What do these terms mean and what are differences? When should which treatment be applied? Can I just clean and disinfect with alcohol? What dangers I walk in when I apply the wrong treatment - and how dangerous is this for the patient? In this article we will elaborate on these questions.

  • Cleaning is the removal of visible dirt and organic material (both visible and invisible), to prevent micro-organisms to survive, multiply and spread.
  • Disinfection implies a reduction of the number of micro-organisms (bacteria, fungi, or viruses) on lifeless surfaces, as well as to intact skin and mucous membranes, to an acceptable level.
  • Sterilization is the killing or inactivation of all micro-organisms on or in an object, such that the probability of the presence of living organisms per sterilized unit is less than one in a million.

In simpler terms we could say, that cleaning removes dirt and micro-organisms, disinfect reduces microorganisms and sterilization reduces micro-organisms thoroughly.

When cleaning would be perfect, all dirt and all micro-organisms would be removed. Disinfection and / or sterilization would not add anything more. In practice however, perfect cleaning is not (yet) possible. That is why additional disinfection and / or sterilization applies.

First, cleaning applies to remove dirt; next disinfection and / or sterilization are used to reduce the micro-organisms. In a statement that the Working Party on Infection Prevention in the Netherlands drafted, cleaning is always applied, either in combination with thermal disinfection or with sterilization:

  • Instruments used in invasive procedures such as surgery - and thus come into contact with human tissue - belong to category A (critical use).
  • Instruments used in treatments with a serious risk for transmission of micro-organisms belong to category B (semi-critical use). Removing tartar, curettage, extractions and root canal treatment are examples of such treatments.
  • Instruments used in procedures with minimal risk of transmission of micro-organisms belong to category C (non-critical use). Examples include orthodontic treatments, prosthetic work and making radiographs.
In practice, the orthodontist mainly performs category C treatments; and dental treatments fall category B or C. In both cases, a cleaning and disinfection machine is required: it removes the debris during the cleaning phase as well as a portion of the micro-organisms. During the disinfection phase, the number of micro-organisms is reduced and / or deactivated. For treatments that fall in category A, additional sterilization in e.g. an autoclave is required.

Manual cleaning with alcohol is no acceptable option anymore:

  • With just manual cleaning not all parts parts of an instrument can be reached. When using a cleaning- and disinfection machine however, a lot of water is sprayed at high pressure against the instruments from all sides to wash dirt away. And chemicals like soap, acid and salt are used too.
  • Alcohol is a form of chemical disinfection. It is less efficient and therefore the working party prescribes thermal disinfection in all cases where this is possible.
  • cleaning, disinfection and sterilizationManual cleaning is very labor intensive, not reproducible and does not necessarily guarantee a good cleaning result. It is clear that this form of cleaning and disinfection is only permitted in highly exceptional cases, ie for instruments that do not withstand thermal disinfection. Such instruments, however we hardly use anymore as they have been replaced by alternatives that are suitable for thermal disinfection.
With the use of a cleaning- and disinfection machine the desired cleaning results will be delivered and the instruments will be thermally disinfected. The number of micro-organisms that remains on the instruments will be so low that all guidelines are met. This is a safe situation achieved for the patient, but also for the staff who work daily with the instruments. If the machine is operated and maintained according to specifications - and this is neatly recorded in a machine logbook - you will almost certainly comply with regulations.
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