When it comes to the health of your patients there is no room for errors or shortcuts. The American Dental Association recommends that all instruments that penetrate soft tissue or bone, such as surgical equipment, scalpel blades, extraction forceps, bone chisels, surgical burs, and periodontal scalers, need to be either discarded or sterilized after every single use. These instruments are considered critical devices and, therefore, need to be thoroughly sterilized. Handpieces are open to contamination and, therefore, must also be heat sterilized after each use. If a handpiece cannot be sterilized using heat, then it should not be used.
Instruments that are not used to penetrate bone or oral soft tissues, such as air and water syringe and amalgam condensers, are considered semi-critical. This means that after each use the instrument must be sterilized with heat, or if head-sensitive, at least be sterilized with a high-level disinfectant. The sterilization methods that can be used for both semi-critical and critical dental instruments are using the autoclave, chemical vapor, and 2 hours of dry heat. Most dental professionals use the steam sterilizer. All three methods of sterilization can damage dental instruments that are not heat-tolerant. According to RDH Magazine, “OSHA, CDC, and OSAP recommend that critical and semi-critical instruments go through both disinfection and sterilization.”
The CDC (Centers for Disease Control and Prevention) has split noncritical dental office surfaces into two categories: housekeeping surfaces and clinical contact surfaces. A clinical contact surface is any surface that may become in direct contact with contaminated gloves, instruments, or devices. Those types of surfaces should have some kind of protective covering, such as clear plastic, to keep them clean. If the clear plastic covering gets soiled in between patients it should be changed. Protected surfaces should be disinfected whenever it is contaminated and at the end of each day. If a surface does not have protection it should be disinfected after every patient using a low-level disinfectant or an intermediate-disinfectant.
Housekeeping surfaces are those are not touched and rarely get contaminated during patient care. Depending on the type of surface and contamination, they may only need to be cleaned with a detergent or disinfected with an EPA-registered hospital disinfectant. However, if a housekeeping surface becomes contaminated by blood or body substance OSHA requires the clinic or hospital or follow infection control protocols.
Studies have shown that not all dental practices meet these standards. Many medical professionals believe they are sterilizing their dental instruments correctly but are not using the appropriate chemical sterilizers or allow for enough exposure time. There was also a study done on Minnesota dental offices which showed that 87% of improper sterilization was caused by the operator, not by the autoclave malfunctioning. Medical professionals were overloading the chambers, using a temperature setting that was too low, leaving dental instruments for an inadequate amount of time, forgetting to preheat the sterilizer, or interrupting the cycle before it was finished sterilizing the instruments.
It’s important to ensure that your patients are safe and that your dental instruments are disinfected and sterilized. Follow the guidelines outlined in the Guide for Disinfection provided by the CDC.