How do I dispose of chemiclave solution?

Hmmm…. Good question. First off, here is the MSDS sheet for Vapo-Steril:
http://www.rtechdental.com/documents/vaposterile.pdf
vapo-sterile

 

The MSDS sheet states the following Waste Disposal Method: “Ignitable, should be disposed of as required by hazardous waste regulations.” It also states that small spills can be flushed with water, but that large spills should be collected for disposal.

Barnstead Thermolyne, the manufacturer of Chemiclave sterilizers simply state the following in their sterilizer owners manual: “Dispose of Vapo-Steril solution in accordance with all prevailing local jurisdictional requirements.”

Our suggestions are as follows:

Some city municipalities will allow for discharge of small quantities of Vapo-Steril (Ethanol 72%, Methanol 4%, Formaldehyde 0.23%) down the drain. However, it is important that you verify this with them.

Most of the time we recommend reclaiming it in liquid form and delivering it for proper disposal to a company like Safety-Kleen. Below is a clickable link to their website where you can check for a location near you. There is also a link to a PDF that talks about their solution recovery service.
safety_kleen

http://www.safety-kleen.com/staticFiles/pdfFiles/brochureInserts/Imaging%20Brochure%20-%20Healthcare%20Services.pdf

Is rectangular collimation required?

I had two doctors, Dr. Klampe and Dr. Lesch, ask me this question today. Both were concerned about costly changes to their X-ray systems that might be required by law. This question stemmed from their reading of Sullivan-Schein’s “Sidekick” Autumn 2005 edition. Below are some of the quotes from the article that caught their eye.

“Note: According to the NCRP Report, Collimating your X-ray beam is required both for digital and film based X-rays.”

“Collimation the X-ray beam to the precise size of the image receptor eliminates scatter radiation.”

“The new report (NCRP #145) mandates the use of a rectangular collimator.”

“The use of leaded aprons on patients shall not be required if all other recommendations in this Report are rigorously followed.”

Ok, after researching everything, here is my take on things.

First off, NCRP stands for National Council on Radiation Protection and Measures. They can be found here: http://www.ncrponline.org/ The NCRP is not a governing body; it is a private corporation. This means that they cannot require you via mandate to do anything. Basically the council attempts to establish universally accepted norms. The council has four objectives in its charter

  1. Collect, analyze, develope and disseminate in the public interest information and recommendations about protection and measurement of radiation.
  2. Provide means for cooperation of organizations concerned with measurements and protections associated with radiation.
  3. Develop basic concepts about radiation quantities, units, and measurements.
  4. Cooperate with the Internation commission on Radiological Protection, The Federal Radiation Council, the International Commission on Radiation Units and Measurements, and other organizations concerned with radiation quantites, units, and measurements and with radiation protection.

Secondly, I spoke with Marge Shaw at the Minnesota Department of Health on the issue of collimation and lead vests. At present there is NO state or federal requirement for rectangular collimation. The use of lead vests in the state of Minnesota is also NOT required. She did not think that we would see anything regarding this issue even in the next year.

Thirdly, I asked myself, what are the pros/cons of this?

  • Is collimation required? — Yes. All X-ray units are required to have collimation.
  • Is rectangular collimation of intra-oral X-ray units required by law — No. Not at present.
  • Is there a substantive reduction in scatter radiation by going to rectangular collimation in place of round? — Yes! Almost a 68% reduction.
  • Will this result in more chance for cone cut and consequent retakes? — Yes.
  • Are retakes counter-productive to the goal of radiation reduction? — You bet they are! Not to mention the frustration of cone cut images and time delays associated with the retakes.
  • Can the cone cut be minimized using positioning devices? — Yes.
  • Will my doctors be required to replace their X-ray machines to realize this reduction in scatter radiation through the use of rectangular collimation? — No. We have Rectangular Position Indicating Devices (PIDs) to replace all intra-oral X-ray units and Film Positioning Instruments (FPIs) both of which are pictured below. Most of these devices and adaptations can be done for under $300 per X-ray unit. If you have interest in this conversion, please call.

Rectangle PIDfpi

Why is it important to supply soft water to wet type vacuum pumps?

Well, first off, most manufacturers of this type of vacuum system, will specifically state that their warranties are null and void if hard water is used in their products. Example:

*Apollo Dental Products by Midmark

“On vacuum products, the warranty does not cover failures due to hard water deposits. Failure to follow installation and operation procedures will void warranty.”

Our first recommendation is to install a dry type vacuum system in place of a wet type system to avoid the water use. Most of these machines can gulp and discharge a gallon of water per minute per head. (1 gpm per head) When you have to run all of that water through a softener, it ends up consuming quite a bit of salt. So the best alternative is to eliminate the wet vacuum system, eliminate the water usage, and eliminate the need for a water softener.

However, for those of you who have wet type pumps it is essential that you have soft water plumbed to your vacuum pump for the following reason:

Inside of a vacuum pump is an impeller. This impeller is offset to the side of the pump housing. Many of these pumps have paper thin tolerances between the impeller and the side wall of the housing. Hard water deposits build up on the impeller as the vacuum pump runs. Eventually these deposits accumulate to the point where the impeller rubs against the housing. This buildup has a ceramic hardness to it, and causes the pump to “freeze up”.

We have a motor rebuilder that has some good solid techniques that they use to repair these pumps, but it is still a costly repair and sometimes the damage is so severe that the pump just needs to be replaced. Below is a picture of the inside of a vacuum pump. You can see how close the impeller sits to one side of the housing.
VacPumpImpeller

 

Hard water can damage a new vacuum pump within a year or two of use, or it can take several years depending on how hard your water actually is.
So, just make sure your wet type pump is fed by soft water not hard.

Is Nitrous Oxide scavenging required by law?

The assistant looked concerned as she posed this question to me. You see, she was pregnant and visibly worried about it. I explained that my understanding was that it is NOT required, but is HIGHLY recommended. I told her that if I were pregnant I would not work in an operatory that did not fascillitate Nitrous Oxide scavenging. I told her that I would try and figure out what the actual agency suggestions were:

*OSHA PEL

“The Occupational Safety and Health Administration (OSHA) does not currently regulate nitrous oxide.”

*NIOSH REL

“The National Institue for Occupational Safety and Health (NIOSH) has established a recommended exposure limit (REL) for nitrous oxide of 25 parts per million (ppm) parts of air (45 milligrams per cubic meter (mg/m(3))) as a time-weighted average (TWA) for the duration of the exposure [NIOSH 1992]”

*ACGIH TLV

“The American Conference of Governmental Industrial Hygienists (ACGIH) has assigned nitrous oxide threshold limit value (TLV) of 50 ppm (90mg/m(3)) as a TWA for a nominal 8-hour workday and a 40-hour workweek [ACGIH 1994, p. 28]”

*Porter Instrument Company, Inc.

“WARNING: Dental workers are exposed to Nitrous Oxide (N2O) during administration of N20/O2 conscious sedation analgesia. NIOSH has recommended the exposures should be minimized. Contact NIOSH (1-800-35-NIOSH) to receive NIOSH Publications on Control of Nitrous Oxide in Dental Opertories. Exposure can be minimized by effective controls. National Institute for Occupational Safety and Health (NIOSH) publications state that controls, including System Maintenance, Ventilation and Work Practices can effectively reduce N2O concentrations in dental operations. Your Porter Scavenger
System is an important part of the system of controls.”

*Rationale for Limits

“The NIOSH limit is based on the risk of reproductive system effects and decreases in audivisual performance [NIOSH 1992].”

“The ACGIH limit is based on the risk or reproductive, hematological, and nervous system effects [ACGIH 1991, p. 1137]”

Quickly following the first question was the next, “Is there a way to test if I am being exposed to Nitrous Oxide?” Honestly, I had heard about offices that had used a badge to monitor Nitrous exposures, but was un-sure where to order them, so I told her I’d do some research on that as well. Here is what I’ve found:

Environmental Monitoring Technology
EMT, Inc.
121 Shivel Drive
Hendersonville, TN
37075
(800) 284-2785
(615) 824-0712
(615) 822-5989 FAX
http://www.emt-online.com/

They sell Nitrous Oxide Monitoring Kits.
NIT001 – 1 badge – $50.00
http://www.emt-online.com/ProductPages/KitsNitrous.htm

Here are some other helpful websites that have information on the topic of Nitrous Oxide:

OSHA Nitrous Oxide Guidelines

NIOSH Nitrous Oxide Guidelines

ACGIH Nitrous Oxide: TLV documentation

Porter Instruments “Is Nitrous Oxide safe?”

“Nitrous Oxide Safety” by Fred Quarnstrom, DDS, FAGD, FASDA, FICD, American Board of Dental Anestesiology, Certified Consultant, American Association of Dental Consultants

Does OSHA require weekly testing of sterilizers?

This question was posed to me today. Here’s the exact wording that OSHA has to answer that, as well as text from the CDC and the AAMI:

OSHA Technical Notes No.23 states…

“OSHA is relying on guidelines published by the CDC as a widely recognized and accepted standard to be followed by employers in carrying out their responsibilities under the Occupational Safety and Health Act…” March 1, 1990

CDC Guidelines state…

“Proper functioning of sterilization cycles should be verified by the periodic use (at least weekly) of biological indicators (i.e. spore tests). Heat sensitive chemical indicators (e.g. those that change color after exposure to heat) alone do not ensure adequacy of a sterilization cycle…” May 28, 1993

AAMI Standards

“Table top sterilizers should be biologically monitored during initial installation and after major repairs. In addition, sterilization loads should be biologically monitored at least once a week but preferably daily. Each load containing implantable devices should be monitored.” 1998 Ed., Vol 1.1 Sterilzation in Health Care Facilities

So, as you can see from the wording above, it is highly recommended that each office perform weekly testing of all sterilizers using spore testing. Additional testing either daily or per load is even recommended. Here is what we recommend:

Weekly spore testing using the following:

sps_ems-052

Per load testing using the following:

sps_ssi-100

MDH Moving to new digs

Effective September 26, 2005 Minnesota Department of Health is relocating. The new address and phone number for the MDH section of Radiation Control is as follows:
Minnesota Department of Health
Radiation Control Unit
P.O. Box 64975
St. Paul, MN 55164-0975
(651) 201-4545
MDH

Associate Search

Byron Dental Group is in search of an associate. They are looking for a dentist to help fill the space of their most recent associate, Valerie, who recently had a baby and has moved out of the area. If you are a dentist that is looking for work, or if you know of someone who could fill this void, Contact either Doug Trebtoske or Ken Zimmerman at 507-775-6445.

Resourceful Clients

There are times when I’m simply impressed by the resourcefulness of my clients. This was one of those times. On August 29th, Dr. Rohrer’s office contacted me and requested that I come over and fix a processor rack that was broken. I scheduled a time for the next day, the 30th. As the need for a processor in an orthodontic practice is great, Dr. Rohrer took matters into his own very skilled hands and masterfully repaired the gear. I was so impressed with how well it looked and worked! I felt it was a terrible shame that I had to repair the rack with a standard Air Techniques idler gear replacement kit. Take a look at his skillful work (Good job Doc!):
ROHCUR_GEARFIX

Help the hurricane victims

Redcross

1-800-HELP-NOW

Dr. Elizabeth Kellogg’s new office

We want to congratulate Dr. Kellogg and her staff on their beautiful new office at 2717 Superior Dr. NW in Rochester, MN.

Metal surface painting

Last month I talked about replacing the plastic pieces on a Gendex X-Ray. One of you spoke out and asked the question, “What about the metal?” What can you do to make the metal of your X-Ray unit or your patient light look better? Here is our answer: Contact Bernie at (507) 282-5951. He runs a Surface Doctor franchise in Rochester, MN. Bernie can do electro-static painting, sandblasting, and other types surface treatments. We have used Bernie to re-paint chairs, lights, X-Ray units, and patient file cabinets.

SURDOC

Hilux LED Blast Curelight

We have available now a new Hilux handheld curelight gun that fascillitates LEDs. It is a cordless light with output levels over 1,000 mw/cm2. It is a cordless light with a long battery life that will deliver 750 five second cures with an overnight charge. The gun uses standard “Demetron style” 11mm light guides. We have been mailing out information cards on this curelight with recent invoicing. Check out the Hilux LED Blast Curelight.

FIR_LB001

Gendex 770 Plastic Covers

Gendex 770 X-Ray units have a set of white plastic pieces that cover all of the critical parts of the X-Ray. It turns out that the plastic Gendex used in many of their earlier Gendex 770s would yellow when exposed to light over long periods of time. This tended to make the X-Ray unit look old and somewhat ugly. We all know that you like it when a patient enters your operatory and finds everything aesthetically pleasing. So in order to repair this problem, Gendex has available a complete GX-770 Plastic replacement kit. Installation is a snap and the end result is dramatic. It will look like you have a new X-Ray unit hanging on the wall.
GEN_112-0656G2
 

Sterilizer Seals

Recently it seems, we have had quite a few sterilizer service calls. Most of these calls could have been avoided if the office staff had been changing the sterilizer seals on a quarterly basis. Due to the heating and cooling, most sterilizer seals become hard and actually shrink in size. This makes it easier for steam or vapor to escape usually leading to some type of sterilizer failure or damage. At R-Tech, we recommend that all offices maintain a stock of replacement seals for their sterilizers. We have them available for all sterilizers in our sterilizer parts area. The statim cassette seal can be especially difficult to change so we have developed a do-it-yourself sheet. We will be happy to show you how to do any sterilizer seal replacements.

Loss of a friend

We are saddened by the loss of Dr. Stephen R. Springmeyer, a dentist from Southern Heights Dental Group in Faribault, MN. He died unexpectedly on Monday, July 18, 2005 at his home.

I always appreciated Dr. Sprigmeyer’s jokes, laughs, and warm cheerful spirit. Our condolences go out to his family and to the staff of Southern Heights Dental Group. We will all miss you “Springs!”

– Michael Wiltrout

Mint-A-Kleen vs. Mouthwash

Today we received a call from a doctor who was expressing a concern. He had noted that the ingredient list of a mouthwash that was available from his supplier matched the ingredient list of Mint-A-Kleen. His concern stemmed from a price difference between the two products. We contacted Anodia Systems, the manufacturer of Mint-A-Kleen, for their input. While Mint-A-Kleen does contain 0.12% Chlorhexidine Gluconate and 8.5% Ethanol it also includes specialized lubricants that are designed to help it flow. We were told that if the doctor decided to try the regular mouthwash that he would soon find that his unit would become “gummed-up”. So, we wanted to let all of you know that though Mint-A-Kleen does share some of the same ingredients as a common Chlorhexidine mouthwash it is most definitely not the same thing.

PAR_2000-500

London Bombings

My heart aches when I think about the people of London having to cope with their recent losses. A cold chill runs down my spine when I think about people who care so little about their own lives, that they are willing to die, just to inflict so much pain, suffering, and death on so many innocent people. I just hope the the people of the world have the resolve to deal with these attacks. England’s people are strong and they have survived much worse.

bbc_news

Spore Testing Safety Check

From time to time I get a call from an office who has been told by SPS Medical or some other spore testing laboratory that the sterilizer in their office has failed a spore test. They are then told not to discontinue use of that sterilizer until it has been re-tested and passed. That wait can be too long for some offices, especially if said office only has one sterilizer. This can be stressful for both of us. First off it has been and always will be our recommendation that an office retain or acquire a “back-up” sterilizer for situations like this.

We have both rental units and loaner units available, but sometimes the delay between when you get a fail and when we are able to get out with a sterilizer may be hours, or sometimes even days. We rent sterilizers when service work is being done by someone other than us. Loaner sterilizers are always free to any of our customers that use us to repair their broken sterilizer.

Many times this “spore-test failure” can be due to user error. (A common failure is over-loading the chamber or not securing the spore test to the wire rack inside of a Stat-m.) If a user error causes a spore test failure, it can be extremely frustrating.

We have a product available that can be run in every cycle, or when you are having troubles with a sterilizer and want to be assured of a good cycle. The test strips are referred to as SSIs (Steam Sterilization Intergrators) and the manufacturer considers them to be equal to spore tests in effectiveness. The SSIs are available in boxes of 100 tests. We recommend that SSIs not be used as replacements for weekly testing of your sterilizer. However, use of these SSI tests can be a very helpful tool when quick reliable testing of your sterilizer is required.

sps_ssi-100

Foreign Mission Dental Trips

If you are planning on going on a foreign mission trip to some remote place abroad and you need the tools to perform dentistry, please give us a call. We work with a company called DNTLworks. They produce delivery systems that are built into a tackle box.
DTL_1250

These delivery systems have their own compressor and even suction systems (ProCare II). They must be ordered in either a 120VAC or 230VAC configuration so it is necessary to determine what type of AC power is available in the country that you plan to operate in. I have also been able to help doctors adapt these and other delivery units like this so that they run off of scuba diving tanks, which can be lugged to the most remote areas and still allow you to provide fairly advanced services.

I have a list of several doctors that make foreign mission trips a part of their yearly schedule. It is amazing how much help talking to someone who does this type of trip on a regular basis can be. They have the tools, they have the knowledge and the wisdom to know how to properly plan a trip like this. For my part, I have donated time, equipment and/or supplies from dismantled offices whenever there has been a need and I have had the ability.

Keeping the Darkroom Dark

darkroom

We have some suggestions on keeping your darkroom dark:

  1. The majority of darkroom failures revolve around the door not being “light-tite”. The best solution for bad darkroom doors is to replace them with a metal exterior door with a threshold and magnetic seals around the edges.
    Metal door threshold

    However, outside of door replacement, here is the website for ZERO DRAFT where you can find many different seal types that will aid you in keeping the light out. The C-Folds and Alumafin seals work well.

    C-Foldalumafin

    Many of these kinds of seals are available at your local hardware store.

  2. Check your safelight for white light leaks. These can come from an improperly sealed safelight or a filter that is cracked or peeling. We can get replacement filters for your safe light (just call). For present day film types, the filter should be at Kodak GX-2 type or equivalent filtration levels, the bulb should not exceed 15Watts (most people will use a 7.5 Watt nightlight bulb), and the distance between the safelight and the counter and top of processor must be at least 4 feet.

kod_gbx2_filter7.5WATTBULB

  1. Drop in ceilings are notorious for letting light from adjacent rooms into the darkroom. Our suggestions for this are to cover the ceiling above the tiles in thick insulation and possibly a heavy mil black plastic being sure to seal the edges.