Instrument processing in the dental office requires considerable attention to detail. Every week, the Compliance Training Partners Technical Services Department receives several hundred calls from dental offices around the country, and many of them are regarding concerns about instrument processing. Too many times the call goes as follows: “Someone in our office just made a big mistake and we need to know what we should do. We somehow mixed up packages of instruments that are sterile with packages that have been cleaned in the ultrasonic but never were placed in the autoclave. It looks like we worked on 4 patients with instruments that were not sterile.” The goal of this article is to make sure your office never needs to make this call. Proper protocols, equipment and training can easily prevent this nightmare situation from occurring in your office.
Assign and Train
Your first step should be to assign an individual to be your Infection Control Coordinator (ICC). I suggest choosing a trusted and organized dental assistant or hygienist. This person should be assigned OSHA compliance duties as well. Next, develop or purchase a set of written protocols for instrument processing that you wish to be followed and work with your ICC to fully implement. This requires having training sessions on a regular basis with your clinical team and ICC. At a minimum, training should occur:
- For all current employees
- For all new employees at the beginning of their employment
- At least annually thereafter
Next, evaluate the area in which you sterilize your instruments. Are you utilizing the latest equipment and technology that can make the job more efficient and effective? Are instruments being hand scrubbed or have you incorporated ultrasonic cleaners and instrument washer/disinfectors that make the job faster, safer and easier. Has your sterilization center been designed according to CDC recommendations, which state your sterilization area should be divided into four clearly delineated areas:
- Receiving, cleaning and decontamination
- Preparation and packaging
If you have an old or poorly designed sterilization center, consider one of the professionally designed and constructed “steri-centers.” They are not only set up according to CDC recommendations, but are made of materials designed to withstand heat, moisture and disinfecting chemicals. They also offer the advantage of immediate depreciation on your corporate tax return—a tremendous advantage!
Standard Operating Procedures
Because multiple individuals (typically the dental assisting and hygiene teams) will be involved in the process of sterilization, it is important to have them doing things the same way each day. Some important considerations are as follows:
- Transport dirty instruments from the operatory to the sterilization in a closed container
- Wear heavy-duty nitrile utility gloves as well as protective eyewear and long-sleeved protective clothing when scrubbing/handling dirty instruments
- Hinged instruments are open and unlocked
- Instruments are wrapped in FDA approved packaging materials that indicate date of sterilization and which machine was used
- Internal and external chemical indicators are used on all packages
- Autoclaves are not overloaded which prevents steam circulation
- Racks are used to hold cassettes
- Allow appropriate drying time
- Do not interrupt a machines sterilization cycle
- Do not handle wet packages
- Check to see that the chemical indicators have changed
- Follow the manufacturers instructions for use regarding operation and maintenance of your autoclave
- Store sterile packages in a dry, closed or covered area
- Examine packages carefully before use
- If damaged—re-sterilize and re-package
- Use biological monitors (spore test) to test all sterilization devices weekly
- Maintain spore test records for 5 years
If your autoclave fails (a positive spore test), do not recall any items (other than implantable devices) but immediately shut the machine down. Re-test the machine and continue to keep the device off-line until confirmation is received the second test was a “pass.” If the second test is also a failure, recall and reprocess all instruments that were run through this device. The need to have “excess capacity” via a second or back-up autoclave cannot be overemphasized! It is simply too costly for your business to be non-operational because you have an autoclave failure.
Certainly, doing infection control the right way takes an investment in time and money. You can easily offset this by marketing what you do to both your patients and your staff. Employees want to work for quality minded doctors who care about their safety and the safety of their patients. Patients seek out offices they perceive as compliant and following the rules. Let them know by posting infection control training certificates in the waiting room, opening packages of sterile instruments in front of the patient and explaining the process the instruments went through. Place information about your infection control prowess on your website, in your office brochure and on social media. All these efforts will be well rewarded, because a quality infection control program will not only protect the financial health of our business but will allow us to know that we are doing the very best for our patients and our dental team.
Karson L. Carpenter D.D.S. serves as President of Compliance Training Partners, a company that has provided compliance services to the dental profession for over 25 years.