IT’S THE LAW! Section 1005. Minimum Standards for Infection Control: c) All licensees shall comply with and enforce the following minimum precautions to minimize the transmission of pathogens in health care settings : 1) Standard precautions shall be practiced in the care of all patients. 2) A written protocol shall be developed by the licensee for proper instrument processing, operatory cleanliness, and management of injuries. 3) A copy of this regulation shall be conspicuously posted in each dental office. 9) Heat stable critical and semi-critical instruments shall be cleaned and sterilized before use by using steam under pressure (autoclaving), dry heat, or chemical vapor. FDA cleared chemical sterilants/disinfectants shall be used for sterilization of heat-sensitive critical items and for high-level disinfection of heat-sensitive semi- critical items.
We don’t want no scrubs…or do we? Presoak solution Hand scrub Ultrasonic Washer (Miele) Presoak & ultrasonic Scrub & ultrasonic Presoak & washer Presoak, scrub & washer
“A quantitative assessment of residual protein levels on dental instruments reprocessed by manual, ultrasonic, and automated cleaning methods.” 3 methods Hand scrub Hand scrub + ultrasonic Washer 6 instruments sickle scalers extraction forceps diamond burs steel burs matrix bands matrix band holders Vassey, M, Budge, C, Poolman, T, et al.
And the results are in: No single instrument prevailed No single method prevailed 72% instruments had residual protein
And the winner is… Presoak solution Hand scrub Ultrasonic Washer!!! Presoak & ultrasonic Scrub & ultrasonic Presoak & washer Presoak, scrub & washer
“Decontaminating dental instruments: testing the effectiveness of selected methods” Sanchez E, Macdonald G. Procedures: 1. Dishwasher w/ water 2. Ultrasonic w/ water & rinsed 3. Presoak w/ 1oz cleanser & rinsed 4. Presoak w/ 4oz cleanser 5. Presoak w/ 4oz cleanser, an ultrasonic w/ detergent & rinse 6. Presoak w/ 4oz of cleanser, rinsed & dishwasher 7. Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser
References Assaf, M, Mellor, AC, Qualtrough, AJE. Cleaning endodontic files in a washer disinfector. British Dental Journal 2008; 204: E17 Sanchez E, Macdonald G. Decontaminating dental instruments: testing the effectiveness of selected methods. JADA. 1995 [cited 2012 Nov 4]; 126(3): 359-362 Vassey, M, Budge, C, Poolman, T, et al. A quantitative assessment of residual protein levels on dental instruments reprocessed by manual, ultrasonic and automated cleaning methods. Br Dent J. 2011; 210(9): E14. Wu, G, Yu, X. Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical instruments. Infect Control Hosp Epidemiol 2009; 30: 702-704. http://www.cdc.gov/hicpac/disinfection_sterilization/3_4surfacedisinfection.html http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf