steralization quiz

3 Pre-Cleaning Methods

Manual Cleaning or Hand Scrubbing ** Ultrasonic Unit Instrument Washer/Thermal Disinfector ** Hint: if you have instruments with dried blood on the bracket tray, dip the tips of into a small dish of hydrogen peroxide before taking them to the pre-cleaning area. It will loosen the debris without reverting to manual cleaning/scrubbing.

Sterilization Monitoring

Mechanical Monitoring Biological testing

Unsaturated Chemical Vapor Under Pressure CHEM CLAVE

Microbial and viral destruction is achieved from heated alcohols, formaldehyde, ketone, water and acetone that produce a gas.

Ethylene Oxide

Not commonly found in private dental offices but in hospitals Requires 10 -16 hours to sterilize items (overnight processing) Sterilize at room temperature Produces a toxic gas so must have good ventilation Can be used on metal, plastic, rubber, or cloth Must air materials following sterilization so no residue remains

Manual Cleaning

Not recommended / higher risk of injury absolutely necessary: wear heavy duty nitrile gloves and use a long-handled brush to minimize the risk of an accidental injury Scrub the instruments under water to decrease aerosols Allow instruments to air dry prior to packaging

Chemical Sterilants

Only used for items that cannot be sterilized by any other method (not a recommended technique) Recommended that the office purchase one time use (disposable) items instead

Packaging Tips

Package "sets" of instruments that are used together instead of putting every instrument in its own bag. Do not package instruments of dissimilar metals together. The metals react and can rust or corrode your instruments. This occurred in our clinic when we were utilizing autoclavable air/water syringe tips and placed in the cassette with instruments. Expel air before sealing bags/pouches

Types of Packages

Paper bags: Paper/Poly bags

How Do Ultrasonics Work?

Physical agitation Chemical dissolution

Operation of Chemical Vapor Under Pressure

Place PPE to protect skin, eyes and mouth Add special solution to unit Pre-clean and dry instruments Load packages on their sides or stagger in pyramid formation Latch door so good seal and activate cycle

Advantages to steam under pressure

Quick, easy and reliable Non toxic (uses distilled water) Items can be packaged to maintain sterility Good penetration of fabrics and paper wrappings Biologically verifiable Cheap and time efficient

Steam Under Pressure instructions

Remove bioburden from instruments Wrap in packages and stand on sides on tray if possible Latch door so good seal Fill autoclave with distilled water (minerals in tap water will destroy the unit) Activate cycle and monitor time and pressure

approved methods of sterilization

Steam Under Pressure Autoclave Dry Heat Chemical Vapor (Chem-clave) Chemical Immersion

Part IV Sterilization definition

Sterilization is the physical or chemical process of complete destruction of all living microbes, including bacterial spores, on inanimate objects

Steps in Instrument Reprocessing

Transportation of instruments to pre-cleaning area Decontamination Packaging, labeling and sterilization Storage of sterile packages Dispensing of sterile packages for reuse Maintaining "Quality Assurance"

Additional Packaging

Tubing Reusable Bags:

Testing the Ultrasonic for Efficiency

Use heavy duty foil - should be 1" greater than the depth of the tank and 1" shorter than the width (light weight foil disintegrates & leaves a mess) Place foil in unit extending down but not touching the bottom or sides Fill unit with water Turn unit on for 15-20 seconds Remove foil, turn unit off, and allow to air dry

Dry Heat Clave

Uses oxidation and dehydrates proteins. Sterilization is achieved by heat that is conducted from the exterior surface to the interior of the object static air: dry heat rapid heat transfer: works like convection oven so functions in less time

Disadvantages of Using Chemical Vapor

Ventilation required since fumes are carcinogenic Requires special solution that is toxic and very expensive Vapor must penetrate all materials Damages plastic and rubbers Cannot sterilize linens, fabrics, cotton rolls, liquids or closed containers

Advantages of Using Chemical Vapor

Very reliable Short cycle so time efficient Does not corrode or rust instruments (but items must be dry) Items dry quickly Can be biologically monitored (same vials as steam under pressure)

Labeling

a sharpie marker to label packages with your bin # so we know who they belong to; and date each package so inventory can be rotated. date does not indicate an expiration date (as long as package is not opened/torn, items remain sterile). Only write on the lip

Removal of Instruments When removing the top to the unit, place handle side

against the countertop so the countertop does not become contaminated. (The inside will be damp and has been exposed to aerosol contamination).

bc biological testing is only once a week we use integrators to

an early indication of a problem so the autoclave can be taken out of use and the cassettes/packages can be recycled in another autoclave to ensure sterility.

paper bags

are very economical however they rip very easily. You must allow them to dry before removing them from the autoclave. If the bag breaks during handling the item is no longer sterile and needs to be rebagged and autoclaved a second time. (used for nail brushes in our clinic)

biological indicators or vials contain

bacterial endospores are purchased, placed in an autoclave bag just like instruments and placed in the autoclave with the rest of the load. Prions and endospores have the highest resistance and are therefore the most difficult to kill which is why we utilize endospores as our testing agent

Note On Handpieces The CDC's current guidelines however require all dental hand pieces to be

be heat sterilized between uses and NOT high level disinfected

Removal of Packages

careful leave door ajar and allow package to dry before removing any items heat resistant gloves when handling trays over gloves when transporting packages

NON CRITICAL x-ray head and exposure button do not enter the oral cavity but we do touch both with contaminated hands after placing film in the patient's oral cavity. Therefore, both should be either

covered with a barrier or cleaned and disinfected with a tuberculocidal, intermediate level disinfectant after use if blood is present.

The first wrap of surgical instruments (which is exposed to dust and particles in the air)

discarded and removed before taking the set-up to the surgical room.

Surgical Instruments

double wrap Open the hinges of any surgical instruments prior to bagging so the steam can penetrate all areas of the instrument.

Ultrasonic Maintenance

drain each night wash inside with soapy solution dry inside then spray or with with disinfectant lid ajar overnight to dry

biologival monitoring

each autoclave must be tested every week autoclave number on outside of vial

Disposal of Vials

sharps container in the instrument processing room. As a precautionary measure, once you have recorded your findings in the Quality Assurance Log, bag the control vial and run it through a sterilization cycle. This will kill all of the spores before disposal.

2 instruments that can't be put in the ultrasonic cleaner

slow speed hand piece for polishing tips to ultrasonic scaler and piezo units ( stacks on tips separated in ultrasonic making less effective to removing calc)

tubing

some offices use tubing since it can be very economical. No need to buy various different sized bags because you can cut to the desired length. You may have seen commercials for a similar product on the television. Many people use this type of a process to store leftovers. Once you fill the tube with instruments you heat seal the ends.

Biological Monitoring

spore testing, is the only reliable test for determining if sterilization has indeed taken place. in office or mail

thermal disinfect ors After completion of the drying cycle items are removed and bagged or wrapped prior to initiating the

sterilization process . One should always have gloves in place when bagging items because although they have been disinfected they are NOT sterile!

Class 5 Integrators

strip is placed on the middle tray with every load. Provides an indication that the sterilization conditions have been met without opening a wrapped cassette to see the internal indicator.

chemical monitoring Internal indicators

that are placed in the package. They change color when exposed to adequate heat and time so they are a multi-parameter indicators.

Environmental Surfaces

the floor, walls, countertops and trash receptacles. not necessarily touched during the patient appointment but they can be contaminated with aerosols, splash and splatter.

why are resin cassettes in the ultrasonic cleaner longer

they absorb ultrasonic energy

Foil Test Results Properly functioning ultrasonics will create

tiny dimples or pebbling on the foil

whats the purpose of pre cleaning

to remove any debris or bioburden that would prevent complete penetration of steam and/or chemicals used during the sterilization process.

Chemical Monitoring

utilization of external & internal indicators as well as Class 5 integrators.

chemical monitoring External indicators

found on the outside of the package that change color when exposed to heat ONLY.

examples of chemical sterilants are

gultaradehydes chloride dioxide

paper/poly bags

"peel-vue" bags. Are paper on one side and clear impervious plastic on the other side. Ideal because you can see inside the package without opening it. The plastic side is more resistant and less likely to tear so we place the plastic side on the autoclave tray so the weight of the instruments will not tear the wet paper side upon removal from autoclave.

Part I Transportation

*Heavy duty nitrile gloves must be worn* when transporting contaminated instruments to the instrument processing area.

advantages of dry heat

-Easy to use, safe and effective -Does not dull cutting edges -Does not rust or corrode -Items are dry after cycle -Can be biologically monitored

Steam Under Pressure

-we use -most effective -destroys essential cellular proteins or enzymes. -pressure serves to elevate temp -steam travels verticals -space is essential between objects so steam is capable of penetrating all items -items must be free of debri/bioburden

biological testing is performed

1 a week

Autoclave Operation temp / time

250f at 15 psi 20-30 mins (1st cycle) 250f 30 psi 15 mins time begins when correct temp is reached

unsaturated chemical vapor under pressure time/temp

260-270 F with 20-40psi 20 mins

StatIM temp/time

273F 15psi 10 mins wrapped 273F 30psi 3 mins unwrapped

dry heat static air time/ temp

320F 1-2 hours NO PSI 350F 1 hour NO PSI

dry heat Rapid heat transfer time/temp

375F 12 mins wrapped 375F 6 unwrapped

how long does the ultrasonic cleaner run for

4-16 mins depending on the load.

Envelope Wrap

A flat sheet of paper used to wrap cassettes. Wrap cassettes like a present and seal with autoclave tape. When placing cassettes in a bag you generally have excess bag on the ends that can touch the sides of the autoclave. The paper gets browned when this happens and creates a strong odor in the sterilization area. The wrap is a neater package that avoids this problem.

Spaulding's Classification of Inanimate Objects

A) Critical Items B) Semi-Critical Items C) Non-critical Items D) Environmental & Touch Surfaces

Part II Pre-Cleaning

All instruments must be pre-cleaned before initiating the sterilization process.

Control Vial

Always incubate a control vial along with the sterilized vials. Control vial does not go through the sterilization process and should therefore show spore growth. The control vial tells you there were spores present before the sterilization process.

External Indicators Paper and peel-vue bags have external indicators on them.

Autoclave tape also has markings that change color do not indicate that sterilization has occurred they only verify that the package was exposed to heat. very sensitive to the heat

Disadvantages to steam under pressure

Can corrode instruments Damages/melts plastics and rubber Can dull sharp instruments Packages are wet at the end of the cycle and packaging can tear Can't use it to sterilize closed containers

Advantages to Using Ethylene Oxide

Can sterilize many types of materials Is reliable Low temperature Can be monitored

Touch  Surfaces

have no contact with the patient but can become contaminated because the clinician touches them during treatment. should also be covered with an impervious barrier. Examples include: light handle, light switch, control center, paddles on the clinician's stool, pens, pencils, clipboard, keyboard and mouse, etc.

Semi Critical Items

Contact soft tissues, mucous membranes and non-intact skin but do not enter the bloodstream Examples include: bite blocks used when placing film, intraoral mirrors, handpieces, impression trays, tip to the curing light

Part V Quality Assurance

Document the results of weekly biological testing as well as the results of the monthly testing on the ultrasonic unit in a "Quality Assurance Log" is essential.

Thermal Disinfectors

Excellent choice for cleaning cassettes without risk of injury Can hold more instruments than the ultrasonic cleaner No water on countertop from rinsing (since there is no need to rinse items upon removal from unit) An expensive unit to buy and hard water must be treated Has a basket for loose items Chemicals are added to these units so the items are "disinfected" during the process. washer rinses the instruments with very hot water.

semi critical items are

heat sterilized just like critical items but there are two additional options since these items do not penetrate tissue or contact the bloodstream a) place an impervious barrier over the item before use and change for each patient b) use a disposable or 'one time' use item (bite blocks and impression trays are 2 examples)

DRY HEAT CONTINUED

least expensive used for instruments that can't withstand steam under press NO CORROSION good for carbon steel scalers/curets

mechanical monitoring

look at the autoclave's temperature and other gauges during the sterilization cycle

NON CRITICAL If no blood is visible, a

low level disinfectant can be utilized to clean the surfaces.

touch surfaces should be cleaned with a

low level disinfectant such as ammonia on a periodic basis.

PART III  INSTRUMENT PACKAGING Purpose: We package instruments so we can

maintain the sterility of the items once they are removed from the autoclave. Packages protect items from aerosols and dust during storage.

ultrasonics must be tested on a ..... Findings should be documented in the office's.....

monthly basis to ensure it is functioning properly Quality Assurance Log in the event of an OSHA visit

can all instruments be place in ultrasonic cleaner

no can be destroyed.

ultrasonic cleaning

not a substitute for sterilization mix free solution every morning doesn't contain disinfectant merely just a cleaning process to loosen debri always wear poe dont overload always cover

foil test results Entire surface should be covered with dimples/pebbling; if an area greater than ½ inch square shows no dimples/pebbling than

one or more zones of the unit are not functioning properly; and the unit must be repaired before further use

biological testing

paper strips or vials containing bacterial endospores are sterilized with other instruments to ensure all spores are destroyed during the sterilization process.

reusable bags

FDA approved. You will purchase two Enviropouch reusable bags, one for your sterimate handpiece and one for the sheath of handpiece. These bags can be sterilized 200 times before discarding. This parameter varies with different companies so always check directions when ordering. There is sometimes a grid on the package that you check each time it goes through a sterilization cycle so you know when to discard.

psi means

pounds per pressure

DRY HEAT INSTRUCTIONS

pre clean single layer don't stack close door don't open mid cycle warm up for 30 mins

When a body fluid, such as vomit, that might contain blood is found on an environmental surface the area should be

pre-cleaned with a low level disinfectant and then disinfected with diluted chlorine bleach.

Loading Autoclave

Heavy items, such as cassettes, should be on the bottom trays with light packages on top. Bags should not be piled on top of one another. Stagger them or build a pyramid so the steam can move about all of the packages. sterilizing glass jars, lay them on their side so the steam can move in and out of the jar.

StatIM "flash sterilizer

quick turn around distilled water immediate use

removal of interments

rinse dry throughly before packaging inspect for cleanliness and you package

What if there is only a faint color change? red flag should go up if this occurs since that indicates one of the following errors most likely occurred:

Improper temperature or time Autoclave was not preheated (always run the first load of the day a little longer since the autoclave is cold from sitting all night) There was a poor seal on the door. (very often this occurs when a bag gets caught between the gasket & the chamber) Autoclave was overloaded so steam was unable to penetrate all packages

Advantages of Ultrasonic Cleaning

Increased efficiency Reduced danger Improved effectiveness for sterilization Reduced spread of microbes

internal indicators

It ensures the instruments in the package have been exposed to the sterilization process. are multi parameter indicators because they will show the autoclave was run for proper time and reached proper temperature. removed from the package in front of the patient.

Non Critical Surfaces

Items or medical devices that come into contact with intact skin but no mucous membranes or oral fluids Examples include: x-ray head/cone, blood pressure cuff and stethoscope, pulse oximeter used when administering nitrous, patient safety glasses, etc

Critical Items

Items that penetrate soft tissues, contact bone or enter into the bloodstream Should be discarded or heat sterilized Examples include: scalpels, burrs, needles, syringes, probes, scalers and curets

Disadvantages of Using Chemical Sterilants

Limited use and reuse life Good ventilation required Must rinse with sterile water after cycle; and items do not retain sterility after removal from solution Time consuming Can corrode items Cannot be biologically monitored

Disadvantages of Using Ethylene Oxide

Long processing hours so time consuming Expensive Toxic Requires ventilation because of gaseous exhaust Must air out plastic, rubber, & cloth for several hours before use

disadvantages of dry heat

Long sterilization cycle required for Static Air Requires 15-30 minutes for unit to warm up Can damage plastics Chars packages (if used) and discolors fabric Loose instruments not sterile once door opened Damages plastics/rubber and cannot sterilize liquids