Give Me Some Space!

Following CDC guidelines for an ideal central sterilization area

Olivia Wann, RDA, JD

Each area of the dental office is critical for the practice’s successful operation and efficiency. Whether it is the administrative area, the clinical operatories, the reception room, or the central sterilization area, all locations are key to the practice’s successful provision of patient care.

Unfortunately in some offices, team members are working in limited spaces, particularly in metro regions. Despite the busy functions taking place in the central sterilization area, it often has the least amount of space.

Define the Space

One primary goal of every dental office should be to comply with the Centers for Disease Control and Prevention’s (CDC’s) Guidelines for Infection Control in Dental Healthcare Settings, 2003. CDC guidelines indicate that the sterilization area must be centrally located and should be divided into sections. This system can greatly increase efficiency and cost savings for your practice. First, designate an area to receive the contaminated instruments, pre-clean, and decontaminate. This section is designated as the “dirty side.”

Next, designate a section to prepare and package the instruments and patient care items. After this area, there is a section for sterilization and finally, there is a storage area. It may be helpful to label this section as the “clean side.”

Common errors that I see in some offices are storing trash receptacles and sharps containers on the “clean side,” and entering the sterilization area from the “clean side” rather than the “dirty side.” Another common violation in the sterilization area is handling loose, contaminated instruments with contaminated patient exam gloves. Minimize handling of such instruments by employing work practice controls. For example, transport loose instruments in a covered container or consider implementing an instrument management system such as instrument cassettes. Wear appropriate personal protective equipment, including utility gloves.

Transporting contaminated instruments on an open tray is a potential hazard. If team members collide, it could result in an individual being exposed to contamination. Manually handling the instruments more than necessary could also be hazardous because of the danger of incurring an instrument stick while dropping and retrieving instruments in and out of the ultrasonic tank, the time-consuming and dangerous sorting of instruments, and having to clean and decontaminate the tray. Saving time with every patient may equal a valuable hour in your day.

Safer and Easier Sterilization

Through the successful implementation of instrument cassettes, the practitioner simply places each instrument back into the cassette after use. The cassette is then closed, locked, and safely transported to the sterilization area. The entire cassette is then placed into an ultrasonic tank or dental instrument washer. After cleaning and thorough rinsing, the cassette is placed upright to dry (if using an ultrasonic cleaner). Once completely dry, package the cassette in either an autoclave pouch with internal and external indicators or instrument wrap. Be sure to include an internal chemical monitor when using sterilization wrap.

Following sterilization, allow the instruments to cool prior to storage. Do not remove from the sterilizer before the cycle is complete. Instruments should remain packaged until the point of use. Store the wrapped cassettes or pouches in dry, closed containers or cabinets.

Instruments should be stored on the “clean side” of the sterilization area. Some practices store instrument sets in the operatories. Regardless, ensure that team members do not contaminate the pouches by attempting to retrieve a set with contaminated gloves. If a team member enters the sterilization area to retrieve an additional item for a procedure, contaminated gloves should be removed and hands washed. One should never reach into a drawer with dirty gloves.

The Importance of Labeling

Compliance with the Occupational Health and Safety Administration’s (OSHA’s) new regulation, known as the Globally Harmonized System of Classification and Labeling of Chemicals (GHS), requires identifying hazardous chemicals with new pictograms. I recommend labeling the ultrasonic tank, the high level disinfect bin, acrylic powder and liquid, amalgam capsule trays, pumice, COE cleaner, alcohol containers, and other products in secondary containers that are not already identified properly. Be sure to provide a legend for cross-reference of the pictograms.

If patient supplies are stored in the sterilization area’s cabinets, address expiration dates on materials such as anesthetic, composite material, and other items. This past year, numerous dental practices unknowingly used expired anesthetic. In these practices, the problem was typically an issue of improper inventory control. To overcome this problem, it is helpful to write the expiration date on the outside of the box so that the date is visible to the workers. Prior to disposing of expired materials, keep in mind that some of the materials are considered hazardous and must be disposed of according to state and local regulations. Consult the safety data sheet or your waste hauler or mail-in vendor for instructions.

The Power of Organization

Regardless of whether you work in a large, spacious office or a confined space, organization is critical. Save valuable drawer space in smaller sterilization areas for items used in this location rather than patient brochures or office tools such as hammers, etc.

Clear organization of supplies eases visibility and retrieval of products. Utilizing consumable procedure tubs can aid in clearly organizing supplies. Serving as portable operatory drawers, consumable materials are organized by procedure type and placed into a single tub that is easily stocked in a central location and transported from operatory to operatory. Depending on the space available in the practice, the tubs can also be stored in the operatory. When a practice incorporates procedure tubs for materials management, it allows for several benefits, including faster treatment room set up/breakdown, simplified organization of supplies, improved inventory management, and efficient supply storage that can be transported from room to room.

Instrument cassettes and tubs keep sterile procedural tools at your fingertips, so team members should not have to enter the sterilization room or another operatory to search for missing materials or instruments.

Larger practices often employ the pass-through cabinet system, which minimizes the amount of people accessing the sterilization area, and therefore the bottlenecking that typically occurs there. The contaminated trays or cassettes are merely passed through a cabinet. A team member assigned to the sterilization area retrieves the contaminated instruments and initiates the instrument management process. Instruments are likewise stored in a pass-through cabinet.

Common Goals

During your team meetings, discuss the importance of safety and infection control. Often, some of the most valuable feedback is found among your team members. With the common goal of achieving safety and efficiency, your practice will run smoothly and you will have more space.

About the author

Olivia Wann, RDA, JD, founded Modern Practice Solutions in 2000 and continues to consult with dental practices on managing risk in a complex regulatory environment. She graduated from the Nashville School of Law with a Doctorate in Jurisprudence. She has a Bachelor of Science degree in Health Care Administration from St. Joseph’s College of Maine.