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INFECTION CONTROL

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 The US Centers for Disease Control and Prevention (CDC) recommends that correct functioning of sterilization cycles should be verified for each sterilizer using a biological indicator (BI) and control at least once a week.1Virtually every state has taken this quality control recommendation from the CDC and turned it into a requirement for most healthcare settings, including dental practices. In addition, loads containing implantable devices should be biologically monitored, and the items quarantined until BI results are known. The importance of routine biological monitoring cannot be overemphasized, as BIs can ascertain the effectiveness of many of the steps involved in instrument reprocessing. Sterilization procedures are routinely monitored using a combination of mechanical, chemical, and biological indicators. Taken together, these indicators evaluate the sterilizing conditions and effectiveness of the process. Because BIs directly monitor sterilization by assessing the processes' ability to kill known highly resistant bacterial spores (eg, Geobacillus or Bacillus species), rather than only testing the physical and chemical conditions necessary for sterilization, the use of calibrated BIs remains the accepted "gold standard" for monitoring. 

Although multiple studies have shown that the most common cause of sterilization failures is human error, other problems can compromise sterilizer efficiency. A few common errors are listed in Table 1.

We have seen advertisements that tout the use of "faster" sterilizers; how are they different from the standard autoclave and what are the advantages of "faster and better"? 
If you are using an autoclave like the overwhelming majority of dental practices, you probably have been using a gravity displacement autoclave. This type of unit has been available for more than a century and sterilizes with self-generated steam that is created within the chamber or by a component steam generator. Because air entering the chamber mixes with air, cool air pockets can form within the chamber, which may result in extended times for sterilization of certain items. In addition, overloading this type of autoclave can lead to incomplete drying of sterilized instrument packs, resulting in the user commonly finding wet packages at the end of the cycle. Modification of later generations of autoclaves has resulted in some sterilizers using pressure-pulsing techniques along with gravity displacement techniques to assist in removing air from the chamber before the sterilization cycle. 
Development of a new generation of autoclaves within the last 2 decades has added a new dimension to this heat sterilization modality. These autoclaves are classified as "Class B" sterilizers or "pre- and post-vacuum" steam sterilizers. The equipment is fitted with a pump that creates an initial vacuum in the chamber to ensure air is removed from the sterilizing chamber before steam enters. In contrast to a gravity displacement autoclave, this procedure allows faster and more thorough steam penetration throughout the entire load. The poststerilization vacuum cycle also is highly efficient because it facilitates drying. Practices that utilize this type of sterilizer frequently report the instrument packs are "bone dry" at the end of the sterilization process.

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INFECTION CONTROL

 If you could present people with fundamental rules of thumb for practicing proper infection control in a dental office, what would they be?

One aspect of infection control that is sometimes forgotten in the ongoing evolution of technologies, methodologies, and products is that long-standing, basic infection control principles have not really changed over the years. While there is certainly no single "best list," I can offer the following to summarize major areas:

  • Perform effective hand hygiene
  • Immunize against vaccine-preventable diseases
  • Use personal protective equipment appropriately
  • Heat sterilize all reusable patient care instruments/items used intraorally
  • Use respiratory hygiene/cough etiquette
  • Prevent cross-contamination with aseptic technique and environmental asepsis
  • Prevent sharp injuries by using safe work practices and engineering controls.

You may find that as you review and consider each of these, many of the procedures and protocols that you perform as routine components of your practice day provide effective applications of these principles. You may be pleasantly surprised as to just how well your infection control program is working.

Demonstration of fit and feel for right- and left-fitted versus ambidextrous gloves.

There are new products on the market that talk about being "eco-friendly," yet many infection control products are labeled as disposable, and I hear some may even be toxic to the environment. What is the status of environmentally friendly infection control products?
A new era of developing strategies and marketing products designed to address environmental issues is rapidly expanding into multiple areas of infection control. Many hospitals and other healthcare facilities took the initiative to lower waste accumulation by using approaches that include adopting programs that use more recyclables and reusable items and looking for products that reduce the amount of disposable waste.

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