CPD article looking at instrument reprocessing

1. 28 auxiliary January/February 2016
infection | CONTROL
T
he ADA infection
control guidelines
applying to dental sur-
geries (incorporating
Australian Standards,
AS/NZS 4815:2006 and AS/NZS
4187:2014) have been updated
in the latest ADA Guidelines for
Infection Control - Third Edition
published in October 2015.
Registered dental practitioners are
legally required to be familiar with and
comply with every new element of infec-
tion control practice included in the cur-
rent guide and to incorporate them into
their practice’s infection control manual.
Policies must be documented, all
clinical staff must be properly trained
in infection control procedures and be
made aware of the risks and obligations
to themselves and patients of working in
a clinical environment - which includes
adhering to the mandated infection
control protocols.
One of the major areas of focus in
infection control is reprocessing of
reusable medical devices (RMD’s) by a
verified process of internal and external
cleaning of the instruments; and effective
sterilisation using a steam sterilizer
with an appropriate cycle type (S or B
type) for the load, together with the
obligation to record Batch Control
Identification for instruments used in
critical procedures.
This aspect has received heightened
attention following numerous investiga-
tions in NSW dental practices across
2015 which found failure to implement
proper infection control practices and led
to actions by the NSW Dental Council
and the Dental Board of Australia. There
were also significant infection control
incidents recorded in 2015 in other Aus-
tralian jurisdictions which resulted in
actions against dental practitioners.
Handpiece management
According to the ADA guidelines, all
dental handpieces must be cleaned
and lubricated in accordance with the
manufacturer’s instructions and must be
sterilized after each patient. Similarly,
ultrasonic scaler handpiece inserts
must be sterilized between patients.
Where the entire ultrasonic scaler can
be steam sterilized, then this is what
should be done in line with the
manufacturer’s instructions. Neither
dental handpieces nor ultrasonic scaler
handpieces can be fully immersed in
water at any stage of cleaning.
The exterior surfaces of dental
handpieces must be cleaned thoroughly
and then their internal aspects cleaned
and lubricated prior to sterilizing,
according to the manufacturer’s instruc-
tions (e.g. using an automated lubricating
and cleaning device or, less preferably,
by using a hand aerosol/pressure pack
spray can).
Infection control guidelines
the responsibility of all
READ
ME FOR
CPD
Figure 1. The W&H Assistina 3x3 makes
handpiece maintenance simple and cost-effective.

2. January/February 2016 auxiliary 29
Care should be taken to ensure that
handpiece lubricants used do not com-
promise the sterilization process. It is
strongly recommended automatic lubrica-
tion and flush-through systems be used for
cleaning and lubricating dental handpieces
because of their lower oil dosing rates.
Following sterilization, handpieces
must be stored in a way to prevent con-
tamination. Handpieces should not be
fitted to the dental unit until required for
use on a patient. Once fitted to the dental
unit and exposed to contamination during
treatment, they must be reprocessed even
if not used on that particular patient.
A range of systems exist for lubrication
of handpieces which provide effective
application and removal of lubricants
to the internal aspects of dental hand-
pieces. The most recent of these has been
developed by leading dental equipment
manufacturer, W&H and provides a
comprehensive solution for internal and
external cleaning and optimum lubrication
of dental handpieces. According to W&H,
the recently released W&H Assistina
“3x3” automated handpiece maintenance
unit is currently the only product in the
world that offers an independently verified
process of internal and external cleaning
of handpieces, combined with optimum
lubrication of the instruments. This makes
it the ideal solution for effective hand-
piece maintenance, consistent with the
latest ADA Infection Control Guidelines.
Figure 2. Sterilisers must be commissioned and validated on installation and the validated on an annual basis. There is also a
requirement for calibration of the thermocouples in the sterilizer by a qualified equipment technician.
Figure 3. Instrument packs should be labelled with the steriliser identification number;
date of sterilisation; and cycle or load number. Barcoding allows the instruments to be
easily tracked to the individual patient treated.
“Registered dental
practitioners are legally
required to be familiar with
and comply with every new
element of infection control
practice included in the
current guide and to
incorporate them into their
practice’s infection
control manual...”

3. 30 auxiliary January/February 2016
infection | CONTROL
Monitoring of sterilizer cycles
An important component of the ADA
Infection Control Guidelines is effec-
tive Batch Control Identification (BCI).
BCI is clearly designated as a manda-
tory requirement in AS/NZS 4815 and
AS/NZS 4187 applying to both small
dental practices and large dental health
providers respectively. Both standards
require pouches or packages with instru-
ments or instrument sets used in critical
procedures to have BCI recording:
a. Steriliser identification number or code
(if there is more than one steriliser
within the office-based health care
facility);
b. Date of sterilisation; and
c. Cycle or load number.
In practice, Batch Control Identifica-
tion (BCI) links a pack of surgical instru-
ments used on a patient to a particular
sterilising cycle, allowing dental practi-
tioners to demonstrate that any critical
dental instruments used on each patient
have been through a particular steriliser
cycle with verifiable performance data.
Dental practices are required to use a
BCI system for critical individual items
and instrument sets, such as those used in
surgical procedures.
The 2015 ADA Infection Control
Guidelines also state that it cannot be
assumed sterilisation has been achieved
without appropriate testing and load
checking. For steam sterilization, the
holding time and temperature and, where
applicable, pressure, must be measured
with continuous, automatic, permanent
monitoring (e.g. process recorder, printer
or data logger).
Retention of hard copy
printouts from steam sterilisers
According to the ADA guidelines, prac-
tices must retain printouts from steam
sterilisers for a minimum of seven years.
Thermal printouts tend to fade with time
and become illegible, thus effective solu-
tions are to either photocopy them to give
a stable hard copy, or scan them for digital
storage. Ink printouts do not fade. Some
modern steam sterilisers offer data capture,
wwhich is a suitable alternative provided
the data is periodically downloaded from
memory cards and regularly backed up.
A good example of this is the latest
W&H Lisa Automatic sterilizer, which
features a built-in data logger that records
the details of every cycle. This data can
be downloaded onto a flash memory card
or automatically downloaded to computer
using W&H’s LisaWARE software to
maintain a permanent digital record of all
batch information.
Another practical solution used in
many practices is the use of a LisaSAFE
bar code label printer to label instrument
pouches. The barcode can then be scanned
at the chairside point of use and this infor-
mation is then saved on the patient record,
linking the procedure and patient with a
successful sterilization cycle.
The Lisa Automatic sterilizer has the
added feature of a pass code-protected
load release function which means that
only trained operators can release the
load after verifying that the cycle has
been completed satisfactorily (physical
parameters met, load is dry, chemical
indicators show a pass).
A requirement on all practices is the
commissioning and validation of their
sterilizers on installation and validation
of cycle parameters on an annual basis.
There is also a requirement for calibration
of the thermocouples in the sterilizer by a
qualified equipment technician. A list of
W&H-trained service technicians can be
found on the A-dec website: a-dec.com or
by phoning A-dec on 1800-225-010.
W&H has also produced a handy
equipment guide entitled Sterilization,
Hygiene and Maintenance, which is
available from local A-dec dealers to help
you choose appropriate products to sup-
port the latest infection control standards.
Regular performance testing of
sterilisers must also be carried out. More
details are contained in the ADA Guide-
lines for Infection Control - Third Edi-
tion, which is required to be kept at each
dental practice for reference and can also
be viewed online.
Figure 4. The W&H LisaSafe printer produces barcoded labels for subsequent scanning at point-of-use to correlate instrument/patient
usage. W&H Lisa sterilisers include integrated data logging and W&H’s LisaWARE software maintains a permanent digital record.
ADA Guidelines for Infection Control - Third Edition - www.ada.org.au/about/publications/guideinfectcont.aspx