INSTRUMENT
DECONTAMINATION
& the Miele
Dangerous little critters
• Blood-borne pathogens
• Other Potentially Infectious Materials (OPIM)
• Creutzfeldt-Jakob disease
Ewwww…there they are
Well, that’s better
IT’S THE LAW!
• Section 1005. Minimum Standards for Infection Control:
c) All licensees shall comply with and enforce the following
minimum precautions to minimize the transmission of pathogens
in health care settings:
1) Standard precautions shall be practiced in the care of all patients.
2) A written protocol shall be developed by the licensee for proper
instrument processing, operatory cleanliness, and management of
injuries.
3) A copy of this regulation shall be conspicuously posted in each
dental office.
9) Heat stable critical and semi-critical instruments shall be cleaned
and sterilized before use by using steam under pressure (autoclaving),
dry heat, or chemical vapor. FDA cleared chemical
sterilants/disinfectants shall be used for sterilization of heat-sensitive
critical items and for high-level disinfection of heat-sensitive semicritical items.
We don’t want no scrubs…or do we?
• Presoak solution
• Hand scrub
• Ultrasonic
• Washer (Miele)
• Presoak & ultrasonic
• Scrub & ultrasonic
• Presoak & washer
• Presoak, scrub & washer
“A quantitative assessment of residual protein levels
on dental instruments reprocessed by manual,
ultrasonic, and automated cleaning methods.”
Vassey, M, Budge, C, Poolman, T, et al.
3 methods
6 instruments
•Hand scrub
• sickle scalers
•Hand scrub + ultrasonic
• extraction forceps
•Washer
• diamond burs
• steel burs
• matrix bands
• matrix band holders
And the results are in:
• No single instrument prevailed
• No single method prevailed
• 72% instruments had residual protein
And the winner is…
• Presoak solution
• Hand scrub
• Ultrasonic
• Washer!!!
• Presoak & ultrasonic
• Scrub & ultrasonic
• Presoak & washer
• Presoak, scrub & washer
“Decontaminating dental instruments: testing the
effectiveness of selected methods”
Sanchez E, Macdonald G.
Procedures:
1. Dishwasher w/ water
2. Ultrasonic w/ water & rinsed
3. Presoak w/ 1oz cleanser & rinsed
4. Presoak w/ 4oz cleanser
5. Presoak w/ 4oz cleanser, an ultrasonic w/ detergent & rinse
6. Presoak w/ 4oz of cleanser, rinsed & dishwasher
7. Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser
Results:
And the winner is…
1. Dishwasher w/ water
2. Ultrasonic w/ water & rinsed
3. Presoak w/ 1oz cleanser & rinsed
4. Presoak w/ 4oz cleanser
5. Presoak w/ 4oz cleanser, an ultrasonic w/ detergent & rinse!!
6. Presoak w/ 4oz of cleanser, rinsed &
washer!!
7. Presoak w/ 4oz of cleanser & ultrasonic w/ 4oz of cleanser
“Influence of usage history, instrument complexity,
and different cleaning procedures on the cleanliness
of blood-contaminated dental surgical instruments”
Wu, G., Yu, X.
• Procedure 1: Dishwasher Alone (WD)
• Procedure 2: Presoak & Dishwasher (PS+WD)
• Procedure 3: Presoak, Hand Scrub & Dishwasher (PS+SH+WD)
Procedures 1, 2, 3
Instrument Complexity
Old & New Instruments
And the winner is…
• Presoak solution
• Hand scrub
• Ultrasonic
• Washer (Miele)
• Presoak & ultrasonic
• Scrub & ultrasonic
• Presoak & washer
• Presoak, scrub & washer!!!
“Cleaning endodontic files in a washer disinfector”
Assaf, M, Mellor, AC, Qualtrough, AJE.
CASSETTES
VS.
MESH BASKETS
IN A WASHER
See the difference?
The top is funky
And the winner is…
•Cassettes
•Mesh baskets!!!
And now…
Group 2 Productions
Presents
Soaks, Scrubs, Ultrasonics, or Washers?
1. Safety
Soaks, Scrubs, Ultrasonics, or Washers?
1. Safety
2. Effectiveness
Soaks, Scrubs, Ultrasonics, or Washers?
1. Safety
2. Effectiveness
3. Time
Soaks, Scrubs, Ultrasonics, or Washers?
1. Safety
2. Effectiveness
3. Time
4. Cost
Fin.
References
• Assaf, M, Mellor, AC, Qualtrough, AJE. Cleaning endodontic files in a washer
disinfector. British Dental Journal 2008; 204: E17
• Sanchez E, Macdonald G. Decontaminating dental instruments: testing the
effectiveness of selected methods. JADA. 1995 [cited 2012 Nov 4]; 126(3): 359-362
• Vassey, M, Budge, C, Poolman, T, et al. A quantitative assessment of residual
protein levels on dental instruments reprocessed by manual, ultrasonic and
automated cleaning methods. Br Dent J. 2011; 210(9): E14.
• Wu, G, Yu, X. Influence of usage history, instrument complexity, and different
cleaning procedures on the cleanliness of blood-contaminated dental surgical
instruments. Infect Control Hosp Epidemiol 2009; 30: 702-704.
• http://www.cdc.gov/hicpac/disinfection_sterilization/3_4surfacedisinfection.html
• http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf