Has there recently been a change in regulation that instrument pouches must be opened in front of the patient?
Ask OSAP can provide you with some general information on this topic. The 2003 CDC guidelines for infection control in dentistry states as follows:
Critical and semicritical instruments that will be stored should be wrapped or placed in containers (e.g., cassettes or organizing trays) designed to maintain sterility during storage (2,247,255–257).1
Critical instruments sterilized unwrapped should be transferred immediately by using aseptic technique, from the sterilizer to the actual point of use. Critical instruments should not be stored unwrapped (260). Semicritical instruments that are sterilized unwrapped on a tray or in a container system should be used immediately or within a short time. When sterile items are open to the air, they will eventually become contaminated. Storage, even temporary, of unwrapped semicritical instruments is discouraged because it permits exposure to dust, airborne organisms, and other unnecessary contamination before use on a patient (260). A carefully written protocol for minimizing the risk of contaminating unwrapped instruments should be prepared and followed (260).1
The CDC states on its Website:
How should items be stored following sterilization?
Sterile items and disposable (single-use) items should be stored in an enclosed storage area (e.g., cabinet or drawer). Dental supplies and instruments should not be stored under sinks or in other locations where they might become wet. Sterilized items should remain wrapped until they are needed for use.
Unwrapped items are susceptible to contamination. Avoid storing items loose in drawers or cabinets because unwrapped items cannot be kept sterile. Items stored in this manner are subject to contamination from dust, aerosols generated during treatment, and the hands of personnel who must handle them.2
The OSAP FAQ states the following:
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.3
In summary, once sterilized instruments are removed from the packages, they have the potential to become contaminated. Sterilized items should remain wrapped until they are needed for use. You may also wish to contact your state dental board/dental licensing agency for further information regarding any state specific requirements pertaining to this matter.
1) 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.
2) US Centers for Disease Control and Prevention. Sterilization — Packaging and Storage.
http://www.cdc.gov/oralhealth/infectioncontrol/faq/sterilization.htm Accessed on April 15, 2015.
3) Organization for Safety, Asepsis and Prevention. Frequently Asked Questions for Sterilization. http://www.osap.org/?FAQ_Instrum_Ster1#canwesetuptheinstrumenttray Accessed on April 15, 2015.