by John A. Molinari
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The DEVELOPMENT and AVAILABILITY of an increasing array of disposable items for use in the health professions have accelerated dramatically in recent years. In addition to the long–standing list of disposables such as anesthetic carpules, syringe needles, scalpel blades, cotton rolls, and gauze, applicable examples for dentistry include prophylaxis cups and brushes, matrix bands, dental dams, saliva ejectors, high volume evacuation tips, impression trays, and air–water syringe tips.
By definition, a single–use disposable device is intended to be used on one patient and then discarded. A true disposable device is not intended to be cleaned and sterilized for reuse since it is not typically manufactured as easy–to–clean or heat–tolerant. Even as you continue to use more disposables in your practice, you might readily recall previous examples of similar items that were routinely used during treatment, then cleaned and sterilized before being reused.
One of the recent infection–control areas of discussion involves dental burs. The question is whether to clean and reuse or treat them as single–use disposable items. Looking at this from an infection–control viewpoint, multiple considerations support the practice of disposing burs after use.
The first is that we can eliminate the risk of patient–topatient cross–infection with a contaminated item when a bur is not used on a subsequent patient. A second reason is that time–consuming cleaning and sterilization procedures can be eliminated. Dentists tend to forget the time a team spends scrubbing burs and diamonds prior to sterilization, and the financial cost of that time.
Studies indicate that they may not even be free of bioburden after reprocessing. Since initial cleaning remains at the heart of infection–control principles and practices, an inability to remove oral debris from used burs before sterilization reinforces the disposable viewpoint.
In addition to the time required and the efficacy of reprocessing, personnel must also be aware of the potential for accidental sharps exposure, especially when hand scrubbing is the method used to clean. Even though we are asked to report these types of accidents and follow up with specicific postexposure protocols established for the practice setting, many people who have experienced a bur accident relate that they did not follow through afterward.
The result is that, traditionally, the number of accidental sticks with burs has been greatly underreported, and therefore underappreciated as to their actual incidence. Besides the understandable concern of the injured dental health–care professional, a postexposure scenario with an outside qualified health–care professional can involve counseling the injured person, assessing microbial transmission risks, and serologic evaluation of potential hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) risk.
In some instances, consultants may recommend postexposure prophylaxis with chemotherapeutic drugs as a precaution. Even though an accident with a solid item, like a surgical bur, is generally considered to present lower occupational blood–borne pathogen risk than a similar incident with a syringe needle (i.e., a hollow bore device), the cost for a single sharps postexposure follow–up can be substantial.
In addition to the concern for accidental exposure to HBV, HCV, and HIV, remember that there are numerous, more readily transmissible oral bacteria that can cause occupational infections following a sharps accident. I can recall seeing three staphylococcal and streptococcal pyodermas that developed following accidental sticks with contaminated burs.
Some might argue that the cost of replacing burs continues to rise and transmission of infection from “sterilized” burs to patients has yet to be documented. As I write this column, my wife — who is a dentist — reminds me of the direct economic impact the cost of replacing burs can have in an era of rising overhead costs.
Most bur and diamond companies now offer low–cost disposable burs and diamonds that lower the cost of purchase to the point that it is more economical to discard them than to sterilize them. These are about $1 for burs and slightly more than $1 for diamonds. From a clinical standpoint, you also will always be using a sharp bur or diamond.
Dr. John A. Molinari is Director of Infection Control for THE DENTAL ADVISOR. Previously, he was Professor and Chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at [email protected].