Safety and efficiency for
Mary Govoni, MBA, RDH, CDA, RDA
THE DAY-TO-DAY MANAGEMENT and organization of instruments is an often
overlooked aspect of both safety and efficiency in dental practices. It is easy to get
caught up in the busyness of treating patients, potentially overlooking safety issues
that can lead to injuries. One area of concern is transporting and handling
instruments during cleaning and sterilization. Similarly, it is easy to overlook
inefficiencies in organizing, cleaning, and sterilizing instruments.
Safety in instrument handling begins with minimizing
the handling of instruments that are sharp and contaminated
from treatment. The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard1
mandates that contaminated, sharp instruments be transported in closed, puncture-resistant containers. Although
moving instruments from the treatment room to the instrument processing area in a typical dental facility doesn’t usually
involve long distances, accidents can happen if instruments
are carried in hand or on an open tray, which could result in
an injury to a team member. In addition, the Centers for
Disease Control and Prevention recommends minimizing
the handling of contaminated instruments to prevent injuries
to dental team members, especially hand scrubbing. 2, 3
Dental teams have a number of options for safe transport
of contaminated instruments. If a practice uses plastic trays,
snap-on lids are available to place on the trays, preventing
instruments from spilling off the tray while a team member
is walking with the tray. In addition, many box-type containers
and cassettes are available for enclosing the instruments.
While the tray lids and the boxes minimize the safety
concerns and meet the OSHA requirements, they don’t necessarily address the efficiency issues in instrument processing.
For example, if boxes are utilized, the instruments must be
picked up from the tray and placed in the box after treatment,
and if the instruments are cleaned in the boxes, they may have
to be removed from the box for rinsing and inspection after
cleaning. In contrast, instruments that are arranged in cassettes
are arranged in one layer, making it quick and easy to rinse
and inspect the instruments for any remaining debris.
If a dental practice aspires to achieve maximum safety
and efficiency, instrument cassettes are the optimal choice.
Once the size and configuration of the cassettes is deter-
mined, the instruments only leave the cassette during treat-
ment (or sharpening, if hygiene instruments). The cassette
serves as the delivery system in the treatment room, and
once the procedure is complete, the cassette is closed for
transport and then placed in an ultrasonic cleaner or instru-
ment washer. After rinsing and inspecting the instruments,
the cassette is packaged and placed in the sterilizer and then
into storage until the next use. This system of instrument
management eliminates the handling and sorting of con-
taminated instruments during the cleaning and packaging
processes, saving time and increasing safety. The time savings
may be as much as five to 10 minutes per procedure, which
also includes setup time in the treatment room.
There are several factors that need to be considered when
implementing a cassette system in a dental practice. The first
is the size and configuration of the cassette and standard-
ization of procedure setups. Second is the capacity of the
ultrasonic cleaner or instrument washer to make sure that
the cassette size can be accommodated. The same applies
to the sterilizer, making sure that the chamber size is adequate
for the size of the cassettes. This may require an investment
in new equipment as well as the cassettes. However, that
investment can be quickly recouped by increasing productive
time and spending less time processing instruments. One
manufacturer of cassettes, Hu-Friedy, has online resources
to assist dental practices in configuring their instrument
management system and to determine the size and type of
ultrasonic and sterilizer needed for the cassettes, streamlining
the implementation process with a more efficient and effective
instrument management system. Company representatives
can readily facilitate this process for dental teams.
Instrument management can be disorganized and labor
intensive, or it can be efficient, safe, and economical for
dental practices. The key differences are good planning and
utilizing instrument cassettes.
MARY GOVONI, MBA, RDH, CDA, RDA,
is an internationally recognized speaker, author,
and consultant, working with dental teams for
more than 40 years on clinical efficiency,
infection prevention, ergonomics, and team
communication. She has published numerous
articles in Dental Economics, The Dental
Assistant Journal, RDH Magazine, Dentistry
Today, Inside Dentistry, and others.
SCIENCE & TECH
1. Occupational safety
and health standards:
toxic and hazardous
Safety and Health
29 CFR 1910.1030.
Dec. 6, 1991. Accessed
April 18, 2017.
2. Guidelines for infection
control in dental
for Disease Control and
htm. Published 2003.
Accessed April 18, 2017.
3. Summary of infection
prevention practices in
dental settings: Basic
Expectations for Safe
Care. Centers for Disease
Control and Prevention
March 2016. Accessed
April 18, 2017.