Volume 7 • 2020 • Issue 1

39 Issue 1 | 2020 | S upporting Y our P ractice • Lumens must be dried using oil free instrument grade air available as a portable unit (during renovation and new builds, consider permanent placement of an air line). Place a cloth over the distal end to capture excess moisture and microorganisms. • Instruments must be dry prior to packaging to avoid wetting the packaging thus compromising the package even before the package is sterilized. Tabletop sterilizers are designed to produce their own steam and consistent steam quality. If more water is introduced because instruments are not dry, the steam quality diminishes. Sterilization occurs when steam penetrates the packaging (paper only for peel pouches) and contacts every surface for the appropriate time; therefore, every surface must be dry so that the steam is able to contact the instrument. Step 6: Inspecting for cleanliness • Instruments are inspected to ensure they are visibly clean prior to sterilization. • Lumens are especially problematic and should be cleaned by hand, dried, and verified for cleanliness using a light. When using an ultrasonic unit, cleaning can be verified with a commercial test strip manufactured for this purpose. Surgical suctions with narrow lumens, or any other lumen that is too small to view with direct vision, should be checked with borescopes, instruments with a camera at the end of a rigid or flexible tube and connected electronically to a viewing screen to allow the user to visually assess its cleanliness. Alternatively, appropriate disposable sterile suctions could be considered. • Consideration should also be given to adequate lighting, especially with magnification for routine inspection as well as ergonomic consideration for staff fatigue during this process. Step 7: Checking for functionality • Assistance is required from many manufacturers of dental instruments for improving the functionality requirement, as it is frequently overlooked in oral health care MIFUs. • Lubrication is also performed at this step, another function where instructions are frequently missing from manufacturers’ instructions. • Comparing the instructions that a medical supply company provides for functionality of its surgical scissors 8 to some MIFUs in oral health care, improvements would be welcomed for the MIFUs currently supplied for dental devices. a References 1. KohnWG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for Infection Control in Dental Health-care Settings- 2003. MMWR December 19, 2003/Vol.52/No.RR-17; 1-76. Available at: cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm (accessed October 28, 2019) 2. Association for the Advancement of Medical Instrumentation, American National Standards Institute. Steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST46-2002 . Arlington,VA: Association for the Advancement of Medical Instrumentation, 2002. 3. Recommendations from the CDC’s Guidelines for Infection Control in Dental Health-Care Settings—2003. 2016. Available at: cdc.gov/oralhealth/infectioncontrol/pdf/recommendations- excerpt.pdf (accessed October 28, 2019) 4. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings . Public Health Agency of Canada. 2013. Available at: canada.ca/content/dam/phac-aspc/ documents/services/publications/diseases-conditions/routine-practices-precautions-healthcare- associated-infections/routine-practices-precautions-healthcare-associated-infections-2016-FINAL- eng.pdf (accessed October 28, 2019) 5. CSA Z314-18 Canadian medical device reprocessing and CSA Z8000-18 Canadian healthcare facilities. Available at CSA Group: store.csagroup.org 6. Guidance Document: Information to Be Provided by Manufacturers for the Reprocessing and Sterilization of Reusable Medical Devices. Health Canada. 2011. Available at: canada.ca/en/health- canada/services/drugs-health-products/medical-devices/application-information/guidance- documents/guidance-document-information-manufacturers-sterilization-reusable-medical-devices. html (accessed October 28, 2019) 7. Buying Medical Devices from the Internet. Health Canada. 2011. Available at: canada.ca/en/health- canada/services/healthy-living/your-health/medical-information/buying-medical-devices-over- internet.html (accessed October 28, 2019) 8. Healthmark Industries Company, Inc. Fraser, MI. ScissorTest Squares; Scissor SharpnessTest. Product Code Numbers LT-130, RT608,YT606. Available at: healthmark.info/InstrumentCare/RepairProducts/ Scissor_Test_IFU_2019-10-03.pdf (accessed October 28, 2019) Introducing CAMDR to Dentistry Being confident that your office is reprocessing, monitoring, and documenting your reprocessing adequately can be anxiety producing and challenging as there are so many changes to Provincial Standards for reprocessing – including the language (what happened to ‘sterilization’?!). The Canadian Association for Medical Device Reprocessing, CAMDR, is a non- profit organization made up of volunteers who share their passion for patient safety surrounding reprocessing practices. CAMDR was established in 2014 and welcomes engagement from hospital reprocessing as well as community reprocessing groups including dentistry. Go to camdr.ca to learn more about the many advantages of becoming a member of CAMDR. Details on the remaining steps required for proper medical device reprocessing (Packaging; Sterilization; Monitoring; Documentation [including traceability]; Storage; and Transport for Use) will appear in Part 2 of this article in CDA Essentials in 2020. Infection Prevention and Control at the Dental Office