does not provide such instructions, the device may not be suitable for multi-patient use. 2. Having manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.
3. Assigning responsibilities for reprocessing of dental equipment to dental personnel with appropriate training. 4. Maintaining sterilization records in accordance with state and local regulations. (CDC, 2016)
ENVIRONMENTAL INFECTION PREVENTION AND CONTROL
determine the product’s compatibility with different surfaces and the conditions of use, the disinfectant contact time, dilution, safe use, and disposal. High-level disinfectants and liquid chemical sterilants (such as glutaraldehyde) are extremely toxic and should never be used for environmental surface cleaning. It is important to remember that all products used for clinical contact surfaces visibly contaminated with blood must be disinfected with an EPA-registered hospital disinfectant with intermediate-level activity (i.e., tuberculocidal claim). Manufacturers’ instructions need to be followed strictly for all products used for cleaning and disinfection in the dental operatory. Dental offices typically use a combination of environmental surface disinfectants and disposable surface barriers to protect clinical contact surfaces and equipment. Barriers are particularly useful for surfaces that are touched frequently by gloved hands during patient care, surfaces likely to be contaminated with blood or saliva, and areas that are difficult to clean. These areas may include chair control panels, air-water syringe buttons, light handles, and computer keyboards. Surface barriers are a single-use item, replaced after each patient. Although barriers are highly effective, contamination of the surface beneath is possible. It is not necessary to clean and disinfect a properly covered surface unless the barrier fails, or the surface becomes accidentally contaminated during treatment. Remove and discard disposable barriers between patients, while dental personnel are still wearing gloves. Place clean barriers with newly washed hands. The use of surface barriers boosts safety and efficiency in that they require less time than cleaning and disinfecting and contain no potentially irritating chemicals. Additionally, surface barriers are available for use on almost every operatory surface. Whether using barriers or disinfectants for clinical contact surfaces, policies and procedures for routine cleaning and disinfection should be in place for each dental facility. recontaminate dental unit water during the course of clinical treatment. Self-contained water systems isolate the dental unit from the municipal water supply. They provide water from reservoirs filled and maintained by the dental staff. This process allows the dental practice to control the quality of water used in the unit, provides a way to introduce chemical agents to waterlines, and allows the use of water of known quality. However, self- contained water systems cannot reliably improve the quality of dental water without additional chemical or mechanical treatment against biofilm. Additionally, if this system is improperly maintained or contaminated, it could deliver water of worse quality than from a municipal source. Several strategies can be used to improve the dental unit water quality, including (but not limited to) self-contained water units with biocides for disinfection, shock treatments, physical barriers, and antimicrobial materials that inhibit biofilm formation. Physical barriers or filters may be positioned on each water- bearing line near the handpiece or air- water syringe. These filters trap free-floating microorganisms before they can be released into the water. Although this method is not labor intensive, it has no effect on the biofilm within the waterline, and it may be more expensive than other methods because
Housekeeping surfaces and clinical contact surfaces are the two primary types of surfaces recognized in the hygiene operatory. Housekeeping surfaces pose a limited risk of disease transmission because, typically, they are not touched directly during the delivery of dental care. Clinical contact surfaces pose a high risk of disease transmission because they are very likely to be contaminated with blood and other infectious materials transferred by frequent touching with contaminated hands, gloves, devices, or instruments or by spatter generated during the dental procedure. Housekeeping surfaces include floors, walls, and sinks. These surfaces should be cleaned routinely with a detergent and water or an EPA-registered hospital disinfectant (CDC low-level disinfectant). If the surface has been contaminated with blood or other potentially infectious material, then an intermediate- level disinfectant should be used after cleaning. Clinical contact surfaces can serve as reservoirs of microbial contamination and may include light handles, unit switches, drawer knobs, dental radiography equipment, and clinical countertops. Preparation of a clinical contact surface may be a one- or two-step process of cleaning, followed by disinfection. When choosing products, read the label instructions to ensure that the cleaning or disinfecting product is correct for the task. Some products are acceptable for cleaning only, some for disinfection only, and other products may be used for both. For convenience and simplicity, many dental offices choose products utilized for both cleaning and disinfection. Products used for environmental disinfection are generally available in a spray or premoistened towelette form. In a two- step cleaning product, the initial cleaning removes most of the bioburden and is a critical step in the disinfection process. The surface must then be disinfected using an EPA-registered intermediate-level disinfectant with a tuberculocidal claim. The surface must remain moist for the contact time indicated on the disinfectant’s label. Also consult the label instructions to Dental unit waterline quality Dental unit waterlines (DUWLs) were developed in the 1960s as a source of irrigation and coolant to high-speed air-driven handpieces. These narrow-bore plastic tubes also carry water to ultrasonic scalers, air-water syringes, and other dental equipment that requires water. All dental and hygiene operatories should be equipped to maintain appropriate water quality. The EPA has set the current standards for DUWLs at the same level as that of drinking water, which requires fewer than 500 colony-forming units of heterotrophic water bacteria per milliliter of water (ADA, 2019). When infectious agents, such as bacteria, viruses, and fungi, from the municipal water source combine to form a microbial colony that adheres to waterlines, this is known as a biofilm . Biofilm and waterborne pathogens generally do not pose disease risks to healthy persons. However, they may pose a risk to the increasing number of patients with weakened immune systems who seek dental treatment. For this reason, the quality of water from DUWLs is of concern. Dental waterlines should be flushed for 20 to 30 seconds between patients to help remove contaminants and free- floating microorganisms that may have been retracted into the DUWL during patient treatment. However, flushing alone will not improve water quality because it does not prevent or eliminate biofilm formation. The effects of flushing are temporary because biofilm bacteria continually break free and
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