Prestige

Day to day operations in a dental practice run by certain routines or systems. There are particular processes that must happen for a practice to run smoothly. This article will provide clinicians with helpful suggestions for an efficient and consistent process, or flow, with the instrument processing cycle. Sometimes the clinical day is not as smooth as it could be. Breakdowns can slow down or impeded the process. Several things can impede the instrument processing flow such as clutter.

Instrument processing space & treatment room

Cluttered spaces require more time for cleaning and disinfection, as well as wasted time on searching for needed items. A clean streamlined space has a better daily flow.  Efficiency not only saves time, but money as well. From an infection prevention standpoint, the Centers for Disease Control and Prevention (CDC) recommends having out only the items needed for the procedure and unit dose dispensing supplies to avoid wasted materials.^1,2

Dental staff enter and exit the sterilization area multiple times per day.3 Having adequate flow in the sterilization center is critical to efficiency.³ Using a designated clean side/dirty side approach, a U shaped, or clockwise directional flow is best.³ Ensuring there is enough space for two people is also critical. Having adequate room for two people to perform processing tasks is much more efficient. A four-foot aisle way without a door is the most efficient design.⁴

The layout of the treatment room is an important consideration in efficiency and cost effectiveness. Treatment rooms stocked identically with color coded procedural tubs keeps staff organized, saves time trying to locate items, and reduces wasted supplies. All these considerations are effective solutions.

Labor savings

Cost effectiveness is another important metric to consider. Labor is the largest expense in a dental practice, consuming approximately 25% of the budget.³ The average dental assistant enters sterilization area up to 80 times per day to perform disinfection and sterilization tasks.³ Practices often avoid investing in sterilization equipment, mistakenly believing it saves money. Money is spent on labor instead. Investing in the right equipment can reduce labor costs. Large purchases with sterilization equipment can pay for itself within a year.

Workflow efficiencies

The flow of instrument processing can be more efficient if performed one way or can be less efficient if performed another way. The workflow begins with receiving (transporting, cleaning, and decontamination), preparation and packaging, sterilization, and storage.¹ The receiving process of handling loose instruments, rinsing, and drying is very labor intensive and time consuming and puts clinicians at higher risk for percutaneous injury. This method is inefficient and unsafe. Using cassettes and an instrument washer saves valuable time and money by reducing the handling of instruments. It is much more efficient from an organization standpoint to use instrument cassettes.

Cassettes

Use of instrument managements systems (IMS) such as cassettes helps create a more organized process by easily being able to find the right instrument when needed. Cassettes help clinicians save time not having to search for loose instruments on a tray. Being unorganized costs time. Stopping to look for an instrument or supply, having to un-glove, or leave the operatory is not efficient. These little time wasters add up if done several times per day. Cassettes are also safer and reduces the risk of sharps injuries.¹

Instrument Washers

The use of instrument washers or washer/disinfectors is another critical element in an efficient process. Instruments must be free of debris that inhibits the sterilization process.^1,4 Washers clean, disinfect, rinse and dry instruments saving valuable time and avoiding the potential for percutaneous injury. Instruments must be thoroughly cleaned and dried prior to preparation and packaging for sterilization.^1-2,4 Instrument washers eliminate several steps of manual labor creating a more efficient and safer process. The CDC recommends automated methods for cleaning.¹ A good quality washer can easily handle the needs of a ^4-6 operatory office. Investing in this technology can be initially expensive, but over time the return on investment in labor savings is huge. Use of cassettes along with instrument washers can save up to 10 hours of labor per week which equates to 40 hours per month in labor savings which is efficient and significantly cost effective.³

Once instruments are cleaned and dried, chemical indicators are placed to demonstrate that items have been exposed to the sterilization process.^1,4 Type 5 integrating indicators are used inside cassettes and secured with a type 1 indicator tape, or pouches with type 4 indicators are used. Both methods are acceptable and are efficient.

Water Quality- protecting your equipment

Water is another important consideration for the sterilization area. Good quality water is needed for the autoclave and instrument washer. Distilled water or reverse osmosis (RO) water systems provide the water quality needed for these devices. Autoclaves require either distilled or deionized (DI) water to run efficiently and reduces the risk of build-up and costly repairs. Deionized water comes from a reverse osmosis system and compares to the same quality as distilled water. Some instrument washers also use distilled water purity for the final rinse cycle. New technology now have models with an auto filler that is paired with the washer and autoclave.  Using a RO system to provide DI water with autofill as opposed to the purchase of distilled water jugs is also much more efficient and cost effective. Having the RO system readily available in your central sterilization saves time, and reduces the risk of running out. Carrying and storing jugs of distilled water is time consuming and takes up space in the practice. Over time, the investment in a RO auto filler system can reap big rewards. Reverse osmosis systems are more cost effective and efficient in the long run. These are turn-key solutions for washing/disinfecting/drying and the complete sterilization cycle.

IFU – capacity to drive efficiency

Sterilization with an autoclave is used for critical and semi-critical items. It is imperative that dental staff understand the manufacturer’s instruction for use (IFU) on how to properly load, operate, unload, and monitor with biological indicators (BI).^1,4 It should be noted that the sterilization capacity should match the instrument cleaning capacity. Practices often make a mistake of increasing cleaning (with a washer), but do not have the sterilization capacity to match the need. To achieve efficiency with the process, you need to match capacity. As a rule, it is good practice to have a standard autoclave with a chamber size of at least 11 inches and a flash sterilizer.³ Larger practices may need multiple autoclaves to match capacity. New autoclave technology also includes a virus protect cycle which adds another layer of safety.

Biological Monitoring

The only way to know if an autoclave is working properly is by testing or validating its effectiveness using biological monitoring, also known as spore testing.^1,4 New technology includes ultra-rapid (twenty minute) biological monitoring. This method provides quicker results saving time and provides peace of mind. Keeping a log of details related to sterilization cycles is required for each load, noting the date, time, which autoclave (if there is more than one), the temperature, and duration of the cycle.^1,4  Some autoclaves can be connected by USB or provide an electronic printout making logging and record keeping convenient and more efficient. In-office B.I. solutions are cost effective in the long run compared with mail-in, preventing possible contamination by using an instrument which failed a sterilization cycle, due to results wait times. Tuttnauer B.I. solutions include incubators holding several B.I. vials and save mailing costs and waiting times.  

In summary, the use of cassettes, instrument washers, having adequate space/flow/capacity, being organized, use of tubs, use of RO water systems with auto fill, and use of rapid BI’s with logging capabilities all contribute to an efficient and cost-effective complete infection control solution.

References

1.  Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings-2003. MMWR 2003;52(RR-17):1-66.

2. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings. Basic Expectations for Safe Care. Available at:  https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf

3. Tholen, M. Increase production and decrease expenses in sterilization. Dental Economics. Oct 2009. Available at: https://www.dentaleconomics.com/practice/overhead-and-profitability/article/16389257/increase-production-and-decrease-expenses-in-sterilization

4.  Occupational Safety & Health Administration. Bloodborne Pathogens Standard 29 CFR.1910.1030. Available at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051

Author: Kandis Garland, RDH MS

Ms. Garland is an educator, author, and speaker. Her career spans 22 years as a dental hygienist and educator where she served as Clinic Coordinator, and Health and Safety Coordinator. Her research, which she presents nationally, focuses on infection control. Garland is an active member of the Organization for Safety, Asepsis and Prevention and Dimensions of Dental Hygiene’s Peer Review Panel. She is a member of the Crosstex Luminary Council, provides infection control consulting services, and serves as an educational consultant for Tuttnauer.

In the technologically advanced world we live in today, how are medical devices keeping up? In this post we will review the development of technology and advancement within the sterilization equipment.

Definition: Connectivity is defined as ‘the quality, state, or capability of being connective or connected.’

On a broad level, for example connectivity is the ability to retrieve information at a moment’s notice on the internet helps to make it easier to stay up-to-date. On a personal level, connectivity examples include monitoring babies while they sleep or houses while owners are away, and medically for robotic surgery procedures and a host of other purposes.

Protocols performed as part and parcel of infection control and prevention also derive significant benefit from connectivity. This may encompass the use of data loggers, messaging, remote monitoring or integrated documentation and digital archiving of steps in the process. In this article, we’ll look at examples in the context of steam sterilization (autoclaving).

Sterilization packs, cycles, monitoring and logs

Mechanical (physical) indicators

For autoclaving, recommendations and best practices required that all packs are labeled for each cycle and load. Sterilization monitoring must be performed routinely, to verify sterilizer efficacy, for every pack and every load in autoclaves, and as part of validation/qualification for an autoclave. This begins with mechanical (physical) indicators to verify that all three parameters (time, temperature and pressure) were met for the selected cycle. In turn, chemical indicators provide verification that one or more conditions required for sterilization were met either for a specific location or for each sterilization pack. Monitoring of mechanical and chemical indicators is used to verify the efficacy of the sterilization process. These indicators act as an early warning system and loads should be reprocessed if parameters were not met. The results of mechanical and chemical indicators are entered in the sterilization log along with the results of biological monitoring (spore testing) if that is a recommendation in your location and performed. All other required details, including the pack and load information is entered and the log is signed by the operator.

Tuttnauers’ Auto Reader allows for Rapid, Super Rapid and Ultra Rapid Biological Indicators.

Tracking reprocessed sterilization packs

The sterilization log and labeling together enable tracking/tracing of reprocessed sterilization packs, should it become necessary to remove these from inventory/storage and to reprocess them. This may occur because someone discovered a wet pack with internal moisture/water when a pack was opened to use the contents. Since the pack was wet, contamination could have occurred, and the contents will need to be reprocessed. Therefore, other packs from the load should be traced and if more packs are wet then all packs from that load must be reprocessed. Another example would be a failed spore test, requiring tracing of all loads since the last passing spore test. The ability to accurately trace and track processed packs and loads is an essential component of infection control.

Traditional processes used during autoclaving

Historically, mechanical indicators were analog gauges on the autoclave, which meant that the operator had to physically observe the gauges to verify the parameters. In addition, all pack labeling information was written manually, and a physical (paper) sterilization log was maintained by the operator and signed. Subsequently, digital ‘mechanical’ indicators were introduced in autoclaves providing a more readable option and now also include information throughout the cycle and information on potential problems and cycle/operational errors.

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.

Remote real-time monitoring

The latest innovations in connectivity for autoclaves include remote real-time monitoring of autoclave cycles, automated labeling and recordkeeping. For example, enabling autoclave monitoring remotely using a smartphone or tablet. This means there is no need to physically assess parameters at the location of the autoclave. In addition, the autoclave offers barcodes for each cycle with all sterilization data that can be affixed to reprocessed pouches and scanned for digital documentation when the contents are used for a patient. Connectivity also has provided more options for documentation since 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 in the autoclave device. 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
• Convenient access to graphs and tables that are easy to understand
• Easily generate PDF reports
• 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.

Other Considerations

While the main focus of this article is on the contributions of connectivity to the sterilization aspects of instrument reprocessing, it is worth noting that connectivity has also enabled streamlining of protocols related to automated cleaning. For example, it is required to keep a record of all instrument washer or instrument washer-disinfector cycles, as well as testing and maintenance.    Some devices have digital readouts and cycle printouts that should be reviewed for each cycle and initialed/signed by the operator to indicate an acceptable cycle. Tuttnauer Tiva washer disinfector line offers graphic reports of washing phases including time and temperature.

In Summary

As in everyday life, connectivity offers significant benefits during and after instrument reprocessing. Connectivity automates and streamlines processes and creates documentation for robust recordkeeping. Appropriate use of connectivity and recent innovations saves effort, time and standardizes digital processes with potential benefits for infection control overall.

Resources

• Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79: 2017. Comprehensive guide to steam sterilization and sterility assurance in health care facilities.
• Dubai Health Authority. Health Regulation Department. Guidelines on Dental Infection Prevention and Safety.
• Health Technical Memorandum 01-05: Decontamination in primary care dental practices. (2013)
• Koninklijke Nederlandse Maatschappij tot bevordering der Tandheelkunde. Richtlijn Infectiepreventie in Mondzorgpraktijken
• Merriam-Webster. Available at: https://www.merriam-webster.com/dictionary/connectivity#h1

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.

Sterilization in today’s infection control environment has taken on a new level of safety. Increasing the risk of infection spread is precisely what laboratory technicians need to avoid, and when dealing with microorganisms, it is critical to understand what your autoclave can do for you.

In the USA alone, there are over half a million laboratory employees, each potentially risking their health and safety with exposure to infections. The potential exists for bacteria and viruses to spread in a laboratory environment. That is why sterilization devices, like autoclaves, are such a critical component within any laboratory environment.

Laboratory autoclaves are designed for research facilities, universities, food, and microbiology settings. These autoclaves must be able to provide high quality, dependable performance that will allow for effective support of cutting-edge life science research.

The following article examines key features to consider when purchasing a laboratory autoclave. By the end of this article, you will be able to answer the following questions:

• Why are biohazard filters necessary for waste sterilization?
• Why are PT 100 sensors necessary for sterilizing liquids?
• When is Vacuum-Assisted Air Removal used?
• What are the benefits of advanced reporting software?

F₀ control for heat-sensitive liquid media

Many of Tuttnauer’s LabSci laboratory autoclaves can perform cycles with F₀ control (pronounced F Sub-Zero) *. This feature reduces the exposure time of the load to high temperatures. It is especially relevant when sterilizing delicate heat-sensitive liquid media. By minimizing the time liquid media are exposed to high temperatures, the integrity of the load is maintained and the cycle time is reduced. The theory behind F₀ is that microorganisms and bacteria can be destroyed prior to reaching the set sterilization temperature, during the heat up stage, allowing for shorter sterilization exposure times.

How does F₀ work?

F₀ will adjust the sterilization hold time according to the F₀ value, which depends on time, temperature and the Z-Value (thermal resistance) of the specific microorganism. This option reduces sterilization hold time according to the F₀ value. If a standard sterilization holding time is set to 15 minutes, the sterilization hold time may be reduced, based on the F₀ calculation, by minutes. This results in saved time and avoids overheating the liquid, while still ensuring appropriate sterilization.

Waste sterilization with biohazard filters

Does your laboratory work with Covid-19 test samples or biohazardous material? Autoclaves generate aerosols during the sterilization process. These aerosols may potentially contain harmful pathogens carried from the processed load. Therefore, the sterilization of biohazardous waste may put at risk both the staff as well as the surrounding environment. It is essential to have an appropriate sterilization solution that provided protection from this potentially harmful aerosol. With this in mind, it is highly recommended to equip the autoclave with an advanced air filter.

How does it work?

During the pre-sterilization air removal and heating stage, the chamber air being removed is passed through a microbiological filter that filters harmful substances before it is release to the air outside the autoclave. Air is filtered by a High-Efficiency Particulate Air filter, known as a HEPA filter. HEPA filters are used to block the passage of microorganisms found in the autoclave effluent. The destruction of pathogens caught inside the filter not only eliminates them and maintains the sterile conditions of the surrounding lab, but it also allows for safe, sterile conditions for the next autoclave cycle to be performed. Tuttnauer’s LabSci horizontal and vertical autoclaves are optionally equipped with a HEPA air filter that blocks microorganisms from exiting the autoclave during the air removal phase. This protective measure prevents the contaminated chamber air from escaping into the atmosphere and, instead, catches the harmful microorganism inside the filter.

PT 100 Sensors (Load Probes):

There is a significant gap between the load and the chamber heating time when sterilizing liquids, the former being significantly slower than the latter. The temperature in the chamber reaches sterilization conditions long before the liquid. For example, the chamber temperature may reach 121°C, initiating the sterilization phase; however, the liquid has not yet reached sterilization temperature. Therefore, the process will not be valid. Our autoclaves provide for two PT100 sensors to be placed within the liquid, ensuring the sterilization phase will only begin, when the liquid reaches the pre-set sterilization temperature. Furthermore, the sensors ensure that the load is cooled down to a safe temperature, protecting the staff when opening the autoclave door. Most laboratory autoclaves contain only one PT100 probe. However, Tuttnauer’s LabSci autoclaves, provide a solution beyond the required standard. All our sterilizers incorporate advanced technological features, providing safe and validated sterilization.

Sterilizing glassware and hollow instruments

When sterilizing glassware, hollows, and pipette tips, it is essential to remove the air before sterilization, to maximize steam penetration. These loads inherently contain air inside the vessels, and this air must be removed to ensure complete sterilization of the load. Using a vacuum pump provides greater sterility assurance, by mechanically removing the air from the chamber and load, via pre-vacuum air removal pulses. The vacuum pump also helps to dry the load more efficiently.

User-friendly control system and advanced R.PC.R. software

The advantages of a state-of-the-art Control System with Multi-Color Display include:

• F₀ software control
• 200 Cycles storage

The Tuttnauer R.PC.R software is an essential addition to research and laboratory autoclaves. It performs automatic cycle monitoring and can be used over the local area network. It is a user-friendly report generator that enables you to:

• Manage cycle history report files online or offline by USB
• Track the entire history of the processes run by the autoclave
• Track-specific parameters that have been used in each cycle and stage
• Choose a reporting style including graphs, tables or printouts
• Generate PDF reports

The control system and RPCR software comply with the 21 CFR part 11 standard.

Tuttnauer, a global sterilization solutions expert, has developed a unique and competitive laboratory sterilizer series. The LabSci product line is a robust, reliable and cost-effective solution for all your laboratory sterilization needs.

These sterilizers are designed to provide high quality repeatable performance and accountability for a wide range of lab applications, including: liquids, media, glassware, instruments, clothing, waste, and other laboratory items.

The LabSci line offers a wide range of models and sizes, from compact benchtop machines to vertical and freestanding sterilizers. These models include electronically controlled sterilizers, some with pre-post vacuum technology, innovative control systems and much more. All LabSci models comply with the highest manufacturing and safety standards and are provided with a built-in printer for GLP-compliant documentation.

About Tuttnauer: Tuttnauer provides end to end sterile processing solutions for laboratories, research institutes, hospitals, medical, dental and ophthalmic clinics, including; advanced autoclave, washer-disinfectors, indicators, and sterile processing products. The safe and reliable biocontainment systems are designed to deal with the environmental threat posed by pathogens and other contaminated materials emitted from laboratories. Tuttnauer takes the most extreme measures in fighting bacteria and viruses, including the Coronavirus (aka SARS-CoV-2), by providing innovative decontamination solutions that go above and beyond the required standards.

For further information and to inquire about purchasing an advanced autoclave for your laboratory, contact a Tuttnauer representative.

Author: Tuttnauer Product Experts

As a dental hygienist who has worked over the years in many different dental practices, there is no doubt that most often dental practices are trying to perform all the correct procedures for infection prevention and patient safety. Most offices understand that instrument reprocessing is an area that can have frequent infection control breaches.

In an effort to do the correct thing, dental offices are more often using chemical indicators, thinking that one is needed for the outside of the package and one for the inside of the package.  What they don’t realize is that there are very different types of chemical indicators.  Instead of using the appropriate chemical indicator for the outside of the package and the correct one for the inside of the instrument package, dental practices are often using the external chemical indicator for both.  This is a mistake often being made despite good intentions. In this article, we will review the proper way to use chemical indicators when sterilizing reusable dental instruments.

Instrument processing is an essential part of daily operations in every dental office. Reusable instruments undergo various sterilization processes to remove infectious material from the previous patient to prevent cross-infection to the next patient or any dental team member.

To verify that the items are clean, sterile, and, more importantly, safe to use on the next patient, the Centers for Disease Control and Prevention (CDC) recommends using a combination of biological (BI), chemical (CI), and physical/mechanical indicators (MI) to monitor the effectiveness of the sterilization process.

The use of Indicators in monitoring sterilization

The current gold standard for monitoring is biological indicators or spore tests, which monitor the functioning of autoclaves by directly evaluating whether any highly resistant microorganisms are left behind during the process. A negative or Inactivated BI indicates that all pathogens in the load have been eliminated, therefore confirming sterilization. However, the performance of biological monitoring is only required on a weekly basis as it takes time to produce results.

Chemical indicators allow us to verify the proper sterilization procedures of instruments in between biological monitoring. Mechanical monitoring can detect equipment malfunctions by ensuring that any machinery involved, such as the autoclave machine, is operating optimally, at the right temperature, time, and for the correct duration.

While they do not confirm sterilization, chemical and mechanical indicators expose procedural errors and equipment malfunctions during reprocessing. Therefore, they must be carried out for every sterilizer load to detect discrepancies, alongside using a biological indicator once every week to ensure successful disinfection.

Understanding different types of chemical indicators

Chemical indicators are an affordable, convenient, and effective way to determine if an item has been through a sterilization cycle.

There are six classes of CIs, and the CDC recommends using at least two: an external (Type 1) and an internal (Type 3, 4, 5, and 6) marker, to be placed on the inside and outside of every instrument package. It is important to note that this classification has no hierarchical significance. Type 6, for instance, is not better than Type 1; they simply measure different metrics. Therefore, deciding which indicator to use for the task at hand merely depends on the required measurement parameters.

Indicators on the outside (Type 1) show whether an article was heat exposed, which means it has undergone the disinfection process and makes it easier to distinguish processed from unprocessed items. 

Internal indicators demonstrate the achievement of sterilization parameters like time, temperature, and pressure. By assessing these variables, chemical indicators show the completion of the sterilization process or any failings in the process.

Type 2 CIs are specific; they assess the efficacy of air removal in a prevacuum sterilizer. Type 3 indicators identify exposure in specific places by measuring only one variable, either temperature or time. Type 4 is a multivariable marker since it can respond to more than one indicated parameter. Types 5, such as the Tuttnauer Chemical Indicator, and 6 can react to all critical parameters and are usually the go-to choice for ensuring sterilization success.

Type 5 internal indicators mimic the response of biological indicators, and some experts consider them to exceed their performance requirements. They clearly demonstrate the effectiveness of the sterilization process by changing color when the sterilizing agent (e.g., steam) successfully penetrates the material and has satisfied all critical parameters.

Best practices for sterilization monitoring

Decisions on when to use which type of chemical indicator depend on the sterilization packaging. When using pouches, the placement of a type 4 internal CI, which is clearly labeled for traceability, is essential inside the package. When utilizing cassettes, each cassette should have a wrapped and labeled type 5 indicator and the case secured with a type 1 tape.  Note, although type 5 indicators mimic the response of a biological indicator, they test only the specific package they were placed into, as appose to a BI which test the entire autoclave chamber.

As a rule of thumb, chemical indicators should be used inside and outside each package to show that it has been through a sterilization cycle. Furthermore, color change or CI alone is insufficient to demonstrate sterilization. Examining all physical, biological, and chemical parameters is required to ensure the sterility of the items.

Chemical indicators are essential to ensure the complete and successful sterilization of dental instruments. In combination with physical monitoring and regular spore testing, indicators assist practices in maintaining high standards for reprocessing, thereby reducing the risk of infection. 
 
However, monitoring should not stop at the autoclave. We should also use indicators in other equipment, such as Tiva Washers. It is essential to ensure that they are checked for efficiency too. Products such as Tuttnauer cleaning and disinfection indicators can make this process much more straightforward and effective.

The correct processing of instruments is an essential pillar of infection control. By implementing and following strict standard operating procedures, favorable results are achievable with a low risk of cross-contamination. 

When employed as part of a comprehensive quality and infection control program, indicators detect problems or errors that could result in non-sterile equipment. Relevant staff members should be well trained on the procedures and understand the rationale for carrying out these tasks that significantly impact patient safety. 

Although there have been significant changes in the dental industry, particularly due to COVID-19, sterilization monitoring remains a constant and vital quality assurance process. It provides peace of mind that staff and patient safety are safeguarded and upholds a high standard of care for the practice.

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.

Choosing a detergent will depend on a combination of three considerations: the utensils being washed, the users, and the washer disinfector cleaning procedure.

Detergents are designed to simplify your work by eliminating manual washing and reducing your manpower. Ensuring the safety of your patients by providing consistent quality washing cycles at all times and ensuring the safety of your staff by eliminating risks of exposure to potentially harmful aerosols.

Detergents help make the cleaning process even more effective. Essentially, they make the water wetter making it easier to trap residue away from the dirty equipment. This means that residue isn’t just moved around and that it is properly removed.  The correct use of chemicals in washer machines ensures optimum washing results, saves money and environmentally friendly!

Manufacture instructions

When selecting a detergent, it is important that the label claim of the cleaning agent you use specifies that the product can in fact be used as a cleaning agent for the reprocessing of medical devices. Finding a suitable detergent can be challenging or incorrect if the detergent does not have a clear label.

Additionally, the detergent’s IFU should be checked to make sure that the intended use of the cleaning agent is compatible with the intended medical utensils. For example, the T-Clean Alkaline Detergent is very suitable for anesthetic and endoscopic equipment, laboratory glassware.  Whereas the T-Clean Enzymatic cleaner is used specifically for surgical instruments and endoscopes.

Manual soapy cleaning agents may generate too much foam during automated cleaning, thereby causing harm to the proper functioning of the washer-disinfectors. But even detergents intended for manual cleaning may not be suited for your specific manual cleaning procedure. For example, you may wish to wipe or spray the device even though the detergent’s IFU indicates that submerging the device is required for proper functioning of the detergent. 

A final consideration is the compatibility of the detergent with the rest of your reprocessing instructions, more specifically if your instructions include high-level disinfection. Not all high-level disinfectants are compatible with all cleaning agents. Hence, the IFU of the disinfectant should be checked to see which detergents can be used in the cleaning phase. If compatibility issues exist with the intended detergent either another detergent should be selected or a rigorous rinsing step after cleaning should be introduced.

Geography of the user

Selecting a detergent will not only depend on your washer disinfector instructions, but also on where the users of your device are located. Several detergent classes exist such as alkaline, neutral pH, enzymatic, etc. and based on the location of your users they may have access to different detergent classes. It has been noted that the majority of healthcare facilities in the USA will rely on enzymatic detergents, whereas European healthcare facilities will mostly use alkaline detergents. It is important to note that enzymatic alkaline detergents like the T-Clean E can be used to cover both the EU and US markets.

Device materials

Keeping the reprocessing instructions and the location of the users in mind, a final consideration is whether the selected detergent is compatible with the materials used in the construction of the device. For example, devices containing aluminum can sustain surface damage when exposed to some alkaline cleaning chemicals. The detergent selected should not affect the compatibility or functionality of the device. The T-Clean Tuttnauer detergent line is completely compatible with the Tuttnauer TIVA washer disinfector line.

In summary, selecting the proper detergent will depend on the reprocessing instructions, the location of your users, and the materials used to construct the device. The IFU of the detergent you wish to use should always be checked to make sure that it is appropriate for the intended reprocessing instructions and that it is compatible with your device’s materials. Detergents are critical to ensure you keep your equipment hygienic and shining.  There is a good reason why detergents have so many different compositions, because many factors must be considered such as temperature, wash cycle time, water pressure.

Author: Tuttnauer Product Experts

Tuttnauer 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.

Post the Covid pandemic, when it comes to dental or medical procedures of all disciplines, you may know that infection control has been a crucial part of your practices’ safety and healthcare standards. Infection control is strongly related to proper disinfection and sterilization. In general, sterilization can prevent cross contamination and disease transformation that happen in all medical practices.

Running a practice makes each practitioner very hands on in relation to all sterilization process, including the usage of autoclaves. A private practice in this article is defined as 3 or less working rooms.

You rely on your staff members to operate the devices involved in the process to sterilize your medical instruments and surgical tools every day. selecting the right autoclave is vital and an essential piece of equipment investment for your practice.

If you are in the market for a new autoclave, here are several important tips that will help you to consider when making your decision. Ensuring you will get the most out of your investment.

Safety and reliability

Reliability is the number one consideration associated with an investment in the right autoclave.

The autoclave chamber is key –it works day in, day out to withstand extreme pressure and temperature. Looking for a high-quality premium made manufacturer is critical to guarantee the autoclave chamber and all other relevant parts are built with strict quality control using long withstanding raw material.

You’ll also need to consider an autoclave with extra safety mechanisms. For example, automatic autoclaves use high-temperature and high-pressure steam in the defined sterilization time to sterilize instruments and tools. The safety protection mechanism of each autoclave is a crucial consideration, the automatic double door locking mechanism is a good choice. It ensures the door is closed during the drying stage and can only open when the sterilization cycle is complete followed by pressing the unlock button.

This feature prevents re-contamination and keeps everyone safe.  This is a feature found in all the Tuttnauer Fast drying Class S autoclave.  For more information about the value of closed door drying watch this short video explanation https://www.youtube.com/watch?v=OlViEWQwCHI

Space is key

In your practice, space is a valuable commodity, often offices are small and tight on space so that front-loading tabletop autoclaves (also called bench-top autoclaves) is the ideal size for you.  It is designed to be compact and perfectly fit small areas to maximize your space. Tuttnauer offers a large variety of many tabletop autoclaves that offer small footprint with great performance. All meeting the strictest and most current international standards and regulatory requirements.

Autoclave automation

In private practices, you will commonly see a tabletop autoclave come in two versions of automatic and manual design.

The automatic autoclave performs the entire sterilization cycle with one click. Once you have your sterilization settings ready, the water will flow into the chamber, and then it will automatically start the complete sterilization cycle including drying. An automatic autoclave has many cycle features that are pre-programmed, very intuitive and easy to operate. For busy practices, the automatic autoclaves will eliminate any thinking and labor needed to operate.  It will simply run on its own and be more efficient for your practice operation.

The manual autoclaves more economical compared to the automated ones.

Yet, with a manual autoclave, the operator performs various actions. The operator must control and monitor more process details for the complete sterilization – some critical factors as water filling into the chamber, set the correct temperature and timer, and more.  There is a variety of Tuttnauer manual autoclaves, which are often purchased as secondary autoclaves when the workload is heavy and your practice needs more than just one autoclave.

The volume of items that needs to be sterilized

Ideally, you want an autoclave with a chamber that’s big enough for your largest instruments and the required load. The bigger capacity also means more costs and more energy consumption. You can use your largest instruments as a guide in determining your required autoclave chamber size.

Automatic autoclaves come in different shapes and sizes. The chamber’s capacity varies depending on the autoclave size. Since every autoclave is designed by different inner configurations, it can further determine how many racks fit into the chamber and how you load those items to be sterilized per sterilization cycle. For smaller private practices the T-Edge is designed to ideally utilize the chamber’s capacity, for growing practices or medium size practices, larger autoclaves such as Tuttnauer HSG with larger capacity is most ideal, because in the long run it will save you costs of running two smaller autoclaves.

It is most ideal if you had an idea about how many tools and instruments are to be sterilized daily.

Materials used for the autoclave

It is important to understand what types of materials you are using in your autoclave, not all instruments can be used in a steam sterilizer. A high-quality automatic autoclave can easily sterilize the following instruments:

• Dental handpieces
• Surgical tools
• Packet of tools

Some materials are not intended for high-pressure steam sterilization and might cause irreversible damage. These are instruments, that are often pricier, and are heat sensitive, and need a different sterilization process that include lower temperatures, as to not erode the utensil.  You can find more information about this here, https://tuttnauer.com/medical-autoclaves/low-temperature-sterilizer

The different types of autoclaves

There are different kinds of autoclaves available in the market.

It is important to understand the differences of each autoclave. The most common types are Class N autoclave, Class S autoclave, and Class B autoclave.

Ease-of-Use

If you have a busy practice, your staff members will want to spend less time to use an autoclave with easy-to-use controls to manage the sterilization process. Therefore, a unit that comes with pre-programmed sterilization cycles, intuitive and clear navigation with a quick click can be a good choice. What you need is a medical device that can make your workflow more effective and safer during your busy hours.

Introducing pure innovation. The ultimate autoclave

Tuttnauer has designed a new automatic class B autoclave called the T-Edge with Sterilization at the click of a button.  It was designed with the understanding that your skills are needed in the practice and your time is of the essence. It is a compact autoclave with increased chamber size and decreased cycle time which means minimizing costs for your practice.  The fast cycles take only 36 minutes for wrapped instruments at a complete cycle, including drying.

The device hosts real time monitoring via a smartphone in which the entire sterilization process can be documented archived and saved.  The user-friendly touch screen control panel features display programs, cycles times, water levels and more.

• T-Edge combines durable and sturdy technology with ease-of-use
• Our autoclaves are designed to provide high quality repeatable performance and accountability for a wide range of applications used in modern practices of all types
• Safety & traceability: Ensure highest safety with a technology that monitors all relevant process parameters. The program logs provide you certainty and can be transferred via network connection or USB
• Flexibility: With integrated water reservoir, the stand-alone concept makes the autoclave completely independent of location and easy to install

In summary buying an autoclave is an expensive investment. Every user must hope his autoclave can be well performed and maintained for years. Make sure the unit you choose comes with a few years’ warranties and trained technicians to work on regular servicing and maintenance when you need them. It is always recommended that you research to ensure you know about the product and your needs, clarify which features are essential to you and find the best option that meets your needs.

Author: Tuttnauer Product Experts

Tuttnauer 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.

Post the Covid pandemic, infection control is understandably a hot topic. With the threats of an ongoing or future pandemic, as well as the usual seasonal illnesses to contend with during the colder months, it’s vital that infection control remains a top priority.

You may have purchased the best cleaning products, but manual washing has been proven to have many disadvantages.  So, have you considered investing in a Washer Disinfector unit?

These devices are not only the best method of ensuring complete sterilization within your infection control procedures, but also saves time, manpower, water, chemicals and improves safety dramatically, ensuring complete sterilization within your infection control procedures.

The ultimate protection

Of course, one of the biggest benefits of Washer Disinfectors is that they provide an exceptional standard of cleaning and disinfection for your instruments. After treatment, it’s essential that reusable instruments are cleaned properly, but doing this by hand leaves margin for error. With a Washer Disinfector you can guarantee that all your contaminated instruments are being effectively cleaned and disinfected to a validated standard, safe to be inspected and sterilized in your autoclave.

Furthermore, as Washer Disinfectors use specific detergents, this process can also help to preserve instruments and guard them from erosion that hand washing can cause over time. The Tuttnauer T-Clean detergent series is specifically designed for the TIVA washer product line. The T-Clean detergent line for medical instruments  delivers all the ingredients that are necessary for the highest quality cleaning outcomes. This eliminates the need for any additional cleaning or conditioning products.  Furthermore, The T-Clean detergent line for surgical instruments replaces costly pre-wash soaking cleaners, enzymatic cleaners, washing detergents, lubricants, and stain removers.

There are a large variety of Washer Disinfector sizes depending on your practical needs.  For Example, the Tuttnauer TIVA line carries machines from 65L all the way to 430L volume.  Whether you need something small to sit on a countertop or a large machine for a heavy load of washing, there is a device to meet your requirements.

Your safety is most important

Hand washing instruments comes with a number of potential risks. Not only does cleaning instruments in this way leave people open to potential of exposing staff to injury from sharp objects, but the risk of infections being passed on to people during this process is much higher in comparison to using a Washer Disinfector.  If someone suffers a sharps injury, there is a chance that any infectious diseases that the patient was carrying could be transmitted.

The gold standard for cleaning and disinfection may seem cumbersome but it is the best way to ensure your decontaminating all your utensils.

Save time

In any medical practice, time is of a premium. In a busy work environment this means that hand washing instruments is unlikely to be the most efficient way forward.

Washer Disinfector units often have cycles which are short in time and can hold a vast number of instruments, streamlining the process so that the time spent hand washing can be put to better use. Furthermore, the majority of Washer Disinfectors have drying cycles, meaning that instruments are ready to be inspected and transferred to your autoclave straight away.

Keep record, keep protected

Another benefit of Washer Disinfectors is that they have features enabling you to obtain traceability of all your cycles. This ensures you keep a validated record for whenever you may need to view or revisit them.

These records are usually automatically stored and are a stress-free way of making sure you are keeping on top of your infection control procedures.

Things to consider

You are looking for powerful, reliable and customizable and at the end of the day an improved user experience.  It’s about making the disinfection process seamless but maintain the safety and effectiveness.

The TIVA washer disinfectors provide a flexible turnkey solution for washing, disinfecting and drying diverse medical instruments for a complete decontamination cycle.  Depending on your specific needs the washer disinfector the TIVA line will minimize consumption and operation costs while maximizing sustainability in for your practical needs. 

An investment that will pay off

The use of instrument washers or washer/disinfectors is another critical element in an efficient process. Instruments must be free of debris that inhibits the sterilization process. Washers clean, disinfect, rinse and dry instruments saving valuable time and avoiding the potential for percutaneous injury. Instruments must be thoroughly cleaned and dried prior to preparation and packaging for sterilization. 

Instrument washers eliminate several steps of manual labor creating a more efficient and safer process. The CDC recommends automated methods for cleaning. A good quality washer can easily handle the needs of a 4-6 operatory office. Investing in this technology can be initially expensive, but over time the return on investment in labor savings is huge. Use of cassettes along with instrument washers can save up to 10 hours of labor per week which equates to 40 hours per month in labor savings which is efficient and significantly cost effective.

In summary there are many benefits to investing in a good quality Washer Disinfector. Although manual washing maybe the method of current choice, times have changed and the need to ensure ultimate safety while saving you time, cost and labor and the best user experience is what counts the most to you.

Author: Tuttnauer Product Experts

Tuttnauer 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.

As a dentist, dental hygienist, or support staff at a dental clinic, you know that having a reliable, effective autoclave is essential to the smooth operation of the clinic. Also called a steam sterilizer, the autoclave is the machine that harnesses the power of high temperature and high-pressure steam in order to sterilize germs on dental equipment, such as forceps, intended for reuse, thus ensuring its safety for the next patient.

How to Choose the Right Autoclave for your Dental Clinic?

If you’re looking to buy a new autoclave for your dental practice, what questions should you consider as part of this important purchase? In this blog post, we will take a look at five general questions to start the discussion, and then we’ll look at three possible responses to why you are buying a new autoclave, found in the flowchart below. The questions and answers we provide here will help you make an informed decision.

Six General Questions to Start the Discussion​:

Is the autoclave manufacturer ​a well-known provider with many years of success and experience in the field?

The manufacturer you are looking to buy your autoclave from should have a good name and reputation, and FDA-approved autoclaves. If you don’t have a machine that is safe it could be extremely dangerous for you, your staff and your patients.

Will the distributor you deal with give you all the options for buying an autoclave or just push the one he wants to sell on you?

Doing your own research on what is out there is always a good idea. This will ensure you know about the products and can talk to your distributor representative about what you prefer.

Does the manufacturer offer the type of autoclave and features you need?

The manufacturer you are looking to buy your autoclave from should have a good name and reputation, and FDA-approved autoclaves. If you don’t have a machine that is safe it could be extremely dangerous for you, your staff and your patients.

What is the volume of items that needs to be sterilized?

Has the volume of items sterilized increased? The volume of items that needs to be sterilized will determine the size of your autoclave. An experienced distributor can recommend the ideal autoclave according to chamber size.

Which autoclave delivers the best reliability for your investment?

Things to look for: What is the warranty? How does service work? Is the sales rep available if you have any questions about using the machine?

Is the autoclave you are considering purchasing easy to operate?

You have a busy practice. Can you set the autoclave and come back to find the instruments sterile and completely dry, ready to use or do you have to constantly monitor the unit?

Now let’s take a look at a flow chart of the most commonly asked questions related to why you need a new sterilizer.

As you can see from our flow chart, there are many questions and angles to consider. Replacing a broken autoclave, buying a new autoclave, or adding another autoclave requires research, forethought, and planning. We hope that this post helps you begin the autoclave purchase process, and we wish you continued successful sterilization for a smoothly operating dental clinic.

Your questions and comments are welcome below in the Comments section.

Author: Tuttnauer Product Experts

Tuttnauer 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.

As an ICC certified in dental infection prevention and control, I am always asking about infection control protocols. Once, during a volunteer program offering dental care services, I asked about their procedures for monitoring sterilization, such as chemical, mechanical, and biological monitoring. Most of the time, offices are making efforts, and I am always excited to help guide them the rest of the way.

In one situation, the answer was, “we don’t do any of that.” I was speechless. I dared to ask about autoclave maintenance and how often the team was cleaning and maintaining the autoclave.  The answer also left me speechless. From that moment on, I assume they are doing nothing until proven otherwise.

A more recent concern while working in a new practice was the use of a mail-in spore tests.  It appeared to me that the mail-in test would be run as instructed, but then it wouldn’t make it up front into the out-going mail that day. Then the mail didn’t get picked up some days, or a holiday was happening so it would be almost 5-7 days before the test reached the testing center.  This means, if it failed, we had used the instruments on patients many times over by the time we got the results.  This was a major concern for me.  Let’s talk about why all these issues are a problem.

What happens when biological monitoring is not enforced?

Regularly monitoring the sterilizer in a dental office is integral to infection control. Biological monitoring is the gold standard for assessing and assuring proper sterilization of dental instruments.

In developing countries, inadequate sterilization of medical devices is one of the leading causes of healthcare-related infections. A study in Mexico found that 17% of sterilizers had bacterial growth due to mistakes in temperature, time, pressure, inadequate supervision, and improper maintenance. In primary and secondary care public hospitals in Nepal, 71.0% of the autoclave cycles were ineffective when tested with biological indicators, and 69.8% showed ‘reject’ results with class 5 chemical indicators.

These high proportions of inadequate sterilization increase the risk of person-to-person transmission of pathogens through reusable medical devices.

While in-office biological monitoring is more strictly controlled and enforced in the USA, when a spore test does fail, letting patients know there was a breach in the sterilization procedures and that non-sterilized instruments were used is a stressful and embarrassing situation to deal with for any office.

Recommended frequency of biological monitoring

Steam sterilization (autoclaving) is the most widely used method. It is considered the most robust and cost-effective method for medical devices, as it can kill highly resistant microorganisms.

Proper functioning of the sterilization cycle should be verified at least weekly, according to the CDC and the American Dental Association. The majority of state dental boards require verification by using a biological indicator, such as a spore check system, and require spore test result records to be retained. Using an in-office spore test allows you to get the results faster and prevent any additional instruments from being run in a malfunctioning autoclave and used on patients until the failure has been corrected, rather than a mail-in system where results can take days. Because spore tests are only performed weekly, and the results are usually not obtained immediately, it is also necessary to perform mechanical and chemical monitoring.

Mechanical indicators detect procedural errors and equipment malfunctions and should be used for every sterilizer load. Checking that pressure, temperature, and exposure time have reached the levels recommended by the sterilizer manufacturer and finding discrepancies could be the first indication of a problem.

A chemical indicator should be used inside every package to verify that the sterilizing agent has penetrated the package and reached the instruments inside. Chemical indicators help to differentiate between processed and unprocessed items, eliminating the possibility of using instruments that have not been sterilized.

The importance of autoclave cleaning and maintenance

The most effective method for avoiding a positive spore test is by using adequate steam sterilization with an autoclave. The best way to ensure the autoclave is functioning effectively is to regularly clean and maintain it using a specialized product such as Chamber Brite.

Regular cleaning of the autoclave protects clients and staff from infection. Inadequate autoclave maintenance can cause failure or a shortened lifespan of the device and can result in your autoclave not sterilizing what it is supposed to.

Daily, monthly, and weekly cleaning of the autoclaves, strictly following the cleaning protocols given by the manufacturer, is recommended. Yearly maintenance should be done by professionals in consultation with the manufacturer.

So what should you do if you follow all these protocols and still end up with a positive spore test result? Firstly, ensure the process indicator has not expired, and check the sterilizer for any inconsistencies. Retest, and contact your biological monitoring service for assistance if the second result is positive.

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.

The spread of airborne pathogens and its prevention is well known to dentists. However, during the COVID-19 pandemic, a heightened awareness of airborne or contact contamination has drawn attention to sterile processing. There is no doubt that dentists across the country are vigilant about the importance of sterilizing their instruments, however, it must be clear that reprocessing requires a series of standardized, repeatable, effective and safe steps. Simply put, all soil must be removed from instruments before they are prepared, and proper autoclaving must be achieved.

Before the Coronavirus pandemic, many dental practices had a level of confidence in their sterilization routine. Today, dental practices need to reassure their patients and their staff, that their instrument reprocessing procedure follows a gold standard.

In this paper, we will outline the key testing tools available for cleaning. In some cases, IFUs (Instructions For Use) require to perform this more frequently than mandated by regulatory organizations.

This is because frequency is the key to optimal safety control.

Instrument Cleaning Efficacy

Instrument thermal high disinfector washers and ultrasonic cleaners

The IFU may recommend testing for each load. Cleaning efficacy tests consist of a strip with a substitute soil containing proteins, carbohydrates, fatty acids and non-toxic dyes. The soil mimics that found on contaminated instruments. The cleaning indicator is included along with the load to be cleaned and examined after completion of the cycle. If all ‘soil’ has been removed, cleaning was effective, alternatively, ineffective if any remains.

Tuttnauer’s product lines include cleaning indicators, which are designed for routine control of cleaning processes for monitoring the effectiveness of automatic high thermal disinfector washers and ultrasonic cleaners. These indicators will allow a quick visual evaluation and identify the potential source of error.

Protein Residue Test

Washer-disinfectors

In addition to these and the routine tests discussed in this article, filters in instrument washer-disinfectors should be checked, removed, and cleaned regularly as well as checking the condition of the door seal as a safety check.

Additional testing for instruments

Instrument washer-disinfectors, ultrasonic cleaners and manual cleaning

As its name suggests, the protein residue test is performed to determine whether there is any residual protein on cleaned instruments. For a protein residue test, a swab is taken from a randomly selected instrument that has been cleaned. This swab is then immersed in a tube containing a custom dye after which the liquid is swirled for 5 seconds. If the color changes to a shade of blue, this indicates that proteins are present.  The darker the shade of blue the more protein is present.

Washing Device Cleaning Inspection

Instrument washer-disinfectors, ultrasonic cleaners and manual cleaning

After cleaning, all instruments must be inspected to check that they are thoroughly clean and free of debris. This inspection should occur under illumination.  Magnification may be required. If any debris is found, the device must be cleaned again. Manual cleaning may not be permitted in your location unless it is the only option, or for isolated spots. It is also discouraged.

Ultrasonic Activity Test

Ultrasonic cleaners

In order for ultrasonic cleaning to be effective, the ultrasonic cleaner must have an appropriate and even level of transducer activity, which results in appropriate cavitation and implosion within the solution, in all areas of the chamber. Without this, instruments will retain soil. Options include the traditional foil test and recently introduced dye tests.

Dye test

The dye test is easier to perform, simple, and provides a clear visual result that is not open to interpretation. It consists of glass vials that are placed in an ultrasonic cleaner rack in a configuration determined by the area, in accordance with the IFU. The vials contain small beads and a blue reactive dye at the start of the test prior to running the ultrasonic cleaner. During cleaning, the beads become agitated causing the dye to change color. If the ultrasonic cleaner is functioning properly, the dye will have turned yellow. If ultrasonic activity is reduced, the dye will change to a shade of green.

Foil test

The foil test is performed using strips of regular aluminum foil configured as recommended. This can consist of nine pre-measured strips adhering to adhesive tape in a 3 x 3 grid.  Fresh ultrasonic cleaning solution should be placed in the chamber, measured to the correct level and at the recommended temperature, as well as degassed. While foil testing is used in some cases – it is not the recommended testing for the ultrasonic cleaners. The dye test using vials is the recommended testing for ultrasonic cleaners, as a more accurate alternative, as described above.

Summary

Additional tests are required for validation and periodic testing, but this is beyond the scope of this article.  Testing by in-office personnel (including its frequency) and periodic servicing and validation should be performed in accordance with the recommendations and regulations in your area, and the manufacturers’ IFU for the reprocessing devices you are using.  Thorough cleaning is critical, and that makes testing critical too.

Visit Tuttnauer’s website product line to learn more about the most effective reprocessing sterilization methods and the necessary products to achieve optimal safety control.

Resources

• Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79: 2017. Comprehensive guide to steam sterilization and sterility assurance in health care facilities.
• Dubai Health Authority. Health Regulation Department. Guidelines on Dental Infection Prevention and Safety.
• CDC. Guidelines for infection control in dental healthcare settings – 2003.
• Health Technical Memorandum 01-05: Decontamination in primary care dental practices. (2013)

Author: Dr. 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.