How Do Cassettes Protect Clinicians From Sharps Injuries?

The dental assistants I work with open the cassettes or take contaminated instruments out of the cassettes before they put them in the ultrasonic cleaner. I informed them that the point of the cassettes and the ultrasonic cleaner is to remove debris and reduce the risk of punctures and injuries. What source can I cite to substantiate this point?

By Kandis V. Garland, RDH, MS On Feb 13, 2015 0

QUESTION: The dental assistants I work with open the cassettes or take contaminated instruments out of the cassettes before they put them in the
ultrasonic cleaner. I informed them that the point of the cassettes and the ultrasonic cleaner is to remove debris and reduce the risk of punctures and injuries. What source can I cite to substantiate this point?

ANSWER: The United States Centers for Disease Control and Prevention’s (CDC) Guidelines for Infection Control in Dental Health-Care Settings—2003 is the gold standard of dental practice.¹ These guidelines are based on numerous literature reviews covering an expanse of topics that were conducted by the nation’s leading infection-control experts. The CDC guidelines discuss cassettes specifically. They are designed to reduce the potential for exposure to sharp instruments. Page 23 of the guidelines states, “Contaminated instruments should be handled carefully to prevent exposure to sharp instruments that can cause a 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.”¹ Cassettes are considered appropriate containers. They should not be opened, nor should items be removed from them (unless absolutely necessary) prior to the completion of the cleaning cycle. Doing so defeats their intended purpose—to protect clinicians from sharps injuries.

The guidelines also assert, “Use of automated cleaning equipment (eg, ultrasonic cleaner or washer-disinfector) does not require presoaking or scrubbing of instruments and can increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids. Thus, using automated equipment can be safer and more efficient than manually cleaning contaminated instruments.” The use of cassettes eliminates the need to handle sharp instruments, reducing associated risks to clinicians—but they must be used properly.

Instrument cassettes play an important role in safety during the instrument processing cycle. Cassettes, perforated metal or plastic locking containers, are designed to keep instruments organized during the entire processing cycle—from patient care through sterilization and storage. ^2,3 Not only do they keep items organized, cassettes significantly reduce the chance of sharps injuries with their “no-touch” system.^4,5Holes in the cassettes enable steam or chemicals to penetrate and sterilize the instruments inside.^5,6

Safety and efficiency are increased by limiting the amount of time contaminated instruments are directly handled.^2–6 After cleaning, the cassette is thoroughly rinsed and dried, then loaded with the needed dry supplies (gauze, cotton rolls, or cotton-tipped applicators). Perforated cassettes must be packaged in order to keep the contents sterile during storage; they could otherwise be contaminated by air and dust.^1,5 Self-sealing pouches or wrapping are used to package the cassettes. The packaging materials must be compatible with the sterilizer and are considered medical devices by the US Food and Drug Administration.^1,2 They must allow penetration of the sterilizing agent (steam or chemical vapor) and keep instruments sterile for up to 6 months.^1,2 Sterilizers can only accommodate a certain number of cassettes, as overloading impedes the sterilization process.

Cassettes may also include customized safety features, such as built-in needle recapping devices and soft rubber rails, to prevent instrument damage.^4,5In the dental office, instrument cassettes simplify the instrument processing cycle and improve clinician safety.

REFERENCES

Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52(RR–17):1–61.
Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 4th ed. St. Louis: Mosby, Elsevier: 2010.
OSHA and CDC Guidelines: Combining Safety with Infection Control for Dentistry. Annapolis, Maryland: Organization for Safety, Asepsis and Prevention; 2008.
Molinari JA. Instrument cassettes: a reasonable and effective approach. Dental Economics. 2009;99:1.
Harte JA, Molinari JA. Instruments cassettes for office safety and infection control. Compend Contin Educ Dent. 2007;28:596–600.
Molinari JA, Harte JA. Cottone’s Practical Infection Control in Dentistry. 3rd ed. Baltimore: Lippincott, Williams, & Wilkins; 2010.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. February 2015;13(2):76.