monitoring tests available that monitor cavitation , and a test that contains a test soil that mimics the presence of blood and tissue that may be found on an instrument after use . During the test , the monitoring strip assesses multiple variables of the cleaning process , including cavitation , time , temperature and detergent . The IFU of the test should be reviewed for what , specifically , it tests . Full removal of the test soil from the strip indicates an effective cleaning process and provides greater assurance that the equipment is functioning properly .
Steam sterilization integrator
Many dental practices forgo the use on an integrator and rely on a color dot located on peel packs as the final result . Type 5 multi-variable sterilization monitor integrators are designed to react to all critical variables in the sterilization cycle ( time , temperature and the presence of steam ). Indicator strips should be used in each peel pack and cassette that will undergo reprocessing .
Type 5 integrators that utilize a moving front indicator technology ( an advancing color bar that moves from “ reject ” to “ accept ,” for example , and eliminates the need to interpret or match colors ) are highly recommended . Because staff knowledge varies greatly , it is also recommended that an educational fact sheet be displayed in all SP areas to clearly identify an item that should be rejected and one that meets acceptable sterilization parameters .
Instrument packaging Peel Packs / Pouches Versus Cassettes The CDC guidelines state that items to be sterilized should be arranged in such a way to permit free circulation of the sterilizing agent ( e . g ., steam , chemical vapor , or dry heat ). 8 , 9 An instrument peel pack that is overfilled may compromise sterilization . In addition , overfilled peel packs have and increased risk of an instrument poking through the packaging , resulting in contamination and a greater likelihood of sharps injury .
It many dental practices , DHCP have a choice in the method in which they package their instruments . Some primarily use cassettes ; however , some locations are instead opting for peel pack / pouches . For those that use peel pack / pouches , it is important to ensure instruments are placed properly and not overly crowded to ensure sterilant ( steam ) comes in contact with all instrument surfaces . The preferred orientation for sterilization peel pack / pouches is to place peel packs / pouches on their edge . ( Note : When cooling hot instrumentation , the packages should remain in the basket or tray they were sterilized in to avoid touching the packages as they are removed from the sterilizer . Many DHCPs place items on an adjacent flat surface . The surface temperature of these areas can vary greatly from the instruments being removed from the sterilizer , which can cause condensation and result in contaminated instruments . An infrared device can be used to measure the temperature of the package before it is handled .)
Conclusion
To reduce the risks associated with instrument reprocessing , governmental agencies and other professional associations have created recommendations , guidance and regulations that help healthcare organizations , including dental practices , to maintain safe environments for the patients they care for and the staff members who work in these areas . Due to its impact on patient outcomes and infections , the SP function is facing greater scrutiny . Device reprocessing has several necessary steps that must be done correctly every time in order to render devices safe and ready for use on subsequent patients . Monitoring the sterilization process must be done and documented appropriately to show compliance with current standards , guidelines , regulations and IFU . Not knowing is not an excuse and has caused organizations to fail inspections , suffer bad publicity from negative outcomes resulting from failed SP processes — and above all , negatively impact patient and employee safety .
Instrument processing is the most important component of an infection prevention program . It is a complex process that requires specialized equipment , adequate space , qualified personnel , and routine monitoring for quality assurance . As dental and medical personnel process instruments for safe patient care , it is imperative that they receive adequate and ongoing education and training from credible sources regarding the entire instrument processing practice , including but not limited to transport , cleaning , packaging , sterilization and storage .
Guidelines from the CDC continue to change and are the standard for infection control in dental settings . Clinicians should also consult the manufacturers ’ IFU for reprocessing dental and medical instruments for each reusable instrument or device within service . ( Note : Other resources available include the Organization for Safety , Asepsis and Prevention , which offers an extensive online collection of resources , publications , FAQs , checklists , and toolkits to help dental professionals deliver the safest dental visit possible for their patients . 10 )
David L . Taylor , MSN , RN , CNOR , is the principal of Resolute Advisory Group LLC , a healthcare consulting firm in San Antonio , Texas . He has served as an IAHCSMM author since 2019 . For more information , email
David @ ResoluteAdvisoryGroup . com
References :
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Device reprocessing has several necessary steps that must be done correctly every time in order to render devices safe and ready for use on subsequent patients .
5 . Radcliffe RA , Bixler D , Moorman A , et al . Hepatitis B virus transmissions associated with a portable dental clinic , West Virginia , 2009 . J Am Dent Assoc . 2013 ; 144 ( 10 ): 1110 – 1118 .
6 . Oklahoma State Department of Health . Dental Healthcare- Associated Transmission of Hepatitis C : Final Report of Public Health Investigation and Response , 2013 . Available at :
http :// www . ok . gov / health2 / documents / Dental % 20 Healthcare _ Final % 20Report _ 2 _ 17 _ 15 . pdf . 7 . Klevens RM , Moorman AC . Hepatitis C virus : An overview for dental health care providers . J Am Dent Assoc . 2013 ; 144 ( 12 ): 1340 – 1347 . 8 . Kohn WG , Collins AS , Cleveland JL , Harte JA , Eklund KJ , Malvitz DM . Centers for Disease Control and Prevention . Guidelines for infection control in dental health-care settings — 2003 . MMWR Recomm Rep . 2003 ; 52 ( RR-17 ): 1-61 .
9 . Centers for Disease Control and Prevention . Summary of Infection Prevention Practices in Dental Settings : Basic Expectations for Safe Care . https :// www . cdc . gov / oralhealth / infectioncontrol / pdf / safe-care2 . pdf . October 2016 .
10 . Organization for Safety , Asepsis and Prevention website .
www . osap . org