Best Practices for Infection Control: Digital Radiography (DR) and Computed Radiography (CR)

An important consideration of digital radiography (DR) or computed radiography (CR) utilization is understanding how to “sanitize” your imaging technology to ensure that infection control standards are met.

As dentists, the health and safety of our patients is of paramount importance — not only for maintaining a trusting relationship with them, but also for shielding them from potential sources of cross contamination and possible infection.  For this reason, I would like to take a moment to address the best practices for infection control for digital intraoral sensors as well as phosphor plate systems.

Digital Radiography Infection Control

Digital radiography sensors and phosphor plates are used intra orally and come into contact with mucous membranes–as such they are considered semi critical devices with respect to infection control. Because neither direct digital intraoral nor phosphor plate sensors can be placed into an autoclave or immersed in contact disinfectants, FDA-approved hygienic barriers must be used to meet infection control standards and prevent cross contamination.

For digital sensors, it is important to cover the sensor and any cords that may come into contact with intraoral surfaces or contaminated hands.   But keep in mind that–according to a Journal of the American Dental Association article on “Assessing the Effectiveness of Direct Digital: Radiography Barrier Sheaths and Finger Cots”–the plastic barriers on direct digital sensors fail up to 40% of the time (the additional use of a latex finger cot reduced this number to 6%).  Therefore, knowing how to adequately disinfect the sensor / plate is important in the event of a barrier sheath tearing or breaking.

While the specifications for disinfecting direct digital sensors will vary greatly depending on the manufacturer, the general process may be the same. Before a sensor can be disinfected, it must first be cleansed.  This is done by:

  1. Removing the barrier sheath
  2. Cleaning off any organic matter or other debris from the sensor surfaces if present with a disposable wipe or brush
  3. Inspecting the sensor and repeating the step above if necessary.

To disinfect the sensor, only disinfecting wipes or a solution containing Environmental Protection Agency (EPA)-registered, intermediate-level hospital disinfectant with label claims of tuberolicidal activity should be used.  Some manufacturers warn against using chlorine-based products—such as bleach—saying that they are too corrosive for the sensors. The guiding principal here is to follow the manufacturer’s recommendations to the letter.

Computed Radiography Digital Infection Control

Recent studies show that phosphor plates can be a potential source of cross contamination.  Like intraoral sensors, phosphor plates should always be used with a protective paper sheath in order to eliminate direct contamination from the user’s hands. Plates should never be autoclaved, as the heat will irreversibly damage the plate. In general, intermediate-level disinfectants—in spray or disposable wipe form—may be used to clean to phosphor plates, including a diluted bleach solution.  To protect your plates and hygiene sheaths, avoid contact with the following:

  • Isopropyl alcohol (isopropanol or rubbing alcohol)
  • Hydrogen peroxide
  • Citrus-based cleaners
  • Hand lotions and water-less hand sanitizers

Phosphor plates should never be soaked overnight and envelopes and pouches must also never be reused.

Don’t forget to disinfect the exposure button and apply a tube head or cover with a fresh protective barrier for each patient. Many positioning devices are compatible with heat sterilization but some are not – best to be sure and check with the manufacturers recommendations.

For additional information on infection control, I recommend visiting the following link:

http://airforcemedicine.afms.mil/idc/groups/public/documents/afms/ctb_109779.pdf

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