We're now into the first full week of May and you may not be aware but this is North American Occupational and Safety Health Week! As always, we're here to serve and protect all Dental healthcare professionals and nothing says safety more than OSHA. In honor of this mission we're dedicating the entire month of May to all things OSHA.
We all probably heard growing up, "cleanliness is next to godliness" and while your mom or granny pulled this golden nugget out to get you to wash your hands before a meal or to coax you into that evening bath, it's a great motto for every Dental office. So let's dive right in to the ultrasonic bath!
Instrument Sterilization is a delicate, yet vital process to ensure the patient receives safe, quality Dental care. While handling any contaminated instrument after patient care, the handler must use eye protection, a mask, a gown, and wear utility gloves, as there is a potential for exposure to patient material and sharps injuries. Saturated waste must be disposed of in a red/orange biohazard labeled plastic bag. Disposable sharps must be discarded into sharps containers.
Handpieces should be processed based on the manufacturer instructions and should NOT be soaked. All other items must be soaked in either a holding solution or the ultrasonic machine. Used instruments must be placed in a holding container with a detergent or an ultrasonic solution to keep bioburden moist. Soaking solutions need not be disinfectants and instruments should be soaked for 10 minutes before sonication. However, while we want to protect both patients and staff, we also want to protect your investment! So, remember that leaving instruments soaking overnight can cause corrosion and pitting.
Prior to sterilization, instruments must be cleaned by an ultrasonic process. If material remains on the instrument after sonication, it can be physically removed with a long-handled brush. Sonication should take 8-10 minutes (15-20 minutes for instruments in cassettes). Do not use disinfectant solutions instead of ultrasonic solutions.
Once the instruments are clean, remove and rinse the entire ultrasonic basket. Roll the instruments onto a layer of paper towels. Pat dry the instruments with a small stack of paper towels and inspect for debris. If any debris can be seen by this visual inspection, manually clean the instrument with a long-handled brush, rinse, dry, and re-inspect. Arrange the instruments into sets and bag them. If cassettes are used, open the cassettes on the stack of towels and inspect for debris, pat dry and rearrange into the cassette to be bagged in sterilization pouches.
Instruments should be packaged by type of sterilization, either autoclave or dry-heat. The packaging should have a chemical indicator and a process indicator that will change color when the sterilization process is complete. There is no time limit on storage of packaged instruments, as long as the package is not damaged. Any instruments that are "cold sterilized" must be rinsed with sterile water and used immediately.
Autoclaving, using steam and pressure, is the most reliable process but can be more corrosive for instruments containing a high content of carbon steel. The most efficient sterilizers have a pre-vacuum and post-vacuum feature, which is beneficial in sterilizing hollow-bore instruments such as air/water syringe tips and high-speed handpieces.
Chemiclaves combine liquid chemicals, heat and pressure. The parameters for sterilization are a combination of temperatures at 131ºC, 20 psi and sterilization time of 30 minutes. Chemiclave and dry-heat are less corrosive to carbon steel than autoclaves.
Weekly monitoring of the sterilizer’s efficacy is necessary and can be done in-house with a spore-strip. These spore-strips must be mailed out to a monitoring service. Record the information and maintain your log for 3 years. In-office 24 sterilization monitoring kits are available that are very convenient and offer little lag time in obtaining the results. If a positive growth occurs, the sterilizer must be taken out of service, then tested again and only can be reinstated after repair and testing for efficacy.
Ultrasonic solutions should be prepared daily and the machine run for a minimum of 15 minutes at the beginning of the day to remove bubbles, also called degassing. Once a month, submerge aluminum foil into the depth of the bath with water/solution and run the machine for 30 seconds. The submerged area will show uniform pitting when placed against a dark background. If the pitting is not uniform, the ultrasonic must be serviced and the transducers calibrated. At the end of the day, drain the ultrasonic, rinse the bath and wipe the container dry.
Sterile bagged instruments must be dated and stored in clean shelves or cabinets. The packages are considered sterile until the packaging is compromised by becoming damaged, torn or wet. If the package is compromised, all the instruments must be processed again and stored in sterile pouches prior to use. If instruments are not in a sterile pack, they must be used immediately. Ultraviolet chambers have not been proven useful or effective and are a waste of your money.
All handpieces used in the oral cavity must be sterilized or single-use disposable. All re-usable handpieces must be reprocessed separately and IMMEDIATELY after use between separate patient care. High-speed handpieces must be sterilized using either a chemiclave, autoclave or dry-heat. Slow-speed handpieces must be cleaned, lubricated and sterilized. Handpieces and inserts for scaling teeth must be cleaned and sterilized between patients.
These processes, though tedious, will guarantee the upmost safety for everyone in the office. Because time is valuable, it is always best to establish a routine and systems that become second nature to the staff. After all, wouldn't you want to be known as "Doctor Clean" rather than make headlines as a low-down, Dirty Doc?