I work with dental offices and do a lot of dental inspections/consults. I help people identify what they need to do differently. We talk through OSHA, HIPAA, infection control, radiology, medications, state board compliance, etc. But I get really excited about infection control and sterilization. That's my stage—my moment to shine. In this episode of Talking with the Toothcop, we're going to talk about instrument processing and cleaning procedures. Find out what you could be doing wrong and what to do instead!
I've seen thousands of sterilizations rooms. Some are great, some are poorly designed, and some just don't shock me anymore. What should it look like? It needs to be physically segregated into different areas for instrument receiving and cleaning, decontamination, preparation and packaging, sterilization, and storage.
There needs to be a "cleaned" area and a dirty area. I can't tell you how often I see cross-contamination issues. When you bring the instruments into sterilization, the rest of the processes need to move in one direction. If you move in the opposite direction, you're contaminating what's supposed to be sterile.
A sterilization area contains two major processes: instrument cleaning and sterilization. If you don't do one part right, it impacts the entire process. There are monitors in place for the sterilizer, color-changing indicators on instrument peel-pouches, and indicator tape on instrument cassettes. They give us visual confirmation of whether or not the sterilization process worked.
People often monitor the sterilization indicators but neglect the cleaning side of the process. You can't just assume the instrument washer or ultrasonic is working effectively. Just because it sounds like it's working properly doesn't mean it is. You need a qualitative test—like a foil test—to make sure that it's working properly. It needs to be done frequently. When those machines fail, they don't sound any different. It is not obvious.
I don't love the foil test. What do I prefer instead? An ultrasonic cleaning monitor. It can be ordered through your dental suppliers. Get and use that weekly. Record in your records that it passes inspection. It gives you information on several data points: cavitation, enzyme concentration, and more.
Are you using the correct concentration of enzymes in the ultrasonic? More than half of dental offices aren't. Whatever product that you use for ultrasonic enzymes, make sure you follow the manufacturer's instructions for use. People frequently use the wrong concentration, which is why I'm partial to tablets. It's easier to calculate.
Secondly, people don't understand the water capacity of the ultrasonic. The box says "one tablet per gallon" so they drop one tablet in, not realizing they have a three-gallon unit. One tablet won't cut it—you're off by a lot. I was in an office last week that had a three-gallon ultrasonic and they were putting in one tablet. According to the IFU, they were supposed to be using two tablets per gallon. They should have been using six tablets total!
What's an easy way to track this? Buy a label maker and print the name of the product and the number of tablets/ounces required each time you fill an ultrasonic.
What else do you need to focus on?
If you run the instruments and find when you're rinsing them that they're still dirty, what do you do? Run the cycle again. Fight the urge to manually scrub instruments. You will never do as good of a job as the instrument washer/ultrasonic.
Tune in next week for part II—the sterilization process!
