Podcast
Questions and Answers
What is one disadvantage of using autoclaving as a sterilization method?
What is one disadvantage of using autoclaving as a sterilization method?
Which method of sterilization functions effectively at low temperatures?
Which method of sterilization functions effectively at low temperatures?
What is a common mistake made during the sterilization process?
What is a common mistake made during the sterilization process?
Which of the following is an advantage of chemical vapor sterilization?
Which of the following is an advantage of chemical vapor sterilization?
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Why is less than 10 hours of immersion not considered sterilization in chemical liquid sterilization?
Why is less than 10 hours of immersion not considered sterilization in chemical liquid sterilization?
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What is the primary reason for using forceps to remove instruments from the chemical solution?
What is the primary reason for using forceps to remove instruments from the chemical solution?
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What does physical monitoring primarily assess during sterilization?
What does physical monitoring primarily assess during sterilization?
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Which type of monitoring is the only definitive way to confirm the sterility of instruments?
Which type of monitoring is the only definitive way to confirm the sterility of instruments?
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What is the role of external and internal chemical monitoring?
What is the role of external and internal chemical monitoring?
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How are biological indicators monitored during sterilization cycles?
How are biological indicators monitored during sterilization cycles?
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Before sending impressions to a dental lab, what critical step must be taken to avoid contamination?
Before sending impressions to a dental lab, what critical step must be taken to avoid contamination?
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What is a common misconception about physical monitoring indicators?
What is a common misconception about physical monitoring indicators?
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What precautions should be taken when trimming models in a dental laboratory?
What precautions should be taken when trimming models in a dental laboratory?
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What is the primary purpose of a holding solution for contaminated instruments?
What is the primary purpose of a holding solution for contaminated instruments?
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Which of the following instruments is classified as critical according to Spaulding's classification?
Which of the following instruments is classified as critical according to Spaulding's classification?
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What is a key advantage of ultrasonic cleaning over manual cleaning?
What is a key advantage of ultrasonic cleaning over manual cleaning?
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What should be done if instruments show visible debris after inspection?
What should be done if instruments show visible debris after inspection?
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Which cleaning method is prohibited by the CDC for instrument processing?
Which cleaning method is prohibited by the CDC for instrument processing?
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Why should disinfectants not be used in ultrasonic cleaners?
Why should disinfectants not be used in ultrasonic cleaners?
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What happens at the end of the cycle in an automated washer?
What happens at the end of the cycle in an automated washer?
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What is an important step during the inspection of instruments after cleaning?
What is an important step during the inspection of instruments after cleaning?
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Study Notes
Instrument Processing Workflow
- Receiving contaminated instruments
- Sorting instruments
- Dispose of unwanted instruments
- Holding solution: Used when instruments aren't cleaned immediately to prevent drying of blood and debris.
- Cleaning instruments
- Packaging cleaned instruments
- Sterilizing instruments
- Storage
- Full PPE should be worn during the instrument processing workflow
Sorting Contaminated Instruments
- Wear thick, non-puncture gloves.
Holding Solution
- Only used if instruments are not cleaned immediately.
- Prevents drying of blood and debris.
- Holds an enzymatic solution that dissolves organic debris.
Spaulding's Classification
- Critical Instruments - Penetrate soft tissue or bone. Examples: forceps, scalpels, scalers, burs.
- Semi-Critical Instruments - Touch mucous membranes or non-intact skin. Examples: mouth mirror, high-volume suction, amalgam condensers.
- Non-Critical Instruments - Intact skin contact. Examples: x-ray tubes, lead apron.
Methods of Cleaning Instruments
- Instruments must be cleaned before sterilization.
- Hand scrubbing – Not approved by the CDC.
- Ultrasonic cleaning – Recommended by the CDC.
- Instrument washing machines/thermal washers - Recommended by the CDC.
Hand Scrubbing of Instruments
- Wear full PPE.
- Only clean one or two instruments at a time.
- Use long-handled brushes to clean instruments.
- Allow instruments to air dry. Never rub or roll in a towel as this risks injury.
Ultrasonic Cleaning of Instruments
- Actions loosen and remove debris on instruments.
- Advantages include reduced risk of injuries while cleaning and no aerosol production.
- Always wear PPE when working with the ultrasonic cleaner.
- Use forceps to place and remove instruments from the liquid.
Ultrasonic Solutions
- Solutions have enzymatic activity to prevent the growth of microorganisms (MOs).
- Never use disinfectants in the ultrasonic cleaner as they fixate blood, saliva, and debris.
- Solutions in the ultrasonic cleaner are highly contaminated – clean and replace the liquid daily.
Ultrasonic Cleaning (Cont.)
- Ultrasonic cleaning produces sound waves that travel from the base plate to the liquid.
- Bubbles called ‘cavitations’ form in the liquid.
- Bubbles burst inward (implosion) to remove debris.
- Cleaning duration should be between 5-15 minutes depending on the amount of debris
Automated Washers to Clean Instruments
- Automated washers + disinfectant + HOT water = thermal disinfecting.
- Instruments are NOT STERILE at the end of a thermal disinfecting cycle.
Preparation and Packaging of Instruments After Cleaning
- Inspect instruments for debris or blood. If visible debris, start the cleaning process again.
- Inspect all hinged instruments (e.g., scissors, forceps).
- Assemble trays or instrument holders.
- Wrap and seal.
- Cleaned instruments are NOT sterile.
Why Instrument Packaging?
- Prevents contamination after sterilization:
- via aerosols and dust in the atmosphere.
- Handling and contact with non-sterile surfaces.
Sterilization Methods
- Steam autoclave
- Dry heat
- Chemical vapor
- Ethylene oxide sterilization
Autoclaving
- Advantages:
- Short cycle (15-20 minutes).
- Steam penetration is good with approved packaging materials.
- Disadvantages:
- Can damage some plastic and rubber items.
- Requires use of distilled water.
- May rust metal instruments and burs.
- Closed containers cannot be autoclaved.
Dry Heat Oven
- Heated air transfers heat to instruments and equipment.
- 160-190 degrees Celsius for 1-2 hours.
Chemical Vapor
- Very similar to autoclaving but uses chemicals instead of water.
- Chemicals include alcohol, formaldehyde, ketone, acetone, and water – heated.
- Chemicals are toxic. Refer to safety data sheets.
- Advantages:
- Does not rust or dull instruments.
- Short cycle.
- Instruments are dry after the cycle.
- Disadvantages:
- Requires adequate ventilation because of toxic fumes.
- Has an odor.
Ethylene Oxide Sterilization
- Functions at a low temperature.
- Sterilizes plastics, rubber, and linen.
- 4-12 hour cycle.
- 16 hours post-sterilization aeration.
- Used in larger institutions/hospitals.
Packaging Materials for Sterilization
- Various materials exist including paper, plastic, and Tyvek.
Mistakes Made During Sterilization
- Using tap water in the autoclave
- Not cleaning the sterilizer
- Interrupting the cycle
- Not monitoring the sterilization process
Chemical Liquid Sterilization
- Less than 10 hours of immersion is not accepted as sterilization but only as disinfection.
- Cannot monitor the efficacy of the sterilization process.
- Specific procedures must be followed.
Cold Sterilization
- Water should be distilled water to mix the solution.
- Instruments should be washed and dried before placing in the solution.
- Instruments should be placed into the chemical using forceps.
- Instruments should remain in the solution for 10-12 hours.
Sterilizing Monitoring
- Quality assurance process to determine if instruments are sterile after the sterilization process:
- Physical monitoring
- Chemical monitoring
- Biological monitoring
Physical Monitoring
- Monitors gauges and readings on the equipment:
- Temperature
- Pressure
- Exposure time
- Does NOT guarantee sterilization.
- Usually the first indication of incomplete sterilization.
Chemical Monitoring
- External and internal.
- Uses heat sensitive chemicals that change color when exposed to certain conditions, e.g., temperature.
- Indicates instruments have been exposed to peak temperature for a specific time. Does not guarantee sterility.
Biological Indicators
- Spore testing – Only way to determine if instruments are sterile.
- Vials contain harmless bacterial spores.
- Spores are highly heat resistant.
- 3 BI per cycle (2 inside, 1 outside).
- All BI cultured post exposure to sterilization.
- Positive reading (failed sterilization cycle) – review sterilization process and/or check equipment.
- Negative reading (successful cycle).
Dental Laboratory Asepsis
- Dental prostheses, appliances, and items used in fabrication are potential sources of cross-contamination.
- Ensure impressions are disinfected before sending to the dental lab.
- Provide a written note informing the lab staff of the disinfection method.
- Use PPE such as eyewear and masks when trimming models.
- Appliances and prostheses delivered to the patient should be free of contamination and disinfected.
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