sterile processing
By David L . Taylor , MSN , RN , CNOR
Dental Reprocessing : Guideline , IFU Adherence Vital to Infection Prevention
Sterile processing ( SP ) is the first link in the chain of infection prevention . Its role is to decontaminate , clean , inspect and sterilize instrumentation for future use ; however , failure to do so can introduce pathogens into the clinical environment and increase the risk for infection .
Safe , thorough device reprocessing isn ’ t
Understanding the process of infection transmission and prevention helps ensure sterile devices and a safe work environment for patients and healthcare professionals , including dental healthcare providers ( DHCP ). just critical in hospitals ; it ’ s also vital across all environments of patient care , including dental clinics . Understanding the process of infection transmission and prevention helps ensure sterile devices and a safe work environment for patients and healthcare professionals , including dental healthcare providers ( DHCP ). Because SP processes are often overlooked and misunderstood , ECRI identified “ infection risks from sterile processing errors in medical and dental offices ” as No . 3 on its list of Top 10 Health Technology Hazards for 2020 . 1 The American Dental Association ( ADA ), in collaboration with the Centers for Disease Control and Prevention ( CDC ), has updated and supplemented its infection control recommendations since 1993 to not only reflect new scientific knowledge but to grow the understanding of the principles of infection control practices .
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Historical perspective
The ADA urges all practicing dentists , dental auxiliaries and dental laboratories to employ appropriate infection control procedures as described in the 2003 CDC guidelines , and the 2016 CDC summary . Additionally , the ADA recommends that all settings keep up to date as new scientific information and regulatory guidelines leads to improvements in infection control , risk assessment , and disease management in oral healthcare .
Along with the proper sterilization of instruments and materials , sterilizer monitoring is an essential part of any in-office / clinic infection prevention program . The CDC advises that dentists use only FDA-cleared dental handpieces and sterilize them in accordance with manufacturers ’ instructions for use ( IFU ). Following manufacturers ’ instructions for sterilization and processing of all dental instruments and materials is critical to patient and employee safety . Sterilizer monitoring and efficacy testing is an essential part of this process .
Each step of instrument processing must be completed per IFU , accepted guidelines and recommendations — with no steps missed or altered in any way . DHCP who clean , inspect , package , sterilize and store instruments must have the skill sets and knowledge of each process and understand the science behind each step . Unfortunately , DHCP often have a myriad of other clinical responsibilities that can divide their attention . As a result , failure to consistently and effectively clean and disinfect or sterilize contaminated items before reuse can expose patients and DHCP to virulent pathogens and create a significant risk of disease transmission within the dental setting . Between 2003 and 2015 , disease transmission in dental settings , including patient-to-patient transmissions , has been well documented . 4-7
Inconsistency in knowledge
The question that must be asked is whether all employees responsible for SP functions have adequate knowledge to mitigate errors and consistently deliver safe , well-functioning instruments and services to meet their customers ’ needs . Unfortunately , in my personal experience as a consultant , the answer is often no .
With the complexities inherent to SP functions — and inconsistencies in design , equipment , material and processes found in dental practices and clinics — careful attention must be paid to ensure all employees are trained to the same standard and have the knowledge necessary to manage their SP duties safely and effectively .
Instrument processing areas
The instrument processing area should be centrally located within a healthcare facility and have a one-way / dirty-to-clean flow to reduce the possibility of cross contamination between dirty and sterile devices . In dental facilities , instrument processing can be located / performed in one space as long as there is a linear flow , without the risk for crossover between dirty and clean .
The instrument processing area includes the following four distinct areas , regardless of whether it is located in dental or traditional medical settings :
➊ Receiving , cleaning and decontamination ( three-sink system for hospital / medical settings ) ➋ Preparation and packaging ➌ Sterilization ➍ Storage
As a result of design , clinic acquisition or other factors , instrument processing areas can vary in size and can compromise DHCP ’ s ability to remain consistent with their processes and infection prevention strategies . Some dental SP areas are so small that DHCP have to create workarounds to complete certain tasks .
Water quality Water quality is a concern in dental practices across the country . Water quality is critical for the sterilization process , and