By Mary Govoni, CDA, RDA, RDH, MBA
In the nearly 20 years since instrument cassettes were introduced in dentistry, they remain one of the most effective safety and efficiency tools for dental practices. Investing in an instrument management system can significantly streamline not only instrument cleaning and sterilization, but also setup and breakdown of treatment rooms and delivery of services. Organization is a key factor in the efficient operation of any business. The nature of dentistry, with all the instruments and materials necessary for patient care, requires the high level of organization that instrument cassettes provide.
Implementation of an instrument management system begins with planning, which is critical in determining which instruments are needed and what sizes of cassettes are required to accommodate them. I recommend listing all the procedures that are provided in the practice, both for the doctor(s) and hygienist(s). For each procedure, list the instruments required. When all the lists are completed, cross-reference them to determine what instruments are common to all procedures; e.g., mirror, explorer, a pair of cotton pliers.
Then design the instrument setup for the most common procedures, such as composite and/or amalgam restorations, crown and bridge, scaling and root planing, etc. With the exception of endo and oral surgery procedures, I recommend that the doctor’s cassettes be standardized to include all instruments required for the most common procedures. This will require more instruments in each cassette, but it will save on the number of different types of cassettes needed. This ensures that the necessary instruments will always be where they are needed — at the clinician’s fingertips. Each clinician has different preferences, however, and may want cassettes specific to each procedure.
Once the cassettes and setups are determined, the next step is to decide how the instruments will be cleaned. The options include ultrasonic cleaners and dental instrument washers. The size of the practice and the size of the cassettes to be placed in the cleaner/washer will be determining factors. Other factors include cleaning cycle time, space requirements, and the volume of instruments that need to be processed daily. One important point to note is that even if a dental instrument washer is used, a small ultrasonic should also be used for those instruments that are not suitable for cleaning in a dental instrument washer (i.e., burs, mixed metals, carbon steel instruments, etc.).
There are similar considerations for sterilization of instruments in cassettes. The sterilizer must be large enough to accommodate the size of the cassettes and a sufficient number of cassettes in a load, so as to decrease the time needed to reprocess the instruments. Manufacturers of both cassettes and sterilizers are very helpful in facilitating this step. In fact, many offices may already be using the required sterilization equipment, because it allows for a larger volume of instruments to be processed at once, saving time.
A common question I am asked about cassettes is whether they need to be packaged for sterilization. The answer is yes. According to the Centers for Disease Control and Prevention (CDC), all instruments must be packaged prior to sterilization if the instruments are not used immediately after being removed from the sterilizer. The cassettes can be wrapped with special CSR wrap, or they can be placed in pouches. This is a preference issue. Both options are effective in maintaining sterility of the instruments in storage, provided that the wrap or pouch is not torn or compromised in any way.
When cassettes are used, setting up and breaking down the treatment room is very efficient. The assistant or hygienist simply needs to retrieve the appropriate cassette that contains the instruments necessary for the procedure. Along with the instrument cassettes, I also recommend using procedure tubs to organize any additional disposable items and materials. The tubs should be organized according to procedures and may be duplicated in each treatment room or stored in central sterilization. This significantly decreases setup time, since the assistant or hygienist doesn’t need to gather the needed supplies from separate containers or drawers each time. In its simplest form, setup requires a cassette and a tub.
At the end of the procedure, the instruments are placed back in the slots in the cassette, which is closed for transport to the sterilization area. Once in the sterilization area, the entire cassette is placed in the instrument cleaner. There is no need to handle individual instruments, which is time-consuming and increases the risk of injury to the clinician.
Studies have shown that one of the most common work-related injuries to dental team members is puncture to the hands while processing contaminated instruments. The reason is twofold: Most dental team members do not comply with the OSHA requirement for wearing puncture-resistant utility gloves when handling contaminated instruments. If the instruments are loose (not in a cassette or container) the sharp, contaminated ends are exposed while the instruments are being handled. Placing instruments in cassettes prevents exposure to the sharp, contaminated ends of the instruments, which helps avoid percutaneous injuries.
Yet another advantage of using instrument cassettes is that protecting the working ends of the instruments during cleaning can prolong their life. Since the instruments are held in slots in the cassettes, they don’t bump into other instruments or items in the ultrasonic cleaner. This preserves any special coatings and maintains the cutting edges longer.
Instrument management can be disorganized and labor-intensive. On the other hand, it can be efficient, safe, and economical for dental practices. The key differences are good planning and the use of instrument cassettes.
Author bio
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety and Asepsis Procedures and is a regular contributor to Dental Assisting Digest™. She can be contacted at [email protected].
