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Practice Safety/Patient Safety Archived Through 2012
 FAQ - Practice Safety/Patient Safety - Archived Through 2012

 

 

I know that JACHO is against using gluteraldehyde, what is the position of OSAP? What research could I present before an employer to recommend change?

OSAP does not test, evaluation, recommend, nor endorse specific products. We can however provide you with general information.

Yes, there are dental offices that have discontinued the use of Glutaraldehyde for high-level disinfection/chemical liquid sterilization. According to the Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings using heat-sensitive semi-critical items that must be processed with liquid chemical germicides is discouraged. Heat-tolerant or disposable alternatives are available for the majority of such items. (1)

The use of "cold” chemical sterilants (e.g. gluteraldehyde) is being discontinued for several reasons (e.g. toxic chemicals, sterilization cannot be verified, states with laws requiring sterilization be verified through use of biological monitors, etc.).

OSAP would like to refer you directly to the Centers for Disease Control and Prevention's Infection Control Guidelines for Dental Healthcare Settings. The guidelines explain the rationale for discontinuing their use as liquid chemical sterilants.

Heat-sensitive critical and semi-critical instruments and devices can be sterilized by immersing them in liquid chemical germicides registered by FDA as sterilants. When using a liquid chemical germicide for sterilization, certain post-sterilization procedures are essential. Items need to be 1) rinsed with sterile water after removal to remove toxic or irritating residues; 2) handled using sterile gloves and dried with sterile towels; and 3) delivered to the point of use in an aseptic manner. If stored before use, the instrument should not be considered sterile and should be sterilized again just before use. In addition, the sterilization process with liquid chemical sterilants cannot be verified with biological indicators. (1)

Because of these limitations and because liquid chemical sterilants can require approximately 12 hours of complete immersion, they are almost never used to sterilize instruments. Rather, these chemicals are more often used for high-level disinfection. Shorter immersion times (12--90 minutes) are used to achieve high-level disinfection of semi-critical instruments or items. These powerful, sporicidal chemicals (e.g., glutaraldehyde, peracetic acid, and hydrogen peroxide) are highly toxic. Manufacturer instructions (e.g., regarding dilution, immersion time, and temperature) and safety precautions for using chemical sterilants/high-level disinfectants must be followed precisely. These chemicals should not be used for applications other than those indicated in their label instructions. Misapplications include use as an environmental surface disinfectant or instrument-holding solution. (1)

When using appropriate precautions (e.g., closed containers to limit vapor release, chemically resistant gloves and aprons, goggles, and face shields), glutaraldehyde-based products can be used without tissue irritation or adverse health effects. However, dermatologic, eye irritation, respiratory effects, and skin sensitization have been reported. Because of their lack of chemical resistance to glutaraldehydes, medical gloves are not an effective barrier. Other factors might apply (e.g., room exhaust ventilation or 10 air exchanges/hour) to ensure DHCP safety. For all of these reasons, using heat-sensitive semi-critical items that must be processed with liquid chemical germicides is discouraged; heat-tolerant or disposable alternatives are available for the majority of such items. (1)

Resource:

1) CDC Infection Control Guidelines For Dental Healthcare Settings: 
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

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