Whether you are looking to replace a piece of equipment or purchase for the very first time there are some things that you should consider which will aid your choice and ensure that the correct equipment is purchased.
Thermal Washer Disinfectors
Thermal Washer Disinfectors are currently not a mandatory piece of equipment within England and Wales however once introduced they play an integral part in ensuring all patient and staff safety. Whether you’re looking to replace an existing unit or starting from scratch it’s important that you consider a few things.
All Washer Disinfectors need to comply with EN 15883 which highlights the testing, validation, and design specifications of all small Thermal washers. The vast majority of dental washer disinfectors will reprocess dental instruments using the following 5 stages:
Flush – removes “difficult” gross contamination, including blood, tissue debris, bone fragments and other fluid and solid debris. Latest standards indicate that a water temperature of less than 45oC is used to prevent protein coagulation and fixing of soil to the instrument.
Wash – removes any remaining soil. Mechanical and chemical processes loosen and break up contamination adhering to the instrument surface. Detergents used in this process must be specified by the manufacturer as suitable for use in a washer-disinfector and compatible with the quality of water used. Detergents should also be compatible with the instruments being processed to avoid instrument degradation including discoloration, staining, corrosion, and pitting.
Rinse – removes detergent used during the cleaning process. This stage can contain several sub-stages. The quality of water to be used for this stage is an important consideration in terms of ensuring a clean unmarked product after sterilization. Advice should be taken from manufacturers with respect to the compatibility of the hardness or quality of the water supply with the equipment and detergents used.
Thermal disinfection – the temperature of the load is raised and held at the pre-set disinfection temperature for the required disinfection holding time: for example, 80oC for 10 minutes; or 90oC for 1 minute.
Drying – Purges the load and chamber with heated air to remove residual moisture.
(Source: HTM 01-05 section 3.14)
Understand the washer size.
In order to get the most out of any washer disinfector (WD) it is mightily important that you match the size of the unit to the number of surgeries that you have. Having a WD that is too large for the number of surgeries that you have will result in an inefficient use of the unit.
When looking at WD’s always ask the supplier how many surgeries the unit will service and how many instruments it will process in one go? Once you know this information you can have a rough idea of how many times it will need to run during a day.
It is a good idea to think about washers that minimise the amount of down time in between cycles. Try not to get washers that are too large for your practice as this will result in a long wait time for it to fill, which in turn will result in a larger acquisition of additional instruments.
On the flip side try not to get a washer too small for your practice as this will result in a back log of instruments waiting to be processed.
Flexible internal furniture
The vast majority of washers will come with pre-selected internal furniture offering the most common dental load types. In-order to maximise the washer capacity its important that the washer you chose has a different array of flexible furniture options. These could include the following:
· Baskets for loose instruments
· Toast racks for clip trays
· Baskets for forceps, scissors etc.
· Inserts for lumen instruments.
A good selection of cycle types
Its difficult to determine the actual cycle times of washers as the main variable that can impact this is your practice mains water pressure. The higher your water pressure then the quicker the cycle, as it can fill up quicker, and likewise if you have low water pressure then the unit will take longer to fill resulting in a slower cycle time.
Try to get a washer, then, that has a good variety of cycle times, including half load quick cycles, so that you have more flexibility with the use of the unit.
Future proof
Dentistry has well and truly entered the digital revolution and decontamination equipment is also progressing that way. It’s worth considering units that could be networked, even if you’re not looking for it to be networked now, having it ready is a great addition for the future. By having the units networked all the daily cycle logs can be stored directly onto a computer, minimising the need for downloading them.
Networking units also allows you to use other items such as Track and Trace software documenting the full journey of your instruments.
All tests and daily checks should also be recorded in a suitable Record Book and kept for a minimum of 2 years somewhere that is easily accessible by all staff and any clinical inspector.