Principles of Sterilization - PowerPoint Presentation

Slide1

Principles of Sterilization

Navy Reserve Dental Corps

Infection Control Program

Slide2

Sterilization

The complete elimination or destruction of all living organisms

Slide3

Categories of Patient Care Items

Critical

:

Penetrate soft tissue or bone or enter bloodstream or other sterile tissue. Ex: forceps, scalpels, bone chisels,

scalers

,

perio

probes

Semi-Critical

:

Do not penetrate soft tissue or bone but contact mucous membranes or non intact skin. Ex: mirrors, amalgam

condensers

Non-Critical

:

Come into contact with intact skin.

Ex: x ray head, blood pressure cuff

Slide4

CRITICAL

SEMICRITICAL

NONCRITICAL

Penetrates soft tissue or bone

Contacts mucous membrane or non intact skin

Contacts intact skin

Sterilization

Sterilization or high level disinfectant. Sterilization is

BEST practice

Low to intermediate level disinfection

Surgical instruments,

perio

scalers

, dental burs,

perio

probes

Mouth mirror, amalgam

carrier, dental hand pieces

X ray head / cone, blood

pressure cuff, face bow

Slide5

Periodontal Probes

are Critical

instruments as they penetrate soft tissue

MUST

be sterilized before use per CDC

guidelines

Slide6

Kerr Single Use, Pre Sterilized…Why is it better?

Ready-to-use.

 Minimizes tray set-up time.

Hygienic.

 Single-use, eliminates cross-contamination issues.

Convenient.

 Excellent for routine use, especially during busy surgery times, staff shortages,

autoclave breakdowns, home visits and for high-risk patients.

PRE -STERILIZED

Time-saving.

 Reduces time spent sterilizing and handling sharps.

Cost-effective.

 Increases productivity and reduces inventory.

Slide7

What is wrong with I

Paks

?

They are

NOT STERILE

!

As part of a standard T2 exam dental probe depths need to measured, and the probe is a

critical

instrument…

it MUST be sterile.

Slide8

Processing of Instruments

All critical and semi critical dental instruments that are heat stable should be sterilized after each use by steam under pressure (autoclaving), dry heat or chemical vapor.

Before treatment instruments should be cleaned so that they are free of debris.

Enzymatic and non enzymatic solutions facilitate instrument cleaning.

Slide9

Instrument Processing

A group of activities that when done in the correct sequence, in the right environment, with the correct materials, and using the appropriate procedures, results in the sterilization of instruments.

Slide10

Consider work flow when planning

Proper work flow prevents error

Receive and Clean

Rinse and Pack

Sterilize

Clean, Dry Storage

Slide11

Instrument Processing Area

Use a designated processing area to control quality and ensure safety

Divide the working areas:

Receiving, cleaning, decontamination

Prep and packaging

Sterilization and Monitoring

Storage

Slide12

Cleaning of Instruments

Use appropriate PPE: eyewear, heavy duty utility gloves, gown, face protection

Rinse / ultrasonic and DRY before packaging

Follow manufacturer’s guidelines for use of ultrasonic.

Use the proper amount of solution and proper time

Cover the unit with lid when in use

Slide13

Wear Proper PPE. Heavy duty puncture resistant utility

gloves

Eyewear, gown and mask

Heavy duty gloves should be worn when handling contaminated instruments.

Instruments

should soak in water or disinfectant / detergent as soon as possible after use to prevent drying and caking of debris

Instrument

cassettes and mechanical cleaner (ultrasonic device) may be used to reduce direct handling of contaminated instruments

Cleaning of Instruments

Slide14

-Applying rust inhibitors will protect instruments from corrosion that may result from autoclaving

.

-Packaging rinsed and dried instruments before sterilization protects them from contamination after they are removed from the sterilizer and during transport chair side or to storage

.

-Single

use instruments are acceptable for use if used only once and disposed of correctly.

Cleaning of Instruments

Slide15

Degassing

Degassing is the removal of large air bubbles found in all fresh solution, which act as a barrier to effective cleaning

**Degassing is needed each time new solution is added**

Degas the solution by activating the unit for 15min before you add any items to be cleaned.

Slide16

Preparation and Packaging

Use a container system or wrapping compatible with the type of sterilization process used and that has FDA clearance

ALL instruments that enter the patients mouth should be wrapped

Open instruments at the chair, at time of use.

Slide17

Sterilization

Recommended for all critical and semi critical items

Must follow the manufacturer’s instructions for cleaning, lubrication, and sterilization to ensure the effectiveness of process

HEAT STERILATION:

Moist Heat-

steam under pressure, Autoclaving 250-273 degrees.

Dry Heat-Static or Forced Air

- No corrosion, uses dry heat 320-375 degrees

Unsaturated Chemical Vapor

-uses unsaturated chemical vapors from formaldehyde and alcohol, 273 degrees

Slide18

Steam Sterilization

Gold standard. Dependable, economical, heats rapidly, destroys most resistant bacterial spores in brief exposure

Indicated for heat stable instruments, device

Methods of steam sterilization differ in the mechanism used for air removal from the chamber

Slide19

Air Removal

Gravity Displacement

Dilution by mass flow

Dilution by pressure pulsing

High-vacuum sterilization

Pressure pulsing with gravity displacement (steam flush-pressure pulse)

Slide20

Gravity Displacement

Steam is admitted through a control valve

Steam forms stratified layer across the top of chamber

Steam mass displaces air via drain vent

Best for unwrapped or lightly wrapped material

Slide21

Steam-Flush Pressure Pulse

MOST effective air removal, using cycles of pressurization, air evacuation

Air is removed to a predetermined pressure

Steam is admitted

Air is removed my gravity displacement

Chamber is re-pressurized

Chamber air is evacuated

Steam in pack expands, removing all air load

Slide22

Steam Flush Pressure Pulse

Slide23

Air Removal Test

First cycle of every day

Indicates good air removal and airtightness

Cannot be performed during regular processing

Slide24

Dry Heat Sterilization

Static Air

Heat coils on bottom or side of sterilizers heat, causing hot air to rise in the chamber

Heat is transferred to the instruments and sterilization occurs after 1-2 hours of consistent heat contact

Forced Air

Circulation of the heat using a fan in the chamber

Transfer of heat to instruments occurs more rapidly

Sterilization time is approximately 12 minutes for wrapped instruments

Slide25

Dry Heat Sterilization

Good heat penetration

Non corrosive

But…diffusion and penetration of heat is slow

Can require an extended time

Requires high temperatures that can damage materials

Oxidation

Slide26

Unsaturated Chemical Vapor

Chemical vapor produced from solution containing formaldehyde, ethanol, or other

Vapors may be removed using a built in purge (older models require ventilation)

Waste liquid is a hazardous waste

Not preferred method

Slide27

More about Autoclaves

Water heated to form steam

Moist heat destroys the microorganisms

Air must be removed for the sterilization process to occur

4 steps: Heat Up Cycle, Sterilization Cycle, Depressurization Cycle, Drying Cycle

Slide28

Dental Hand Pieces

DO NOT

surface disinfect, use liquid chemical

sterilants

, or ethylene oxide on hand pieces and other instruments!

Follow the manufacturer’s instructions for cleaning, lubricating, and sterilization

Slide29

Steam Sterilizer

Loading

Allow for circulation

Dry non porous containers must be positioned so that water will not run out

Slide30

Sterilization Monitors

Physical

- cycle time, temperature, pressure

Chemical

- heat or chemical sensitive inks that change color when germicidal-related

Biological

- bacillus spores that directly measure sterilization

ALL 3 need to be done!!!

Slide31

Physical Monitoring

Monitor cycle time, temperature, and pressure

Observe gauges / displays

Review print-out from sterilizer if available

Error message will indicate an important parameter has not been met

Only one part of the monitoring process indicating only the condition in the chamber of the sterilizer

Slide32

Chemical Indicators

External Indicator

Provides visual of sterilization process

Internal Indicator

Visual

sterilant

penetrated the tray or pack

Slide33

Chemical Indicators

Internal

indicators MUST be included inside EACH sterilization package

External

Indicators MUST be used IF the internal indicator is not visible

Multiple types of indicators Class I-V for different units

STOP if indicator shows processing failure and DO NOT use instruments, reprocess prior to use

Slide34

Biological Monitors

Perform weekly

Types:

Steam –

Geobacillus

stearothermopholis

Dry Heat- B.

atrophaeus

Spore Tests are standard and are accepted for assuring sterility. They kill highly resistant micro-organisms, spores.

Slide35

Spore Testing

Only a biologic indicator consisting of resistant spores can measure the microbial killing power of the sterilization process.

IF the spores are killed then all other microorganisms are killed

Slide36

Sterilization Cycle Verification

Verifies process before a sterilizer is first used

Autoclaves should be tested with chemical indicator and biologic indicator prior to:

First use

Relocated (on AT)

After sterilization failure has occurred

After a major repair

RUN 3 CONSECUTIVE CYCLES and TESTS

Slide37

Why do we need to spore test?

Sterilizers fail spore tests for different reasons

Most often cause: operator error

cycle interrupted

incorrect package

overloaded

incorrect time or temp

Slide38

Positive Spore Test

Following a single positive biological indicator:

Remove the sterilizer from service and review sterilization procedures, is it operator error

Retest the sterilizer by using biologic, mechanical, and chemical indicators

Make sure to use the same cycle that failed

Repeat the spore test again, if negative the sterilizer may be placed back in service

Best to recall all instruments, not required

Slide39

Positive Spore Test

If REPEAT positive test:

-

DO

NOT USE until it has been inspected or repaired or the exact reason has been determined

- Recall

and reprocess all items since the last negative test

After repaired, re-challenge with biological indicator tests in

3

consecutive empty chamber cycles

Slide40

Causes of Sterilization Failures

Overloading- increases heat up time and prohibits agent to completely penetrate the load

Slide41

Causes of Sterilization Failures

Instruments loaded too closely together- agent not able to move about within the unit and may not be able to penetrate all packages

Incorrect packaging materials

Interruption if sterilization cycle

Incorrect operation of the sterilizer

Slide42

In the FieldGenerators may fail and power supply to sterilizer may be interrupted. Reprocess these instruments! Watch your unit!

Slide43

Documentation

Monitoring Log

Sterilizer identification number (serial # and model)

Load number

Duration and temperature of cycle

Contents of load

Record if charts, readings, printouts

Biological Monitoring

Maintenance Records

MUST keep a log!

Operators signature and name on log

Slide44

Biologic Monitoring Options

Multiple options: on site, mail in, university

Must have a control outside the sterilizer

Incubate both the control and the test vial

Should have bacterial growth in control sample

If the Control has no growth test is NOT conclusive and must be re-done

Slide45

Dispose of Spore Test

Must be no active spores

Autoclave the control or failed vials

Slide46

ATTEST

3M Attest 390 Rapid Auto Reader

Results in 3 hours

3M Attest 490 is a one hour auto reader, works with both Gravity and Pre-

Vac

Sterilizers

Quick results, useful in isolated settings

The auto-reader allows onsite quick

results

Slide47

3M ATTEST Auto-readerExpensive

Read by operator

No third party verification

Slide48

Crosstex

Confirm10

In office results

10 hours

Easy to use and read tests

Slide49

ConFirm Monitoring System, Crosstex

Mail In service

Test results in 24 hours

Benefit- third party verification of test results

Economical

Slide50

Other options

www.autoclavespore testing.com

www.microtestlabs.com

www.dent.ohiostate-state.edu/sterilization

www.tambcd.edu/education/bms/services/index.html

MANY more options, not all will work in our unique setting. Time is crucial in 2 week mission.

Slide51

Some other reasons tests fail

Inadequate cleaning of instruments- if there is caked on debris it won’t be sterile!

Improper packing- don’t overload instruments, they should be able to lay flat within the cassette

Slide52

More Reasons Cycles Can Fail

Processing Instruments in a cold sterilizer-

a cold sterilizer takes much longer to come up to temperature, since it must heat the chamber and its contents. Run an empty chamber first before the first load is processed

Selecting the Wrong Cycle

-some units will have manual and automatic settings. ALWAYS select the longer cycle when sterilizing mixed loads

Slide53

Reasons Cycles Fail

Aborting a Cycle

: NEVER abort a cycle so that instruments may be used more quickly.

NEVER

open during a cycle to add more instruments. Even though it may save time

DO NOT

stop cycle before its complete, including the drying time.

If you need to add more instruments, restart the cycle

Slide54

Storage of Sterile Items

Well ventilated to protect against dust and moisture

Consistent temperature and humidity

Packaging should include load number, sterilization date

Shelf Life: can be time related or event related

Depends on type

o

f packaging

Slide55

Common Problems

White Build Up on Instruments

Thoroughly dry before packaging and sterilizing

Damage to Plastics

Monitor temperature

Avoid flash cycles

Ensure plastics are heat stable to temperature used in sterilizer

Wet Packs

Do not overload sterilizer

Allow full drying cycle

Purchase sterilizer with vacuum drying cycle

Slide56

Residual Debris on Instruments after cleaningDebride instruments at time of use (NOT with gauze and your hand…washer or utility gloves and brush)

Use enzymatic pre-soak or pre-spray for organic materials

Corrosion of surgical hand pieces

Internal components and nitrogen-driven hand pieces are prone to corrosion

Stand the hand pieces on end or at an angle to sterilize

Allow to thoroughly dry before removing from sterilizer

Slide57

Dental Burs

Cleaning and sterilization do not reliably remove all organisms from burs

Ideal practice is to move towards pre-sterilized single use disposable burs.

Slide58

Culture

All

Reserve Dental Corps Officers and Enlisted members

should know how to operate the sterilizer

All should know how to tell if the instruments have been effectively sterilized

Best practice to open sterile wraps in front of patient, builds trust

All member should call a STOP if they suspect a breach in sterilization

Slide59

Duty of the Health Care Team

Chain of Command, who can step up if they think instruments are not being properly sterilized…

ALL HANDS!!!!

All patients and instruments must be treated with universal precautions no matter where we are, or who we are working on!!!

Slide60

Resources

OSAP

www.osap.org

From Policy to Practice: OSAP’s Interactive Guide to the CDC Guidelines

CDC Guidelines for Infection Control in the Dental Health Care Setting 2003