Ch.21 Instrument Processing

What are the 7 steps of instrument processing?

1. Transport

2. Cleaning

3. Packaging

4. Sterilization

5. Storage

6. Delivery

7. Quality assurance

What are critical instruments?

Touch bone/penetrates soft tissue

• Must be sterilized

• Ex: forceps, scalpels, bone chisels, scalers, burs

What are semicritical instruments?

Touch mucous membranes but do not penetrate

• Sterilize or use high-level disinfectant

• Ex: dental mirrors, amalgam condensers

What are noncritical instruments?

Contact intact skin

• Clean with intermediate/low-level disinfectant

• Ex: lead apron, X-ray head

What are examples of PPE for processing instruments?

• Utility gloves

• Mask

• Protective eyewear

• Protective clothing/lab coat

What are the instrument processing areas?

• Clean areas - preparation, packaging, sterilization, storage

• Contaminated area - soiled instruments held, cleaning must remove all debris/bioburden

What is a holding solution?

Used if instruments can’t be cleaned immediately

• Prevents drying of blood/debris

• Must be labeled biohazard + chemical

• Change 1-2x daily or when cloudy

What is hand scrubbing?

Least preferred due to high injury risk

• Use puncture resistant gloves/PPE

• Clean 1-2 items at a time with long-handled brush

What are ultrasonic cleaners?

Preferred method using sound waves to loosen debris

• Use proper solution

• Replace daily or when cloudy

What is proper packaging for sterilization?

Use FDA-approved wraps/pouches

• Insert indicator inside if not visible

• Label with date + sterilizer ID

What is steam autoclave sterilization?

Uses moist heat under pressure to sterilize instruments

What is flash sterilization?

Steams unwrapped instruments for quick sterilization

• Used for immediate use only

What is chemical vapor sterilization?

Uses chemical vapor (formaldehyde/alcohol) under pressure instead of water

What is dry heat sterilization?

Uses heated air either:

• static air = slower

• forced air = faster

What is liquid sterilant?

Instruments are immersed in liquid chemical solution for several hours

• used for heat-sensitive items

What are 5 results of sterilization errors?

• Improper cleaning

• Improper packaging

• Overloading

• Wrong time/temp/pressure

• Sterilizer malfunction

What is a Safety Data Sheet (SDS)?

Info sheet for each hazardous chemical

• lists hazards, handling, PPE

• Must be accessible to staff

What are 6 ways to monitor sterilization?

1. Physical - Record gauges, time, temp, pressure

2. Chemical - Heat-sensitive tapes/strips

3. Process indicators - external only

4. Single-parameter indicators: Measure one factor

5. Process integrators - Measure time/temp/pressure

6. Biological (spore test)- only TRUE proof, weekly

What are key points of handpiece sterilization?

• Must be heat sterilized

• Not disinfected with chemicals

What is the flushing technique for handpieces?

Flush water/air 20-30 sec after patient

What are the steps for for hand piece sterilization?

• Hand piece sterilization

  • Must be heat sterilized between patients

• Flushing tecnique

  • Flush with air and water for 20-30 seconds

• Sterilization

  • Lubricate per manufacturer

  • Package in pouch

  • Autoclave

What are the 14 steps to sterilize a dental handpiece?

1. With handpiece attached & bur in chuck, wipe debris, run 10-20 sec to flush

2. Remove bur

3. Disconnect handpiece

4. Rinse exterior under running water

5. Dry with air or gauze

6. Apply cleaner (per manufacturer)

7. Blow out cleaner with compressed air

8. Apply lubricant

9. Run briefly to distribute

10. Wipe away excess lubricant

11. Package in pouch/wrap

12. Seal/label with date and sterilizer ID

13. Autoclave, run full cycle

14. Allow to cool/dry before use/storage