jorgelerner

By Tuttnauer Product Experts

Opening a medical clinic offers unique opportunity to combine medical expertise with entrepreneurship. Having greater control and autonomy along with the potential of financial gain depending, gives incentive for practitioners to go private. After fully assessing the opportunity and proceeding with the process, the set up and purchasing of new devices and technology can be overwhelming. First, you need to determine what equipment can best help your practice; then you need to choose a vendor with a range of products and price points.

Choosing the right infection control equipment is crucial for any healthcare practice. The right devices ensures that patients receive effective treatment, and proper care. With so many options available, it can be challenging to determine what to invest in.

It’s a good idea to understand each process step that needs to be taken to sterilize instruments and purchase the devices that are relevant for each step. 

Identify your needs

The first step in choosing the right infection control device for your practice is to identify your needs. Determine the types of procedures you perform and the volume of patients you see and the instruments used. Consider your space limitations, budget, and potential growth of your practice. Once you have a clear understanding of your needs, you can begin to research the available options.

Research the equipment

Research is critical when choosing medical equipment. Look for equipment that meets your practice’s specific needs and is designed for your specialty. Consider the equipment’s features, specifications, and warranty. Look for equipment that is user-friendly, easy to maintain, and has a low risk of errors. Additionally, consider the equipment’s cost, including the initial purchase price and ongoing maintenance expenses.

Consider a long term ROI

A reliable manufacturer will have a range of products that are high end to mid end.  The Tuttnauer T-Top autoclave has been specifically designed for small to medium clinics.  Its key functionality is simplicity and economy.  This tabletop autoclave covers the fundamental needs for general clinic sterilization with the aim of increasing the productivity of your practice.  It is an affordable and reliable solution for managing your daily practice sterilization process workload https://tuttnauer.com/dental-autoclaves/pre-post-vacuum/t-top-autoclave.

Consider critical features

Narrow down essential features for your needs is very important to ensure the purchase of sterilization device that will perform to your expectation.

Consider regulatory compliance

Regulatory compliance is essential when choosing sterilization devices.  While affordability is important, never compromise on the safety and quality of sterilization equipment.  Ensure that the equipment you select complies with all relevant regulatory requirements. Compliance ensures that the equipment is safe for patient use and avoids potential legal issues.

Get to know your dealers/service providers

With so many dealers in the healthcare industry, it’s difficult to tell the difference between real and fake poor-quality products, especially because many transactions are made online. You can learn about manufacturers and their equipment through networking with others who are knowledgeable about healthcare equipment. To obtain quality and most advanced products, a thorough search of well-certified, quality manufacturers is necessary. For example, www.tuttnauer.com contains all the necessary technical and product features to make well informed decisions.

Advanced equipment

In the medical industry quality is crucial, especially when your business model relies on it for success and accuracy. You don’t want to compromise on quality for price.  Good reliable sterilization devices today can be very technologically advanced with software documentation and traceability.

The Tuttnauer T-Top autoclave is designed with advanced technology that features the T-Connect software capability; an innovation unique to Tuttnauer.  The T-Connect enables the autoclaves to contain advanced documentation and traceability features. T-Connect is a cloud based IOT solution that provides access to all processing documentation remotely, anywhere, anytime in a secure way, by utilizing the device wi-fi connection. In addition, full diagnostics for maintenance and technical errors can be viewed in real time, significantly minimizing the clinics downtime.

Size and space

Determine the available space in your clinic for the sterilization equipment. Choose equipment that fits comfortably within your clinic’s layout without causing congestion or safety concerns.  The Tuttnauer tabletop autoclaves are designed to fit 60cm shelf depth and comfortably fit into small spaces.

In conclusion, sterilization equipment is a critical component of your clinic’s operations and success. Balancing affordability with reliability and safety is key to making the best choices for your new clinic.

About the Author:

Tuttnauer Product Experts

uttnauer Team is made up of veteran staff at Tuttnauer that are responsible for communicating with our customers about sterilization and infection control. Let us know if there is anything specific you want to read more about.

By Michelle Strange, MSDH, RDH

Proper packaging of instruments in an autoclave is a critical task and one that needs to be done right.

Unfortunately, common daily errors can easily occur without careful consideration when handling packages. Any small mistake can cause disastrous results for patients or even staff members, from using incorrect packaging materials and improper sealing techniques to inadequate sterilization times.

Consider these 7 important factors when evaluating instrument packaging in your dental practice.

Using incorrect packaging material

Using packaging material not designed for autoclave sterilization, such as regular plastic bags or aluminum foil, can lead to contamination of other instruments and the autoclave chamber.

Autoclaves use high heat and steam to sterilize all instruments within the chamber thoroughly. However, if wrapped in material not designed for autoclaving, the heat and steam may not penetrate properly and cause incomplete sterilization of the instruments.

Improper packaging can also damage instruments due to moisture getting trapped in the package or thermos-chemical reactions occurring, such as plastic degradation. This damage can lead to a shortened lifespan of instruments, resulting in more frequent replacements.

For instance, purchasing a quality pouch for your instruments can make a difference.  Tuttnauer Tyvek Pouches and Reels meet the Medical Industry’s requirement for high quality, hygiene and safety levels. Suitable for the packing of any Medical Device before sterilization and for maintaining the sterility after sterilization.  Choose from a wide range of standard sizes and for double packing purposes.

Overfilling packages

When packages are overfilled with items, large air-pockets could form, resulting in uneven distribution of pressure, preventing steam from reaching all contents of the package during the sterilization process. As a result, sterilization may fail, posing potential risks to patient safety.

Specifically, items enclosed in pouches should have sufficient space to lay flat or move freely within the package. For instance, dental scalers placed in sterilization pouches should be able to roll around or lay flat inside the pouch. If they cannot do so due to overfilling, opting for a larger pouch or dividing the instruments into multiple pouches is recommended.

By ensuring adequate spacing and proper arrangement within sterilization pouches, optimal steam penetration can be achieved, promoting effective sterilization of dental instruments. This proactive approach significantly reduces the likelihood of inadequate sterilization and enhances patient safety within the dental practice.

Wrapping packages incorrectly

Incorrectly wrapping packages can lead to inadequate steam penetration and incomplete sterilization. Packages should be wrapped securely but not too tightly to allow steam to penetrate. This means, if using pouches, seal on the perforated line, and if using wraps, know the best way to wrap the instruments according to the instructions for use.

A common mistake observed in sterilization is the over-folding of pouches, resulting in the plastic layers touching each other. It is crucial to emphasize the importance of folding only along the designated perforated line. Over-folding not only compromises the integrity of the pouch but also obstructs the adequate penetration and flow of steam through the material, thereby jeopardizing the sterilization of all instruments contained within.

Proper wrapping helps maximize efficiency when using an autoclave. The correct technique exposes all items while ensuring secure containment within their packaging material. This can also reduce time spent re-wrapping instruments and prevents additional water spots on surfaces due to over-saturation caused by improper wrapping techniques. Incorrect wrapping techniques could also result in decreased post-sterilization shelf-life of the contents in the wrapped package.

Using damaged packaging material

Damaged packaging material, such as torn or punctured wraps or damaged pouches, can lead to contamination of the instruments and put patients at risk of infection. Any tears or punctures in the packaging will allow for contamination once the items are removed from the autoclave. As a result, these packages must be checked for integrity before use to avoid compromising sterility.

The risk of mishaps during sterilization is heightened when dental professionals find themselves in a time crunch. Instances such as hurriedly placing instruments, like scalers, into pouches can result in the accidental piercing of the pouch material. Similarly, failing to ensure that all instruments are securely placed within a cassette before wrapping can lead to an instrument protruding from the package, posing a potential sharp injury to anyone handling the cassette. Furthermore, an instrument that extends beyond the package will not undergo proper sterilization and remain non-sterile even after autoclaving.

These scenarios underscore the importance of exercising caution and attentiveness during instrument handling and cassette preparation. The risk of piercing the pouch material or protruding instruments can be mitigated by carefully placing instruments within pouches and ensuring their complete containment within cassettes. These preventive measures not only safeguard the safety of dental professionals handling the cassettes but also guarantee the effectiveness of the sterilization process.

Not properly labeling packages

Properly labeling packages in an autoclave is essential for ensuring the sterility of medical instruments. Labeling packages with the date, load number of the day, initials of the person packaging, and sterilizer used provides an accurate record for tracing any potential problems related to sterilization. This helps ensure that all instruments are properly sterilized and allows professionals to identify any issues that may have occurred during the process.

Additionally, by including the initials of the packer on each package, any potential mistakes can be traced back quickly and easily, potentially identifying any gaps in staff education of proper autoclave use that require addressing. 

In the event of a failed biological indicator validation, the labeling system enables dental professionals to swiftly locate and isolate any affected instruments. Adhering to established quarantine protocols can safely withhold these instruments from use until the issue is resolved and retesting confirms successful sterilization. This proactive approach helps maintain high patient safety and ensures that only thoroughly sterilized instruments are utilized during dental procedures. Always refer to the guidelines as well for your autoclave’s IFU on the steps that should be followed regarding B.I. test fails.

Failure to use chemical indicators

Chemical indicators are essential when using an autoclave because they can visually indicate that many necessary parameters have been met for proper sterilization. 

Temperature-sensitive strips are widely employed as the most common type of indicator in sterilization processes, undergoing a color change once the required temperature is reached. However, having a temperature-responsive indicator on the outside of the package AND a comprehensive chemical indicator on the inside that accounts for multiple variables such as time, temperature, and pressure is crucial.

Placing a chemical indicator on the outside of the packaging provides a visual cue to indicate whether the package has undergone the necessary temperature threshold. This external indicator is essential for quick verification and serves as an initial assurance of successful sterilization.

Internally, a chemical indicator that responds to multiple variables, including time, temperature, and pressure, is indispensable. This indicator offers a more comprehensive and accurate assessment of the sterilization conditions within the packaging. By monitoring these critical variables, dental professionals can ascertain that the sterilization process has been properly conducted, ensuring the safety and integrity of the instruments contained within. Find out more about Tuttnauer chemical indicator options: https://tuttnauer.com/consumables/chemical-indicators/steam-indicators

Single-use is single-use

Do not reuse pouches or wraps for more than one sterilization cycle. Repeated exposure to high temperatures and steam can cause them to break down, increasing the risk of contamination. 

Ensure the correct use of packaging to reduce the risk of cross-contamination, enhance infection control in your clinic, and keep everyone safe. 

Always refer to the guidelines, as well as your instruments’ & autoclave’s IFUs pertaining to the proper sterilization procedures.

GUEST AUTHOR

Michelle Strange, MSDH, RDH

Michelle Strange, MSDH, RDH, brings over 20 years of experience to her numerous roles in dentistry. A graduate of the Medical University of South Carolina with a Bachelor of Health Science and the University of Bridgeport with a Master’s in Dental Hygiene Education, she focuses her career on expanding the knowledge of her colleagues in all aspects of health care. Her passion for dentistry and its connection to overall health extends to her community and global efforts. Michelle was the co-founder of the longest-running podcast for dental hygienists, A Tale of Two Hygienists.

By Michelle Strange, MSDH, RDH

The sterilization center, serving as the bustling hub within the dental office, demands the utmost attention from dental healthcare professionals who juggle multiple tasks simultaneously. They diligently reprocess reusable dental instruments while simultaneously preparing for the next patient, retrieving items from sterile storage, and acquiring necessary consumable products. However, due to the inherent potential for contamination and subsequent infection control breaches, it is imperative to establish a well-structured workflow and implement clear labeling within the steri-center.

By implementing a systematic workflow, dental professionals can effectively manage the complex operations of the sterilization center. This entails defining streamlined processes for instrument reprocessing, setting up for the next patient, and ensuring seamless retrieval of items from sterile storage. Moreover, labeling various areas within the sterilization center enhances efficiency and minimizes the risk of errors or oversights. Clear and visible labels enable easy identification of different zones, tools, and consumables, ensuring that each component is utilized in the appropriate context, ultimately reducing the chances of cross-contamination and infection transmission.

Establishing a well-defined workflow and employing comprehensive labeling practices in the sterilization center is paramount. These measures optimize operational efficiency and mitigate the risk of infection control breaches, safeguarding dental healthcare professionals’ and patients’ well-being and safety.

So, what can creating workflows and mandating labeling in the steri-center do for your clinic?

Tuttnauer offers a thermal printer option with the Tuttnauer autoclave devices, that is compatible with all machines, easy to use.

1. Ensure the safety of patients (and staff!)

Effective labeling of various areas and establishing workflows in the steri-center can help prevent the spread of infectious diseases. This helps patient safety outcomes by minimizing the risk that the tools used on one patient are not placed on the wrong side of the steri-center or sterile instruments are not placed on the side where dirty instruments are being received. 

Cross-contamination is a leading cause of infection in dental practices, so it is essential to have a system in place to prevent it. Establishing a workflow with proper zones for dental offices might look like:

• Receiving dirty/contaminated instruments
• Cleaning/Rinsing/Drying
• Inspection and packaging
• Sterilization
• Storage of sterile items

Placing labels to show team members that certain areas of the steri-center are dirty vs. clean is simple yet very effective at reducing the chances of cross-contamination.  Implementing effective labeling and workflows in the steri-center is crucial for preventing the spread of infectious diseases, minimizing cross-contamination, and ensuring patient safety through proper sterilization and storage of instruments.

2. Improve efficiency

Implementing well-defined workflows and comprehensive labeling practices in the sterilization center enhances operational efficiency and contributes to the dental team’s overall effectiveness. The presence of clear labels within the steri-center becomes particularly valuable for new team members, temporary staff, or individuals who are not extensively familiar with the intricacies of the sterilization process. Labels serve as visual cues, guiding personnel through the flow of operations and indicating the appropriate placement of instruments and supplies.

For instance, by labeling the outside of the autoclave with crucial details such as packaging instructions and whether the handles should be touched with clean or dirty hands, potential errors in sterilization practices and cross-contamination can be significantly reduced. The labels provide a simple yet effective reminder to follow the correct procedures, preventing mistakes and ensuring that each instrument undergoes proper sterilization.

By enabling easier comprehension of the workflow and facilitating adherence to established protocols, labeling in the steri-center promotes a cohesive and efficient team dynamic. It ensures that all team members, regardless of their familiarity with the sterilization process, can quickly grasp the essential steps and correctly handle instruments and supplies. Consequently, the implementation of labeling practices contributes to a higher level of teamwork and consistency in infection control measures, ultimately enhancing patient safety and the overall quality of care provided by the dental office.

3. Maintain compliance

Clear labeling within the steri-center serves as a visual aid for compliance. The labels can clearly display essential information, such as proper packaging techniques, designated storage areas, handling instructions, and the current steri-center workflow. This ensures that all team members have easy access to vital information and can readily follow the correct procedures, minimizing the risk of errors or non-compliance.

Moreover, established workflows help streamline operations within the sterilization center, ensuring that each step of the sterilization process is properly executed. A well-structured workflow acts as a roadmap, guiding dental healthcare professionals through the necessary tasks and ensuring that no crucial steps are missed. This level of consistency in processes promotes adherence to compliance requirements and helps maintain a high standard of infection control practices.

By incorporating proper labeling and established workflows, dental practices create an environment where staff members are empowered to consistently follow regulatory guidelines. This proactive approach to compliance protects patients’ health and safety and safeguards the dental practice’s reputation and integrity.

4. Reducing errors

Errors in instrument sterilization often go unseen. Proper labeling and workflow processes can help reduce mistakes in equipment processing, such as incorrect packaging, issues with the autoclave, mislabeling, or missing steps. In addition, instituting regular quality checks within the workflow can help identify potential errors before they become a problem.

Having a staff training program to train and troubleshoot the workflows can help ensure that employees are knowledgeable about utilizing the steri-center. This can help reduce the risk of errors and ensure that instruments are processed safely.

5. Facilitating communnication

Implementing workflows and effective labeling systems within the steri-center can greatly enhance communication among staff members and different departments, fostering a cohesive and collaborative environment focused on shared goals. By ensuring that everyone is on the same page, the risk of sterilization breaches can be significantly reduced. How often do we observe team members inadvertently placing instruments in areas that could lead to cross-contamination, handling equipment with unclean hands, or struggling to locate essential tools by rummaging through numerous drawers? Fortunately, there are more efficient and effective means of communication to convey protocols and ensure the proper organization of items within the steri-center.

By clearly defining and labeling specific areas, the steri-center becomes a hub of streamlined communication. Vital information, protocols, and designated locations can be visually communicated through labels, providing an intuitive and accessible framework for the entire team. This simple yet powerful approach minimizes confusion, increases efficiency, and promotes adherence to established guidelines, thereby reducing the likelihood of errors and improving overall patient safety.

In conclusion, implementing workflows and embracing effective labeling strategies within the steri-center not only streamlines operations but also unlocks the potential for improved communication among team members. This enhanced communication fosters a culture of collaboration, reduces the risk of sterilization breaches, and ensures that dental professionals can easily access the necessary tools and information to provide optimal care.

GUEST AUTHOR

Michelle Strange, MSDH, RDH

Michelle Strange, MSDH, RDH, brings over 20 years of experience to her numerous roles in dentistry. A graduate of the Medical University of South Carolina with a Bachelor of Health Science and the University of Bridgeport with a Master’s in Dental Hygiene Education, she focuses her career on expanding the knowledge of her colleagues in all aspects of health care. Her passion for dentistry and its connection to overall health extends to her community and global efforts. Michelle was the co-founder of the longest-running podcast for dental hygienists, A Tale of Two Hygienists.

By Ad Geilings, Global Product Manager Laboratory

Water is the lifeline of an autoclave. It is the most critical component of a steam autoclave. Sterilization will not happen in a steam autoclave without water. Steam sterilization uses saturated steam to the items in the autoclave. The steam comes into contact with the items placed inside the autoclave. In the case of packed surgical instruments, for example, the steam must permeate the pack wrappings and heat the instruments inside the packs. For this reason, steam must be free from impurities in order to avoid staining or corroding the items being autoclaved.

Water can damage stainless steel instruments. Stainless instruments are susceptible to pitting in several scenarios; an increase in the chloride content in the water, or when there is an increase in temperature, with decreasing pH values, increased exposure times, insufficient drying and concentration of chloride from dry residues to instrument surfaces after evaporation.

The type of water you use can dictate the types of loads you can sterilize and affect the lifespan of your autoclave chamber and steam generator significantly.

Since autoclaves are costly investments, it is crucial that it is used appropriately and maintained regularly, especially autoclaves that are used very frequently.

The leading question almost every autoclave operator asks, is can I use tap water in my autoclave?

The answer is NO. Tap water, even when its potable water, is generating low quality steam, which is not suitable for a proper sterilization.

There are several things that can affect water quality: its hardness, its minerality, whether it contains chlorides. Using tap water might be common practice for some, however this will most certainly lead to costly downtime and expensive repairs over time, if the water quality is inadequate. Tap water is certainly a practical source for creating steam, but it can also be destructive to your autoclave.

It is important to note that the water quality requirements for safe drinking water are often different from the water quality requirements of industrial machinery. If your municipal water quality report does not indicate the hardness of your tap water, we recommend that you perform an independent water quality test. Ideally, whether you have the municipal water quality report or not it is ideal to test the water right before it enters the steam boiler as building pipes can contribute to water hardness.

Damage to your autoclave caused by water:

Tap water contains a variety of dissolved minerals and salts. Depending on your geographic location and water source (e.g., ground well, lake, river, etc.) the amount of dissolved substances can be very high. The more minerals water contains, the “harder” it is. When hard water is boiled into pressurized steam, it leaves behind salt and mineral deposits within the steam generator, pipes and valves. These deposits build up over time like layers of paint. As they build up, they decrease the efficiency and functionality of the steam generator, as well as clogging up pipes and valves.

Your autoclave chamber should be shiny from the stainless steel, any coloring, white spots, or rusting is a clear indication of poor water quality causing damage to your autoclave operation.

Scale can wreak havoc on a generator.  Scale is caused from chemicals that are deposited onto a surface and create a hard layer.  Scale can form inside water level sensor tubes, which can cause the sensor elements to malfunction. This can potentially lead the heaters to melt down and fail.

Alternatively, scale could flake off and fall into the shell of the generator, or stay stuck to the surface, where it can form calcium deposits. These calcium deposits are electrically conductive and can create bridges between heaters, which can, again, cause them to short circuit and overheat.

Given the potentially dangerous consequences, it is important to be mindful of the water quality used for your autoclave device.

Tuttnauer offers several water treatment products, the water treatment system supplies the autoclave with demineralized water and provides the basis for maintaining the value of the autoclave.

The Tuttnauer water treatment units deliver a number of advantages: providing value-for-money, it is an environmentally friendly and highly effective method with which to produce demineralized water of a constantly high quality.

Other methods of purifying water

Carbon Boilers:

• Reverse Osmosis (RO) – RO systems filter water by forcing it through a thin permeable membrane that removes most solid contaminants and dissolved minerals but does not remove biological particles, such as bacteria or viruses. An RO system is the #1 recommended solution for standard carbon steel boilers.
• Another option for carbon steel boilers is the use of a water softener system. These systems are a chemical treatment that reduces hardness, but can leave other impurities dissolved in the water, so is only applicable to customers who meet all water quality requirements except for hardness.

Stainless Steel Boilers:

• Deionization (DI) – DI systems remove the ions from the water and produce a very high purity level. It does not affect uncharged molecules, viruses or bacteria. Deionized water should only be used to feed stainless steel boilers.
• Distillation – Distillation removes virtually all impurities from water by boiling it and then condensing the steam into a clean container. This process removes virtually all dissolved materials.  Distilled water should only be used to feed stainless steel devices.

Fixing an autoclave that is damaged by poor water quality

There are several options based on the severity of the damage. For minimal damage use the automatic generator blow-down feature to drain out scale, especially for any carbon steam boiler that isn’t fed with purified water.

The second option is to implement a water filtration system, like the Type IV RO filter mentioned above. This water system, which is a step up in complexity from the kind you’d find under your kitchen sink, will remove minerals from your generator and feed it more purified water. This is an acceptable response to all but the most severe cases.

The third option based on severe damage is to purchase a new autoclave.  This level of damage is most common in areas of very poor water quality where scale likely built up over the course of a few years.

Generally, it is always a good idea to use good quality cleaners for your autoclave, to remove accumulated residue. Tuttnauer offers a variety of cleaners that will assist in maintaining the longevity of your autoclave investment.  https://tuttnauer.com/consumables/cleaning-materials

Water contaminants that may have a negative effect on autoclaves

• Ions – Calcium and magnesium salts are less soluble in hot water than in cold water. This leads to scaling, which is the main concern for autoclaves. Carbonate deposits are usually porous, while sulfate deposits tend to be much harder and dense. Scale deposits inside hot water pipes, boilers and heat exchangers restrict water flow and reduce heat exchange efficacy.
• Metals – Iron, copper and manganese may also form deposits in the steam generator and reduce heat transfer. In addition, they can generate discoloration and stains of the instruments being autoclaved.
• Particles – They may form deposits in the steam generator or in the instrument and alter their functioning. They may also contaminate the solutions or instruments being autoclaved.
• Bacteria and their by-products – Levels of bacteria and endotoxins should be minimized in the steam feed water of autoclaves, as there is a risk that they may be deposited onto the items being autoclaved. Although steam sterilization inactivates bacteria, it does not fully inactivate their by-products, such as endotoxins. Endotoxins may affect experiments (such as cell culture, etc.) or patient care (by causing inflammation and delaying wound healing).
• Chlorides – They lower steam efficiency. When present in large quantities, they lead to uneven steam delivery and may provoke foaming in the steam generator.

ABOUT THE AUTHOR

Ad Geilings, Global Product Manager Laboratory

Ad has been working for Tuttnauer Europe from 1997 until 2001 as Technical Manager, he has been in senior roles as Managing Director Tuttnauer Europe for 20 years.  As a global product manager Ad works very closely with the engineering and R&D team.  Ad has been a member of Dutch Committee Sterilization & Sterility since 1997.

By Michelle Strange, MSDH, RDH

If I have heard it once, I have heard it a thousand times; We load the autoclave like this! *Inserts items the wrong way*. That’s how you did it with the last autoclave? That’s great, but what makes you think this one is the same?

The correct answer is; what do your instructions for use say? Not all autoclaves are made equal, and if you haven’t gotten to know yours, you could be misusing it and putting your patients at risk. However, you can apply some general rules to most autoclaves to set them up for sanitization success!

Dos

• Follow The correct answer is; what do your instructions for use say? Not all autoclaves are made equal, and if you haven’t gotten to know yours, you could be misusing it and putting your patients at risk. However, you can apply some general rules to most autoclaves to set them up for sanitization success!

• Make sure instruments undergone cleaning and disinfection, prior to sterilization. International guidelines state that the entire process of instrument reprocessing needs to be performed by trained personnel using monitored procedures to ensure reproducibility. These requirements contribute to the health and safety of patients, users and third persons.

• Ensure you only put items in the autoclave that can withstand the high temperature and pressure required for sterilization, such as glass, metal, and plastic instruments.

• Arrange the items in a way that allows for efficient steam penetration and circulation. Items should not be tightly packed, and there should be space between them. Be aware of the “pouching effect,” which can occur if objects are placed too close together in the autoclave.

• Place heavier items on the bottom of the autoclave and lighter items on top to ensure that steam reaches all items. Or use racks to place cassettes on their sides to maximize the steam penetration.

• Run your autoclave! What I mean is, even if it isn’t completely full, go ahead and run it.  In busy practices, we often wait to fully load the autoclave, then we try to get every last instrument that is wrapped and ready to go inside the chamber for that load. This often leads to it being overloaded. It is ok to load your autoclave and run it before it is completely full.

• Use a chemical / biological indicator to receive an immediate indication of the quality of the sterilization.

• Apart from loading the autoclave correctly it is also very important that the customer is choosing the correct cycle. This means, the right temperature, wrapped or unwrapped makes a big difference and, in some cases, the prion cycle might be needed.

• Keeping the autoclave clean!! It is contradictory to render ‘sterile’ instruments from a device that is very dirty.

• Check the cycle result and then approve and document the cycles.

Don’ts

• Do not overload the autoclave. Overloading can prevent steam from circulating properly around the materials, resulting in ineffective sterilization. This happens so easily in a busy practice or if you are running behind and have many instruments to sterilize, and they often just get shoved in willy-nilly. Don’t do it! You are increasing your risk of infection significantly

• Do not use packaging that isn’t designed for use in an autoclave. Using improper wraps or pouches, sometimes even gauze, can lead to breakage or malfunction, which can be hazardous.

• Do not place materials that cannot withstand high temperatures or pressure inside an autoclave, such as paper towels, cloths, or rubber gloves. These will be damaged by heat or steam during the sterilization process and possibly result in the contamination of objects inside the chamber.

• Do not place items too close to the walls of the chamber, or door of the autoclave, as this can interfere with steam circulation and lead to incomplete sterilization. 

• Do not be afraid to remove a tray from the chamber so larger cassettes have room and can have sufficient steam reach its contents.

Train your staff regularly!

Regular training for autoclave use in dental practices is critical. Without regular training on proper autoclave use, staff may be using outdated techniques that are ineffective in sterilizing instruments, leading to potential risks of cross-contamination and patient illness. 

By ensuring staff members remain educated on the latest developments in autoclave use, dental practices can guarantee their patients receive the highest quality of care possible.

GUEST AUTHOR

Michelle Strange, MSDH, RDH

Michelle Strange, MSDH, RDH, brings over 20 years of experience to her numerous roles in dentistry. A graduate of the Medical University of South Carolina with a Bachelor of Health Science and the University of Bridgeport with a Master’s in Dental Hygiene Education, she focuses her career on expanding the knowledge of her colleagues in all aspects of health care. Her passion for dentistry and its connection to overall health extends to her community and global efforts. Michelle was the co-founder of the longest-running podcast for dental hygienists, A Tale of Two Hygienists.

By Ad Geilings, Global Product Manager Laboratory

There are three technological processes associated with autoclaving material and are based on the following elements: gravity, pre-vacuum, and isothermal.

Each process has a variety of cycles that may be employed and are dependent upon the process, or options associated with each autoclave. These include: heat, gravity, pre-vacuum, sterilize, exhaust and dry. Exhaust may either be undertaken rapidly or slowly. The rate of exhaust will depend upon the nature of the load. Dry material will permit a fast exhaust, while liquids require slow exhaust to prevent boiling over of super-heated liquids. Refer to the autoclave manual to obtain a complete description of the cycles available.

Some autoclaves also have the ability to perform special cycles designed to avoid damage to delicate goods that need to be sterilized but would be damaged or destroyed by the rapid changes in temperature and pressure in a normal cycle. These special cycles include much longer cycles at lower temperatures, steam-air mix cycles with special pressure controls to avoid breaking sealed test tubes, and cycles that use special instrumentation to ensure full sterilization temperature is achieved.

When is it ideal to use an Isothermal or Low Temperature Cycle?

When the objects are not heat-stable, prone to congeal, or do not reach temperatures higher than atmospheric steam. For example,

• Thermoplastics, like LDPE
• Sensitive liquids, like milk or baby formula
• Some medical devices
• Media and agar preparation, as this cycle allows for the media (agar) to melt without overheating it.

Various Tuttnauer laboratory vertical and horizontal autoclaves offer advanced cycle programs, including the media processing cycles: For preparing agar and other biological media with a temperature range from 60°C to 95°C that allows for gentle heating and cooling down of agar.

To learn more visit https://tuttnauer.com/laboratory-autoclaves

What is the isothermal (Agar) process?

An isothermal process is a thermodynamic process in which the temperature of a system remains constant. The transfer of heat into or out of the system happens so slowly that thermal equilibrium is maintained.

The most effective and suitable method of sterilizing agar is by using moist heat in the form of steam under pressure i.e. 121°C for 15 minutes at 15 pounds per square inch (psi). This method will denature & coagulate enzymes and other cell constituents in the bacterial cell.

Optional isothermal cycles are typically used for preparing agar and other biological media.  Tuttnauer offers a flexible isothermal cycle with a temperature range from 60°C to 95°C that allows for gentle heating and cooling down of agar.

The isothermal process is usually used for pasteurization, inspissation, or fractional (intermittent) sterilization. Each process has a variety of cycles that may be applied and are dependent upon the process parameters, or options associated with each autoclave.

About the author

Ad Geilings, Global Product Manager Laboratory

Ad has been working for Tuttnauer Europe from 1997 until 2001 as Technical Manager, he has been in senior roles as Managing Director Tuttnauer Europe for 20 years.  As a global product manager Ad works very closely with the engineering and R&D team.  Ad has been a member of Dutch Committee Sterilization & Sterility since 1997.

By Michelle Strange, MSDH, RDH

We all know how passionate I am about ensuring proper infection control in dental practices, and one of the key factors to achieving this is having the most effective equipment. This includes an autoclave that meets international standards and all the regulatory requirements.

Running a subpar autoclave puts your practice at a higher risk of spreading infections, cross-infection, and contamination, let alone the inefficiencies that end up costing you time and money.

After working in the dental industry for so many years, I can tell you with confidence that one autoclave that is notsubpar is the T-Edge from Tuttnauer, whose features make it an ideal choice for the busy medical professionals.

Connectivity is the new wave in infection control

The connectivity of the T-Edge Autoclave is one of its most valuable features, especially in today’s technology-focused world. A connected autoclave allows medical professionals to easily monitor and manage the sterilization process, even remotely. They can see the autoclave cycle data in real-time and receive alerts when the cycle is complete or when there is an issue that needs attention. This is essentially the bottom-line benefit that’s worth the feature many times over.

In comparison, the majority of older autoclaves require a certain amount of physical monitoring to ensure that instruments are properly sterilized, which is not easy or convenient, particularly in busy practices. The connectivity of an autoclave, however, means medical professionals can check the autoclave’s cycle data and make sure that it is working as expected, without having to physically visit the autoclave.

It then stores and archives data, making infection control record keeping a breeze and ensuring compliance with regulatory requirements EN13060, ISO 13485, and CE certifications. It’s almost like outsourcing a part of your infection control process so that you can give more of your attention to your patients.

Connectivity options and innovations

Connectivity has introduced a host of options related to autoclaving. USB ports and data loggers have automated the process for information for logs, print-outs are available and information can be digitally archived. Best practices now include the use of electronic records by way of recording devices in sterilizers or an accessory device used for recordings and printouts. Options for labeling now also include barcoding with scans retained digitally. These are easily created, read and stored without the amount of effort required to manually create labeling. They also cannot be altered. Instrument tracking systems are also available that provide for traceability, and digital records are available for spore testing.

Tuttnauer autoclaves are designed with an advanced user-friendly control system for repeatable high performance. Including load tracing with barcodes. When loading the autoclave, a barcode reader can be used to scan the barcodes of each load. Once the cycle starts the barcode numbers will be printed together with cycle information. 

The interface of the Tuttnauer Autoclaves is intuitive and user-friendly, which keeps it simple enough for medical professionals to quickly get up to speed with how to use it. This simplicity helps reduce training time and ensures that personnel can operate the autoclave with minimal user error. For dental professionals its use is compatible with commonly used software for easy data integration and streamlined reporting.   The Tuttnauer T-Edge autoclave completes the entire sterilization process with the click of one button, providing ease of use and simplicity.

Since connectivity provides more options for documentation, the cycle data can be printed, transferred to a PC or network through the Ethernet connection, or the data can be stored in the autoclave. Remote PC Reporting (R.PC.R) Software automates and truly streamlines documentation, since all sterilization data can be saved as a pdf, transferred using a USB port or the ethernet or online, and with automated downloading of cycle information. It has become possible to digitally store information on the cycles performed, parameters reached, and to generate graphs, tables and charts for reports and analyses. It is also possible to remotely monitor multiple autoclaves, further streamlining efforts in a busy office.

Tuttnauer offers the optional addition of R.PC.R to be installed on the PC connected to the same network as the autoclave. The R.PC.R Software  provides cycle records you can rely on and will provide the following service:

• Automatic recording of cycle information to any PC on your network via an Ethernet network
• Easily generate PDF report
• No need to file printouts, saving you time
• Load Traceability – conveniently trace loads from a PC on your network with R.PC.R software. When barcodes of loads are scanned before a cycle starts, the barcode information is reported together with the cycle records. With R.PC.R you can see: Graphs of the cycle data, Numeric cycle data, Cycle print-outs, Measured values table, Parameter table.

With the modern technologically advanced autoclave, you’ll have a reliable and efficient autoclave that can help you provide quality patient care.

Bringing innovative connectivity to sterilization devices

Tuttnauer has launched the T-Connect, a cloud based IoT solution for your sterilization center. It is based on a unique device connectivity, providing clinics with data intelligence in real time, accessible from anywhere, anytime, in a secure way. Essentially an intelligent solution designed for your improved success and business management. T-Connect will communicate with your sterilization devices onsite or remotely, providing a gateway solution for devices without wifi feature capability to connect and leverage the benefits of complete connectivity. T-Connect provides real time data documentation, analysis and troubleshooting. Knowing where and what the technical glitches are, allows you to have accelerated service, saving you time and money.

Why access to a quality autoclave is so important?

Access to a high-quality autoclave in any medical practice environment is essential because it ensures effective sterilization and disinfection of tools.  The risks of running an autoclave that underperforms include the potential for cross-contamination or infection of patients or staff and increased costs associated with needing to replace tools more frequently than necessary.

The incidence of disease transmission from autoclaves in the dental industry is frustratingly more frequent  than  in other healthcare settings, so autoclaves must meet the highest standards.

While still in use in some practices, older models require frequent calibration and manual monitoring, which can be highly time-consuming. Advances in technology, however, have led to the development of autoclaves that are much easier to use and maintain.

Modern autoclaves have in-depth safety protocols and automated features, including cycle verification and monitoring. These models also come with advanced programming options that make it easy to customize sterilization cycles according to the type of tools being sterilized, which is a real game changer once you get used to it.

Features of the T-Edge autoclave

Designed with a patented closed-door drying system, the T-edge ensures fast and efficient drying. Considering how quickly we sometimes have to turn over patients, this speediness is a godsend for a high-volume practice. The 27-liter chamber means it can also sterilize larger instruments such as instruments used in implant treatments and oral and maxillofacial surgeries.

The autoclave also comes with an advanced LCD screen that allows monitoring of every stage of the sterilization process, and its safety features ensure that it will not overheat or under-oxygenate during the sterilization process.

To up your infection control game and protect your patients, staff and your business, you must invest in the best sterilization products out there, and there is nothing better than the T-Edge autoclave.

Watch this T-Edge video to learn more: https://tuttnauer.com/videos-about-sterile-processing/t-edge-autoclave

GUEST AUTHOR

Michelle Strange, MSDH, RDH

Michelle Strange, MSDH, RDH, brings over 20 years of experience to her numerous roles in dentistry. A graduate of the Medical University of South Carolina with a Bachelor of Health Science and the University of Bridgeport with a Master’s in Dental Hygiene Education, she focuses her career on expanding the knowledge of her colleagues in all aspects of health care. Her passion for dentistry and its connection to overall health extends to her community and global efforts. Michelle was the co-founder of the longest-running podcast for dental hygienists, A Tale of Two Hygienists.

Autoclaves are a critical part of effective infection control in the dental office, with a plethora of autoclaves to choose from. If you are replacing an existing autoclave, and your needs are unchanged, you may be happy to purchase the same or a similar one. Whether you are looking to purchase your next autoclave, an additional autoclave, or your first autoclave, there are a number of considerations.

With that in mind, here are ten steps in choosing your next autoclave that  will help you make a good decision:

Step 1: Volume and types of instruments

First consider the instruments being sterilized. How many instruments are/will you use per day, and how often will they be needed? What types of instruments? How many handpieces do you use daily? Do you have any instruments you are keeping or purchasing that require a dedicated cycle?

Step 2: Gravity displacement or vacuum autoclave

Gravity displacement (Class N) and pre-vacuum (Class B) autoclaves are available. A third type, the Class S, has varying features and indications provided by the manufacturer for a specific autoclave. (EN 13060) Gravity displacement autoclaves are the simplest, relying on gravity to push air out through exit valves at the chamber’s base when steam enters to displace the air. Pre-vacuum autoclaves contain a vacuum pump that creates negative pressure and forces steam in. This results in more effective air removal than gravity displacement, particularly for wrapped loads and devices with lumens, e.g., handpieces. For autoclaves with a post-vacuum, drying efficiency is also improved.

Which type do you want or need? It depends. It is essential to know the regulations and standards where you practice! In Europe, standard EN 13060 recommends vacuum autoclaves for medical devices. Depending on your location, gravity displacement may only be recommended (or allowed) for unwrapped loads and solid instruments (i.e., no hollows/lumens) and a pre-vacuum autoclave for packaged loads, solid and lumened instruments. In another location, pre-vacuum autoclaves may be mandated for handpieces. In yet another, any type of autoclave may be recommended, while unwrapped/unpackaged loads are not allowed or are strongly discouraged.

Note that autoclaves are validated by the manufacturer for the loads and cycles indicated in the instructions for use (IFU), for wrapped and unwrapped loads as appropriate. Medical device approval by the relevant authority occurs for each location

Step 3: Chamber Size and load capacity

For small steam sterilizers used in the dental clinic chamber size can be up to 60 liters. The internal dimensions of the cylinder itself and configuration of trays and racks within it also vary, influencing the loads that can be accommodated. A chamber large enough and configured to accommodate the instrument loads you need, but not excessive, is ideal. Consider whether two smaller or one large autoclave would be best.

Step 4: Cycle times

Cycle times vary by autoclave type and cycle parameters, as do warm-up and cooling times. Consider each stage in the process. If an autoclave requires a pre-heat phase, that needs to be added in, as does drying time. Quicker cycles do result in more rapid reprocessing and autoclave availability for subsequent loads.

Step 5: Available space

In a previous article we discuss the design of the instrument reprocessing room, as part of a clinic design. Designating and designing a space in advance can help to improve future performance and efficiency. The autoclave(s) must fit in the designated area in the reprocessing room, still allowing for set-down areas. We already considered load capacity and cycle times. If you have or anticipate a high throughput of instruments, it may be helpful to purchase two smaller autoclaves rather than one large one, depending on available space. This presents several potential advantages:

• Flexibility in processing smaller loads
• Smaller autoclaves require less energy than larger autoclaves
• Potential for simultaneous use/staggered loads
• Accommodation of anticipated growth 
• You have a back-up! Instruments can be reprocessed uninterrupted (albeit fewer) should one autoclave be taken out of service.

Step 6: Manual or automated, ease-of-use

Manual autoclaves require time be spent on tasks that are effortlessly performed with automated autoclaves. For example, pre-programmed cycles remove the need to set sterilization parameters. Other examples include automated door-locking and release, a water-fill function, and digital documentation for the sterilization log. Nonetheless, manual autoclaves can be simple to use and are less expensive. For automated autoclaves, check there are sufficient pre-programmed cycles for your needs – note that an excessive number is not ideal either. Once you have narrowed down your choices, you may want to review IFUs.

Step 7: Accessories

Consider the availability and versatility of accessories such as racks for cassettes and trays for packaged instruments. These help to arrange instrument loads, and ensure sufficient space between packages, helping to avoid some errors and, e.g., wet packs. An incorporated printer may be included or USB ports for transfer of digital records.

Step 8: Sterilization logs

Autoclaves with digital output for record-keeping not only save time, they provide reliable records of autoclave performance and cycles for each load, for inclusion in the sterilization log. This is helpful in meeting requirements, and a best practice. In some cases, transmission of data occurs electronically.

Step 9: Maintenance Requirements, Warranties and Support

Make sure you know how much maintenance your autoclave will require, including replacement of consumables (e.g., gaskets, filters). Be clear on the warranty – the longer and more comprehensive, the better. Consider the reputation, expertise and quality of customer support from the autoclave company, and how quickly technical support would be available.

Step 10: Costs

Considering costs is inevitable and important. Are there additional installation costs? Are accessories included in the price? Assess initial and all ongoing costs, e.g., future maintenance, technical support and replacement parts. Smaller autoclaves are generally less expensive than larger autoclaves of the same quality – potentially another reason to consider a smaller autoclave initially and an additional one later for increased capacity.

In conclusion

When it comes to autoclaves, ‘one size does not fit all.’ There are choices galore and careful consideration and planning is invaluable. The distributor or local office for the autoclaves you are interested in can help you determine the best fit for you and your office. Investing time in these 10 steps can help you make the right investment when choosing a new autoclave for your dental office.

About Tuttnauer – We’re a one-stop shop for sterile dental processing

Tuttnauer provides end to end sterile processing solutions for dental clinics, including; advanced autoclave sterilizers, washer-disinfectors, indicators and sterile processing products. The T-Edge 23 autoclaves were explicitly developed for dental practices. They meet all your sterilization needs by creating cyclic parameters that accommodate with the most challenging loads, ensuring sterility and efficient drying, helping dentists achieve today’s challenging workloads and provide superior patient care, without risking cross patient contamination.

For further information and to inquire about purchasing the T-Edge 10 autoclave for your practice, visit the T-Edge page on our website.

Author: Fiona M. Collins

Dr. Collins graduated as a general dentist from the University of Glasgow and holds an MBA and an MA from Boston University. During her career, she has lived and worked in 5 countries and has given presentations internationally. Fiona is currently the ADA’s representative to the Association for the Advancement of Medical Instrumentation (AAMI), a member of the ADA, OSAP, a participant in infection control-related Standards working groups in AAMI, and a Fellow of the Pierre Fauchard Academy.