Our office references several organizations to establish and maintain infection control and sterilization protocol. Since 1993, the American Dental Association (ADA) and Centers for Disease Control (CDC) have updated and supplemented their infection control recommendations to reflect new scientific knowledge and a growing understanding of the principles of infection control.
In addition to the ADA and CDC, the Occupational Safety and Health Administration (OSHA) and the Organization for Safety, Asepsis, and Prevention (OSAP) are included in our policy development. Each organization approaches the subject from a slightly different angle; however, the end goal is the same: a safe sterile environment for both patients and employees.
The first step after a cassette of used instruments leaves the room is to place it in the ultrasonic bath.
Mounted deep inside the ultrasonic tank are ultrasonic transducers. These are placed according to size and shape of the unit. These transducers create microscopic bubbles in the ultrasonic solution that is placed in the unit.
The act of cavitation is the rapid formation and collapse of millions of tiny bubbles in a liquid.
Alternating high and low pressure waves generated by the high frequency sound called ultrasonic produces the bubbles. During the low-pressure phase, they grow from microscopic size until during the high-pressure phase they are compressed and implode. This action removes debris from the recently used instruments.
Once air-dried, the cassette is ready to be wrapped for the next phase of sterilization: the Steam Autoclave.
Steam sterilization (autoclaving) is the most dependable and economical process. It is the most widely used method for wrapped and unwrapped critical and semi-critical items that are not heat and/or moisture sensitive. To kill microorganisms, steam sterilization requires exposure of each item to direct steam contact at a specified temperature and pressure for a defined period of time.
Less than 3% humidity produces what’s called dry or superheated steam. This steam increases sterilization time because it reduces energy transferability. Superheated steam lowers humidity to roughly 0%, transforming the autoclave to a dry-heat oven. The energy transfer is reduced, and what takes three minutes in an autoclave at 134°C takes two hours at 160°C and thirty minutes at 180°C!!
However, greater than 3% humidity generates saturated or wet steam, which requires higher sterilization pressure and temperature. Wet steam also extends the drying time at the end of the sterilization process. A dry load is required at the end of the process when the load is wrapped and not intended for immediate use.
Autoclave sterilization standards and directives permit some flexibility in steam humidity levels, since it’s almost impossible to supply perfect steam at a steady flow. Even if conditions are nearly optimal, many variables affect steam as it’s transferred to an autoclave.
Our autoclave is spore tested every week by an independent company that specializes in this process.
Super Sani-Wipes are effective against 30 microorganisms in 2 minutes including the following MDROs, blood borne pathogens and viruses: MRSA, VRE, HIV, HBV, HCV
They meet CDC, OSHA and CMS Tag F441 guidelines and are easy to use between each patient on practically all areas in the operatory and throughout the office.
Official Reports fron Third Party Spore Testing Agencies
Most tap and well water in the U.S. contain moderate to heavy levels of contamination from industrial and environmental pollution. All sources of water whether it be a lake, river, glacier or well, contain some level of contamination.
Contaminants range from naturally occurring minerals to man-made chemicals and byproducts. Water from surface water (river or lake) can be exposed to acid rain, storm water runoff, pesticide runoff and industrial waste. Water from groundwater (private wells or public water supplies), can be contaminated by disease-producing pathogens, leachate from landfills and septic systems, hazardous household products and agricultural chemicals.
The majorities of contaminant levels are not high enough to cause immediate sickness but are more likely to cause chronic health effects. This means effects that occur long after repeated exposure to small amounts of a contaminant.
Unwanted Substances in Our Water
Our Tuttnauer water distiller provides pure water that is 99% free of total dissolved solids and eliminates Cysts, Bacteria and Viruses. It purifies by steam distillation and carbon filtration.
This is an ideal way to further purify the water eliminating impurities that may slip through the main line filter.
As a back-up, commercially available distilled water may be purchased.
BluTab® is specially formulated to be continuously present in our dental waterlines and to keep lines clean.
Odorless and tasteless, each BluTab contains a low-level concentration of non-toxic ingredients that are safe enough for patient contact, bonding, and dental unit equipment.
BluTab remains effective for up to 28 days. Purging at the end of the day is not necessary.
BluTab has been proven to be one of the most effective waterline maintenance treatments available.
The ADA recommends testing and treating your lines to maintain a 500 CFU/mL level – the standard for drinking water : BluTab Maintains 10 CFU/mL or less.
BluTab is registered with the FDA and is one of the most effective and economical treatments on the market
Shock Treatments are used periodically to ensure the ongoing daily water treatments keep the water line biofilm content under control.
The Biofilm Problem:
The narrow diameter and extensive length of dental unit waterline tubing provides the ideal surface area for the growth and survival of bacterial biofilm.
In the early stages of contamination, the first microorganisms to colonize the surface of DUWL tubing adhere by using a weak bond that is relatively easy to break with conventional treatment. However, if these first layers of bacteria aren’t treated, they begin to build a sticky matrix that creates biofilm, or a protective “slime layer.”
This biofilm layer provides an ideal environment for new microorganisms passing through to anchor themselves to the microbial community attached to waterline walls. As layer upon layer of biofilm continues to build up on the walls, it decreases the size of the lumen, promoting water stagnation and increased CFU count within the biofilm community. When untreated, or improperly maintained, the water flowing through these contaminated DUWL’s and out through the air/water syringe, ultrasonic scaler or high-speed handpieces can carry floating pieces of microorganisms that have broken off from the biofilm in the waterline—carrying potential risk of exposure and cross-contamination.
The CDC recommends dental practices ensure the use of water that meets environmental protection agency regulatory standards for drinking water (≤500 colony forming units (CFU)/mL of heterotrophic water bacteria) for non-surgical dental treatment output water.
Both the CDC & ADA recommend regular testing as the only way to know water meets those requirements despite the best intentions of proper water treatment protocol.
ProEdge utilizes the Heterotrophic Plate Count (HPC) method found in Section 9215 in Standard Methods for the Examination of Water and Wastewater, 22nd Edition. The HPC is a procedure for estimating the number of live culturable heterotrophic bacteria in water.
Heterotrophs are broadly defined as microorganisms that require organic carbon for growth. They include bacteria, yeasts, and molds.
A Colony Forming Unit (CFU) is a single cell, pair, chain, or cluster of organisms.
Official Reports from Third Party Water Testing Agencies.
Purevac Evacuation System Cleaner -Super Concentrated, Non-Foaming, Biodegradable and Non-Toxic, Lemon Scented. Dissolves impression materials, bone fragments, organic tissue, rope-like saliva, and calcium deposits.
Daily use maintaines clean, safe suction lines in the office.
Copyright © 2020 Larry R. Goldstein, D.D.S., P.C. - All Rights Reserved.
Updated Regularly by E.M. @ Damesanddaces, Inc.