Adding 'wow' to safety: Federal health advisory recommends review of infection control practices

Dec. 24, 2015
One aspect involves regulatory compliance. Compliance includes adherence to the Bloodborne Pathogens Standard published by the Occupational Safety and Health Administration (OSHA), combined with the latest infection control guidelines published by the Centers for Disease Control (CDC).

Comply with regulations, and promote a safe dental team

By Olivia Wann, RDA, JD

One aspect involves regulatory compliance. Compliance includes adherence to the Bloodborne Pathogens Standard published by the Occupational Safety and Health Administration (OSHA), combined with the latest infection control guidelines published by the Centers for Disease Control (CDC).

As I travel throughout the country conducting assessments, I find it interesting to compare safety and flow in offices that use an instrument management system versus those that use traditional trays.

The problems I identify in practices not using the cassette system are:

• Wasted time

• Potential for injuries and cross-contamination

• Not eliciting the "wow" perception from patients.

Picture this: A dental assistant or hygienist, wearing contaminated exam gloves, walks a tray of contaminated instruments into the sterilization area, grabs the dirty instruments, and dumps them into the ultrasonic tank. Then, while wearing the same contaminated gloves, he or she grabs a disinfectant wipe, wipes the tray, and immediately places the tray on the "clean" side of the sterilization center. What's wrong with this picture?

Let's identify key issues:

Safety: Loose, contaminated instruments place the assistant and hygienist at risk for an injury. Never be deceived into thinking that your dental practice is immune to sharps injuries. As a matter of fact, years ago, the American Dental Association (ADA) revealed that accidental exposures to blood and body fluids did occur while cleaning instruments.1

Note that the auxiliary involved in this incident was wearing patient exam gloves to handle the loose, contaminated instruments. According to the CDC, heavy-duty puncture- and chemical-resistant utility gloves should be worn for the instrument cleaning and decontamination process.2

Cross-contamination: Dirty gloves were used to apply the disinfectant wipe. Oftentimes, the auxiliary fails to apply the two-step process of precleaning the surface prior to application of the hospital-level disinfection.

Time: Sorting instruments into procedural setups is time-consuming. Time is valuable and better spent serving the patient directly while adhering to exceptional infection control practices.

Products and instruments: Instrument tips are susceptible to damage (breakage, for example), increasing costs. Additionally, the plastic trays may be eliminated if cassettes are used. If a patient is staring at a plastic tray with stains from disinfectants and cements, we lose the "wow" experience. They may perceive a lack of cleanliness.

Now let's create a new picture: The dental assistant and hygienist utilize cassettes with instruments organized into setups using a color-coded silicone rail system to make visual identification easy. Minutes are saved with every patient, equaling more patient care time. He or she initiates dialogue with the patient as the cassette is unwrapped: "In our dental office, we do everything possible to assure a safe

Patients want and deserve optimum infection control. Let them truly understand the efforts invested in achieving compliance and how this benefits them as a patient.

When I was conducting a recent walk-through assessment, the receptionist shared a story from a potential new patient she had spoken to on the phone. This caller had gotten up from the dental chair in another office and dismissed herself due to fear of improper sterilization and infection control. The caller explained that a friend referred this particular dental office because "they are clean." Does your office project this image of cleanliness?

Implementing an instrument management system achieves positive patient perception, employee safety, compliance with regulations, and organization. The added benefit is saving time and money. RDH

Safety features in cassette systems

In a cassette system, the instruments are locked into place, thus minimizing the risk of an injury during transport from the patient operatory to the sterilization area. According to OSHA, following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow up.3 Minimizing the risk of an injury promotes a safer workplace, and saves time and money.

Time is also money. The instruments are already organized into setups. Following a completed procedure, the cassette is closed, locked, and transported. The entire cassette is placed into the ultrasonic cleaner or instrument washer. Sorting and unnecessarily handling loose and contaminated instruments is eliminated, and the lifetime of the instruments is extended by protecting the working ends.

Following the ultrasonic cleaner, the cassette is rinsed, dried, and wrapped or placed into a sterilization pouch. Following sterilization, the cassette is stored, awaiting selection.

My preference is the stainless steel cassettes for durability and their professional appearance.

OLIVIA WANN, RDA, JD, attended Tennessee Technology Center as an RDA and earned a bachelor of science degree in health-care administration from Saint Joseph's College. She graduated from the Nashville School of Law with a doctorate in jurisprudence and is licensed to practice law in Tennessee. In 2000, she founded Modern Practice Solutions, which is dedicated to the compliance issues of dental practices. For more information visit or send an email to [email protected].


1. Ramos-Gomez F, Ellison J, Greenspan D, Bird W, Lowe S, Gerderding JL. Accidental exposures to blood and body fluids among health care workers in dental teaching clinics: a prospective study. J Am Dent Assoc. 1997;128:1253-61.
2. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings - 2003. MMWR 2003;52(No. RR-17).
3. Organizational Safety & Health Administration [OSHA]. Bloodborne pathogens: Post-exposure Evaluation and Follow-up. Standards-29 CFR 1910.1030(f)(3). OSHA website. Accessed July 28, 2015.