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September is Dental Infection Control Awareness Month, as designated by the Organization for Safety, Asepsis and Prevention (OSAP).

To Reuse or Not to Reuse...That is the question!

Dental assistants are responsible for so many important functions in the dental office that it would require a 5-inch thick, tabbed binder to list them all so I'm going to direct the attention of this article to just one; when to reuse and when not to reuse dental products.
 
I began my dental assisting career in the day when PPE were only worn by construction workers, cold sterile was the most frequently used method for processing instruments between patient use and we reused everything except cotton products. 
 
It is refreshing to witness that in 2017 safety and infection prevention in the dental office has been elevated to a much higher standard than in 1972. 
 
So where do we start?  There is so much information about infection prevention that it is difficult for a private dental practice to keep up and stay abreast of the current research, standards, guidelines and recommendations.  It becomes overwhelming for many.  What do you really need to know?  My suggestion is to be familiar with and have a copy of each of the following:  Oregon OSHA Bloodborne Pathogens Standard (OAR 437, Division 2, General Occupational Safety and Health Rules, Subdivision Z -Toxic and Hazardous Substances, CDC Guidelines for Infection Control in Dental Health-Care Settings - 2003, CDC Summary of Infection Prevention Practices in Dental Settings - 2016, and Oregon Board of Dentistry, Division 12, Standards of Practice, 818-012-0040 - Infection Control Guidelines.  Although these are the main resources for dental infection prevention safety standards and guidelines there are many others that are reliable.  Check out the Organization for Safety and Asepsis Procedures (OSAP) www.OSAP.org, the new CDC mobile Dental App and Dr. Chris Miller's 6th edition of Infection Control and Management of Hazardous Materials for the Dental Team. 
 
My second suggestion is to always read the manufacturers' instructions.  Instructions for use (IFU'S) should be easily accessible for anyone using the equipment or product.  Whenever a new product is received the IFU's should be read and discussed with all the providers and staff that will be preparing, measuring, cleaning, disinfecting, sterilizing, disposing or storing the product or equipment.         
 
I have heard some dental assistants claim they did not know a cleaning solution should be run through the sterilizer every month or that many burs are not reusable.  I have heard a few indicate it is okay to immerse the plastic HVE tips into high-level disinfectant ("cold sterile") for 10 hours and then rinse and reuse them.  A dentist once indicted that, "If you do not touch the outside of a mask you can reuse it."...WHAT????  There are many other examples of this misinformation that can be found in dental practices everywhere.  These comments are obviously not made by dental assistants alone.  Often the dentist is unaware of the IFU and may pass on incorrect information.  Or a new inexperienced dental sales representative may not have shared correct information. 
 
Dental professionals are anything but lazy, they are committed to providing the best care to their patients and most are exhausted at the end of the work day.  The excuse is they have not had time to read the IFU's.  It is very important there is time allotted for reviewing the use of new items.  In fact, OSHA states there must be training when new equipment, products or procedures are introduced into the dental practice.  For every piece of equipment and product that enters the dental office, time should be allowed for reading the IFU's and becoming familiar with the contents.  Even if the sales representative explains its' use, it is the responsibility of the end user to know the facts. 
 
What about the burs.  Are they reusable?  Can they be sterilized?  What does the manufacturer recommend? The terms you must look for on the package or in the IFU's are:  Single use, disposable, not for reuse, one time use only, etc.  If the IFU's do not provide instructions for cleaning, disinfecting or sterilizing it means they are considered single use only; after use on one patient they should be disposed into the sharps container. 
 
Dr. John Molinari, Director of Infection Control for The Dental Advisor states, "...multiple considerations support the practice of disposing burs after use...eliminate the risk of patient-to-patient cross-infection as burs may not be bioburden (microbe-laden debris) free after reprocessing...time-consuming cleaning and sterilization procedure can be eliminated.  Most bur and diamond companies now offer low-cost disposable burs that lower the cost of purchase to the point that it is more economical to discard them than to sterilize them. 
 
Here is another interesting article regarding a study of burs and endodontic files.  The results of the study indicate..."dental burs and endodontic files are not sterile when purchased and should be cleaned and sterilized before use.  Routine sterilization procedures for previously used burs and files were not effective, and further research is warranted to devise an effective sterilization protocol."
 
https://www.cda-adc.ca/jcda/vol-75/issue-1/39.pdf
 
Composite Compule Tips are sold as single use although I have witnessed many who wipe them with alcohol or disinfectant when composite material remains in the Compule Tip.  This left-over composite is then used on a future patient.  Disposing would be expensive and wasteful?
 
The TPH Spectra Universal Composite instructions state the following:
            Cross-contamination of Compule Tips:

  • After intraoral use do not reuse Compule Tips
  • Properly dispose the intraorally used and/or contaminated Compules Tips in accordance with local regulations.

 
Items you probably wipe with disinfectant every day may run the risk of cross contamination.  For example, the FDA has posted this article on their website.
 
https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/ucm404472.htm
 
So, the answer to the question, "Use or Reuse?"  is really very simple; follow the manufacturers IFU's.  If the instructions do not include how to process the item for reuse then follow the instructions for disposal.
 
Ginny Jorgensen, CDA, EFDA, EFODA, AAS
Smith & Jorgensen Dental Consulting
Comments or questions - contact Ginny at smithandjorgensen@gmail.com
 
About the Author...
Ginny began her dental assisting career as an orthodontic and general chairside assistant. After 18 years of clinical experience she was employed for 6 years as a Dental Training Specialist for Kaiser Permanente Dental Program.  Ginny graduated from Portland Community College with an Associate Degree in Professional Technical Education and was a full time clinical dental assisting instructor at Portland Community College from 1998 to 2013.
 
She is an approved speaker on Bloodborne Pathogens for the National Association of Dental Laboratories (NADL), and the owner of Smith & Jorgensen Dental Consulting, a firm that provides current infection control, audits and compliance training for dental professionals.
 
Ginny served as a founding member on The Dental Auxiliary Learning Education (DALE) Foundation Board of Trustees from 2010 to 2017.  She is currently an Organization for Safety and Asepsis Procedures (OSAP) member and serves on the DANB/OSAP Infection Control Certificate Certification Steering Committee.
 
 
Additionally, Ginny served on the Dental Assisting National Board’s (DANB) Orthodontic Assisting Test Construction Committee from 1988 to 1992, and the DANB Infection Control Test Construction Committee from 1999 to 2005.
 
Ginny’s main goal is to provide current “Best Practice” infection control trends for her clients and how to implement these trends into an efficient, safe working environment for dental professionals and their patients.
 
Ginny Jorgensen, CDA, EFDA, EFODA, AAS


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