| FAQ - Office Design & Management - 2015
Can the containers used to transport the contaminated instruments and utility gloves be disinfected and kept under the sink in the operatory?
There are actually several aspects to this question. Ask OSAP would like to note that some states may regulate what can be stored under a sink in the dental operatory. It is recommended that you contact your state public health agency (i.e., state health department) to find out if there are any applicable regulations in your state.
Ask OSAP can provide you with some general information on this matter.
Attached for your review is some information pertaining to instrument processing and workflow design obtained from Infection Control and Management of Hazardous Materials for the Dental Team. There are some general principles in the design of an instrument processing area. As this information states:
One should accomplish three goals when designing or organizing an instrument processing area in a dental office.
· Locate in a low-contamination low-traffic area
· Base the physical design on workflow
· Separate “clean” instruments from “dirty” instruments (sterile from contaminated). 1
Ideally, the instrument processing area should be located centrally, if possible, for easy access from all operatories, but it should be away from traffic flow. That is, the area should be a facility dedicated only to instrument processing, be physically separated from the operatories and dental laboratory. And, not part of a common walkway. 1
The 2003 CDC guidelines for infection control in dentistry provides the following general information:
Transporting and Processing Contaminated Critical and Semicritical Patient-Care Items DHCP can be exposed to microorganisms on contaminated instruments and devices through percutaneous injury, contact with nonintact skin on the hands, or contact with mucous membranes of the eyes, nose, or mouth. Contaminated instruments should be handled carefully to prevent exposure to sharp instruments that can cause a percutaneous injury. Instruments should be placed in an appropriate container at the point of use to prevent percutaneous injuries during transport to the instrument processing area (13).
Instrument processing requires multiple steps to achieve sterilization or high-level disinfection. Sterilization is a complex process requiring specialized equipment, adequate space, qualified DHCP who are provided with ongoing training, and regular monitoring for quality assurance (247). Correct cleaning, packaging, sterilizer loading procedures, sterilization methods, or high-level disinfection methods should be followed to ensure that an instrument is adequately processed and safe for reuse on patients. 2
Additionally, Practical Infection Control In Dentistry states:
Handling and Transporting Contaminated Patient-Care Items Contaminated instruments should be handled as little as possible and carefully to prevent exposure to sharp instruments that can cause percutaneous injury. Also of concern is exposure to microorganisms on contaminated instruments and devices through contact with nonintact skin on the hands or with mucous membranes of the eyes, nose, or mouth. All contaminated instruments and devices should be handled carefully by DHCP wearing heavy-duty utility gloves in addition to other appropriate PPE such as protective clothing, protective eyewear, masks, and head and shoe covers. Examination gloves do not provide adequate protection against sharps injuries. Instruments should be placed in an appropriate covered puncture-resistant container in the dental treatment area to limit cross-contamination and prevent percutaneous injuries during transport to the instrument-processing area. These carrying containers should be either red or labeled with the biohazard symbol.3
Infection Control and Management of Hazardous Materials for the Dental Team states as follows:
Operatory Cleanup and Instrument Processing
To provide more protection for the hands during operatory cleanup and handling of instruments than that provided by the thin latex or vinyl patient care gloves or thin copolymer or plastic gloves, one should use utility gloves of nitrile or heavy latex when preparing and using chemicals, precleaning and disinfecting contaminated surfaces, and handling contaminated items during instrument processing. Each person in the office needing these gloves should have his or her own pair or pairs of gloves. The heavy utility gloves are reusable and can be washed with an antimicrobial handwashing agent, rinsed, and dried. 1
1) Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Pages 109, 143-145.
2) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on April 15, 2015
3) Molinari JA and Harte JA. Practical Infection Control In Dentistry – Third Edition. Wolters Kluwer / Lippincott / Williams & Wilkins. Pages 222-223.