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Awareness of instrument sterility is paramount for dental offices

April 19, 2012
Every day health-care professionals sterilize instruments. But, Constance Schuster, RDH, BS, asks how often are steps either skipped or ignored and the integrity of sterility compromised? Schuster points out the need to avoid complacency toward sterilization in dental practices.
By Constance Schuster, RDH, BS
Healthcare professionals take pride in providing the best quality of care to their patients. Attention to detail is extremely important, not only while performing diagnostic procedures, but also behind the scenes in the central sterilization room. Unfortunately, when patient flow is high and staff is low, details can be lost in the busyness of the day. Dental professionals have the same issue and occasionally complacency occurs. Just imagine allowing this oversight to infect someone you love with hepatitis or worse yet HIV. Wouldn’t it make sense to take every precaution to prevent an exposure incident from occurring? Every day health care professionals sterilize instruments. But, how often are steps skipped/ignored and the integrity of sterility compromised? Parents feel the need to protect their children from injury and keep them safe. They want to provide them with the best care and look to the healthcare professional to perform preventive services to help protect the child’s well-being. However, the families of eight children receiving dental care on a mobile van in Wisconsin were disappointed in the trust they gave to the dental providers. (National Prevention Information Network, 2012) The children may have been exposed to an infectious disease because the instruments used to provide care were autoclaved but the indicators on the pouches did not change color. This is a prime example of the loss of awareness occurring in dental offices regarding infection control and sterility. There have been several instances demonstrating the complacency occurring in dental practices. According to the Centers for Disease Control, biological monitoring, otherwise known as spore testing, should be performed at least weekly. (Kohn, 2003) Non-compliance to CDC guidelines can result in disciplinary actions varying from fines, license suspension, and even probation. The Supreme Judicial Court of Massachusetts upheld a 6-month license suspension followed by five years of probation of a dentist who did not comply with CDC guidelines regarding spore testing. The dentist, Stephen Chadwick, DDS, had several violations to CDC guidelines, Occupational Safety & Health Administration standards, and the Department of Public Health regulations. (Massachusetts Supreme Court, 2011)One study performed in Brazil focused on oral surgeons’ sterility techniques. The results were alarming. It was reported that 83% of these practices did not perform weekly biological monitoring. (Matsuda, 2011) Monitoring must be performed on a regular basis and the results need to be logged into a book for proof of compliance. Currently, there are options available to either a 24-hour in-office monitoring system or mail-in service to provide spore testing results in a quicker manner than in the past. However, weekly testing does not provide assurance of sterility between testing. It is taken for granted that as long as instruments have been autoclaved they are sterile. Unfortunately, this is not always the case. It is in the best interest to dental providers and the care of their patients to provide the best quality of care, which includes protection from cross contamination from inadequate sterilization of instruments. The majority of dental offices currently utilize sterilization pouches that have only one parameter, indicating the package was processed in an autoclave. This indicator only proves that the package was heated to a specific temperature. Many of these pouches only have an indicator on the outside. Without an indicator on the inside of the pouch where the instruments are located, how is one to have the assurance of instrument sterility? If the indicator is only detecting temperature, it is imperative to understand what other criteria are required for sterilization.
ConFirm 24 In-Office Biological Monitoring System
Easy to use and interpret .... results in just 24 hours! Simply process vial in a normal sterilizer cycle, then activate vial, incubate and record results. If any spores survive the process, the vial medium will turn yellow.
The parameters of proper sterilization of instruments require the correct time, temperature, and presence of steam to be present for sterility to occur. If the majority of indicators only check whether or not the package reached the correct temperature, how can one be reassured that steam and pressure has reached appropriate levels to provide instrument sterilization? Failure of reaching the requirements of sterilization is falling short of best practice. Providing optimum indication of instrument sterility can be reached through the use of Class 4 multi-variable internal/external indicators. These indicators are located on the outside and inside of the sterilization pouch and do not change color unless all three criteria have been met.
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It is up to each one of us to decide what level of importance should be put upon the services we provide including the integrity of sterility of the instruments we use on the best commodity we have, our patients.
Kohn, W. C. (2003). Guidelines for Infection Control in Dental Health Settings. Atlanta: Morbity and Mortality Weekly Report.Massachusetts Supreme Court. (2011, December 8). Justia US Law. Retrieved 4 15, 2012, from, J. G. (2011). The Assessment of Infection Control in Dental Practices in the Municipality of Sao Paulo. Brazil Journal of Infectious Disease, 45-51.National Prevention Information Network. (2012, February 27). News Record #59294. Retrieved April 15, 2012, from NPIN:
Constance Schuster, RDH, BS, is the Member Outreach Coordinator for Scion Dental. She has clinical experience not only in general dentistry, but also orthodontics, pedodontics, prosthodontics, and periodontics. She studied Orofacial Myology is Los Angeles, Calif., and completed her internship in Pacific Palisades, Calif. Her passion for dentistry continues to grow through mentoring hygienists and networking with other dental professionals through ADHA membership and involvement with CareerFusion.Editorial Director’s Note: For more information on this topic, as well as face masks, sterilization pouches and environmental barriers, visit