Fiona Collins Liliana Donatelli Andrew Smith

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1 Fiona Collins Liliana Donatelli Andrew Smith

2 DISCLOSURE STATEMENT The presenters have no conflict of interest regarding the content of this presentation

3 Develop a database for various countries globally Compare and contrast similarities and differences Discuss these differences Develop action items during the session Expand understanding

4 Instrument Decontamination (Processing) PPE Sharps treatment Transport Categorization of instruments Handpieces Cleaning (+/- presoaking) Packaging requirements Sterilization or disinfection Storage Type of monitoring recommended/required

5 Brazil Mexico Scotland Netherlands Australia Canada USA

Gloves Patient care nonsurgical Patient care surgical Australia Brazil Canada Mexico Netherlands Scotland USA Nonsterile, single-use Nonsterile, single-use Decontamination/Instr processing -

6 Gloves Patient care nonsurgical Patient care surgical Australia Brazil Canada Mexico Netherlands Scotland USA Nonsterile, single-use Nonsterile, single-use Decontamination/Instr processing - Nonsterile, single-use Sterile, singleuse Nonsterile, single-use Sterile, singleuse Thick gloves; rubber - Nonsterile, single-use; latex, vinyl or nitrile Sterile, single-use; latex, vinyl or nitrile Heavy duty/nitrile gloves Nonsterile, single-use Sterile, single-use for CH-1 procedures Heavy duty gloves Nonsterile, single-use Sterile, singleuse Heavy duty Nonsterile, singleuse Sterile, single-use Heavy duty (utility) gloves Mask Single-use/ change out if damp Single-use/ change out if damp Protective Eyewear Yes Safety glasses or face shield Single-use/ change out if damp Yes Single-use/ change out if damp Safety glasses or face shield Clinical attire/gown Yes Long-sleeved Long-sleeved Long-sleeved gown; preferably elastic cuff, no pockets, closed at neck. white or light Single-use/ change out if damp Safety glasses or face shield Single-use/ change out if damp Yes Single-use/ change out if damp Safety glasses or face shield Yes Yes Long-sleeved, knee-length Head cap No Yes No No No No No Shoe requirements No Non-slip, closed No No No No Caps/surgical boots in some situations Waterproof apron for spatter Yes Yes No No No No No Patient protective eyewear - Yes Yes Yes - - Required -potential exposure to bloodborne pathogens; blood, other body fluids, opim Yes

7 Plastic gloves over exam gloves Brazil Mexico ( if necessary to avoid CI) Uniforms and scrubs should not be worn outside the dental office Brazil, Mexico, Canada, USA Asbestos gloves allowed in parts of Brazil for use in clean area

8 Solid containers + Biohazard Symbol Sharps containers must not be overfilled Sturdy sharps containers Needles may not be bent, broken, manipulated Engineering and Work Controls Resheathing- one-handed technique

9 Australia Brazil Canada Mexico Netherlands Scotland USA Color - Yellow - Red - Yellow Red Biohazard Symbol - Y - Y - - Y Cardboard Propylene, chlorine-free Material - allowed - Hard plastic - - Fill level - Line at ⅔ - 80% Line - Line Puncture-resistant - Y Y Y Y Y Y Leak-resistant - Y - - Y - Y Needle separator Y Y - - Closable and sealable - Y - Y Y Y Y In operatory, close Y Y Y Humidity low - Y Point of origin, date of closure Y -

10 Australia Brazil Canada Mexico Netherlands Scotland USA Transportation Containers recommended/required Variable Y Y No specifications Not addressed Y Y Processing Separate processing areas - Line at ⅔ Y No specifications Not addressed Y Line Dirty vs clean flow in processing area - Y Y No specifications Not addressed Y Y Area measurement given N Y N No specifications Not addressed Y N Second sink required if in operatory - Y - No specifications Not addressed Y Y Designated hand hygiene sink Y Y - No specifications Not addressed Y - Not addressed in Mexico or The Netherlands Differ most in specifications and specificity of containers used for transportation Contaminated instruments should be placed in a puncture-resistant container at the point of use and then transported to the instrument processing area ( Scotland, Canada)

11 All countries use Spauldings classification Critical, semi-critical and non-critical All give examples The Netherlands does not state Spauldings and refers to Categories A, B and C USA subdivides semi-critical Heat-resistant Heat-sensitive Handpieces not specifically addressed in Brazil Upcoming revised Dutch guidelines specify that endodontic files are single-use Scotland: Endodontic files single use

12 All countries included address cleaning Method of cleaning: Manual in Brazil guidelines soft bristle brush and long handle Wire brush for drills Brush lumen cleaning Sink with deep tub specific for this purpose and preferably with tap with steerable jet Detergent and running water Australia does not address pre-soaking Point-of-use cleaning in Australia

13 Method of cleaning: Preference for automated (mechanical) cleaning (except Brazil) Safer Can validate Greater control on process Mechanical washer or washer-disinfector or ultrasonic Dutch guidelines do not address method other than mention of brush or pressurized gun for lumens Upcoming revised Dutch guidelines state use of mechanical washer/disinfector where possible or ultrasonic cleaner Ultrasonic cleaner for burs, hollow and hinged instruments

14 Australia Brazil Canada Mexico Netherlands Scotland USA Packaging Critical Yes Not addressed Yes Not addressed Yes Yes Semi-critical (heat-resistant) Yes Not addressed Yes Not addressed No Yes Sterilization/'Decontamination' Critical Steam Steam Heat Steam/Dry Heat Steam Heat Heat Semi-critical Heat-resistant W-D Steam (dry heat ortho pliers allowed) Heat Steam/Dry Heat Heat-sensitive W-D Immersion Not addressed Noncritical W-D Steam (hr) or Not addressed immersion (hs) W-D or flash sterilization W-D or flash sterilization W-D (hr) or immersion (hs) Heat Immersion Disinfection Scotland: Nonvacuum autoclaves only unpackaged solid items USA: Flash sterilization only if for immediate use (not implantable devices) Mexico: All offices must have an autoclave Proposed revised Dutch: Packaged only Class B autoclaves

15 Australia Brazil Canada Mexico Netherlands Scotland USA Handpieces Sterilize Heat-sterilize for surgical procedures Sterilize Steam sterilize Stem sterilize Class B (vacuum) Vacuum Autoclave Not addressed further Follow manufacturer's instructions Proposed revised guidelines: CH- 1 packaged and CH-2 unpackaged Follow manufacturer's instructions Follow manufacturer's instructions Proposed revised Dutch guidelines on cleaning: Washer/disinfectors with special adaptors for cleaning or handpiece cleaning device

How Australia Brazil Canada Mexico clean, dry, contained, secure Enclosed space, e.g., area; Minimum distance of 20 closed or covered cm from the floor, 50 cm from cabinets.

16 How Australia Brazil Canada Mexico clean, dry, contained, secure Enclosed space, e.g., area; Minimum distance of 20 closed or covered cm from the floor, 50 cm from cabinets. Do not store the ceiling and 5 cm from the wall; adequate protection, monitor for integrity Stored in designated area in containers under sinks or elsewhere where may become wet and contaminated Netherlands - Clean, dry and dustfree area, in a closed drawer or cupboard Scotland clean, dry, well ventilated and secure; adequate protection for package integrity USA Clean, dry, contained areas for sterile packages. Do not store above the sterilizer. Event-related No No, but if packaging damaged, reprocess Validate instead Yes - allowed; reprocess if loss of package integrity Not specified - usually eventrelated No No; reprocess if loss of package integrity Yes - reprocess if loss of package integrity Time-related Yes months; in surgery drawers up to 28 days NO Yes - allowed. FIFO basis. Not specified Yes - store up to 6 months. Proposed revised guidelines: Reprocess after 6 months Use FIFO No

17 Australia Brazil Canada Mexico Netherlands Scotland USA Mechanical Yes Yes Yes - Not addressed in existing or proposed guidelines. Use sterilizer in accordance with manufacturer's instructions Yes - satisfactory cycle shown; Temperature and pressure record shpwing required conditions Yes Chemical? Yes - specific recommendations unclear Biological (Spore Tests) Must have external; recommended also have internal? Yes - at least weekly Yes - each day used; with implantable devices (quarantine until results known) - External indicator Not mandatory Yes - must have internal and if not visible also external Bi-monthly is mandatory Not addressed in existing or proposed guidelines Not mandatory Yes - weekly and every time implantable device

18 Australia Brazil Canada Mexico Netherlands Scotland USA Yes - with mechanical Document Log results Document Yes - document parameters (time, sterilization sterilization sterile product temperature and procedures and processes release and pressure for each load), results. operator date, load, equipment identification and Steriliser print out circling and signing required parameters. Signature date and time on release of items. Audit of sterilisation sheets, checking parameters and signatures etc. at end of month. Bench top SD cards down loaded weekly and checked against sterilisation sheets. Results graphed out with trends etc. investigated. expiration date, spore testing If a load fails any parameters, reprocess. Have the periodic maintenance and control measurements performed Document all parameters for each load, date, sterilizer number, load number, operator, date and signature. Document all spore testing.

19 No requirements for BI s in Scotland Detailed decontamination room requirements in Scotland Detailed room dimensions in Brazil Preference for manual instrument cleaning in some countries Subdivision of surgical procedures in NL Requirement for decontamination/sterilization for semicritical instruments varies

20 More clarity on handpiece reprocessing Endodontic file re-use reaction? More clarity on PPE what & when? Discussion on other points

21 For country information received: Dr. Enrique Acosta Gio Mexico Dr. Wendy Bacalja Australia Dr. Nita Mazurat Canada For reviewing Brazil data: Dr. Jose Geraldo Conrado

Christina Bradley Laboratory Manager Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK

Christina Bradley Laboratory Manager Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK Irrespective of where the decontamination is performed or who it is performed by the