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February 2, 2006

Making Pitt work: Kristin Hoenig

Patients who open wide for dental procedures can rest assured that the instruments their dentist is using are properly sterilized, thanks to testing done in Pitt’s School of Dental Medicine.The sterilization equipment evaluation service program, better known as SEES, serves more than 300 dental practices in the tri-state area and beyond.

Although weekly testing of autoclaves and similar sterilization equipment is not mandated in Pennsylvania, the Centers for Disease Control (CDC) and Prevention recommends it and many insurers insist on it as a condition of covering dental practitioners.

In addition to providing a service important to the peace of mind of thousands of dental patients, profits from the SEES program — typically $10,000 to $15,000 each year — are channeled into a dental school scholarship fund.

Day-to-day operations for the little-known program are handled by Kristin Hoenig, who spends most of her workday in a small, windowless laboratory, testing sample strips and recording the results.

In addition to her SEES work, Hoenig monitors more than two dozen in-house sterilizers at the dental school and operates gas sterilization equipment for departments whose sensitive equipment requires the specialized sanitation process. Once a week, she hand-carries test strips to the dental school departments for the weekly tests that verify their sterilization equipment is working properly.

“That’s my day out,” she jokes, adding that many people in the dental school may recognize her from her weekly rounds, but few know her name or exactly what she does.

Spending her workday largely on her own doesn’t mean she’s isolated from co-workers. She commutes in a vanpool and makes a point of getting outdoors midday, in addition to lunching with colleagues on occasion.

Another upside to working behind the scenes is flexibility, an aspect that Hoenig found particularly important when her two (now teenage) daughters were small. A single mom, Hoenig said she appreciated the ability to have some flexibility in work hours when she needed to balance family and work obligations.

“This has been a really great job for me,” she said.

A would-be marine biologist, her graduate work “took a left curve,” leading her to pharmaceutical giant Wyeth in eastern Pennsylvania, where she monitored the quality and safety of batches of penicillin.

“This is basically the same job on a much smaller scale,” the New Kensington native said, recounting how she was hired 14 years ago by SEES founder Herman Langkamp because her experience was a perfect fit for the requirements of the growing SEES program.

While she wears a white lab coat and carries the official Pitt job classification research specialist II, for practical purposes she labels herself simply “SEES administrator/technician.”

The all-encompassing title does little to describe her duties, which range from ordering supplies and billing clients to performing the actual tests and meticulously logging the results by hand in a logbook and in a computer database.

At the beginning of each year, Hoenig sends a supply of 55 bar-coded two-part envelopes to clients. Once a week, the client opens one half of the envelope and places a Band-Aid sized strip impregnated with heat-resistant bacterial spores into the autoclave along with a regular load of instruments to be sterilized.

At the end of the sterilization cycle, the strip is returned to the envelope (which also holds a control strip) and mailed to Hoenig at the SEES lab.

Each day when Hoenig collects her mail, she sorts the day’s samples and readies them for testing.

Hoenig processes between 40 and 50 samples each day Monday through Wednesday; Thursdays and Fridays are more hectic with 80 to 90 arriving in her mail to wrap up the week. Over the years, she’s performed the test procedure more than 172,000 times and placed more than 350,000 samples into test tubes in her Salk Hall lab.

When she started, the SEES program had logged about 37,000 tests. As of Jan. 23, the log read 209,458 and counting.

One by one, she meticulously drops the spore strip and its control strip companion into test tubes filled with purple liquid — the yummy (to bacteria) tryptic soy broth. Each tube is labeled, then each batch is popped into ovens: one set at 55 degrees Celsius for autoclave samples, another at 37 degrees Celsius for dry heat sterilizers used for instruments that are too sensitive for an autoclave’s steam sterilization process.

The samples are kept warm for a week, with Hoenig checking them each morning to see if any have changed color — an indication of a potential sterilization failure.

The tubes containing the control strips turn bright yellow to show that the bacteria spores were indeed viable and capable of growing. But, if a tube containing an autoclaved strip changes from purple to yellow — meaning the test bacteria that should have been killed in a client’s autoclave may have survived — it merits a closer look.

“That rarely happens,” she said, adding that, by her calculations, fewer than 1 percent of samples come back positive. If one does, she immediately phones the client to ask for an additional test.

“Nine times out of 10, the next test is fine,” she said.

Most often, a positive reading is caused by someone in the client’s office overloading the autoclave — analogous to putting a large amount of food into a microwave without increasing the cooking time to handle the additional amount. Or, it could be an indication that the client’s equipment may have a leaky gasket that needs servicing.

Sometimes, try as she might to keep each sample sterile, common germs such as streptococcus or staphylococcus contaminate a sample, causing a false positive result. A quick peek under the microscope can differentiate: The staph and strep that live on everyone’s hands are round; the spores on the test strips — Bacilus stearothermophilus and Bacilus subtilis var. niger — are rod-shaped.

Even if there’s a positive reading, it’s not cause for immediate alarm. “It’s a misconception that there could be a danger if the test comes back positive,” she said, explaining that the reason the two bacteria spores are used on the test strips is that they are extremely heat resistant and much harder to kill than the human pathogens that can’t survive heat even 5 to 10 degrees above body temperature, much less the typical autoclave temperatures that reach 250-270 degrees Fahrenheit (121-132 degrees Celsius) or dry heat sterilizers that reach 325-375 degrees Fahrenheit (163-190 degrees Celsius).

“As long as the machine is coming up to temperature, it’s killing human pathogens,” she said.

Although the SEES program has for-profit competition and, at a current fee of $260 per machine per year, isn’t the cheapest available, Hoenig said her clientele is loyal. Many are graduates of Pitt’s dental school; others are referred by Pitt grads. The program’s philanthropic bent toward supporting student research with its profits is a selling point. “It doesn’t line anybody’s pockets,” Hoenig said. The program’s small size also helps retain clients, she said. “I can give them real personal service, so I think that helps.”

—Kimberly K. Barlow

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