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Handpieces Archived Through 2012
 FAQ - Handpieces - Archived Through 2012

 

 

I have worked in many offices and no one has the same protocol for sterilizing dental hygiene handpieces. What is the legal, ethical stand on sterilization of these specific handpieces? My current office says just to wipe them down and lube them daily. Since we have a Statim and autoclave, the thought of using it all day long without sterilization just does not seem right. Also, if a room is sprayed or wiped with the sani-cloth style wipes, is it still necessary to use plastic covers on the chair, light, instrument cart, air/water syringe, saliva ejector and hand speed? One office where I work is totally naked and just wipes down everything and the other has so much plastic on everything it is almost overkill!! Is there an OSHA standard or is it just preference?

With regard to sterilization of handpieces, there may be state laws/regulations that OSAP is not aware of. You should contact your State Board of Dental Examiners/Licensing Board for specific requirements in your state. Often times State Boards mandate the sterilization of handpieces and handpiece attachments after each patient use.

In addition, State Boards may also require dentists to be in compliance with the Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings.

OSAP provides links to state agencies that may be viewed at: http://www.osap.org/displaycommon.cfm?an=1&subarticlenbr=71

It should further be noted that the American Dental Association (ADA) recognizes the CDC guidelines and developed a position statement that may be viewed at:

http://www.ada.org/prof/resources/positions/ statements/infectionconrol.asp

The ADA also provides links to State Boards at: http://www.aadexam.org/links.htm

OSAP would like to refer you directly to the CDC guidelines. In part, the guidelines state the following:

Sterilization and Disinfection of Patient-Care Items: 
Patient-care items (dental instruments, devices, and equipment) are categorized as critical, semi-critical, or non-critical, depending on the potential risk for infection associated with their intended use (Table 4). Critical items used to penetrate soft tissue or bone have the greatest risk of transmitting infection and should be sterilized by heat. Semi-critical items touch mucous membranes or non-intact skin and have a lower risk of transmission; because the majority of semi-critical items in dentistry are heat-tolerant, they also should be sterilized by using heat. (1)

Dental Handpieces and Other Devices Attached to Air and Waterlines: 
Multiple semi-critical dental devices that touch mucous membranes are attached to the air or waterlines of the dental unit. Among these devices are high- and low-speed handpieces, prophylaxis angles, ultrasonic and sonic scaling tips, air abrasion devices, and air and water syringe tips. Although no epidemiologic evidence implicates these instruments in disease transmission, studies of high-speed handpieces using dye expulsion have confirmed the potential for retracting oral fluids into internal compartments of the device. This determination indicates that retained patient material can be expelled intraorally during subsequent uses. Studies using laboratory models also indicate the possibility for retention of viral DNA and viable virus inside both high-speed handpieces and prophylaxis angles. The potential for contamination of the internal surfaces of other devices (e.g., low-speed handpieces and ultrasonic scalers), has not been studied, but restricted physical access limits their cleaning. Accordingly, any dental device connected to the dental air/water system that enters the patient's mouth should be run to discharge water, air, or a combination for a minimum of 20--30 seconds after each patient. (1)
This procedure is intended to help physically flush out patient material that might have entered the turbine and air and waterlines. (1)

Heat methods can sterilize dental handpieces and other intraoral devices attached to air or waterlines. For processing any dental device that can be removed from the dental unit air or waterlines, neither surface disinfection nor immersion in chemical germicides is an acceptable method. Ethylene oxide gas cannot adequately sterilize internal components of handpieces. In clinical evaluations of high-speed handpieces, cleaning and lubrication were the most critical factors in determining performance and durability. Manufacturer's instructions for cleaning, lubrication, and sterilization should be followed closely to ensure both the effectiveness of the process and the longevity of handpieces. (1)

Some components of dental instruments are permanently attached to dental unit waterlines and although they do not enter the patient's oral cavity, they are likely to become contaminated with oral fluids during treatment procedures. Such components (e.g., handles or dental unit attachments of saliva ejectors, high-speed air evacuators, and air/water syringes) should be covered with impervious barriers that are changed after each use. If the item becomes visibly contaminated during use, DHCP should clean and disinfect with an EPA-registered hospital disinfectant (intermediate-level) before use on the next patient. (1)

With regard to environmental infection control and the use of barriers, the CDC guidelines, in part, states: 
Environmental Infection Control: 
In the dental operatory, environmental surfaces (i.e., a surface or equipment that does not contact patients directly) can become contaminated during patient care. Certain surfaces, especially ones touched frequently (e.g., light handles, unit switches, and drawer knobs) can serve as reservoirs of microbial contamination, although they have not been associated directly with transmission of infection to either DHCP or patients. Transfer of microorganisms from contaminated environmental surfaces to patients occurs primarily through DHCP hand contact. When these surfaces are touched, microbial agents can be transferred to instruments, other environmental surfaces, or to the nose, mouth, or eyes of workers or patients. Although hand hygiene is key to minimizing this transferal, barrier protection or cleaning and disinfecting of environmental surfaces also protects against health-care--associated infections. (1)

Environmental surfaces can be divided into clinical contact surfaces and housekeeping surfaces. Because housekeeping surfaces (e.g., floors, walls, and sinks) have limited risk of disease transmission, they can be decontaminated with less rigorous methods than those used on dental patient-care items and clinical contact surfaces. Strategies for cleaning and disinfecting surfaces in patient-care areas should consider the 1) potential for direct patient contact; 2) degree and frequency of hand contact; and 3) potential contamination of the surface with body substances or environmental sources of microorganisms (e.g., soil, dust, or water). (1)

Cleaning is the necessary first step of any disinfection process. Cleaning is a form of decontamination that renders the environmental surface safe by removing organic matter, salts, and visible soils, all of which interfere with microbial inactivation. The physical action of scrubbing with detergents and surfactants and rinsing with water removes substantial numbers of microorganisms. If a surface is not cleaned first, the success of the disinfection process can be compromised. Removal of all visible blood and inorganic and organic matter can be as critical as the germicidal activity of the disinfecting agent. When a surface cannot be cleaned adequately, it should be protected with barriers. (1)

Clinical Contact Surfaces:

Clinical contact surfaces can be directly contaminated from patient materials either by direct spray or spatter generated during dental procedures or by contact with DHCP's gloved hands. These surfaces can subsequently contaminate other instruments, devices, hands, or gloves. Examples of such surfaces include: (1)

light handles, 
switches, 
dental radiograph equipment, 
dental chairside computers, 
reusable containers of dental materials, 
drawer handles, 
faucet handles, 
countertops, 
pens, 
telephones, and 
doorknobs. 
Barrier protection of surfaces and equipment can prevent contamination of clinical contact surfaces, but is particularly effective for those that are difficult to clean. Barriers include clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture. Because such coverings can become contaminated, they should be removed and discarded between patients, while DHCP are still gloved. After removing the barrier, examine the surface to make sure it did not become soiled inadvertently. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient. (1)

If barriers are not used, surfaces should be cleaned and disinfected between patients by using an EPA-registered hospital disinfectant with an HIV, HBV claim (i.e., low-level disinfectant) or a tuberculocidal claim (i.e., intermediate-level disinfectant). Intermediate-level disinfectant should be used when the surface is visibly contaminated with blood or OPIM. Also, general cleaning and disinfection are recommended for clinical contact surfaces, dental unit surfaces, and countertops at the end of daily work activities and are required if surfaces have become contaminated since their last cleaning. To facilitate daily cleaning, treatment areas should be kept free of unnecessary equipment and supplies. (1)

Manufacturers of dental devices and equipment should provide information regarding material compatibility with liquid chemical germicides, whether equipment can be safely immersed for cleaning, and how it should be decontaminated if servicing is required. Because of the risks associated with exposure to chemical disinfectants and contaminated surfaces, DHCP who perform environmental cleaning and disinfection should wear gloves and other PPE to prevent occupational exposure to infectious agents and hazardous chemicals. Chemical- and puncture-resistant utility gloves offer more protection than patient examination gloves when using hazardous chemicals. (1)

Resource:

1) CDC Infection Control Guidelines for Dental Healthcare Settings:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

Additional CDC Resources and Information May Be Viewed At:

Appendix A: Regulatory Framework for Disinfectants and Sterilants;
includes Figure: Decreasing Order of Resistance of Micro-organisms to Germicidal Chemicals 
Appendix B: Immunizations Strongly Recommended for Health-Care Personnel (HCP) 
Appendix C: Methods for Sterilizing and Disinfecting Patient-Care Items and Environmental Surfaces

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