When times are tough, the tough get going by carefully framing an ethical response to a ticklish situation.
Pamela Zarkowski, RDH
Utility Equipment Primer
Cathy Alty
They`re big and ugly ... they hum and gurgle ... they contain yucky, slimy stuff ... and they`re in the closet. Sound like a child`s "There`s a monster in my closet!" nightmare?
In this case, it`s the dental office`s utility closet, and it`s not nightmare (although if you are cleaning the traps, you may think so). Most dental offices keep "the closet" where the air and vacuum system are housed. Most of us, though, don`t have a clue on how they work or what they do.
These machines are so taken for granted their importance isn`t fully appreciated unless there is a failure of some sort. Equipment failure, admittedly, is a rare occurrence. So why should staff understand how this equipment works? As with any expensive, important piece of dental office equipment, it`s better understand how to maintain it and keep it working optimally.
Looking for fresh air
The air compressor draws air into a chamber and compresses it with a piston. The compressed air is dried by being forced through a desiccant or drying chamber. The air is then stored in a large tank and released on demand to drive a turbine or motor in the handpiece, or by the air syringe.
Some compressors use oil to lubricate the piston; other compressors are oil-free. In the former, it is possible for oil to pass through the compressor`s cylinders into the storage tank. Handpieces and air syringes that subsequently use air from the storage tank may end up passing along traces of oil, especially as the oil-lubricated machine ages.
Oil can also enter the compressor if the air comes directly from outdoors, particularly in urban areas. Air that is saturated with exhaust from automobiles or industries can literally have the oil squeezed out of it as it is compressed.
So it is important for the air compressor to "breathe" only clean, conditioned air - not too hot or cold. A filter on most air compressors needs to be cleaned or changed regularly.
The desiccant dryer portion of the compressor needs to be checked periodically to make sure it is still capable of removing moisture from the compressed air. Many air compressors have moisture monitors that change color to indicate moisture. When the indicator is blue, it means the unit is removing moisture. But a pink indicator means the desiccant is overwhelmed and needs to be replenished or replaced.
Some compressors also have a green bubble-type indicator which is the oil level indicator. A black indicator probably means bacteria have invaded the desiccant and it needs to be changed immediately. For more humid areas, a refrigerated dryer may help reduce moisture.
All of this concern about oil and moisture in the air is critical because restorative material manufacturers say that moisture and/or oil in the air line when using the air syringe or handpiece can result in a failed restoration.
Air compressors are sized for the number of users. If the office puts more and more demands on the compressor, a larger capacity unit may be needed to maintain performance levels.
"The air compressor should hold enough air that it does not run continually," said John Young, DDS, a clinical professor and director of research in the department of general practice at the University of Texas Health Science Center at San Antonio. "It should kick off for 20 minutes at a time. If it runs continually, you will probably have wet air" due to cool air condensing on the hot pistons.
A dirty trap
The vacuum or suction system can be a wet or dry system. In the wet system, water is used to create and maintain a vacuum. Equipment experts estimate that a wet vacuum system consumes approximately 3/4 to 1 1/2 gallons of water per minute when operating, as well as a relatively large amount of electricity. Matthew Langdon, a technical service representative at Air Techniques Inc. in Hicksville, N.Y., points out that recent technology focuses on a dry vacuum system, which requires no water.
In either system, the vacuum line exits the machine and branches out into the operatories. As fluid and debris are suctioned in the operatory, it is carried back into the vacuum system where solids are captured by traps in the line. The exhaust air is vented, and the water exits via a drain into the waste water system.
"The trap needs to be checked and/or cleaned every day," said Dr. Young. "The person doing this job is at risk and must wear protective gear: mask, nitrile gloves, protective eyewear. There is contaminated medical waste in here! The staff needs to develop a protocol for this and work out a timing schedule for how often this needs to be done."
Some vacuum systems have disposable, sealed traps that make the job easier. To clean the vacuum system lines, always use the manufacturer`s recommended cleaner. "Skim the (suction) tube along the top of the surface of the water (in the bucket of cleaning fluid) to pull in air," says Langdon.
"Never stick the entire end of the suction tube under water because it can damage or destroy the pump," adds Dr. Young. "You need to hear some air sucking."
Avoiding a (nervous) breakdown
Besides the air and vacuum systems, other important pieces of equipment are also taken for granted. The X-ray machine, dental handpieces, ultrasonic cleaner, and instrument sterilizer are also critical to the smooth operation of the practice. In dental hygiene school, most of us were taught how these items work. But we may need to be refreshed on their maintenance.
X-ray equipment. A service representative for Gendex, a manufacturer of X-ray equipment, said the biggest problem with X-ray equipment is that offices forget to have their equipment inspected and calibrated annually. When an X-ray machine is out of calibration, inconsistencies may be noted in the contrast or lightness of the X-ray.
Technicians also check the unit for cracks and other problems.
Dental handpieces. High- and low-speed handpieces require specialized care to maintain performance. This care is especially true for complying with infection control protocols.
The first rule of handpiece care is to read and follow the manufacturer`s instructions. This includes using the manufacturer`s recommended cleaners and lubricants in the handpiece and expelling any excess cleaner and lubricant prior to sterilizing and use in the patient`s mouth.
Another tip is to make sure you are spraying the cleaner and lubricant in the correct hole. Some staff members think each hole needs a shot of lubricant. In reality, only the drive-air tube requires it. Not sure which hole is the right one? Read the manufacturer`s instructions!
Remember that when running a high-speed handpiece to expel excess lubricant, a bur must be in the chuck. But when sterilizing, the bur should be removed.
If a handpiece`s speed is slowing down as sterilization cycles build, excess lubricant may be remaining in the rotating parts and is gumming up the works. Technical service representatives at Midwest, a manufacturer of handpieces, recommend flushing cleaner through the turbine to dissolve any buildup, congealed oil. Make certain in the future that all excess lubricant is expelled.
"Never immerse any handpiece unless manufacturer`s instructions specifically allow it," said Dr. Young. "When removing debris, scrub it under running water and dry it off. I`ve seen many handpieces with internal corrosion from soaking it in disinfectants" or water.
Ultrasonic cleaner. The ultrasonic cleaner is basically designed to accelerate the action of cleaning chemicals. Mel Rouse, technical service representative at Health Sonics Corporation in Pleasanton, Calif., gives several tips to ensure the cleaner is allowed to work effectively and efficiently:
The staff should not bundle instruments together because the instruments in the center will not get cleaned.
Never overload the unit (usually one-third full is the maximum).
Always use a basket or beaker to hold instruments. Never place items to be cleaned on the bottom of the tank.
Clean the tank often and use only manufacturer-approved chemicals for ultrasonic cleaning and unit cleaning. Wipe up water and chemical spills from around the cleaner immediately. Maintain the correct fluid level and change fluid often.
Conduct monthly "foil" tests to ensure that the cleaner is operating at its regular power level.
Instrument sterilizer. When using a steam autoclave, service representatives at Pelton and Crane suggests that the unit be cleaned every 15 to 20 cycles. They said to run cleaner through a cycle and scrub out the chamber with a cleanser such as Bon Ami.
It is very important to use steam-distilled water in the autoclave. Regular tap water contains undesirable chemicals and sediment which will leave deposits in the chamber. Be sure to use only manufacturer`s suggested chemicals in the chemical sterilizer and have the unit vent outside.
All manufacturers of dental equipment want the staff to have a good grasp of how their machines work, how to maintain them, and how to use them safely. They ask for dental personnel to read and retain the manuals and instruction sheets that come with the equipment. By following recommended maintenance schedules, the equipment in the "closet" will have a long, productive life with few problems. Now if only our "body machinery" could come with those kind of guarantees!
Cathleen Terhune Alty, RDH, is a contributing editor for RDH and is a member of the Office of Sterilization and Asepsis Procedures Research Foundation.
