The ‘BIG’ PRACTICAL DECONTAMINATION
Product Review
NSK iClave plus ; Vacuum B sterilizer
It came as a surprise to some, when NSK entered the decontamination field some 5 years ago, or perhaps to others, leaving it so late in the day! But having worked in dentistry for so long and the last 17 years dedicated to decontamination, I believe it may have been a clever move to wait, watch the market, look at the guidance settling down, learn from others ‘mistakes’ which seems a pretty shrewd move to me. The machine however is not all-new as it shares its history & roots with the Dental X brand that NSK purchased into, back in 2013. Again no bad thing, as starting with a ‘blank-canvas’ will inevitably mean having to go through a sometimes painful learning curve before ‘perfection’ in sterilizers can be achieved. NSK is on the move.....as far as their decontamination range of products and I am sure they will aim to be a leader in every respect, as they claim to be with their handpiece ranges. But is this desire enough to have produced a good product ?
Perfection, the iClave plus isn’t , but any quality manufacturer will tell you that striving to make the perfect machine will probably never be achievable as they have always to make a compromise at some point! Producing a machine that complies with all of the users requirements, their differing guidance and standards whilst trying to keep within the reach of the ever-tighter budget constraints of the busy dental practice is never going to be easy.
On the face of it the iClave plus has a pleasing appearance, sometimes difficult to achieve within the traditional constraints of a rectangular box and a door on the front, which seems to have been the norm now for many decades when applied to a standard multi-instrument/multi-load bench top sterilizer. It has a shiny white metal casing that should be easy to wipe down together with the screen that is smoked black glass and integrated in the casing. With most recent machines now adopting touch controls and LED screens the iClave plus screen joins with them, but not being an industry first they have benefited from some of the mistakes made by the early adopters.
Close inspection of the screen and the pleasure of having unhurried time to go through the whole menu and sub-menus, it is pretty intuitive, and easy to use. The limited use of touch buttons with arrows is not overly fussy and once the cycles have been highlighted for the user at set-up, it simply defaults to your own, most popular cycle, remembering it for the next time. If you need to select another, it is a simple scroll with the arrow keys and select to start. Same with daily & weekly test cycles when using the B cycle vacuum. These, as with other cycles, can be ‘delayed’ to start when you want them to, which is a time saving benefit especially when carrying out the routine vacuum and Helix tests. Routine tests can be programmed to begin while you are still at home eating your cornflakes and reading the morning papers…I wish! A nice feature is the cycle profile picture is displayed on the screen, discreetly flashing on the section of cycle the machine is currently on, giving a good estimation of how much longer to wait for the finished articles! A closer look and a digital counter also tells you where you are; together with a message telling you which cycle is running. All the other usual symbols alerting to fill or drain water tanks etc... are where they should be. Another nice feature, I admit I initially felt was a ‘gimmick’, is the colour-changing screen. This however, is really useful to indicate if the machine is asleep, working, stopped or alarmed and is clear from a distance the other side of the decon-room.
The standardness of the machine is somehow particularly pleasing, just like when driving a hire car for the first time, the relief when you just sink into the seat and all the controls and pedals are where you think they should be. There is the reassuring latched and safety interlocked handle on the door, the only noticeable difference is that with the machine asleep or switched off, the door remains stubbornly locked, no bad thing when a machine’s chamber remains hot with a cycle pre-heater. Power the iClave plus up and the door is ready to open and load.
Loading is also a slightly different experience, only 4 trays! However these trays are sized to use the whole chamber with very wide trays in the middle and standard trays nearer top and bottom. NSK say this gives the effect of having a much larger chamber machine than the already generous 17.5 liters claimed. These extra-wide trays should be good too for those difficult and bulky implant sets, that will also benefit from the iClave plus full B cycle with drying. Just to finish on the aesthetic looks, the fascia has a slightly quirky numbered cycle choice menu printed below the screen. This is, to my mind, really unnecessary as many of these cycles are not for the UK and Ireland consumption and can only be a temporary confusion or distraction to the operator until they learn simply, to just ignore it.
Performance is one of the major factors in deciding which machine to go for. The iClave plus does not disappoint. With a long history of listening to sterilizers for seemingly hours on end; the thing that struck me instantly was how really quiet it is. There are no rattles, banging, hissing, whirring, droning etc. It was uncannily silent, to such an extent of having to check to see it hadn’t expired without me noticing! Yes you can hear the vacuum pump from time to time and initially it has a strange but reassuringly, pre-cycle clunk-click, checking all of the valves to make sure they are free & working, but that's about all!
NSK say that cycle times and temperature stability were big on the design and development agenda. To achieve this they have not gone down the ‘bolt on a steam generator’ route, that they claim would only mean more heaters, more controls, more valves and this they say, could lead to less reliability. What they have done is go ‘outside the box’ and use copper, utilising its well-known thermal qualities, in the fabrication of the chamber. Being an eternal cynic, I of course questioned the durability of this remarkable but malleable material and was cut off in my prime with countless figures and statistics of extreme pressure testing and compliance, together with the remarkable amount of cycles these chambers have already covered, way beyond normal expectations.
I should explain how they know this; the new iClave plus is a continuing development of a range of machines that Dental X has been producing in Europe for many years. Many components, including the chamber have been on earlier models still in use to this day. So its more than just bench testing statistics, its real-time running used by real people and I suppose with the engineer blood running deeply through my veins, this appeals to me most. Reliability can be a subjective word but nothing beats real historical data. Many other components follow this same path and the machine is internally, near identical to the first NSK iClave, which has gained a deservedly ‘reliable ’ handle, already to its name. Time will tell if it really is 'bullet proof' in the long term but initial feedback is positive.
Cycle times aren’t just about raising steam in the chamber, its how NSK achieve temperature stability by separating the top and bottom heaters in the chamber and process-controlling the temperature precisely by independently monitored sensors. What this means simply is more rapid cycles than a ‘conventional’ set-up and a better and therefore safer control over the load temperature. The cycle times are not up to the fastest steam generator models but at circa 37 minutes for a loaded B cycle and 23 minutes for the single wrapped cycle it’s not at all bad, and if it turns out to be as reliable as its predecessor it may be worth a few minutes extra wait!
Other features you may or may not expect for this mid to high range product are the ability to put the machine into economy mode for low users so the machine turns itself off completely when not in use. There is also a useful Small Load cycle that will process around 7 or eight handpieces rapidly. Then there is the inevitable progressive march towards greater traceability and the iClave plus is now able to store 20 cycles on the internal memory and a separate mini USB stick to save, store and download the cycle information. All of this comes as a standard feature, as it should in these regulated days. There is no need for special software too, as it saves information in a universal txt. file. The iClave plus has a printer option if a paper report is also desirable and can even print as a bar code on labels for pouches. It is also possible to set the ever-fluctuating use-by dates for labels in the sub-menu. There is also the option to fill and drain the water tanks automatically using NSK’s rather unconventional, sit-on the casing top, filtration system. However, unlike many other systems, this filtration unit has the added benefit of a built in air-gap to keep your regional water authority happy with their compliance and practice inspection program.
Importantly, the machine is now a fully-fledged NSK product with recent decontamination developments focused around their extensive handpiece range. This knowledge should ensure it will also be ‘kind’ to instruments and observing the drying phase they seem to have kept chamber temperatures low throughout this important stage, resisting the temptation to trim off precious seconds by running 'drying' at a higher temperature. There is an important feature to assist in the longevity of both the machine, and instruments of any make, it is the special cleaning cycle. A message at 60 cycles reminds you to pop a tablet into the water and run a fairly short cleaning cycle. This is said to remove any debris build-up that could start to cause problems with the sterilizer components and of course within your instruments, especially handpieces.
This ‘fully-fledged’ feeling runs right through to include the support, installation and service requirements. Accessories and spares parts are carried by NSK in Stevenage and available via their national and regional support companies that have all benefited from the training and refresher courses run by NSK. This I am sure can and will develop as more and more machines are used nationwide.
Validation is as you would expect from a quality manufacturer, the iClave range is compliant with BSEN13060 that covers manufacture and the initial Works Test which has been carried out by the factory prior to delivery. According to this norm the machine is then suitable to be installed and operated. Further validation using independent test equipment will not be an issue, if that has been specified in your protocol as a standard 1/4" test-port has been provided for this purpose and a protocol is in place for your engineer or one of NSK’s authorised companies to carry this out, either initially on installation or/and annually as you may require.
So, in conclusion the iClave plus is a very good machine, it feels robust and judging by its track record, should prove to be very reliable over the long term. It has minimal and infrequent servicing requirements, which will benefit the practice immediately in the low operational costs and with less ‘downtime’. It is straightforward, uncomplicated but modern enough to have all the operator features you need and I see no reason why it will not continue to look good in your decon-room for many years.
At the time of writing there is a "try before you buy" scheme. Contact NSK UK or your NSK supplier for details.
Specification at a glance NSK iClave+ B cycle vacuum sterilizer
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Will it fit…………………………………...Standard bench-size as front feet are set back, 626mm deep/430mm high/443mm wide
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What does it weigh…………………….Around 55 kgs. but allow extra for water and the load, once sited
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What is the chamber capacity………17.5 litres but has a large 'useable' space, 2+2 larger width trays, 4kgs load
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What’s the average cycle time………Normal load under 40 minutes and a small load cycle in under 18 minutes
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How long is the warranty …………….2-Years parts and labour unlimited cycles. (subject to misuse etc.)
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How often do I need it servicing …..National requirements for validation/inspection at 1 year/1500 cycles
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Where can I purchase one…………….The same distributors you buy your NSK instruments from.
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How much will it set me back. ………..Circa £5,000 plus VAT. ****new March 2020 promotion**** Malcolm
