we recommend disinfecting using other methods because most chemicals used to disinfect are poisonous. They are poisonous to the people who work in factories making them and they are poisonous to the people who use them to clean tools. But chemicals may be the only way you have to disinfect your tools, and some tools can only be disinfected with chemicals.
If you do need to use chemicals, take your tools apart and clean them (see steps 1 and 2, above). Then disinfect them by:
- soaking in 0.1% bleach solution for 20 minutes OR
- soaking in 6% hydrogen peroxide for 30 minutes OR
- soaking in 70% ethanol or isopropyl alcohol for a whole day
Germs living in dirty cotton can easily get inside a tooth socket and start an infection. So it is important to keep the cut pieces in a disinfected container with a cover. Use disinfected tweezers to remove the cotton gauze from the container when you need some.
Keep your room and work area clean. Sweep or mop the floor one or two times a day, and wipe down the chair and tables after every patient.
Staying clean is a part of staying healthy.