The guest editorial, “Sterilization requirements for the placement of temporary anchorage devices,” in the April 2009 supplement (Scholz RP, Cook A. Am J Orthod Dentofacial Orthop 2009;135:S20-2) asked the sort of real-world orthodontic sterilization questions that many orthodontists have as they begin to place miniscrew implants (MSIs). New orthodontic treatment protocols can require new equipment, education, and hands-on team training for successful practice implementation. Patient well-being and excellent orthodontic care are always the first priorities for orthodontists when introducing new treatment protocols.
I first attended a seminar on MSIs in 2005 at the International Orthodontic Congress in Paris. I was honored to speak there on orthodontic instrument sterilization, and I attended an Italian orthodontist's presentation on MSIs. As I listened to her words and looked at the photographs, my first thought was “what a great treatment option for orthodontic patients.” And my second thought was “orthodontists and orthodontic assistants will want checklists and training on sterile assurance for MSIs to ensure patient safety and prevent potential infection complications for this surgical orthodontic procedure.”
As a microbiologist, I closely review the literature and science on infection prevention, sterilization, and safety. As an orthodontic consultant, my goal is to implement efficient, cost-effective protocols that meet standards set by state dental boards, the Centers for Disease Control, the Food and Drug Administration, and the Occupational Safety and Health Administration. Sterilization is a challenge for fast-paced orthodontic teams treating 80 to 120 patients per day, and cleaning and sterilizing 500 to 1000 instruments per day. As the Centers for Disease Control guidelines state, sterilization is a complex process.
Dr Scholz and Ms Cook provided a good summary of the sterilization requirements with practical implementation tips for placing orthodontic MSIs. Sterile placement requires that the implant is not contaminated during placement. Contamination of MSIs is possible if nonsterile gloves touch the implant, the implant rests on a nonsterile tray cover, or the instruments used to place the implant are not sterile because of unpackaged storage after sterilization. Contamination could result in micoorganisms causing an osseous infection. Yes, infection is a remote possibility for MSIs, but providing sterile implant placement is the right thing to do. Thank goodness for the open forum discussion and research published in the AJO-DO. Sharing information contributes to and ensures continued orthodontic professional excellence.
I would like to correct 2 statements in the editorial.
1.Waterline maintenance tablets for dental unit water bottles disinfect water, but they do not sterilize. Closed water systems can have up to 500 colony-forming units per milliliter; this could contaminate a surgical site. Therefore, sterile water should be purchased from a dental or medical supplier if needed for surgical irrigation. A sterile bulb or syringe should be used for irrigation.
2.The sterile instrument package protocol discussed in the editorial is the FDA requirement for implantable devices, not for surgical instruments. The sterile package protocol for surgical instruments includes the following steps.
1.Dry and visually inspect instruments for debris.
2.Place instruments in a self-sealing or heat-sealed plastic or paper pouch, or wrap cassettes with central sterilization room wrap and seal with autoclave tape. Double-package or double-wrap surgical instruments so that the outer package (which might have been contaminated during storage or transport) is removed when setting up for the surgical procedure.
3.Chemical indicators should be on the outside and inside of the package. Some self-seal sterilization pouches have internal chemical indicators printed inside the package. If the pouch does not have an internal chemical indicator, indicator strips can be added to the the instrument package or cassette before sealing. The internal chemical indicator ensures that the sterilizing agent (steam) touched the surface of the instruments. An internal chemical indicator provides a higher level of sterility assurance but is not required at this time.
4.Sterilize.
5.Allow the sterile instruments packages to dry in the autoclave; do not remove wet packages.
6.Store sterile instrument packages in closed or covered cabinets or drawers.
Emerging antibiotic-resistant diseases, medically compromised patients, and new orthodontic treatment protocols require continued practice improvements. Sterilization is a changing world. The Centers for Disease Control published new “Guidelines for Disinfection and Sterilization in Healthcare Facilities” in the fall of 2008. The orthodontic specialty is dynamic, constantly improving, and changing. New treatment protocols, new techniques, and new equipment such as MSIs can seem complicated and perhaps intimidating at first. Orthodontists sharing knowledge, training, checklists, and systems can ensure excellent, safe orthodontic care for every patient.
Jackie Dorst, RDH, BS, is a consultant on infection prevention, safety, and instrument sterilization. She is a member of the Organization for Safety & Asepsis Procedures, the Association for Professionals in Infection Control and Epidemiology, the National Speakers Association, and she is OSHA certified to deliver safety training courses.
Fernandina Beach, Fla
∗The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.
FULL TEXT