Hu-Friedy

THE ESSENTIAL GUIDE TOINFECTION CONTROL

PART 2: INSTRUMENT REPROCESSING

Pre-cleanerDetergents

Wrap & PouchesChemical Indicators

Biological Monitoring

UltrasonicWasher-Disinfector

AutoclaveHandpiece Lubricator

InstrumentsCuring Lights

Ultrasonic Scaler TipsHandpieces

INSTRUCTIONS FOR USE

A key task of the infection control coordinator’s duties in instrument reprocessing is to become familiar with the manufacturer’s instructions for use (IFU) for the equipment found in the sterilization area, their accompanying supplies and the reusable medical devices used for patient care. By understanding the relevant IFUs and how they should be used together, you can establish protocols that incorporate efficient, effective, and compliant policies and procedures.

Once you have reviewed all the IFUs for reprocessing reusable dental instruments and equipment, make a list of the processes and procedures and review them with the dental team along with the CDC’s categories of patient-care items (Table 1). Note that dental handpieces, low-speed motors, and reusable prophylaxis angles must never be high-level or surface disinfected. Instead, these devices must always be heat sterilized according to the manufacturer’s IFU.1

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A successful infection prevention program hinges on properly written protocols and a knowledgeable and well-trained staff. The Essential Guide to Infection Control provides the dental team with a great starting point. Whatever your role or level of experience with infection prevention, this two-part eBook provides practical methods that can be used to help:

• Comply with best practice and industry standards in infection prevention

• Ensure patient and employee safety• Reduce risk and liability• Operate at optimal efficiency

Part 1: Getting Started as an Infection Control Coordinator leads the team through the critical steps of establishing an effective and compliant infection prevention program. This includes the identification of a champion, a review of regulations and guidelines, and protocol

development. To download Part 1, click here.

In Part 2: Instrument Reprocessing, the champion and dental team take a deep dive into the seemingly complex process of cleaning and sterilizing dental instruments. Each step in dental instrument reprocessing is critical to maintaining a safe, healthy and efficient environment for you, your staff and your patients. From transportation and cleaning to sterilization and storage, this guide breaks it down step by step into easy-to-implement best practices and highlights the applicable guidelines and regulations that come into play. By the time you finish Part 2, you will be well on your way to becoming an infection control champion. The journey continues!

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Additionally, all new reusable products should be cleaned and sterilized before the first use in order to remove any debris left from the manufacturing process. Please note single-use devices cannot be used more than once and should be disposed of in accordance with the manufacturer’s IFU.

Organizational Tip:

Collect copies of all IFUs, organize them, and place them together in a binder near or in the sterile section of the reprocessing area for easy and quick reference. Review, replace, and update the binder annually or whenever new products or equipment are used.

CHAIRSIDE TO TRANSPORTATION

Prior to chairside cleanup, clinicians should remove all personal protective equipment (PPE) related to patient-care and don puncture- and chemical-resistant, heavy-duty utility gloves. All disposable sharps, single-use items, and waste should be separated and properly disposed of before transporting patient-care items to the sterilization area. Every patient room should have a puncture-resistant sharps container and hands-free trash receptacle that are easily accessible to a seated clinician. Instruments should then be checked for coarse impurities such as composite material, which should be removed chairside. If instruments will not be cleaned promptly following patient treatment, a pre-cleaning

detergent or product such as Hu-Friedy’s Enzymax® Spray Gel should be applied to the instruments’ surfaces. This will help prevent debris from drying onto the instruments making it easier to remove during the cleaning process. Instruments noted with excessive wear, defects or damage should be separated so they can be removed from service or recycled once they have been cleaned and sterilized.

The final step in preparing the instruments for transportation to the reprocessing area is to place them in a rigid, leak-proof container. This is both an Occupational Safety and Health Administration (OSHA) requirement and part of the CDC’s guidelines stating that personnel should “minimize handling of loose contaminated instruments during transport,” and “use work practice controls (e.g., carry instruments in a covered container) to minimize exposure potential.”2,3

Incorporating sterilization cassettes like Hu-Friedy’s Instrument Management System (IMS) allows for safe transportation, reduced instrument handling, efficient instrument processing, and much more. Whether or not your office uses IMS, a tray or tub with a locking lid can be used to safely transport instruments, cassettes, and other reusable patient-care items to the sterilization area for processing.

INFECTION CONTROL CATEGORIES OF PATIENT-CARE ITEMS

* Although dental handpieces are considered a semicritical item, they should always be heat sterilized between uses.

SOURCE: Centers for Disease Control & Prevention, 2003

Table 1

CATEGORY DEFINITIONPOTENTIAL RISK OF DISEASE TRANSMISSION

METHOD OF DECONTAMINATION

DENTAL INSTRUMENT/PATIENT-CARE ITEM

CriticalPenetrate soft tissue, contact bone, or enter into or contact the bloodstream or other normally sterile tissue of the mouth

Very high to high SterilizationSurgical Instruments, periodontal scalers, scalpel blades, surgical dental burs

Semicritical

Contact mucous membranes, or non-intact skin, but will not penetrate soft tissue, contact bone, or enter into or contact the bloodstream or other normally sterile tissue of the mouth

ModerateSterilization or high-level disinfection

Dental mouth mirror, amalgam condenser, reusable dental impression trays, dental handpieces*

Noncritical Contact intact skin Low to noneIntermediate- to low-level disinfection

X-ray head/cone, blood pressure cuff, stethoscope, facebow, pulse oximeter

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INSTRUMENT REPROCESSING AREA

It is important to ensure the dental team understands the proper flow of instrument reprocessing. The CDC recommends every processing area to be divided into four sections to control quality and ensure safety: 2

1. Receiving, Cleaning & Decontamination

2. Preparation & Packaging

3. Sterilization

4. Storage

Proper PPE must be worn at all times when reprocessing contaminated patient equipment. This includes the use of utility gloves, clinic gown or jacket, mask, and protective eyewear. Scrubs are not considered PPE. Contaminated utility gloves should only be worn on the dirty side of the sterilization area and should be disinfected according to the the manufacturer’s IFU. Gloves are not required when removing wrapped cassettes or packs from the sterilizer once the sterilization cycle has been completed.

Sterile Cassette Storage

Steam Sterilizers

Automated Handpiece Cleaner (optional)

Operatory Prep Area

Dental Instrument Washer

Waste ReceptaclesChutes for regular waste and sharp/biomedical articles

Wrapping Drawers

Drying Drawers(optional)

Rinsing Sink

Drying Rack

Utrasonic Countertopor Recessed

ORGANIZATION• Instruments, accessories, and disposables

are standardized by procedure type

• Easy to locate and identify each procedural set-up

• Closed, sterile packages present a professional chairside image

• Requires less counter space than a tray and pouch system

STAFF SAFETY• Virtually eliminates hand scrubbing

• Provides safe transportation of instruments

• Minimizes handling of contaminated sharps to reduce risk of injury and exposure to bloodborne pathogens

INSTRUMENT INTEGRITY• Instruments are held securely in place with silicone rails

• Reduces chance of damage, lost or misplaced instruments

• Instruments are held in proper position for optimal cleaning (i.e. hinged instruments in open position).

EFFICIENCY• Spend more time chairside with patients and less

time locating instruments

• Ease of staff training with standardized set-ups

• Reduces set up and cleaning time

• Reduces need for manual sorting of instruments into pouches

• Entire cassette can be placed into ultrasonic or dental instrument washer and autoclaved for facilitated cleaning and sterilization

WHY USE A CASSETTE-BASED INSTRUMENT MANAGEMENT SYSTEM?

CLEANING PREPARATION STERILIZATION STORAGE

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RECEIVING, CLEANING & DECONTAMINATION

Once contaminated cassettes or instruments have been transported to the dirty side of the sterilization area, they should be immediately processed. Cleaning is always the first step in the sterilization process as soils, residues, and heavy contamination can serve to protect pathogens on the instrument surface and prevent them from being sterilized. Dried-on debris can be difficult or nearly impossible to remove.

The method of cleaning must be as safe as possible for the personnel involved. According to OSHA standards, “all procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.”3

Using an automated system such as an ultrasonic cleaner or washer disinfector will improve cleaning effectiveness and decrease worker exposure to sharps and bloodborne pathogens.8 Only equipment cleared by the Food and Drug Administration (FDA) for use in a medical setting should be utilized. Residential or commercial dishwashers should never be used to reprocess medical devices — the temperatures, cycle times, and detergents used have not been validated for use with these devices. Additionally, their use may violate device warranties, cause corrosion, and/or premature wear.

Hand scrubbing should be avoided if possible. It raises the risk of sharps injuries and exposure to aerosols and bloodborne pathogens. If hand scrubbing is absolutely necessary, wear puncture-resistant utility gloves and use a long-handled brush to allow enough clearance between your hands and sharp points.

If the instruments will be held for a period of time before cleaning and have not already been pretreated (as noted above), they should now be sprayed with an enzymatic pre-cleaner or placed in an enzymatic solution for pre-soaking. The enzymes help break down debris. Follow

the label directions for the pre-soak: it will likely include rinsing before cleaning the instruments. High-level disinfectants (also known as cold sterilants) are not intended for presoaking or using as holding solutions.

When using an ultrasonic cleaner, always follow the instructions for use for the cleaning device, the detergent, and the instruments being cleaned. Pay close attention to the time of exposure, detergent concentration, and temperature based on the IFUs. Keep the ultrasonic lid on during use to prevent aerosols from entering the air, change the detergent daily or more often if needed, avoid overloading the ultrasonic, follow weight limits and ensure all instruments are submerged in the solution. Never add instruments or cassettes to an ultrasonic that is already in use.

HU-FRIEDY CLEANING MONITORS

ULTRASONIC & WASHER-DISINFECTOR

The cleaning step is critical to proper instrument reprocessing. Improper cleaning resulting in unremoved debris prevents proper sterilization. To assure your cleaning process achieves the highest quality results, a cleaning monitor is recommended. The monitors contain a non-toxic soil that mimics the presence of blood and tissue on an instrument surface. Full removal of the test soil indicates an effective cleaning process. For the ultrasonic cleaner, the cleaning monitor provides insight into cavitation, time, temperature, and detergent concentration. As a multi-parameter test, the cleaning monitor is a superior test to traditional foil testing, which only provides an indication of cavitation. For the washer-disinfector, the cleaning monitor tests for time, temperature, water impingement, detergent effectiveness, and spray arm function. These tests are easy to read and provide reliable and accurate results. Including cleaning monitors in your daily or weekly cleaning protocols is a good way to ensure consistency, reliability, and effectiveness in your cleaning process. Click here to learn more about cleaning monitors.

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When selecting an ultrasonic detergent, there are many options. A dual enzymatic cleaning detergent will provide accentuated cleaning. Hu-Friedy’s Enzymax and Enzymax Earth Ultrasonic Detergents include both a protease enzyme (breaks down proteins in blood and saliva) and an amylase enzyme (breaks down carbohydrates and starches). In addition, Steelgard™ agents protect instruments from harmful minerals found in water that contribute to buildup, spotting, and corrosion.

If using a dental instrument washer, the manufacturer will recommend a length of soaking time, ratio of detergent concentration, and cycle time. Reference the IFUs for both the dental instrument washer itself as well as the instruments being placed into the washer, as not all instruments can be cleaned in a washer. In addition, prior to considering the use of a dental instrument washer in the practice, a water test must be performed to assess the water quality (water hardness, water conductivity, and pH-value). Poor water quality can result in unsatisfactory cleaning results, including stains, spots, and corrosion on instruments.

After cassettes and instruments have gone through the cleaning cycle, they must be rinsed and thoroughly dried. If you use a dental instrument washer, the system will do the rinsing and drying. If using an ultrasonic cleaner, your protocol should include rinsing cassettes and instruments with tap water to remove any chemical residue and allowing the instruments to air dry thoroughly. Rinsing with hot water can help accelerate the drying process, as it encourages evaporation. Note that some cassette and instrument IFUs may recommend using demineralized water during this step. If using cassettes, utilize drying racks or stand them on edge to allow for proper drainage and to promote

air circulation. Fans should never be used to dry instruments or cassettes as they may cause cross contamination between dirty and clean items.

It is imperative that cassettes and instruments are completely dry before they are packaged for sterilization to help prevent cross contamination, corrosion, and discoloration. If packages go into the sterilizer wet, they will come out wet. If the packages come out wet, the paper on the pouch or wrap can funnel any moisture or bacteria from your hands through the paper, compromising the package’s sterility. This is referred to as “wicking.”

PREPARATION & PACKAGING

Prior to packaging, evaluate the condition of the instruments and check for any remaining debris or contamination as well as any broken, cracked, rusted, or damaged instruments. If damaged, package separately, sterilize, and remove from service. An environmentally friendly option is to recycle your instruments through a program like Hu-Friedy’s Environdent® .

Packaging used in the sterilization process must be an FDA-cleared medical device such as Hu-Friedy’s Bagette® Sterilization Pouches, Hu-Friedy Sterilization Wraps or Sterilization Containers. FDA-cleared packaging has been tested for use in a sterilizer and is permeable to either the chemical or steam used in the sterilization process.4

WHAT SHOULD I DO WITH HANDPIECES AFTER TREATMENT?

When packaging instruments and cassettes, it is important to ensure that the packaging does not have open gaps.

Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semi-critical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.1

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Sterilization wrap and pouches come in a variety of sizes. It is imperative to follow the IFU for the packaging. For example, many wrap IFUs call for the use of two sheets either sequentially or simultaneously when wrapping packages for sterilization.

When utilizing pouches, avoid overloading by laying contents flat in a single layer and allowing for at least one finger width of space between the instruments or cassettes and the inside edge of the pouch.

Unless otherwise indicated, most packaging is for single use only. That includes plastic tubing, wrap, and plastic or paper pouches.

Be sure to place an internal chemical indicator or integrator inside every instrument package prior to sterilization. If the internal indicator is not visible from outside the package, an external indicator, such as autoclave monitor tape, should be used on the outside of the package. Never cut an indicator or integrator to shorten it or use it in multiple packages. Using a non-toxic marking pen or ink, label packages with the date and load. If you have multiple sterilizers, you should also note which sterilizer was used. When using pouches, always write on the plastic side. When using wrap, only write on the tape.

STERILIZATION

After critical and semi-critical patient-care items have been wrapped or prepared to maintain sterility during storage, they must be heat sterilized. The most common and most widely accepted best practice is steam sterilization (autoclave). Other methods include dry heat and unsaturated chemical vapor sterilization, however these are not widely used today. Most instruments are validated for use with steam sterilization. Follow the sterilizer and instrument manufacturer’s IFUs to set the proper sterilization cycle and only use sterilizers cleared by the FDA for use in medical settings.

Sterilization Tips:

• Every sterilizer must be routinely inspected and maintained. Please follow manufacturer’s IFU.

• Understand manufacturer’s IFU for which sterilization cycle to use (i.e., pouches cycle, packs, etc).

• All sterilizers have a weight or load capacity. Know what this is for all of your sterilizers and adhere to those maximums. Cassettes help to stay compliant with these requirements.

• Don’t stack pouches and wrapped cassettes on top of one another in the sterilizer. This can prevent the sterilizing agent from reaching the instruments inside. Use appropriate racks as recommended by the equipment manufacturer.

• Always allow the sterilizer to complete its full cycle, including drying, before removing any items. Packages should be completely dry and allowed to cool to room temperature before handling to avoid contamination.5 Packages removed prematurely or are wet upon removal are not considered sterile.

• Never store sensitive items or sterile packages, including pouches and wrapped cassettes, above the sterilizer where they may be exposed to released moisture.

STERILIZATION MONITORING

There are three ways to monitor the sterilizer: mechanical, chemical, and biological. Every sterilization pack and load should be monitored with both mechanical and chemical indicators.2 External and internal indicators (if visible) should be checked after each sterilization cycle is complete. If internal indicators are not visible, as is the case with a wrapped cassette,

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STERILIZATION MONITORING TIPS

• Chemical indicators should not replace biological indicators, as only a biological indicator consisting of bacterial spores can measure the microbial killing power of the sterilization process.

• The CDC’s 2003 recommendations suggest utilizing both an internal indicator, which shows if the chemical or steam reached the item, and an external indicator, which shows if the item was processed. There are some packages on the market that include both.

• Due to the sensitive materials contained in chemical indicators, it is important to store both processed and unprocessed indicators at room temperature and away from sources of heat, steam, and moisture.

Table 2

they should be checked when opening the package at chairside. The sterilizer itself should be tested at least weekly using a biological indicator.2 If you receive a failure at any step of monitoring, consult your autoclave and indicator instructions for use on what to do in the event of a failure. Do not allow the use of any items from a sterilizer pack or load linked to a failed test.

Mechanical indicators

Autoclaves are equipped with gauges or readouts indicating the cycle time, temperature, and pressure for each instrument load. Many automatically log this data on a printout or capture it electronically and provide warnings when an error or failure has occurred.

Chemical Indicators

Chemical indicators are either physical or chemical devices used to monitor one or more of the process parameters (time, temperature, and presence of saturated steam) of the sterilization cycle in packs and loads. These indicators provide easy-to-interpret visual cues, such as a color change, to indicate when they have been exposed to the proper sterilization parameters. There are various types (formerly referred to as classes) of chemical indicators and each

TYPE DESCRIPTION COMMON USES

Type 1: Process Indicator

Reacts to one or more of the process variables to show whether or not the pack has been exposed to sterilization

Monitor Tape, indicator strips, pouches

Type 2: Specific Test Indicator

Bowie-Dick tests Used for equipment control to evaluate sterilizer performance

Type 3: Single Critical Process Variable Indicator

Reacts to one critical process variable Rarely, if ever, used in dental settings

Type 4:Multi-Critical Process Variable Indicator

Reacts to more than one critical process variable Indicator strips

Type 5: Integrating Indicator

Reacts to all process variables; performance is comparable to biological indicator in saturated steam

Indicator strips; used as pack control and load control (that do not contain implants)

Type 6: Emulating Indicator

Cycle verification indicators designed to react to all critical process variables for specific sterilization cycles

Test for specific sterilization cycles. An end user will need to inventory a different emulating indicator for each sterilization cycle time and temperature run.

STERILIZATION MONITORING – CHEMICAL INDICATOR CATEGORY TYPES

SOURCE: ISO 11140-1:2014 Sterilization of health care products — Chemical indicators — Part 1: General requirements

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type measures the sterilization variables a bit differently. Please review the types and their descriptions in Table 2 on the previous page.

Knowing the types of indicators available is important so that you can incorporate the appropriate one to fit your needs into your protocols. Most indicators found in the dental industry are Types 1, 4 and 5. Any of them are acceptable according to the CDC Guidelines. However, since integrating indicators such as Hu-Friedy’s Steam Sterilization Integrators are generally considered equivalent to the performance requirements for biological indicators, they are the most accurate type of internal chemical indicators.

If a chemical indicator indicates a failure, it means it was not exposed to the proper sterilization conditions. In such cases, the instrument pack or load should be re-sterilized.

Biological Indicators

The CDC recommends monitoring sterilizers at least weekly with biological indicators and with every load of implantable devices. In the U.S., most states have adopted CDC recommendations as law. Check to see whether your state or provincial dental board or governing body has different requirements. A simple solution for remembering to do biological spore testing is to put it in the calendar with an alert to remind you, as well as assigning one person to perform this task.

Biological monitoring can be performed in two ways. The quickest option is to use an in-office incubator and spore monitoring vials such as Hu-Friedy’s SporeCheck™ In-Office Biological Monitor Test. This method can detect a failure within two to three hours and provides complete results within 24 hours giving you the peace of mind that your sterilizer is working properly. The other option is to use a mail-in spore monitoring program, but it can often take up to a week to receive results. Read your IFU for your sterilizer and follow the manufacturer’s instructions. Always use the proper test for your specific sterilizer and maintain a log of spore test results.

RECORD-KEEPING

Proper and detailed record-keeping is critical in responding to a positive monitoring result as well as demonstrating proper compliance to CDC guidelines. Retain sterilization records (mechanical, chemical, and biological) for a time period that complies with standards (e.g. three years), statutes of limitations, and state and federal regulations.6

STORAGE & PREP TIPS

• The shelf life of a sterilized pack can be based on either date- or event-related storage practices.2 Always check the integrity of the package and instruments before opening the package. Compromised packages need to be cleaned, repacked and sterilized again.

• Instruments should remain packaged until the clinician is ready to use them. This will help reduce the possibility of cross contamination.

• Reassure the patient of sterility by opening the sterile package in front of them. You can also be sure that no fomites or aerosols have impacted the instruments.

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It is important to keep a log that includes all sterilization parameters for reference:

• Sterilizer identification number (if multiple)• Sterilization date/cycle• Duration & temperature of cycle• Contents of load• Confirmation of mechanical monitoring• Confirmation of chemical monitoring• Operator’s name• Weekly biological monitoring & maintenance

STORAGE & PATIENT PREP

If kept for any period of time prior to patient treatment, sterilized packages should be stored in a dry area with no chance of exposure to moisture. Avoid storing packs under sinks, near compressors, or over sterilization devices or ultrasonic baths. These are areas that can result in contamination of the instrument packaging.

Storage areas should be clean and free of debris, dust, or contaminated substances or instruments. Cleaning and maintenance of these areas should be performed on a regular schedule. If drawers or cabinets are used to store packs, ensure that opening and closing them does not compromise the packaging material.

SHARPS INJURIES

Sharps injuries occurring during instrument reprocessing are most commonly a result of not utilizing proper personal protective equipment and an instrument management system such as cassettes. They often happen when transporting and cleaning instruments. Here are three areas to focus on in order to avoid sharps injuries.

1. Utility Gloves

Always use utility gloves when handling instruments and cassettes following patient treatment. Using patient exam gloves instead of puncture and chemical resistant utility gloves puts the staff at risk for chemical exposure and sharps injuries. Utility gloves should not be bulky and should enable tactical sensitivity. Always order gloves to fit every member of the clinical team, label them with the clinician’s name and store them in an easily accessible spot.

2. Cassette-based Instrument Management Systems (IMS)

IMS is a great tool in the office. It not only reduces the handling of loose instruments that can lead to sharps injuries, but it helps prevent dulling, damage and loss of instruments. It also helps prevent overloading the instruments in the sterilizer and ultrasonic bath.7 In addition, properly utilizing IMS saves time in sterilization and helps everyone stay organized. It also helps team members keep instruments organized by procedure type and keeps them together so nothing is missing during a procedure.

3. Transportation

The CDC states, “Contaminated instruments should be handled carefully to prevent exposure to sharp instruments that can cause percutaneous injury. Instruments should be placed in an appropriate container at the point of use to prevent percutaneous injuries during transport to the instrument processing area.” 2 This prevents any possibility of spilling or dropping the instruments during transportation and lessens the risk of a sharps injury.

CONCLUSION

Instrument reprocessing is not a static function. It is something that needs to be reviewed and evaluated on a regular schedule. Take advantage of the list of resources in this eBook which include regulatory guidelines as well as educational webinars and articles. Reading the two parts of this guide and utilizing the resources provided will set you on the right track for success.

Want to find out how your practice’s instrument processing and infection prevention protocols line up with the Centers for Disease Control and Prevention (CDC) Guidelines for Infection Control and best practices in the dental office?

Find out with this short quiz from Hu-Friedy!

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DO DON’T

Have and know the IFU for your sterilizer, cleaning equipment, instruments and other FDA-cleared medical devices

Go by what others tell you in place of reading the IFU

Use an enzymatic pre-cleaner or pre-soak in an enzymatic solution when you cannot immediately clean the instruments

Use a detergent or cleaner not developed specifically for use with medical instruments in place of an enzymatic cleaner

Utilize single-use disposable sterilization pouches and wrap

Reuse single-use sterilization pouches and wrap

Load the sterilizer according to the manufacturer’s instructions for use

Overload the sterilizer or lay packs on top of one another

Always cover instruments when transporting them

Transport loose instruments on a tray or carry them in your hand

Perform biological testing weekly or with every sterilization of an implantable device in the load

Move or relocate the sterilizer and not perform an additional spore test

Use an FDA-cleared washer-disinfector to clean instruments

Use a residential- or commercial-grade device to clean instruments and other medical devices

Wear utility gloves that are puncture and chemical-resistant in the dirty section of the sterilization area and when breaking down rooms or working with chemicals

Wear exam or household gloves in the dirty area of the sterilization area and when breaking down rooms or working with chemicals

Dry instruments thoroughly before packaging Load wet instruments or cassettes into sterilization packaging

Fill the pouch properly Overfill the pouch

Allow sterilization packs to run through the entire cycle, including drying, to avoid wicking of bacteria and viruses

Interrupt the sterilization cycle or remove packs while wet

Immediately put instrument packs in an enclosed cabinet, drawer or container after sterilization

Leave instrument packs on counter or remove instruments from sterilization packaging until immediately before use on patient

REPROCESSING DO’S AND DON’TS

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RESOURCES FOR INSTRUMENT REPROCESSING

CDCGuidelines for Infection Control in Dental Health-Care Settings — 2003

Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care (includes infection prevention checklists)

Infection Prevention & Control Guidelines & Recommendations

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

OSHAOSHA Standards

OSAPThe Role of the ICPC

Knowledge Center

STATE DENTAL BOARDS Find your state & download the infection control regulations at ada.org

HELPFUL TOOLS: Hu-Friedy’s Reprocessing Guidelines

Hu-Friedy Infection Control Self Check

3 hour CE: Team-Centered Approach to Instrument Processing & Infection Control

Infection Prevention & Instrument Processing Recommendations

HU-FRIEDY EDUCATION: On-Demand Webinars

Key Webinars:Why Instrument Processing Matters: The Reality By Mary Govoni, CDA, RDA, RDH, MBA

Protecting Yourself & Your Patient: Sterilization Protocol By Mary Govoni, CDA, RDA, RDH, MBA

Navigating Infection Prevention Practices in the Dental Setting By Noel Brandon-Kelsch, RDH, RDHAP

Process Monitoring: Instrument Reprocessing & Waterlines By Karen Gregory, RN

Working Smarter, Not Harder in the Operatory By Jessica Wilson

ARTICLES: Instrument Processing

Key Articles:Considerations for Processing Dental Instruments: Trays vs. Cassettes By Catherine Pawloski, RDH and Marie T. Fluent, DDS

On Your Mark, Cassette, Get Organized By Olivia Wann, JD, RDA

Give Me Some Space! Following CDC Guidelines for an Ideal Sterilization Area By Olivia Wann, JD, RDA

Instrument Cassettes: An Effective Infection Control Precaution By John Molinari, PhD; Jennifer A. Harte, DDS, MS; and Peri Nelson, BS

Instrument Cleaning: Why, Who, and How? By Marie T. Fluent, DDS

CITATIONS 1. Summary of Infection Prevention Practices in Dental

Settings: Basic Expectations for Safe Care. Centers for Disease Control and Prevention. Published March 2016.

2. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for Infection Control in Dental Health-Care Settings — 2003. MMWR Recomm Rep 2003;52(RR-17). Published December 19, 2003.

3. OSHA Bloodborne Pathogens Standard Title 29 Code of Federal Regulations, Part 1910.1030. Federal Register 56(235):64004-64182. Published December 6, 1991.

4. Rutala WA, Weber DJ. Choosing Sterilization Wrap for Surgical Packs. Infect Cont Today 2000;4:64-70.

5. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Care Team. Elsevier Health Sciences; 2014.

6. Rutala WA, Weber DJ, et al. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Centers for Disease Control and Prevention website. Updated February 15, 2017.

7. Sanchez E, Macdonald G. Decontaminating dental instruments: testing the effectiveness of selected methods. J Am Dent Assoc. 1995 Mar;126(3): 359-62, 364, 366 passim.

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