Sterilization procedures should be monitored using biological, mechanical, and chemical indicators. Biological indicators, or spore tests, are the most accepted means of monitoring sterilization because they assess the sterilization process directly by killing known highly resistant microorganisms(e.g., Geobacillus or Bacillus species). However, because spore tests are only done weekly and the results are usually not obtained immediately, mechanical and chemical monitoring should also be done.
Mechanical and chemical indicators do not guarantee sterilization; however, they help detect procedural errors (e.g.,overloaded sterilizer, incorrect packaging) and equipment malfunctions.Mechanical and chemical monitoring should be done for every sterilizer load.Mechanical monitoring involves checking the sterilizer gauges, computer displays, or printouts, and documenting in your sterilization records that pressure, temperature, and exposure time have reached the levels recommended by the sterilizer manufacturer. Since these parameters can be observed during the sterilization cycle, this might be the first indication of a problem.
Chemical monitoring uses sensitive chemicals that change color when exposed to high temperatures or combinations of time and temperature.Examples include chemical indicator tapes, strips, or tabs and special marking son packaging materials. Chemical indicator results are obtained immediately following the sterilization cycle and therefore can provide more timely information about the sterilization cycle than a spore test.
A chemical indicator should be used inside every package to verify that the sterilizing agent has penetrated the package and reached the instruments inside. If the internal chemical indicator is not visible from the outside of the package, an external indicator should also be used. External indicators should be inspected immediately when removing packages from the sterilizer; if the appropriate color change did not occur, do not use the instruments. Chemical indicators help to differentiate between processed and unprocessed items, eliminating the possibility of using instruments that have not been sterilized.
A spore test should be used on each sterilizer at least weekly. Users should follow the manufacturer's directions for how to place the biological indicator in the sterilizer. A spore test should also be used for every load with an implantable device. Ideally, implantable items should not be used until they test negative.
Records of sterilization monitoring (mechanical, chemical, and biological) should be maintained long enough to comply with state and local regulations. The Centers for Disease Control and Prevention (CDC) does not maintain information on time limits for every state but provides an example of 3 years in its sterilization guidelines, which is the timeframe used by the Joint Commission inspection agency.
For each sterilization cycle, record the type of sterilizer and cycle used; the load identification number; the load contents; the exposure parameters (e.g., time and temperature); the operator’s name or initials; and the results of mechanical, chemical, and biological monitoring.
Check your equipment to see if it has a fuse— find out what typeof fuse it uses and keep a few spares on hand. They are inexpensive, so having a few spares on hand is cheap insurance against down time. A multi-compartment box makes a great organizer for all of your fuses and will help you find the correct fuse quickly when you need one.
Just like fuses, a spare bulb or two is an inexpensive defense against unexpected down time.
Your office should have a circuit breaker controlling the electricity throughout.Make sure yours is well labeled and you know what circuit is for which piece of equipment. Some pieces of equipment (e.g. sterilizers) take a lot of electricity to run, so they should be on a dedicated circuit. Be careful about what is on the same circuit as something else. You don’t want a sterilizer down because someone microwaved his or her popcorn.
You don’t need to become an electrician, but it’s a good idea to purchase a simple multi-meter.This device can save you hundreds by allowing you to troubleshoot electrical devices throughout the office.
Make sure to unplug devices before working on them and don’t be afraid to call in the professionals either. We want to help teach you about the simple things you can do without the expensive technician fees. Sometimes it is good to push your comfort zone, but there is no need to take unnecessary risks. It’s an axiom among electricians to“work with one hand in your pocket.” Be careful about what other objects you touch when working on electricity and avoid water. For your own protection, as well as to protect the equipment you’re working on, it’s usually best to remove any jewelry as well (gold is a particularly good conductor).
The American Dental Association wants dentists to drastically cut back on prescribing opioid painkillers.
The association announced a new policy Monday that"essentially says eliminate opioids from your arsenal if a tall possible," said Dr. Joseph Crowley, the group's president. The Chicago-based group represents around161,000 dentists.
The group is also pushing for limiting opioid prescriptions to no more than a week and mandatory education for dentists that encourages using other painkillers.
Dentists write fewer than 7 percent of U.S. opioid prescriptions, but new research shows that practice has increased in recent years, despite evidence that ibuprofen and acetaminophen work just as well for most dental pain and are less risky opioids, which can be addictive.
In many dental cases involving opioids, dentists prescribeVicodin or Percocet for short-term pain from procedures including removing wisdom teeth and other tooth extractions, root canal work, or dental implants.
But non steroidal anti-inflammation drugs including ibuprofen (sold as Motrin and Advil) are as effective for these conditions; and ibuprofen plus acetaminophen(Tylenol) can provide better pain relief in some cases, according to an analysis of five studies published in theJournal of the American Dental Association.
The difference between good leaders and great leaders is the habits they master. Here are some behaviors you can develop to become a better leader:
One shortcoming to being a better leader is trying to accomplish everything by yourself. There are plenty of reasons why. Maybe you’re a perfectionist who feels it’s easier, or maybe you feel your own work is better than that of your employees. A great leader knows that his or her most important task is developing others—teaching people how to think and ask the right questions. It is a skill that is the least developed in most organizations. The bottom line: If leaders don’t delegate, subordinates don’t learn to improve and organizations can’t grow.
Although email and texts are great for communicating across time and distance, effective leaders realize the value in talking face to face. One of the best ways to find out what’s going on is to set aside time each week to get out of your office and talk to everyone—the receptionist, the supply clerk and team members, not just managers. You will uncover problems and opportunities you may never have learned of otherwise.When you ask people how they are doing, what’s working well and what could work better, you not only get information but also increase the camaraderie between you and your employees.
Richard Branson says leaders should listen more than they talk because that’s how they learn what’s going on.
Great leaders learn to listen for context as well as content—what I call deep listening. Deep listening is being fully present in the moment with the person who is speaking, and not trying to judge or control the conversation. We let go of our assumptions to hear not only what is being said, but also the emotions, motives, needs and goals of the person speaking. This kind of listening builds trust and respect, and it encourages the sharing of information you need to make good decisions.
As with everything, some of these habits will be easier to develop than others. The real goal is to improve the way you lead, and with practice and time spent on the right things, you can become the leader you want to be.
It’s been about two years now since the CDC published their “Summary ofInfection Prevention Practices in DentalSettings” in the Spring of 2016.
Despite using the term “summary” in the name of this 44-page document, the CDC has come out with completely new rules for infection control in the dental office (in addition to summarizing previously published guidelines).
This month, we'd like to discuss the dramatic changes to the guidelines for sterilization of dental handpieces.
“Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high level or surface disinfected.”
What does this mean to you? You cannot re-use a handpiece on a patient unless the entire handpiece and all components have been heat sterilized — even slow-speed handpieces (and components) that are only being used for prophylaxis.
Unfortunately, several popular hygiene handpieces on the market do not conform to this specification and must be removed from service. Handpieces with any drive component that cannot be heat sterilized are now only suited to personal use, use in a veterinary office, or use outside of the country (such as for mission trips).
Drive mechanisms that aren't heat tolerant (cannot be autoclaved) are commonly encountered with many“stand-alone” electric units, but all systems must conform to the new standard. Any component with any type of gear, drive shaft, or similar mechanism must be autoclaved.Fortunately, most air-driven handpieces on the market are fully autoclavable and have been for decades. Periodic removal of motors and other components should already be a part of your office’s routine handpiece maintenance, now you just need to increase the frequency.
The CDC guidelines were the result of several studies (mostly conducted by various branches of the US military) that showed contaminants had a tendency to work through the drive mechanisms of slow-speed handpieces and contaminate all of the components (even those that do not enter the oral cavity). These studies have shown a high probability of contamination of all handpiece components. The risk of contamination is very real.
In the infection control guidelines, theCDC goes on to state: “Although these devices are considered semi critical…” and a major handpiece manufacturer has seized upon this statement to claim that their motor does not need to be heat sterilized as it is non-critical. However, all motors are non-critical devices. That is in the nature of a motor. Under normal circumstances, a motor should never contact mucous membranes or non intact skin. The CDC explicitly spells out that handpieces “including low speed motors,” must be heat sterilized. It is clear motors must be heat sterilized, regardless of their standing— critical, semi-critical, or non-critical. To attempt to skirt infection control guidelines based on a loose interpretation of a technicality is a dangerous prospect and not something we can recommend, nor support.
There are a number of other developments in this latest document from the CDC.