Single-use items are designated to be just that—single use. While using them more than once after running them through a sterilization process may be tempting, there’s a big reason why that shouldn’t happen: it is a violation of the manufacturer’s instructions for use.
Single-use tools and items can indeed appear to be wasteful and costly for the dental practice. However, the money- and waste-saving capabilities of using these items after processing and sterilization do not outweigh the severe risk of infection that can come if even a tiny number of bacteria manage to make it through the sterilization process.
There are specific guidelines set out for the proper use of single-use items. The issue is, not everyone is following these guidelines. When using single-use items more than once, dental professionals run the risk of having basic infection prevention procedures break down.
In some cases, more frequent training may be necessary to ensure that all dental professionals are hyperaware of the instructions for each single-use item and understand just how vital following these instructions is for infection control and prevention.
Why is infection prevention so important?
If you are in the dental industry, you have undoubtedly been made aware of the risk of infection that even the simplest dental procedures can bring. Because of this, you and other dental professionals have made all the right moves to ensure that the transmission of infectious agents in a practice is a rarity.
Yes, the spread of infection is rare, but it is not impossible. According to a Centers for Disease Control and Prevention (CDC) report, the transmission of infection in dental settings still occurs.1 In most cases, it is hard to pinpoint precisely how infection spreads. This must mean that somewhere along the line, mistakes are still happening.
Infection control is crucial to help protect patients while they are receiving treatment in the dental office. In some cases, infection control can be a life-or-death situation. Research has shown that although it is rare, insufficient care and protection can lead to infection, which can directly cause a patient’s death.2
Further studies show that knowledge about preventing cross-transmission and cross-infection may still be insufficient.3 Putting safety at the core of a practice’s protocol to reduce the risk to patients or dental professionals’ lives is why infection control should be a top priority.
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Why you should not use single-use items twice
Single-use devices are to be used on one patient only. The equipment is no longer viable after removal from its packaging and usage on a patient. Single-use devices are not designed to be cleaned or sterilized, and, thus, using them to reduce waste or costs should not even be considered. Some of the most common single-use items—such as dental burs, gauze, syringe needles, scalpel blades, saliva injectors, and high-volume evacuation tips—are clearly outlined to be used one time only. However, some items may not state on the packaging that they are single use only but should be considered disposable if there are no reprocessing instructions.4 If you are unsure, call the manufacturer!
These items need to be disposed of after a single use because they are not made to withstand the heat or cleaning products typically used for sterilization in a dental setting. The integrity of the devices will not hold up after the first use, meaning that even if they are still semiusable, they are not as effective as they should be.
The dental burs debate
Dental burs have been a topic of discussion in the infection control arena for many years, and they have become a hot subject in recent times. Many dental professionals believe they can reuse burs, while others are adamant that they are single-use disposables. Disposing of burs after only one use is the right way to go when taking infection control seriously.
The risk for cross-infection between patients is much higher when using dental burs on more than one person. They are also time-consuming to clean and sterilize, so in effect, sterilizing and reusing burs leads to higher costs than just using a new one. Ensuring a fresh, disposable bur is used also reduces the risk of facing a lawsuit or damage to the dental practice’s reputation resulting from cross-contamination.
One revelation surrounding dental burs is that these tools may still have bacteria living on them even after reprocessing. Since infection control relies heavily on the complete eradication of bioburden between uses, dental burs should always fall into the category of single-use disposables. Research has found that as many as 5% of all sterilized dental burs contain bacterial contaminants even after the cleaning process is complete.5
Not only does using burs more than once put patients at risk, but it can also expose employees to unnecessary risk. When employees hand-clean these tools before sterilization, there is an increased risk of an accident. If any type of infectious bacteria manages to get into their bodies because of this hand-cleaning process, they, too, are at risk for contracting an infectious agent simply by doing their job.
Instructions for use need to be followed
The instructions provided for the safe use of single-use items are not suggestions, nor are they there to help the manufacturing companies sell more products. They are there because infection control must be a top priority when it comes to dentistry.
The U.S. Food and Drug Administration’s (FDA) guideline document, known as “Labeling Recommendations for Single-Use Devices Reprocessed by Third Parties and Hospitals: Final Guidance for Industry and FDA,” provides clear instructions on this.6 It guides dental and other medical professionals on using tools properly in accordance with best practices for infection control and general safety.
The CDC also has written guidelines to ensure that the basics of infection control are met at all times in dental practices.1 There is no excuse to ignore these guidelines and risk infection in a dental practice.
Dental professionals are obliged to follow the instructions on single-use items. That obligation is to both their patients as well as their staff. Infection control is something that everyone in the dental industry needs to take seriously, and when single-use items are repurposed to help keep waste down or save money, the corner-cutting does not pay off in the end. Protect your patients, team, and practice by following the instructions on single-use items.
- Summary of infection prevention practices in dental settings: basic expectations for safe care. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. October 2016. Accessed August 30, 2021. https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf
- Reuter NG, Westgate PM, Ingram M, Miller CS. Death related to dental treatment: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(2):194-204.e10. doi:10.1016/j.oooo.2016.10.015
- Volgenant CMC, de Soet JJ. Cross-transmission in the dental office: does this make you ill? Curr Oral Health Rep. 2018;5(4):221-228. doi:10.1007/s40496-018-0201-3
- Single-use (disposable) devices. Centers for Disease Control and Prevention. Division of Oral Health. National Center for Chronic Disease Prevention and Health Promotion. Updated June 29, 2021. Accessed August 30, 2021. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/single-use-devices.html
- Al-Jandan BA, Ahmed MG, Al-Khalifa KS, Farooq I. Should surgical burs be used as single-use devices to avoid cross infection? A case-control study. Med Princ Pract. 2016;25(2):159-162. doi:10.1159/000442166
- Labeling recommendations for single-use devices reprocessed by third parties and hospitals. U.S. Food and Drug Administration. July 2001. Updated February 2, 2018. Accessed August 30, 2021. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/labeling-recommendations-single-use-devices-reprocessed-third-parties-and-hospitals
Editor's note: This article appeared in the November 2021 print edition of RDH.
Michelle Strange, MSDH, RDH, brings over 20 years of experience to her numerous roles in dentistry. A graduate of the Medical University of South Carolina with a bachelor’s of health science and the University of Bridgeport with a master’s in dental hygiene education, she is focused on expanding the knowledge of her colleagues in all aspects of health care. Strange’s passion for dentistry and its connection to overall health extends to her community and global efforts. Currently, she is the cofounder and cohost of the longest-running podcast for dental hygienists, A Tale of Two Hygienists, the cofounder of Level Up Infection Prevention and TriviaDent, a practicing dental hygienist, and client success manager for MouthWatch.