Saving money or increasing risk?

March 1, 2012
There is no doubt that infection prevention protocols have a financial impact on dental practices.

by Mary Govoni, CDA, RDA, RDH, MBA

There is no doubt that infection prevention protocols have a financial impact on dental practices. Some experts have estimated that infection prevention protocols add as much as $15 to each patient visit — a cost that cannot be charged directly to the patient.

Supplies such as gloves, masks, equipment barriers, disinfectants, and other disposables add to overhead expense. Sterilizers, instrument cleaners, handpieces, and other equipment also add to the equation. In an effort to control these expenses, some dental teams have adopted cost containment practices that seem appropriate but actually put the practice at risk. One of the most common practices is that of using over-the-counter, or consumer, products as infection-prevention devices.

It may seem practical to use plastic food wrap or dry cleaner’s bags as equipment barriers, but the Food and Drug Administration (FDA) has not cleared these products as medical devices. Products that are cleared, such as the Pinnacle barriers from Kerr Total Care, have undergone several types of tests by the FDA to make the product claim, “protecting the patient and health-care worker from transfer of microorganisms, body fluids, and particulate matter.”

These include testing for viral penetration, tensile strength, and synthetic blood penetration. In other words, these products have proven their effectiveness at preventing contamination of equipment that can lead to an infection transmission.

While over-the-counter plastic products may provide some barrier protection, they have not been tested for effectiveness in health-care settings. It is also important to note that cloth barriers are not impervious, and may allow fluids to penetrate onto equipment. In this case, when the barriers are replaced after each patient, the equipment must be disinfected.

Patients deserve the best protection we can provide for them. Dental teams should be aware of their potential liability if a claim of infection transmission is made against a practice.

Another common practice in dentistry is the use of dishwashers to clean instruments. The cost of a dishwasher is considerably less than an instrument washer or a washer-disinfector. This increases its appeal to practices that try to save money on equipment.

But again, the dishwasher does not have FDA clearance as a medical device, and has not been tested by the FDA for effectiveness. In addition, the cleaning solutions tested and cleared by the FDA for use in ultrasonic cleaners and instrument washers are not appropriate for use in a dishwasher. The equipment warranty may be voided if such solutions are used. Dishwashers are to be used with dishwasher detergents, which do not have the enzymatic additives of instrument-cleaning solutions.

Solutions such as Enzymax from Hu-Friedy, Enz-It from Biotrol, and EmPower from Kerr Total Care are designed and tested for effectiveness in removing organic and nonorganic debris that can interfere with the sterilization or disinfection process. These solutions also have rust inhibitors to protect instruments.

Dishwashing detergents do not have these ingredients, and may actually be harmful to the finish of dental instruments. Use of instrument-cleaning solutions in dishwashers could cause the units to malfunction.

It is never a good idea to try to cut costs at the expense of patient safety. When making purchasing decisions, select products and equipment that you know have been FDA-cleared. This is your assurance that the products and equipment you use provide you and patients with maximum protection from infection and liability.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected].

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