The 7 Deadly Sins of Sterilization Failure
How clean are your instruments? If you think you can tell just by looking, think again.
The degree of cleanliness is only clear through detailed, microscopic examination. A study by the Centers for Disease Control found that 91 percent of instruments may be visually clean but, when these same instruments were examined under a microscope, 84 percent actually had some kind of residual debris. Statistics like that indicate the importance of maintaining proper dental office sterilization equipment.
We’ve outlined seven “deadly sins” that can spell doom for your dentist’s sterilization machine. Don’t let your practice fall prey to these problems.
1. Failure to test equipment on a regular basis.
The CDC recommends doing a spore test weekly. While a failed spore test doesn’t automatically indicate a problem with your sterilizer, the test should be immediately repeated to help determine the issue.
Sterilizers should also be tested when they are:
Whenever there is a failed spore test, an action plan must be set into place immediately.
2. Failure to test by using biological indicators (BI)
There are several ways to test sterilizers, but the most reliable way to test dental office sterilization equipment is by using spore test strips.
There are two types of spores that are often used in these BI tests. These are the same spores that manufacturers must test for when getting FDA clearance for their sterilizers.
Geobacillus stearothermophilus spores are used for testing steam sterilizers and sterilizers that use unsaturated chemical vapors.
Bacillus atrophaeus spores are used for testing dry heat sterilizers.
We’ve provided some extensive, useful information on how to biologically monitor your sterilization equipment in one of our earlier blog articles.
3. Testing using only BI indicators
While biological indicators are the most reliable method of testing equipment, it should not be the only method. Why? Spore testing is typically done once a week, and it may take a while to get the results of the spore tests. Therefore, any good sterilization process should also involve mechanical and chemical monitoring.
Mechanical monitoring involves being sure that the sterilizer’s gauges and displays are working properly. Granted, this doesn’t guarantee that everything is functioning as it should. However, this is usually the first sign that something could be wrong with your dental office sterilization equipment.
Chemical monitoring utilizes indicators that can change color or shape depending upon the operational parameters. According to Dental Economics magazine, the CDC recommends that an internal chemical indicator should be placed into each package.
4. Incorrectly loading the sterilizer
Overloading can lead to sterilization failures—and it’s a very common problem. It can cause prolonged warm-up times, taking your sterilizer longer to reach the necessary temperature. In addition, if a sterilizer is overloaded, it could be difficult to ensure that all surfaces of the dental instruments have been sufficiently sterilized.
Another problem occurs when you load the dental office sterilization equipment using the wrong packaging material. Always follow the manufacturer’s instructions for the type of dentist’s sterilization machine that you are using.
Incorrectly loading by inserting certain types of packaging can prevent sterilizing agents from reaching the instruments. In some cases, plastic parts of packaging can melt and paper can burn. Be aware that some thick cloths can absorb excessive amounts of steam.
5. Insufficient temperature
Remember that it is imperative that the instruments—not just the chamber—are heated to the correct temperature for a sufficient amount of time. The exact temperature will vary according to the manufacturer’s instructions.
However, in general, an autoclave sterilizes instruments at around 243 to 250 degrees F, while with dry heat sterilizers, that temperature is 300 F to 375 F. Unsaturated chemical vaporizer sterilizers work at around 270 degrees F.
Before you begin to sterilize your equipment, be sure you have the correct temperature as outlined in the instructions.
6. Insufficient exposure time
How long you should sterilize your instruments depends upon several factors, including the type of sterilizer you use and whether your instruments are wrapped or unwrapped. Manufacturer’s instructions should be followed to the letter to ensure that you use the correct exposure times.
In an autoclave, material should be sterilized in four to 30 minutes. By comparison, in dry heat sterilization takes from 12 to 150 minutes and in unsaturated chemical vapor sterilizers from 20 to 40 minutes.
7. Failure to use infection prevention protocol
Scrubbing is sometimes needed before sterilization after certain procedures. Mechanical cleaning will reduce the amount of time staff spend handling contaminated dental instruments, and therefore reduce the chances of injury.
However, if your employees do need to scrub the instrument by hand before putting it into the sterilizer, heavy-duty gloves, eyewear, a gown and a mask should always be worn. Scrub only one instrument at a time in order to minimize the risk of a puncture.
What to Do If There is a Sterilizer Failure
If there are indicators that your sterilizer has failed, you should immediately put an action plan in place. Remember that most of these sterilization failures are due to human error –such as improper wrapping or packaging—and not to the equipment itself.
Still, any time there is an indicator of a sterilization problem, no matter what its source, the following steps should be taken, according to Registered Dental Hygienist magazine:
- Immediately take the unit out of service. This should happen after receiving the second positive spore test. Remember that any items that were processed between the first and second spore tests may have not been adequately sterilized.
- Review all sterilization procedures. This means securing all records of parameters and indicator results. It’s also a good opportunity to review the sterilization protocol with staff.
- Retest and observe all the operational parameters. All repaired sterilizers must be spore tested before they can be used again.
- Determine what you should do with the sterilizer. If the sterilizer continues to fail spore tests despite proper operations and repairs, you should consider purchasing another sterilizer.
Diatech Specializes in Reliable Sterilization Equipment
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