This week’s TIPisode is with Noel Brandon-Kelsch.
Are you still working with the cold sterile solution in your office? Noel gives us the deets on the proper way to use cold sterile in our practice, and asks the questions: Should we still be using it?
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:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date, and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Noel Kelsch: Hi, this is Noel Kelsch bringing you a TIPisode. Today, we’re going to talk a little bit about cold sterilization. Cold sterilization is the method of sterilization that requires the reusable semi-critical items to be immersed in an EPA-approved liquid chemical. These chemicals include glutaraldehyde, hydrogen peroxide, and a variety of other materials. Single use items can never be cold sterilized. They are not manufactured to be sterilized, and they may resist the process because of the materials which they are made from. So keep in mind that if it has the number two on the side and a slash through it, you can never cold sterilize.
And I really want to kind of have you think a minute about what immersion sterilization is. Is it really sterilization? Is it something that can be valued? Is it something that you’re going to be able to tell if an item is truly sterilized?
I want to back up here for a minute. What is it that you as a dental heath care professional need to know? Well, the Centers for Disease Control and Prevention have made strong statements in this area. They state that in all dental and other health care settings, indications for use of liquid chemical germicides to sterilize instruments are very, very limited. The first choice is always heat sterilization.
The CDC refers to heat sterilization as the method of choice when sterilizing instruments and devices. If an item is heat sensitive, it is preferable to use a heat stable alternative or a disposable item. So, as you look at the different holders that you have for x-rays, you look at the different items that maybe you’ve been putting in cold sterilization, please go back and read the manufacturers instructions for use. You may find that you are not doing it properly.
For heat sensitive instruments, this procedure may take up to a total of ten hours of immergen exposure. Items that are immersed have to be timed. This can be very difficult because you may put one item in and then the next item in and you’re not going to be able to tell the difference between those two items. You have to go by the last time an item was immerged. There is no method of marking the time the item was immersed, so you have to go, again, by that last item that went in.
This method is bringing unnecessary exposure to one or more chemicals in the dental environment that is not required. When we look at the time-wait average — time-wait average is how long a single provider can be exposed to a given chemical — on many of these things that we’re using for immersion, it’s very low. And, on many of these chemicals, you’re not going to be able to have them in the environment without direct ventilation and without it being — wearing specific personal protective equipment. Extra specific personal protective equipment could be required, and it’s vital that you read all the directions on the label and the SDS sheet that goes along with that.
Once the items have been sterilized, the process doesn’t end there. That’s where some of these limitations come into play. The item must be rinsed with sterile water to remove the entire chemical agent that could cause irritation or a chemical reaction with the patient. It then must be used immediately or packaged in a sterile package without touching the outside of the package that has been exposed to the environment. It’s very difficult to maintain sterility — you would have to use something sterile to pick it up with; you’d have to use something sterile to dry it with — and doing this process and putting it in packaging gives us a lot of limitations.
As we look at the limitations, the biggest issue with this system is there’s no specific indications of sterilization. Heat sterilization gives you three methods of monitoring has the processed really worked that includes the time or the timer on the sterilizer; the chemical, which is an internal and external indicator on packages that assures exposure to heat; and biological, which is that weekly spore test of the device.
There’s no way to monitor cold sterile with these methods. Even the time has limitations. Sterility is not verified or assured with this process. Studies have made it clear that heat can penetrate barriers. It goes beyond biofilm, blood, and tissues to kill organisms. Liquids cannot get past those barriers to penetrate and kill. On top of that, some of the sterilants are so viscous they cannot even go into the narrow tubing, the lumens, or even matted surfaces of some devices.
I want to get to the bottom line here. The bottom line is the CDC states, “Therefore, due to the inherent limitations of using liquid chemical sterilants, their use should be restricted to reprocessing devices that are heat sensitive and incompatible with other sterilization methods. All other items should be heat sterilized or disposed of. No disposable device should ever be reprocesses.”
I hope that all of you are thinking about where cold sterile is involved, that you’re reading the label, that you’re keeping yourself safe by having proper ventilation, by having proper personal protective equipment on. In keeping your patients safe, I hope you’re thinking about how single-use devices are to be disposed of and never put into a liquid sterilant.
Thank you for being here, thank you for making a difference with all your patients, and thank you for taking care of yourself.
I want to thank Medicom for allowing us to bring these TIPisodes forward. I look forward to more questions from you. You can reach me at n.kelsch — K-E-L-S-C-H — @sbcglobal.net. Keep sending those questions. I love answering them. Have a great day.