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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
Complacency around sterilizer maintenance can create poor infection control habits.
Sometimes a task is so common that it ends up being performed incorrectly. And, if that task is incorrectly repeated without the realization that a mistake was made, those errors become bad habits. This cycle is especially concerning in infection control. Sterilizer maintenance is no exception. It’s a routine that staff may feel they’re familiar with, but complacency can breed bad habits, and dangerous mistakes can be made.
“People figure it’s something that they have to do all the time, but there are more details to it,” says Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts. “It’s a process that you really need to make time for because it takes time to do. And if your equipment’s not working correctly, you’re really putting everything at risk.”
The adage, “When in doubt, read the directions,” isn’t just pithy, it’s correct. But for sterilizer maintenance, it’s really just the first step.
“First and foremost, they really need to refer to the manufacturer’s instructions for use for whatever unit they have,” Moore says. “Different brands have different recommendations on how to do the process, different products used to maintain the equipment, and any follow-up that might need to be done.”
Manufacturers are the first place to turn for proper sterilizer maintenance steps. However, the Centers for Disease Control and Prevention (CDC) also shares its best practices, especially for loading and unloading a sterilizer, says Mary Bartlett, president of SafeLink Consulting.
Roles and Responsibilities
Practices should make sure that staff has clearly defined roles for infection prevention, including sterilizer maintenance. The CDC recommends that each practice appoint an infection control coordinator, a staff member that reviews policies, keeps up to date on policy changes, updates the practices’ infection control procedures, monitors compliance, and offers training and education for staff.
“In order to properly maintain all equipment used in a dental practice, it is critical to designate someone who will review the manufacturer’s operating manual and write procedures for staff to follow,” Bartlett says. “A sterilizer is an expensive asset; therefore, proper use and maintenance helps avoid downtime and costly repairs.”
Unfortunately, some practices do not have those instructions, which can lead to staff misunderstanding proper procedures. Keeping written instructions and checklists posted in the area of the sterilizer can ensure they’re easily available to all staff members, Bartlett says.
“A written checklist is helpful for the staff required to maintain the equipment, even though most sterilizer units have an indicator when it’s time for certain maintenance,” she says. “Maintenance performed by staff may be daily, weekly, and monthly, depending on the brand of equipment. Manufacturers may also recommend a thorough maintenance check by the manufacturer after so many years. Ensure that these maintenance steps are being performed as indicated by the manufacturer. It could even affect the warranty if the instructions are not being followed.”
Allocating time for sterilizer maintenance is another key, according to Moore. As this is usually monthly maintenance, it can be time-consuming.
“You have to make sure that you have the time, because whatever instruments aren’t being run, you need to make sure you have enough while you’re doing the maintenance, so you don’t run out,” Moore says.
A sterilizer is the workhorse of infection control, but it can’t function on its own. There are a host of other products that enhance the sterilizer for proper operation. It’s important to use the products that are recommended by the manufacturer, Moore says. This not only keeps the sterilizer operating at peak performance but also protects the unit’s warranty, she says.
“If you have a specific cleaner to use for that unit, you don’t want to cause any internal damage by using another product that may or may not be appropriate,” Moore says. “You want to make sure that you’re using the right product because you don’t want to void any kind of warranty.”
Water quality, too, is important for the proper function of your sterilizer, Bartlett says. When water is boiled, the water’s hardness or minerality can leave salts and mineral deposits behind, which can build up over time, she says.
“This can decrease efficiency and functionality of the sterilizer plus clog up valves and pipes. Distilled water, or water that has been treated for use in a sterilizer, is typically used to fill steam autoclaves,” Bartlett says. “As you can see, water quality can play a significant role in the daily use of your autoclave, so make certain to only use appropriately prepared water to keep it working well and maintain the vital sterility of your instruments.”
Sterilizer maintenance includes checking the air filters, which are there to catch any debris before the water enters the chamber, Bartlett says. Vent screens should also be part of routine sterilizer maintenance, Moore adds.
“Depending on what you’re wrapping or packaging with, there can be debris that will clog those and will stress the sterilizer. Some facilities use instrument lubricants—sometimes referred to as ‘dental milk’—to lubricate their instruments. If they’re using that, that unit may need to be drained of the water and refilled on a daily basis. It’s important to review the unit’s instructions to clarify this process.”
Just like cleaning filters, removing, cleaning, and inspecting gaskets is a fairly simple task, Moore says. It’s a good idea to keep extra gaskets on hand in case of failure.
Checking Your Work
Performing maintenance and following best practices is a critical function, but just as important is monitoring and tracking the maintenance process, Bartlett says. This can be done using biological, mechanical, and chemical indicators, she says.
The first step is mechanical monitoring, which is often overlooked and includes maintaining documentation about the sterilizer. This can be documented by using a log where staff would indicate the date, time or cycle number, the temperature reached, and successful completion of the process, Bartlett explains.
“This monitoring can be the first indication of a problem with the sterilizer, but is not always being documented,” she says.
Next, chemical and biological monitoring ensure that the sterilizer is performing its job properly. Chemical monitoring is performed with the use of chemical integrators and the internal and external indicators on pouches or tape placed on the outside of wrapped cassettes, according to Bartlett.
“It’s extremely important for staff to check every pouch or wrapped item to ensure that the color changed to indicate adequate processing in the sterilizer. Biological indicators or spore tests are performed weekly, at a minimum,” Bartlett says.
Biological or spore tests indicate that the sterilization process killed highly resistant microorganisms, she explains. Practices should have procedures in place to document the date of the spore test and track that they have received the results.
“An easy way to do this is to create a log to write down the date of the test and the test number. I’ve seen some staff make a photocopy of the front of the test envelope that contains a specific test number and retain that until results are returned,” Bartlett says.
Third-party company testing provides confirmation of a practice’s sterilizer maintenance efforts. If 1 of these companies runs a test that fails, they normally call the practice so the staff can act quickly, Bartlett says. In the event a sterilizer fails any of its tests, immediate action must be taken.
“Taking the sterilizer out of service immediately upon notice of a failure of the spore test is highly important,” Bartlett says. “Most dental supply houses will provide a loaner until the results of another spore test can be received from the lab. It’s not wise to continue to use the sterilizer during this period of time.”
Any instruments that were sterilized from the date of the last passed test to the date the practice receives a notice of a failed test must be repackaged and sterilized prior to use, Bartlett says. If this information is unavailable, all tools and instruments must be re-sterilized.
“The instruments that were sterilized from the date of the last Pass to the date the practice receives notice of a Fail must be re-packaged and sterilized prior to use,” she says. “Practices that follow the CDC’s recommendations for indicating on each pouch or wrapped cassette the date of sterilization, plus cycle number or time, can reduce the number of items to be re-sterilized.”
It’s easy to become complacent when following ordinary infection control procedures. Bad habits can put yourself, your colleagues, and your patients at risk. Following proper maintenance protocols and guidelines can ensure a safe environment for all.