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Choices Concerning Recycling Patient-Care Items

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.


  1. Collins, FM. Bugs, bibs, and the chain of infection. RDH. 2011(10).
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