There are a few items in every dental practice that present a unique challenge when it comes to disinfection and cleaning.
It goes without saying that cleanliness is especially important in any healthcare setting, and there are different levels of cleaning necessary at the dental practice. For instance, some items need to be sterilized, while others need only be disinfected. But what about those items that are too big, bulky, or delicate to be either sterilized or disinfected?
Follow the Directions
No matter what is to be cleaned, doing it the right way starts with reading the directions – for dental practice devices and equipment, those directions are also known as the manufacturer’s instructions for use (IFU).
“Read the instructions for use from the manufacturer,” says 'OSHA Lady' Karen Daw. “They’ll guide you on whether or not you want to use a disinfectant, and if so, what type of disinfectant. And that’s something else a lot of people don’t do—they don’t read the active ingredients for the disinfectants that they’re using. Reading it, the safety data sheets, understanding the active ingredient for that disinfectant and whether or not this surface or this item can be used with this particular brand of disinfectant, or would it be best to use barrier protection?”
“Certainly, make sure you read the instructions for use on how to clean, disinfect and use those,” infection prevention consultant Katherine Schrubbe, RDH, BS, MEd, PhD says. “The biggest, bulkiest thing in that operatory is that dental chair. How do you make sure that it’s clean? You need to check with the manufacturer because it depends on what kind of a surface it has. Is it a cloth? Is it leather? Is it a vinyl? Whatever it is, that will drive how that material can be cleaned, and where you find that out is going to be in the dental chair’s manufacturer’s IFU.”
The easiest and most effective way to keep something is clean is not to have to clean it at all. This can be accomplished with the use of barriers. Barriers are protective plastic coverings that prevent unsterilizable or hard-to-clean objects from becoming contaminated.
“Obviously you’re not going to try and put your camera in a sterilizer. That’s not going to work,” Dr Schrubbe illustrates. “So, in most cases, we have to use barriers. That means that when you use a barrier over your bulkier items, such as computer keyboards, cameras, x-ray heads, dispensing syringes, and curing lights – that you can protect the equipment and protect the patients. These types of items cannot be sterilized, but still, need to be cleaned prior to barrier use – and barriers must be changed between patients.”
Barriers aren’t just any old material lying around the office. They must be specifically designated as protective barriers.
“You want to make sure that you have a protective cover that is actually going to do its job,” Daw says. “I see some offices that think that a paper bag over something counts as a barrier, and that’s not the case. Or, I see some people using non-food grade or non-FDA cleared barriers. And you look at them, and they’re rather flimsy, they’re easy to poke through. And then you see these patterned ‘barriers’ in use, and you’re thinking, ‘Oh my gosh, there’s a bunch of holes in that barrier.' You’re definitely going to have to disinfect that surface after you remove that plastic covering.”
“The thing about barriers that’s important is that people sometimes think, ‘Well, I’ll just go get baggies from the grocery store,’” Dr Schrubbe adds. “No, you can’t do that. Barriers must be FDA-approved. They are FDA-approved medical devices. They must be fluid-resistant to keep microorganisms, saliva, or blood from penetrating through the barrier to the surface that it covers.”
Barriers don’t just protect things like computers, cameras, and radiographic equipment. They were even useful to prolong the life of big pieces of equipment, like a dental chair
“Ideally, the best thing you can do is put a big chair barrier over it, because that’s going to save your equipment,” Dr Schrubbe says. “The constant use of surface disinfectants on items like dental chairs and hoses is really tough on equipment. Over time, the disinfectants can dry it out. Some of these pieces of equipment, like the buttons on the air/water syringe, is difficult to clean and disinfect effectively and again. The constant use of disinfectants on the moving parts can affect the efficiency of the syringe. So, the idea is clean and disinfect items at the start of the work shift, then put your barrier on to keep everything clean throughout the day, and use a new barrier for each patient. This process will also help maintain the life of the equipment.”
Simply using the barrier isn’t enough. When those barriers are swapped out between patients, care must be taken.
“The trick is, in between patients, to not contaminate what’s under the barrier and place a new barrier for each patient,” Dr Schrubbe says. “And the reason, of course, that you want to use a barrier on something that’s been disinfected is that you don’t want that disinfectant chemical in anybody’s mouth. Most surface disinfectant chemicals are for non-porous. hard surfaces and pose a health hazard to humans. That goes for everything that is for patient use – the curing lights, dispensing syringes, your digital sensors, digital impression scanners. They might not even touch any teeth, but if it’s in somebody's mouth, it should still have a barrier on it. “
Some items don’t lend themselves to either cleaning or barriers, and in that case, single-use items are ideal. Single-use items are just as their name suggests—items that are used once and then thrown away.
“If an item cannot be properly disinfected or sterilized and it’s a patient use item, then it should be treated as single-use, disposable,” Daw says. “And there’s an argument for treating burs and endo files and broaches as single-use, disposable too.”
“Single-use items are actually labeled by the FDA as single-use,” Dr Schrubbe adds. “And that means 1 time – you unwrap it, you use it, you must get rid of it. And the thing about that is, it is not for any clinician, or any practice to say, ‘Well gosh, I only had this throwaway impression tray in the mouth for 2 seconds. It was the wrong size. I’ll just put it in some disinfectant solution or a high-level disinfectant.’ We can’t do that. It’s not for us to do determine how to reprocess a single-use item so that it can be used again. You cannot try to autoclave a single-use item on your own, thinking if it doesn’t melt or become malformed, its OK to reuse – the answer is, ‘no’.
“The answer is ‘no’, because you don’t know how that process may have affected that item,” she says. “And then if it’s used on a second patient and the patient is injured in any way, or let’s say the plastic fractures, whatever happens, then that is considered ‘off-label use.’ And now that’s a real problem the provider or whoever did that. There are very strict rules on single-use from the FDA. We have a lot of single-use items in dental. I’ve seen practices where sometimes people wonder, ‘Can’t we just put it in the sterilizer?’ No. It’s not for us to make that decision. If the FDA has labeled it as a single-use item, that’s it. And there is a logo on every single-use item, either the box or the wrapper. It’s a circle with a 2 in it and a slash. And that indicates single-use.”
Regrettably, some practices do try to get as much life out of the product as they can, often trying to re-process single-use items.
“We see things like suction tips and disposable impression trays sitting in a cold sterile solution, ready to be reused,” Daw says. “And, usually, when I do a deeper dive with the offices that I consult with to find out how this is allowed to happen, typically the response is, ‘Well, this is the way we’ve always done it.' So, here you have somebody who was onboarded with this process. Maybe the person who turned them onto it no longer works there. So, this person carries on that tradition. Then they train the new person who works in the office on this practice. And we know that nobody’s told them at any point that this is unacceptable. And some of the doctors aren’t watching everything that’s going on in sterilization, they’re not paying attention to what the team may or may not be sterilizing or reusing, or what should be considered single-use or whether it’s allowed to be reprocessed. The emphasis here is that everyone needs to be educated. If we’re not taking continuous infection control training or continuing education, let’s make sure we sign up for it. Let’s just sign up the entire team for training and continuing education, so that they hear it as well.”
Dental practice cleanliness is critical. And while not everything can be popped into an instrument washer or a sterilizer, that doesn’t mean they can’t be cleaned or, at the very least, protected from becoming contaminated.