Product evaluation cannot only identify the high-quality products, but it also can determine the most cost-effective approach.
Chris Miller, PhD
Performing infection-control procedures requires numerous products and several types of equipment (such as gloves, masks, eyeglasses, protective clothing, handwashing agent, surface covers, cleaner/disinfectant, towels/wipes, instrument cleaners, detergent solutions, sterilizers, sterilization wrap, instrument trays/cassettes, spore tests, chemical indicators, and sharps containers). Ideally, one needs reasonably priced, safe items that do what they "say" they`ll do. In order to achieve this, someone in the office (infection-control coordinator) needs to spend time searching for and evaluating products and equipment. Also, having good sales representatives who can at least introduce new or different products to the office can be a great time-saver if the products presented are worthy of consideration. There are at least four facets of product/procedure evaluation: be informed, challenge the claims, try it out first, and perform a thorough cost analysis.
Be informed. The selection of good infection-control products and equipment requires knowledge of at least the basics of disease prevention. The more you know, the more critical you can be in evaluating items and the less you will have to depend on others to make decisions for you. Much of the infection-control information you need is acquired during formal training/degree programs, at infection-control conferences and CE programs, and through self-learning. Staying informed of changes, new concepts, regulatory issues, etc., can be accomplished through contact with an educational infection-control organization. An example of such an organization is the Organization for Sterilization and Asepsis Procedures-OSAP: (800) 298-6727.
If you know the basic rationale of each infection-control procedure (what it is supposed to accomplish), it will be much easier to select the type of product or piece of equipment to use for that procedure. For example, the goal of cleaning instruments prior to sterilization is to remove as much debris (bioburden) as possible in a safe manner. Nothing on the instruments should interfere with the subsequent sterilization process.
Since cleaning rather than microbial killing is key here, selection of an ultrasonic unit or instrument washer and appropriate detergents that give good cleaning (as judged by the naked eye) is the goal. If you can achieve some rust inhibition and/or lubrication along with a little microbial killing at the same time, then great, but cleaning is the goal.
Another example of how basic information may help relates to packaging/wrapping instruments before sterilization. Instruments are packaged to protect them from recontamination after sterilization and before reuse. Thus, the packaging material not only must be able to resist puncturing and withstand storage condition, but also must allow the sterilizing agent to reach the instruments during sterilization.
Evaluation of packaging materials will allow the discovery that a packaging material for steam sterilization may not work in a dry-heat sterilizer. Also, some materials are less
resistant to tearing and puncturing than others. Just having the basic information that the same latex glove can have several different brand names will allow you to ask a supplier to identify the manufacturer when you want to switch brands.
Challenge the claims. Claims stated verbally ("This is the best disinfectant on the market") need to be backed up by written material that is supported by unbiased, nonanecdotal information. If a claim in an advertisement is footnoted with statements like "supporting information is available on request" or "report on file," ask for the information or report.
Make sure products have the proper clearances that substantiate their safety and effectiveness. For example, if it`s a device such as gloves, a sterilizer, spore tests, or an item claiming to improve the quality of dental-unit water, it should have a clearance from the FDA (called a 510[k] clearance). This clearance is documented in writing from the FDA and should be available from the supplier/manufacturer.
Perform cost analysis. If you`re trying to compare products of equal quality or thinking of using an alternative procedure, do a thorough cost analysis and include not only the costs of products but also consider availability, shelf life, storage space needed, bulk prices, and labor involved in using the products or new procedure.
For example, if you are renting uniforms and protective clothing from a medical laundry service, compare this overall cost with purchasing a washer and dryer for the office. Don`t forget to include the labor costs associated with the in-office sorting and laundering.
In summary, product evaluation cannot only identify the high-quality products, but it also can determine the most cost-effective approach.
Chris Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.