Should the transmission (gears) inside prophy heads and slow speed hand pieces be sterilized between patients?
This question was submitted by a general dentist: “Should the transmission (gears) inside prophy heads and slow speed hand pieces be sterilized between patients? I find to my surprise that assistants and hygienists leave these on the angle nose cones.”
A quick initial response is provided by Dr. Nita Mazurat, Associate Professor in the Faculty of Dentistry at the University of Manitoba, representing the Organization for Safety, Asepsis and Prevention (OSAP)
1. Should all hand pieces be sterilized following patient use?
The recommendations from the Center for Disease Control (CDC) “Guidelines for Infection Control in Dental Health-Care Settings – 2003” is “to sterilize all dental devices that touch mucous membranes and are attached to the air or waterlines of the dental unit”. This includes hand pieces used for tooth polishing.
2. Should these be sterilized intact or taken apart?
This depends on the brand and the manufacturer’s instructions. Some could be taken apart, cleaned, and lubricated manually. Others are cleaned and lubricated internally, using a system specifically designed for cleaning and lubricating hand pieces; and some are manually lubricated only following cleaning. The question is whether or not the inside of an instrument with a bore or lumen becomes sterile during regular sterilization. Tests with class 5 integrators have demonstrated adequate steam penetration in these areas. However, it is intuitive that a hollow bore and exposed surfaces, when the opportunity presents (manufacturer), will be more readily available to sterilization than solid state hand pieces.
3. How are hand pieces cleaned prior to sterilization?
All instruments that will undergo sterilization must be cleaned prior to sterilization. Following patient care, oral fluids that may have been retracted during treatment need to be expelled prior to sterilization. This is done by running hand pieces for 20-30 seconds following patient care in order to remove as much oral fluid as possible from the hand piece. The outside is cleaned by brushing the hand piece with a wet brush, dried by wiping dry, and inspected prior to sterilization.
4. In order to address any “surprises”, procedures in the dental office are best standardized by providing careful instructions following manufacturer instructions in the Office Infection Control Manual.
These instructions can even be accompanied by photographs demonstrating hand piece cleaning and lubrication featuring the office staff in the photos. Good instructions plus individual engagement helps to assure knowledge and definitely contributes to improved compliance.
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