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Principles of Sterilization

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Presentation on theme: "Principles of Sterilization"— Presentation transcript:

1 Principles of Sterilization
Navy Reserve Dental Corps Infection Control Program

2 The complete elimination or destruction of all living organisms
Sterilization The complete elimination or destruction of all living organisms

3 Categories of Patient Care Items
Critical: Penetrate soft tissue or bone or enter bloodstream or other sterile tissue. Ex: forceps, scalpels, bone chisels, scalers, perio probes Semi-Critical: Do not penetrate soft tissue or bone but contact mucous membranes or non intact skin. Ex: mirrors, amalgam condensers Non-Critical: Come into contact with intact skin. Ex: x ray head, blood pressure cuff According to the CDC dental instruments are classified into three categories depending on the risk of disease transmitting infection.

4 CRITICAL SEMICRITICAL NONCRITICAL
Penetrates soft tissue or bone Contacts mucous membrane or non intact skin Contacts intact skin Sterilization Sterilization or high level disinfectant. Sterilization is BEST practice Low to intermediate level disinfection Surgical instruments, perio scalers, dental burs, perio probes Mouth mirror, amalgam carrier, dental hand pieces X ray head / cone, blood pressure cuff, face bow Sterilization is achieved by steam under pressure, autoclaving, dry heat or chemical vapor. Some items can’t be sterilized. A high –level disinfectant is registered with the EPA.

5 Periodontal Probes are Critical instruments as they penetrate soft tissue MUST be sterilized before use per CDC guidelines

6 Kerr Single Use, Pre Sterilized…Why is it better?
Ready-to-use. Minimizes tray set-up time. Hygienic. Single-use, eliminates cross-contamination issues. Convenient. Excellent for routine use, especially during busy surgery times, staff shortages, autoclave breakdowns, home visits and for high-risk patients. PRE -STERILIZED Time-saving. Reduces time spent sterilizing and handling sharps. Cost-effective. Increases productivity and reduces inventory.

7 What is wrong with I Paks. They are NOT STERILE
What is wrong with I Paks? They are NOT STERILE! As part of a standard T2 exam dental probe depths need to measured, and the probe is a critical instrument… it MUST be sterile.

8 Processing of Instruments
All critical and semi critical dental instruments that are heat stable should be sterilized after each use by steam under pressure (autoclaving), dry heat or chemical vapor. Before treatment instruments should be cleaned so that they are free of debris. Enzymatic and non enzymatic solutions facilitate instrument cleaning.

9 Instrument Processing
A group of activities that when done in the correct sequence, in the right environment, with the correct materials, and using the appropriate procedures, results in the sterilization of instruments.

10 Consider work flow when planning
Proper work flow prevents error Receive and Clean Rinse and Pack Sterilize Clean, Dry Storage

11 Instrument Processing Area
Use a designated processing area to control quality and ensure safety Divide the working areas: Receiving, cleaning, decontamination Prep and packaging Sterilization and Monitoring Storage

12 Cleaning of Instruments
Use appropriate PPE: eyewear, heavy duty utility gloves, gown, face protection Rinse / ultrasonic and DRY before packaging Follow manufacturer’s guidelines for use of ultrasonic. Use the proper amount of solution and proper time Cover the unit with lid when in use

13 Cleaning of Instruments
Wear Proper PPE. Heavy duty puncture resistant utility gloves Eyewear, gown and mask Heavy duty gloves should be worn when handling contaminated instruments. Instruments should soak in water or disinfectant / detergent as soon as possible after use to prevent drying and caking of debris Instrument cassettes and mechanical cleaner (ultrasonic device) may be used to reduce direct handling of contaminated instruments

14 Cleaning of Instruments
-Applying rust inhibitors will protect instruments from corrosion that may result from autoclaving. -Packaging rinsed and dried instruments before sterilization protects them from contamination after they are removed from the sterilizer and during transport chair side or to storage. -Single use instruments are acceptable for use if used only once and disposed of correctly.

15 Degassing Degassing is the removal of large air bubbles found in all fresh solution, which act as a barrier to effective cleaning **Degassing is needed each time new solution is added** Degas the solution by activating the unit for 15min before you add any items to be cleaned.

16 Preparation and Packaging
Use a container system or wrapping compatible with the type of sterilization process used and that has FDA clearance ALL instruments that enter the patients mouth should be wrapped Open instruments at the chair, at time of use.

17 Sterilization HEAT STERILATION:
Recommended for all critical and semi critical items Must follow the manufacturer’s instructions for cleaning, lubrication, and sterilization to ensure the effectiveness of process HEAT STERILATION: Moist Heat- steam under pressure, Autoclaving degrees. Dry Heat-Static or Forced Air- No corrosion, uses dry heat degrees Unsaturated Chemical Vapor-uses unsaturated chemical vapors from formaldehyde and alcohol, 273 degrees

18 Steam Sterilization Gold standard. Dependable, economical, heats rapidly, destroys most resistant bacterial spores in brief exposure Indicated for heat stable instruments, device Methods of steam sterilization differ in the mechanism used for air removal from the chamber

19 Air Removal Gravity Displacement Dilution by mass flow
Dilution by pressure pulsing High-vacuum sterilization Pressure pulsing with gravity displacement (steam flush-pressure pulse) The methods of steam sterilization differ in the method that air is removed from the chamber. Here are the different methods.

20 Gravity Displacement Steam is admitted through a control valve
Steam forms stratified layer across the top of chamber Steam mass displaces air via drain vent Best for unwrapped or lightly wrapped material

21 Steam-Flush Pressure Pulse
MOST effective air removal, using cycles of pressurization, air evacuation Air is removed to a predetermined pressure Steam is admitted Air is removed my gravity displacement Chamber is re-pressurized Chamber air is evacuated Steam in pack expands, removing all air load

22 Steam Flush Pressure Pulse

23 Air Removal Test First cycle of every day
Indicates good air removal and airtightness Cannot be performed during regular processing

24 Dry Heat Sterilization
Static Air Heat coils on bottom or side of sterilizers heat, causing hot air to rise in the chamber Heat is transferred to the instruments and sterilization occurs after 1-2 hours of consistent heat contact Forced Air Circulation of the heat using a fan in the chamber Transfer of heat to instruments occurs more rapidly Sterilization time is approximately 12 minutes for wrapped instruments

25 Dry Heat Sterilization
Good heat penetration Non corrosive But…diffusion and penetration of heat is slow Can require an extended time Requires high temperatures that can damage materials Oxidation

26 Unsaturated Chemical Vapor
Chemical vapor produced from solution containing formaldehyde, ethanol, or other Vapors may be removed using a built in purge (older models require ventilation) Waste liquid is a hazardous waste Not preferred method

27 More about Autoclaves Water heated to form steam
Moist heat destroys the microorganisms Air must be removed for the sterilization process to occur 4 steps: Heat Up Cycle, Sterilization Cycle, Depressurization Cycle, Drying Cycle

28 Dental Hand Pieces DO NOT surface disinfect, use liquid chemical sterilants, or ethylene oxide on hand pieces and other instruments! Follow the manufacturer’s instructions for cleaning, lubricating, and sterilization

29 Steam Sterilizer Loading Allow for circulation
Dry non porous containers must be positioned so that water will not run out

30 Sterilization Monitors
Physical- cycle time, temperature, pressure Chemical- heat or chemical sensitive inks that change color when germicidal-related Biological- bacillus spores that directly measure sterilization ALL 3 need to be done!!!

31 Physical Monitoring Monitor cycle time, temperature, and pressure
Observe gauges / displays Review print-out from sterilizer if available Error message will indicate an important parameter has not been met Only one part of the monitoring process indicating only the condition in the chamber of the sterilizer Each time the sterilizer is used the operator needs to check all physical parameters and ensure the machine is being operated properly.

32 Chemical Indicators External Indicator Internal Indicator
Provides visual of sterilization process Internal Indicator Visual sterilant penetrated the tray or pack

33 Chemical Indicators Internal indicators MUST be included inside EACH sterilization package External Indicators MUST be used IF the internal indicator is not visible Multiple types of indicators Class I-V for different units STOP if indicator shows processing failure and DO NOT use instruments, reprocess prior to use

34 Biological Monitors Perform weekly Types:
Steam – Geobacillus stearothermopholis Dry Heat- B. atrophaeus Spore Tests are standard and are accepted for assuring sterility. They kill highly resistant micro-organisms, spores.

35 Spore Testing Only a biologic indicator consisting of resistant spores can measure the microbial killing power of the sterilization process. IF the spores are killed then all other microorganisms are killed

36 Sterilization Cycle Verification
Verifies process before a sterilizer is first used Autoclaves should be tested with chemical indicator and biologic indicator prior to: First use Relocated (on AT) After sterilization failure has occurred After a major repair RUN 3 CONSECUTIVE CYCLES and TESTS

37 Why do we need to spore test?
Sterilizers fail spore tests for different reasons Most often cause: operator error cycle interrupted incorrect package overloaded incorrect time or temp

38 Positive Spore Test Following a single positive biological indicator:
Remove the sterilizer from service and review sterilization procedures, is it operator error Retest the sterilizer by using biologic, mechanical, and chemical indicators Make sure to use the same cycle that failed Repeat the spore test again, if negative the sterilizer may be placed back in service Best to recall all instruments, not required

39 Positive Spore Test If REPEAT positive test:
- DO NOT USE until it has been inspected or repaired or the exact reason has been determined - Recall and reprocess all items since the last negative test After repaired, re-challenge with biological indicator tests in 3 consecutive empty chamber cycles

40 Causes of Sterilization Failures
Overloading- increases heat up time and prohibits agent to completely penetrate the load

41 Causes of Sterilization Failures
Instruments loaded too closely together- agent not able to move about within the unit and may not be able to penetrate all packages Incorrect packaging materials Interruption if sterilization cycle Incorrect operation of the sterilizer

42 In the Field Generators may fail and power supply to sterilizer may be interrupted. Reprocess these instruments! Watch your unit!

43 Documentation Monitoring Log
Sterilizer identification number (serial # and model) Load number Duration and temperature of cycle Contents of load Record if charts, readings, printouts Biological Monitoring Maintenance Records MUST keep a log! Operators signature and name on log

44 Biologic Monitoring Options
Multiple options: on site, mail in, university Must have a control outside the sterilizer Incubate both the control and the test vial Should have bacterial growth in control sample If the Control has no growth test is NOT conclusive and must be re-done

45 Dispose of Spore Test Must be no active spores
Autoclave the control or failed vials

46 ATTEST 3M Attest 390 Rapid Auto Reader Results in 3 hours
3M Attest 490 is a one hour auto reader, works with both Gravity and Pre-Vac Sterilizers Quick results, useful in isolated settings The auto-reader allows onsite quick results

47 3M ATTEST Auto-reader Expensive Read by operator No third party verification

48 Crosstex Confirm10 In office results 10 hours Easy to use and read tests

49 ConFirm Monitoring System, Crosstex
Mail In service Test results in 24 hours Benefit- third party verification of test results Economical

50 Other options www.autoclavespore testing.com www.microtestlabs.com
MANY more options, not all will work in our unique setting. Time is crucial in 2 week mission.

51 Some other reasons tests fail
Inadequate cleaning of instruments- if there is caked on debris it won’t be sterile! Improper packing- don’t overload instruments, they should be able to lay flat within the cassette

52 More Reasons Cycles Can Fail
Processing Instruments in a cold sterilizer- a cold sterilizer takes much longer to come up to temperature, since it must heat the chamber and its contents. Run an empty chamber first before the first load is processed Selecting the Wrong Cycle-some units will have manual and automatic settings. ALWAYS select the longer cycle when sterilizing mixed loads

53 Reasons Cycles Fail Aborting a Cycle: NEVER abort a cycle so that instruments may be used more quickly. NEVER open during a cycle to add more instruments. Even though it may save time DO NOT stop cycle before its complete, including the drying time. If you need to add more instruments, restart the cycle

54 Storage of Sterile Items
Well ventilated to protect against dust and moisture Consistent temperature and humidity Packaging should include load number, sterilization date Shelf Life: can be time related or event related Depends on type of packaging

55 Common Problems White Build Up on Instruments Damage to Plastics
Thoroughly dry before packaging and sterilizing Damage to Plastics Monitor temperature Avoid flash cycles Ensure plastics are heat stable to temperature used in sterilizer Wet Packs Do not overload sterilizer Allow full drying cycle Purchase sterilizer with vacuum drying cycle

56 Residual Debris on Instruments after cleaning
Debride instruments at time of use (NOT with gauze and your hand…washer or utility gloves and brush) Use enzymatic pre-soak or pre-spray for organic materials Corrosion of surgical hand pieces Internal components and nitrogen-driven hand pieces are prone to corrosion Stand the hand pieces on end or at an angle to sterilize Allow to thoroughly dry before removing from sterilizer

57 Dental Burs Cleaning and sterilization do not reliably remove all organisms from burs Ideal practice is to move towards pre-sterilized single use disposable burs.

58 Culture All Reserve Dental Corps Officers and Enlisted members should know how to operate the sterilizer All should know how to tell if the instruments have been effectively sterilized Best practice to open sterile wraps in front of patient, builds trust All member should call a STOP if they suspect a breach in sterilization

59 Duty of the Health Care Team
Chain of Command, who can step up if they think instruments are not being properly sterilized… ALL HANDS!!!! All patients and instruments must be treated with universal precautions no matter where we are, or who we are working on!!!

60 Resources OSAP www.osap.org
From Policy to Practice: OSAP’s Interactive Guide to the CDC Guidelines CDC Guidelines for Infection Control in the Dental Health Care Setting 2003


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