Volume 7 • 2020 • Issue 4

more packages have not passed or when the BI has not passed. By transferring the label information (sterilizer #, load #, date) accurately to the patient chart, it is then possible to link the instruments used to records of BI testing. There are now commercial companies that have developed affordable and efficient traceabililty and documentation record keeping tools for offices that save time and provide peace of mind. Step 12: Storage •  Offices need to determine if they will use event or date related storage or shelf life. Event related means that the package remains usable until such time that it is compromised. The length of time for date related storage is determined by office policy. However, if a sterile package is compromised, the contents will have to be reprocessed as if it were contaminated during patient use. •  Rotate items on a first in, first out basis (FIFO). •  Storage in corrugated cardboard is not permitted as it is not clean and cannot be made clean. This also applies to all supplies associated with a reprocessing area. •  Sterile storage areas need to be protected from dust, moisture, insects, and temperature and humidity extremes. Sterile packages should be protected from contaminated items via barriers or distance. If they must be stored in the reprocessing area, they should be kept in the clean area and in enclosed cabinetry. Step 13: Transport for use •  Following transport from the storage area to the operatory, packages should be inspected to assure they have not been compromised prior to opening in the presence of the patient (i.e. aseptic presentation). •  Packages of sterile instruments and devices should be placed in the area of the operatory that will be considered the “contaminated area” (i.e. not used during active patient care). All surface areas in a dental operatory should be decontaminated and clean prior to setting up the operatory for patient care. •  The outer surface of sterile instrument packaging is no longer sterile after it is removed from the sterilizer and comes into contact with unsterile surfaces/items. Therefore, gloved hands that will come into contact with a patient’s intraoral tissues should not come into contact with the outside of the package. Packages are opened with bare hands before handwashing, being careful not to touch the sterile contents of the package. Operators should then continue preparation for patient care and once ready, after donning personal protective equipment (PPE, including hand hygiene just prior to placement of gloves) then the instruments are removed from the package being careful to avoid touching the outside of the package by slipping the gloved hand into the open package to remove the instruments which are then placed on the working area. Finally, the gloved hand is slipped into the opened package to discard the package, again without touching the outside of the package. Why All the Steps of Medical Device Reprocessing Must be Followed Health care acquired infections can occur due to lack of compliance from health care workers, either due to lack of knowledge or failure to follow known best practices. Frequently the argument is made that dental offices are not hospital operating rooms, especially since the mouth is a contaminated area. However, patients expect and assume that instruments and devices that are used during their dental treatment have been prepared with the same care and to the same standard as in hospital settings. Seeking assistance from knowledgeable experts, attending relevant courses, and following guidelines will help ensure that best practices for medical device reprocessing (all steps before and after the Sterilization step) are consistently and correctly implemented to keep all patients and the dental team safe. References 1. KohnWG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for Infection Control inDental Health-care Settings- 2003. MMWR December 19, 2003/Vol.52/No.RR-17; 1-76. Available at: cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm (accessedOctober 28, 2019) 2. Association for the Advancement of Medical Instrumentation, AmericanNational 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. Winter S, Smith A, LappinD, McDonaghG, Kirk B. Failure of non-vacuum steam sterilization processes for dental handpieces. J Hosp Infect 2017 Dec;97(4):343-47. 4. CSAZ314-18. Canadianmedical device reprocessing. Available at: scc.ca/en/standardsdb/standards/29301 Infection Prevention and Control at the Dental Office S upporting Y our P ractice 29 Issue 4 | 2020 |