Questionable infection control procedures
S asked 5 months ago
I was recently hired at a new office that has a questionable sterilization process. They keep their instruments in perforated plastic cassettes which are not wrapped for sterilization. The cassettes are then stored inside the drawers in the operatories, still unwrapped. They don't use indicator strips; they only use a tiny strip of indicator tape on the autoclave tray per each load. The cassettes are not dated or marked in any way to indicate they've been sterilized. Personally, I feel this is subpar for infection control especially during a pandemic. It is also not meeting OSHA's guidelines for instrument sterilization. Would you feel safe treating patients with these instruments? If not, how would you address it with the dentist?
1 Answers
Kristen Pratt Machado Staff answered 5 months ago
From Kandis Garland, RDH, MS
Every office should have written standard operating procedures (SOP) that follow the United States Centers for Disease Control and Prevention (CDC) guidelines for instrument processing, which include safe transportation, receiving, cleaning and decontamination, preparation and packaging, sterilization, and storage.1 Written SOP are step-by-step instructions that help standardize many tasks or procedures, aid in proper employee training, and serve as part of an overall office policy manual. Instrument processing must follow standards outlined by the Occupational Health and Safety Administration (OSHA), which mandates employers develop and use an exposure control plan (ECP) manual.2–4 The ECP can be separate or include general infection control policies. Written SOP for a variety of tasks can be included in the ECP. The instrument processing cycle should have an efficient flow that complies with OSHA standards. The CDC recommends safely transporting instruments from the operatory to the sterilization area in a hard-walled container to avoid percutaneous injury.1 Instrument reprocessing involves cleaning to remove debris and bioburden (via ultrasonic, washer, or washer/disinfector including rinsing and drying), packaging (use of pouches with built-in chemical indicators or placement of chemical indicators inside of wrapped cassettes), sterilization, and storage.1,5
The first step in instrument processing protocol is to do a careful visual inspection after cleaning to ensure instruments are free of debris and in good working order before sterilization, as loose instruments can easily become bent or broken. Cassette systems can prevent this. Ensuring that instruments with thin or fine tips maintain their original shape and contour is key. Proper maintenance of ultrasonic tips/inserts must also be done including inspecting the insert tips and O-rings, and checking the metal stacks. All oral health professionals should be able to process any type of dental instrument in the practice, regardless of whether they use the instrument. Having manufacturer instructions for use readily accessible is important.
The next step is sterilization, which occurs after instruments are clean, dry, and packaged (pouch or cassette) with chemical indicators. The CDC requires heat sterilization for all critical and semi-critical items1 in compliance with the OSHA Bloodborne Pathogen Standard.2 Critical items are those that penetrate soft tissue, bone, bloodstream, or other normally sterile tissue such as surgical instruments and periodontal instruments including dental hygiene scalers and curets.1 Semi-critical instruments contact mucous membranes but do not penetrate bone or soft tissue such as mouth mirrors and dental handpieces.1
Sterilization monitoring ensures proper equipment functioning and verification of sterility. Monitoring of the sterilization process using physical (watching gauges for time, temperature, and pressure), chemical (color changes on pouches or internal indicators to verify all sterilization parameters are met), and biological monitoring is required by the CDC.1 Biological monitoring is used to assess the functioning of autoclaves by testing for the inactivation of highly resistant microorganisms.1 Inactivated biological monitoring indicates pathogens in the load have been killed, resulting in the verification of “sterilization.” CDC requires spore testing weekly.1 Keep in mind, this is the minimum requirement.
Tracking all sterilization activities is required by the CDC. Keeping a log that contains information related to mechanical, chemical, and biological monitoring is prudent.1 It should contain the date, autoclave number (if more than one), batch number, operator initials, time/temperature details, chemical and biological indicator results (pass/fail), and load contents.
References
- Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003; 52:1–66. Available at:https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
- Occupational Safety & Health Administration. Bloodborne Pathogens Standard 1910.1030 at:osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051. Accessed August 2, 2021.
- Occupational Health & Safety Administration. Hazard Communication 1910.1200 Standard at: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1200 Accessed August 2, 2021.
- Occupational Health & Safety Administration. Respiratory Protection Standard 1910.134 At: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134 Accessed August 2, 2021.
- United States Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf. Accessed August 2, 2021.
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