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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
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