BY NOEL BRANDON KELSCH, RDHAP
Sometimes a single sentence is all that’s needed to make an impact on the world. One single sentence that can change the chances for cross-contamination and the possible spread of disease comes from the Centers for Disease Control (CDC): “Use single-use devices for one patient only and dispose of them appropriately.”1 This sentence has great impact on the way dentistry is practiced. But, the question is, are you applying the knowledge contained in this one simple sentence?
So Why Single Use?
There are great advantages to using single-use items as compared to reusable products. Because these items are used only to treat one patient and then disposed of, they help reduce the potential of patient-to-patient contamination.3 Reuse of single-use items has the potential of putting both the patient and clinician at risk.
Single-use items should not be reprocessed. They are usually not heat tolerant and cannot be reliably cleaned, disinfected, or sterilized.
They may be made of plastic or less expensive metals. They are not designed or intended to be cleaned, submerged into disinfectant, or sterilized.
Many companies use this symbol to remind you that an item is single-use:
There are many added benefits to single-use items. These concepts encompass infection control but can go far beyond. Here are a few examples:
Single-use sterilization pouches: A single-use pouch is clean and appears clean to the patient when presented; it maintains a proper seal, which assures confidence when opened before the patient; and the color-changing inks visually demonstrate that the internal space has been exposed to the conditions necessary for sterilization. A single-use pouch eliminates the question of counting cycles and the fear of failure from over-cycling; there is never a soiled appearance from previous uses; and the position of the instruments is clear to the operator so there is no injury when pressure sealing or opening. A single-use pouch costs no more, but it offers more.4
Dental carpules: Once a dental carpule is set on the patient’s tray, it may not be reprocessed. It is single-use. Not only is there the risk of spreading disease, if the carpule has been cleaned, disinfected, or submerged in a disinfectant, it can cause adverse reactions. Dr. Daniel Haas stated in his article, “Localized Complications from Local Anesthesia”: “Even though the anesthetic cartridge was not used, it must be considered contaminated and should be disposed of. Since disinfectants can diffuse through the diaphragm and contaminate the anesthetic solution, do not store or submerge cartridges in these agents. Instead, anesthetic cartridges should be dispensed using the concept of unit dose measurement to prevent contamination of unused supplies.”5
Administration of local anesthetic from a cartridge contaminated by alcohol or sterilizing solution may induce paresthesia.6 Neurotoxicity may be a factor, since a review of the literature suggests that local anesthetics have this potential. Cartridges stored in a disinfecting solution such as alcohol may have residual amounts of solution on the end of the cartridge, or solution may be diffused into the cartridge through the semipermeable diaphragm that can then be administered inadvertently during injection. (For more information on this reaction, see RDH magazine “Part One: Dental Carpules Single use,” March, 2008).
Single-use masks: The CDC guidelines are very clear: “Change masks between patients or during patient treatment if a mask becomes wet.” There are so many reasons why masks should be single-use; yet there are so many people who do not comply with this guideline. Health-care professionals take their masks off and hang them on their necks or tuck them in their pockets. All the bacteria, viruses, and debris will now go home with them.
This regulated medical device is designed to avoid various situations of cross-contamination. The mask can become damp either from condensation due to breathing or moisture from procedures. Once a mask begins to wick, the efficacy of filtration and protection is progressively diminished.7 The mask loses its filtering capacity over time due to breathing and the environment (splatter, moisture, and other elements). Bacteria can easily develop under a mask and may account for skin irritation or outbreaks.8
Simple sentences can impact the world in ways we never imagined. Each clinician has the responsibility to apply this simple sentence and the knowledge surrounding it. “Use single-use devices for one patient only and dispose of them appropriately.” RDH
CDC focus on single-use devices
A single-use device, also called a disposable device, is designed to be used on one patient and then discarded, not reprocessed for use on another patient (e.g., cleaned, disinfected, or sterilized). Single-use devices in dentistry are usually not heat-tolerant and cannot be reliably cleaned.
Examples include syringe needles, prophylaxis cups and brushes, and plastic orthodontic brackets. Certain items (e.g., prophylaxis angles, saliva ejectors, high-volume evacuator tips,and air/water syringe tips) are commonly available in a disposable form and should be disposed of appropriately after each use. Single-use devices and items (e.g., cotton rolls, gauze, and irrigating syringes) for use during oral surgical procedures should be sterile at the time of use.
Because of the physical construction of certain devices (e.g., burs, endodontic files, and broaches), cleaning can be difficult. In addition, deterioration can occur on the cutting surfaces of some carbide/diamond burs and endodontic files during processing and after repeated processing cycles, leading to potential breakage during patient treatment. These factors, coupled with the knowledge that burs and endodontic instruments exhibit signs of wear during normal use, might make it practical to consider them as single-use devices.2
1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings 2003. MMWR 2003;52(No. RR-17): p 46.
2. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings 2003. MMWR 2003;52(No. RR-17): p 33.
3. From Policy to Practice: OSAP’s Guide to the Guidelines.
4. Interview with Mike Durda, Dux Dental 5/6/12
5. Haas DA. Localized complications from local anesthesia. Journal of the California Dental Association 1998.
6. Shannon IL, Wescott WB. Alcohol contamination of local anesthetic cartridges. J Acad Gen Dent 1974; 22:20–21.
7. Interview with Leann Keefer, Crosstex 5/6/12
8. Interview with Elisabeth Masse, Medicom 5/6/12