Ch21 sterilization

DENA 54

What are the seven steps for instrument processing?

Transport, Cleaning, Packaging, Sterilization, Storage, Delivery, Quality assurance program

What should an effective quality assurance program incorporate?

Training, Record keeping, Maintenance, Use of biologic indicators

What are the classifications of patient care items?

Critical instruments, Semicritical instruments, Noncritical instruments, PPE

What are critical instruments?

Instruments used to penetrate soft tissue & bone, must be sterilized

Give examples of critical instruments.

Scalpels, bone chisels, scalers & burs

What are semicritical instruments?

Instruments that come in contact with oral tissues but do not penetrate soft tissue or bone, can be sterilized or high-level disinfected

Give examples of semicritical instruments.

Mouth mirrors, amalgam condensers, alginate impressions

What are noncritical instruments?

Instruments that only contact intact skin, can be placed in intermediate to low-level disinfectants

Give an example of a noncritical instrument.

X-ray heads

What are the three basic ways to reduce the transfer of organisms between patients?

Sterilization, Disinfecting, Cleaning/sanitizing

Why is adequate sterilization and disinfection important?

To protect the well-being of dental patients and dental staff

What personal protective equipment should always be used when processing instruments?

PPE including utility gloves

Can utility gloves be decontaminated, sterilized, and reused?

Yes

What are the two areas involved in transporting/processing contaminated patient care items?

Contaminated area and sterilized area (clean)

What should you never do with contaminated instruments?

Place them in the clean area.

How should contaminated instruments be transported?

In a manner that minimizes the risk of exposure, using appropriate PPE and a rigid, leak-proof container.

What are the different areas in the instrument-processing area?

Clean area, workflow pattern, contaminated area, preparation and packaging area.

What are the steps involved in pre-cleaning and packaging instruments?

Holding solution, hand scrubbing, ultrasonic cleaning, automated washer/disinfectors, drying, lubrication, corrosion control, packaging instruments, sterilization of unwrapped instruments.

What are the sections in the cleaning process?

Contaminated section, clean section, ultrasonic

What is an ultrasonic cleaner used for?

Cleaning contaminated instruments and items.

What should be worn when working in the contaminated section?

Utility gloves and safety eyewear.

What is a holding solution used for?

To prevent bioburdens from becoming dry on contaminated instruments.

What precautions should be taken when handling sharps?

Never take your eyes off the sharp, accidents can happen even when taking out the sterilizer, and there should be a sharps container in each treatment room.

What can happen if blood or dental materials remain on instruments after ultrasonic cleaning?

They can become a protective barrier for pathogenic organisms.

What color is the puncture-resistant container for sharps?

Red

What is the least desirable method of cleaning instruments?

Hand scrubbing

What protective eyewear should be worn during hand scrubbing?

Goggle-type eyewear

What type of gloves should be worn during hand scrubbing?

Puncture-resistant gloves

What should be worn during hand scrubbing to protect clothing?

Protective clothing

Which direction should instruments be scrubbed away from?

Away from your body

How many instruments should be scrubbed at a time?

One or two

Is ultrasonic cleaning more effective than hand scrubbing?

Yes

What does ultrasonic cleaning do to instruments?

Loosens debris

What is the purpose of ultrasonic cleaning?

Minimizes handling of soiled instruments

Which instruments should not be placed in the ultrasonic cleaner?

Dental handpieces

What type of solution should be used for ultrasonic cleaning?

General purpose cleaner solution

How should items be immersed in the ultrasonic cleaner?

Completely

Where should dentures and partials be cleaned?

In a jar with general all-purpose cleaner solution

What does the aluminum foil test determine?

If the ultrasonic cleaner is working properly

What does the holding bath (pre-cleaning) do?

Removes gross soil

Does ultrasonic cleaning replace other means of sterilization?

No

What happens to carbon steel instruments and burs during steam sterilization?

They rust

What cause ultrasonic cleanser?

Cavitation and implosion, implosion

Which sterilization methods do not rust carbon steel instruments and burs?

Dry heat or chemical vapor sterilization

What are the two areas in the sterilization processing room?

Contaminated area and sterilized area

What should be worn in the sterilization processing room?

Full PPE, including utility gloves

Where should contaminated instruments never be placed?

In the clean area

In the clean are, Instruments be wrapped/package in what materials?

In appropriate materials

What should be placed inside the package next to the instruments?

Chemical indicator

What should be done if an indicator is not visible on the outside of the package?

Place an external process indicator on the package.

What are suitable packaging materials for sterilization?

Biofilm and paper bags.

What should be done before sterilization?

Precleaning, rinsing, and drying.

What are some examples of items that can be placed in a sterilizer?

Instruments, sterilized instrument tray set ups.

What can instruments be grouped into for packaging?

Special setups.

What are some characteristics of biofilm packaging materials?

Different sizes, small ones are for burs, sealant, and they are see-through.

What can be found in the clean section?

Sterilizers, sterilized instruments, sterilized instrument tray set ups.

What is another name for sterilization of unwrapped instruments?

Flash sterilization.

When should flash sterilization be used?

Only under certain conditions, when instruments are needed immediately.

What are the 6 major methods of sterilization?

Steam under pressure sterilization, steam (flash) autoclave sterilization, unsaturated chemical vapor sterilization, dry heat sterilization, rapid heat sterilization, liquid chemical sterilization.

What instruction should you follow to operate sterilizer?

Follow the manufacturer's instructions.

What should be done before removing packages from the sterilizer?

Allow them to cool.

What can be used to handle hot packages?

Sterile forceps or hot pads.

What is the most effective method of infection control for critical and semi-critical instruments?

Sterilization.

What happens to all forms of microorganisms during sterilization?

completely destroyed.

What is the dental assistant's responsibility in sterilization?

To ensure proper sterilization of items that touch the skin or mucosa, or are used in invasive procedures.

What choices are available for sterilization?

Several choices.

Who decides which method to use for sterilization and disinfection?

The DDS (dentist).

What is the best method of sterilization?

Autoclave

What is the temperature and pressure for steam under pressure sterilization?

249.8 F (121 C), 15 psi

What are the advantages of steam under pressure sterilization?

10-30 minutes, good penetration of steam, commonly used in dental offices, easily monitored

What are the disadvantages of steam under pressure sterilization?

Rusts nonstainless (carbide) steel instruments & burs, 15 min. drying cycle, corrosive effect on carbide steel

What instruments can go into the autoclave?

Surgical burs, all surgical instruments, stainless steel instruments, dental rotary handpieces

What is the temperature for steam (flash) autoclave sterilization?

270-273 F (132C)

What are the advantages of steam (flash) autoclave sterilization?

Easily monitored, sterilized in 3 min unwrapped

What are the disadvantages of steam (flash) autoclave sterilization?

Instruments should be used promptly, requires distilled water

What is the temperature for chemical vapor sterilization?

270F (132C)

What are the advantages of chemical vapor sterilization?

20 min to sterilize, very reliable & easily monitored, no corrosion on carbide & non-stainless steel

What are the disadvantages of chemical vapor sterilization?

Requires formaldehyde & alcohol, must be vented, instruments must be thoroughly dry before sterilizing

What instruments can go into chemical vapor sterilization?

Carbon steel/non-stainless steel, surgical burs, surgical instruments, stainless steel instruments

What is the purpose of physical monitoring?

Ensures proper tech & operation

What should be maintained for each sterilizer?

Records

What are biological monitors?

Most accurate way to assess sterilization occurred

How are biological monitors utilized?

Utilize harmless spores

How often should biological monitors be verified?

Weekly

What should be done if a positive report is received from biological monitoring?

Corrective procedures must be taken immediately

What are process monitors?

Printed on packaging or indicator tape

What happens to process monitors when exposed to correct heat?

Changes color

Do process monitors indicate sterilization has taken place?

No

Where are records of all biological monitoring kept?

On file as part of the documentation of the practice's 'Infection Control Program'

What is physical monitoring?

Looking at gauges and readings

What is chemical monitoring?

Heat sensitive

What do process indicators indicate?

That the package has been processed

Where are process indicators placed?

Outside on the package, autoclave tape

What do process integrators respond to?

Combination of pressure, temperature, and time

How often is biological monitoring done?

Weekly

What does biological monitoring verify?

Sterilization is happening

What is another name for biological monitoring?

Spore test

What must be followed for handpiece sterilization?

Manufacturers instructions

What may be lodged in the head of the handpiece?

Blood, saliva, tooth fragments, and dental materials

Can the handpiece be emerged in liquid?

No