Infection Control for Dental Professionals ________________________________________________________
High-speed dental hand pieces, low-speed hand pieces, rotary components and dental unit attachments (e.g., reusable air or water syringe tips and ultrasonic scaler tips) shall be pack- aged and heat-sterilized in a manner consistent with the same sterilization practices as a semi-critical instrument or item [9]. Single-use disposable items such as prophylaxis angles, cups, brushes, tips for high-speed evacuators, saliva ejectors, air and water syringe tips, and gloves must be used for one patient only and discarded. Proper functioning of the steril- ization cycle of all sterilization devices should be verified at least weekly through the use of a biologic indicator (such as a spore testing monitor). It is recommended that test results be documented and maintained for 12 months [9; 10]. Studies have demonstrated variability among dental practices in meet- ing sterilization standards. In one study, 49% of respondents did not challenge autoclaves with biological indicators. Other studies using biologic indicators found a high proportion (15% to 65%) of positive spore tests after assessing the efficacy of sterilizers used in dental offices [21]. Laboratory Areas Splash shields and equipment guards should be used on dental laboratory lathes. Fresh pumice and a sterilized or new ragwheel should be used for each patient. Devices used to polish, trim, or adjust contaminated intraoral devices must be disinfected or sterilized and stored in a manner so as to prevent contamination [9]. All intraoral items, such as impressions, bite registrations, and prosthetic or orthodontic appliances, must be cleaned and disinfected with an intermediate-level disinfectant before manipulation in the laboratory and before placement in the patient’s mouth. Such items should be thoroughly rinsed prior to placement in the patient’s mouth [9]. Reprocessing Reusable Medical Equipment Reusable instruments, medical devices, and equipment should be managed and reprocessed according to recommended and appropriate methods. Industry guidelines as well as equipment and chemical manufacturer recommendations should be used to develop and update reprocessing policies and procedures. Written instructions should be available for each instrument, medical device, and equipment reprocessed. The FDA has issued guidance on ensuring the safety of reusable medical devices [23]. All procedures involving blood or OPIM must be performed in such a manner as to minimize splashing, spraying, spatter- ing, and generation of droplets of these substances. Splatter shields should be used on medical equipment associated with risk-prone procedures. Equipment that may become contaminated with blood or OPIM must be examined before servicing or shipping and should be decontaminated as necessary, unless the employer can demonstrate that decontamination of such equipment or
portions of such equipment is not feasible. A readily observ- able label should be attached to the equipment stating which portions remain contaminated. The employer must ensure that this information is conveyed to all affected employees, the servicing representative, and the manufacturer before handling, servicing, or shipping, so appropriate precautions may be taken. Single-Use Devices A single-use device is a device that is intended for use on a single patient during a single procedure. An unused single-use device is referred to as an original device. A reprocessed single- use device is an original device that has previously been used on a patient and has been subjected to additional processing and manufacturing for the purpose of an additional single use on a patient [22]. Dental Unit Waterlines, Biofilm, and Water Quality Studies have shown that dental unit waterlines, such as narrow-bore plastic tubing that carries water to high-speed handpieces, air/water syringes, and ultrasonic scalers, can become colonized with micro-organisms, including bacteria, fungi, and protozoa. Protected by a polysaccharide layer known as a glycocalyx, these micro-organisms colonize and replicate on the interior surfaces of the tubing and form a biofilm. This biofilm serves as a reservoir that can increase the number of micro-organisms in the water used during dental treatment [10]. Manufactured dental units are now engineered to be anti- retractive to prevent patient material, such as oral micro-organ- isms, blood, and saliva, from entering a dental water system during treatment. These dental unit lines and devices should be purged with air or flushed with water at the beginning of the clinic day for at least two minutes prior to attaching hand- pieces, scalers, air water syringe tips, or other devices [9; 10]. The dental unit lines and devices should be flushed between each patient for a minimum of 20 seconds [9]. Commercial devices and procedures shown to improve the quality of water used in dental treatment include self-contained water systems with chemical treatment, in-line microfilters, and combinations of these treatments. Simply using tap, distilled, or sterile water will not eliminate bacterial contamination in treatment water if biofilms in the system are not controlled. Microbial load should be less than or equal to 500 colony- forming units of heterotrophic bacteria per milliliter (≤500 CFU/mL) of water, the standard set for drinking water by the EPA [7]. Removal or inactivation of dental waterline bio- films requires use of chemical germicides. The definition of “germicide” is a chemical agent that can be used to disinfect items and surfaces based on the level of contamination. All germicides must be used in accordance with intended use and label instructions [9].
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