When taking stock in your dental practice's inventory, knowing your sterilizer’s ins-and-outs, including when to retire it and get a new one, is vital.
The leader of the dental practice’s infection control efforts is its sterilizer. Even though so much is asked of it, it can often be taken for granted. We expect it to do its job without fail or falter, but in the event something goes wrong, like failing of biological indicator test, wet packages, or even failure, it can bring the practice to its knees.
Practices running into trouble with their sterilizer or overall infection control workflows might benefit from a new sterilizer.
Maintenance vs. Replacement
The first step with an underperforming sterilizer is by reaching out for technical support. Even better is avoiding the need for repair in the first place. That means keeping on top of necessary maintenance.
“It is very important that you are doing the monthly maintenance, as well as any other maintenance outlined in the manufacturer’s instructions for use. Working closely with a trained technician is important for any indication of improper functioning,” Karen Gregory, RN, Director of Compliance and Education for Total Medical Compliance observes. “They’re going be able to assist you in determining if it is cost effective to repair the unit or if it is better to replace the unit. Determining factors for replacement include the age of the unit as well as the daily use. That technician will be a key in your decision-making process.”
Maintenance is not an overwhelming task but it’s something that can help the sterilizer’s efficiency and overall lifespan.
“Some of the things that they’re going to notice they can take care of themselves if they learn how to do it,” Simon Schwendener, SciCan/Coltene Territory Manager for North and South Carolina says. “It’s just like with a car and an oil change. For instance, the sterilizer’s door seal is a simple thing. Without it leaking at all, it runs much more smoothly. It doesn’t wear it out as quickly. Almost all of the sterilizers will continue to function after that seal has been exhausted, but they ultimately need to change it, simply because if it’s leaking just a little bit, obviously all the parts and mechanisms are working that much harder to get the pressure and temperature they need.
“A lot of them have filters built into them and we are putting fiber products in there when we wrap the instruments,” he continues. “If they keep up with that, it helps the whole system. If those little mesh filters within the chambers start to get blocked up, these fibers block the flow of the steam back out. The moisture that needs to get out of that chamber is stifled, so it doesn’t help its drying process. Again, it’s a very simple thing that they can do, and if they keep up with it and make sure that those things are clean, the machine works just so much more efficiently, and it doesn’t wear out as quickly.”
Knowing When It’s Time to Replace
Sometimes, sterilizers just need to be replaced, and knowing when to do that is critical.
“If repairable, but constantly causing downtime, impacting provider productivity and patient scheduling, it could be time replace,” Joyce Moore, RDH, CRCST, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts says. “At some point a sterilizer will reach its end of life and the manufacturer will no longer offer service or replacement parts. If paying repeatedly for costly service and difficult to source parts causes the unit to become a money pit, it may be time to move on.”
“When you have a sterilizer that you are running cycles based on the manufacturer’s instructions for use, and packages are wet at cycle completion, this should be a red flag,” Gregory adds. “Is this a fixable problem or is it time to invest in a newer unit? I also encourage people who have older units which may require manual selection of sterilization cycles to investigate new technology. There are actually newer units on the market that actually can anticipate a unit failure and provide notification to the user. We seem to be making all these amazing technological advances in our society, and that applies to your sterilizer, as well.”
Technology is great and has many capabilities, but it is still up to the human beings to understand what the high-tech equipment wants you to know.
“Sterilizers are critical to providing safe patient care in the dental practice,” Moore says. “Often, they are in constant use and like other equipment, experience wear and tear that can cause downtime. Obviously, if the sterilizer is broken it would require replacement.”
Sterilizers with the feature to do so can indicate problems, but it’s up to the practice to understand the codes.”
“You’ve got to start understanding what those messages are telling you,” Schwendener adds. “That’s going to start indicating that things aren’t working properly. What are those cycle faults? Is it a major component? Is it something that is it going to cost a third the cost of the machine? And at that point, really consider how long you’ve had the machine, too. If it’s a two-year old machine and it’s got a component failing on it, it’s probably conducive to repair that thousand-dollar part. If it’s 10 years old, that doesn’t make that much sense.”
When It’s Time to Buy
When the day comes that the practice does decide to buy another sterilizer, be aware of the specific features that are needed.
“If the practice is looking to purchase or acquire new equipment, the item’s manufacturer’s instructions for use (IFU) should be read and followed,” Moore says. “This could mean that instead of the gravity cycle sterilizer that is currently being used, that a pre-vacuum cycle is needed. Even better, before buying new equipment do the research to see what will be required to follow the IFU.”
Recordkeeping is required and, happily, newer sterilizer models offer built-in recordkeeping features.
“If your practice is an accredited facility then the sterilizer may require an upgrade to add or already be purchased with a recording or logging device in order prove that cycles are running within the correct parameters,” Moore says. “The records are either kept digitally or in print for a period of time. If your sterilizer doesn’t have a recording device, consider having one as a best practice, if it isn’t already considered a requirement.”
Dental practices are busy places, and sterilizers that can get the job done as fast as possible can keep them moving.
“Size is obviously always a huge thing, but then the time it takes to get through the process,” Schwendener says. “They really need to start looking at the drying process, too.
It is sterile, but because the packaging’s wet, it’s allowing an opportunity for something to wick into that packaging. Part of that, too, goes back to the volume. A lot of people are going to push what that sterilizer will do. They’ll put as much as they can in there, which often renders it ineffective in its drying process.”
Having a good relationship with your repair technician is a good idea.
“‘We’ve got this problem. Is it worth my time?’,” Schwendener says. “‘Is it worth my money to get this repaired or should we look at buying a new one?’ The second part is that you have to look at it from a couple different perspectives as far as how old is it, how long has it been there? And at, at a certain point if it’s been in there for 10 years, the technology has jumped up substantially.”
While a great feature to look for is a sterilizer with a short cycle, at some point – especially as the practice gets busier – it may be more useful to add additional sterilizers. Two or more sterilizers are practical when instruments are needed throughout the day and in the event of a sterilizer malfunction or biological indicator (BI) test failure. That is, a second sterilizer can keep the practice running if the first sterilizer has problems.
“On a number of occasions, I’ve seen dental practices using 1 sterilizer, but really needing a second in order to manage the volume of items requiring sterilization,” Moore says. “The addition of another doctor or hygienist to the practice may add a sizable number of instruments to the practice workflow. Sterilized items should not be removed while packaging is damp due to wicking, which will allow bacteria to enter the packaging and rendering the items unusable. If the staff is removing wet-packs because they must run another instrument cycle to keep up with the number of instruments being used, another sterilizer would be a definite need.”
Sometimes adding a new sterilizer, while keeping the old one in service, is a wise practice.
“If you’ve got 1 that’s old and it’s doing everything it’s supposed to, it’s passing its BI tests, it’s a good idea to keep that machine running,” Schwendener says. “At that point, if you’re considering it, go ahead and buy a second one so that when that starts to dissipate and starts to peter out, if you’ve got the backup plan already, you’ve got your system. If it’s working, go ahead and purchase a second one, and then you can start to phase that one out and you’ve got some more volume to push through it.”
“When I work with practices and they are constantly removing wet packages from their sterilizer, it may not actually be a problem with the unit,” Gregory adds. “It may be an indication that they’re shortening the dying cycle because they need the instruments. Here is the question: Is it really a sterilizer unit issue or is it that they are not following the manufacutrer’s instructions and are stopping the drying cycles early? In fact, it may be that they need another sterilizer to keep up with the instrument need to deliver patient care.”
At some point, the practice may decide that it’s necessary to buy a new sterilizer, and the indications run from poor performance to simply being overwhelmed by the practices need for sterile instruments.