Understanding CDC Compliance in the Orthodontic Office

by Andrea Cook

checklist MC900432663Understanding and compliance with the CDC guidelines is a challenge for today’s busy practice.  The statement below should remind us all of how important this is and the impact non-compliance can have:

The Supreme Judicial Court of Massachusetts upheld the suspension of a dentist who failed to conduct and record weekly spore testing, which is a method of sterilizing dental instruments.

“Spore testing” involves placing a test strip (or vial) containing spore bacteria in a sterilizer, removing the test strip and allowing it to incubate, and then comparing the results to those for a “control” strip containing the same bacteria but that is not placed in the sterilizer.

Part of my sterilization and clinical consulting is helping offices get as close to compliance as possible.  I would like to share a few reminders for you to help you with this challenge. 


  1. All sterilizers must be tested on a weekly basis

Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic use (at least weekly) of Biological indicators (BIs) (i.e., spore tests).  Test strip should be placed inside the package.  CDC guidelines, 2003
  1. Results must be recorded and kept in the office

Results of biological monitoring should be recorded and sterilization monitoring records (i.e., mechanical, chemical, and biological) retained long enough to comply with state and local regulations.  CDC guidelines, 2003
  1. Pouches

Pouches must be folded along the perforation when sealing to ensure a proper seal is formed.  Do not fold the pouch further down and seal.
  1. Instruments rinsing

After cleaning, instruments should be rinsed with water to remove chemical or detergent residue.  CDC guidelines, 2003
  1. Storage of unwrapped sterilized instruments

Semicritical instruments that are sterilized unwrapped on a tray or in a container system should be used immediately or within a short time. When sterile items are open to the air, they will eventually become contaminated. Storage, even temporary, of unwrapped semicritical instruments is discouraged because it permits exposure to dust, airborne organisms, and other unnecessary contamination before use on a patient.  CDC guidelines, 2003
  1. Handpieces

For processing any dental device that can be removed from the dental unit air or waterlines, neither surface disinfection nor immersion in chemical germicides is an acceptable method.  Dental handpieces and other intraoral devices attached to the air lines and/or waterlines must be sterilized using heat.  CDC guidelines, 2003
  1. Water lines

Dental devices that are connected to the dental water system and that enter the patient's mouth (e.g., handpieces, ultrasonic scalers, or air/water syringes) should be operated to discharge water and air for a minimum of 20-30 seconds after each patient. CDC guidelines, 2003
  1.  Single use/disposable items

A single-use device, also called a disposable device, is designed to be used on one patient and then discarded, not reprocessed for use on another patient. CDC guidelines, 2003


Your state may have additional regulations that you must comply with.

Often non-compliance is due to staff turnover and new team members not being fully trained--employees are simply not aware.  To help protect yourself, make sure each new team member is fully trained in PPE, OSHA compliance as well as the CDC guidelines as part of their new employee training process.


About the Author

andrea cookAndrea Cook’s  in-office, hands-on training is based on knowledge gained through 20 years of chair side experience. She is a clinical consultant and trainer for premier orthodontic offices across the country. Contact Andrea at  Andrea Cook Consulting.




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