Instrument ProcessingDA 116 Infection Control

Instrument Contamination Levels:

• 1. _______________

• 2. _____________________

• 3. _____________________

Critical Instruments

– _______________________________________________

– Ex. Forceps, scalpels, scalers, dental burs

After each use:

_________________all these instruments

Semi-Critical Instruments ________________________________________________________________

__________________________________________________• mirrors, amalgam condensers, x-ray film and digital sensor holders and high and low speed handpieces• Use high-level disinfection with all lab materials used in the mouth

After each use:

Sterilize all that are heat resistant Use disposable items or high-level disinfection/cold sterilant

on others ***Do not reprocess or reuse any disposable items!

Non-Critical Instruments

• _______________________________________________________________________– Ex. X-ray Heads, Light handles, BP cuff

Use intermediate or low level disinfection agent Floors and walls: okay to clean if no blood contamination If an item is visibly contaminated

with blood, choose intermediate level disinfection

Transporting Items to Sterilization Center

____________________for used instruments:

– In operatory or (more commonly) sterilization center

– Enzymatic properties– ________________________

________________________________________

Transport contaminated Instruments

– from the point of use – in a ____________________– to the initial receiving area of

the sterilization area

• Instrument Processing Area • DHCP should process all instruments in a designated

central processing area to more easily control quality and ensure safety (248). The central processing area should be divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. Ideally, walls or partitions should separate the sections to control traffic flow and contain contaminants generated during processing. When physical separation of these sections cannot be achieved, adequate spatial separation might be satisfactory if the DHCP who process instruments are trained in work practices to prevent contamination of clean areas (248). Space should be adequate for the volume of work anticipated and the items to be stored (248).

Which do you think is the correct choice?

#2 is CORRECT!

2

1

_________________________• Instrument processing area

– well-designed and conducive to accomplishing the multiple steps to achieve sterilization or high-level disinfection.

____________:receiving and decontaminatingrinsingdryingpackaging

_______________:sterilizationsterile storage

• ________________________________– remove bioburden from instruments– Place dental burs in a bur basket before placing them in

the ultrasonic cleaner• Mechanical methods– _______________________

• ___________________ (ultrasonic sounds waves create bubbles that implode cause an unseen scrubbing action)

• 10 minutes• Change solutions daily• Aluminum Foil test

– __________________

_________________

BE CAREFUL!

DO THIS! NOT THIS!

________________________

• Require special handling due to internal mechanical parts

• Flush for ________________at chairside

• Remove bur• Clean outer surface with handpiece

wipe• Lubricate according to

manufacturer’s instructions• Wipe off excess lubricant • Package and heat sterilize• Some handpieces must be

lubricated after sterilization; check manufacturer’s directions

Manual and automatic methods are available

Packaging

_______________________• Permeable so steam can

reach instruments• Appropriate for specific

sterilizer

_________________________• Plastic or metal

– Perforated so steam can penetrate

• Less instrument handling reduces risk of percutaneous injury

• Can go into ultrasonic and autoclave• Must be wrapped for autoclave and

storage

Loading the Sterilizers

• Wrap securely• Hinged instruments open• Do not overfill

Methods of Sterilization:

• Process by which all forms of organic life are destroyed by physical or chemical means

• Steam under pressure Autoclave• Dry Heat Sterilization• Chemical under pressure (Chemical Autoclave or

Chemiclave)• EPA registered disinfectant/sterilant; also called

“cold sterilization” least preferred method• Always best to use heat sterilization

Monitoring the Sterilizer

• __________________– Treated indicator (inside package) or tape (outside package)– Indicates that items have gone through the sterilization process

• DOES NOT GUARANTEE STERILITY

• _________________________(weekly per CDC)– Live bacterial spores– Autoclaves/chemical vapor:

• Bacillus Stearothermophilus or Geobacillus Stearothermophillus

– Dry heat/ethylene oxide:• Bacillus Subtilis or bacillus atrophaeus

• ____________________________– Monitor gauges for times, temperatures, cycles– Check and keep print-outs if available

Storage

• Keep sterile items and disposable items – Covered, enclosed area (not under a sink)– Keep packages/cassettes wrapped and unopened until use

• Do you need to re-sterilize?– Per CDC, wrapped items are

sterile indefinitely– Re-sterilize if it becomes

contaminated (i.e. wet, torn)– Some offices date each package

and rotate use according to dates