Dental disinfection gel sterilization compliance status study at private clinics

Dental disinfection gel is one of the important chemical agents used in stomatology for the intermediate level of sterilisation of impression materials, dental handpieces and environmental surfaces. The basic idea is to make use of active antimicrobial substances like quaternary ammonium compounds and biguanides to destroy the cells of microorganisms and kill them ^[1]. To achieve the expected effect of these agents in clinical applications, strict sterilisation compliance must be maintained. Follow the manufacturer's instructions for the time of contact, cover the entire surface area completely and check that the concentration is appropriate before use. If there is a departure from the standard procedures, it will affect the antibacterial effect and increase the risk of hospital-acquired cross-infection.

With high turnover of patients and limited operating resources in private dental clinics, the practical application value of compliance will be very obvious. Private dental clinics do not have a dedicated sterilisation centre like large hospitals and therefore need the help of all staff to properly perform disinfection procedures. Therefore, the state of compliance will affect the basic safety of the clinical environment. Therefore, it is necessary to assess the current state of compliance with the sterilisation of dental disinfection gel in private clinics ^[5]. It can help to find common problems in the operation and systemic risks, and then provide an empirical basis for targeted improvement measures. Based on the gap between the theory of antimicrobial standards and daily clinical work, we need to improve the relevant operating procedures to ensure the safety of patients at the clinical level of infection control in private stomatology.

Dental disinfection gel is a special kind of semi-solid or gel-type disinfectant that is only approved for use in oral clinical settings. It is used to clean the surface of dental operation tools, disinfect parts of the oral mucosa, and disinfect the skin around the treatment area. Therefore, compared with general disinfection gels, it is specially used in stomatology for special reasons.

According to the latest guidelines for the dental disinfection industry, the entire set of quantifiable sterilisation compliance indicators has been formulated to assess how well it is applied in practice. These are as follows: the type of gel product that is selected must meet the requirements of the disinfection scenario; the effective concentration of the active ingredients in the gel is correct; the time required for the full contact of the gel with the target has been reached; the storage conditions of unopened and partially used gel products meet the requirements of the product manual; the opening date, expiry date and operator's signature on the gel container after opening are correct; and the waste disposal procedures for expired or residual disinfection gel after use are correct.

The foundation for building this indicator system is to turn the theoretical basis of clinical programmes into objective parameters for research, and all indicators must be measurable in practice. By defining these specific indicators, a strict, quantifiable standard for assessing the quality of sterilisation practices is established to avoid arbitrary judgments and thus accurately determine the degree of non-compliance of private medical institutions.

Research in the field of dental disinfection management regulations for private dental clinics overseas has been relatively mature, mainly because of the special infection control guidelines issued by many international dental industry associations. Therefore, the definition and main principles of disinfection gel sterilisation have been put forward in terms of chemical stability, a wide range of functions and conformity to contact time. Continuous longitudinal tracking studies have been conducted in North America, Western Europe and Oceania for more than five to ten years and have produced some continuous monitoring data. The data shows that the compliance rate of community private clinics is directly affected by how well the disinfection gel standard management has been incorporated into the daily operation of the Standard Operating Procedures (SOPs). Overseas private practices can apply the theoretical compliance to practical work by adding specific rules for gel application, surface contact and disposal to daily clinical work. In addition, researchers have identified the main ways to maintain a high compliance rate: regular staff skill assessments, third-party external hygiene audits and transparent disclosure of patient rights. The above measures are a tool for continuously improving quality to help us find areas where there is a lack of implementation; at the same time, they also serve as an objective basis for the development of new regulations. However, in recent years, several cases of non-compliant disinfection gel sterilisation have been reported in overseas private clinics; these cases have shown that when there is a deviation in the SOP, for example, dilution of the concentration or incorrect contact time, there may be serious consequences. Therefore, the above incidents have shown that the application of strict regulations is necessary. Finally, the relatively developed overseas experience can provide a relatively good basis for the construction of the research background of this thesis, in terms of sound industry guidelines, longitudinal data verification, the integration of SOPs and strict multidimensional audits, etc.

In recent years, various cross-sectional surveys of different areas have shown that there are many problems with the compliance of oral clinical operation materials in private dental clinics. Currently, most domestic studies are concerned with the sterilisation of dental handpieces, the disposal of single-use medical equipment, etc., and the disinfection of the environment is relatively insufficient. There is no study on the monitoring of dental disinfection gel. According to data from the local oral health association and medical quality control platform, the pass rate of effective concentrations of disinfection gel and deviation from standard use in clinical practice have shown fluctuations. It is insufficiently addressed by the existing literature that there is no specialised training for the staff of private clinics regarding the use of dental disinfection gel; the division of responsibilities for disinfection management is not clear; and there is no regular self-inspection system to continuously meet the standards. The compliance of domestic studies varies in urban and rural private dental clinics. The compliance rate of urban clinics is relatively high due to stricter compliance with industry regulations and more convenient access to professional training. Conversely, the suburban clinics have lower compliance due to insufficient supervision, unskilled staff, and inadequate investment in quality control equipment. Therefore, it is necessary to carry out targeted monitoring interventions and standardise operating procedures in this area. We need to determine what constitutes basic compliance monitoring and its main aspects, as well as how this will help in carrying out the sterilisation process to prevent cross-infection and thus be applied in practice in the private clinical environment.

There is a lack of targeted and focused research in the current domestic academic field on the full-process sterilisation compliance of dental disinfection gel. Most of the studies on this area of research are not particularly in-depth and do not form a complete system. There is a lack of empirical studies that can precisely analyse the multi-level influencing factors of dental disinfection gel sterilisation non-compliance in small private dental clinics, and they are not the same as large public hospitals. The operation of private clinics has its own particularities; therefore, generalised results cannot be applied to solve their specific problems. To solve this problem is to make a contribution to the standardisation of clinical work. Targeted compliance assessment research can help private clinics find hidden problems in their management of dental disinfection gel quickly and close the gap between theory and practice. At the same time, based on the characteristics of small private clinics and the limited resources they have, this research will propose some targeted optimisation strategies for their management rather than simply adopting the management model of large public hospitals, which is not feasible in small places. Finally, the above assessment framework can provide some reference data for local dental industry self-regulatory organisations. Based on the above findings, these organisations will conduct targeted disinfection operation training for private clinic personnel, and the training will address the problems raised in actual practice. Finally, this study will change the former loose management of infection to a new kind of management, which can be tested and improved systematically, so that the safety level of private stomatological services will be enhanced.

When planning the cross-sectional investigation plan for selected private dental clinics, the definition of the sample selection area and basic information collection standards will be implemented to improve the scientific validity and representativeness of the research. A stratified random sampling approach is employed in this research to select 60 private dental clinics of various sizes in the target city. There are three different categories in terms of the operational scale: 30 small private clinics with a single chair, 20 medium-sized clinics with 3 to 5 dental treatment chairs, and 10 large chain private dental branches with more than 6 treatment chairs. The reasons for exclusion are that the dental departments of general private hospitals have been included in the sample to ensure that the research objects are independent private dental clinics. The reason is that the affiliated departments usually have a common centralised sterilisation supply centre and thus cannot evaluate the independent compliance of private clinics. Basic information collection standards will be set up after selecting samples. Investigate the basic data of all participating clinics anonymously and provide first-hand information to maintain the secrecy of operations and avoid falsification of data. The collection criteria are as follows: years in operation, total number of full-time clinical dental practitioners, whether there is a full-time dedicated disinfection management post, annual average number of outpatient visits, how many types of dental disinfection gel are purchased by the clinic and whether the clinic has participated in formal disinfection operation training organised by industry associations in the past two years. Collect these particular parameters; these are necessary basics for subsequent analysis of the relationship between clinic attributes and sterilisation compliance. Standard7 Standardised collection of these basic variables, investigation 8)8, to form a strict basis for finding out how8) the characteristics of institutions affect8 people's obedience to the rules of disinfection.

In this part, the specific measurement dimensions of the dental disinfection gel sterilization compliance indicators will be introduced, and the three mutually verified data collection methods will be employed to guarantee objectivity and accuracy. First of all, on-site investigation and monitoring will be carried out; that is to say, during the real dental treatment process, trained personnel will observe and document how dental disinfection gel is actually used. It is to be assessed whether the important steps of operation, such as the hand disinfection of the operators before use, the full coverage of the gel on the target disinfection area, and the retention time of the required action, are in line with the requirements. Second, on-site physical and chemical testing is conducted with special test strips to determine the concentration of active substances in the disinfection gel that is now being used or stored in the clinic. It is to be checked whether the actual sterilisation effect is in line with the prescribed national standards. Third, by way of archive and product inspection, we can check the labels, purchase records, opening date marks and other evidence from all stored and in-use dental disinfection gel products. To know if the products' traceability and storage are in line with regulations, conduct a small-scale investigation. For the purpose of quantifying the compliance state in a regular way, a certain scoring rule has been formulated. The total number of compliance points is 100, and the results of the three types of measurements will be combined. A total score less than 80 will be strictly defined as non-compliant. A reasonable distribution of detailed scoring weights is made for all sub-indicators in the three aspects of observation, testing and filing, and it reflects their relative importance in ensuring good infection control and safe clinical operation. Based on the above multi-faceted measurement design, a general, scientific and systematic standard for evaluating the compliance of sterilisation in private clinics has been put forward.

This subsection will carry out a descriptive statistical analysis of the dental disinfection gel sterilization compliance situation from the cross-sectional data of sampled private clinics. It will present the overall pass rate of sterilization compliance in all sampled clinics and break down the pass rate of compliance for each sub-indicator among the five important areas of product selection, effective concentration, operation process, storage management and waste disposal. In addition, by comparing the differences in the pass rate of compliance of private clinics with different operating scales, different years of operation, and whether there is a full-time disinfection management post, a graph can be drawn to clearly show the data. Frequency distribution histograms and cross-tabulations are used to display the comparison data. Statistical results have found that the top three items with the lowest compliance rates are: no opening date on the gel container; insufficient contact time of the gel with the object to be disinfected; and a mismatch in the type of gel used for intraoral disinfection. In order to show the above results, this part will also list some typical cases of non-compliance that have been identified during the on-site investigation. The above examples are all anonymised cases that can reflect the actual operating state and problems in daily life. There is a clinic where the gel containers were reused without being marked with the opening date; thus, the effective concentration was insufficient, and another clinic used a surface-disinfecting gel for the treatment of an intraoral suction line, so there was a serious problem with the application of the product. Based on the above descriptive statistics and actual cases, this paper shows the basic problems of non-compliance, indicates the need to strictly follow the operating procedures, and emphasizes the importance of standardizing the way to ensure safety in clinical operations.

The reasons for the non-compliance of dental disinfection gel sterilization in private clinics are divided into three levels: individual staff, clinic operation and management, and industry supervision. At the level of individual staff, there is not enough professional knowledge about the specific chemical properties and operation instructions of various dental disinfection gels; therefore, they will be misused. In addition, in order to save time, they will reduce the disinfection steps during the daily high-intensity work of outpatient services, and there is also a lack of basic knowledge about how infections can spread from improperly disinfected gel. At the level of clinic operation and management, the small private clinic has a tight cost control mechanism and is more willing to buy cheap, unqualified disinfection gel. Due to the lack of a special post to regularly check the storage condition and validity period of the gel, expired or broken materials will be used. The lack of regular embedded evaluations of disinfection gel operations in the daily management system of the clinic leads to non-compliance. At the level of industry supervision and support, there is still a lack of targeted and scene-based special training on the management of dental disinfection gel for private clinic workers. At the same time, the frequency of regular disinfection compliance spot checks for small private clinics is insufficient, and they have no external supervision. Based on a strict statistical analysis, this study will examine how each identified influence factor relates to the overall compliance level and provide an empirical basis for targeted improvement.

In order to improve the sterilization rate of dental disinfection gel in private clinics, a targeted optimisation plan will be drawn up based on the factors mentioned above. First, as for the operation guide, a small quick-reference card will be prepared for the front-line staff. The card will clearly show the exact correspondence between different clinical situations and various types of gel, outline the standard operating procedure, and list all necessary storage measures to help people understand the procedures more easily. Second, to improve the organisational structure of the clinic, it should be equipped with a cheap regular check system. Assign a particular person to check the expiration date, label marks and remaining amount of all disinfectant gel every working day to keep an eye on them and avoid excessive administration. Third, in light of the support for the industry, local dental industry organisations are being encouraged to provide short-term, scenario-based practical training for private clinic practitioners free of charge. It transforms abstract theoretical learning into real-world instruction based on daily life, effectively solving the problem of practical use. Finally, peer-to-peer supervision is also carried out by other private clinics in the surrounding area. By regularly checking each other's disinfection gel management, small clinics can reduce their own supervision costs by a large amount and promote co-operation to take responsibility. Each plan has specific and feasible execution steps, such as the quick reference card being printed and laminated generally for chairside use, daily inspections utilising a simplified digital checklist, training conducted at off-peak times, and mutual audits adopting a standardised exchange log. The purpose is to reduce selection errors, remove expired items, improve practical abilities, and continuously improve compliance with regulations through community supervision.

Based on the above, it can be concluded that the sterilization compliance of dental disinfection gels in private clinics is still unsatisfactory and may harm the clinical effect. Sterilization compliance in this sense is to follow the norms closely and make sure that before the gel is applied to the patient, its disinfection effect is stable and meets the requirement of killing bacteria. The basic idea of compliance is a continuous chain of infection prevention; thus, the chemical stability, concentration, and application method of the gel must be in line with industry regulations to prevent cross-contamination. The study shows that there have been some deviations in some basic operations, such as storage conditions, expiration time, etc., and the use of the technology is not up to standard. There are some problems with the private hospital's implementation path; for example, it does not carry out regular efficacy checks and has poor dispensing equipment, etc. The importance of strict compliance in the actual application of dental disinfection gel cannot be overemphasised ^[4]; it is a crucial measure to prevent the spread of harmful bacteria in the mouth. If there is a problem with the compliance of the gel, it will lose its intended purpose and directly threaten both patients and practitioners. Therefore, to address this problem, we need to take action now, follow the rules for operation strictly, have constant professional supervision, and strengthen the overall quality of the personnel. To improve compliance is not only a matter of procedure but also a need for the standardisation of stomatological technology and the prevention of infection in private medical institutions.

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[6]Smith, J., Brown, A.. Advances in Dental disinfection gel ... (6)[J]. Journal of Interdisciplinary Studies, 2022, 18(6): 39-96.