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Instrument Decontamination. & the Miele. Dangerous little critters. Blood-borne pathogens Other Potentially Infectious Materials (OPIM) Creutzfeldt-Jakob disease . Ewwww…there they are. Well, that ’ s better. IT ’ S THE LAW!. Section 1005. Minimum Standards for Infection Control :
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Instrument Decontamination & the Miele
Dangerous little critters • Blood-borne pathogens • Other Potentially Infectious Materials (OPIM) • Creutzfeldt-Jakob disease
IT’S THE LAW! • Section 1005. Minimum Standards for Infection Control: • All licensees shall comply with and enforce the following minimum precautions to minimize the transmission of pathogens in health care settings: • Standard precautions shall be practiced in the care of all patients. • A written protocol shall be developed by the licensee for proper instrument processing, operatory cleanliness, and management of injuries. • A copy of this regulation shall be conspicuously posted in each dental office. • 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” Procedures: • Dishwasher w/ water • Ultrasonic w/ water & rinsed • Presoak w/ 1oz cleanser & rinsed • Presoak w/ 4oz cleanser • Presoak w/ 4oz cleanser, an ultrasonic w/ detergent & rinse • Presoak w/ 4oz of cleanser, rinsed& dishwasher • Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser Sanchez E, Macdonald G.
And the winner is… • Dishwasher w/ water • Ultrasonic w/ water & rinsed • Presoak w/ 1oz cleanser & rinsed • Presoak w/ 4oz cleanser • Presoak w/ 4oz cleanser, an ultrasonic w/ detergent & rinse!! • Presoak w/ 4oz of cleanser, rinsed& washer!! • Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser
“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.
And the winner is… • Presoak solution • Hand scrub • Ultrasonic • Washer (Miele) • Presoak & ultrasonic • Scrub & ultrasonic • Presoak & washer • Presoak, scrub & washer!!!
“Cleaning endodontic files in a washer disinfector” Assaf, M, Mellor, AC, Qualtrough, AJE. CASSETTESVS. MESH BASKETS IN A WASHER
And the winner is… • Cassettes • Mesh baskets!!!
And now… Group 2 Productions Presents
Soaks, Scrubs, Ultrasonics, or Washers? • Safety • Effectiveness
Soaks, Scrubs, Ultrasonics, or Washers? • Safety • Effectiveness • Time
Soaks, Scrubs, Ultrasonics, or Washers? • Safety • Effectiveness • Time • Cost
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