When you sit down to start a procedure, what do you expect to see? A good dental assistant will have prepared a table for you - a syringe is loaded with the appropriate needle and carpule; instruments lined out perfectly; bur in handpiece. You expect to have everything prepared for you so that you can sit down and get to work, right? Have you ever thought about what goes on behind the scenes? How sure are you that the stuff you’re using inside a patient’s mouth is sterile, I MEAN STERILIZED? 

There is much more to verifying the sterility of your dental instruments than you might think. 

Dental instruments are bagged or wrapped. The date should be written on the outside. (If more than one autoclave is used in your dental practice, label each autoclave. Indicate which autoclave the instrument pack or cassette is run). An easy way to determine if an instrument is sterile or not is to check the external chemical indicator on either chemical indicator tape or special markings on sterilization bags that change color. Steam autoclaves are pretty standard in dentistry. Type 1 sterilization pouches have one external chemical indicator that confirms that the outside of the pouch has been exposed to heat. Sterilization indicator tape on wrapped cassettes is another external chemical indicator. But what about the inside of the pouch? I encourage you to consider Type 4 sterilization pouches for processing loose dental instruments. The Type 4 sterilization pouch comes with multiparameter (internal and external) chemical indicators ensuring contents inside the pouch have been exposed to steam heat for enough time.

Chemical indicators confirm that instruments have been processed but these indicators do not contain microbial spores. Spore testing provides the most reliable method to assure sterility. Depending on the area your practice is located, you might be required to spore test every autoclave load. In other areas, governmental regulatory and advisory agencies require spore testing your autoclave at least once a week. If your governing body requires you to spore test every cycle, you might want to invest in an incubator offering quicker results. 

Inspect your sterilization pouch when removing it from the autoclave. If the color indicator did not change, do not use the instruments. The cycle failed. The entire load must be reprocessed.  Before you call your local technician, troubleshoot the issue because 9 times out of 10, the failed cycle is caused by human error. Review your autoclave maintenance schedule and protocols per manufacturer IFU’s (instructions for use). 

Document, Document, Document! Documentation of the sterilization of instruments and devices is vital to a dental practice’s infection control guidelines. Always follow state and local guidelines for documenting the sterilization of instruments. 

• Staff will label instrument bags and wrapped cassettes with date and document the autoclave - use a marker with ASTM values https://www.amazon.com/Sharpie-SAN-30001-Point-Permanent-Markers/dp/B07X3HTTNT
• Make sure to have a visual sterilization cycle log (I like to post it near the autoclave)
• Staff will add the date and time of the cycle then start the machine. 
• Document pass/fail cycles
• Document maintenance protocols
• Document spore testing
• Document repair activity

Do you remember that date stamp we discussed earlier in the blog? Here’s where that information is critical. If a spore test ever comes back positive, every instrument in that cycle is not sterile. Without a date on the instrument pack or cassette - well, you’re going to be busy re-sterilizing all of your instruments.  

Bottom line - Always have a plan 

Many automatic autoclaves come equipped with technology that provides documentation of sterilization results - less work. I am all in on that! The sterility of your dental instruments will always be highly dependent on your human capital so make your process simple! Provide standardized work examples. Mistake proof sterilization by instituting checklists. Trust but verify that the sterilization protocols are being followed. The life of your practice is dependent on your ability to treat patients. Without the tools, you’re dead in the water. 

For help instituting simple and worry free sterilization guidelines, contact me at reboottraining@desergo.com. Reboot Practice Productivity Training addresses the efficiency of your entire clinical department. Sterilization is just one component.