Chris Miller, PHD
If you`re in a position to make recommendations or final decisions on infection control products to purchase for the office, you should be prepared to justify your decisions. Product evaluation can be achieved in the following steps:
- Confirm that the product considered will fit into the infection control program.
- Clearly define the desired results to be achieved after using the product.
- Consider possible consequences if the product fails to achieve the desired results.
- Determine the scientific merits of the product and compare with other similar products.
- Determine the cost effectiveness and availability.
- Use the product on a trial basis, if possible.
Fitting products into the office program
Each office has specific approaches to achieving infection control, and products are selected to help facilitate those methods. For example, if your office has a policy to sterilize all contaminated instruments before reuse, then all reusable items that enter your patients` mouths must be able to be sterilized or covered before use.
In addition, if your policy is to package all instruments before heat sterilization, then don`t buy a particular sterilizer just because it has a "flash" cycle. These shorter-time, higher-temperature cycles require instruments to be unwrapped. Try very hard not to purchase products that may compromise your established and agreed-upon approaches to infection control.
Also, don`t purchase a product because someone says it is "OSHA-approved" or "CDC-approved." Neither OSHA or CDC approves specific brands of products.
Searching for reliability
First determine what you want a product to do, and then seek a product that meets or comes closest to your goals. In some instances, it may not be possible to find such a product.
There is not, for example, a perfect surface disinfectant that is a sterilant; has no toxicity to humans or to the environment; does not serve as an allergen; has an indefinite shelf-life; has no odor; does not have to be mixed or activated; and is inexpensive.
For most, if not all, infection control products, product failure usually means an increased chance for spreading disease. It is important to determine that a product will indeed accomplish what it is supposed to accomplish. This aspect is so important that the manufacture and sale of most infection control products are regulated to help assure both the safety and effectiveness of the product.
Make sure the manufacturer of products being considered have obtained all the necessary approvals or clearances for those products. These include EPA registration for surface disinfectants and liquid sterilants. FDA clearance should be noted with liquid sterilants, sterilizers, spore tests, patient care gloves, masks, surface covers, sterilization packaging materials, ultrasonic cleaners, instrument washers, handpieces, instruments, etc.
One of the major problems of using "household" products and appliances for infection control procedures in the office is that these products are not official medical devices cleared by FDA based on safety and effectiveness. The key issue in ensuring that a product "works" is to store and use the product exactly as directed by the manufacturer in information on the product label, or package insert, or operator`s manual. Any product can fail if it`s not used correctly.
Ask to see the data supporting claims made for products. Is the information given to support these claims just anecdotal or is it based in science? Are there publications describing evaluations of the products in peer-reviewed, scientific journals? Frequently, advertisements contain a journal reference or an asterisk indicating "documentation available upon request." Request this documentation.
When considering costs, consider the rate of use for a product. One frequently saves money by buying in bulk - but only if the product can be used up before it changes or expires with time. For example, check the expiration date on spore tests, and make sure sufficient storage space is available for bulk purchases. If frequent reorders will be necessary, make sure the supplier will be able to promptly supply you with what you need on a routine basis.
Try to limit the total number of products purchased when possible, but don`t compromise infection control by using products in tasks for which they were not designed. For example, if you use a glutaraldehyde sterilant to sterilize items that melt in a heat sterilizer, don`t use that same product to disinfect contaminated operatory surfaces. While glutaraldehyde sterilants are highly antimicrobial, they are not designed or cleared for use as surface disinfectants.
Another important aspect of cost comparison is to always consider any labor costs in using a product. For example, if your office is considering a switch from hand scrubbing instruments to the use of an ultrasonic cleaner or thermal disinfector, consider the labor cost related to hand scrubbing. Staff can be doing other things while the mechanical unit is cleaning the instruments. As a side note, remember that hand scrubbing enhances sharps injuries while mechanical cleaning reduces the handling of contaminated sharps.
When comparing products, or when wanting to switch brands, check to make sure one brand is really different than the other. For example, gloves may be sold under several different brand names, and the same is true for some masks, liquid sterilants, surface disinfectants, and other products. When sample products are available for trial use, take advantage of this.
Gathering the information above for products does take time. However, this effort will allow you to not only justify your decisions but also to enhance quality assurance in the infection control program for the office.
As mentioned in previous articles, a good way to become familiar with infection control manufacturers and distributors and their products is to join the Office Sterilization & Asepsis Research Foundation (OSAP) [call (800) 298-6727; if in Maryland, call (410) 798-5665].
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.