Reprocessing Gaps

In September 2015, the Organization for Safety, Asepsis and Prevention (OSAP) – the organization dedicated to dental infection control and patient safety – introduced the Safest Dental Visit™, an initiative designed to promote an increased commitment to infection control and safety. Clinicians, educators, speakers and consultants, product manufacturers and distributors, and others are collaborating to help ensure that every patient visit is the safest one. In this month’s First Impressions, we feature high points of the CDC’s newly released summary of infection prevention practices. The CDC guidelines are the foundation of the Safest Dental Visit.

Reprocessing Gaps

As dental personnel reprocess items for reuse, compliance with relevant regulatory agencies is required. However, dental personnel may face “gaps” in regulations, instructions, and feasibility of reprocessing certain instruments and devices. Examples include the cleaning of items that are difficult to clean, and safe methods of removing dental materials from sharp instruments.

Two experts facilitated a discussion of such gaps – and how dental practices can bridge them – at this summer’s 2016 Annual Conference of the Organization for Safety, Asepsis and Prevention (OSAP), “Leading the Way to the Safest Dental Visit™.” They were Karen Daw, MBA, CECM, an authorized OSHA trainer and Clinic Health and Safety Director for The Ohio State University College of Dentistry; and Nina Mazurat, MSc, DDS, of the College of Dentistry, University of Manitoba.

First Impressions gathered comments from both following the OSAP conference.

“I first recognized there are problems with medical device reprocessing when I attended the Canadian Association of Medical Device Reprocessing in Winnipeg, October 2014,” said Mazurat. “At that time I recognized that although we are processing our instruments correctly and our patients are safe, we are not receiving enough information about medical device reprocessing and therefore we are not as sophisticated about this topic as we should be.”

Added Daw, “Gaps in instrument processing appeared on the radar because dental personnel have expressed difficulty with compliance with relevant regulatory agencies in this area.” Many device issues defy easy resolution, she said, including the reuse of some single-use devices, such as burs; infection control questions relative to multi-use dispensers; and disinfection of high-technology devices, such as digital impression wands and radiography sensors.

“What was interesting about this presentation [at the OSAP conference] is that participants included dental team members (assistants, hygienists and dentists), educators, consultants, manufacturers, healthcare administrators and military personnel, to name a few,” she said. “And they all had wonderful questions and comments. Apparently, ‘gaps’ are not unique to any one person, and the discussion was a unifying topic among these various stakeholders.”

Training

Changing and improving the dental practice’s approach to instrument processing starts at the beginning – the purchasing of dental instruments.

“When it comes to infection prevention and control, generally dentists step away and allow their staff to take over,” noted Mazurat. But when it comes to sterilization, they are keenly interested, which might explain the large number of dentists in attendance at the “Gaps” discussion.

“Partly this is because dentists are making the choices for purchasing items, and we are finding that we need a culture change when purchasing devices,” she continued. “The days of purchasing devices and then, almost as an afterthought, assuming that their processing can be achieved with a normal cycle, are over. Due to technology and increased sophistication of our devices, many are being sold from parts of the globe where the processing cycle is different than our tabletop sterilizers will allow. We are conflicted with either ignoring those instructions or not using the device. Dentists are becoming keenly aware of this concern.”

Better training is needed, said Mazurat.

“I don’t think that there has been any change in training for years,” she said. “There needs to be increased training, so that people who are processing know that manufacturer’s instructions have to be consulted for every device in the dental office.” Areas in which training is needed include:

• Quality assurance, whether using biological indicators or using process-challenging devices (PCDs).
• The impact of conditions in the processing area, such as humidity, temperature and negative pressure.
• Quality assurance in cleaning instruments and devices prior to reprocessing.
• Specific areas of concern, including sterilization of air/water syringe housing, suction housing and handpiece adaptor sterilization.”

Step it up

Oftentimes, dental assistants have responsibility for instrument processing, pointed out Daw. “[But] in some states, they are not required to take any type of formal training before being placed in charge of this very important responsibility. In essence, they were not being set up for success in this critical role. Dentists and hygienists also may have received minimal instruction in instrument processing, yet the doctors are the ones that end up on the 6 o’clock news when there is a breach in infection control in the practice.”

At The Ohio State University, all dental and dental hygiene students rotate through Central Sterilization, where they receive live and online instruction in instrument processing and relevant guidelines, Daw explained. The central sterilization department is staffed with dental assistants who have been certified through the International Association of Healthcare Central Service Materiel Management, or IAHCSMM.

“I remember attending Eve Cuny’s (University of the Pacific) fantastic OSAP presentation on this years ago, demonstrating there is a place for instrument processing education in schools,” Daw continued. “I think it is a matter of ‘You don’t know what you don’t know.’

“It would be great if instrument processing could be included in educational curriculum at all schools, and if the training could include discussion of FDA regulations, manufacturers [instructions for use] and best practices, for starters. Continuing education in this area would be beneficial as well. I feel, overall, the dental community is receptive and doing a fantastic job, and that organizations like OSAP assist by framing the narrative and facilitating ongoing discussion.”

Said Mazurat, “We have to become better educated. We need help from medicine, and we need to start using more certified sterilization technicians in our areas. Hopefully, this was just the beginning of a whole new area of learning in OSAP.”