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Dental Surgeons of Ontario
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Infection prevention and control in the dental office: some common questions

Originally published in Dispatch 2017 Issue 2

The College receives many calls from members, staff and the public asking about infection prevention and control in the dental office. Here are some of the common ones:

WHAT IS REPROCESSING?

Reprocessing is the cleaning, disinfecting and sterilization of reusable instruments and equipment.

WHAT ARE THE GENERAL PRINCIPLES FOR REPROCESSING?

All instruments and equipment that are reused in the treatment of patients must be capable of being cleaned, disinfected and/or sterilized according to the College’s Standard, the most current standards and guidelines from the Canadian Standards Association (CSA), the Public Health Agency of Canada (PHAC) and recommendations from the Provincial Infectious Diseases Advisory Committee (PIDAC). All members of the dental team, including all principal and associate dentists and dental staff, share the responsibility for ensuring instruments and equipment are reprocessed appropriately.

DO INSTRUMENTS NEED TO BE CLEANED PRIOR TO BEING STERILIZED?

Instruments must be thoroughly cleaned before being disinfected or sterilized. Cleaning involves physically removing all debris and contaminants from the instruments as soon as possible after use so that organic material will not dry on them. If there will be a delay in reprocessing, soak the instrument in an approved solution. The instruments should be cleaned with a detergent/enzymatic agent according to the manufacturer’s directions or in an ultrasonic unit. Once cleaned, the instruments should be inspected before disinfection/sterilization.

WHAT ARE NON-CRITICAL, SEMI-CRITICAL AND CRITICAL ITEMS?

Patient care items are categorized as critical, semi-critical or non-critical, depending on the potential risk for infection associated with their intended use. This classification determines their reprocessing requirements. “Critical” items penetrate the soft tissue or contact bone (for example, all surgical instruments, periodontal scalers). These items must be cleaned followed by sterilization.

“Semi-critical” items contact mucous membranes or non-intact skin (e.g. mouth mirrors, explorers, handpieces). These items should also be cleaned and sterilized. The majority of semi-critical items, including handpieces, are heat-tolerant and should always be heat-sterilized between uses. If a semi-critical item is heat-sensitive, at a minimum, it should be reprocessed using high-level disinfection.

“Non-critical” items contact intact skin, but not mucous membranes, or do not directly contact the patient (e.g. suction tubing, pulse oximeters, etc.). These items should be cleaned followed by low-level disinfection. Suction lines should be purged between patients by aspirating water or an appropriate cleaning solution to remove debris and micro-organisms. At least once per week, suction lines should be flushed with an enzymatic cleaner or appropriate cleaning solution.

DO INSTRUMENTS NEED TO BE PACKAGED?

Critical and semi-critical instruments must be kept sterile until the time they are used. Suitable packaging materials include wrapped perforated instrument cassettes, peel pouches, and woven or nonwoven sterilization wraps. Packaging materials should be designed for the type of sterilization process being used.

The most common wrapping materials for the clinical office are plastic/peel pouches. They are easy to use, often come with both external and internal chemical indicators, and come in a variety of sizes that can accept a single instrument or small number of instruments. Packages, including pouches, should not be overloaded. Instruments should not touch or overlap and any hinged instrument should be processed open and unlocked. The date of sterilization should be marked on the product wrapping.

HOW OFTEN DOES SPORE TESTING NEED TO BE DONE?

Spore testing (biological indicators) must be done each day the sterilizer is used and the results of the test recorded in a logbook. A control test must also be used when spore testing is performed and those results also recorded. The performance of sterilizers should be monitored with biologic indicators, as well as physical and chemical monitors and indicators.

IPAC UPDATES

The College continues to monitor issues around IPAC. The latest information is always available directly from our website – rcdso.org. Breaking news will be highlighted in email blasts. Stay tuned!

IPAC Resources

RCDSO Standard on Infection Prevention and Control in the Dental Office
Public Health Ontario IPAC Documents
Infection Prevention and Control (IPAC): Core Elements in Dental Practice
Checklist: Reprocessing in Dental Practice Settings