Suspend a piece of heavy-duty aluminum foil into a tank filled with fresh cleaning solution. Run the unit and expose the foil to ultrasonic waves for 30 seconds. Uniform pitting and indentation on the previously immersed foil indicates uniform cleaning power. Areas of the foil without pebbling -- "blind spots” -- are an indication that the unit needs service.
Following the concept of universal precautions, process the unit as recommended for all patients. The use of an intermediate-level or low-level disinfectant (depending upon the degree of contamination) after cleansing should be adequate. Some nitrous oxide masks are intended to withstand heat sterilization processes and may be sterilized. Single use disposable nitrous masks should be discarded.
Consult the manufacturer of your high-velocity evacuation system (vacuum/suction) and equipment for information on proper care and maintenance, and follow the directions and frequency of use for the recommended cleaning product.
The suction system is routinely exposed to large amounts of saliva, debris, and blood. Infection control experts recommend daily maintenance of the high-velocity evacuation system, including the use of cleaners.(1,2)
References: (1) Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team 2nd edition. St. Louis: Mosby, 1998. (2) Cottone JA, GT Terezhalmy, Molinari JA. Practical Infection Control In Dentistry 2nd edition. Philadelphia: Williams & Wilkins, 1996.
Filters that are specifically designed for use with dental units include micropore in-line filters that must be placed on each water delivery line. In addition, unit filters can be placed close to the control box to filter all lines delivering water to devices. Commercially available devices in this category also release small amounts of antimicrobial agents purported to control biofilm formation. Both types of filters require changing and maintenance according to manufacturer's instructions.
Large-pore diameter filters are provided with most dental units to prevent particulate materials suspended in tap water from entering the dental water systems; these filters have no beneficial effect on the microbiological content of water used in dental treatment.
References: (1) OSAP Issue Focus: Dental unit water lines.
The International Health Care Worker Safety Center at the University of Virginia maintains a list of available sharps safety products at http://www.healthsystem.virginia.edu/internet/epinet. OSAP's Issue Focus on Sharps Safety also has some valuable information on safer sharps devices.
The Centers for Disease Control and Prevention (CDC) has developed some tools to assist dental practices in evaluating and, if appropriate, incorporating safer sharps devices in practice. First, the CDC has developed Sample Screening and Device Evaluation Forms to assist dental clinicians in determining which safety devices may be suitable for their practices. Also, CDC has posted information on a program called "Safer Device Implementation in Healthcare Facilities," which shares the experiences of medical and dental professionals who have already considered and evaluated safety devices for their work settings.
Each time you use the ultrasonic scaler, high-speed handpiece, or an air/water syringe, aerosols are created. Aerosols are the invisible particles that can remain airborne for a long while. Aerosolization is one of the main contributors to airborne microorganisms in the operatory. By diminishing aerosolization, you also reduce the microbial load in the air and the risk of cross-contamination or exposure.
To best manage aerosolization:
Use high-volume evacuation (HVE).
Use a dental dam whenever possible.
Use personal protective equipment, such as disposable gowns and face shields (in combination with face mask).
Have each patient use a pre-procedure mouthrinse to reduce the microbial dose load in any aerosol generated.
While OSHA does not prohibit the use of cuspidors, they do pose infection control concerns. Patient materials are continually expelled into the basin, so cuspidors are continually contaminated. For this reason, many practices have opted to eliminate them, instead using high-volume evacuation (HVE, "suction”) to clear away oral fluids.
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