The cleaning of photographic retractors; a survey, clinical and laboratory study

Objectives: To determine the methods currently being used to decontaminate photographic retractors in specialist orthodontic practice and to investigate the effectiveness of the cleaning methods.

Design: The study was carried out in two parts: I – a postal self-report questionnaire, and II – a cross-sectional clinical and laboratory investigation.

Setting: The Orthodontic Department of the Charles Clifford Dental Hospital.

Subjects and materials: I – The questionnaire was sent to 278 specialist UK orthodontists. II – One hundred and twenty pairs of photographic retractors were collected following use. One retractor from each pair was randomly chosen to be the unwashed control and immediately placed in 20 ml of PBS-Tween for elution. The other was subjected to the one of four cleaning procedures: alcohol wipe, handwashing, ultrasonic bath or washer-disinfector, before being placed in PBS-Tween. Aliquots were taken for assay.

Main outcome measures: Antibody capture (ELISA) for amylase, to detect the presence of saliva, and for albumin, to detect the presence of serum.

Results: I – The questionnaire response rate was 65% and the majority of respondents (87.2%) were routinely taking clinical photographs. A wide variety of techniques were being used to decontaminate photographic retractors. II – All unwashed controls had detectable levels of amylase and albumin. All the retractors that were cleaned using an alcohol wipe had residual detectable levels of amylase and 80% had detectable levels of albumin. Only one retractor had detectable amylase and one had detectable albumin following cleaning using the washer-disinfector. There was a highly significant statistical difference between the techniques in the proportional reduction in both amylase and albumin detected from the unwashed control and cleaned experimental retractors (p <0.001). The infective risk from inadequate cleaning of photographic retractors is discussed.

Conclusions: The washer-disinfector is the most effective method of cleaning photographic retractors, but no method was found to be 100% successful at removing amylase and albumin.