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Information for Students>Clinical Policies and Procedures>Chapter 8 

Chapter 8 - Instrument Sterilization & Distribution System

8-1. PURPOSE: 

The purposes of the centralized instrument and distribution system are the following: 

1.       To assure appropriate sterilization of dental instruments.

2.       To reduce the educational cost to dental students and residents.

3.       To provide appropriate accountability for the dental instruments and hand pieces.

To achieve these purposes, specific guidelines, supporting system policies, definition of procedures, and detailed lists of instruments provided are outlined in the following sections. 

8-2. POLICIES 

General policies for the Centralized Instrument Sterilization and Distribution System are outlined below.  Policies and procedures specific to a particular group of students, doctors or clinics are appended.  General policies are the following: 

1.       All instruments will be packaged and sterilized in the central sterilization (CS) area on the third floor.

2.       Hand pieces will be lubricated and sterilized in the CS area.

3.       Gross debridement of instruments, cement & acrylic removal, and discarding of disposables are the responsibilities of the operator and should be performed in the operatory.

4.       Instruments will be routed to several dispensing areas for decentralized issue and collection.

5.       Issue and return will be in the same dispensing area during normal operating hours.  Instruments may not be returned to a different dispensary.

6.       Clinic 14 (instrument returns) and the 3rd floor Dispensary (supplementals and blue vouchers ONLY) are open until 5:30 PM.  After 5:30 PM all remaining instruments must be returned to CS.

7.       Each clinic dispensing area will maintain a minimum inventory of each type of routine cassette, hand pieces and individually packaged instruments which will be dispensed by and returned to Central Sterilization daily.

8.       Individually wrapped instruments will be maintained for each instrument used in any cassette.

9.       Anyone may request any type of instrument package regardless of the specialty, the status of the provider or the location of the clinic. (e.g. a prosthodontic resident may request an endodontic kit.)

10.   Supplemental instruments that are not part of a standard setup will be individually inventoried (but sterilized centrally) in each dispensing area.

11.   Expendable supplies will be maintained and dispensed in each clinic in accordance with the individual department policies.

12.   CS staff is accountable for the security of instruments in the CS area.

13.   Departments are responsible for picking up instruments from CS and returning them.

14.   Department representatives are accountable for instruments from the time of issue at CS until they are issued to the doctor.

15.   Doctors (students) are accountable for instruments from the time they receive them until they return them to the designated Dental Assistant.

16.   Dental assistants are then accountable until the instruments are returned to CS.

17.   Vouchers will be issued to acknowledge receipt of instruments and to identify the accountability.

18.   Broken instruments will be replaced on a one-for-one exchange from the dispensary and worn burs will be replaced on a one-for-one exchange from Clinic 14 instrument room.

19.   Lost instruments will be charged to the responsible person (student or department).  NO EXCEPTIONS

20.   Students, faculty and residents will not be allowed to treat patients if instrument packages are not returned at the end of the clinic session (AM or PM).

21.   Student, faculty and resident instruments will be assembled based on information provided though the computer appointment system.  This is to be duplicated for chart requests.

22.   Requests for instruments must indicate the procedure that conforms to a standard language. (A list of standard abbreviations is listed in Appendix B)

23.   Packages of instruments are routinely issued for each general procedure.

24.   Protocols may vary among clinics to accommodate special needs.  Protocols may not be altered without written approval of the infection control committee (ICC).

25.   Implant packages, EVA systems, and other specialty items will be packaged and inventoried in the appropriate clinic.

26.   Staff dental hygienists will follow the appointment protocol for faculty to receive instruments. 

27.   Sterile indicator strips will be included in each cassette to indicate sterilization effectiveness.

28.   No operator may use an instrument for patient treatment if the instrument is not sterilized by CS.

A.      Hours of operation

Hours of operation for the CS area will be 7:30 AM - 6:00 PM.  Clinical procedures generally begin after 9:00 AM and are completed by 11:45 AM.  The afternoon appointments generally begin at 1:00 PM and are completed before 4:45 PM.  Instruments may be picked up and returned at the appropriate dispensary.  If procedures continue beyond 12:30 p.m. or 5:30 PM, instruments may be returned to CS in accordance with policies below.

B.      Dispensary locations

Dispensing Area Activities Include 

Clinic 1   Oral Surgery students, faculty, and residents; Clinic 2 activities.

Clinic 3 Pediatric Dentistry students, faculty and residents.

Clinic 6   Endodontics students, faculty and residents.

Clinic 8   Orthodontic students, faculty and residents.

Clinic 10   Periodontics/Students.

Clinic 11   Periodontics faculty and residents

Clinic 12   Oral Diagnosis

Clinic 13   Emergency Dental Service

Clinic 14 (Room 3420) Dental hygiene, Treatment Planning Board.

Clinic 14 (3410)   Oral Rehabilitation

Clinic 16   Faculty practice, staff hygienist.

Clinic 17   Prosthodontics residents

Admissions   Patient Screening 

8-3. PROCEDURES 

A.      Request for instruments

If a student makes an appointment before 3:30 p.m. the day before treatment, the fee ticket, instruments and vouchers will be delivered to the clinic.  Records will be checked out and placed in the records room.  You do not need to make a chart request for these appointments. 

Late appointments:  For late changes and appointments (after 3:30 p.m. on Friday), we will run a chart pull list at 7:30 a.m. on Monday only to accommodate weekend changes.  If the students make a Monday morning appointment before 7:30 a.m. Monday, the correct instruments and vouchers will be delivered to the clinics.

If you make a change or an addition for an afternoon appointment before 10:30 a.m., we will run another printout to supply instruments and vouchers to the clinic.  A chart request must be made on the computer and the chart picked up in Records.  Fee tickets will be in the Business Office.  Instruments and vouchers will be sent to the clinic (NO BLUE VOUCHER).

If you book or change a morning appointment for the next day after 3:30 p.m. (Monday thru Friday), you must:

1.      Get instruments on BLUE VOUCHER from the third floor dispensary

2.      Make a chart request on the computer

3.      Pick up the chart in records

If you book or change an afternoon appointment after 10:30 a.m. on the day of service, you must:

1.      Get fee ticket from Business Office.

2.      Get instruments on BLUE VOUCHER from the third floor dispensary

3.      Make a chart request on the computer

4.      Pick up the chart in records.

Emergency appointments:  Extra sets of instruments are available to accommodate dentists and students when an emergency patient arrives.  These instruments may be issued in the dispensary using a supplemental voucher.  A minimum inventory will be maintained and should be issued only for emergencies or appropriate procedural changes.  Students should be directed to the dispensary on the third floor for last minute issues if the change is not to accommodate a dental emergency.

Unexpected appointments/Change of procedures:  Instruments are available in each clinic to accommodate the unanticipated change in procedure.  Because there will be only a minimum inventory, these instruments should be used only for emergencies or appropriate changes in the course of treatment.  Operators with walk-in patients, those who forgot to make an appointment or those who made last minute appointments should be issued instruments at the Dispensary on the third floor and records at Central Records on the first floor.

Instruments will be issued upon signature of a supplemental voucher and presentation of original fee ticket.

B.      Return of Instruments

Instruments should be returned to the site of issue immediately after the patient reappointment and gross debridement of instruments are complete.  Clinical procedures should be completed before 11:45 AM and 4:45 PM.  If a procedure extends beyond 5:00 PM, the instruments must be returned to CS by the operator before 6:00 PM.  Instruments received on a blue voucher are to be returned to the Dispensary before 5:30 PM.  After 5:30 PM they are to be returned to Central Sterilization.  Resources are not adequate for the operators to delay returning instruments.  They must be returned at the end of the clinic session to allow staff to reprocess them before they are needed for the next cycle.  Operators who have overdue instruments will not receive instruments until the previously used instruments are returned. 

Cleaning instruments:  Operators (dentists, students, hygienists) are responsible for removal of gross debris, cements and acrylics.  Cassettes must then be returned with instruments in the order in which they were issued.  CS staff will lubricate, package and sterilize hand pieces. 

Missing Instruments:  At each step along the distribution path, someone will sign a voucher to indicate that they accept responsibility for loss of instruments.  The CS staff is responsible for missing instruments in the CS area.  The department representative (who will sign an inventory voucher) is responsible for instruments from the time of receipt at CS until the time of issue to the operator.  The operator (who will sign an issue voucher) will be responsible until the instruments are returned to the department representative (or CS if after 5:00 PM).

If an instrument is missing, the user will first be asked to look for the instrument.  If it cannot be found, the missing instrument will be noted on the voucher.  The user will sign the voucher which will be returned with the other instruments.  The user will be billed and the instrument will be replaced. 

Dispensary staff will note missing instruments on the voucher.  The responsible person will be billed.  Department chairmen may elect to pay for some or all losses from department funds. 

Broken/contaminated instruments:  Immediate exchanges are available in the dispensaries in the event that an instrument is dropped or contaminated.

Broken instruments are expected on occasion.  Exchanges are available in the dispensaries.

C.      Appointment Manager Responsibilities

Each department should identify a person responsible for making faculty and resident appointments.  This person must assure that appointment information is available before 3:00 PM on the day preceding treatment (morning packs and vouchers will be assembled in the afternoon).  This appointment manager will transmit the message in the prescribed format (see appendix A) to CS and CR.  Morning and afternoon appointments should be separated.  The staff will accept updates of afternoon appointments at 10:15 AM for the current afternoon.  Packs and vouchers will be assembled in the morning before 12:00 PM.

D.      Dispensary Assistants' Responsibilities

Each clinical dispensing area will have an assistant to whom is delegated the responsibility of transporting, issuing and accounting for instruments between CS and the clinic. 

This person will report to CS between 7:30 and 8:30 AM to receive instruments.  They should verify the contents of the cart (cassettes, hand pieces, vouchers); sign the inventory voucher accepting responsibility (see appendix F) and transport the cart to the clinic dispensary.  The instruments should then be dispensed to the user and a signature should be obtained on the instrument voucher (see appendix G) transferring responsibility.  At the end of the clinic session, instrument cassettes should be collected and contents verified.  The dental assistant will sign the instrument voucher and return the instruments by 12:00 PM.  The afternoon carts may be collected at this time and the dispensing process is repeated, returning the afternoon cassettes by 5:00 PM. 

At the time of issue, each package of instruments will be accompanied by a voucher which outlines the instruments to be issued to the user.  The assistant will record the handpiece number or cassette number on the voucher and have the user sign the voucher.  Extra instruments are available upon request.  These will be issued and the supplemental instrument voucher will be prepared and signed (see appendix H).

E.      Students/Residents/Faculty Responsibilities

Each dental care provider is responsible for making appointments in a timely fashion (prior to 3:15 PM for the next day's appointment).  After the appointment has been made, the department appointment manager for each foundation provider and the central appointment system for students will transmit necessary information to assure that the providers receive the appropriate instruments and patient record.  Dental students, dental hygiene students, and periodontics residents will pick up their instruments at the appropriate dispensing area.  

After receiving instruments, the operator should set up the operatory; unwrap the cassettes (using the wrap as a tray cover) and packages; and verify the contents.  All missing instruments must be reported within 20 minutes.  Otherwise the provider will be accountable for the lost instruments.  Finally, the operator should verify the change in the sterile strip indicator; and a note to that effect in the treatment record is suggested.

F.      Voucher Management

A voucher is a signed receipt that indicates the person responsible for the contents listed.  Advice:  Either have the voucher or the instruments and you will not be held accountable for lost instruments. 

There are three types of vouchers:

Inventory Voucher: A list of all the packages issued from CS to the dispensing assistant.

Instrument Voucher: A list of all packages issued by the dispensing assistant to the user.

Supplemental Instrument

Voucher: (Blue) A handwritten list of all supplemental instruments issued because of unexpected needs.  This is prepared and signed by the user and exchanged with the dispensing assistant for the appropriate instruments. 

Green vouchers are used for supplementals to clinics (issued on each cart of clean instruments). 

Contaminated instruments are exchanged with no paperwork (even swap).

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Please email comments, suggestions or questions to:
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October 13, 2006