Sterilization Standards Unpacked - From Paper to Practice: CSA Standards in Action

0:00Hello and welcome to Sterilization Standards Unpacked, Navigating Canada's Dental Guidelines. Where we'll talk about the evolution of dental sterilization, the people shaping it, and the standards guiding it forward. I'm your host, Sarah B. Cruz, and in every episode we'll connect innovation to intention. Because progress in dentistry doesn't just happen. It's built through consistency, clarity, and care. We'll explore the practices that protect patients, the standards that impact the process, and the professionals who set the tone for excellence. Whether you're in the operator, the sterilization room, or leading a team. This space is for those who believe that quality isn't a check box. It's a mindset. Sterilization Standards Unpacked, Navigating Canada's Dental Guidelines, is supported by Sylventum, creating smarter, safer ways to deliver healthcare and advancing the future of dentistry, through innovation, and education.

1:03So let's get ready to get dirty and go dental. Hello, my fellow MDR colleagues, and welcome back to another episode of Sterilization Standards Unpacked, the podcast series where we go into the dental standards and all the different processes coming your way in Canada. This podcast is brought to you by Sylventum, and today we're stepping inside an actual dental clinic. Well, hypothetically into a dental clinic, to see what standards look like and when the day actually gets moving. Between patient care, turnaround time, and a whole lot of stainless steel, dental sterilization is a rhythm, and every role plays a part. Not to mention when you're in a dental facility, very much like our sterile processing department,

2:04our dental colleagues often play all the roles in the entire facility, right? I feel like we can all relate to that, wearing a bunch of different poofons. Everybody's got lots of different scrubs for lots of different things, okay? So this is where theory meets coffee and sometimes a full sterilization queue by 10 a.m. Am I right? So you're just starting your day and you've already turned over instruments for, well, your third or fourth because we all know those early dental appointments are usually highly sought after. And just remember, safer care starts with smarter systems and smarter systems start with people who understand the process. So as we discuss going into the dental facilities, I cannot wait to chat with our special guest today as we look at the CSAZ314, we'll be looking at the IPAC and all the different letters between LMNOP together. So let me welcome our guest, Melissa Arnold.

3:08She is a registered dental assistant in Nova Scotia, Canada, who is actually returning chair side after a tenure of four years in management. Hello, Melissa and thank you for joining us. Thank you so much for having me Sarah. So it's been really interesting on this dental ride because we've had a number of colleagues from, well, I guess all over the country. We recently interviewed somebody from Alberta who is, well, that's on the complete opposite side of you, right? Yes. Right, because we're on the east coast, right? We're in the same time, though. Yeah, pretty much. Beautiful, beautiful. And Alberta's way out there. Okay, great. We'll hang out and then we'll just send messages to Alberta. No, it'll be great. So Melissa, take me in through your regular work day. What does your day start with?

4:10When do the patients start coming in just, you know, as a patient, I really only know that I need to show up on time, which I try really hard to do. And then there's a cleaning, a scaling, and I'm out the door. I'm not really sure what's happening before I get there, while I'm there or after I leave. So shed a little light on that for us, will you? Yeah, no, definitely. Yeah. So usually the way the day starts in a dental office, the first thing when we come in, turning all on all the equipment, next thing we're going to do is headrate to our sterilizers, any items that may have been put through through the evening, that just finished off. Everything is unloaded. Everything is tagged based on the sterilizer that they were in, the load number, as well as the date. So everything is tagged, put into our sterilization cupboard, ready for all of our staff, dental assistants, dental hygienists, to come in and basically grab their things to get started for the day.

5:11After that, usually, next thing we're going to do is kind of fill our ultrasonic cleaner for the day, get that ready with nice clean solution, empty our hydrome, or as some people like to refer to it as a dishwasher, and say, we've heard that before, we call it a dishwasher, but yeah. So we empty that if it had been kind of finished up the evening before, anything that needs to be wrapped or bagged to basically go through the next process of being sterilized is then kind of prepared as well. The other thing that we do every morning, as soon as we come in as well, is we run our daily biological indicating tests. Those are ran in all of our sterilizers, and yeah, so we have three sterilizers and those biological indicating tests are ran through first thing in the morning. We tend to do the 24-minute biological indicating test, just so that it's kind of done as fast

6:12as possible so that we know that we can just kind of continue on with our day, making sure everything's good. Then usually as the staff kind of come in to get started for their day, they're grabbing their sterilized instruments from the cupboard, they're setting up for the patient, that they're going to see first, and kind of just go from there. So all of that starts at what time? Usually, we're starting that usually around 7 to 7, 15 in the morning, as when we're going to get in a head start on our day, our patient usually started 8 a.m., so it just gives us some time there, just to kind of get prepped for the day, restock rooms, things like that. Actually, by the time the first load is actually going into the sterilizer, we've already had our biological indicating test back and know that everything's good to go. We'll get the negative test results back from that, so that we know things should be good

7:14for the next 24 hours. Okay, so I think you've already mentioned a bunch of the keywords that are translating through a lot of these standard updates, whether it's through the CSA, Z314, and through the infection prevention and control manual, and not to mention the different things you're seeing from Ontario. It just kind of seems like everything is creeping across the continent and getting towards the east side, so a lot of the things that you're talking about are resonating in some of our previous episodes and with our future guests. So it is interesting to see the cascading of information. What has it been like on your end receiving that information and has it come in bits and pieces? How are you getting the information? Have you relied on other professionals? Can you talk to us a little bit about that? Yeah, I mean, definitely being like a dental professional.

8:16It's definitely like certain things were things that you were kind of taught and learned in your programs at school, whether it was dental assisting, dental hygiene, even for the dentists themselves, things that they all had to learn through their years of schooling. The different sterilization techniques, kind of what different instruments require, what single use versus like how many times can you kind of sterilize an instrument, kind of the care and kind of like even just kind of checking things every day to make sure hey, is that piece of equipment like is that tool still in working order or has something broken? So that's kind of something that's kind of just kind of always been there. Now as far as these new standards that have come to Nova Scotia, these hit in about March of 2023 and leading up to that the Nova Scotia Dental Association kind of held a lot of information sessions. They put out a lot of information to all of the dental offices to kind of say,

9:18hey, we're going to start kind of reviewing these new guidelines before we go live March 1st of 2023. And then every office had to actually kind of adopt kind of their own kind of office policy based on these new infection control procedures that they wanted to have implemented and all of the offices straight across Nova Scotia. Wow, so it kind of seems like everything was going, how it was going and then it went. Boom. And everybody kind of jumped on board, yeah? Yes, definitely, yeah, yeah, they gave us, they gave us time to kind of like get things prepared just because with like the knowledge of this coming a boat and I mean it was just kind of a couple years kind of post COVID. So there was still shortages of a lot of supplies and the supply and demand for like even these biological indicating tests. This wasn't something that was done in an office on a regular basis.

10:21So even trying to get those pieces of equipment and purchasing the different tests and stuff like that, it just skyrocketed. Everything was on back order. Oh, yeah, that's great. And you know, it can't be the first time you experienced back order, but that's definitely a thing with sterilization, am I right? Yes, definitely. I do like that you went with the 24 minute readout, you know, the industry is coming out with a lot of these new rapid readouts and making sure that the Jehovah's Witnesses' serothermaplish, that sport, that culture has the time it needs to create a genuine chance to grow instead of just looking for that surface reconstruction and seeing if there's any changes on the surface. There's just something quality that comes out of that 24 minute readout and especially in a dental clinic with how many patients and how many hygienists you see within an hour.

11:21I can't imagine you having to wait hours for a test. So it made my heart happy when you said, we went with the 24 minute readout and I said, meet you. Yeah, yeah. No, yeah. And that's exactly why it was like at the end of the day, it was like the different variations that were available and it was like, we don't have hours to wait. Like, we've got like, we kind of have to keep things going and I mean, sometimes sterilizers break, sometimes they go down for maintenance and things like that. So you kind of got to keep things moving and going. So the 24 minutes was just a no brainer when it came down to it. That's great. Yeah, definitely. I like that logic for sure. And you know, you mentioned the broken equipment that's, you know, a given, right? It's inevitable. And especially when you needed the most, that's when it decides to go on vacation, right? So as these standards have moved into Nova Scotia, specifically in your facility around

12:222023 that you had mentioned, what's it been like with record keeping or tracking these quality repairs and these audits? You know, can you talk to us a little bit about how those things might have invested, how those things might have been impacted with this? Yeah, definitely. So I mean, obviously to before this, there wasn't like, I mean, you always had your regular maintenance on your, your sterilizers and your equipment, things like that. As far as like tracking sterilization loads, things like that, like all of the sterilizers kind of do have their own internal tracking systems, or I mean, at least ours do. So by having this now, like now that we're doing a labeling system with like kind of, like I said before, the date, the sterilization load and the sterilizer that it's actually come out of. All of the instruments are tagged with those labels. We also keep a paper copy as well of the day, as well as the sterilizer.

13:26Those are initialed by whoever has kind of put them in and taken them out. So that's kind of tracked that way as well. And then as each, as we see each patient, every single item that has been bagged or wrapped that we are using on that patient, all of their labels are sterilization load numbers, as we kind of write in their chart are actually documented in the patient chart by just kind of writing sterile load number. And then you just list off all of your numbers. So it might be like sterilizer 001 dash load number might have been 3456. And then the date is there as well. So we can always kind of go back to our records. If we open something and say, hey, this actually wasn't sterilized. What else came out of that load? So we can go back and we can track way back to the date. And then we just go through and find all the appropriate packaging that were may have been in that load that day. Yeah, I mean, that's your classic case of a load recall.

14:29It happens to the best of us. And even in the largest and the smallest sterilizers, I mean, I'm not saying that a load recall is any easier and a small sterilizer. It's quite termotuous. It's arduous. It makes us anxious when we have to do it. It's a little nerve wracking. You don't have to reach out to patients, especially with the volume of patients that are in a dental clinic at any given time versus the inventory of the instrument, right? So I mean, a single mirror could probably be used at least what, like, five times in a day, eight times in a day. Am I far off? No, yeah, I was going to say majority of our staff have probably about six, seven kits that they use, like, throw it a day. So usually in the run of a day, their kits, like, they may use them about two times a day. So it's not, uh, yeah. Oh, wow. OK, so yeah, I, uh, it sounds like I underestimated that even more.

15:32Despite the size of the sterilizers, those things are kicking them out, huh? Yeah, yeah, no, but yeah, it just depends because, uh, yeah, like, I would say from office to office, just depends on the amount of inventory that you have with our dental hygienist. We like to at least ensure that they have enough instruments to get through the whole morning, even though usually by mid-morning allodes going through. So usually at least one or two of their kits are already through by lunchtime and ready for the afternoon. Excellent, excellent. And, uh, you know, hopefully they're brushing after they eat. But at the same time, right, you're just clearly saying what you're doing with the cleaning, the inspecting, packaging process release, you know, these are the sterilization processes on repeat over and over. And with the consistency of those steps, that's what's making compliance visible, you know. And that's the big push in these updates to standards, specifically in this dental space, right?

16:34You know, clause seven in the CSAZ314 focuses on that verification, um, on that verification and load release, making sure your records look good, making sure that they're trackable linked to the patient. And all of that is what transforms good habits into documented assurance. You know, so after our break, when we come back, maybe we can dive a little bit into what it's like welcoming the team to, uh, quality control and quality assurance systems. Yep, sounds great. All right, we'll be right back, guys. See you soon. It's time for practice to find a quick pause to unpack a key term shaping dental sterilization and safety. Let's talk sterility assurance level. Sterility assurance level or cell represents the probability that a single viable microorganism survives a sterilization

17:36process. A cell of 10 to the negative 6 means there is no more than a 1 and a million chance of survival after sterilization. CSAZ314 and health Canada's medical device reprocessing guidance uses this benchmark to define sterile. It's the mathematical measure behind every biological test chemical indicator and cycle parameter you track in practice. That process defined now that we're one term closer to excellence. Let's jump back into today's episode. Hello and welcome back to this episode of sterilization standards on path sponsored by Sylventum. If you're joining us just now, stop now and go all the way back to the beginning of the episode because our guest, Melissa Arnold,

18:38is taking us through the daily process and workflow of a dental facility. And she is sharing her insight with the transition and implementation of the new standard updates throughout. Well, almost every type of Canadian standard document, including our CSAZ314, the RCDSO, and the infection prevention and control manual, health Canada, it's all coming through in this episode with the information Melissa sharing with us. So thanks again for being our subject matter expert on this. We really appreciate it. Thanks so much, Sarah. Nice, so we teased a little bit before we went on our break that we were going to talk about quality management systems. And I got to tell you, I've been saying this whole series. That's a love language for me. Not a lot of people feel that way.

19:38So what was the impression and impact of this heightened documentation expectation and essentially asking your entire office team to become part of a quality control and assurance dynamic? Yeah, no, it was definitely challenging at first. I will definitely say it was hard, just kind of with all of the different standards that we're kind of hitting. I mean, obviously, there to be honest, there were days that things were labels were changed and things like that. And it was just kind of like, just kind of like, once a week, we were kind of having meetings, just kind of following up and just kind of reviewing the documentation protocols that we had to ensure that we were following. Eventually, it just kind of became the part of everybody's daily routine of if you were the one emptying the sterilizer, this is what you did and things like that. The really great thing that we've just implemented

20:40in our practice is we have actually brought on a sterilization tech, which is now kind of their day to day things are just basically to take the instruments from the hygienists and the assistants and kind of look after them from there. So now it's just kind of one person in charge of kind of looking after the whole sterilization section. They basically meet the staff at their rooms, take their instruments. And it's kind of just the one person that's responsible for kind of getting them in the hydrome dishwasher and then kind of just tagging or bagging and wrapping everything and then tagging everything. So all of the labels are changed, dates are changed and sterilization loads are changed and everything's documented, which is great. One thing too, I did forget to mention earlier as well, is that all of our bags are class four bags, which is kind of the highest class that you can use, as well as all of our indicating strips

21:42that we use in all of our bags, as well as all of our sterilization wraps, our class five test strip indicator as well. So we basically are doing the highest that we can possibly do, as well she has now kind of taken on doing our daily biological indicating test for us, as well as once a week we do run a sport test with Dahazi pathology department there. So that's kind of a second step, just making sure that that is kind of performed weekly, usually Monday's mornings is when we do that. Oh yes, you're taking it and running with it. I love that, that's great, listen, so the moment you started talking about type four, type five, like you personally my favorite type is a type five. I love an integrator, let me tell you when there's nothing more satisfying than that entire line is changed to a different color. It's in that past range, but when you're coupling it with the 24 minute readout,

22:45you're doing it at the expectations. It's just that's so awesome. Has your sterilization tech brought any information that you didn't realize or what are some things that they may have taught you in this space? So they're actually kind of just new to this role. They actually did some sterilization actually in a veterinary clinic. So things are very similar to kind of straight across the board from like working in a veterinary clinic to working in a dental office. So just kind of some of the different things are just kind of more like the different instruments that we're using and kind of like the different sterilizers because they are a little bit different, but basically run very similar. So it's been, we've probably had her now with us for probably about three weeks to a month and she's caught on really quickly and it's great. The staff really find it a huge help. Oh, I can't imagine the moment you cannot have to wear one hat

23:47and you can just wear the gloves and be a hygienist or be the assistant or be the front end assistant, you know, it just makes that different. As even in just like the steril processing or the medical device reprocessing department, it's, you know, if you don't have to answer the phone while you're trying to inspect the instruments, it makes the world of a difference, right? So, you know, as we start to wind down this episode, I do wanna talk about documentation fatigue going from a space that documented but not in the way that the new standards are expecting and now making that transition. What can you tell us about the impacts of documentation fatigue and then what kind of hope and inspiration and encouragement can you give some of our colleagues out there? I would definitely say first off, it was definitely hard kind of getting used to all of the documentation. Over time, it just kind of becomes a new norm

24:48just like the daily meetings and the daily reminders of a hey, just like just reminder, like we're gonna get there and I mean, here we are two years later and we're there but I mean, it's taken some time. I mean, yes, it's tiresome. I just actually chair-side assisted on Friday and probably had to input about 12 different sterilization numbers of instruments that we used because just with that certain procedure that we were doing, there was 12 separate items from different sterilizers and different things that were used. My heart feels sad, I'm so sorry. Yeah, but you know what, you create a system. My system was I'm going to like any kind of wrapped cassette I peeled the sticker off and I set it aside. Anything that was bagged, I kind of, because all of the labels go on the plastic part of the bag

25:52instead of on the paper side of the bag. So I just kind of kept all of the plastic pieces aside and after the patient left, I sat there and documented everything, every single number right down to it. Now we do have, we have a couple of our hygienists, actually their way of kind of documenting it is they will take a picture of all of the labels on all of the instruments that they use for that patient and it's put right in the patient file as well. So everybody kind of has their own different ways of kind of documenting it, but as long at the end of the day as long as that documentation is in the patient's chart and it's documented and as long as you're keeping your records in a sterilization book as well to show, hey, here's all of the loads that went through on these days as well as documenting all of your tests as well. So we keep that all in a binder together so that everything's kept in one place.

26:53So if we ever had to go back, it's all right there. Sage, sage advice, if you can simplify it, do so. If you can streamline it, act quickly and if you can create ease and transition, why wouldn't you, right? Exactly. I love that, great advice. My biggest intention for this specific episode is that everybody listening, whether they are medical device reprocessing technicians, whether they're registered dental assistants or if they're a new sterile tech in a dental facility or, geez, just even a new tech in the space at all, they can find information here that helps them understand why things are done the way they're done now. And the nice thing about joining the field now is that this is the only way you'll know it, right? But at the same time,

27:54the why is so important behind the how? Exactly. Because by the end of the day, sterilization, it's not just a cycle. It's a reflection of that team behind it, Melissa, yeah? Oh, definitely. Yeah, at the end of the day, it's a team effort from first thing in the morning to last thing at the end of the day. It's a team and that's the only way you kind of get through it. Exactly, exactly. That's where the real success lives, not in completing the task, but the consistency with repeating the task. Yeah, and that's just the biggest thing I've found from listening to all of our guests so far on the podcast series and later on, it's just that what it comes down to is consistency and that's what that 2023 update was frankly really looking for is that documentation, that consistency, and even inside of your infection prevention manual,

28:54you know, making sure it's there and easily translatable and it sounds like you've got a really good grasp of that and we wanna thank you for rejoining the chair side during your time as management. It sounds like the team's gonna really benefit from you being in that space as well. Thank you again for joining us today. Thank you for having me. Oh, truly our pleasure. So next time we'll step beyond the chair to hear from the professionals who are shaping the future of infection prevention in Canada. But until then, keep fighting dirty and solving with momentum. Bye. Thanks for listening to sterilization standards unpacked navigating Canada's dental guidelines where we connect innovation to intention and recognize the progress driving dentistry forward. Every conversation here is a reminder that progress doesn't just live in policies and products, it lives in people, the professional choices we make,

29:57the standards we uphold, and the care we deliver every day. If today's discussion inspired and motivated you, share it with your team and keep the conversation going. Sterilization standards unpacked. Navigating Canada's dental guidelines is supported by Sylventom. Creating smarter, safer ways to deliver healthcare and advancing the future of dentistry through innovation and education. I'm Sarah B. Cruz, thanks for joining me. And until next time, keep fighting dirty and solving with momentum. I'm Sarah B. Cruz, thanks for joining me.