Sterile Supplies
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Sterile Supplies

Dental Instument Sterilization
Dental Instrument Sterilization is clearly defined and outlined by the Centers for Disease Control Guidelines for Infection Control in Dental Health-Care Settings, issued in 2003. These guidelines are intended to educate dental personnel regarding infection control and to prevent the transmission of bloodborne pathogens.
This comprehensive document covers: hand hygiene, personal protective equipment, contact dermatitis/latex allergy, disinfection/sterilization, environmental infection control, waterlines/biofilms and special dental considerations such as hand pieces, radiographs and laboratory procedures.
The CDC's Guidelines for Infection Control in Dental Settings are evidenced based and well documented. The sterilization of dental instruments is one of the main areas of concern in dental offices. Along with the proper sterilization of instruments and materials, sterilizer monitoring is an essential part of the infection control program.
Many factors can cause sterilization to fail--from procedural errors that are easily remedied, like overloading, to mechanical problems that can take a sterilizer out of service until repairs can be made. Since this variety of factors can influence successful sterilization, the CDC and the American Dental Association encourage dentists to regularly assess the efficiency of their in-office sterilizers.
Sterilization should be monitored using both chemical and biological indicators. Chemical indicators, such as indicator tapes, are to be used with each instrument load. A color change of these indicators reveals exposure to the proper sterilization conditions.
Failure of the indicator to change color indicates that it was not exposed to the proper sterilization environment (e.g., proper pressure or temperature). In such cases, the instrument load should be re-sterilized. Indicator tapes are made specifically for certain types of sterilizers (i.e., tapes for steam sterilizers cannot be used to test chemical vapor sterilizers). Chemical indicators should not replace biological indicators, as only a biological indicator consisting of bacterial endospores can measure the microbial killing power of the sterilization process.
The CDC and ADA both recommend that sterilizers be monitored at least weekly with biological indicators. Each state dental board may actually have a requirement for biological monitoring.
Biological monitoring can be done in two ways. In-office incubator and spore monitoring strips can be purchased from dental supply houses. This method usually gives results in 24-48 hours. Mail-in spore monitoring programs are also available. This process usually takes a week. Although it takes longer to get results, mail-in monitoring programs may be more reliable and credible than in-house monitoring. A log of spore test results should be maintained in the dental office, usually in the sterilization area.
A positive test using chemical or biological indicators signifies that sterilization failed. If the chemical indicator does not change color or the spore test result is positive, the following steps are recommended. The sterilizer should be taken out of service. Instruments that were used after the last documented negative spore test should not be used. Sterilization procedures being followed in the office need to be reviewed to make sure operator error can be ruled out as the cause of failure.
Any identified procedural problems should be corrected, and the sterilizer retested using mechanical, chemical and biological indicators. If the repeat biological indicator test is negative and the other test results fall within normal limits, the sterilizer can be returned to service. If the biological indicator or the chemical tests indicate failure, sterilizers should be removed from use until the problem is identified and corrected. The dental repair company should be contacted for a service call and possible loan of an interim sterilizer.
Before the sterilizer can be returned to service, negative results should be returned for biological indicator tests conducted during three consecutive empty-chamber sterilization cycles to ensure that the problem has been corrected.
About the Author
Steven J. Brazis DDS writes many articles explaining
dentistry for patients. He practices family and cosmetic
dentistry in Sacramento, CA. His web site may be found at:
www.toothhaven.com.
Why is "sterile supply" on a medical bill so damn pricey?
I was charged $6000 for the actual procedure, about $500 for drugs, and a whopping $11,835 for "sterile supply". It was a colonoscopy, during which some tissue was removed for pathology.
Why so much for clean instruments? (Not that I'd prefer them dirty....)
If you have PPO or POS type insurance (or traditional Medicare), you need to check your insurance company's actual payment. Of the more than $18,000 billed (for doctor and facility fees) the actual transfer of money will be in the $3,000 range. If you have HMO type insurance (or "Medicare Advantage") the doctor and the facility get even less. (They may get "nothing" above and beyond the monthly "capitation" checks they get. If there is a fee-for-service contract, it will probably pay 2/3 or 3/4 of the PPO's payment and something between 75% and 150% of the "Medicare allowable."
If you're paying out of pocket, you are getting screwed by being billed for amounts that have no basis in reality.
The reasons that we in the US are having a big battle about health care reform is that the non-system we have makes no sense and because there's no one answer that will satisfy all of "the players" or the spectrum of political/economic philosophies in our country.
Hospitals and outpatient surgical or diagnostic facilities price items and services much higher than the insurance companies want to pay so they can be sure to get the the most that companies' will pay after negotiations are over
In addition, sterile supplies really are more expensive than non-sterile supplies because of increased costs regarding handling, packaging and sterilization as well as because of the fact of limited shelf-life.
For colonoscopy your sterile supplies included IV tubing and IV insertion kit, oxygen cannula, pulse oximeter sensing unit, blood pressure cuff, the doctor's and the nurses' splash protection items, etc., etc. Not even included in "supplies" is the labor intensive and expensive machine-dependent sterilization procedure for a colonoscope. The sterilizing procedure takes "too long," so facilities need to double up on scopes and non-disposable accessories. For example, if you have 3 working rooms you need not 3 but 6 or 9 colonoscopes OF EACH TYPE. Here we're talking about something like $25,000 a pop. In a busy lab, they are lucky to get 3 years out of a scope. During the three years there will probably be $25,000 in repairs as well.
May your biopsies be negative and your future colonoscopies be normal!
Lisa Shore Success Story




































































































