c. If a multidose vial enters the patient treatment area, it should be dedicated for single use and discarded immediately after use d. Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies otherwise. Sterilization and disinfection of patient-care items The Spaulding classification system differentiates infection risks associated with contaminated dental instruments. Patient-care items are categorized in the system as critical, semicritical, or noncritical and methods of decontamination are provided. Typical critical items that pertain to the dental hygienist are periodontal scalers and probes. Because infection transmission risk is the greatest when using these items, they must be heat sterilized. Semicritical items are instruments that touch mucous membranes and have a lower risk of infection transmission during use. These items should also be sterilized using heat
9. Do not use fluid infusion or administration sets (IV bags, tubings, connections) for more than one patient. (CDC, 2016)
or processed with a high-level disinfectant if they are heat sensitive. Noncritical items merely contact intact skin and include such items as radiograph heads and blood pressure cuffs. These items pose the least risk of infection transmission during use and may be cleaned or, if visibly soiled, cleaned and then disinfected with an EPA-registered low- to intermediate- level hospital disinfectant. Table 4 provides a summary of the Spaulding classification of dental instruments and methods for decontamination.
Table 4: Summary of Methods for Decontamination in the Dental Office Item Category Definition Is Item
Potential Risk of Disease Transmission
Method of Decontamination
Used in Mouth?
Critical
Penetrates soft tissue, contacts bone, enters into or contacts the bloodstream or other normally sterile tissue. Contacts mucous membranes or non-intact skin, but will not penetrate soft tissue, contact bone, enter into or contact the bloodstream or other normally sterile tissue.
Yes
Very high to high.
Sterilization.
Semicritical
Yes
Moderate.
Sterilization or high-level disinfection.
Noncritical
Contact with intact skin.
No
Low to none.
Intermediate- to low-level disinfection or simple cleaning
Note . Adapted from (Cuny, 2019). It is important to note that as more high-tech devices are introduced into the field of dentistry, limitations of the Spaulding classification become evident. Many items such as curing lights, intraoral radiology sensors, oral camera wands, and digital impression wands fall into the category of semicritical, yet these items are not able to withstand heat sterilization. In these instances, consult the manufacturers of these devices about appropriate barriers and recommendations for disinfection and sterilization of these items. To ensure safety and quality control, all instruments in the dental office should be processed in a designated central processing area that is divided into four sections. The first section is for receiving, cleaning, and decontamination of instruments. The second is for preparation and packaging. The third section should be designated for sterilization and the fourth for storage. Receiving, cleaning, and decontamination Instruments must be carefully transported from the dental hygiene operatory to the receiving section of the instrument processing area. Placing the instruments in an appropriate container or cassette helps to prevent injury during transportation. The first step in the sterilization process is cleaning to remove all debris as well as organic and inorganic contamination. Ideally, instruments should be cleaned using automated equipment, such as an ultrasonic cleaner or washer- disinfector, which is safer and more efficient than manual instrument cleaning (CDC, n.d.c.; Vavrosky, 2017). Because of the increased risk of occupational exposure with manual cleaning, it is important to follow certain work-practice and engineering controls such as using long-handled brushes to help keep hands away from sharp instruments and strainer-type baskets to hold instruments, which prevents dental personnel from having to reach into trays or containers holding sharp
instruments that they cannot see. It must be noted that a high- level disinfectant such as glutaraldehyde should never be used as a precleaning or soaking solution or in the ultrasonic cleaner. Misuse of high-level disinfectants can lead to tissue toxicity reactions and equipment failures. Preparation and packaging The next section of the processing area is used for the preparation and packaging of cleaned but not yet sterilized instruments. The instruments should be clean, dry, and inspected prior to being assembled into cassettes or placed into sterilization bags. Properly packaging instruments helps to ensure that they maintain sterility during storage. All materials used for packaging of dental instruments are considered medical devices and must be cleared by the FDA. Sterilization The third section of the processing area is for sterilization. The most common method of sterilizing heat-tolerant dental instruments is steam under pressure in an autoclave. Less commonly, dental facilities may sterilize instruments via dry heat in a dry-clave or use unsaturated chemical vapor in a chemiclave. Whichever method is chosen, all sterilization procedures should be performed using only medical sterilization equipment cleared by the FDA. Each of these devices has its own process for sterilization and monitoring, and the manufacturer’s instructions for sterilization times, temperatures, and other operating parameters should always be followed. During steam sterilization, instruments are exposed to direct steam at a required temperature and pressure for a specified time. Two types of steam sterilizers are the gravity displacement sterilizer and the high- speed prevacuum sterilizer. The majority of sterilizers used in a dental practice are gravity displacement sterilizers; however, prevacuum sterilizers are becoming more widely used. In
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