July 1, 2015
by George Freedman, DDS, FAACD, FIADFE, FACD
Over the past five decades, the dangers of microbial threats in the dental practice have been more specifically recognized, and more definitively addressed, than ever before. There has been significant progress in the understanding of previously known and newly identified organisms, and their necessary eradication from the dental treatment process.
There has been a parallel dramatic revolution in the science and technology of in-office sterilization and disinfection, both in process and in awareness. These innovations have focused on improving, speeding, and simplifying the various steps that the practitioner (or the dental team) must undertake in order to effectively cleanse and process instruments between patients.
Dentists and team members must have a comprehensive familiarity with sterilization and disinfection in the practice; patients’ health and lives may depend on it, as does the health of the entire team and their families. It is important to note that while most dentists are not directly active in the sterilization process, dental staff rely upon dentist leadership in this area for their personal protection.
Sterilization and disinfection are often seen as complicated and confusing subjects because there are so many separate components that must all be correctly managed to achieve a successful procedure. In fact, the individual tasks are quite straightforward. Most problems occur with the integration of the various devices, the proper sequencing of the required steps, and the documentation of the sterilization procedure. If any of the necessary steps are missed, or incorrectly ordered, the entire sterilization process is at risk; sterilization is evaluated in absolutes, success or failure, not in degrees of achievement.
The universal availability of internet connectivity offers an opportunity to bring disinfection and sterilization into the 21st century, and to solve many clinical uncertainties. The recently introduced G4 Technology (SciCan Ltd, Toronto ON) allows the practitioner to integrate all the sterilization components through the G4 web portal interface that provides third party cycle validation and data storage for each element, as well as service logs and remote access options for verification, maintenance, updates, and repair (Fig. 1).
The clinical disinfection and sterilization process consists of two distinct elements:
1. Interactive Instrument Processing
Automated instrument washing achieves the mandates of the instrument cleaning process: effective physical removal of debris; comprehensive washing, rinsing; and thorough drying of the instruments.1,2 The instruments are handled by the staff only during loading; thus, there is little or no danger of glove/hand puncture or facial aerosol contamination to the auxiliary. The use of cassettes, as opposed to loose instruments, reduces the risk to the dental team members even further. Automated instrument washing has the additional benefit of minimizing the cross-contamination risk to patients (Figs. 2 & 3) (HYDRIM C61w G4, SciCan Ltd, Toronto, ON).
The reduced effort that is required for the highly efficient, automated instrument washing process frees up staff time and energy for other essential duties. The shorter washing cycle, as compared to manual instrument washing or the use of ultrasonic equipment, improves the instrument kit turnover rate significantly, permitting fewer instrument kits to be utilized more frequently. This reduces the number of kits required for the practice. Since the handpieces, hand instruments, cassettes, and other items can be quite expensive, needing fewer kits significantly lowers the initial and ongoing investment in the practice. Thus, the automated washer is an excellent financial investment at the same time as it reduces the risks of patient cross-contamination.
The G4 two-way web monitoring of each HYDRIM cycle assures that the unit is operating at its peak efficiency, and alerts both practice and service providers of any change in status. The unit’s operation can be monitored in real time, offering total confidence in its performance, and the integrated-access cycle history permanently documents the process. The G4 web-based documentation software is included and there is no installation required.
2. Interactive Sterilization
The STATIM compact sterilizer line (SciCan Ltd, Toronto, ON), first introduced in 1989, has long been the world leader in the category. The incorporation of G4 two-way web monitoring of each STATIM cycle guarantees optimal operating efficiency, and alerts both practice and service providers of any change in status (Figs. 4 & 5).
Initially, its autoclaving speed, particularly for handpieces, was the primary attraction; the STATIM, utilizing saturated steam positive pressure pulse displacement technology, can complete the sterilization process for unwrapped instruments in as little as six minutes.3 Over the years, its dependability has been extensively documented. Furthermore, the process is gentle on delicate dental instruments.
Most conventional autoclaves heat their entire water reservoir. STATIM, on the other hand, introduces a miniscule amount of water into a steam generator heating device that rapidly heats and converts it to steam in seconds. Moreover, the steam injection process forces air out of the sterilization chamber automatically to speed drying.
STATIM utilizes a fully-removable cassette or sterilization chamber. It has thin stainless steel walls that permit ultra-rapid heating and cooling of the chamber. Thus, STATIM can achieve sterilization and drying in far less time th
an most other autoclaves.
The longer the sterilization cycle time, the more instrument sets and handpieces that a busy practice requires. A single operative kit, including a high-speed handpiece, can cost $3000 or more.2 Rapid, validated turnaround times for sterilization can provide a major financial benefit to the practice.
The drying time involved in sterilization is often overlooked. Instruments (or wrapped packs) dry inside the sterilizing chamber before removal and handling. The packing, if hot and moist, can act as a wick, absorbing moisture and bacteria from the outside, and transporting them to the instruments inside.
Microprocessor-controlled STATIM autoclaves constantly monitor all of their important parameters internally. This operational data is displayed on a user-friendly screen, offering prompts for ongoing operation and error messages. The operator has complete confidence in the successful completion of the sterilization cycle as the STATIM automatically aborts the sterilization process in case of malfunction.
The clinical procedures of instrument washing and sterilization are linked together through the internet by continuous “integration” to assure the optimal cleansing of instruments between patients.
The automation of the various component steps of sterilization creates improved overall clinical simplicity, reduces technique sensitivity that can adversely affect sterilization, and thereby makes process of cleansing instruments more predictable and more secure. The addition of STATIM G4 interactivity, through the LCD touch screen control and STATIM live networking, puts the operator in total control and provides the practice with exceptional ease of use and comprehensive documentation (Fig. 6).
The individual responsible for the instrument processing can view the HYDRIM and STATIM operations in real time, including during function, to determine the ongoing status of both the equipment and the cleansing cycle. Both dental auxiliary and practitioner can examine all operations, present and past, through the networked portal that integrates all the sterilization devices. It is possible to access the cycle history and validation data for each component appliance. This information, as well as sterilization records, can be stored electronically or in the cloud, or printed in a hardcopy record. The documented sterilization validation record, whether electronic or printed, is an extremely important safeguard for the practice in case any questions of cross infection arise; just as effective sterilization protects the patient and staff from cross infection, comprehensive records protect the practitioner from liability. The G4 software can be set to transmit cycle information errors directly to the selected maintenance provider by email. This automatically and seamlessly alerts qualified technicians when service is necessary. The technology interface is also able to request, receive, and execute service and software upgrades remotely.
G4 integration allows the dental team to utilize the touchscreen of any compatible sterilization device (or any networked computer, for that matter) to connect to the entire sterilization system, to ensure its ongoing successful operation, and to collect and store all the necessary validation documentation. The G4 technology is available on SciCan washer/washer disinfectors and sterilizers at no additional expense to the practitioner.
The patients’ and dental team’s safety is highly dependent on each employee who operates the sterilization system paying total attention to protocol and detail. The G4 verification process is keyed to user-defined, PIN-protected identification for each staff member who is authorized to run a cycle. This documentation of responsibility encourages additional attention to protocol and is designed to create a safer environment for both staff and patients.
An undocumented sterilization cycle is much like an undocumented dental restoration; it might as well not have been performed. All the data from each and every cycle must be collected and stored to protect patients, staff, and practitioner.
The G4 technology’s integrated DataLogger stores all of the cycle information for the entire lifetime of the unit. This data is readily retrievable through: USB (manual retrieval), Ethernet connection (web-based archiving or desktop printing), or RS232 (external printer) (Fig. 7).
The sterilization system integration introduced by G4 technology serves to improve the predictability and security of the sterilization process, to define and simplify the sequence of the steps required to achieve a successful protocol, and to permanently document every phase of every cycle. The innovative two-way web monitoring of equipment status and function is of tremendous benefit to the busy practice. Integrated internet connectivity promises better and smarter dental devices in the future.OH
Dr. George Freedman is a founder and past president of the American Academy of Cosmetic Dentistry, a co-founder of the Canadian Academy for Esthetic Dentistry and a Diplomate of the American Board of Aesthetic Dentistry.
Oral Health welcomes this original article.
1. Kohn WG, Collins AS, Cleveland JL, Harte JA, et al: Guidelines for Infection Control in Dental Health-Care Settings, Division of Oral Health National Center for Chronic Disease Prevention and HealthPromotion, CDC MMWR 52(RR17):1-61, 2003.
2. Small steam sterilizers, British-Adopted European Standard, Voluntary European Standard EN 13060:2004, 2005.
3. Freedman G, Simplified Predictable Sterilization Spectrum, Oct/Nov, 46-48,