Looking at some of the best ways to keep equipment cleaners up and running for a long lifespan.
In theory, the equipment used in a dental practice for cleaning and sterilizing instruments should clean itself. After all, that’s what it’s doing all day long – cleaning. But, over time, dirt, organic material, and other impurities remain in the equipment, reducing overall efficiency, and potentially, leaving instruments dirty or non-sterile.
As such, it’s necessary to observe proper and routine maintenance on such equipment. The good news is that it isn’t hard to do. The device’s manufacturer will tell you exactly what needs to be done, but it’s up to the practice to actually do it and do it the right way.
Follow the Directions
It sounds like the kind of advice that you’d find on a bumper sticker, a T-shirt, or a motivational poster, but that doesn’t make it any less valid: Follow the directions.
“The instructions are referred to as the IFUs, or you’ll also hear it referred to as the MIFUs, and that stands for the manufacturer’s instructions for use,” Jackie Dorst, RDH, BS observes. Dorst is an infection prevention consultant and speaker. “And those instructions for use are part of the approval from the Food and Drug Administration for that piece to equipment. Over the years, the manufacturers don’t make significant changes to those instructions for use, and it’s so critical to have the manufacturer-specific instructions for use.”
“Each manufacturer has its specific maintenance and cleaning recommendations,” infection prevention speaker, author, and consultant Mary Govoni, CDA, RDH, MBA adds. “That’s one of the things that is overlooked by a lot of the dental practices. I always recommend that practices have some type of a schedule or a log that they keep – either a paper log or, even better, an electronic log of all their sterilizers, their ultrasonic cleaner, or their instrument washer, whatever it might be. And they set up schedules and reminders so that they are performing any kind of cleaning processes on a regular basis of what’s recommended by the manufacturer.”
IFUs should also be kept on-hand and readily available in case a question arises.
“If a practice has space, they should keep the manuals for those devices somewhere near where they’re used, so that nobody has to go searching for them if they have a question,” Govoni says. “But if they don’t have the manual, they can always go to a manufacturer’s website, because so many of them now have great support, documents, even videos, or troubleshooting questions and answers to maintain them.”
Proper operation and long life are, of course, important. But there’s another necessity in following the IFUs.
“Following the manufacturer’s directions is key to making sure that their warranty stays in force,” Govoni adds.
Will the Instructions Ever Change?
The manufacturer details specific instructions for use as part of a lengthy FDA approval process. Because the process can take years for ultimate approval, it’s rare when those instructions change.
“Those instructions will remain consistent from the time that it’s approved by the FDA throughout the life use of that brand and model of the sterilizer,” Dorst says. “If there are changes, significant changes, then it would have to have a new approval from the FDA.”
That doesn’t mean that the instructions would never change. It’s a good idea to check-in with the manufacturer from time to time and to ensure that the device has been registered with the manufacturer in case any changes do occur.
“For the most part, they’re going to stay the same, because – especially in the case of a sterilizer – those maintenance instructions have been part of the FDA clearance that that piece of equipment has received in order to be used in a healthcare setting,” Govoni says. “But it certainly doesn’t hurt to check periodically. The other thing is that the dental practice should also make sure that they register their devices with the manufacturer – just like you do with a home appliance – so that if there is anything that’s changed or a device gets recalled – which doesn’t happen very often to us in dentistry – but if that happens, then they would get a notification from the manufacturer.”
Regrettably, practices do make very common mistakes in the maintenance and upkeep of their equipment. The best way to avoid those mistakes is through education.
“The number 1 mistake is not reading the manual and not really understanding the frequency and the type of cleaning solution that they should use for a device and how to do the process,” Govoni observes. “So, they don’t necessarily look at those manuals and see what the instructions are. And we may have turnover of personnel, too. One dental assistant, for example, may know the routine and they may know what to do, but then they leave or maybe they’re off on maternity leave or something, and somebody else takes over and they’re not familiar, so there’s not a lot of continuity. But I think most of the mistakes literally come from people not being aware of what the manufacturer recommends.”
Often, mistakes stem from inadequate training.
“If there are mistakes, it’s because there was a lack of training,” Dorst says. “The person in the sterilization room did not receive initial onboarding or training, or the office acquired a new piece of equipment, and the service technician didn’t provide comprehensive training, and the dental team just started using that new piece of equipment the way that they had previously.”
Some mistakes are more serious than others.
“Another error that I will see in offices is that the autoclave has never been cleaned,” Dorst says. “They’re supposed to clean it once a month and run cleaner through it. I will go into the office and ask for their records, because they should keep a maintenance log sheet. They may have had that autoclave for a couple of years, and I’ll say, ‘How often do you clean it?’ And I get that blank look like, ‘Oh… Clean?’
“It sounds like they had no idea, especially with that lengthy 2-and-a-half-hour process where you have to run the run the cleaner through, and then run a couple of cycles and rinse,” she continues. “That’s time-consuming. Or I know that 1 manufacturer uses a cleaning tablet, and you put it inside the chamber and close the door and run it. Maybe they ran out of that type of cleaner. And once they ran out of it, whatever samples they received when they bought it, they just discontinued doing that. So, it’s important to provide training and to keep records of the cleaning and maintenance schedule.”
Equipment should be routinely tested to ensure its proper, safe operation.
“Many offices have never tested their ultrasonic,” Dorst says. “And that’s another thing that I’ll ask for the log sheet for. ‘Do you have any records?’ And they look at me like, ‘Oh, we didn’t have that.’ Each office should have their own custom disinfection and sterilization protocols with it – and that should be written. That should be part of their infection prevention plan. And if they don’t have that, a starting point to write it would be going to the 2016 CDC guidelines. And they can download an app called the CDC DentalCheck. It’s interactive. They go through each checkpoint, answer ‘yes’ or ‘no’. And there’s a place on the side to add what corrective action they might need to take if they find a gap in their sterile maintenance protocols.”
Some practices may replace a sterilizer or an ultrasonic cleaner that has been in service for years. However, the new piece of equipment probably doesn’t use the same instructions as the previous one.
“They will often say, ‘Well, we always did it this way with the old one, it must be the same with the new one’,” Govoni says. “It still just keeps going back to not being familiar with what the recommendations are. And now the newer sterilizers are so much more sophisticated than the older models, back in the days of there not even being a whole lot of electronic components. They do tend to generalize, especially some practices will have maybe two or three different sterilizers all from different manufacturers, and they tend to generalize that as well.”
Even if a piece of equipment has been properly maintained and is running fine, is there ever a point where the equipment has reached the end of its lifespan despite good cleaning?
“Absolutely,” Govoni says. “Although this is not something that most dental practice owners want to hear, but the manufacturers of sterilizers will say that on average, these devices have a useful life of somewhere between 7 to 10 years. Yet many practices have sterilizers that they’ve had for 20 or 30 years. But the perception, of course, on the part of the end user. is that they should work forever, because we invested so much money in them, and that these recommendations that are made by the manufacturers are a ploy to sell more equipment. And especially now with the newer sterilizers having more capabilities, meaning they’re still sterilizing the instruments the way the older ones are, but you can have printers attached to or built into them. So, you can print out a validation document that says that a particular load of instruments has met all the requirements or parameters to sterilize the instruments. You can have them connected directly to a sterilization monitoring service that can or the manufacturer that can monitor how that unit is functioning and can contact you if they see some issues, so there’s a lot of benefit to that. It’s just like at car – we invest in it; we want to drive it till it dies. That’s not so appropriate with medical devices.”
It may seem counterintuitive that a piece of equipment like an instrument washer or a sterilizer needs to be cleaned, but those devices do get dirty and must be cleaned to ensure everyone’s safety.