| FAQ - Handpieces - Archived Through 2012
Can OSAP address evacuator safety guidelines for the saliva ejector, surgical evacuators, and high volume evacuators?
Risk potential for cross-contamination; recommended installation; recommended performance; compare tips and handpieces; proper delivery; maintenance.
OSAP is not in a position to develop nor maintain guidelines for saliva ejectors, surgical evacuators, and high volume evacuators.
We do not test, evaluate, endorse products, nor maintain performance data and standards. All equipment must be installed, used, and maintained according to manufacturer's directions or instructions. The same holds true for evacuator lines, they must be maintained according to manufacturer instructions in order to avoid damage to the equipment. The instructions are available in the equipment operator's manual. If the manual is not available you will have to contact the manufacturer for a replacement copy.
We can only provide you with general information and comments.
Handling evacuator tips are treated no differently than any other item or supplies used in dentistry. They may be delivered to the point of use with clean gloved hands, or delivered to the point of use with forceps.
Any instrument, evacuator tip, or equipment/supplies could be inadvertently contaminated during use (e.g. touching someone's hair, clothing, dropping on floor, etc.). Care must always be used when handling equipment, instruments, and supplies in order to avoid cross-contamination. Should the item become contaminated during use it should be removed and replaced with a new one.
Saliva ejectors are single use disposables only and must be disposed of after each patient use. The Centers for Disease Control and Prevention's (CDC) Guidelines for Dental Healthcare Settings state the following:
Backflow from low-volume saliva ejectors occurs when the pressure in the patient's mouth is less than that in the evacuator. Studies have reported that backflow in low-volume suction lines can occur and microorganisms be present in the lines retracted into the patient's mouth when a seal around the saliva ejector is created (e.g., by a patient closing lips around the tip of the ejector, creating a partial vacuum).This backflow can be a potential source of cross-contamination; occurrence is variable because the quality of the seal formed varies between patients. Furthermore, studies have demonstrated that gravity pulls fluid back toward the patient's mouth whenever a length of the suction tubing holding the tip is positioned above the patient's mouth, or during simultaneous use of other evacuation (high-volume) equipment. Although no adverse health effects associated with the saliva ejector have been reported, practitioners should be aware that in certain situations, backflow could occur when using a saliva ejector. (1)
A single-use device, also called a disposable device, is designed to be used on one patient and then discarded, not reprocessed for use on another patient (e.g., cleaned, disinfected, or sterilized). Single-use devices in dentistry are usually not heat-tolerant and cannot be reliably cleaned. Examples include syringe needles, prophylaxis cups and brushes, and plastic orthodontic brackets. (1)
Certain items (e.g., prophylaxis angles, saliva ejectors, high-volume evacuator tips, and air/water syringe tips) are commonly available in a disposable form and should be disposed of appropriately after each use. (1)
Surgical suction tips are available in both disposable and metal-sterilizable form. Metal-sterilizable surgical suction tips are difficult to clean due to the diameter size and angle of the tip, therefore, disposables are recommended.
High volume evacuators are also available in both disposable and metal-sterilizable form. Disposables are more convenient and commonly used.
The CDC Guidelines further state the following:
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. 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)
The authors of Infection Control & Management of Hazardous Materials for the Dental Team state the following concerning high-volume evacuation:
High-volume evacuation (HVE) during use of rotary equipment and the air/water syringe greatly reduces the escape of salivary aerosols and spatter from the patient's mouth, which reduces contamination of the dental team and nearby surfaces. One should clean the HVE system at the end of the day by evacuating a detergent or water-based detergent-disinfectant through the system. One should not use sodium hypochlorite because this chemical may induce corrosion of metal parts in the system. One should remove and clean the trap in the system periodically. A safer approach, however, is to use a disposable trap. (2)
These traps may contain scrap amalgam that should be disposed of properly. The dental team member must wear gloves, masks, protective eyewear, and protective clothing when cleaning or replacing these traps to avoid contact with patient materials in the lines from splashing and direct contact. Disinfection of the trap by evacuating some disinfectant-detergent down the line followed by water is best before one cleans or changes the trap. (2)
The CDC guidelines provide recommendations for handling patient care items, use of barriers, proper disinfection and sterilization procedures, etc. We are going to refer you directly to these guidelines for further information. The guidelines may be viewed at:
1) The Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Facilities (December 2003):
2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. edition. By Miller and Palenik. Elsevier/Mosby Publishers. Copyright 2005