Volume 7 • 2020 • Issue 1

38 | 2020 | Issue 1 S upporting Y our P ractice members are different and use of PPE for this purpose will reflect these differences. • Consideration must be given to space for disinfection and storage of transport containers. Step 3: Preparation and disassembly for cleaning • Instruments that cannot be cleaned immediately need to remain moist. It is preferable to treat with an enzymatic cleaner (check with compatibility from the manufacturer) and remain in the covered transport container to prevent drying of soil. Avoid immersing instruments in water for extended periods of time as this results in instrument corrosion. Saline and blood should be removed as soon as possible to prevent damage to instruments. • Many mirrors, composite guns, manual dental implant torque wrenches, and other instruments and devices require disassembly according to MIFUs. • Hinged instruments are opened for cleaning and must remain in the open position until reprocessing has been completed. Step 4: Cleaning, including rinsing • Instruments and devices must be visibly clean prior to being sterilized. • Instruments or devices that are especially difficult to clean should be considered disposable or single use. Cleaning verification tools (chemicals) specific for protein, blood, or adenosine triphosphate (ATP) are available and should be used. Manual cleaning • Follow MIFUs for manual cleaning including use of appropriate brushes purchased for this explicit purpose, correct water temperature, specific detergents, and adequate rinsing (water is often specified for rinsing). If these instructions have not been provided when the instruments were purchased, contact the manufacturer (especially prior to purchase to prevent surprises). Automated cleaning using ultrasonic cleaning units • Follow MIFUs for cleaning with ultrasonic cleaning units. Attention is required to the use of recommended ultrasonic cleaning solution, correct water temperature, degassing the fresh solution, and placement allowing all instrument surfaces to be exposed to the cavitation process. Cavitation is a process whereby the bubbles implode causing a vacuum that results in soil removal. • Note that dental ultrasonic units tend to be purchased too small for office requirements potentially resulting in inadequate cleaning. Excess soil must be removed by rinsing from instruments prior to placement in an ultrasonic cleaner to maintain efficacy of the cavitation process. Ultrasonic units need to be checked for performance using a commercial test or a foil test at least weekly, preferably each day that they are used. • A foil test is performed in an ultrasonic unit when the ultrasonic solution is clean, filling the ultrasonic unit as required by MIFUs, and then degassing for at least 10 minutes. The test foil is made using 10–25 μm thickness aluminum foil, cut slightly shorter than the length of the ultrasonic unit and slightly longer than the depth of the pan to allow it to be attached to a dowel while ensuring that it does not touch the bottom of the ultrasonic unit. Place the foil into the ultrasonic unit so that the dowel rests on the edges, run the ultrasonic unit for a minute, remove it, allow it to dry, and then check for a consistent pattern of perforations. • Fresh ultrasonic solution should be used at least daily or when visibly soiled. The pan is cleaned and dried before placement of new solution. Instruments must be rinsed well following removal from the ultrasonic unit. • Stainless steel instruments should not be cleaned at the same time as instruments made from other metals (copper, aluminum, brass) as this will result in corrosion of instruments and noticeable changes in color. • Instruments and devices made from rubber, chrome, chrome-plated, plastic, wood, glass, or cork should not be cleaned in an ultrasonic unit. Automated cleaning using washers and washer/ disinfectors • When using washers or washer/disinfectors, use correct water, water temperature, enzymes, and detergents as recommended, load as directed, and test using a commercial soil test daily. These machines require cleaning and a schedule of cleaning following MIFUs noted in the office infection control manual as well as documentation of cleaning maintained (according to PDA requirements). Step 5: Drying • In order to inspect for cleanliness and functionality, instruments must be dry. Purchase low linting materials manufactured for health care for this purpose. Lint must be avoided to prevent clogging sterilizers and more importantly, to prevent health care acquired infections during surgical procedures where lint could act as a foci of infection. • Do not air dry. • Do not use fans for drying instruments as this adds to the bioburden in the air especially since most dental offices do not have the recommended HVAC systems to support the required 10 air exchanges/hour. Infection Prevention and Control at the Dental Office