Instrument Processing DA 116 Infection Control

Instrument Contamination Levels: 1. Critical 2. Semi-Critical 3. Non-Critical

Heat sterilize all these instruments Critical Instruments Instruments that touch bone or penetrate soft tissue. Ex. Forceps, scalpels, scalers, dental burs After each use: Heat sterilize all these instruments

Semi-Critical Instruments Instruments that will touch mucous membrane or nonintact skin but do not penetrate soft tissue or bone mirrors, amalgam condensers, x-ray film and digital sensor holders and high and low speed handpieces Use high-level disinfection with all lab materials used in the mouth After each use: Sterilize all that are heat resistant Use disposable items or high-level disinfection/cold sterilant on others ***Do not reprocess or reuse any disposable items!

Non-Critical Instruments Non-critical instruments are those that come into contact only with intact skin Ex. X-ray Heads, Light handles, BP cuff Use intermediate or low level disinfection agent Floors and walls: okay to clean if no blood contamination If an item is visibly contaminated with blood, choose intermediate level disinfection

Transporting Items to Sterilization Center Holding Solutions for used instruments: Transport contaminated Instruments In operatory or (more commonly) sterilization center Enzymatic properties Prevents debris from drying and becoming difficult to clean from the point of use in a sturdy, solid container to the initial receiving area of the sterilization area

Which do you think is the correct choice? 1 2 Instrument Processing Area DHCP should process all instruments in a designated central processing area to more easily control quality and ensure safety (248). The central processing area should be divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. Ideally, walls or partitions should separate the sections to control traffic flow and contain contaminants generated during processing. When physical separation of these sections cannot be achieved, adequate spatial separation might be satisfactory if the DHCP who process instruments are trained in work practices to prevent contamination of clean areas (248). Space should be adequate for the volume of work anticipated and the items to be stored (248). Which do you think is the correct choice? #2 is CORRECT! 1 2

Sterilization Center Instrument processing area well-designed and conducive to accomplishing the multiple steps to achieve sterilization or high-level disinfection. DIRTY: receiving and decontaminating rinsing drying packaging CLEAN: sterilization sterile storage

Pre-Cleaning Basic first step of decontamination Mechanical methods remove bioburden from instruments Place dental burs in a bur basket before placing them in the ultrasonic cleaner Mechanical methods Ultrasonic cleaner Cavitation (ultrasonic sounds waves create bubbles that implode cause an unseen scrubbing action) 10 minutes Change solutions daily Aluminum Foil test Instrument Washer

BE CAREFUL! DO THIS! NOT THIS!

Instrument Washer http://www.youtube.com/watch?v=2a6_OIsZQ7w

Dental Handpieces Require special handling due to internal mechanical parts Flush for 20-30 seconds at chairside Remove bur Clean outer surface with handpiece wipe Lubricate according to manufacturer’s instructions Wipe off excess lubricant Package and heat sterilize Some handpieces must be lubricated after sterilization; check manufacturer’s directions Manual and automatic methods are available

Packaging Paper Pouches Cassettes Permeable so steam can reach instruments Appropriate for specific sterilizer Plastic or metal Perforated so steam can penetrate Less instrument handling reduces risk of percutaneous injury Can go into ultrasonic and autoclave Must be wrapped for autoclave and storage

Loading the Sterilizers Wrap securely Hinged instruments open Do not overfill

Methods of Sterilization: Process by which all forms of organic life are destroyed by physical or chemical means Steam under pressure Autoclave Dry Heat Sterilization Chemical under pressure (Chemical Autoclave or Chemiclave) EPA registered disinfectant/sterilant; also called “cold sterilization” least preferred method Always best to use heat sterilization

Monitoring the Sterilizer Chemical Treated indicator (inside package) or tape (outside package) Indicates that items have gone through the sterilization process DOES NOT GUARANTEE STERILITY Biological (weekly per CDC) Live bacterial spores Autoclaves/chemical vapor: Bacillus Stearothermophilus or Geobacillus Stearothermophillus Dry heat/ethylene oxide: Bacillus Subtilis or bacillus atrophaeus Mechanical Monitor gauges for times, temperatures, cycles Check and keep print-outs if available

Storage Keep sterile items and disposable items Covered, enclosed area (not under a sink) Keep packages/cassettes wrapped and unopened until use Do you need to re-sterilize? Per CDC, wrapped items are sterile indefinitely Re-sterilize if it becomes contaminated (i.e. wet, torn) Some offices date each package and rotate use according to dates