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Infection Prevention and Control Strategies for Managing Reusable Medical/Dental Instruments and Devices in Ambulatory Care Settings

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Ambulatory healthcare facilities — such as clinics, surgery centers, medical offices, and dental offices — must make concerted efforts to prevent and control the spread of infectious diseases and outbreaks. As more patient care services have shifted from inpatient to outpatient settings, the importance of infection prevention and control (IPC) has become more pronounced — and, in the wake of the COVID-19 pandemic, concerns about IPC have reached new heights.

A number of methods can help practitioners and staff members in ambulatory healthcare facilities prevent and control outbreaks of infections and other infection-related adverse events. One area to target as part of infection control initiatives is the appropriate and thorough decontamination of reusable medical/dental instruments and devices. Examples of these items include thermometers, otoscopes, stethoscopes, forceps, ultrasound equipment, blood glucose meters, blood pressure cuffs, dental handpieces, periodontal scalers, etc.

Healthcare providers and staff members should consider the following risk management strategies related to medical/dental instruments and devices as part of their overall IPC plan.1

Strategies for Reprocessing Reusable Medical/Dental Instruments and Devices

  • Make sure that reusable instruments and devices are clearly differentiated from single-use disposable devices.
  • Reinforce to providers and staff members that single-use disposable devices should not be reused under any circumstances or in any situation.
  • For each reusable instrument or device, determine the level of disinfection or sterilization needed. The level will depend on how the item is used.2
    • Critical instruments/devices are those that penetrate sterile tissue, bone, or the vascular system; they require thorough cleaning and sterilization.
    • Semi-critical instruments/devices are those that contact mucous membranes or skin that is not intact; they require thorough cleaning and high-level disinfection.
    • Noncritical instruments/devices are those that contact only intact skin; they require low-level disinfection.
  • Develop written policies and procedures for reprocessing reusable devices.
  • Keep policies, procedures, and manufacturer’s reprocessing instructions for reusable devices in reprocessing areas.
  • Provide training and validate competency for employees who reprocess reusable devices. Training should occur at least annually and when new equipment is introduced.
  • Provide thorough guidance for the appropriate use of personal protective equipment during reprocessing procedures.

Strategies for Sterilizing Reusable Medical/Dental Instruments and Devices

  • Ensure that the facility’s IPC policies require appropriate cleaning, decontamination, and sterilization of critical reusable instruments and devices.
  • Establish standards for routine maintenance of sterilization equipment according to manufacturers' instructions.
  • Implement biological monitoring of the sterilization process.
  • Develop written policies and procedures for managing reprocessing errors or failures.

Strategies for High-Level Disinfection of Reusable Medical/Dental Instruments and Devices

  • Ensure that the facility’s IPC policies require at least thorough cleaning and high-level disinfection for reusable semi-critical instruments and devices.
  • Make sure that high-level disinfection procedures require use of Food and Drug Administration-cleared high-level disinfectants and manufacturers’ recommended exposure conditions. Ensure adequate supplies of the product(s).
  • Develop a system for identifying which instrument was used on which patient.
  • Perform routine maintenance on high-level disinfection equipment according to manufacturers' instructions.

Strategies for Low-Level Disinfection of Reusable Medical/Dental Instruments and Devices

  • Implement a policy for low-level disinfection of noncritical medical/dental instruments and devices. Disinfection should occur periodically or when the items are visibly soiled.
  • Ensure that adequate supplies of a disinfectant or germicide approved for use in healthcare facilities are available and accessible to staff.

For more detailed information about reprocessing reusable medical/dental instruments and devices, see the various resources from the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee as well as the Association for Professionals in Infection Control and Epidemiology’s disinfection and sterilization resources.

Endnotes


1 Note: The types of instruments and devices used in ambulatory healthcare facilities vary. Not all guidance in this document applies to all facilities. Healthcare leaders, providers, and staff should determine appropriate IPC efforts based on their facilities and patient populations.

2 Centers for Disease Control and Prevention. (2016, September). Guide to infection prevention for outpatient settings: Minimum expectations for safe care (Version 2.3). Retrieved from www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html; Centers for Disease Control and Prevention. (2016, October). Summary of infection prevention practices in dental settings: Basic expectations for safe care. Retrieved from www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm

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