Best Practices in Infection Control

By Dr. John Molinari and Peri Nelson

Q: Our office recently began using cassettes and it was recommended we purchase an instrument washer/disinfector. Is this really necessary? What is the advantage of using this? Seems like a very expensive dishwasher.

A: Cassettes provide a very useful infection control innovation. Routine use of cassettes minimizes handling of contaminated instruments, allows for safer transport of instruments to the reprocessing center, and can organize instruments into specific procedure set-ups. It is not necessary to purchase an instrument washer for cleaning instruments in a cassette. However the capacity of these units is typically far greater than that found for ultrasonic. In addition, another positive feature of an instrument washer is that freshly cycled water is used for each load. Instrument Washer/Disinfectors are much more than an expensive dishwasher; they are FDA approved for healthcare settings.


Q: We need to replace some of our cassettes due to wear and tear on the hinges. Do you have any suggestions for newer cassettes that have a better design for durability? Are we caring for them properly?

A: One of the first things to consider about cassettes wearing is the quality of solution you are using to clean. Many manufacturers of ultrasonic cleaners recommend distilled water for ultrasonic cleaning solutions. Tap water can have varying concentration of metals which may affect the integrity of your cassette. In addition, it is possible that too many instruments are being placed in the cassettes which stresses the hinges that keep the cassettes closed. There are newer generations of cassettes which are available, specifically the Hu-Friedy Infinity Series. They have large vented surface areas to maximize instrument cleaning, rinsing, and draining during instrument processing. Other good examples of cassettes designs include those manufactured by SciCan.


Q: Our waterlines seem to be clogging much more than usual. What is the proper maintenance protocol to be sure we don’t have clogged lines during patient care? Is there something we should be checking daily or weekly?

A: Water quality is a big issue in dentistry. What is most likely clogging your waterline system is the accumulation of biofilm. A major problem is not following the instructions-for-use and maintenance of the water treatment system. Some systems require periodic shocking of the waterlines, while others require specific source water. Our advice is that you have a complete understanding of your treatment process and equipment used in your office.


Q: Recently, our autoclave has left bags with burn marks and in those areas, the instruments are rusted inside the bag. What are we doing wrong?

A: A couple of things could be happening here. One, your instrument pouches may be touching the walls of the autoclave chamber which can cause burn marks on the outside. Pouches should not touch the walls of the chamber. Two, another thing to consider is that the autoclave chambers need to be cleaned periodically with specific cleaners to remove debris and organic material. If this is not done, the water being used to sterilize instruments can stain the paper/plastic pouches more readily.




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