Choosing the right sterilization process

I obviously have a dry heat sterilizer bias because of the groundbreaking developments Dentronix has made in this technology during the last 25 years, but our FDA-cleared, biologically verifiable dry heat system is no longer a compliant option in jurisdictions such as California and Nevada.

In these states, dental board regulations requiring mandatory bagging of instruments have overridden the reasonable “flash” sterilization choices of a vast number of orthodontists.

From an effectiveness standpoint, steam sterilization is a perfectly viable option; however, it can be damaging to hinged instruments, sharps and non-stainless materials — exactly the types of instruments orthodontists use.

Offices now using steam need to be aware of the implications of their process and what steps they need to take to preserve the integrity of their tools.

Not surprisingly, there was some pushback on my approach to allowing orthodontists to make their own informed choices within the CDC guidelines. There is a feeling among some clinicians that tougher regulations automatically translate to a safer clinical environment.

In my opinion, this is a solution in search of a problem. Until we thoroughly assess the microbiological implications of predominately non-invasive orthodontic treatment vis-a-vis (a) the unsterile clinical environment, (b) unsterile barriers and personal protective equipment (PPEs) and (c), in many cases, unsterile treatment components, the idea of enhancing patient and staff safety by delivering a sterile instrument at the point of treatment is legitimately questionable. There is a viable debate that can be had between the proponents of “sterile” instruments and those that accept “sterilized.”

The risks to instrument longevity and functional integrity are exponentially increased once we begin exposing hinged and inserted orthodontic instruments to steam, water and high-humidity conditions. The disconnect between prudent instrument care and the selection of compatible infection control methods has become significantly pronounced in an increasingly digital world.

There are, in fact, instruments manufactured that have a better tolerance to steam sterilization, but there are numerous tradeoffs in functionality. Many older instruments in practices that are purchased by graduating residents have no tolerance for steam sterilization, and if sterilization protocols are changed in these practices without consulting instrument manufacturers, the replacement of an entire damaged instrument inventory can be a significant unanticipated cost.

I also fear the false sense of security that may come through bagging instruments might mask other more subtle areas of potential infection control breakdown. The infection control goal of any patient treatment procedure performed in a non-sterile environment should be to break the chain of cross-
contamination.

The sheer number of patient and staff interactions that happen daily in an orthodontic environment demands a thorough assessment of how we biologically isolate one patient from the next. This includes the many infection control tools at our disposal — things as simple as hand washing, plastic barriers on computer keyboards and covers on curing lights.

Creating a totally sterile environment in the orthodontic clinic is certainly one answer, but it’s not a practical one. We need to identify the problem we are seeking to solve, create an office procedure based on current state and federal guidelines, document it, train it to your staff and periodically audit it. This should provide adequate levels of protection in a practical, legal and moral context.

(Source: Dentronix)