Which of these is the recommended methods for sterilizing dental handpieces?
Many local home centers offer short courses on a variety of repair and remodeling topics. One popular offering is interior painting of walls, floors, and ceilings. Attendees are surprised when instead of paint and a brush they are handed a bucket of soapy water and a sponge. In order to have a favorable result in the end, proper preparation in the beginning is required. Surfaces need to be repaired, sanded smooth, cleaned well, and then rinsed completely. The paint must contact the
surfaces directly. The presence of oils, dirt, adhesives, or stains could negatively affect the quality of the painting. Surface preparation is the key to successful painting. Show CATEGORIES OF PATIENT CARE ITEMS
The Centers for Disease Control and Prevention (CDC) has categorized patient care items as critical, semicritical, or noncritical based on the potential risk of infection to the patient during use. The system is based on the classification first proposed by Spaulding in 1968 (Table 1). The CDC recommends that critical and semicritical items be first cleaned and then sterilized by heat.1,4 CHAIRSIDE AND TRANSPORT Operatory preparation for the next patient cannot begin until all contaminated items are safely removed, discarded, or processed. The removal of contaminated patient care items from the operatory should be performed in a careful manner to prevent exposure to microorganisms. Contact with nonintact skin on the hands, mucous membranes of the eyes, nose, or mouth, and percutaneous injuries from sharp instruments provide the risk of disease transmission. Instruments being transported to the instrument-processing area must be contained to prevent injury. Containment can be defined as instrument cassettes or cages in which dental care items are cleaned, sterilized, and stored until point of use. Sharp instruments should not be carried openly to the instrument-processing area. Percutaneous injuries may occur to other dental healthcare personnel (DHCP) or patients in hallways leading to the instrument-processing area. HOLDING/PRESOAKING If the DHCP are unable to begin the instrument-processing procedure immediately after transporting the dental care items to the instrument-processing area, the items should be placed into a holding solution in a puncture-resistant container for a precleaning process. This facilitates the cleaning process by preventing patient material from drying on the instruments. Cleaning becomes easier and less time consuming. The holding solution can be a disinfectant/detergent or an enzymatic cleaner. The use of a sterilant/high-level disinfectant (eg, glutaraldehyde) is not considered appropriate and therefore not recommended. Some plastic/resin cassettes should not be placed into a holding solution. Always consult and follow the recommendations made by the cassette manufacturer. Also, be aware that some instruments may corrode if left in the holding solution for more than a few hours. Precleaning is not required when using an instrument washer. Contaminated instruments may be placed directly into the instrument washer and held there until the washer cycle is started. CLEANING Cleaning soiled dental instruments is essential for any sterilization procedures. Cleaning reduces the bioburden (microorganisms, blood, saliva, oral hard tissues, and dental materials). Bioburden could isolate or protect microorganisms from sterilizing agents. There are 2 ways to clean dental instruments: mechanically (ultrasonic cleaning, instrument wash-ers/washer-disinfectors) and manually.1-3 Ultrasonic Cleaning Ultrasonic cleaning, when com-pared to manual scrubbing, reduces direct contact with contaminated instruments and thus decreases the chances of cuts and puncture wounds. Ultrasound, because of its cavitation action (billions of imploding bubbles are generated, which produce a cleaning turbulence that removes and disrupts debris), is usually more effective and efficient than manual scrubbing. For example, office staff can properly clean more instruments within a given period of time. Almost all instruments can be ultrasonically cleaned. One major exception is the majority of dental handpieces, which usually must be hand-cleaned. Both loose instruments and those held in cassettes can be cleaned with ultrasound. Always check the manufacturer’s clean-ing instructions.2,3,5 Table 2. Selecting an Ultrasonic Cleaner.* •Purchase a unit that meets the practice’s needs (eg, sufficiently large to hold 15 to 20 loose instruments at a time or is configured to clean several stacked cassettes at the same time). *Modified From References 2, 3, 5, and 6. Ultrasonic cleaners come in a variety of sizes, from pint-sized round units to multiple-gallon, rectangular-shaped types that can be used on a countertop or built into the counter cabinet (Table 2). Table 3. Recommendations for Using an Ultrasonic Cleaner.* •Wear appropriate personal protective equipment—heavy duty gloves, masks, protective eyewear, and a clinical gown. *Modified From References 2 and 6. Loose instruments and those held within cassettes must be suspended within the solution but off the bottom of the unit’s chamber (Table 3). Placement of
instruments directly on the floor of the unit will result in poor cleaning, and excessive bouncing could damage the unit and the instruments. The use of a suspending basket or rack will position the instruments or cassettes for optimal cleaning. A cover should be in place whenever the unit is being operated. Instrument Washers Another method of mechanical instrument cleaning is an in-strument washer (sometimes called “a washer-disinfector”). These units have been used in hospitals and larger clinics, and have become available to dental offices. Manual Scrubbing Table 4. Recommendations for Manual Scrubbing.* •Always wear personal protective equipment, such as heavy duty utility gloves, masks, protective eyewear, and a gown. *Modified From References 2 and 5. Scrubbing instruments by hand is a traditional method of
cleaning and is a relatively effective method for removing debris (Table 4). However, scrubbing is dangerous and is not as effective as mechanical methods of cleaning. CORROSION CONTROL/ DRYING/LUBRICATION After cleaning, instruments and instrument cassettes should be rinsed well. Some cleaning units (eg, instrument washing machines) have automatic rinsing cycles. After rinsing, instruments and cassettes should be allowed to drain and ideally to dry completely. Shaking the instruments and cassettes can accelerate this process. However, care must be taken so the instruments are not damaged. Drying instruments by hand using some type
of toweling materials must be done carefully. Some instruments (eg, hinged types) require lubrication in order to function properly. PACKAGING The goal of sterilization is more than just sterilizing instruments between patients; it is delivering sterile instruments chairside every time they are to be used. Proper cleaning is important, but so is maintaining sterility of instruments
after they have been processed through the sterilizer. Packaging instruments before processing will help keep them from being contaminated while being stored or when they are transported chairside for use. Unpackaged instruments have no practical shelf-life. Instruments processed without protective packaging can be readily contaminated after processing.2
Only packaging materials that have been designed for use in sterilizers should be used. Packaging is considered to be a medical device and thus is regulated by the Food and Drug Administration for effectiveness and efficiency. Also, packaging must be appropriate for the type of sterilizer used (Table 5). Improper packaging may retard sterilization, be destroyed during processing, or even release toxic chemicals with the application of heat. CONCLUSION The Organization for Safety and Asepsis Procedures (OSAP) is dentistry’s resource for infection control and safety. OSAP has recently published a book on the CDC guidelines—From Policy to Practice: OSAP’s Guide to the Guide-lines. The book is designed to support the efforts of dental practices to understand better the recommendations and to identify effective and efficient methods for compliance, including preparation of instruments for sterilization. Order information is available at osap.org or by calling (410) 571-0003. References 1. Kohn WG, Collins AS, Cleveland JL, et al; Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings, 2003. MMWR. 2003;52(RR-17):1-61. Ms. Jorgensen has been employed as an orthodontic assistant, a general chairside assistant, and a trainer for a large group practice. Currently, she is a full-time, clinical procedures, dental assisting instructor at Portland Community College in Portland, Ore. She is an approved speaker on bloodborne pathogens for the National Association of Dental Laboratories (NADL) and is a member of The Dental Assisting National Board, Infection Control Exam (ICE) test construction committee. She can be reached at (503) 977-4036 or . Dr. Palenik has held over the last 25 years a number of academic and administrative positions at Indiana University School of Dentistry. These include professor of oral microbiology, director of human health and safety, director of central sterilization services, and chairman of infection control and hazardous materials management committees. Currently he is director of infection control research and services. Dr. Palenik has published 125 articles, more than 290 monographs, 3 books, and 7 book chapters, the majority of which involve infection control and human safety and health. Also, he has provided more than 100 continuing education courses throughout the United States and 8 foreign countries. All questions should be directed to OSAP at . What is the recommended method for sterilizing dental handpieces?The acceptable methods of sterilization include chemical vapor sterilizers, dry heat, and autoclaves.
What is usually recommended before sterilizing handpieces?Before starting the sterilization process starts, you should lubricate the heads, the nosecones, and the contra angles of all your handpieces are properly lubricated. Once you lubricate before sterilization, you should connect your dental handpieces to a special air supply unit and operate it for up to a minute.
How do you clean dental handpieces?Do not immerse handpiece in water. Do not place handpiece in an ultrasonic bath. Remove bur from the handpiece. Clean the exterior of the handpiece with warm soapy water and a long-handled brush or a universal disinfectant wipe to ensure all debris and contaminates are visibly removed.
What is the best way to maintain a sterile handpiece?Wipe down the handpiece with a damp disposable cloth. A mild detergent is acceptable but make sure to run clean of all dirt, dust, and bio-matter before sterilizing. If there is still some bio-burden left on the handpiece, clean under running water using a brush.
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