Recently I read that a dental office in Hamilton had several breaches in infection control and a media release was issued to notify their patients. The Infection Prevention and Control (IPAC) Lapse Report indicated that deficiencies such as improper record keeping, not labelling pouches appropriately, improper cleaning, not using chemical and biological indicators, and not having a one-way workflow in the reprocessing area. This is a good time to review the IPAC standards from your provincial/territorial regulator and public health to make sure you are providing a safe environment for your team and patients. Let’s look at some of these lapses and others in this top 10 list of what is being done wrong and how to correct it.
1. Not Using and Testing your Ultrasonic Cleaner or Automated Washer properly.
Remove gross debris before placing contaminated instruments in the ultrasonic cleaner. If using an automated washer, read the manufacturer’s instructions to see if instruments should be scrubbed or pre-soaked beforehand.
Ultrasonic cleaners and automated washers must not be overfilled with instruments and must be activated for the proper time as per the manufacturer’s instructions. Ultrasonic Cleaners must be tested at least weekly. Automated Washers must be tested each day they are used. Log the testing and maintenance of these equipment.
2. Overpacking and not Labelling Packages
Instruments must be packaged in pouches or cassettes in a single layer with hinged instruments being unlocked and open. Pouches and cassettes must be labeled with the date, sterilizer used, cycle or load number and the sterilizer’s initials. Wrapped cassettes must be labelled with the type of content as the instruments cannot be seen.
3. Not Using Biological and Chemical Indicators Properly.
A biological indicator test must be done for each sterilizer for each day it is used. The biological indicator must be placed in a process challenge device along with a class 5 or 6 chemical indicator in the centre of the package. This package must be placed in a location within the sterilizer which is deemed by the manufacturer as the most challenging location.
Each package must have an external indicator in addition to a class 4, 5 or 6 indicator inside each pouch or cassette. You can buy pouches that have both an internal class 4 indicator and an external indicator.
4. Not Documenting Properly
Document the daily use of each sterilizer and keep your sterilization logs for 10 years. Record physical indicators (time, temperature and pressure) of the sterilizer for each cycle/load. If your sterilizer has a recording device, the end of each cycle/load still needs to be checked to ensure physical parameters were met and this needs to be documented in the sterilization log. Record whether the biological indicator passed or failed and if the chemical indicators showed a colour change. Maintenance of your sterilization equipment must also be logged.
5. Sterilizing Implantable Devices the Same Way as Routine Loads
Extra precaution is required when sterilizing implantable devices (e.g. screws and implants). When implantable devices are being sterilized, a biological indicator (BI) must be placed inside a process challenge device in the same load. Implantable devices cannot be released for use until the BI test in the load they were in has passed. A flash cycle, sterilizing instruments unpackaged for a quicker cycle for immediate release, should never be used for implantable devices.
6. Sterilizing Single Use items
Single use items must be discarded after use. They cannot be sterilized and reused as their integrity may be affected. Read the manufacturer’s instructions to see which items can be sterilized and which ones are disposable. I was sad to read that my favourite polisher is single use only. I switched to a polishing bur that can be sterilized to decrease waste and expense.
7. Not following a One-way Flow in the Reprocessing Centre
There must be a one-way flow of instruments in the reprocessing centre from dirty to clean. There must be a physical distance or a wall or shield separating the dirty and clean sides. Don’t wrap and pouch your dirty instruments in the same area where you are taking out clean instruments. Also, make sure the sink in the reprocessing area doesn’t create splashes to the clean side.
8. Asking your patient to seal their lips around the saliva ejector
Closing on the saliva ejector creates a backflow of contaminants from the suction line into the patient’s mouth. This may bring up microorganisms in the suction line into patients’ mouths leading to cross contamination. To prevent backflow, don’t ask your patients to close their mouth on the saliva ejector. Another option is to purchase one-way valves to prevent backflow.
9. Not Following Manufacturer’s Instructions
Do you know how much you can load in your sterilizer? Make sure you read the instructions on how to load your sterilizer to ensure proper sterilization. Packages should be in a single layer and not touch the walls of the chamber. Some sterilizers want the plastic side of pouches up while others want the paper side up. Don’t overload your sterilizer like you do your dishwasher in your kitchen.
10. Not Wiping Properly
Do you know there is a minimum contact time the surface has to be wet from a disinfectant to be effective? Do you know that most wipes state that visibly soiled areas need to be wiped twice? Save time, money and the environment by using one-step cleaning & disinfectant wipes. These are the only wipes that successfully clean and remove blood proteins in one single application, and kill TB, bacteria and viruses in just one minute or less. You will help the environment and your costs by using half as many wipes. Look for VOC-free, no hazard symbols, and compatible with many surfaces.
Conclusion
Share this top 10 list with your team and do go through an IPAC checklist with them to see where your office can improve. Read the manufacturer’s instructions for your sterilizing equipment, materials and instruments. Make sure you have safety data sheets available for all your materials. Need help? Contact SciCan – your infection control specialist – who wants to help you provide dental care safely. Your SciCan representative who will make sure you provide the standards of infection control. That way, when your dental practice is in the news, it will be about how you are helping the community, not because of an IPAC lapse.
References
- RCDSO Standard – Infection Prevention and Control
Source link