A-dec Equipment Asepsis User manual

Owner's Guide

Equipment

Asepsis

85.0696.00

A-dec warrants its products and A-dec/W&H
handpieces against defects in material or workmanship
for one year from time of delivery. A-dec’s sole
obligation under the warranty is to provide parts for the
repair, or at its option, to provide the replacement
product (excluding labor). The buyer shall have no
other remedy. (All special, incidental, and coincidental
damages are excluded.) Written notice of breach of
warranty must be given to A-dec within the warranty
period. The warranty does not cover damage resulting
from improper installation or maintenance, accident or
misuse.The warranty does not cover damage resulting
from the use of cleaning, disinfecting or sterilization
chemicals and processes. The warranty also does not
cover light bulbs. Failure to follow instructions provided
in A-dec’s Operation and Maintenance Instructions
(Owner’s Guide) may void the warranty.

A-dec warrants A-dec dental chair cylinders, both lift
and tilt, for ten years from the date of purchase of
the chair or the cylinder. This warranty is retroactive
to A-dec chair cylinders already in the field. The
warranty covers chair cylinders A-dec finds to have
manufacturing related irregularities. Stool cylinders

are covered under A-dec‘s one-year warranty.

Warranty

NO OTHER WARRANTIES AS TO

MERCHANTABILITY OR OTHERWISE ARE MADE.

All product names used in this document are trademarks or

registered trademarks of their respective holders.

Printed in U.S.A. • Copyright © 2002 • All Rights Reserved

Equipment Asepsis

Equipment Asepsis

CONTENTS

A Message to the

Dental Professional .................................... 2

Surface Management ....................................... 3

Chemical vs. Barriers ....................................... 5

Surface Management Protocol ........................ 9

Cleaning ......................................................... 13

Surface Disinfecting ....................................... 14

Upholstered Surfaces

(Includes Dental Chairs and Stools) .......... 14

Iodophors ................................................. 15

Phenolics .................................................. 15

Other Dental Equipment Surfaces ........... 16

Upholstery Cleaners

and Conditioners ..................................... 17

Identification of symbols ............................... 18

Classification of Equipment ........................... 18

1

Equipment Asepsis

A Message to the Dental Professional

Dental equipment asepsis remains one of the
most confusing issues in dentistry today. A-dec is
committed to giving appropriate asepsis guide­lines based on these goals:

1. To encourage and support dental
professionals in practicing state-of-art
dental equipment asepsis.

2. To develop practitioner and patient confidence
in realistic, effective, and economic dental
equipment asepsis methods.

3. To provide guidance in helping practitioners
protect their dental equipment investment.

A-dec continually evaluates asepsis procedures
and products so that we can give information
consistent with the above goals. We hope that
this information proves valuable to you, and we
welcome any and all comments as we continue
in our efforts to meet your ever-changing needs.

If you have any comments, please call or write:

Infection Control Specialist
A-dec, Inc.
2601 Crestview Drive
Newberg, OR 97132
USA
1-800-547-1883

Additional information on dental infection control is
available from the Office Sterilization and Asepsis
Procedures (OSAP) Research Foundation. Write:

OSAP Research Foundation
P.O. Box 6297
Annapolis, MD 21401
USA
1-800-298-6727

2

Equipment Asepsis

Surface Management

“What surface disinfectant should I use?”

Ideally, there would be a simple answer to this
question; however, with so many infection control
requirements and increased concerns about damage
to dental equipment, there are no simple answers.

No materials available for the manufacturing of
dental equipment are impervious to every chemical,
but some materials are better than others. A-dec does
incorporate the most chemical-resistant materials
available in its new Cascade
are also thousands of dental units in service that were
produced long before the heightened attention to
infection control. Even more planning and care
must be given to prevent premature damage to
older equipment.

Just as there are no materials used in the
manufacturing of dental equipment that will
withstand every chemical, no chemical should
be considered harmless to dental equipment.
Even the surface disinfecting chemicals listed in
previous A-dec Owner’s Guides as being “least
harmful” can damage equipment over time.

®

product line, but there

In addition to the many chemicals that are
available for surface disinfecting, a wide range of
methods are used by practitioners to deal with
surface contamination. These methods can either
decrease or prolong the life of dental equipment.
For instance, some dental practices rely on
frequent copious applications of disinfecting
chemicals that may not only be unnecessary,
but also are expensive and damaging. Other
dental practices incorporate single-use barriers
and disposable items that significantly reduce
the frequency and need for chemical usage, thus
prolonging the life of their equipment.

3

Equipment Asepsis

Besides surface disinfectants, there are many
other factors contributing to dental equipment
damage. Handpiece lubricants, residual sulfur in
latex gloving, chemical sterilants, heat, humidity,
cleaning chemicals, the applicators used to apply
cleaning and disinfecting chemicals, ultraviolet
light, dental treatment materials and high
mineral content water are just a few other factors
related to dental equipment damage. There are no
simple answers for dealing with these factors and
the many others that exist in dentistry.

“Surface Management” is a term used at A-dec
to describe the collective use of products and
methods to deal with equipment asepsis issues.
With proper surface management techniques,
effective infection control can be ensured and
practitioners can protect their dental equipment
from premature damage. The question shouldn’t
simply be “What surface disinfectant should I use?”
The question should be “How can I best manage

the surfaces on my dental equipment?”

4

Equipment Asepsis

Chemicals vs. Barriers

The concerns over using chemicals versus barrier
covers are common in dentistry. We recommend
that each dental practice analyze its own asepsis
protocol based on the following:

1. Does your protocol include the specified wait
time (usually 10 minutes) for the chemical
surface disinfectant to be effective?

We often hear practitioners report that they
couldn’t possibly have their operatories down
for 10 additional minutes per patient visit. So
instead of following the label instructions on
the disinfectant product, they “do the best they
can.” Any disinfecting protocol that differs
from specified label instructions are
equivalent to not disinfecting at all. If you are
not currently waiting the specified kill-time, we
recommend that you do, or that you rely upon
a method of infection control that does not
require the 10-minute wait time. You should be
confident that your asepsis protocol is effective
and not assume that a reduced kill time will
always work.

2. When determining the cost of infection control
using a chemical protocol, do you include an
“equipment damage” factor in the cost?

By spraying a dental chair with alcohol or phe­nolic-alcohol surface disinfectants, we estimate
that in addition to the cost of the chemical, the
labor to apply it, and the operatory downtime
waiting for 10 minutes to elapse, each applica­tion will cost approximately $.50-$2.00

1

in
additional upholstery damage. If you have
concerns about cross-contamination on your
dental chair, then we recommend that you use
single-use chair barrier covers instead of caus­ing up to $2.00 damage for each patient visit!

1

Based on chemical test research conducted at A-dec.

5

Equipment Asepsis

3. Should your entire operatory be covered
in plastic?

You should analyze where barrier covers are truly
needed—on cross-contamination surfaces—then
select barriers that are simple to install and create
the least amount of waste.

4. Have you identified the most economical
balance between the use of chemicals and
barriers to develop your asepsis protocol?

(Make sure to consider all the costs, including
the hidden costs of operatory downtime and
equipment damage.)

The following analysis should help in
your decision:

2

Proper disinfecting:

• Requires approximately 5 minutes of pre­cleaning contaminated operatory surfaces to
be disinfected.

• Requires a “kill-time” specified on the label
of the chemical disinfectant. While a few
indicate a 5 minute “kill-time”, most require
10 minutes.

• Chemical cost is nearly $50 per week.

• Accumulated damage to equipment can range
between $30 and $200 per week, depending on
how damaging the cleansing chemicals are.

2

The basis for this analysis is available upon request from A-dec.

6

Equipment Asepsis

• With 10 minutes disinfectant kill-time per
patient visit, total operatory down time per
week is 15-1/2 hours.

In smaller offices, this could result in fewer
available schedule slots for patients. In
larger offices, this can result in poor
utilization of operatories.

Proper barrier use:

• Requires approximately 5 minutes of
removal and installation for operatory sur­faces to be covered.

• Amounts to approximately $93 per week in
barrier expense.

• Adds waste for disposal.
Barrier covers typically are polyethylene

products which can easily be compacted.
When compacted, the total volume of
93 “sets”

3

(one week’s volume) of barrier

covers is a little over 2 gallons (1/3 cubic foot.)

The typical home garbage can holds 35 gallons.

Even more important than any economic
argument, however, is the argument of effectiveness.
There should be no doubt in any practitioner’s mind
that the proper physical removal of a contaminated
surface is more effective in breaking the chain of
infection. With the many variables affecting disin­fection such as proper precleaning, proper chemical
coverage, proper chemical mixing, proper spray­wipe-spray technique, and so on, you can be much
more confident in the effectiveness of your asepsis
protocol if you incorporate the use of barrier covers.

3

A “set” includes barriers for the headrest, chair back,
delivery system control head, light handles, assistant’s
instrumentation holder, HVE, saliva ejector, syringes (2)
and handpiece tubings (3).

7

Equipment Asepsis

5. Are you concerned about operatory
appearance when using barrier covers?

We recommend that you use the presence of
barriers to educate your patients on how you
are protecting their health. We also
recommend that you not apply barrier covers
to surfaces that don’t need them. If your
patients are more confident because of your
barrier protocol and you use barriers only
where required, you can achieve effective
infection control and protect your equipment
investment. Being able to achieve all three
asepsis goals (refer to page 2) should outweigh
most of your concerns about using barriers.

8

Equipment Asepsis

Surface Management Protocol

Keeping previous issues in mind, the following is

A-dec’s recommended surface management protocol:

1. Heat sterilize all items that enter the
oral cavity (or use single-use disposable
replacements).

A-dec products that are designed for use in the
oral cavity include:

• High speed handpiece

• Tooth dryer

• High volume evacuation (HVE) tip

• Syringe tip
Many other items found in the dental operatory

will fall into this category as well. The items
listed above are the only current A-dec products
designed for use in the oral cavity.

4

4

While bur tools are not used in the oral cavity, they are used
on handpieces; therefore, they must also be pre-cleaned and
heat sterilized.

9

Equipment Asepsis

2. Identify and manage “touch surfaces” and
“transfer surfaces”, reducing their number

in the dental operatory.

“Touch surfaces” are those areas that require con­tact and become potential cross-contamination
points during dental procedures. The key word is
“require”. Many surfaces in the dental operatory
could be touched during dental procedures, but
only a few require touching. For example, dental
lights typically are repositioned (and thus,
touched) during most procedures. If only the
light handle is touched during this positioning
and not the housing, arm or other parts of the
light, the number of touch surfaces has, in effect,
been minimized. Also, the light switch could be
operated with the forearm, eliminating it as a
touch surface.

Surfaces contaminated by contact with
instruments or other inanimate objects are
identified as “transfer surfaces”. Handpiece
holders and instrument trays are examples of
transfer surfaces. Well thought-out operatory
setup and disciplined chairside procedures
will contribute to reducing the number of
transfer surfaces in the operatory.

10

3. Use barriers (covers) on all touch surfaces
and transfer surfaces (unless the surface is
on an item that enters the oral cavity, which
must be heat sterilized or disposed of).

Replace barriers between patients. Use barriers
made from waterproof material. Use care to
not cross-contaminate when removing a
contaminated barrier cover.

Equipment Asepsis

4. Use surface disinfectants on touch surfaces
and transfer surfaces between patients only
when it’s evident that the barriers have been
compromised, and once at the end of each
clinic day.

Always follow the label instructions on surface
disinfectant products, including any specified
kill-time.

5. Use mild cleaners on all “splash and
splatter surfaces”.

“Splash and splatter surfaces” (also referred to as
“aerosol surfaces”) include all operatory surfaces

which are not touch surfaces, transfer surfaces,
or parts of items that enter the oral cavity.

Use surface disinfectant on a “splash and
splatter surface” only when it has been visibly
contaminated. At least once each day, clean
all splash and splatter surfaces with a mild
cleaning solution. Never use abrasive
cleansers, brushes or scrubbing pads. Damp
surfaces should always be dried with a lint­free cloth.

Limit the touching of splash and splatter
surfaces to those who wear cleaning gloves
while performing cleaning procedures.

5

Do not use “latex gloves”for cleaning procedures. “Cleaning
gloves” should be made from nitrile rubber.

5

11

Equipment Asepsis

6. Use chair headrest barriers.

The adjustment knob or lever on the back of a
chair headrest is a touch surface that may
need to be adjusted mid-procedure and should
therefore be covered with a barrier. The
headrest barrier will also protect the chair
vinyl from the many hair treatment products
used by your patients that could damage your
headrest upholstery.

Replace headrest barriers between patients.
Again, use care to not cross-contaminate when
removing a contaminated barrier cover.

7. Minimize the use of surface disinfecting
chemicals on upholstery vinyl.

Use surface disinfectants on upholstery vinyl
between patients only when barriers have
been compromised.

Use cleaning and barriers as your primary
asepsis approach on chair upholstery.

12

If cross-contamination on chair upholstery is
a concern, we recommend the use of barrier
covers for the chair instead of relying on
chemicals. Barriers will significantly extend
the life of your chair upholstery. If used for

infection control, barriers must be replaced
between patients.

Equipment Asepsis

In following the recommended surface manage­ment protocol, you will focus more on cleaning
environmental surfaces which are not points of
cross-contamination:

Use a solution of mild non-ionic detergent
and water, or commercially available cleaners
containing no alcohol, bleach, or ammonia.
Common dishwashing detergent is usually
non-ionic.

Because the hardness of water varies from locale
to locale, you should experiment to determine the
best mix of detergent to water. Mix just enough
detergent to allow for good cleaning without
leaving a soapy film on the surface.

Never use abrasive cleansers, scrubbing pads, or
other abrasive applicators because they can
permanently scratch or otherwise damage
equipment surfaces. Be careful in using recycled
paper products, such as paper towels, that some­times are more abrasive than first-use products.

Cleaning

13

Equipment Asepsis

Surface Disinfecting

A wide variety of chemical surface disinfecting
products are available for use in the dental opera­tory. Their availability, however, should not be
construed as an indicator of either efficacy or
safety to the equipment.

There are many complicating matters when it
comes to selecting a surface disinfecting product.
Infection control experts do not always agree on
which chemical is “the best” for killing microbes. It
is also very important to note that chemical product
formulations can be changed by the manufacturers
without notice. New formulations are introduced all
the time. Also, government agencies will continue
to monitor these products and periodically change
regulations that will affect their availability.
Because of the dynamic nature of the chemical
surface disinfectant industry, your selection of a
disinfectant should be dependent on your overall
equipment asepsis protocol, instead of simply
choosing a particular brand.

When considering how to prevent damage
from surface disinfecting chemicals, the dental
operatory should be analyzed under two
categories, upholstered surfaces and all other
dental equipment surfaces:

Upholstered Surfaces
(Includes dental chairs and stools.)

Upholstery discoloration, cracking and drying
from the use of surface disinfectants is probably
the most frequently discussed damage to dental
equipment. The very nature of upholstery
materials—soft, comfortable surfaces along with
designer colors—is contrary to the application of
harsh, microbe-killing chemicals.

14

Equipment Asepsis

While they are famous for their orange-yellow
staining, iodophors can cause the least amount
of permanent structural damage to upholstered
surfaces. If our recommended protocol is followed
(refer to “Surface Management Protocol”), then a
minimum number of iodophor applications will
be needed. The recommended protocol, with the
use of iodophors only when necessary, can pre­vent premature damage to upholstery when
combined with routine cleaning (with detergent
and water) along with the occasional use of an
iodophor neutralizer

6

.

Phenolic surface disinfectants are available in
two primary formulations, alcohol-based and
water-based.

Iodophors

Phenolics

Alcohol-based phenolic disinfectants are very
damaging to soft plastics such as those used in
upholstery materials.

High-dilution water-based phenolic disinfectants
are not as damaging as alcohol-based phenolic
disinfectants. However, like all chemicals, they
should not be considered “safe.” But when care­fully used with the Surface Management Protocol
in this manual, premature damage to upholstery
may be avoided.

CAUTION

Using most other commonly available surface
disinfecting chemicals can prematurely and
permanently damage upholstered surfaces.

6

Usually containing sodium thiosulfate.

15

Equipment Asepsis

Other Dental Equipment Surfaces

If our recommended surface management protocol
is followed, then the main concern is with surfaces
that can contribute to cross-contamination: touch
surfaces and transfer surfaces. If these surfaces are
covered with barriers that are properly installed and
removed between patients, the amount of needed
chemical surface disinfecting will be reduced. Only

one surface disinfecting procedure is needed (at
the end of the clinic day) if barriers are properly
installed and removed between patients. While

the possibility of damage from chemicals is less on
hard dental equipment surfaces (as compared to the
damage upholstery can incur), we still recommend
the more economical and effective barrier protocol.

The following chemicals have the most detrimental
effect on A-dec dental equipment surfaces:

16

• 5.25% sodium hypochlorite
(household bleach)

7

• Glutaraldehyde

• Ethyl alcohol (50% or higher concentrate)

• Isopropyl alcohol (50% or higher concentrate)

• Alcohol-based phenolics

In addition, most foam spray products can cause

premature damage to dental equipment.

7

A solution of 1 part 5.25% sodium hypochlorite (household
bleach) to 9 parts water is recommended to disinfect the internal
components of the A-dec Self-contained Water System. Refer
to Self-contained Water System Owner’s Guide, A-dec
Publication No. 85.0675.00.

Equipment Asepsis

Upholstery Cleaners and Conditioners

Much confusion exists over whether or not the
many available commercial upholstery cleaners
and conditioners should be used on dental chair and
stool upholstery. These products, many of which are
silicon-based, were developed primarily for the auto­motive industry. While they improve appearance
and are gentle to upholstery materials, they may
complicate the cleaning and disinfecting process by
creating inconsistent surface characteristics on the
upholstery. One part of the upholstery might be
sealed with silicon and another part may not. This
may affect the efficacy of surface disinfectants.

Hundreds of upholstery cleaners and conditioners
are designed for upholstery material, and are
formulated from many different chemicals.
Whatever chemical product you choose, you
should first experiment on an upholstery surface
that is hidden from view to determine if there is
any negative interaction.

17

Equipment Asepsis

Identification of Symbols

Recognized by Underwriters Laboratories Inc. ®
with respect to electric shock, fire and mechani­cal hazards only in accordance with UL 2601-1.
Recognized with respect to electric shock, fire,
mechanical and other specified hazards only in
accordance with CAN/CSA C22.2, No. 601.1.

UL listed to US (UL 544) and Canadian

LISTED

(CAN/CSA C22.2, No. 125) safety standards.

Classified by Underwriters Laboratories Inc. ®
with respect to electric shock, fire and mechani­cal hazards only in accordance with UL 2601-1.
Classified with respect to electric shock, fire,
mechanical and other specified hazards only in
accordance with CAN/CSA C22.2, No. 601.1.

Conforms to European Directives

(refer to Declaration Statement)

Protective earth (ground).

Functional earth (ground).

Attention, consult accompanying documents.

!

TYPE B APPLIED PART.

CLASS II EQUIPMENT.

Type of shock protection:

Classification of Equipment

CLASS I EQUIPMENT
(Dental Chairs, Dental Lights, & Power
Supplies)

18

(EN 60601-1)

Equipment Asepsis

CLASS II EQUIPMENT
(Chair, Wall, & Cart Mounted Delivery Systems)

Degree of shock protection:

TYPE B APPLIED PART (All products)

Degree of protection against water ingress:

ORDINARY EQUIPMENT (All products)

Mode of operation

CONTINUOUS OPERATION
(All models except Dental Chairs)

Mode of operation

CONTINUOUS OPERATION WITH
INTERMITTENT LOADING (Dental Chairs)

Environmental

Storage - Temperature: -40°C to 70°C (-40°F to 158°F)

Relative Humidity: 95% maximum

Operating - Temperature: 10°C to 40°C (50°F to 104°F)

Relative Humidity: 95% maximum

Electromagnetic Compatibility

This equipment has been tested and found to comply
with the
limits for medical devices in IEC 601-1-2:1994. These
limits are designed to provide reasonable protection
against
harmful interference in a typical medical installation.
Contact A-dec Customer Service if you have any ques­tions.

Flammable Gasses

Not suitable for use in the presence of a flammable
anesthetic mixture with air, oxygen, or nitrous oxide.

19

A-dec Inc.

2601 Crestview Drive

Newberg, Oregon 97132

USA

Tel: [phone] Within USA/Canada

Tel: [phone] Outside USA/Canada

Fax: [phone]

Website: www.a-dec.com

A-dec International Inc.

2601 Crestview Drive

Newberg, Oregon 97132

USA

Tel: [phone]

Fax: [phone]

Website: www.a-dec.com

A-dec United Kingdom

Austin House

11 Liberty Way

Nuneaton, Warwickshire CV11 6RZ

England

Tel: 0800 ADECUK (233285) Within UK

Tel: [phone] Outside UK

Fax: [phone]

Website: www.a-dec.com

85.0696.00
2002-4 Rev H
(03597)

A-dec Australia

41-43 Bowden Street

Alexandria NSW 2015

Australia

Tel: [phone]

Fax: [phone]

Website: www.a-dec.com.au

Made with recycled paper.

Printed in USA.

Copyright © 2002,

All Rights Reserved.