Dental practices know they need to be working towards meeting best practice requirements but complain of resulting bottlenecks which can be costly in both time and money. However, there are some simple ways of reducing the processing time – especially useful when practice incomes are being squeezed.
Clean
Probably the biggest decision currently faced by dental practices is whether to buy a washer disinfector– if you are still manually scrubbing in a sink at your practice, then these are the questions you need to consider:
• Do you have two sinks?
• Do you have a dedicated decontamination nurse?
• Do you have clear and concise manual cleaning protocols/procedures in place and documented?
• Have the staff undergone training, if yes by whom?
• Do you inspect the instruments after cleaning?
• Are you able to validate the process?
• How long do you spend cleaning each instrument?
The fact is, correctly cleaning instruments by manually scrubbing is not only a messy but a time-consuming process. The majority of dental practices would find the installation of a correctly-sized washer disinfector to be a much quicker and more cost effective alternative, resulting in a faster turnaround of instruments.
Size matters
Having decided that it is time to invest in a washer disinfector, next you have to decide how to choose between an under bench or a bench top model. Those who prefer an under bench design say it is because of the space saving benefits of not having a large washer disinfector occupying work top space. There is a theoretical advantage in an under bench washer in that they are usually bigger and have the capacity to process more instruments per cycle. However, most surgeries are not big enough to utilise all that additional capacity, so it goes unused and the washer disinfector is run only half full. Alternatively, the practice ends up needing to buy additional instruments as they wait until the machine is filled to its capacity. Bear in mind that this is only step one in the decontamination process – having hundreds of instruments suddenly ready for autoclaving might create another bottleneck further along the line. In addition, some of the big under bench machines can be difficult to install and expensive to run. Some bench top washer disinfectors can have a limited capacity yet take up valuable space on a worktop. Look for a manufacturer who can advise on the correct capacity for your needs, whether you want a bench top or an under bench machine. Ask for information about cycle times – recent technological advances have resulted in the latest generation of washer disinfectors being much quicker than their predecessors – some up to as little as half the time.
Lubricate
An important part of the process after cleaning is lubricating in order to ensure that expensive hand pieces are correctly maintained and ready for sterilising. Probably the quickest and most effective method is to invest in an automatic air-operated method. This also results in just the right amount of oil being applied, significantly reducing waste and extending the life of the hand piece.
Sterilise
Most practices assume that their main choice is whether or not to buy a vacuum autoclave and what size to buy. Most manufacturers provide both vacuum and non-vacuum autoclaves, in varying sizes with varying cycle times and tray capacities.
A slow or low capacity autoclave can be a major bottleneck in the decontamination process, especially when a washer disinfector is being used for instrument washing. You might find that you need to buy more autoclaves to get the appropriate throughput of instruments because their capacity or cycle times are restricted. The best option is therefore to look for an autoclave that combines both faster cycle times with high instrument capacity.
A ‘B Class’ vacuum autoclave is essential for the correct sterilisation of wrapped, porous or hollow instruments – the type of instrument found in all dental practices – but, in the past, the vacuum cycle has been much slower than a non-vacuum cycle, meaning that practices have been reluctant to change. Ask for information about cycle times, tray capacity and instrument weight - as with washer disinfectors, technological advances means that there are much faster true ‘B Class’ machines now available but there can be big differences in load capacities.
Conclusion
The importance of cross infection control is increasingly apparent across all health sectors and, due to recent high profile cases, is also very much in the public consciousness. The dental practice will need to continue to show high standards of patient care by demonstrating excellence in dental instrument decontamination. By making informed choices, dental practices can choose to invest in equipment that will demonstrate these high standards whilst at the same time removing the old practice bottlenecks – saving time and money in the future.