This week’s TIPisode is with Noel Brandon-Kelsch.
The ultrasonic bath is more important in the sterilization process than you may have given it credit for. Noel breaks down how it works, how we monitor, and why hand scrubbing instruments is not advised.
Send in your infection control questions! Noel would love to answer them for you.
Medicom sponsors this episode. Head over to their website and learn more about their products to keep you and your patient protected
Noel Brandon-Kelsch is an international speaker, writer, Registered Dental Hygienist in Alternative Practice and Director of Cabrillo College Dental Hygiene Program. She is passionate about oral health and has the uncanny ability to motivate and enlighten audiences through her unique humor and cutting edge information. She takes the tough subject matter and presents it in such an exciting way that it becomes thought-provoking even to those not involved in her industry.
Noel is an infection control guru and is going to bring us tips that can make use more informed clinicians!
Check out her webpage noelkelsch.com
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This TIPisode has been transcribed for your viewing pleasure:
Noel Kelsch: Welcome to TIPisode. My name’s Noel Kelsch, and today I’m going to talk to you about a really important medical device that you have in your office. It’s called an ultrasonic bath. I really think this is an important piece of equipment that is overlooked many times. The CDC has asked all of us to limit our hand scrubbing. In fact, OSHA takes it even a step further. OSHA is very specific in that we are to limit hand scrubbing and even handling of our dental instruments after they’ve been used on a patient. The ultrasonic bath is one of the things that can allow us to take that recommendation to the next level.
So what is an ultrasonic? Well, deep inside your ultrasonic tank are ultrasonic transducers. These are placed according to the size and shape of the unit. These transducers create microscopic bubbles in the ultrasonic solution that is placed in the unit. The act of cavitation is that rapid formation and collapse of a million tiny bubbles in a liquid. Alternating high- and low-pressure waves generated by the high-frequency sound called “ultrasonics” places and produces bubbles in the action. During the low-pressure phase, they grow from microscopic size until during the high-pressure phase, they are compressed and implode, removing debris.
You know, I really love the sound of the hissing of the bubbles literally imploding on dental instruments, cleaning them as a result. As you peak in the lid — make sure you have on your personal protective equipment — you will see moving waves as a result of those bubbles imploding. These actions allow us to follow the directions from the CDC and OSHA and limit that hand scrubbing.
There’s some vital parts we have to think about when we’re doing this process. The first one is liquid. Liquid is a vital part of the process. It’s important to keep the level of the fluid at a level the manufacturer recommends. Low-level fluids can decrease the effectiveness, changing the frequency and even damaging the units. When the proper solution level is in its place, it protects the units and the transducers from overheating and allows the solution to flow around the parts maximizing contact with cavitation and fluid. Monitoring the fluid level throughout the day is a must. As you take instruments out, you are removing solution. The unit’s function gives of heat, which causes evaporations, and that will lower the fluid level.
The length of time. Each of us has to look at our unit, has to read the directions and make sure that you’re following the instructions for use. As you look at those directions, you’re going to be told that the time may change due to variables. Variables can include the type of solution, the temperature, the length of time that allows drying of solids and debris right on to your instrument. Very dirty instruments that have set for a long period of time can increase the need for time. Now, most units are going to tell you it’s an average of three to five minute, but you need to be checking and see what’s going on with your own specific unit.
Monitoring the load is really important. Monitoring to see if the instruments are debris free. If they’re not, you should first check your fluid level and also clearness of the fluid. Now, you’re going to change that fluid at least daily, but many times you have to change it more frequently if you are doing a lot of instruments or if you are doing a lot of instruments with debris such as doing extractions or things like that. If those are normal, then we’re going to look and see if we need to run a test. And that test — at least monitoring monthly — we should be checking to see if the unit is working properly.
There’s a couple of different ways plus a manufactured way that you can test the unit. The first one is called a “foil test.” That’s with the basket out of the unit, fill your unit with the recommended level of water, fold a piece of aluminum foil in half the width of the unit, don’t touch the bottom of the unit with the foil, and run the unit for one minute. You should see pinholes and pockmarks. If there’s a place where there’s no pinhole or pockmarks, that’s called an area where this isn’t working or a “cold spot,” which means that one of the transducers is not working.
The second way is called a “glass slide test.” You take a glass slide, wet the frosted part, mark with a number two pencil with an “X” from one corner to the other, put the slide vertically into the solution, and turn the solution on. Hold it in place not touching the bottom of the unit. The “X” should disappear in about 10 seconds.
There’s also commercially available tests that will show us whether the soil or protein is sticking — is being removed or not being removed. So, important to look at some of those commercially available tests.
The things that I want you thinking about as you go through what you’re doing within your offices to keep yourself safe:
In keeping yourself safe, you’ll want to make sure the unit has the lid on the entire time it is running to limit the aerosols and lower the noise level.
The second thing has to do with not overfilling the load with instruments as this will limit the cavitation process and exposure to the bubbles — makes sure the unit — and making the unit less effective.
You’ll want to, as I said before, check to make sure you have fresh solution. It shouldn’t be visibly cloudy or filled with debris. If it’s visibly dirty, it’s time to change the fluid.
The fourth thing is the type of fluid. It’s important that you choose the right fluid, that as you add the chemical to help with the process, you want no foam, or you will have a very big mess. Make sure you read the manufacturer’s directions to see what kind of a chemical you’re going to put in there. Want to make sure that you don’t put anything in that could impact the instruments. And I know we’ve had some speakers out there saying that you could use something like Spic and Span. Not recommended because these could impact your instruments over time. Follow the recommendations by the instrument manufacturer as well as the recommendations for ultrasonic use when choosing that additive.
The next thing I want you thinking about is the — as you read the directions, they’re going to recommend that you de-gas the unit before adding instruments. This is a simple act of adding the solution, the water, the tablet without the basket, and turning the unit on allowing it to de-gas or run until the bubbles have been allowed to implode on each other. This will take about five minutes.
Make sure that if — that you are rinsing the instruments after they’ve been through the ultrasonic bath, rinsing all the chemicals and debris off of that.
At the end of the day, empty all the fluid in the unit, flush your unit with clear water, and allow to dry overnight.
Do not ever set the unit on a wet towel or in a sink to fill. This is an electrical item and should not be wet. Bring the water to the unit, dry the unit off in between, but never set on a wet towel.
Never place items directly on the bottom of the unit with no basket. This can impact those transducers over time, and it can also limit the cavitation process.
Never set a plastic bag with a denture or partial directly into the water. The unit itself as it implodes can break down that plastic allowing bacteria and debris to enter that bag. Follow the manufacturer’s directions for using a glass beaker and their special unit accessory to allow this to work.
As you think about the ultrasonic bath, I hope that you’ll be thinking about keeping yourself safe and following the CDC and OSHA guidelines.
This is Noel Kelsch. I want to thank Medicom for sponsoring this TIPisode. I want to thank all of you and look forward to your questions coming to me.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.