by Noel Kelsch, RDHAP
While rummaging through a sewing box filled with buttons, bows, and zippers, I finally found it! A tiny pink sock with blue grosgrain ribbon crocheted on the edge. The sock had been missing for almost 25 years! It was supposed to be on my daughter’s foot, making a matching pair for her first day of kindergarten. Socks have always driven me crazy. I am sure there is some mystical force at the back of the dryer that sucks socks into a black hole in space.
Dental instruments have been a lot like socks for me. I send them to the sterilization room and sometimes they end up in that same black hole in space.
I always wondered if there were a better way. There is. Instrument cassettes are a simple, cost-effective solution. They are designed to hold instruments securely during cleaning, sterilization, and storage, thereby minimizing the dulling, breaking, and warping of instruments. The cassettes eliminate the need to search for that lost instrument, and they save hours of time, production, and frustration. They can help simplify organization and setup for specific procedures. Cassettes also help stop overloading the sterilizers with contaminated instruments, which can affect the sterilization efficacy.
More importantly, they help prevent sharps injuries.
An instrument cassette limits exposure to pathogens by restricting the handling of the instruments. Scrubbing instruments by hand creates possible exposure to sharps injuries, aerosols, and pathogens. Scrubbing should be replaced by using the ultrasonic bath with instruments securely divided in cassettes. A 10-year study conducted by the New York University College of Dentistry revealed that 41% of sharps injuries occurred during instrument cleanup. A cassette can limit the exposure to both sharps and aerosols.
The Centers for Disease Control and Prevention guidelines remind us that contaminated instruments “should be placed in an appropriate container at the point of use as soon as the procedure is complete.”
Instruments must be transported to and from the operatory in a rigid, leak-proof container.
What do you need to look for in a cassette?
- Hole pattern: Cassettes need to have an efficient hole pattern that allows steam and chemicals inside during the sterilization cycle, as well as allowing the ultrasonic waves from the ultrasonic unit to reach the instruments. They should not allow the instruments to protrude outside the cassette.
- Fit: Cassettes need to fit in both the sterilizer and the ultrasonic bath, limiting exposure to pathogens.
- Materials: A variety of materials are available, ranging from metal to plastic. Make sure the material that you choose matches the type of sterilizer you are using. Some units cannot go into chemical-based sterilizers.
- Hinge: It is important to open and close the hinge in a way that ensures complete closure of the cassette. Some plastic cassettes have a history of the hinge breaking.
- Latch: Keeping the cassette closed between usage is very important. Make sure the latch works properly and is easy to engage and open.
- Identification tabs and assorted colors: Having an identification system for the units will make sorting for task very easy.
I finally solved my sock dilemma many years ago by offering my children five cents for each found sock and hosting weekly “sock fests” where the entire family divided and conquered. The sterilization area can achieve the same results simply by utilizing cassettes and involving the entire staff in the process.
Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety and Asepsis Procedures and has received many national awards and owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists’ Association, on the board of directors for the Simi Valley Free Clinic.