Disinfecting the DTR Between Patients

You have just finished with a patient, and the dental officer is15 minutes behind schedule and your last patient for the morning is waiting in the reception area. You are in a hurry to set up for the patient. Stop, slow down, and think! Disinfecting your DTR for your next patient takes time and must be done correctly. Always wear gloves while handling nonregulated waste materials and instruments or cleaning contaminated surfaces. Place all nonregulated, nonsharp, disposable materials in designated containers lined with plastic bags. Use foot operated containers if they have lids.

The ultimate goal of an aseptic technique is to break the chain of infection and eliminate the possible transmission of infectious disease between patients and between patients and staff. Use the following information when breaking down your DTR and setting up for your next patient.

DENTAL INSTRUMENTS.\You must never lay contaminated instruments directly on countertops or work surfaces. Rewrap cassettes, packs, or trays in the original wrap and place individually packaged instruments in a leakproof covered container to transport to the CSR.

LIQUID REGULATED WASTE.\Place all regulated liquid wastes in designated leakproof containers identified either by the color red or by a biohazard label. Pour liquid regulated wastes into the sanitary sewer system through clinical sinks (not handwashing sinks) or unit cuspidors unless local or state regulations prohibit this practice.

THREE-WAY SYRINGE TIPS.\Disposable syringe tips are preferred. Sterilizable syringe tips may also be used if disposable syringe tips are not available.

DISPOSABLE SHARPS.\Treat used disposable sharps, such as needles, scalpel blades, carpules, disposable syringes, used burs, and broken instruments as regulated waste. Handle these items with extreme care to prevent any unintentional injury and the possible spread of bloodborne diseases. Place used disposable sharps in puncture resistant containers specifically designed for needles and other sharp items. The universal symbol for biohazard must appear on these containers. Do not recap, bend, break, or otherwise manipulate needles by hand. In the dental setting, because a patient may require a second injection of local anesthetic, and most syringes are not disposable, recapping is sometimes necessary. Use the following guidelines when recapping:

Never recap a needle using a two-handed technique.

Use one of the commercially available sheath holders, or use the "scoop" technique.

If using the scoop technique, the cap is scooped up from the tray with the needle tip using only one hand.

Never allow uncovered needles to remain on the instrument tray.

DENTAL HANDPIECES.\Many dental clinics with CSRs will have you remove the contaminated handpieces you have used to complete a procedure and turn them into the CSRs along with your instruments. The CSR technician will handle, disinfect, lubricate, and sterilize the dental handpieces. This saves the dental assistant valuable time and avoids any excess aerosols that occur during the disinfection and lubrication procedure.

If your command requires you to perform handpiece maintenance in the DTR, you should remove handpieces after each patient, then lubricate and run them for 30 seconds. (This will also serve to purge the tubing as stated previously.) This procedure removes any potentially infectious material from retraction of coolant water during previous treatment. Many manufacturer's require lubrication of handpieces before and after sterilization. To prevent cross-contamination, follow these procedures:

Use two separate containers of lubricant-one marked for lubrication before sterilization and another marked for after sterilization.

Lubricate handpieces with one end in a headrest cover to capture the aerosol contaminants or use one of the many commercial products for cleaning and lubricating handpieces.

For disinfecting nonautoclavable handpieces while wearing gloves, use the following procedures:

Submerge two gauze sponges per handpiece in a high level, EPA registered disinfectant. Squeeze out any excess.

Use one sponge to wipe the handpiece and discard.

Wrap the second sponge around the handpiece and return it to the holder for the period of time specified by the manufacturer.

Before reuse, wipe the handpiece thoroughly with potable water to remove residual disinfectant.

If the handpiece is autoclavable, perform the following:

Remove the handpiece from the couplings, clean, and lubricate following the manufacturer's instructions.

Barrier Clean Up

After you complete the previously mentioned procedures, remove and discard the disposable coverings or barriers contacted during patient treatment while you are still gloved. It is important to remove the surface covers carefully to prevent contamination of the covered areas. This is accomplished by turning the soiled outer side toward the inside, or inside-out.

You must clean and disinfect the previously covered surfaces between patients only when the integrity of the physical barriers has been compromised or when the surface is visibly soiled. For example, if moisture is absorbed through the cover to the underlying surface, then the purpose of the barrier is defeated, and the surface must be disinfected.

Cleaning Unprotected Areas

Using the spray-wipe-spray technique, clean and disinfect all unprotected "high touch" areas with an intermediate-level, EPA-registered disinfectant. Remove all debris and particulate matter before disinfection. To be effective, the disinfectant must remain in contact with the surfaces for the time specified by the manufacturer. Do not use 2 percent glutaraldehyde as a surface disinfectant because of its caustic vapors and high cost.

Bringing Contaminated Items to the CSR

After completion of the above procedures, you can now take all metal and heat stable items to the CSR for sterilization. Ensure all instruments and equipment are handled properly and no sharp objects are protruding through packs or cassettes while transporting items to the CSR.

Preparing for the Next Patient

When you return to the DTR from the CSR and if your room is clean, remove your gloves and wash your hands and other exposed skin surfaces with an antimicrobial soap. When discarding a face mask after removing gloves and washing hands, handle the mask only by the elastic or cloth tie strings. Never touch the mask itself. Plan the above process carefully for efficient use of time. Replace clean disposable barriers and set up clean handpieces and instruments for the next patient.