It’s been well over a year now since the CDC published their “Summary of Infection Prevention Practices in Dental Settings” in the Spring of 2016. Despite using the term “summary” in the name of this 44 page document, the CDC has come out with completely new rules for infection control in the dental office (in addition to summarizing previously published guidelines).
This month, we'd like to discuss the dramatic changes to the guidelines for sterilization of dental handpieces. Page 14 of the CDC document specifies (emphasis added):
“Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high level or surface disinfected.”
What does this mean to you? You cannot re-use a handpiece on a patient unless the entire handpiece and all components have been heat sterilized — even slow-speed handpieces (and components) that are only being used for prophylaxis.
Unfortunately, several popular hygiene handpieces on the market do not conform to this specification and must be removed from service. Handpieces with any drive component that cannot be heat sterilized are now only suited to personal use, use in a veterinary office, or use outside of the country (such as for mission trips).
Drive mechanisms that aren't heat tolerant (cannot be autoclaved) are commonly encountered with many “stand-alone” electric units, but all systems must conform to the new standard. Any component with any type of gear, drive shaft, or similar mechanism must be autoclaved.
Fortunately, most air-driven handpieces on the market are fully autoclavable and have been for decades. Periodic removal of motors and other components should already be a part of your office’s routine handpiece maintenance, now you just need to increase the frequency.
The CDC guidelines were the result of several studies (mostly conducted by various branches of the US military) that showed contaminants had a tendency to work through the drive mechanisms of slow-speed handpieces and contaminate all of the components (even those that do not enter the oral cavity). These studies have shown a high probability of contamination of all handpiece components. The risk of contamination is very real.
In the infection control guidelines, the CDC goes on to state: “Although these devices are considered semi-critical…” and a major handpiece manufacturer has seized upon this statement to claim that their motor does not need to be heat sterilized as it is non-critical. However, all motors are non-critical devices. That is in the nature of a motor. Under normal circumstances, a motor should never contact mucous membranes or non-intact skin. The CDC explicitly spells out that handpieces “including low-speed motors,” must be heat sterilized. It is clear motors must be heat sterilized, regardless of their standing— critical, semi-critical, or non-critical. To attempt to skirt infection control guidelines based on a loose interpretation of a technicality is a dangerous prospect and not something we can recommend, nor support.
We recommend reviewing Practice Tips #71 & Practice Tips #72 for definitions of a motor, a handpiece, and an attachment to further clarify why the CDC’s statement regarding motors is so important.
As most handpieces on the market are already autoclavable, there are a number of economical solutions available to help you remain compliant. American Dental Accessories carries many affordable, reliable, and autoclavable hygiene handpieces. Handpieces like the American Hygienist or the Vector MICROLite are economically priced, ergonomically designed, and fully autoclavable to help your hygiene department stay compliant.
Vector's MICROLite Hygiene handpiece, #15-207
Feel free to call or e-mail us with any questions you have pertaining to the guidelines, as well.
There are a number of other developments in this latest document from the CDC. We recommend downloading and taking some time to familiarize yourself with it, so you can remain compliant in all aspects of infection control. In addition to the new information pertaining to handpieces, the CDC summary includes convenient infection control checklists for use by your office staff and other helpful tools. Please click here to visit the CDC disinfection & sterilization guidelines.. The new summary is a much more easily digested 44 pages. Every dentist should read it. Make certain your office staff is familiar with it too.
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