Have you ever wondered how instruments get sterilized? Probably not. Your assistant just sets up a tray (or hopefully cassettes) and has the instruments ready (or should) when the procedure starts. I was prompted to write this blog after responding to a Dentaltown post: “new sterilizer needed.” It occurred to me that maybe I should take this opportunity to write about it.
When was the last time you asked your clinical staff to go over the sterilization process in your dental practice? You are probably not bothered with the process until you need to buy a new autoclave. They are not cheap, nor should they be; the health and safety of your patients and staff relies heavily on the autoclave. Unless you have immediate back up, when that thing goes down, you can kiss that production bye bye.
There are several things to consider when buying a new autoclave. I’ll take the obvious checklist items off the list like: price, reliability and price. Oh, did I say price twice? While you’re mulling over your options, let me tell you what you are buying.
I don’t see a lot of dry heat or bead sterilizers around anymore and in fourteen years, I have never come across a chem-clave. The most common type of sterilizer used in dentistry today is the steam autoclave. There are three types of steam autoclaves. They are classified as Class N, Class B and Class S.
The ‘N’ type autoclave is a steam autoclave that uses steam to move air downwards within the chamber where unpackaged instruments are placed on a metal perforated tray. No instruments can overlap. The instruments must be laid out in a single layer so that the steam can make direct contact with the surface of each. For this reason, the Class N is the least reliable. Since the instruments are unpackaged, there is no way to indicate if the instrument is sterile. Your manual autoclaves are type ‘N’.
Class ‘S’ autoclaves are the most widely used autoclave in North America. Air is sucked out of the chamber which creates a vacuum so that steam can penetrate packaging such as cassette wrap and/or sterilization bags to reach the instrument. This is done through a series of vacuum pulses which removes the air inside the chamber. The pressure and temperatures continue to rise until it reaches a constant level which is where the actual sterilization takes place. Once the sterilization cycle is complete, the chamber is depressurized and the dry cycle starts.
While Class ‘S’ autoclaves are more prevalent in dental offices across the U.S., I wouldn’t be surprised if (again, in light of COVID) the CDC requires that every dental practice purchase a Class ‘B’ autoclave. Maybe you’ve never thought about how the inside of a dental handpiece motor gets sterilized. Maybe you’re not autoclaving your motors at all - that’s another blog topic.
Class ‘B’ autoclaves are designed with a pump that removes all the air from the chamber (pre-vacuum) before steam enters and post vacuum that pulls the steam out which makes for faster drying times. The only way you can be assured that your hollow instruments, including handpieces, nitrous masks, your Dry Shield, implant motors and tubing are sterilized is with a Class ‘B’ autoclave. Did you know that? I haven’t seen the sterilization police, yet, but think about it…..a government bail out...a new president…. Don’t get me started.
Better safe than sorry. We’ve heard that phrase a lot. I am not suggesting that you go out and replace what you have right now. But, if you are looking for a new autoclave, get a Tuttenauer T-Edge. They have manufactured the only autoclave on the market that is upgradable to Class ‘B’ sterilization. What does that mean? Well, it’s a gravity autoclave (Class ‘S’) upgradeable to pre and post vacuum (Class ‘B’) via software upgrade. You may need it!
The success of proper sterilization weighs heavily on the operator. Human error accounts for the majority of failed autoclave cycles. There are ways to prevent errors from occurring by instituting checklists and standardized work examples. The technology built into the T-Edge provides real time Wi-Fi monitoring of cycles and water levels via a Smart device. It’s also super fast and instruments packs/cassettes are completely dry in 35 minutes. The door does not pop open until the entire dry cycle is complete. That’s a big deal. Fast, efficient, less chance of human error, large capacity and the assurance that everything is sterilized? Hmm, I’m going with the Tuttenauer T-Edge. I’ll get you one! Let me know how quickly I can get one in your practice.
