Choices Concerning Recycling Patient-Care Items
Organization for Safety, Asepsis, and Prevention
Patient-care items (dental instruments,
devices, and equipment) are categorized as critical, semi-critical or
noncritical, depending on the potential risk for infection associated with
their intended use. Critical items are used to penetrate soft tissue or bone and
thus pose the greatest risk of transmitting infection and should be sterilized
by heat. Examples include surgical
instruments, handpieces, scalers, hand instruments, scalpel blades and surgical
and restorative dental burs. Semi-critical
items (e.g., dental mouth mirror, amalgam
condenser and reusable dental impression trays) touch mucous membranes or non-intact skin and have a lower risk
of transmission. Because the majority of semi-critical items in dentistry are
heat-tolerant, they also should be sterilized by using heat. If a semi-critical
item is heat-sensitive, it should, at a minimum, be treated using a high-level
disinfectant.
Noncritical
patient-care items pose the least risk of transmission of infection, contacting
only intact skin, which can serve as an effective barrier to microorganisms.
Examples include radiograph heads/cones,
blood pressure cuffs, face bows and pulse oximeters. In the majority of cases cleaning followed by
disinfection with an EPA-registered hospital disinfectant is adequate. When the
item is visibly contaminated with blood or other potential infectious microorganisms,
an EPA-registered hospital disinfectant with a tuberculocidal claim (e.g.,
intermediate-level disinfectant) should be used. Cleaning or disinfection of
certain noncritical patient-care items can be difficult or damage the surfaces;
therefore, use of disposable barrier protection of these surfaces might be a
preferred alternative.
Heat-tolerant
dental instruments usually are sterilized by 1) steam under pressure
(autoclaving), 2) dry heat or 3) unsaturated chemical vapor. All sterilization
must be performed using equipment cleared by FDA. Sterilization times,
temperatures and other operating parameters recommended by the manufacturer of
the equipment must be used, as well as instructions for correct use of
containers, wraps, and chemical or biological indicators, should always be
followed.
Some items, such
prophy angles, can either be metal and reusable requiring sterilization or
single use, disposable wrapped plastic types. The choice to sterilize, disinfect
or be disposable depends on an item’s use status (critical, semi-critical or
non-critical), chances of becoming contaminated and its composition, especially
its heat resistance.
An interesting
example of a common dental piece of equipment is the bib holder or a bib chain1.
While
the bibs used in the dental office are single-use disposable items, the bib
holders usually are not. Reusable clips exist as the traditional chains of tiny
cylindrical stainless steel balls with metal clips at the end or as more
contemporary types with stylized clips and smooth tubing. There are some types
that are used once and thrown away.
Bib
holders or chains often contact patient bare skin and can be readily
contaminated during treatment by aerosols and spatter and by contact with
contaminated gloved hands. So, it is no surprise that pathogens can be found on
bib holders.
Three
small studies indicate that bib holders or chains readily become microbially
contaminated during patient use and that wipe disinfection is not wholly
effective. This leaves three choices, the safest being cleaning and then
sterilization for heat resistant bib holder or chains. Heat sensitive types can
undergo immersion in a hospital grade disinfectant after surface debris is
first removed for an appropriate length of time. A simple resolution could be
to use single-use, disposable bib holders.
Bib
holders or chains are examples of many types of items used clinically in
dentistry. Some items are offered in a one-time use, disposable form. However,
for reusable items, it probably would be best to sterilize.
References:
- Collins, FM. Bugs, bibs, and the chain of
infection. RDH.
2011(10).