poor water quality can impact the sterilizer ’ s ability to function properly . Poor water quality can also damage and reduce the life expectancy of instruments and processing equipment . Critical water , such as distilled , is the recommended water type for use in countertop sterilizers ; however , many dental practice clinics use various water filtration systems — with no assurance that these systems meet the recommended water purity standards .
It is highly recommended that water testing be conducted for all water sources to ensure it meets the water purity specifications or parameters outlined in the IFU . ( Note : If a filtration system meets all parameters for use , dental facilities should consider standardizing filters across their practice or clinic system , while also developing water testing methods , establishing testing frequency , and documenting the same going forward . If filtration systems do not meet water purity standards , it is essential that those filters are removed from use and that distilled water is provided .)
Biological testing and instrument tracking
Biological indicator ( BI ) vials contain Geobacillus stearothermophilus bacterial spores and are intended for monitoring the efficacy of steam sterilization . Biological monitoring allows facilities to take control of their steam sterilizer testing and provides peace of mind that the sterilizer is functioning properly . It also helps organizations follow CDC guidelines , which recommend that steam sterilizers be monitored at least weekly . Although the CDC recommends weekly BI testing ( at a minimum ), the prefer method is to perform BI testing daily , as well as with every load that contains implantable devices . Dental SP professionals across the country have come under greater scrutiny by regulatory and government agencies ; therefore , BI testing on every load is highly recommended ( Note : BI monitoring for each load is not included in the standards ; however , many facilities have gone to a higher level by performing BI testing for each load .)
Instrument tracking
Instruments that are reprocessed and rendered safe for patient use should be traceable ; however , in the dental environment , few offices or clinics can effectively track their instrumentation to a sterilization cycle . Once sterilized , those instruments are placed on trays , in bins and / or in cabinets for future use . In some cases , they are used immediately following sterilization .
If a BI test comes back positive , it is important that dental professionals have a way to track instruments and when they were reprocessed . If a positive BI result comes back from the lab and instruments from that particular day or subsequent days were used , the results could be catastrophic .
Individual instruments and sets should be logged for every sterilizer load . This allows organizations to track when instruments were processed , under what conditions , and whether parameters were appropriately documented . If a recall is needed ( based on a positive BI test result or equipment malfunction , for example ), instruments should be able to be located easily , in real time . Documentation can be as simple as a logbook or use of a record envelope . Some institutions and groups use a patient tracking card and document load specifics in the patient ’ s record .
Currently , The Joint Commission ( TJC ) is asking operating room ( OR ) and SP professionals across the country how they track their instruments to the patient ( e . g ., which instruments were used on which patients and when ?). The surveyors are then retracing each step in the process back to SP and validating that all processes were met in the reprocessing of those items . All documentation is being reviewed to include ( but not be limited to ) date , time , parameters met or unmet , staff member ( s ) involved , and how those instruments are being stored ( temperature and humidity ). For the staff member who processed those instruments , TJC surveyors will review that individual ’ s competency , training and education . ( Note : TJC and the Centers for Medicare and Medicaid Services ( CMS ) are now sharing findings with one another . Depending on the severity of the TJC ’ s findings , CMS may initiate its own investigation and survey the organization / facility . Again , this is important because dental industry practices are coming under greater scrutiny these days . )
Ultrasonic equipment cleaning and efficacy testing
Proper cleaning is the first step to effective instrument reprocessing . If debris ( bioburden ) is not removed , the instrument cannot be effectively sterilized . Automated processes such as ultrasonic cleaning aids in the proper cleaning of instruments . Ultrasonic cleaners are used to remove soil from difficult-to-clean areas such as joints and crevices , using cavitation . Cavitation is a process in which low-pressure bubbles in a cleaning solution burst inward and dislodge soil from instruments . Ongoing routine testing of equipment used to reprocess instrumentation is necessary to ensure each piece of equipment is functioning properly and as intended .
During my observations as a consultant , dental staff often report they are changing the ultrasonic fluid and using the correct type and amount of detergent ( per IFU ) twice a day or “ as needed ” as water becomes cloudy ; however , when asked , many dental professionals could not answer how many individual instruments or cassettes may be processed before each water change or how long it took before water became cloudy . In addition , most dental offices and clinics do not keep logs showing when the units were cleaned , and / or they fail to document in-between water changes . Cloudy water can be a subjective observation ; therefore , leaving it ( and the need for water change ) up to the user ’ s interpretation is risky . If time pressures exist ( which is not unlikely ), dental staff may forgo a water change until the next batch of instruments — a decision that could jeopardize patient safety . ANSI / AAMI ST79 , Section 7.6.4.4 , states that when using an ultrasonic cleaner , each load should use a “ fresh cleaning solution ,” which includes detergent . Each time the sonic is filled , it should also be degassed . Further , the sonic should be cleaned each day in accordance with the IFU .
To ensure equipment is working properly , efficacy testing should be done routinely , and the results should be documented , per ANSI / AAMI ST79 , Section 13.2 . Ultrasonic machines are frequently used in dental practice . In my experience , many dental employees are unaware of what efficacy testing is and what it entails . When asked what the test results should look like when using that product , different answers are common ( dented , pin hole , etc .). Also , when asked how they test the machine ’ s effectiveness , many state that they perform an aluminum foil test . Foil tests , unfortunately , do not ensure proper function of the ultrasonic device . If three different manufacturers of foil products were used for this type of testing , each test would be subjective and left up to the determination of the user , which is problematic .
Efficacy testing must be done daily , with the appropriate challenge test to ensure each unit performs cavitation and can remove soil . It is highly recommended that dental organizations incorporate appropriate monitoring of their ultrasonic machines and document testing results . There are commercial
www . healthcarehygienemagazine . com • september 2021
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