Infection prevention and control involve important tasks that we know we need to do, but often, we are squeezing them in between patients in a rush to stay on time. Our brains are on autopilot as we perform the steps, often thinking about our next patient without concentrating on the task at hand.
Amanda Hill, RDH
This is certainly the case when it comes to instrument sterilization. In fact, the U.S. Centers for Disease Control and Prevention notes that operator error causes 87% of sterilizer failures. I don't know about you, but I'm usually five minutes behind, running my tray into sterilization, chucking my instruments into the ultrasonic, and trying to be a team player and quickly bag a set of instruments while I wait for the kill-time of my disinfectant.
Today's modern sterilization equipment has features that address the top errors we make and set us up for success.
Loading
Ah, the great paper up, paper down debate. There is a correct way to load your sterilizer, and you must look at the instructions for use (IFU) to determine what that is. It's tempting to cram as much stuff as possible into each load.
Overloaded sterilizers are the leading cause of improper instrument reprocessing. An overloaded cycle takes more time to get to temperature, and it inhibits the proper airflow needed for sterilization (think of what happens when you put too many clothes in your dryer). Each pack might not come in contact with a sufficient amount of the sterilizing agent. As a result, you may have unsterilized instruments and have to start over. Who has time for that?
Some sterilizers, like the Midmark M9 and M11, come with pouch racks to load sideways, so it's not paper up or down! This loading style allows the steam plenty of room to circulate, and the packages can dry properly. Wet packages are not properly sterilized and should never be what you find when you open the sterilizer.
The next-generation Midmark M9 and M11 Steam Sterilizers are designed with intuitive technology to help make instrument processing as easy and automated as possible. Images courtesy of Midmark Corporation.
Wet packaging can wick in bacteria once unloaded, compromising sterility, and instruments can easily poke through. If you are loading your sterilizer properly and still getting wet packages, it’s time to evaluate your process. Ensure your instruments are dry before packaging, you are following the instrument IFUs, and your maintenance is up to date.
Wrong cycle
It would be great if everything we used could be sterilized at the same temperature for the same amount of time. But much like your laundry, where some outfits are delicate, some are dry clean only, and some will turn your whites pink, it’s important to know what cycle each item requires to be reprocessed properly to ensure sterilization and longevity. Just like you don’t want to shrink your new sweater, you don’t want to melt your equipment.
Preprogrammed sterilization cycles and an LCD display with prompts ensure quick, confident operation.
Look for a sterilizer that offers multiple unique preset options and plenty of additional custom cycles. Most sterilizer manufacturers offer two or three unique presets, but I recently found that the next generation of Midmark sterilizers has four unique presets and five custom cycles. This feature allows you to improve compliance by following the instrument IFUs easily and can likely increase their longevity.
Documentation
Learning and performing all the steps to reprocess instruments can be daunting. Add proper documentation, and you might be ready to give up. Every load must be monitored and results documented to ensure the sterilizer reaches the desired time, temperature, and pressure.
While correct readings do not ensure sterilization, they are an early indicator of a problem with your sterilization process (and a required step in reprocessing). Unless you have someone hanging around to stare at the sterilizer, this one is tough. Choose technology that automatically records this data while you are busy seeing patients.
Maintenance
The often-forgotten step of proper instrument reprocessing is maintenance. Your sterilizer can't talk and say it needs to be cleaned or drained. But when we ignore proper maintenance, we end up with a broken sterilizer and a panicked call to the service tech begging for a loaner at any cost. Not only does this disrupt patient care, but it can also be an expensive lesson in maintenance.
While sterilizers still don't talk, they now come with built-in reminders to perform maintenance. Much like the oil change light in your car that tells you your 5,000 miles are up, today's modern technology guides you through daily, weekly, and monthly maintenance. The new Midmark units also document that maintenance was performed. They can even tell you if a task is due or overdue. This feature can surely extend your machine's life and keep everyone accountable.
Instrument reprocessing requires a series of steps to ensure everything is safe for reuse. Manufacturers like Midmark are designing products that honor the work of the dental team to help us get the job done right and back to patient care.
Editor's note: References available upon request.
Amanda Hill, RDH, is a speaker, consultant, and award-winning author who brings over 25 years of clinical dental hygiene and education to dentistry. She is a recipient of OSAP’s Emerging Infection Control Leader award, Hill (also known as the Waterline Warrior) can be reached at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
