Print Page   |   Contact Us   |   Your Cart   |   Sign In
Search
Sign In


Forgot your password?

Haven't registered yet?

Breaking News
Calendar
Test FAQ's Handpieces
Frequently Asked Questions (FAQs) On Dental Infection Control -Handpieces


Frequently Asked Questions for Handpieces

Q
Since handpieces are degraded regularly and require frequent turbine replacement as a result of conventional autoclaving, is glutaraldehyde a suitable alternative to autoclave sterilization?
QDo any states require heat sterilization for handpieces?
QI 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?
QCan OSAP address evacuator safety guidelines for the saliva ejector, surgical evacuators, and high volume evacuators?
QI am trying to locate printed material that discusses the "sucking on the saliva ejector” or the old "Mr. Thirsty” and the negative effects due to possible water line contamination. Can you help?

Back to Top

______________________________________________________

QSince handpieces are degraded regularly and require frequent turbine replacement as a result of conventional autoclaving, is glutaraldehyde a suitable alternative to autoclave sterilization?
A
No. The Centers for Disease Control and Prevention (CDC,1), the American Dental Association (ADA,2), OSAP(3), most state dental licensing boards, and dental handpiece manufacturers all recommend heat sterilization between patient uses. Virtually all handpieces currently in production are heat-tolerant, and those that are not can be retrofitted to allow heat-processing. Autoclaving and chemical vapor sterilization are considered accepted methods of heat sterilization. High-level disinfection via chemical germicides cannot be biologically monitored to assure sterility. Further, extended contact with chemical germicides may corrode handpiece components.References:
(1) CDC. Recommended Infection Control Practices for Dentistry. MMWR Morbid Mortal Weekly Rep 1993;42(RR-8):1-14. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021095.htm
(2) ADA Council on Scientific Affairs and ADA Council on Dental Practices. Infection Control Recommendations for the Dental Office and Dental Laboratory. J Am Dent Assoc 1996;127:672-680.
(3) OSAP. Infection Control for Dentistry Guidelines , September 1997.

Back to Top

_________________________________________________
Q
Do any states require heat sterilization for handpieces?
AYes. Numerous states including California, Florida, Indiana, Kansas, Missouri, New Mexico, Ohio, Oregon, South Carolina, Virginia, and Washington all require heat sterilization. This is regulated by the state dental board. For regulations in your state contact the appropriate licensing agency(1). References:
(1) The Dental Student Network list of state licensing agencies. Available at http://www.studentdoctor.net/dental/state_boards.html

Back to Top

_________________________________________________
QI 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?
AWith 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


Back to Top

_________________________________________________
QCan OSAP address evacuator safety guidelines for the saliva ejector, surgical evacuators, and high volume evacuators?
ARisk 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:

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

Resources:

1) The Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Facilities (December 2003):

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

2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. edition. By Miller and Palenik. Elsevier/Mosby Publishers. Copyright 2005


Back to Top

_________________________________________________
Q
I am trying to locate printed material that discusses the "sucking on the saliva ejector” or the old "Mr. Thirsty” and the negative effects due to possible water line contamination. Can you help?
AThe United States Centers for Disease Control and Prevention's (CDC) Infection Control 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. (1)

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)

OSAP would also like to refer you to the American Dental Association's position statement that may be viewed at:

http://www.ada.org/prof/prac/issues/statements/saliva.html

Resource:

(1) The Centers for Disease Control and Prevention's (CDC) Guidelines for Infection Control in
Dental Healthcare Settings:

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


Back to Top

_________________________________________________

 

 

 

OSAP Disclaimer | Please notify our webmaster of any problems with this website.
OSAP thanks its Super Sponsors for their support in 2016. Sponsorship does not imply endorsement by OSAP of a company's products or services.