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 interesting 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
Thank you to Medicom for sponsoring Noel’s TIPisode. Head over to medicom.com/en
For your viewing pleasure this TIPisode has been transcribed:
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: It’s Noel Kelsch in beautiful downtown Santa Cruz. This has been one of those funny times where I got asked to come and do a consultation with a dental office recently, and when I walked in I could hear something going tick, tick, tick, tick, tick, tick, tick and I thought it was a time bomb. It was pretty loud, and I said, “What is that noise?” “Oh, don’t mind that. The doctor went and got an egg timer for on top of the sterilizer, and it makes quite a bit of noise because it’s echoing off the sterilizer.” I walked into the back and, much to my surprise, there really was an egg timer on top of the sterilizer. The egg timer was there because the mechanics of the sterilizer was not working.
Remember that we’ve got three things that we have to do in order to understand if our sterilization technique is working. We’ve got some gauges to monitor. We’ve got some things to look at. So we’ve got mechanical techniques, we’ve got chemical indicators, and we’ve got biological indicators. All of those have to be completely functional in order for us to be sure that the sterilizer is working.
When we look at mechanics — we got to back up here a little bit. Remember monitoring gauges? You get in the car. The oil light is on. It’s telling you something’s not working. Well, it’s the same with the sterilizer, the mechanical techniques, including monitoring gauges, dials, and, at present, which I absolutely love, is the printout on your sterilizer. This reviews the time, the pressure, the temperature, just like on those gauges in your car. How close are you to empty? Do we have good tire pressure? Is the temperature of the car right?
We want to observe those gauges and display during the process, and, if available, monitor the computer printout. On most units with a timer and temperature — the pressure gauge — the timer should not start until the proper temperature and pressure has been reached. And that’s why the egg timer will not work. We got to get it up to the right temperature and the right pressure, and then the timer goes on. And you can’t be sure of that unless this is mechanically set up together. And the timer should not start until the proper temperature and pressure are reached.
This technique detects gross equipment malfunction. It doesn’t tell us that it’s sterile. It just tells us if something’s not working. If the gauges are not functioning, we got to take this out of service. Remember that the sterilizer itself is an FDA-grade medical device. If that sterilizer is not working properly, we can’t use it, and we have no guarantee.
The second thing is the chemical indicators. This indicator comes in many forms. It includes ink that changes color, heat-sensitive chemicals, and it shows that one or more of the conditions necessary for sterilization are met. This includes temperature, penetration of the sterilant. It can be built in to the pouch or tubing, and it’s available in tape and strips. It should be used in every package, and, ideally, paced both inside and outside.
The external indicator on the outside of the package gives you a clear view that the package has been processed, and then the internal indicator shows that something has gone inside of the package and reached the instruments themselves. It cannot be used to show that the conditions necessary for sterilization were met. It’s used to identify that the packets have been processed in the heat cycle and identify gross sterilization malfunction, again. The test should be performed with every single load.
The third way is those wonderful biological indicators. Now, biological spore testing is a method of verifying sterilizer performance through the use of a filter paper strip saturated with resistant spores and a matching control. The spore strip is placed in the center of the sterilization cycle. The control strip is not processed. This will evaluate the effectiveness of the cycle. It’s killing very specific bacteria, and as it goes through the system, you’re going to be able to tell whether or not you got a positive result or not.
A positive result indicates conditions are inadequate to achieve sterilization through actual organism killed. It directly measures the sterilization process, and it’s really effective. This is what we have to be doing at least on a weekly basis. This is the ultimate assurance that all the microbial life has been destroyed. If the test is positive, the machine should be removed from service and a retest of the machine performed. All instruments that were sterilized since the last test must be pulled from service and resterilized in a sterilizer that has negative test.
I can’t tell you enough how it means to me that most offices really understand this. They understand the three-step process and why we’re doing this on a regular basis. Monitor your gauges. Look at the mechanical technique. Monitor your chemical indicators and notice them each time they come out of the sterilizer. Make sure that you’re logging both those things. And, finally, those biological indicators.
I’m glad you know now, and I’m hopeful that you’re going to take care of yourself and take care of those patients.
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.