[STUDY] Sterilization and Disinfection of Patient-Care Items in Oral Healthcare Settings

Sterilization

• Kills all organisms including spores

Example

• Steam autoclave

• Dry heat

• Chemical sterilants

Levels of disinfectants

Kills bacteria, viruses, fungi, mycobacteria — not spores

High level

• Heat sensitive items

Intermediate level

• Clinical contact surfaces

Low level

• Kills vegetative bacteria, some viruses n fungi

Germicide

Includes

• Disinfectants

  • Dont use on skin

• Antiseptics

  • Use on skin, never on surfaces

Disinfectant → Dead things

Antiseptic → Alive things

Spaulding classification

Critical

• penetrate tissue, bone, blood

• High infection risk

• Sterilized

Semi critical

• Touch mucous membrane

• Doesnt penetrate

• Lower infection risk

• Dental hand pieces must be sterilized

Non critical

• Intact skin

• Never touched mucous membrane or tissue

EPA Disinfect Lists B, E, N

B and E — Tuberculocidal

N — Good against Sarscov2

Sterilization methods

Heat tolerant instruments

• Steam

• Chemical vapor

• Dry heat (dmged by moisture)

  • Long process & high temp

  • Not rec

  • Static air = oven

  • Forced air

Heat sensitive

• Erhylene oxide — low temp

• Hydrogen peroxide

• Chemica sterilants

  • Criticals: (immerse for 3—12 hrs in liquid germicide)

  • Semi criticals (High level disinfection)

  • Non critical (Tuberculocidal disinfect)

Central processing area (CPA)

Station 1

• Receiving and cleaning

• PPE and ultrasonic cleaner preferred

  • Less sharps injury, manual cleaning discouraged

Station 2

• Package, internal and external indicators

• Label

Station 3

• Sterilization

• Don’t overload

Station 4

• Clean, dry, closed cabinet

Flash sterilization

For immediate use only — unwrapped

Don’t store afterwards

Not rec for implants

Types of autoclave

• Gravity displacement

  • Steam enters and air pushes out naturally

  • Doesnt work if overloaded

• High speed prevacuum

  • Removes air first

  • Steam enters

Chemical vapor sterilization

• Uses alcohol

• Less corrosion

• Good for burs

• Instrument must be dry

Dry heat sterilization

• For items damaged by moisture

• Burs/ orthodontics

• Doesn’t rust instruments

Long cycles and high temp

Low temperature sterilization

• Heat sensitive instruments

• Ethylene oxide gas

• Used in hospital

• Not used in dental office — takes 10—48 hrs

Transporting dirty instruments

• Sealed container

• Leak proof

• Biohazard

• PPE

Quality assurance

Physical

• Time

• Temp

• Pressure

Chemical

• Placed outside or inside packages

• Class 1 — Outside (process indicator)

• Class 2 — Test air removal / Bowie dick

• Class 3 — measures time and temp

• Class 4 — Measures more variables

• Class 5 — Measures critical variables and biological indicator

Biological indicator (Spore test)

• Gold standard

Steam sterilizers use

• Geobacillus

Heat uses

• Bacillus atroph

quaratined until spore test is negative

If positive = must service/ repair until pass 3 tests

Maintenance record — 3 years