The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#158 Dental Lab Makeover
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Technology is not only impacting sterilization centers, it's also impacting many lab procedures. This in turn impacts worker safety and compliance. Has your lab undergone a "makeover" recently with newer products and devices? If so, check out this episode of the Compliance Divas.
- CDC Guidelines: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
- From Policy to Practice: OSAP's Guide to the CDC Guidelines (2022 Edition): https://www.osap.org/from-policy-to-practice-osap-guide-to-the-cdc-guidelines-2022-edition
Welcome.
SPEAKER_03I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Wan, and together we are the Compliance Divas.
SPEAKER_01Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Any resources that we mentioned during the podcast can be found on the website. And we invite you to submit questions to support at the compliancedevas.com. And don't forget, at the end of this podcast, scroll down and leave us a review. Have you noticed how technology is not only impacting our sterilization centers? It's also impacting many labs and lab procedures. This in turn impacts worker safety and compliance. So has your lab undergone a makeover recently with newer products and new devices? Let's talk about that a little further. And before we talk about what's new in labs and what's happening, Mary, I'd like to talk with you first and ask you to go back and let's just start with a basic review of how our listeners should manage impressions for those that are still taking impressions for lab work.
SPEAKER_03Thanks, Linda. And I think this is a very, very relevant topic because with more emphasis on digital impressions, we forget about those that are not digital. They're, I guess we would call them analog impressions. And we are required under this CDC guidance to disinfect those items before we do any manipulation, like pouring them up, or before they're sent to a dental lab. That comes under the OSHA rules as well, under bloodborne pathogens, that any items that are sent from the practice must be disinfected or sterilized. So sterilization would apply to instruments or hand pieces, disinfection, obviously, to impressions. So you need to start with, first of all, knowing what is compatible with the impression material that you're using. And can you immerse or should you spray an impression and what is the contact time and making sure that you're not going to let it sit too long so that there's a possibility of the impression being distorted. I see fewer people using the old type of alginate, the water, powder and water that you hand mix, more people now using a VPS or a vinyl type of impression or alginate substitute. And most of those vinyl materials are compatible with pretty much all of the disinfectants that we use. But if you're in doubt, check with the manufacturer of the disinfectant or check with the manufacturer of the impression material. They may have recommendations. Now I hear questions, and I'm sure that the rest of the divas do, um, from um practices that we work with, and they say, well, why do I have to disinfect this impression? Because they're just going to do it again at the lab. Well, the reason the lab does it, in my opinion, is that they probably don't trust that you've done it. So they're they're duplicating the process. But again, the bloodborne pathogen standard says that anything that is um sent out of a facility must be disinfected first. So it might be a good thing to put something on your lab case slip or on the impression that's bagged up to be sent that it has been disinfected, just so the lab knows. They certainly indicate that to you when they send it back to you.
SPEAKER_01Mary, those are some great tips, and I loved your comparison between the digital and the analog. That was clever. But oftentimes, you know, I've been in labs over the years, and I've read been on a lot of dental practices, each of us have, and I hear it from both sides. Well, the office never disinfects the impression, and the lab says, you know, and they vice versa. So it's a good reminder for all of us. Doesn't matter who you think is supposed to do it, the responsibility lies with you. So disinfect those uh lab impressions before sending them out. I'd like to call on our diva, Olivia, and ask about any chemicals that are used in the lab. Olivia, what are you finding? Uh, maybe some of the new chemicals or old chemicals. What can you and shed some light on for us, please?
SPEAKER_02Well, one, Linda, is recognizing that we do have hazardous chemicals in the dental lab. Uh, for example, there's co-tray cleaner, there may be uh glutaraldehyde, cold sterile solution, uh, and other chemicals being used there. So, one, we want to make sure that we have the safety data sheet on file and that it's listed on the inventory. And then if these containers are secondary containers, meaning it's come out of its original container, we want to put a pictogram label to identify what the chemical is and select the pictogram that corresponds to the hazard. Also, I wanted to make mention that I find it handy and I keep it on my desk as a reference, is OSAP's publication, Infection Control from Policy to Practice, OSAP's Guide to the CDC guidelines. And there is such helpful information in the book. And one of the points that it makes out makes is on page 121 always consult the impression material manufacturer on the stability of specific materials during disinfection. So to avoid distorting it or ruining it, we want to follow the manufacturer's instructions. And then OSAP lays out the different types of impression material and then the types of disinfectant agents that could be used, which is helpful. So I just want to emphasize, Linda, making sure that items are labeled. My experience of auditing dental offices is the dental lab typically is the most sloppy, messy area. Uh patients don't go in there and it's just sometimes in disarray and uh powder on the countertops. So we want to pay close attention and making sure it is a safe place, particularly when using these chemicals that have hazardous ingredients.
SPEAKER_01Olivia, you raised some very valid points about those different chemicals because that brings us back then to being sure that our listeners are compliant with OSHA's hazard communication standard with the labels, the pictogram labels that you mentioned, and having the SDS sheets, not to mention the proper PPE in the lab as well. And when you have those fine particles, um I'll I'll use the phrase flying around the lab, uh, you know, although it's not very technical, we're subject to inhaling those. So having proper ventilation, wearing the right mask, and PPE is also important. And I think Mary'd like to share some thoughts.
SPEAKER_03Absolutely, and you completely set it up for me with the particles flying around because OSHA has a relatively new standard on respirable clinic crystalline silica, and silica is in many of the um materials that are worked with in the laboratories that are used for making appliances. And so if we don't have appropriate PPE on and we don't have appropriate exhaust near where those materials are polished, that standard probably affects our commercial dental laboratories more. But um, as we were discussing among ourselves earlier, there are a lot of dental practices now that have their in-house laps. So that's something that every practice needs to be aware of that there is that risk. Silicosis of the lungs is a very serious and can be a fatal um disease. So we need to be very careful about dust particles.
SPEAKER_01Mary, on top of that, you mentioned something very interesting, and that is again having an on-site dental lab. So while the purpose of this podcast is not to discuss legal requirements, this would be a good time to remind our listeners that if you are thinking of setting up a lab in your dental practice, talk to the state dental board, know the guidelines, because that laboratory may need to have a separate license and whatnot, and to be compliant there. Let's call in our diva Leslie. Leslie, if I could ask you to please address how to handle metal trays versus disposable trays.
SPEAKER_00Well, Linda, this is a very um common error that I see in dental offices, the reuse of a single-use disposable plastic impression tray. And when I ask about why they're reusing them, they say, Well, I tried in the impression tray and it didn't fit. So what they want to do is process it in cold sterile and use it on another patient. And of course, there's no instructions for single-use disposable items to be reprocessed in any way, shape, or form. So my recommendation is why not try using a metal tray and then you try that in and get the correlating uh plastic tray. That way you know your size, because metal impression trays can be heat sterilized, and everything that we possibly can heat sterilize, we want to go that way. And of course, packaging and wrapping our impression trays is important as well. I'd like to touch on uh just a couple of little thoughts that come across my mind when you talk about uh disinfection or sterilization, is I think a lot of times I'm finding that dental offices are not taking the steps to spray disinfect their impressions. And that's after they're removed from a patient's mouth, after the saliva's been rinsed off. And and then uh they're also uh reluctant again to uh spray or disinfect partials and dentures and prosthesis, and not only before taking them into their lab to adjust them, but then again when they bring them back to the patient. When I ask why, I see I hear that, well, it just takes too much time and you know we're just making a little adjustment. But infection control is important and we're not bringing infectious agents into the laboratory from the chair side.
SPEAKER_01Leslie, one of my pet peeves is when it's a brand new appliance and they need to polish it or before it's gone into the patient's mouth, and they use the dirty old pumice that's sitting on the on the tray or dirty rag wheel, and they're more worried about bringing in a contaminated item, but now they don't think about the contamination they may be taking to the patient's mouth. So those are some very good points indeed. Follow-up question, Leslie?
SPEAKER_00Well, yes, and I just wanted to point out again state dental boards might mandate uh either a new or sterilized rag wheel, which remains in the pouch until a time of use, or uh they may also mandate the requirement for fresh or new premise for each appliance. So that's something that I think uh again, we oversee overlook that. I see in a lot of dental offices where you can tell that that pumice has been used over and over and over and over again. And I wanted it, while we're talking about polishing, it brought to mind PPE when you're in the lab, making sure that you have adequate eye protection or even face protection and a sign that reminds everyone to use the uh protective attire when they're using a model trimmer or the polishing lathe.
SPEAKER_01Leslie, when you talked about using the same pumice over and over again, it reminded me of years ago when I was in a practice and I saw the pumice tray full of pumice. And the dull assistant told me that she sprayed it down in between patients with the disinfectant. So we had to adjust that protocol so that it became unit dose. And by that I mean a small amount of pumice on a clean tray, whether it's a piece of tinfoil or a plastic bag that can be pulled out and changed in between every patient. Uh Mary, what thoughts do you have?
SPEAKER_03Well, Leslie had mentioned um something about state dental boards having to um having requirements about reuse of pumice or rag wheels. Well, it's written in the CDC guidelines that they should not be reused. They should be pumice should be dispensed only for one patient. And um rag wheels can be um even heat sterilized, or there are disposable rag wheels that work just fine for um for polishing. It's um not a rag wheel is not something we'd necessarily want to soak in gluteraldehyde because you're never going to get all that out. Now you're gonna be rotating it around on the lathe and potentially causing some chemical contamination, more particles flying around. So, yeah, we should, as you said, Linda, line the pan, only put out as much pumice as you need for that particular patient and replace that when you're done. And every patient should have their own rag wheel.
SPEAKER_01Great tips, Mary. Levy, what are your thoughts?
SPEAKER_02I just wanted to mention that uh food and drink, you know, the same rules that apply to clinical areas where patients are served, that we must refrain from consuming food, snacks, drinking beverages, applying chapstick, handling contact lenses. The same is true in the dental lab area. I have seen offices where there's a collection of water bottles and cups and mugs and things like that, or even worse yet, someone's working on a case and sipping on coffee. So uh the same rules apply to that area.
SPEAKER_00It brings to mind um sometimes when we are in our dental laboratory, I know we're in a hurry, and I see a lot of times sandblasters that they use and where the sleeves, which are supposed to contain all of that particulate material that could be either inhaled or aerosolized outside, many times the sleeves are either bent or they're old and cracked and not really functioning anymore. Or they place the little sandblaster wand on the uh sleeve, on the plastic sleeve, and that bends it so that it people can't uh rely on that uh particulate to remain inside of the sandblaster.
SPEAKER_01That's another good tip, Leslie, something we have forgotten about. So thank you for bringing that to our attention. Divas, I'd like to turn the conversation with labs to some of the new technology that I see offices using. And I have a number of clients when I've walked in their office recently, I see that their lab has gone through what I call an HDTV makeover because the upper cabinets have been removed, they have digital printers and just bigger devices now. So, of course, there's no room for the cabinets in the top. And it's much cleaner and neater to some degree, as we've mentioned earlier, when you like, as I think Olivia said, because when you were talking about the um plaster and ever and powder everywhere, it reminded me of just how I've seen some of the eyewash stations frozen over because plaster's gotten in those little and the eye in the valves. So let's talk about that for a moment because some of the wands and the digital scanning machines, the wands can be disposable or reusable. And knowing how to handle those properly is very important. And I've seen some of the reusable ones. Um, companies actually give directions for how to sterilize them. In other words, um, they you know, put them in a package, they recommend they put a gauze on top of the mirror so that way uh it doesn't damage, you know, or get scratched during the sterilization process and different things along those lines. So I was wondering, Divas, have you all seen anything else that you'd like to share?
SPEAKER_03I have had clients tell me that their sales rep has told them just use a two by two and alcohol on those some of those devices. And my answer is always what you alluded to earlier. We have to follow the manufacturer's instructions. Um, but we also have to make sure that what we're doing would be compliant with CDC guidelines. So there's, I think it's kind of all over the place what the instructions are with those devices. Um, for some, barriers can be used. For some, people will say that the barrier interferes with the scanning properties. So um there's probably a huge discussion that needs to go on with um manufacturers of those um products or those devices so that we can kind of get on the same page. But I've discouraged people from just wiping things down with alcohol because we know that alcohol is not meant to be a disinfectant because um we know it's not a good cleaner. So if we can't remove all the debris from a device, we can't disinfect it.
SPEAKER_01That's so true, Mary. And I know I was in an office recently where I passed by the scanner, and then I asked a question about this device because it obviously had a wand on the end, but it had no bag over it, no barrier to protect it while it was just sitting there in the air to be contaminated. And I certainly wouldn't want that used in my mouth. And the staff replied, Oh, we were just trained that we just wipe this down in between patients. So the process is now we're getting the manufacturer's instructions for use to verify that. In the meantime, I said if you're wiping this down, you need to keep this barriered in between patients so it's just not sitting here collecting germs in the air. Um, so there's just a lot of things to bear in mind with that, and it all comes down to something we've talked about many, many times over the past years, and that is the manufacturer's instructions for use. Having all those pamphlets, guidelines, booklets, leaflets, whatever they've give you've gotten when you purchase a new piece of equipment in one location is very important. It keeps the team standardized so that way it's not my way or your way, it's the correct way. And it's also a good thing to have for onboarding new team members. We hope you enjoy today's podcast. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedevas.com. Any resources that we mention on the podcast can be found in the show notes. And we invite you to submit questions to support at thecompliancedevas.com. And don't forget to scroll down at the end of your podcast and leave us a review. Thanks for joining us. We'll see you next time.