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Instrument Processing - Best Practices




Dental Guidance

Recent breaches in dental infection control have been reported from West Virginia and Missouri. The West Virgina case involved 3 patients and 2 clinic volunteers who developed hepatitis B after a Mission of Mercy (MOM) Clinic in Hedgesville, WV on June 26-27, 2007. Notification letters were mailed to 1,137 patients and 826 volunteers. The letters recommended testing for hepatitis B. Testing for hepatitis C and HIV also was recommended not because there were cases of HCV or HIV associated with MOM attendance, but because these viruses are transmitted in the same manner as HBV.

OSAP has developed two resources for those delivering oral care outside of the traditional dental office.

The first is new draft guidance on infection control considerations for dental services performed in sites using portable equipment or mobile vans (see link below under "Dental Guidance"). The second resource is designed to keep dental workers and patients safe in the provision of humanitarian aid in nontraditional care settings.

The second apparent breach of infection control occurred at the John Cochran Veterans Administration (VA) Medical Center in St. Louis, MO. The facility recently mailed letters to 1,812 veterans treated between February 2009 and March 2010 advising them to get tested for Hepatitis B&C and HIV.  The VA said quality reviews determined that some instrument processing steps for dental instruments were not in compliance with standards, creating a low risk of infections such as hepatitis C and HIV. In a video interview, Dr. Gina Michael, a spokesperson for the VAMC, said that dental instruments were sterilized but the proper sequence of instrument processing was not followed.

The US Centers for Disease Control and Prevention (CDC), in its most recent infection control guidance for dental facilities (see CDC Guidelines below), indicate that, "Removal of debris and contamination is achieved either by scrubbing with a surfactant, detergent, and water, or by an automated process (e.g., ultrasonic cleaner or washer-disinfector) using chemical agents. If visible debris, whether inorganic or organic matter, is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process...using automated equipment can be safer and more efficient than manually cleaning contaminated instruments."

Therefore, while automated cleaning equipment does not require presoaking or scrubbing of instruments and can increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids, manually cleaning is still a recognized option.

OSAP will continue to monitor this issue.

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Dental Guidance

CDC Chart Methods for Sterilizing and Disinfecting Patient-Care Items and Environmental Surfaces.  Appendix C of December 19, 2003 MMWR/52(RR17):66.
CDC Guidelines Guidelines for Infection Control in Dental Health-Care Settings, 2003. NOTE: Please see "Sterilization and Disinfection of Patient-Care Items" on pp.20-25 and 42-44 of document.
OSAP Newsletters on the Consequences of Improper Infection Control and Safety Procedures                                                      
OSAP Checklist Incorporating CDC Guidelines into your dental practice. OSAP Check-Up: 2003 CDC Guidelines. Is your infection control program up to date? 
OSAP - IC Checklist for Dental Settings Using Mobile Vans or Portable Dental Equipment

The Centers for Disease Control and Prevention (CDC) published infection control guidelines for dental healthcare settings in 2003. Although the 2003 recommendations are applicable to all settings in which dental treatment is provided, the recommendations focus mainly on dental settings that use traditional, fixed equipment (e.g., private practice dental settings). In contrast, a variety of non-traditional dental settings, such as school-based dental programs, use portable dental equipment. These programs often operate in challenging settings. For example, hallways, gymnasiums, or other high-traffic locations may be the only space available for dental screenings or treatment. Additional guidance may be useful in these unique situations, where space and resources needed to comply with recommended infection control practices may be limited (e.g., absence of sinks) or other challenges exist.

OSAP Guidance for Oral Healthcare Missions Guide for Safety and Infection Control for Oral Healthcare Missions

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