Principles and Techniques of Instrument Processing and Sterilization

If the instrument-processing area is small, you can use signs like?

"Contaminated items only" "Precleaning area" "Cleaned items only" "Sterile items only" "Sterilization area"

Processing of instruments should proceed in a single loop, from dirty to clean to sterile to storage, without ever what?

"Doubling back."

What is the seven step in Instrument Processing?

(1) Transport (2) Cleaning (3) Packaging (4) Sterilization (5) Storage (6) Delivery (7) Quality.

What are the four designated central processing area?

(1) receiving, cleaning and decontamination. (2) preparation and package. (3) sterilization. (4) storage.

The time may vary from what in the Ultrasonic Cleaner?

5 to 15

The ultrasonic cleaning unit should be labeled with both What?

A chemical label and a biohazard label because it contains a chemical and contaminated instruments.

The flooring should be?

An uncarpeted, seamless, hard surface.

is a method for sterilizing unwrapped patient-care items for immediate use.

An unwrapped cycle (sometimes called flash sterilization)

Why shouldn't the instrument-processing areas have a door or windows that open to the outside?

Because dust may enter the area.

What is strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies (studies of patterns and caused of diseases).

Category IA.

What is strongly recommended for implementation and supported bu experimental, clinical, epidemiologic studies and a strong theoretical rationale?

Category IB.

What is required for implementation, as mandated by federal or state regulation or standard?

Category IC.

These sound waves can travel through metal and glass containers, causes what?

Cavitation. (formation of bubbles in liquid.)

The dental assistant may be exposed to microorganisms through contact with?

Contaminated instruments or other patient-care items.

What are the items used to penetrate soft tissue or bone?

Critical Instruments.

What has the greatest risk of transmitting infection and should be sterilized with the use of heat?

Critical Instruments.

Patient-care items are categorized into what, three classifications?

Critical, Semicritical, Noncritical.

What also makes a good holding solution because it is low-cost, low-foaming, and readily available?

Dishwasher detergent.

What doesn't the Holding/Pre-Soaking step do?

Disinfect the Instruments. Only Prevents debris from drying on them so it is easier to clean later.

Thorough cleaning should be done before all What?

Disinfection and sterilization processes. It should involve the removal of all debris and organic materials (e.g., blood and saliva).

What is the process that kills disease-causing microorganisms, but not necessarily all microbial life?

Disinfection.

What is an alternative to a rust inhibitor?

Dry the instrument thoroughly with the use of dry heat or unsaturated chemical-vapor sterilization (discussed later), which does not cause rusting.

What are some examples of critical instruments?

Forceps, scalpels, bone chisels, scalers, and burs.

What is the least desirable method of cleaning instruments because it requires direct hand contact with the contaminated instrument?

Hand Scrubbing.

Instruments may be precleaned ion one of three ways?

Hand scrubbing Ultrasonic cleaning Instrument-washing machine

A deep sink should have what?

Hands-free controls for instrument rinsing and (if space permits) a foot-operated or other hands-free trash receptacle.

What is the majority of semicritical items in dentistry?

Heat-tolerant, and they should also be sterilized.

What is process that kills some but not all bacterial endospores and inactives Mycobaterium tuberculosis?

High-level disinfection.

What should you do to determine whether the ultrasonic cleaner is working properly?

Hold a 5-by-5-inch sheet of lightweight aluminum foil vertically (like a curtain) half-submerged in fresh, unused solution.

What is suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale?

II.

Patient-care is based on the risk of what?

Infection associated with their intended use.

What requires linger cleaning time in the Ultrasonic Cleaner?

Instruments in plastic or resin cassettes because the material absorbs some of the ultrasonic energy.

What inactivates Mycobacterium tuberculosis and destroys less-resistant organisms such as hepatitis B virus and human immunodeficiency virus?

Intermediate-level disinfection.

What is one of the most important responsibilities of the dental assistant?

Is to process contaminated instruments for reuse.

What if an item can be heat sterilized?

It should be heat-sterilized.

What if the item will be damaged by heat?

It should undergo, at a minimum, high-level disinfection.

Entrance -> Contaminated areas (discard waste, holding solutions, ultrasonic cleaner, dry instruments, rust inhibitors) -> Packaging Area (arrange set-ups, insert biologic monitors, wrap instruments) -> Sterilization/Storage Area (sterilize packs, store packs, record keeping, assemble disposables on trays) -> Exit _______>____________>__________>_____

Linear Flow Instrument Processing Area.

What ineffective against M. tuberculosis and should be used only in the dental office for housekeeping purpose?

Low-level disinfection.

The size of the area should accommodate all the equipment and supplies necessary for instrument processing, with what?

Multiple outlets and proper lighting, water, and air and vacuum lines for flushing of high-speed handpieces.

The holding solution may be any What?

Noncorrosive liquid. A commercial enzymatic solution that partially dissolves organic debris may be used.

What items should be cleaned and processed with the use of an EPA-registered intermediate-level or low-level disinfectant after each patient use?

Noncritical Instruments.

What pose the least risk of transmission of infection because they come into contact only with intact skin, which is an effective barrier to microorganisms?

Noncritical Instruments.

Exposure may occur through?

Percutaneous injury, or contact with mucous membranes of the eye, nose, or mouth.

For disease agents from a previous patient to be prevented from being transferred to yourself, another dental-team member, or the next patient, instrument processing must be performed in a consistent and disciplined manner?

Personal Protective Equipment.

What is reducing the number of microorganisms that are present by physically removing debris?

Precleaning.

Instruments and burs made of carbon steel will what during steam sterilization?

Rust.

What instruments touch mucous membranes or nonintact skin and have a lower risk of disease transmission?>

Semicritical Items.

What is proper processing of contaminated dental instruments is actually a, what?

Seven-Step Process.

What is the ideal instrument-processing area?

Should be dedicated only to instrument processing; Should be physically separated from the operatories and dental laboratory; Should not be a part of a common walkway.

All WHAT are brought into the contaminated area, the initial receiving area, where they are held for processing. Any disposable items that have not already been discarded in the treatment room are removed from the instrument tray and disposed of as contaminated waste.

Soiled instruments.

What is a process intended to kill all microorganisms and is the highest level of microbial destruction?

Sterilization.

What is process that inactivates all microbial life, including bacterial spores, viruses, bacteria, and fungi?

Sterilization.

What works by producing sound waves beyond the range of human hearing?

The Ultrasonic Cleaner.

What should be centrally located in the office to permit easy access from all patient-care areas?

The instrument-processing area, or sterilization area.

Regardless of the size or shape of the instrument-processing area, four basic areas govern what?

The pattern of workflow.

Noncritical clinical devices include, what?

The position indicator device of the x-ray unit tube head, the lead apron, and the curing light that comes into contact only with intact skin.

What if a instruments cannot be cleaned immediately after a procedure?

They should be placed in a holding solution to prevent the drying of blood and debris on the instruments.

Why should the processing area should have good air circulation?

To control the heat generated by the sterilizers.

Entrance -> Contaminated areas (discard waste, holding solutions, ultrasonic cleaner, dry instruments, rust inhibitors) -> Packaging Area (arrange set-ups, insert biologic monitors, wrap instruments) -> Sterilization/Storage Area (sterilize packs, store packs, record keeping, assemble disposables on trays) -> Exit | ^ V_______>________>|

U-Shaped Instrument Processing Area.

What is no recommendation. Practices for which insufficient evidence or no consensus regarding efficacy exists?

Unresolved Issue.

You must always use personal protective equipment (PPE), including what?

Utility gloves, mask, eyewear, and protective clothing, when processing instruments.

What is a central location minimizes the need to carry contaminated items through clean areas of the office?

Where sterilized instruments, fresh disposable supplies, and prepared trays are stored.

Instruments processed in an automatic washer/disinfector must be what?

Wrapped and sterilized before use on a patient.