Patient care items are those instruments, devices and equipment use in the delivery of the dental service. They may be categorized as critical, semi-critical or non-critical depending on their potential for source of infection.
• Critical items are used to penetrate soft tissue or bone. They have the greatest risk of transmitting infection.
• Semi-critical items are those that superficially touch mucous membranes or non-intact skin. They have a lower risk of transmission.
• Non-critical items contact only the intact skin. Skin is considered a natural barrier to microorganisms.

When the equipment or environmental surface is visibly contaminated with blood or OPIM, an EPA-registered hospital disinfectant with a tuberculocidal claim (ie, intermediate-level disinfectant) should be used. Cleaning or disinfection of certain noncritical patient-care items can be difficult or damage the surfaces; therefore, use of disposable barrier protection of these surfaces might be a preferred alternative.

FDA-cleared sterilant/high-level disinfectants and EPA-registered disinfectants must have clear label claims for intended use, and manufacturer instructions for use must be followed. Three levels of disinfection—high, intermediate, and low—are used for patient-care devices that do not require sterility and two levels—intermediate and low—for environmental surfaces. The intended use of the patient-care item should determine the recommended level of disinfection. Dental practices should follow the product manufacturer’s directions regarding concentrations and exposure time for disinfectant activity relative to the surface to be disinfected. A summary of sterilization and disinfection methods is included.

RECOMMENDATIONS:

1. Use only FDA-cleared medical devices for sterilization and follow the manufacturer’s instructions for correct use.
2. Clean and heat-sterilize critical dental instruments before each use.
3. Clean and heat-sterilize semi-critical items before each use.
4. Allow packages to dry in the sterilizer before they are handled to avoid contamination.
5. Use of heat-stable semi-critical alternatives is encouraged.
6. Reprocess heat-sensitive critical and semi-critical instruments by using FDA-cleared sterilant/high-level disinfectants or an FDA-cleared low temperature sterilization method (eg, ethylene oxide). Follow manufacturer’s instructions for use of chemical sterilants/high-level disinfectants.
7. Single-use disposable instruments are acceptable alternatives if they are used only once and disposed of correctly.
8. Do not use liquid chemical sterilants/high-level disinfectants for environmental surface disinfection or as holding solutions.
9. Ensure that noncritical patient-care items are barrier-protected or cleaned, or if visibly soiled, cleaned and disinfected after each use with an EPA-registered hospital disinfectant. If visibly contaminated with blood, use an EPA-registered hospital disinfectant with a tuberculocidal claim (ie, intermediate level).
10. Inform DHCP of all OSHA guidelines for exposure to chemical agents used for disinfection and sterilization. Using this report, identify areas and tasks that have potential for exposure.