08 Nov Multiple Use Dental “Syringes” (Dispensing Devices)
Many pre-filled plastic syringes are intended for use on more than one patient and contain a variety of dental materials such as composite, etching kits, etc. Although the syringe is considered multi-patient use, the tips are disposable and are meant for use on one patient.
Although there are many options for dispensing dental materials, generally, the multi-patient use syringes are most commonly seen in my consulting practice. When visiting dental practices, I frequently see pre-filled dental syringes stored in the operatory, either in a holder (as pictured) which remains on the counter throughout the day or in a bin which may or may not be in a drawer. Generally, tips are attached to the syringes during storage. The dental healthcare workers (e.g. dental assistants, hygienists, etc.) change the tip prior to storage (after the last use).
Infection control concerns with this device include the potential for contaminating the outside of the syringe during use by touching a patient’s cheek or lips or handling the syringe with contaminated gloves (such as during a procedure). Common practice is to decontaminate the syringe with a disinfectant wipe or cloth after each use. The disinfectant wipe is only used on the barrel. No mention of the plunger part of the syringe, which is probably just as well since disinfectant could theoretically seep into the contents and alter the material or make it unsafe for patients.
Because of these concerns and the variability among manufacturer’s instructions for decontaminating the syringes, the Food and Drug Administration (FDA) has developed some guidance for these dental syringes.
Note that the composite syringes in the acrylic holder are capped rather than having the disposable tips attached. As a consultant, there are a multitude of concerns with composite syringes and attached tips remaining on the operatory counter: 1) It is not uncommon for the tips to touch the bottom surface of the holder, which contaminates the clean tip; 2) syringes are exposed to the “elements” in an operatory such as splatter, etc. 3) tips touching the countertop may be inadvertently ‘disinfected” when the counter is decontaminated after each patient. Besides the ‘yuk’ factor….Most manufacturers recommend storing the syringes ‘capped’ rather than leaving the contents open to the environment. In other words, most manufacturers do not recommend storing the syringe with a clean tip in place.
The FDA doesn’t believe these syringes can be properly decontaminated and recommends discarding any multiple-use (prefilled) syringe that becomes contaminated. The rationale behind this recommendation is to reduce the potential to transmit bloodborne pathogens (e.g. Hepatitis B or C or HIV), bacteria, or bacterial toxins from patient to patient by using a contaminated composite syringe, the FDA recommends discarding
Clearly, prevention is the key. To that end, the FDA advises dental practices to use an effective (disposable) barrier to prevent cross contamination. Some ideas include sleeves or wrapping the syringe with plastic barrier material. In this example, only the disposable (one-time use) tip is exposed.
Other recommendations from the FDA include using clean, uncontaminated gloves when handling multiple-use dental syringes. Ideally, change gloves prior to handling the syringe, prior to applying the barrier. A dental assistant could dispense the resin/composite material for the dentist. However, fresh gloves and a barrier should still be used. Avoid contact of the reusable parts of the syringe such as the barrel and plunger with the patient’s mouth. The easiest method to avoid contact is to cover the syringe with a barrier since it is difficult to anticipate when a patient might move or shift positions.
Lastly, always follow the pre-filled syringe manufacturer’s instructions for handling, use, and decontamination. The FDA information indicates that this device can’t be reliably or safely steam or cold (chemical) sterilized or effectively decontaminated by wiping with a disinfectant cloth. If the manufacturer’s instructions haven’t been updated recently, call or visit the manufacturer’s website to obtain current manufacturer’s directions.
Infection Control Results offers comprehensive consulting services and can assist with this or any other dental concerns.