Reprocessing of dental instruments and angle handpieces

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2 Reprocessing of dental instruments and angle handpieces Martiny Heike1, Simonis Anette2 Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin Technical Hygiene 1 2 Prosthodontics and Propaedeutics 2

3 Dental instruments 3

4 Dental instruments 4

5 Dental instruments 5

6 Dental instruments C Paul

7 Dental instruments Classification Non critical Semi critical critical Requirements DIN EN ISO Robert Koch-Institute (RKI) 7

8 Patient-used instrument after inadequate cleaning, disinfection and steam sterilization 8

9 Patient-used instrument after inadequate cleaning, disinfection and steam sterilization 9

10 Patient-used instrument after inadequate cleaning, disinfection and steam sterilization instrument with lumen 10

11 Patient-used instrument after inadequate cleaning and disinfection Handpiece 11

12 Endodontic files 12

13 Residual protein levels on reprocessed dental instruments Smith et al, JHI 61 (2005) 22 dental practices 220 dental endodontic files Examination after inadequate reprocessing Light microscope Protein determination (OPA-method) 13

14 Residual protein levels on reprocessed dental instruments Smith et al, JHI 61 (2005) No contamination visible through light microscope (40 x) Contamination visible through light microscope (40 x) Contamination visible without light microscope Residual protein levels (Median) ,4 µg (0,5 63,2 µg) 14

15 A study of visual and blood contamination on reprocessed endodontic files from general dental practice Letters et al, Br Dent J (2005) Endodontic file Decontaminated and ready for re-use 15

16 A study of visual and blood contamination on reprocessed endodontic files from general dental practice Letters et al, Br Dent J (2005) Endodontic file Decontaminated and ready for re-use 16

17 Suitability of manufacturer s instructions MJ Oh manufacturers of endodontic instruments 6 without instructions 17 with instructions 11 instructions in the correct order 6 manufacturers present 60% of the required information of ISO RKI 17

18 Suitability of manufacturer s instructions MJ Oh patient-used Hedström files after inadequate cleaning, disinfection and steam sterilization Visible Loupe Binocular Binocular Binocular N clean x loupe 10 x loupe 20 x loupe 40 x

Suitability of manufacturer s instructions MJ Oh 2009 25 patient-used

19 Suitability of manufacturer s instructions MJ Oh patient-used Hedström files after inadequate cleaning, disinfection and steam sterilization 19

20 Driven instruments 20

21 Diamonds 21

22 Arkansas stones 22

blood Drying (15 min, room temperature) Manual cleaning (brushing (brass

23 Surface structure and cleaning M Koschke 2006 Driven dental instruments Rosehead bur 023 Arkansas stone Diamond Test soil and method Native human blood Drying (15 min, room temperature) Manual cleaning (brushing (brass brush) and rinsing (1 L/sec)) Protein determination with OPA-method Eluating over 1 h (1% SDS) 23

24 Surface structure and cleaning Recovery of protein hke 2006 Driven dental instrument Blood amout N No drying Diamond 2 µl 50 Rosehead bur 3 µl Arkansas stone 5 µl N 15 min drying N drying + cleaning 83 % % % % % % % % % 24

25 Dental angle handpieces 25

26 Way of contamination: Reflux C Paul 2009 reflux Stop in a coloured solution Coloured solution on filter paper 26

27 Patient-used instruments after inadequate cleaning and disinfection C Paul

Test method for patient-used instruments after inadequate cleaning and disinfection C Paul 2009 1 ml 1% SDS /

28 Test method for patient-used instruments after inadequate cleaning and disinfection C Paul ml 1% SDS / channel Eluated with dental silk floss (SuperFloss ) shaking 30 min in 10 ml SDS OPA-method Air and water channels 28

29 Patient-used instruments after inadequate cleaning and disinfection C Paul 2009 Residual protein Number Extinction [µmol / 10 ml SDS]

30 Angle handpieces: Testing for cleaning efficacy Washer-disinfectors tested LIFEtime (KaVo) Hygiene Center (Sirona) Turbocid (micro-mega) G 7835 CD (Miele) DAC-Universal (Sirona) 30

Testing of a Testing of a device destinated for cleaning and disinfetion of dental angle handpieces D Raab 2007 Dental angle handpieces KaVO 20 LN 0.

31 Testing of a Testing of a device destinated for cleaning and disinfetion of dental angle handpieces D Raab 2007 Dental angle handpieces KaVO 20 LN 0.1 ml test soil 0.5 ml Heparin + 1 ml human blood + 1 ml Enterococcus faecium suspension 1 h drying Reprocessing Recovery (neutralization solution) 31

32 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces D Raab 2007 after contamination after inadequate cleaning 32

33 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces Log CFU/ channel D Raab 2007 Water channel Water channel Air channel K = Kontrolle HV 1 = 1x Aufbereitung HV 2 = 2x Aufbereitung HV 3 = 1x Reinigung HV 4 = 4x Reinigung HV 5 = 1x Reinigung + 4x Desinfektion O = Ausreißerwerte (liegen 1,5 bis 3 Box-Längen von der Box entfernt) * = Extremwerte 33

34 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces P Schönherr 2005 Dental angle handpieces KaVO 20 LN Test soil and method Native human blood + aqua dest. (1:2) 1 h drying Reprocessing Recovery (neutralization solution) SuperFloss in 10 ml SDS Shaking 30 min OPA-method 34

35 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces P Schönherr 2005 Residual protein Water channel A Air channel A Water channel B Air channel B 35

36 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces P Schönherr 2005 Residual protein after inadequate reprocessing [µmol / 10 ml] Water channel N = 30 Water channel N = 30 Air channel N = 30 Air channel N = 30 A A B B

37 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces E Pantazi 2010 (??) Dental angle handpieces KaVO 20 LN Test soil and method Native human blood + aqua dest. (1:2, 1:10, 1:100) 1 h drying Reprocessing Recovery (neutralization solution) SuperFloss in 10 ml SDS Shaking 30 min OPA-method 37

38 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces E Pantazi 2010 (??) after inadequate reprocessing (blood 1:2) 38

39 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces E Pantazi 2010 (??) Human blood N 1: : : Visible not Visible clean clean 39

40 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces L Radimersky 2010 (??) Dental angle handpieces KaVO 20 LN Test soil and method Native human blood + aqua dest. (1:2) 1 h drying Reprocessing Recovery (neutralization solution) SuperFloss in 10 ml SDS Shaking 30 min OPA-method 40

41 Testing of a device destinated for cleaning and disinfetion of dental angle handpieces L Radimersky 2010 (??) Residual protein ; extinction (blood 1:2) Testing of a Testing of a device device unmaintained maintained N

42 Reprocessing of dental instruments and angle handpieces Conclusions Dental instruments may be filligree / small Dental instruments may be rough Dental instruments may have lumens / channels At present there are only few washer-disinfectors which enables the user to reprocess via a validated process 42

43 Results of Petra Schönherr (2005) Christian Paul (2009) Michael Koschke (2006) Eleni Pantazi (> 2009) Daniel Raab (2007) Lars Radimersky (> 2009) Min-Jung Oh (2009) 43

Hygienic Reprocessing

Hygienic Reprocessing HEINE UniSpec Instrument head General warning and safety information: WARNING! This symbol draws attention to a potentially dangerous situation. Non-observance can result in moderate