Combating Cross-Contamination

The following information is part of an article by Mary A. Borg from Inside Dental Technology (July/ August 2013)

Mary A. Borg

July/August 2013 Issue

Inside Dental Technology

– Read the whole article at http://idt.cdeworld.com/courses/4695-Combating_Cross-Contamination#sthash.bW2XYRe3.dpuf

Infection control procedures are a necessity in any environment that deals with patient care.

Communication between the dental office and the dental laboratory regarding decontamination procedures is absolutely imperative, as it helps to minimize cross-contamination between the two facilities.

Use Warning Labels to Indicate Biological Hazards

Warning labels should be affixed to all containers of regulated waste. In a dental setting, this also includes impressions shipped to the dental laboratory.

Methods for Disinfection

There are a number of methods for disinfection explained by the CDC in Appendix C of the Guidelines for Infection Control in Dental Health-Care Settings-2003. The two methods most commonly used in dental laboratories are low-level disinfection and intermediate-level disinfection.

Low-level disinfection “destroys the majority of vegetative bacteria, certain fungi, and viruses. It does not inactivate Mycobacterium bovis, a bacterium that can cause tuberculosis in humans.”⁵ Liquid contact is the standard method of application. The CDC describes low-level disinfectants such as EPA-registered hospital disinfectants with no label claim regarding tuberculocidal activity such as quaternary ammonium compounds, some phenolics, and some iodophors. Low-level disinfection is used on countertops and other surfaces in the dental environment.

Intermediate-level disinfection “destroys vegetative bacteria and the majority of fungi and viruses and inactivates Mycobacterium bovis, although it is not necessarily capable of killing bacterial spores.” Liquid contact is the standard method of application and the CDC-provided examples are EPA-registered hospital disinfectants with label claims of tuberculocidal activity (eg, chlorine-containing products, quaternary ammonium compounds with alcohol, phenolics, iodophors, and EPA-registered chlorine-based products). Intermediate-level disinfection is the method most used for the disinfection of items that are received by the dental laboratory from the dental office.

Impressions and other items that have been in a patient’s mouth are to be considered potentially infectious. The CDC recommends: “When a laboratory case is sent off-site, dental health-care personnel (DHCP) should provide written information regarding the methods (eg, type of disinfectant and exposure time) used to clean and disinfect the material (e.g., impression, stone model, or appliance). Clinical materials that are not decontaminated are subject to OSHA and US Department of Transportation regulations regarding transportation and shipping of
infectious materials.”

Disinfection of Items Shipped to the Dental Laboratory

Disinfection procedures used in the clinical environment should include: (1) rinsing the item prior to disinfection; (2) using an appropriate disinfectant; (3) managing the timing of the disinfection process; (4) rinsing after disinfection; and (5) ensuring proper packaging of the item for delivery to the dental laboratory, including separation of the prescription from the items being shipped. The dental staff should also remove cotton rolls, retraction cords, and bioburden from impressions and implant components sent to the dental laboratory. Extracted teeth sent to the dental laboratory must be packaged and handled as biopsy specimens.

– Read the whole article at http://idt.cdeworld.com/courses/4695-Combating_Cross-Contamination#sthash.bW2XYRe3.dpuf

In order to protect patients, clinicians and staff, Alpine Dental Designs requires that all items sent to the laboratory must be disinfected.

Impressions

– rinse blood and saliva

– remove cotton and cord (without damaging the impression)

– disinfect

– again rinse to remove disinfectant

– dry and place in a plastic bag separate from the prescription

Bites

– rinse blood and saliva

– disinfect

– again rinse to remove disinfectant

Partials

– disinfect

– rinse

– place in mouthwash and send to the lab

Crowns and/or crown pieces

– disinfect

– place them in a sterilization pouch (not in our crown box)

Implant parts (that have been in the patient mouth)

– disinfect

– place them in a sterilization pouch (not in our crown box)

Casts

– most difficult to disinfect

– sprayed with an iodophor or chlorine product

– rinse and dry

All items being sent back to the lab, that have been in the patient’s mouth, must be disinfected. This includes crowns for contact add-on, impression copings, abutments, etc. Place them in a sterilization pouch (not in our crown box or back on the model) if placed on the model in office, then the model must be disinfected prior to returning to the lab. If in doubt, always disinfect.

Lets protect our patients and ourselves!