The Importance of Proper Instrument Processing in the Dental Office

By Karson L. Carpenter D.D.S.

Instrument processing in the dental office requires considerable attention to detail. Every week, the Compliance Training Partners Technical Services Department receives hundreds of calls from dental offices around the country; many regarding concerns about instrument processing. Too many times the call goes as follows: "Someone in our office made a big mistake and we need to know what we should do. We somehow mixed up packages of instruments that were sterile with packages that have been cleaned in the ultrasonic but were never 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 phonecall. 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 a team member 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 them. Implementation will require having training sessions on a regular basis with your clinical team and ICC.

At a minimum, training should occur:

1. For all current employees
2. For all new employees at the beginning of their employment
3. At least annually thereafter

Evaluate

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:

1. Receiving, cleaning, and decontamination
2. Preparation and packaging
3. Sterilization
4. Storage

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 all doing things the same way each day. Some important considerations are as follows:

1. Transport dirty instruments from the operatory to the sterilization center in a closed container
2. Wear heavy-duty nitrile utility gloves as well as protective eyewear and long-sleeved protective clothing when scrubbing/handling dirty instruments
3. Make sure hinged instruments are open and unlocked
4. Instruments are wrapped in FDA approved packaging materials that indicate the date of sterilization and which machine was used
5. Internal and external chemical indicators are used on all packages
6. Autoclaves are not overloaded which prevents steam circulation
7. Racks are used to hold cassettes
8. Allow appropriate drying time
9. Do not interrupt a machines sterilization cycle
10. Do not handle wet packages
11. CHECK TO SEE THAT CHEMICAL INDICATORS HAVE CHANGED COLOR
12. Follow the manufacturers' instructions for use regarding operation and maintenance of your autoclave
13. Store sterile packages in a dry, closed or covered area
14. Examine packages carefully before use
15. If damaged—re-package and re-sterilize
16. Use biological monitors (spore test) to test all sterilization devices weekly
17. Maintain spore test records for 5 years

Autoclave Failure

If your autoclave fails (a positive spore test), do not recall any items (other than implantable devices), but immediately shut the machine down. Restart the machine and test it for a second time, continue to keep the device off-line until confirmation is received the second test was a "pass." If the second test results in yet another "fail", 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.

Value Added

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 trust to be following OSHA rules! Let your team and your patients know that you adhere to proper infection control 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 your business but will allow the public to know that you are doing the very best for your patients and your dental team.

HIPAA Checklist