Infection Control: Support Equipment

The physical aspects of today’s dental practice are quite complex. A lot of equipment and other items are needed in the office not only to support the treatment of patients but also to keep all patients and employees safe during normal and emergency situations. The term “support equipment” may be defined in different ways, but this article considers support equipment as items other than the dental chair/light, handpiece units and hand instruments. Examples include equipment needed to:

• reprocess contaminated instruments (eg, sterilizers, cleaners)

   

• operate high-speed handpieces and 3-way syringes (eg, air compressor)

   

• provide good quality water for the handpieces and 3-way syringe (eg, water treatment systems)

   

• provide vacuum (eg, vacuum pump)

   

• take, develop, record, and view radiographs (eg, x-ray equipment, darkroom apparatus, view boxes, computers)

   

• enhance vision (eg, loupes [see Glossary], microscopes)

   

• document cases (eg, regular and intraoral cameras)

   

• take patient records (eg, face bows, articulators)

   

• maintain patient records, appointment schedules, insurance/billing information (eg, computers, printers, fax)

   

• administer sedation and monitor body responses (eg, nitrous oxide system [see Glossary], nitrogen tank)

   

• cure resins (eg, curing lights)

   

• adjust or prepare appliances and prostheses (eg, dental lathe)

   

• take blood pressure (eg, BP cuff)

   

• provide emergency care (eg, oxygen, resuscitation bag, automated external defibrillator [see Glossary])

   

Not all of the support equipment mentioned requires routine infection control procedures during use. For example, the vacuum pump, air compressor, and sterilizer are necessary equipment but usually do not become contaminated with patient materials and are not normally handled with patient-contaminated gloves. On the other hand some support equipment becomes contaminated with every use through direct contact with patients or through indirect contact with contaminated gloves or other items.

The infection control aspects of using support equipment depend upon several factors including:

• the equipment manufacturer’s directions for preventing contamination or for decontamination (see Glossary)

   

• when and how the equipment becomes contaminated

   

• the ability of the equipment to withstand heat sterilization or sterilization with a liquid sterilant

   

• whether the equipment can be protected with a surface barrier

   

So the general options for equipment asepsis are to:

• discard after a single use

   

• protect from contamination

   

• clean and sterilize

   

• clean and disinfect (see “Putting It All Together”).

   

Safety Support Items

Numerous other items are needed to support patient and employee safety in the office such as medical emergency kits; MSDS files; fire extinguishers; emergency exit plans and signs.¹ Keeping these items updated and making sure all employees know where to find these things are very important.

Communicating for Compliance

Communication is important in any business. In the dental office the infection control coordinator should express infection control information to the boss, the rest of the staff, and the patients.

Employer

Monitor the status of support equipment, and keep your employer informed of:

• any equipment problems or potential problems

   

• any equipment service contracts that should be considered after the warranty period has expired

   

• any equipment service contracts that need to be renewed

   

• any equipment service manuals that need to be obtained

   

• any routine equipment maintenance/certification activities that have been performed

   

Staff

Communication to the office staff about support equipment can include:

• providing any training needed to new or temporary staff about the proper use, maintenance and asepsis aspects of the office equipment

   

• organizing any staff training sessions needed about the operation, maintenance and asepsis aspects of new equipment

   

• making sure any service technicians coming into the office have had proper infection control training and are aware of any contaminated parts of equipment to be serviced

   

• reminding the staff to report any equipment problems or potential problems

   

• encouraging the staff to offer any suggestions on the purchase of new equipment that may affect their activities

   

Patients

Some patients may be curious about the workings of a dental office. Also young or first time patients will hear “unusual” noises (eg, vacuum pumps, air compressors, highspeed handpieces, ultrasonic scalers, beeps, buzzers, etc). So be ready to explain about the office equipment to calm their nerves or answer questions. Give special consideration to children: allow the young patient to first hear the noise from the particular piece of equipment and describe it, before using it intraorally.

Q&A

Question:

Do we have to do anything to equipment that needs to be sent away for repair?

Answer:

Yes. If the equipment has been contaminated with patient materials, it needs to be cleaned and sterilized or cleaned and disinfected by office staff following the manufacturer’s directions. If any parts remain contaminated, they must be identified with labels before sending the equipment out for service.

Practice Tips

Of course maintaining the office equipment is very important. These tips may help you prepare for those unexpected equipment problems that can stop or interfere with patient care. Sooner or later equipment will fail, so it is always better to have a plan in place when this happens.

• Make sure there are operating/maintenance manuals for the equipment, and that someone in the office performs any necessary routine maintenance (eg, periodically cleaning the autoclave drain).
• Ideally a maintenance log should be kept to document service on each equipment item.
• Review the warranty period on all equipment; when this expires, a preventive maintenance contract may be desirable.
• Review all preventive maintenance contracts to determine renewal consideration dates.
• Confirm radiographic equipment certification dates.
• Make a list of contact information for all equipment repair/service technicians. Be sure to update this list when new equipment is purchased.

Resources

1. Miller CH, Palenik CJ. Management of the office safety program. In Infection Control and Management of Hazardous Materials for the Dental Team. 3rd ed. St Louis, MO: Elsevier-Mosby; 2005:351-365

2. Environmental Protection Agency. EPA registered disinfectants: EPA’s registered sterilizers, tuberculocides and antimicrobial products against certain human public health bacteria and viruses (as of June 30, 2008). http://www.epa.gov/oppad001/chemregindex.htm. Accessed August 2008.

3. Rutala WA, White MS, Gergen MF, Weber DJ. Bacterial contamination of keyboards: efficacy and functional impact of disinfectants. Infect Cont Hosp Epidemiol. 2006;27:372.

4. Centers for Disease Control. National Institute for Occupational Safety and Health. Control of nitrous oxide in dental operatories. http://www.cdc.gov/niosh/nitoxide.html. Accessed August 2008.

5. World Health Organization. Millennium Development Goals. http://www.who.int/mdg/en/. Accessed September 2008.