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FAQ's Sterilization

Frequently Asked Questions (FAQs) on Dental Infection Control



Top|Instruments & Equipment|Sterilization


Frequently Asked Questions for Sterilization

Q How can infection control be incorporated into the office design?

Q Should a specific, well-defined area be designated for instrument processing?


Q
What is the acceptability on glass bead sterilizers?

Q Is it okay to use dishwashing detergent, rather than an enzymatic solution, in an ultrasonic cleaner?

Q Since handpieces are degraded regularly and require frequent turbine replacement as a result of conventional autoclaving, is glutaraldehyde a suitable alternative to autoclave sterilization?


Q
Is a thermal washer/disinfector an acceptable substitute for ultrasonic cleaning of dental instruments?

Q If multiple patients use a personal music system during treatment, is it necessary to sterilize the earphones in between patients?

Q What are the best methods to ensure sterility of stored instrument packages?

Q What are the guidelines for sterilizing dental burs, according to OSHA?

Q Do any states require heat sterilization for handpieces?

Q Is there a way to disinfect anesthetic cartridges before touching them with sterile gloves?

Q If a sterile needle is inserted into the rubber of the anesthetic cartridge without decontamination, is there any risk of infection?

Q What exactly is a cold sterilant?

Q How often should the autoclave be cleaned?

Q Is a sterilization log required indicating the cycle, length, type of load processed?

Q What is the shelf life of a packaged instrument after it has been sterilized? Should sterile pouches be dated?

Q What are the advantages and disadvantages of "flash sterilization?"

Q Why is it important to package instruments for sterilization and storage?

Q What is an effective protocol for biological monitoring and instrument sterility quality assurance?

Q Should a handpiece used on an HIV-positive patient be sterilized twice?

Q Could a kitchen-grade convection oven be used for sterilization?

Q When using a computerized sterilizer, do you still need to do monitoring?

Q What are the advantages and disadvantages to the use of a dry heat sterilizer in a dental office?

Q Is dry heat equally effective in killing microorganisms as steam autoclaves?

Q The instructions for the electrosurgery tips my practices uses say to "cold sterilize” them. What cold sterilization methods does the Food and Drug Administration (FDA) approve for use?

Q How do you handle the sterilization of instruments used on known hepatitis patients? Can you put them in the ultrasonic cleaner or separate them and handscrub them? If you use the ultrasonic cleaner, do you have to then empty it and sterilize it?

Q Can OSAP recommend a non-corrosive alternative to glutaraldehyde for use in reprocessing impression trays?

Q Can we store our sterile dental instruments under the sink?

Q Should my dentist be heat-sterilizing all of the instruments used in my mouth?

Q Does repeated autoclaving compromise instrument sharpness?

Q Can we set up the instrument tray before the patient arrives and cover everything with a disposable napkin?

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Q How can infection control be incorporated into the office design?

When designing an office, keep in mind six main considerations for the safety of patients and workers: (1) office flow; (2) cabinetry; (3) laminate, wall, and floor coverings; (4) fixtures, dispensers, and waste drops; (5) support equipment; and (6) ventilation.

A Office flow should expedite moving from one area to another with minimal cross-contamination. In cabinetry, the number of drawers and their contents should be minimized to ease clean-up and reduce possible cross-contamination. Drawers should also be no less than five (5) inches deep to accommodate support instruments. Laminates, wall, and floor coverings allow cleaning and disinfection of all surfaces. Fixtures, dispensers, and waste drops should require minimal hand contact to maximize the effectiveness of infection control. Support equipment should be positioned strategically with operator ease, comfort, and team safety in mind. Finally, work areas must have positive ventilation to rid area of noxious vapors(*).

References:
(*) Pollock R, Young, J. Infection control considerations in dental office design. Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control in Dentistry, 2nd ed. Philadelphia:Williams and Wilkins, 1996:281.

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Q Should a specific, well-defined area be designated for instrument processing?

A If possible, instruments should be cleaned and sterilized in an area designated for that purpose. If a lack of space prohibits this scenario, establish a clearly defined location for holding and processing contaminated instruments and devices. Ensure that this area is physically separated from the area where clean instruments are stored. If instruments must be decontaminated in patient treatment areas, don't seat the next patient until all instrument processing has been completed and the area has been cleaned and disinfected.

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Q What is the acceptability on glass bead sterilizers?

A Hot salt/glass bead sterilizers are not acceptable for the sterilization of items between patients. The endodontic dry heat sterilizer (glass bead sterilizer) is no longer cleared by the Food and Drug Administration (FDA). The FDA Dental Device Classification Panel has stated that the glass bead sterilizer presents "a potential unreasonable risk of illness or injury to the patient because the device may fail to sterilize dental instruments adequately."

References:
(1) Food and Drug Administration. Revision 11/3/99 - import alert 89-11, detention without physical examination of class III devices without PMAs or PDPs. Available at http://www.fda.gov/ora/fiars/ora_import_ia8911.html
(2) American Electrology Association Infection Control Standards for the Practice of Electrology. Available at http://www.fda.gov/ohrms/dockets/ac/02/briefing/3839b1_I8_aea.doc

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Q Is it okay to use dishwashing detergent, rather than an enzymatic solution, in an ultrasonic cleaner?

A To ensure maximum ultrasonic cleaning action and to avoid problems with the equipment, use a quality detergent specifically formulated for and recommended by the manufacturer of your machine. Using products not intended for ultrasonic machines may cause pitting or other harm to the unit.

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Q Since handpieces are degraded regularly and require frequent turbine replacement as a result of conventional autoclaving, is glutaraldehyde a suitable alternative to autoclave sterilization?

A No. The Centers for Disease Control and Prevention (CDC,1), the American Dental Association (ADA,2), OSAP(3), most state dental licensing boards, and dental handpiece manufacturers all recommend heat sterilization between patient uses. Virtually all handpieces currently in production are heat-tolerant, and those that are not can be retrofitted to allow heat-processing. Autoclaving and chemical vapor sterilization are considered accepted methods of heat sterilization. High-level disinfection via chemical germicides cannot be biologically monitored to assure sterility. Further, extended contact with chemical germicides may corrode handpiece components.

References:
(1) CDC. Recommended Infection Control Practices for Dentistry. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm
(2) ADA Council on Scientific Affairs and ADA Council on Dental Practices. Infection Control Recommendations for the Dental Office and Dental Laboratory. J Am Dent Assoc 1996;127:672-680.
(3) OSAP. Infection Control for Dentistry Guidelines , September 1997.

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Q Is a thermal washer/disinfector an acceptable substitute for ultrasonic cleaning of dental instruments?

A Yes. Washer/disinfectors and washer/decontaminators that have been cleared for marketing by the Food and Drug Administration (FDA) are a suitable alternative to ultrasonic cleaning. Household dishwashers, however, are not acceptable for healthcare applications. Dishwashers and other household appliances have not been evaluated by the FDA to guarantee adherence to the strict operating parameters that healthcare applications demand.

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Q If multiple patients use a personal music system during treatment, is it necessary to sterilize the earphones in between patients?

A This is more of an issue of clean ears rather than disease control. One may consider disposable foam or paper covers. The patients also can be encouraged to bring headsets of their own when they come for dental treatment.

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Q What are the best methods to ensure sterility of stored instrument packages?

A Maintain sterilized instruments in the pouches or wrapping in which they were sterilized. If the packaging becomes torn or wet, the items must be repackaged and heat sterilized. Avoid mingling non-sterile packages with sterile ones. There should be a visible indicator, such as chemical indicators or color-change autoclave tape on the outside of each package to allow staff to easily discern sterilized instrument packages from those that have not yet been heat-processed(1).

References:
(1) CDC/Center for Disease Control and Prevention. Recommended infection-control practices for dentistry, 1993. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm

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Q What are the guidelines for sterilizing dental burs, according to OSHA?

A Since sterilization of instruments is not an employee health issue, OSHA does not provide guidance for sterilization. However, since used burs are a contaminated sharp, employees must wear the appropriate personal protective equipment when handling them after patient care. Like other contaminated disposable sharps, used burs should be discarded into sharps containers(1). Because dental burs are difficult to clean and are degraded by the sterilization process, dental offices should consider making burs a single use disposable item.

References:
(1) OSHA. 29CFR 1910.1030. Bloodborne Pathogens, Final Rule. Available at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

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Q Do any states require heat sterilization for handpieces?

A Yes. Numerous states including California, Florida, Indiana, Kansas, Missouri, New Mexico, Ohio, Oregon, South Carolina, Virginia, and Washington all require heat sterilization. This is regulated by the state dental board. For regulations in your state contact the appropriate licensing agency(1).

References:
(1) The Dental Student Network list of state licensing agencies. Available at http://www.studentdoctor.net/dental/state_boards.html

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Q Is there a way to disinfect anesthetic cartridges before touching them with sterile gloves?


A
Remember that the product inside the cartridge is already sterile. Anesthetic cartridges should not be sterilized because exposure to high temperatures can affect the cartridge contents. Application of chemical germicides likewise is not recommended because of the potential for the germicide to leak into the cartridge. Store anesthetic cartridges in a manner that prevents cross-contamination and eliminates the need for disinfection. Contaminated cartridges should be discarded.

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Q If a sterile needle is inserted into the rubber of the anesthetic cartridge without decontamination, is there any risk of infection?

A With single-use cartridges, the risk of infection is negligible as long as the anesthetic cartridges have been stored in a manner that prevents cross-contamination and standard infection control precautions are applied during handling and use.

Separate precautions may be indicated for multi-use vials in, for example, medical or surgical settings.

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Q What exactly is a cold sterilant?

A A cold sterilant is a chemical agent that can destroy all microbial life, including highly resistant bacterial endospores when used according to the directions on the product label. At shorter contact times, the product is capable of inactivating all microorganisms and some, but not all bacterial endospores.(1) Please note that most dental instruments are heat-tolerant and, as such, should be heat-sterilized via autoclave, chemical vapor, or dry heat. If chemical germicides are required, the Food and Drug Administration (FDA) maintains a list of germicides that it has cleared for market as safe and effective high-level disinfectants/sterilants when used as directed(2).

References:
(1) Sterilization or Disinfection of Medical Devices: General Principles, Division of Healthcare Quality Promotion, Centers for Disease Conrol and Prevention, available at http://www.cdc.gov/ncidod/hip/Sterile/Sterilgp.htm
(2) Food and Drug Administration. FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices. Available at http://www.fda.gov/cdrh/ode/germlab.html

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Q How often should the autoclave be cleaned?

A Autoclaves should be cleaned according to the schedule described in the autoclave's instructions or operator's manual. Often the manufacturer has specific recommendations on the agents to use for the safest and most effective cleaning. If you've lost your manual, contact the autoclave manufacturer for a replacement.

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Q Is a sterilization log required indicating the cycle, length, type of load processed?

A This is required in hospitals and other institutional settings by agencies that accredit these facilities. No national mandate requires such a log in a private practice dental office, but requirements in individual states can vary. For example, Indiana requires that sterilizer time(s) and temperature(s) be documented in the dental office infection control manual. Contact your state dental licensing agency to determine if similar requirements exist in your area(1). Because recordkeeping can play a role in risk management, it may be wise to consult your attorney for advice on maintaining such records.

References:
(1) The Dental Student Network list of state licensing agencies. Available at http://www.studentdoctor.net/dental/state_boards.html

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Q What is the shelf life of a packaged instrument after it has been sterilized? Should sterile pouches be dated?

A Although either event- or time-related practices for storage of sterile packages may be used, it is important to understand that the package contents should remain sterile indefinitely unless some outside event, such as tearing or moisture causes the pouch to become compromised. At that time it is important to repackage and resterilize the package contents to ensure sterility of the instruments. Placing a date on a package cannot ensure sterile contents if the package was compromised during the storage period. Sterile packages should, however, be marked to indicate the date the item was processed and the sterilizer they were processed in. This will facilitate recall of items in the event monitoring detects a problem with a sterilizer.

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Q What are the advantages and disadvantages of "flash sterilization?"

A Flash sterilization (sterilization of unwrapped items) may be considered if an emergency occurs (for example, the practice's only available handpiece is dropped on the floor in the middle of patient treatment) and a single instrument needs to be sterilized in a hurry. Since the item is not to be wrapped for processing, the sterilized item should be used immediately (as soon as it cools off) and must be protected from re-contamination during transport to the point of use by using a previously agreed upon protocol designed for this purpose.

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Q Why is it important to package instruments for sterilization and storage?

A Packaging cleaned instruments prior to placing them in the sterilizer is a standard of care that protects instruments and maintains their sterility until they are ready for use on a patient(1). Unprotected instruments may be re-contaminated with dust and spatter or by coming into contact with any number of non-sterile surfaces during transport, storage, tray set-up, and operatory set-up.

References:
CDC/Centers for Disease Control and Prevention. Recommended infection-control practices for dentistry, 1993. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm

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Q What is an effective protocol for biological monitoring and instrument sterility quality assurance?

A The Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA), and OSAP all recommend weekly spore testing for most dental offices (1,2,3). Your state may have specific requirements for spore testing. Watching gauges and checking seals on your sterilizer (physical monitoring) and the use of chemical indicators with each instrument package (chemical monitoring) to identify items that have been exposed to heat also are important components for sterility assurance.

References:
(1) CDC. Recommended infection-control practices for dentistry, 1993. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm
(2) ADA Council on Scientific Affairs and ADA Council on Dental Practices. Infection Control Recommendations for the Dental Office and Dental Laboratory. J Am Dent Assoc 1996;127:672-680. Available at http://ada.org/prof/prac/issues/topics/icontrol/ic-recs/index.html
(3) OSAP. OSAP Position Paper: Instrument Processing, January, 1997. Available at http://osap.org/issues/pages/position/pp-ip.htm

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Q Should a handpiece used on an HIV-positive patient be sterilized twice?

A The cornerstone of today's dental infection control and safety recommendations is the practice of "universal precautions” (also referred to as Standard Precautions in hospital settings. Practicing universal precautions means that you treat every patient as if he or she is carrying an infectious disease. Under this concept, the same acceptedsterilization and other infection control precautions are used on all patients, regardless of HIV, hepatitis, or other disease status(1,2). Repetition of the sterilization process is not necessary.

References:
CDC/Centers for Disease Control and Prevention. Recommended infection-control practices for dentistry, 1993. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm
(2) ADA Council on Scientific Affairs and ADA Council on Dental Practices. Infection Control Recommendations for the Dental Office and Dental Laboratory. J Am Dent Assoc 1996;127:672-680. Available at http://ada.org/prof/prac/issues/topics/icontrol/ic-recs/index.html

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Q Could a kitchen-grade convection oven be used for sterilization?

A No. Commercial grade cooking ovens do not have the insulation or temperature criteria stringent enough to fulfill requirements put forth by the Food and drug Administration (FDA). It is critical that healthcare professionals only utilize units that have been cleared by the FDA for use as sterilizers.

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Q When using a computerized sterilizer, do you still need to do monitoring?

A Biological monitoring (spore-testing) is still the medico-legal standard for sterilizer quality assurance and is required by many state dental practice acts. There are a number of factors that contribute to sterilization failure that the computer simply cannot acknowledge. The most frequent cause of sterilization failure is operator error, not malfunction of the sterilizer. The use of a biological indicator helps provide assurance that all aspects of sterilization, including both the mechanical and the procedural, are being performed as intended. If the sterilizer has a recording printer, the printout should be maintained in the sterilization log, along with the results of spore-testing.

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Q How long do spore ampules and documentation for sterilization monitoring need to be kept?

A Consult with and follow the manufacturer's directions concerning the use of the spore test. Spore ampules may be disposed of after test results have been read, interpreted, and recorded, but again, consult the spore test instructions supplied by the manufacturer.

The sterilization monitoring log record book should be used to record the results of biological monitoring, as well as, mechanical, and chemical process integrators. Sterilization monitoring log record books may be purchased (e.g. through the monitor's distributor/manufacturer, dental sales representative, etc.) or can be developed by the practice. Most dental practices choose to purchase a monitor record log book because they are simple to use and maintain.

Requirements, regulations, and recommendations do vary among states, therefore, records must be maintained long enough to comply with regulations in your state or locality. Sterilization monitoring requirements, including recordkeeping, can be regulated by the State Board of Dental Examiners, through the State Health Department/Agency and/or through legislative law. To determine if you are in a state with required recordkeeping regulations and requirements contact your State Board of Dental Examiners/State licensing agency, as well as, State Public Health Agency.

OSAP is not in a position to offer legal advice. Because recordkeeping can play a role in risk management and there are no state regulations concerning this issue you should consult with the dental practice's attorney and/or attorney knowledgeable in medical law for legal advice on maintaining such records.

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Q What are the advantages and disadvantages to the use of a dry heat sterilizer in a dental office?

A Dry heat sterilization requires a higher temperature (320º - 375º F) than other sterilization processes and therefore may not be suitable for all dental instruments (most notably dental handpieces, which are not manufactured to withstand that sterilization process). The following are some of the advantages and disadvantages(1). Dry heat is effective and safe for sterilization of metal instruments and mirrors; it does not dull cutting edges, and it does not cause rust or corrosion. On the down side, it requires a long cycle for sterilization (except for forced-air, rapid heat transfer sterilizers, at 375º F); has poor penetration; may discolor and char fabric; destroys heat-labile items; cannot be used to sterilize liquids; and is generally unsuitable for handpiece sterilization. Always read and follow the instructions/directions from the manufacturer of the dry heat sterilizer you are using.

References:
(1) Molinari JA, Rosen S, Runnells RR. In Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control In Dentistry, 2nd edition. Philadelphia:Williams & Wilkins, 1996

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Q Is dry heat equally effective in killing microorganisms as steam autoclaves?

A Dry heat sterilizers have been used effectively in dental office for many years. Just as with any other sterilization method, dry heat sterilization is highly dependent upon the operator following the manufacturer's instructions for cycle time, temperature, instrument packaging, and loading technique. Because dry air is not as efficient a heat conductor as moist heat at the same temperature, a much higher temperature is required for a dry heat unit to accomplish sterilization.(1).

There have been some recommendations that dry heat be used only in situations where moist heat is not desirable due to the material, such as oils, powders, sharp instruments and glassware(2). However, the same source points out that dry heat provides excellent penetration and prevents the corrosion of metals. Since forced-air dry heat systems have very short sterilization cycles and are kind to high carbon steel instruments, they are very often used in orthodontic practices to re-process pliers and cutters.(2)

Keep in mind that the only way to assure that sterilization parameters are routinely met is to use spore tests/biological monitors. Weekly testing is recommended.(2-4)

References:
1) Molinari JA, Rosen S, Runnells RR. In Cottone JA, Terezhalmy GT, Molinari JA, eds. Practical Infection Control In Dentistry, 2nd edition. Philadelphia:Williams & Wilkins, 1996
2) Josly L. In Block SS, ed. Disinfection, Sterilization, and Preservation, 5th edition. Philadelphia: Lippincott, Williams and Wilkins. 2001
3) CDC. Recommended Infection Control Practices for Dentistry. MMWR Morbid Mortal Weekly Report 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm
4) ADA Council on Scientific Affairs and ADA Council on Dental Practices. Infection Control Recommendations for the Dental Office and Dental Laboratory. J Am Dent Assoc 1996;127:672-680.
5) OSAP. Infection Control for Dentistry Guidelines, September 1997. Available at http://osap.org/resources/IC/icguide97.htm

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Q The instructions for the electrosurgery tips my practices uses say to "cold sterilize” them. What cold sterilization methods does the Food and Drug Administration (FDA) approve for use?

A "Cold sterilization” entails the use of chemicals that FDA classifies as high-level disinfectants/sterilants. Chemicals in this category are required to have FDA clearance for their claims.

Ideally, all items that enter the patient's mouth and come into contact with oral tissues should be heat sterilized. If this is not feasible because the device or instrument cannot withstand the heat sterilization process, a high-level disinfectant should be used.

The FDA maintains a list of products that have received clearance as chemical sterilants.(1) The list includes information regarding proper contact time, active ingredients and reuse or shelf life. Always read instructions carefully before using a chemical germicide.

References:
1) Food and Drug Administration. FDA-cleared sterilants and high level disinfectants with general claims for processing reusable medical and dental devices. Available at http://www.fda.gov/cdrh/ode/germlab.html

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Q How do you handle the sterilization of instruments used on known hepatitis patients? Can you put them in the ultrasonic cleaner or separate them and handscrub them? If you use the ultrasonic cleaner, do you have to then empty it and sterilize it?

A Instruments used on known hepatitis patients do not require special reprocessing procedures. The same sterilization and other infection control precautions should be used regardless of a patient's HIV, hepatitis, or other disease status.

The Centers for Disease Control and Prevention's guidelines for infection control in dentistry state: "Universal precautions were based on the concept that all blood and body fluids that might be contaminated with blood should be treated as infectious because patients with bloodborne infections can be asymptomatic or unaware they are infected … Standard precautions integrate and expand the elements of universal precautions into a standard of care designed to protect HCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion . Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) nonintact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between universal precautions and standard precautions."(1)

In other words, the same sets of instrument processing, personal protection equipment, and engineering and work practice control precautions can be expected to protect against all bloodborne disease agents.(1) As such, instruments used on a known hepatitis patient need not be segregated from other contaminated instruments, can be cleaned in an ultrasonic cleaner, and do not require special post-cycle maintenance or cleaning of ultrasonic equipment.

References:
1) CDC. Guidelines for Infection Control in Dental Health-Care Settings --- 2003. December 19, 2003 MMWR 52(RR17);1-61 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

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Q Can OSAP recommend a non-corrosive alternative to glutaraldehyde for use in reprocessing impression trays?

A Metal impression trays are heat-stable and therefore should be thoroughly cleaned and heat-sterilized after each use.

Plastic impression trays are intended for single-use and should be discarded when laboratory procedures are completed.

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Q Can we store our sterile dental instruments under the sink?

A Sterile items should not be stored on the floor, under sinks, on windowsills, or adjacent to air vents. Conditions in these areas can compromise the sterility of the packages and instruments.*

*CDC Oral Health Resources Frequently Asked Questions. Infection Control. Sterilization-Packaging and Storage.

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Q Should my dentist be heat-sterilizing all of the instruments used in my mouth?

A Unless it is heat-sensitive or single-use/disposable, all items that enter the mouth should be sterilized using heat (for example, via autoclave, chemical vapor, dry heat). When available, single-use disposable items are a good infection control alternative to heat sterilizing instruments between patients. As their name suggests, single-use disposable items are used for only one patient and then discarded.

A few instruments and devices in the dental office may not be able to withstand the heat sterilization process. Any heat-sensitive item used in the mouth should be sterilized by immersion in a powerful (high-level) chemical disinfectant/sterilant for the time listed on the product's label for sterilization (usually 3-10 hours).

Ideally, heat-sensitive devices/instruments should be replaced with either heat-tolerant or single-use disposable devices.

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Q Does repeated autoclaving compromise instrument sharpness?

A According to infection control experts, dulling of instruments in an autoclave is minimal. Newer tabletop pre-vacuum autoclaves cause less dulling/corrosion than the gravity fed, and stainless-steel instruments are less susceptible than carbon steel.

If the cutting edges of your hygiene instruments seem to dull quickly, contact the instrument manufacturer and the manufacturer of the sterilizer for advice and assistance.

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Q Can we set up the instrument tray before the patient arrives and cover everything with a disposable napkin?

A While each dental office must determine what is best for its practice setting, infection control experts recommend that sterile packs, packages, and/or cassettes remain sealed until the patient arrives.

Once sterile instruments are removed from the packages, they can become contaminated. Keeping them wrapped until use maintains sterility. Also, patients are better educated today concerning infection control procedures in dentistry. Opening sterile packages in front of them provides the assurance that instruments are sterile. Further, if a patient fails to arrive for an appointment, any instruments/packages opened in advance would need to be repackaged and sterilized again, even though they were not used.

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