by Mary Govoni, CDA, RDA, RDH, MBA
Flash steam sterilizers, such as the m3 UltraFast® from Midmark and the STATIM® from SciCan, have become popular in dental practices, particularly for handpiece sterilization.
The Joint Commission (JC) that accredits health-care facilities, and the Association for Advancement of Medical Instrumentation (AAMI), along with the Food and Drug Administration (FDA), have undertaken a concerted effort to clarify the use of flash sterilizers. These organizations now refer to them as "immediate use” sterilizers.
Such devices are considered appropriate for use in health-care settings when a one-of-a-kind instrument becomes contaminated and must be returned to use immediately, when specific instruments are needed for an emergency procedure, and when there is inadequate inventory of instruments or devices. Flash or immediate use sterilizers are not meant to be used for routine instrument sterilization, according to the CDC.
Some dental practices use these sterilizers for all instrument processing and some for handpiece sterilization because of the shorter sterilization cycle time. In cases where a practice or facility does not have a large inventory of handpieces, the faster turnaround with an immediate use sterilizer is a major factor with respect to efficiency.
It is important to note that the shortest cycle times are for unwrapped or unpackaged items. So the greatest time savings is contrary to the CDC guidelines for infection control that recommend instruments be wrapped or packaged prior to sterilization and to maintain sterility once the items are removed from the sterilizer.
Although items can be sterilized in packages in an immediate use sterilizer, this does require a slightly longer sterilization cycle time. The cycle for wrapped or packaged items requires a longer drying time as well. If the team member who is in charge of instrument sterilization is not aware of these cycle parameters, the sterilizer may be used incorrectly and may put patient safety at risk.
The sterilization cycle time for unwrapped items in an immediate use steam sterilizer is typically 3.5 minutes at 270° F at 27.1 psi (pressure). The cycle time for wrapped items is 5.5 minutes at 270° F at 27.1 psi.
Immediate use sterilizers can accommodate pouches, wrapped instruments, and wrapped cassettes. These sterilizers must also be monitored with spore tests, the same as conventional steam sterilizers. The sterilizer monitor service will select the appropriate type of test, depending on the type of sterilizer.
In addition to immediate use steam sterilizers, rapid dry heat sterilizers are available for shorter sterilization cycle times, such as the Cox Rapid Dry Heat Sterilizer. These sterilizers operate at 375° F for six minutes (unwrapped) and 12 minutes (wrapped). The higher temperature in the rapid dry heat sterilizers may not be appropriate for all instruments and handpieces.
Because the chambers of these sterilizers are smaller than conventional sterilizers, the volume of instruments that may be processed in a load is limited. A common error that occurs with these types of sterilizers is overloading. This may result in unsterile instruments or handpieces.
The shorter sterilization cycle times can prolong the use life and decrease the repairs necessary for high-speed handpieces. But in terms of efficiency for instrument turnaround, a practice may be better off increasing its instrument and perhaps its handpiece inventory. These sterilizers also serve an important role as backups to the main (larger volume) sterilizer in the practice.
The bottom line is that immediate use sterilizers are wonderful tools in the dental team's sterilization toolbox, but they should not be the only ones.
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.
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