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Infection Control

46

Column I Infection Control

Monitoring gauges

By Noel Kelsch, RDHAP

Ihad to drive my childs car today. Mind you, I dont really careabout cars. As long as they start, the brakes work, and there is noduct tape holding it together, I am fne. My sons project car,

a VW Van, is a testament to the miracles that a mechanic can per-orm. I turned the ignition, and the engine purred. The gear shi t

which had to be welded into place last month worked smoothly. The brakes that Brice put in the day be ore gently brought me toa stop, preventing my demise. I drove down the reeway with theair gently sweeping my hair back (the sunroo is wide open and willnot close).

As I started up a hill, the engine surged and then sputtered. The van slowly came to a stop. I looked at the gauges the gas was ull,and the oil was ull and the gauges told me that this machineshould be working fne. I called my son and asked him to come andget me.

He said, Mom, did you put gas in it?I replied, No, it says the tank is ull.Brice laughed and said, All the gauges are disconnected. The

sticky note on the visor tells you at which mile you have to addgas.

Understanding the system or monitoring a machine is very important. Not only will it prevent you rom having to walk up

a hill in your high heels, but it willaid you in monitoring your sterilizer.Sterilizers are a vital tool in in ectioncontrol. Monitoring them correctly

will assure that they are working eectively and that instruments are

properly sterilized. The Centers orDisease Control, American Dental

Association, and the Organizationor Sa ety and Asepsis Procedur

provide dental pro essionals guidelines or three basic ways to monitor your sterilizer.

Mechanical techniques This includes monitoring thegauges, dials, and i present, thprintout o your sterilizer. Itreviews the time, pressure, andtemperature. Observe the gaug-

es and displays during the pro-

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Column I Infection Control

cess. I available, monitothe computer printout. Onmost units with a timer andtemperature and pressuregauge, the timer should notstart until the proper tem-perature and pressure hasbeen reached. This tech-nique detects gross equip-ment mal unction, but doesnot indicate sterility. I the

gauges are not unctioningtake the unit out o service

This test should be done with every load.

Chemical indicators

This indicator comes inmany orms, includincolor-changing ink andheat sensitive chemicals. Ishows that one or more othe conditions necessary osterilization were met (tem-perature, penetration o ste-rilant, etc.). It can be builtinto the pouch or tubing,and it is available in tapor stripes. It should be used

with every package, ideall

placed both inside and out-side.

The external indicator on theoutside o the package gives yoa clear view that the package hasbeen processed. The internal in-dicator placed inside the packageor cassette verifes that the ster-ilizing agent has penetrated the

packaging materials and reachedthe instruments. It cannot be

Six tips for monitoring1. Read the directions and refer to them frequently. Many sterilization fail-

ures are the direct result of operator errors. Follow all the directions formaintenance and cleaning. Set up a calendar for service and mainte-nance. 2

2. All results of mechanical, chemical, biological monitoring and repair forthe sterilizer must be recorded in a notebook. Place the date, test, loadtype, sterilizer serial number and results, as well as repairs and mainte-nance.

3. Date all packages before sterilizing. Do not use any items from a failedtest. Pull all items that were processed during the time period followingthe last test that did not fail and reprocess them. This is why it is vital todate the packages.

4. All implantable items must go through a biological indicator process andthe results seen before they are placed in a patient mouth. Ofces shouldtake this into consideration when planning patient appointments, givingtime for the results to be returned or read before placement. 3

5. The single most common error in sterilization is overloading. Refer tothe unit directions for instructions on loading. Make sure you are notoverloading and are leaving enough space between instruments to allowpenetration of the sterilant. 2

6. It is important to know who is doing your biological spore testing if youhave it done by a third party. Make sure you use a reputable companythat has the background and understanding of the process. Find outwhat their turnaround time is (some take up to two weeks). Ask if theycharge for retesting. There are many simple in-ofce systems that take aslittle as 24 hours to deliver results.

Sterilizer Temperature Pressure Time

Steam autoclave 121 C (250 F) 15psi 15 minutesUnwrapped items 132 C (270 F) 30psi 3 minutesLightly wrapped items 132 C (270 F) 30psi 8 minutesHeavily wrapped items 132 C (270 F) 30psi 10 minutesDry heat 170 C (340 F) 60 minutes

160 C (340 F) 120 minutes150 C (300 F) 150 minutes140 C (285 F) 180 minutes121 C (250 F) 12 hours

Dry heat (rapid fow) 190 C (375 F) 6 minutesunwrapped items

Dry heat (rapid fow) 190 C (375 F) 12 minutespackaged items

Chemical vapor 132 C (270 F) 20-40 psi 20 minutesEthylene oxide Ambient 8-10 hours

As published by Journal o American Dental Association, Dec. 1991

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