Infection control is a critical element to practice dentistry, but sterilization confuses practioners. In our last issue of Practice Tips, we discuss the importance of cleaning before sterilization. This refers to an instrument free of "gross debris" before rendering it "sterile" per the CDC guidelines.
The guidelines provide us with a wealth of information. They also indicate what items need sterilization after use (or disposed of). The CDC refers to necessary sterilized instruments as "critical."
What Is Critical?
In determining what items are "critical" in a dental office, the CDC worked closely with the ADA and have included the ADA recommendations in their guidelines:
"The American Dental Association recommends that surgical and other instruments that normally penetrates soft tissue or bone (e.g., extraction forceps, scalpel blades, bone chisels, periodontal scalers, and surgical burs) be classified as critical devices that should be sterilized after each use or discarded."
PHOTO: Critical Surgical Instruments (scalpel #43-600, forceps #43-420, needle holder #NH-02, explorer/probe #AE-320, and Luxator #33-L3S)
The above recommendation is fairly straight-forward and common sense in nature. The CDC makes infection control very clear on what needs sterilization in the dental office.
Dental handpieces are specifically mentioned (just high-speed styles). They require sterilization, even though they do not directly penetrate tissue or bone. "Handpieces can be contaminated internally with patient material and should be heat sterilized after each patient. Handpieces that cannot be heat sterilized should not be used." Thus, handpieces are "critical" instruments.
Critical Items for Sterilization
Be mindful of how you use an instrument to determine its sterilization treatment. It is equally important to note that the CDC defines what they consider "sterile" (instrument subjected to heat). In most offices, this means autoclaving. Although chemical vapor sterilizers (Chemclaves) and dry heat sterilizers are also common.
Dry heat sterilizers operate at a much higher temperature, so consult your owner's manual, the manufacturer, or the dealer you purchased the item from. Determine if it can withstand dry heat sterilization before you sterilize an instrument in a dry heat sterilizer.
PHOTO: Dry Heat Sterilizer (#97-01)
As the name implies, dry heat sterilizers DO NOT use water or vapor. This means instruments sterilized using dry heat DO NOT corrode as readily as they could from the application of steam. However, the lack of steam to penetrate instruments and orifices means items must be sterilized at a higher temperature for a longer duration (i.e. cycle time) than with a vapor sterilizer. Longer cycle times can have a significant impact on instruments with lower heat-resistance, so be careful about what you place in a dry heat sterilizer.
Exceptions to Dry Heat
DO NOT sterilize some items (like handpieces) with dry heat. For items that will withstand dry heat (most hand instruments) the lack of moisture allows you to get a much longer life out of your instruments. Their edges (like those on scalers or scalpels) stay sharper longer also. If you have a number of instruments that can withstand the higher temperatures, dry heat can be a wonderful addition to an office's sterilization equipment.
The CDC has a wealth of helpful information you should familiarize yourself with. Be critical about what instruments can withstand sterilization and what you disinfect. Keep in mind how an instrument's use determines how it needs to be treated after use. If it can withstand the heat of sterilization, sterilize it!
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