THERE REALLY ARE NO SECRET WEAPONS, BUT THIS COMES PRETTY CLOSE: EVERY DAY INFECTION PREVENTION, BUT NOT AN EVERYDAY SOLUTION

By Dr. John A. Molinari, PhD

As the COVID-19 pandemic continues to spread throughout the global community, it may be difficult for many of you reading this to think about your infection control precautions before dental facilities were recently closed or severely limited only to emergency treatment. As governmental health projections indicate, this crisis could worsen throughout the coming months, and it is incumbent upon medical and dental professionals to maintain the highest infection prevention standards possible when treating all patients.

In addition, as real and perceived concerns mount about infection risks and safety of healthcare workers in general, some people are becoming more fearful of going into hospitals. Could this also extend to patients reentering dental offices when restrictions are ultimately removed? As you plan for the future, additional efforts could include looking for ways that may perceptibly augment what you have already accomplished. One approach is to explore and select product technologies that can visibly benefit a practice’s infection control program, protecting dental professionals and patients alike.

An example here is to consider the integration of instrument cassettes, like the Instrument Management System (IMS), into the practice infection control program. The introduction of perforated cassettes into dental schools and clinics in the 1980s signaled a major shift from earlier instrument cleaning practices. Previously, cleaning often included debris removal by hand scrubbing with a brush. As dental, dental hygiene, and dental assisting schools gained more experience with cassettes, an increasing number of graduates and established practitioners alike gradually began to utilize this technology. Many of you have been using cassettes of multiple sizes for years. Their presence in clinical settings continues to expand to the place where they are currently found in most dental academic programs and a rapidly increasing number of practices.

If you previously incorporated cassettes into the practice routine, most likely you have already experienced benefits both in instrument reprocessing efficiency and safety to individuals in the practice. The following summarizes features and documented advantages of a cassette system, which may assist in planning.

Advantages of an Instrument Cassette

• Improved safety: reduces risk of injury and exposure to microbial pathogens, by lessening handling of contaminated instruments during processing for re-use, providing safer transportation of soiled instruments to reprocessing area, and eliminating hand scrubbing.
• Improved organization: sharps injuries can be reduced as instruments are more organized during treatment when reaching for them.
• Time savings: eliminates the need to gather multiple packages for a procedure; one cassette can be used to hold and organize a complete set of instruments for a specific procedure from use on a patient through cleaning, rinsing, drying, packaging, sterilization, and storage.
• Decreased contamination potential: help to maintain instrument sterility during storage as instruments are secured safely inside the wrapped or pouched cassette and allow for aseptic, organized presentation of instruments to patients.
• Increased instrument longevity: can decrease the need to replace instruments that become damaged or misplaced.
• Streamlined Workflow: can decrease the need for repackaging and re-sterilizing instruments from torn paper/plastic wraps.

Adapted from: Molinari JA, Harte JA, Nelson P. Instrument cassettes: an effective infection control precaution. Inside Dent. August 2013, 51-60, and; Molinari JA, Nelson P. Instrument cassettes: effective and safe. Translating the Science. The Dental Advisor (March 2015) 

In 2000, the Needlestick Safety and Prevention Act was passed as a revision of the OSHA bloodborne pathogens standard. In part, this law requires healthcare facilities to use engineering and work practice controls designed to eliminate or minimize accidental employee exposures. When the features listed above are taken together, the case can be made that instrument cassettes represent an effective combination of engineering and work practice controls.

As an engineering control, they are technology-based and can reduce the potential for sharps injuries chairside when a person reaches for instruments during a procedure. Also, contaminated instruments in cassettes require less handling during cleaning and sterilization, further reducing sharps injuries. Work practice controls include behavior-based practices that are incorporated to reduce the likelihood of accidental exposure by altering the manner in which a task is performed. These controls include using a one-handed scoop needle recapping technique or a needle recapping device. This work control is addressed by having a built-in needle-recapping device inside a cassette to assist with the one-handed techniques.

While instrument cassettes are not required for dental practices, they do provide yet another example of your ongoing commitment to providing patient care in a safe and efficient setting. While no one can predict as yet when the current coronavirus pandemic will slow or end, all health professionals need to continue to do what they can to provide safe care and allay the public’s concerns about healthcare facilities. Improved infection control measures in dental settings over the last few decades have resulted in well-documented safety for treatment providers and patients alike. Addition and integration of cassettes into today’s modern dental practice can add to this accomplishment by providing both a highly visible and effective infection prevention component.

ABOUT JOHN A. MOLINARI

Dr. Molinari earned a PhD in Microbiology from the University of Pittsburgh and subsequently worked as a faculty member in the School of Dental Medicine. He is currently Professor Emeritus at the University of Detroit Mercy, where he served for 32 years in the School of Dentistry as Professor and Chairman of the Department of Biomedical Sciences and Director of Infection Control. Later, he was Infection Control Director for DENTAL ADVISOR where he was involved in research on newly developed infection prevention technologies and products. He has published over 500 scientific articles, text chapters, and abstracts in the areas of microbiology and immunology, and lectures nationally and internationally on topics dealing with infectious diseases and infection control. He has also been a consultant for the CDC, ADA, and regional hospitals.