1. 1 Clean? Disinfect? Sterilize? What does it all mean?? DA 116 Infection Control

2. 2 Instruments, supplies, equipment, surfaces After each patient treatment procedure is completed Instruments, supplies, equipment, surfaces After each patient treatment procedure is completed

3. 3 Clean? (“pre-clean”) Basic first step of decontamination process –Reduce the number of microbes and remove bioburden –Prevent debris from harboring microorganisms during sterilization process **if a surface is not CLEAN it cannot be disinfected** Remove all disposables and contaminated items from operatory first Use soap and water OR an EPA-registered product that cleans and disinfects Basic first step of decontamination process –Reduce the number of microbes and remove bioburden –Prevent debris from harboring microorganisms during sterilization process **if a surface is not CLEAN it cannot be disinfected** Remove all disposables and contaminated items from operatory first Use soap and water OR an EPA-registered product that cleans and disinfects

4. 4 Pre-Cleaning the operatory PPE with utility gloves

5. 5 Pre-Cleaning Instruments preferred method: mechanical cleaning Ultrasonic Cleaner Instrument Washer

6. 6 Disinfect? After precleaning NOT the same as sterilization Kills most disease-causing microorganisms, but not spores –Non-pathogenic microorganisms may remain on an object after disinfection Use an EPA-registered hospital disinfectant with tuberculocidal, HIV, and HBV claims –Note: Hydrogen Peroxide is NOT an acceptable disinfectant After precleaning NOT the same as sterilization Kills most disease-causing microorganisms, but not spores –Non-pathogenic microorganisms may remain on an object after disinfection Use an EPA-registered hospital disinfectant with tuberculocidal, HIV, and HBV claims –Note: Hydrogen Peroxide is NOT an acceptable disinfectant

7. 7

8. 8 Levels of Disinfection: Low level disinfection: (actually cleaning) –Least effective. Does not kill spores or Tuberculosis Intermediate level disinfection: –Kills TB, which is the most difficult to kill as spores –If you use a process that kills TB spores, you will also be able to kill other organisms that are easier to kill (HBV and HIV) High level disinfection: –Kills some, but not all bacterial spores, including TB as well as other bacteria, fungi and viruses Almost as effective as true sterilization but not as thorough Low level disinfection: (actually cleaning) –Least effective. Does not kill spores or Tuberculosis Intermediate level disinfection: –Kills TB, which is the most difficult to kill as spores –If you use a process that kills TB spores, you will also be able to kill other organisms that are easier to kill (HBV and HIV) High level disinfection: –Kills some, but not all bacterial spores, including TB as well as other bacteria, fungi and viruses Almost as effective as true sterilization but not as thorough

9. 9 Disinfectant Comparisons note: rubbing alcohol is NOT an approved disinfectant DisinfectantLevelAdvantages Disadvantages Required times GlutaraldehydeHigh disinfect impressions Corrosive Eye irritation 10-90 min. Iodophor IntermediateFast acting Residual activity Cleans and disinfects discoloration10 min on surface Complex (synthetic) Phenolics Intermediate Fast acting Residual activity Clean and disinfect Skin/mucous irritation No use on plastics 10 min Chlorines Intermediate economical Corrosive, skin irritation, must prepare daily 2-10 min

10. 10 Disinfecting Sprays How to Use: For surface disinfection – use the 2 step method. Clean by wiping surfaces thoroughly with disinfectant and paper towels or 4 x 4 gauze to remove all soils. Disinfect by reapplying disinfectant, keeping surfaces wet for 10 minutes. Wipe off excess solution after contact time is completed. Place barriers.

11. 11 Disinfecting wipes How to Use: For surface disinfection – use the 2 step method. To clean, remove one or more wipe towelettes and wipe surfaces thoroughly to remove all soils. Discard used wipe towelettes. Remove one or more additional fresh wipe towelettes. Reapply disinfectant to previously cleaned surfaces for a 10 minute contact time.

12. 12 Additional Disinfecting Concerns: Radiography Film holders and positioners for digital radiographs should be heat sterilized between patients, UNLESS they are disposable items. Sensors for digital radiographs cannot be sterilized and should be covered with a new barrier sleeve for each patient. Dental Lab All items used in the mouth should be cleaned and soaked in a high level disinfectant before sending to the laboratory for processing.

13. 13 Sterilize? –Process by which all forms of life are completely destroyed destroys all living microorganisms, including bacterial spores and viruses. Kills good and bad microorganisms, all life –After proper sterilization, no microorganisms will be alive –Heat or Liquid Chemical –Process by which all forms of life are completely destroyed destroys all living microorganisms, including bacterial spores and viruses. Kills good and bad microorganisms, all life –After proper sterilization, no microorganisms will be alive –Heat or Liquid Chemical

14. 14 Steam under pressure Steam (autoclave) Flash (Statim)

15. 15 Rapid Heat Sterilization AKA ‘Statim’ Works like a convection oven, high temperature plus circulating steam 375 F degrees (190C) 12 minutes for wrapped items 375 F degrees (190C) 6 minutes for unwrapped items AKA ‘Statim’ Works like a convection oven, high temperature plus circulating steam 375 F degrees (190C) 12 minutes for wrapped items 375 F degrees (190C) 6 minutes for unwrapped items

16. 16 Autoclave: Uses moist heat to sterilize Steam under pressure is considered the sterilizing agent 15 pounds of pressure per square inch 250 degrees F (121 degrees C) For 15-20 minutes for wrapped instruments 30 minutes for porous materials Avoid overloading or wrapping instruments too tightly Steam must circulate to all surfaces Uses moist heat to sterilize Steam under pressure is considered the sterilizing agent 15 pounds of pressure per square inch 250 degrees F (121 degrees C) For 15-20 minutes for wrapped instruments 30 minutes for porous materials Avoid overloading or wrapping instruments too tightly Steam must circulate to all surfaces

17. 17 Chemical Vapor Sterilizer

18. 18 Chemical Vapor Sterilization: Combination of heat and unsaturated chemical vapor (produces hot vapors of alcohol and formaldehyde that act as sterilizing agent) Chemicals used: alcohol, acetone, ketone, formaldehyde and distilled water Advantage: –No corrosion or dulling of instruments –Instruments are dry at end of cycle –All instruments which can be autoclaved, can be chemiclaved Disadvantage: needs well ventilated area due to odor 270 F degrees (131C) 20-40 minutes 20 PSI pressure Clean, rinse and dry instruments well before sterilizing; wrap loosely Combination of heat and unsaturated chemical vapor (produces hot vapors of alcohol and formaldehyde that act as sterilizing agent) Chemicals used: alcohol, acetone, ketone, formaldehyde and distilled water Advantage: –No corrosion or dulling of instruments –Instruments are dry at end of cycle –All instruments which can be autoclaved, can be chemiclaved Disadvantage: needs well ventilated area due to odor 270 F degrees (131C) 20-40 minutes 20 PSI pressure Clean, rinse and dry instruments well before sterilizing; wrap loosely

19. 19 Dry Heat Sterilizer

20. 20 Dry Heat Sterilization: “ Baking” – high temperature is sterilizing agent 320 F degrees (160C degrees) = 2 hours (120 minutes) 340 F degrees (170C degrees) = 1 hour (60 minutes) Advantage: no rust or corrosion or dulling sharp edges Disadvantage: some plastics, gauze, impression trays cannot tolerate high temperatures, can cause damage Instruments must be clean and dry prior to sterilization Usually requires special metal instrument trays used during sterilization “ Baking” – high temperature is sterilizing agent 320 F degrees (160C degrees) = 2 hours (120 minutes) 340 F degrees (170C degrees) = 1 hour (60 minutes) Advantage: no rust or corrosion or dulling sharp edges Disadvantage: some plastics, gauze, impression trays cannot tolerate high temperatures, can cause damage Instruments must be clean and dry prior to sterilization Usually requires special metal instrument trays used during sterilization

21. 21 Glass Bead Sterilizer Ethylene Oxide Sterilizer

22. 22 Glass Bead Sterilizer: *no longer OSHA accepted Previously used chairside during endodontic procedures to sterilize files between canals – used on the same patient Consists of glass beads, metal beads and salt 450 degrees F, for 20-30 seconds The set of files are then autoclaved between patients *no longer OSHA accepted Previously used chairside during endodontic procedures to sterilize files between canals – used on the same patient Consists of glass beads, metal beads and salt 450 degrees F, for 20-30 seconds The set of files are then autoclaved between patients

23. 23 Ethylene Oxide Sterilizer This is another chemical sterilization method Considered a poisonous gas Runs on a 10-16 hour cycle Used in hospitals but not in dental settings This is another chemical sterilization method Considered a poisonous gas Runs on a 10-16 hour cycle Used in hospitals but not in dental settings

24. 24 Liquid Sterilant ( cold sterilant orhigh-level disinfectant ) Glutaradehyde product

25. 25 Liquid Sterilants: AKA “Cold Sterilants” Destroys all microorganisms IF exposed long enough to the sterilant Disadvantage: –Time consuming (10 – 16 hours) –No bacterial spore test available; May use a color monitor dip stick to test the strength –Whenever new item is added, time is reset to ten hours –Toxic chemicals: glutaraldehyde; do not leave container uncovered Advantage: –No packaging; will not harm heat sensitive items Clean and dry everything before immersion; any water will dilute solution and lower effectiveness After cycle, must rinse with sterile water; dry with clean towels, and wrap in clean packaging AKA “Cold Sterilants” Destroys all microorganisms IF exposed long enough to the sterilant Disadvantage: –Time consuming (10 – 16 hours) –No bacterial spore test available; May use a color monitor dip stick to test the strength –Whenever new item is added, time is reset to ten hours –Toxic chemicals: glutaraldehyde; do not leave container uncovered Advantage: –No packaging; will not harm heat sensitive items Clean and dry everything before immersion; any water will dilute solution and lower effectiveness After cycle, must rinse with sterile water; dry with clean towels, and wrap in clean packaging

26. 26 Sterilization Monitoring –Biological monitoring with spore tests: Liquid Disinfectant Monitoring: color monitor dip stick (not a spore test) –Biological monitoring with spore tests: Liquid Disinfectant Monitoring: color monitor dip stick (not a spore test) Process indicators