1. INSTRUMENT DECONTAMINATION & the Miele

2. Dangerous little critters Blood-borne pathogens Other Potentially Infectious Materials (OPIM) Creutzfeldt-Jakob disease

3. Ewwww…there they are

4. Well, that’s better

5. 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.

6. 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

7. “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.

8. And the results are in: No single instrument prevailed No single method prevailed 72% instruments had residual protein

9. And the winner is… Presoak solution Hand scrub Ultrasonic Washer!!! Presoak & ultrasonic Scrub & ultrasonic Presoak & washer Presoak, scrub & washer

10. “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

11. Results:

12. And the winner is… 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 & washer!! 7. Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser

13. “Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical instruments” Procedure 1: Dishwasher Alone (WD) Procedure 2: Presoak & Dishwasher (PS+WD) Procedure 3: Presoak, Hand Scrub & Dishwasher (PS+SH+WD) Wu, G., Yu, X.

14. Procedures 1, 2, 3

15. Instrument Complexity

16. Old & New Instruments

17. And the winner is… Presoak solution Hand scrub Ultrasonic Washer (Miele) Presoak & ultrasonic Scrub & ultrasonic Presoak & washer Presoak, scrub & washer!!!

18. “Cleaning endodontic files in a washer disinfector” CASSETTES VS. MESH BASKETS IN A WASHER Assaf, M, Mellor, AC, Qualtrough, AJE.

19. See the difference?

20. The top is funky

21. And the winner is… Cassettes Mesh baskets!!!

22. And now… Group 2 Productions Presents

24. Soaks, Scrubs, Ultrasonics, or Washers? 1. Safety

25. Soaks, Scrubs, Ultrasonics, or Washers? 1. Safety 2. Effectiveness

26. Soaks, Scrubs, Ultrasonics, or Washers? 1. Safety 2. Effectiveness 3. Time

27. Soaks, Scrubs, Ultrasonics, or Washers? 1. Safety 2. Effectiveness 3. Time 4. Cost

28. Fin.

29. 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