Podcast: Your AAO Exhibit Hall Shopping List: PPE, Instruments, and Sterilization Equipment

Alison Werner:

Hello, my name is Alison Werner and I am the chief editor of Orthodontic Products. Thank you for joining us for today’s podcast episode of In the Sterilization Room with Jackie, where we talk to infection prevention expert Jackie Dorst about what you need to know to keep the orthodontic team and patients safe during the COVID-19 pandemic and beyond. For over 30 years, Jackie’s been a consultant specializing in instrument sterilization and infection control and prevention in the dental setting. She has degrees in microbiology and dental hygiene, has been a featured speaker at the American Dental Association and the American Association of Orthodontists. Hi, Jackie, how are you doing?

Jackie Dorst:

Very good, Alison, and thank you for hosting In The Sterilization Room with Jackie. As we get into over 25 months of the pandemic, there is always new information and new things to talk about. And the big event that we have coming up in May next month is the AAO’s annual session in Miami Beach.

Alison Werner:

Yeah, exactly. And so that’s where we’re going to focus in on today because the exhibit hall offers a great opportunity for attendees to see the latest products up close and try that, and they haven’t had that for the last two years. So I’m sure everybody is kind of chomping at the bit to check out what is going to be on offer. And so I know we wanted to talk specifically about what attendees should be looking for when it comes to PPE, instruments, and the sterilization room.

Alison Werner:

So, Jackie, let’s get started. When it comes to PPE, in the last two years, it’s been more important than ever. And practices are still though looking … Practices still aren’t quite happy with what they’ve got. So I know you recommend that they take advantage of the exhibit hall and the ability to try things out and to get samples. So what should attendees be on the lookout for at the AAO this year?

Jackie Dorst:

Well, the PPE, especially during the pandemic, we’ve learned more about mask and respiratory protection and shields and safety glasses. We’ve all worn procedure masks, but it’s those N-95 respirators that have been a real challenge for everybody to wear. And some of the ones were available at the beginning of the pandemic, and orthodontics team members, the doctor and the assistants, had never worn N-95 respirators prior to the pandemic. And they found out that the ones that were available were, if they could buy them with the shortage, rubbed their noses and actually cause sore places, and they fit so tight that they were getting a rash around their face.

Jackie Dorst:

And during the pandemic, there have been a lot of new products that have been introduced, including new N-95 respirators, new design, softer materials, special cushioning with them, both for added comfort, for breathability, and a better fit. There are even some extra small N-95 respirators that are now available for people who have real slender, petite faces. So, lots of improvements. If they tried an N-95 respirator in 2020 and they haven’t tried again, I would highly recommend getting samples on the exhibit floor and trying on the different ones that are there.

Jackie Dorst:

Because as we get through the pandemic, infections are declining. We have vaccines. There are great treatments now. The emphasis is not as much on airborne diseases. But OSHA, with their respiratory protection standard, will continue to issue guidance on how to protect workers from airborne diseases. And I know in my seminars and webinars, I actually have a slide that lists 16 diseases that can be transmitted in the air. So I think finding that comfortable N-95 respirator that everyone knows how to put on and they will wear … If it’s not comfortable, you won’t wear it. There isn’t compliance with it.

Jackie Dorst:

And then you provide the training, and will that respirator pass a fit test? Many of us have heard, Hey, you’re supposed to do a fit test. That’s what OSHA requires. But in reality, many offices have not conducted a fit test. And one of the things that I was excited about in the past couple of weeks was that I learned that one of the instrument manufacturers, Hu-Friedy, is actually selling a fit test now. It’s an N-95 fit test. It sells for about $275. And you don’t have to have a certified or trained person to do a fit test. You can watch the videos, learn how to do your own fit test, and with this kit, provide the fit test that you need for everyone in your office.

Jackie Dorst:

The only additional thing that would be required is that each employee needs to do the OSHA medical evaluation. And that needs to be reviewed by a nurse or a physician. There are no physiological reasons that the employee should not be wearing an N-95 respirator. But that can be easily review. The employee fills out the questionnaire, and then it’s reviewed by that healthcare professional, and you do your own fit test in the office. And that’s such a convenience because you may have to change brands of N-95 respirators. And if you change brands, then you have to do a fit test again, to be verified. So I’ve been real excited about showing audiences and live seminar attendees, now that we’re resuming live meetings, how to use that fit test. And so looking at the N-95 respirators that are available.

Jackie Dorst:

And gloves. Oh my gosh. There’s been a price increase in gloves, a shortage increase in gloves. And when I attended the OSAP bootcamp, Darby, one of our suppliers for orthodontic products, they featured in their new product description some nitro gloves that you can put on and that easily slide onto your hands, even when your hands are wet. Now, what happens when you wash your hands with soap and water and you dry them off with a paper towel? If you don’t get them absolutely dry, and you’re trying to put on an exam glove, it sticks. It won’t get on. It will tear on you. But these gloves slide on like silk. So they’ll have those in the booth there. You can try them out and I’m anxious to try on a pair on the exhibit floor.

Jackie Dorst:

And then another thing I would, under PPE, is highly recommend that offices look at cure light shields. Find a cure light shield or cure light safety glasses that match the wavelength of your cure light. Because remember, we had that great eye safety video with our In the Sterilization Room series that Dr. Marie Fluent talked about potential damage to the eyes when we are using a cure light and not wearing cure light safety glasses. So many offices, that might be something that they don’t have and it would be good to look at on the exhibit floor.

Alison Werner:

Yeah, exactly. Great. Well, I know that instruments are always number one or very high on the list for orthodontists when they go to the AAO to check out. So we’ve talked about instrument inventory in previous episodes, but I know that you recommend that before doctors head to the exhibit floor, that they have a plan in place for how they’re going to go about their instrument shopping. What do you recommend?

Jackie Dorst:

Oh, yes. It’s easy to get on the exhibit floor, and you know you need some new instruments and everybody’s so happy to be back together and see each other face to face, and the manufacturers have specials. And when you get intrigued with that special, buy six, get one free, and try this, and you go, oh, well I know we need some new distal end cutters in the office, but you don’t know how many, or gee, the doctor be standing there on the floor and go, this distal end cutter feels good to me, but who uses that distal end cutter? 90% of the time in the practice, it’s the orthodontic assistants.

Jackie Dorst:

So before the doctor goes, or whoever is going to do the purchasing on the exhibit floor, have a plan. Be prepared. Do an audit of all of your instruments in the office and an inventory. Remove instruments, those Mathieus that the tips don’t come together anymore, and that’s the ones that assistants keep throwing in the back of the drawer or going, “Dang, we need to get a new one here.” But which brand? Which style? Do the assistants prefer the long, slim handles? Or do you want those shorter, fat handles? And if you have cassettes, which instruments fit in those cassettes?

Alison Werner:

Right. Exactly.

Jackie Dorst:

So it’s real important to create a master list of the manufacturer’s name and the number of that instrument that the orthodontic assistants prefer. So you have that master list. Then it’s easy to go back and look at the inventory. How many wine guards, how many ligature cutters, how many distal end cutters do you have? And then I’d say, look at your schedule too. If you’re seeing more aligner patients now than you did in 2019, then it’s time to adjust your inventory of instruments. You may need some more of those aligner instruments where you’re going to put a dimple in or punch a hole or do some changes. And maybe you need two of those for every patient chair if you’re over 50% aligner patients now. So making that determination before going to the AAO and knowing the number of those instruments you need, and what is the preferred instrument by the orthodontic team is very important to making smart purchase decisions and taking advantage of those specials that the manufacturer will offer at the AAO.

Jackie Dorst:

So another thing that I’m going to put out there as a consideration is for offices to ask the manufacturer of the instruments, are your instruments guaranteed for steam sterilization, for sterilizing in an autoclave? And to look at the warranty. What’s the warranty on that? Does the company provide free maintenance on it, sharpening for those instruments? Or is there a cost with it? Knowing that upfront. Because I have many offices recently that have been calling me that have had dry heat sterilizers that are now having to look at changing to an autoclave.

Alison Werner:

Okay. Okay. Well, on that front, with the sterilization room, what should orthodontic practices have on their shopping list? What do you think they should be on the lookout for? Because you did mention that dry heat is those-

Jackie Dorst:

That’s right.

Alison Werner:

That system is … yeah.

Jackie Dorst:

One of the most popular dry heat sterilizers that orthodontists have used for years is the Dentronics DDS 5000 sterilizer. And the manufacturer has discontinued it. It is no longer sold. And now parts are no longer available to repair it. So that’s what I’ve been getting a lot of calls about is now doctors are realizing, Hey, our dry heat sterilizer died. That’s usually the first thing. Jackie, our dry heat sterilizer died. What do you recommend? And looking at autoclaves, there are different types of autoclaves that are available. There’s the gravity sterilizer. That’s the traditional, older design where it creates the steam, has the sterilization cycle, and then at the end of that cycle, the door pops open, the residual steam is released into the air, and then there’s another 20 minutes added to the cycle for those instrument packages, the pouches or the wrap cassettes to dry inside of there. And it doesn’t always completely dry those instruments and it’s a long cycle with it.

Jackie Dorst:

The other type of sterilizer is what is called a pulse type sterilizer, and that injects steam into the chamber. So many orthodontic offices invested in a pulse sterilizer, such as a Statim, to sterilize their hand pieces because it is a shorter cycle time. However, with the CDC standards that all instruments should be wrapped before sterilization, sterilized, and remain wrapped until used with the patient, the Statim doesn’t dry quite as well. You have to do several things to ensure the drying of it.

Jackie Dorst:

And there is a newer type, more recently approved by the FDA, sterilizer that is a dynamic air removal sterilizer. Now, by dynamic, it means it has a vacuum pump that pulls the steam into the chamber to speed up the cycle and get that penetration throughout the chamber. And at the end of the cycle, that vacuum pump or dynamic air removal removes the steam from the chamber and reduces the drying time. It reduces the overall cycle time versus a gravity sterilizer about 40%. So we’re seeing 35-40 minutes from start to finish for dry packaged instruments.

Jackie Dorst:

So I’d highly recommend that they look at this on the exhibit floor. I know I talked one company. Normally we don’t see a lot of sterilizers at the AAO. The exhibitors don’t bring … It’s a big, heavy piece of equipment. 150 pounds and they need electrical setup or something if they’re going to set it up. However, I did talk with Hu-Friedy at the Chicago Midwinter and they are going to have an actual sterilization center at the exhibit. So it will show you the cabinetry that will move from dirty to clean to sterile. What’s the correct setup with it? And they will have some equipment there, and you can actually have the cassettes, maybe lay your instruments in the cassettes and see how those cassettes load into the sterilizer.

Jackie Dorst:

And there will be other are equipment manufacturers there. Boyd manufactures an excellent sterilization center and they will have their sterilization center there on the exhibit floor. So that would be another good place to look, and they usually will have maybe a stack clave and maybe a [inaudible 00:14:31] washer and an ultrasonic that will be there.

Jackie Dorst:

And I’m going to go down an extra little recommendation for a product that I saw at the Chicago Midwinter. There’s an ultrasonic manufacturer named iSonic, just like your iPhone or your iPad. This is iSonic. And iSonic is a ultrasonic manufacturer that has a great small ultrasonic. It’s almost like a personal use. Well, it is a personal use. You can keep it on your bathroom counter at home and it is fabulous for cleaning those stinky aligners that, oh my gosh, when you’re wearing them all day and all night, you take them out and you try to brush them to get them clean, but there can still be odor with them.

Jackie Dorst:

And of course, there are special aligner cleaners, but there is nothing like using an ultrasonic that implodes the bubbles and pulls all of the debris off of … whether it’s a retainer or an aligner with it. So I highly recommend that you go by the iSonic booth and look at … They’re economical, cost under a hundred dollars, and it might even be something that orthodontic offices would look at offering their patients. And definitely anybody who’s wearing aligners or retainers will want one of these if they know about infection control and preventing disease transmission and getting their aligners clean.

Alison Werner:

Yeah, no, exactly. Is there anything else you’re looking forward to in the exhibit hall?

Jackie Dorst:

For innovative products, all of them, and socializing and learning from the different manufacturers. We’ve missed sharing information. Just, I always learn. I was recently at the Chicago Midwinter and there was so much that I did learn from spending time with the manufacturers and learning about the new products. I would highly recommend that doctors look at hand pieces. We all need those hand pieces and being short of hand pieces is a real challenge. And just because we are transitioning more to aligner treatment doesn’t mean that we’re not going to be using as many hand pieces to remove cement after we do a debond, because there’s all those buttons that we’re using with aligner treatment. So I would say hand pieces would be another top priority.

Alison Werner:

Okay. Well, Jackie, before we go, I know that you are going to be speaking at the AAO on Tuesday at 8:00 AM. What will you be talking about?

Jackie Dorst:

Infection control in OSHA. What’s changed. what’s new, what we need to go know going forward from this pandemic. And we are seeing … the pandemic, I’m not going to say it’s over. We are getting to a manageable stage now with this airborne disease. We know from both OSHA and CDC guidance what’s effective in our offices, installing that MERV 13 filter and looking at the HVAC system for removing airborne diseases, and even our high volume evacuation. So I’ll talk about the specifics and what OSHA’s going to look at with their new permanent standard after the emergency temporary standard expires with it. And CDC’s latest guidance. So I’ll be updating the team on what we need going forward, because there are all those other airborne diseases that we’re going to need to protect ourselves and our patients from even post pandemic.

Alison Werner:

Yeah, exactly. Well, thank you, Jackie, so much. And I look forward to, actually, I’ll get to see you too in Miami Beach. And for our listeners, we look forward to hopefully seeing you there as well. And check back soon for the next episode of In the Sterilization Room with Jackie. And in the meantime, to catch up with past episodes or to check out the latest orthodontic industry news, visit our website at orthodonticproductsonline.com. Until next time, take care and stay safe.