Cleaning and Disinfection Flashcards
What is bioburden?
The measure of the total number of viable micro-organisms (total microbial count)
Describe potentially pathogenic organisms which may make up part of the bioburden
- BBV (HIV, Hep B, Hep C)
- VCJD (prions)
- Bacterial infections (MRSA)
Name 4 ways to mitigate risk
- Reduce
- Transfer
- Accept
- Avoid
Describe 3 levels of risk for the Spaulding classification
- Critical
- Semi-critical
- Non-critical
What is a critical level of risk according to Spaulding?
Entry or penetration into sterile tissue, cavity or bloodstream
What is a semi-critical level of risk according to Spaulding?
Contact with intact non-sterile mucosa or non-intact skin
What is a non-critical level of risk according to Spaulding?
Contact with intact skin
What is the processing required for a critical level of risk according to Spaulding?
Sterility required
What is the processing required for a semi-critical level of risk according to Spaulding?
Sterilisation preferred where possible but if not, high-level chemical disinfection required
What is the processing required for a non-critical level of risk according to Spaulding?
Clean as necessary with detergent and water
Name 3 examples of critical levels of risk
- Surgical instruments
- Extraction forceps
- Surgical dental burs
Name 2 examples of semi-critical levels of risk
- Dental mirror in mouth
2. Wards carver
Name 2 examples of non-critical levels of risk
- Blood pressure cuff
2. Dental chair
What is the function of high level disinfection?
Kill all microorganisms except high numbers of bacterial spores
Name 3 liquid chemical sterilizing agents
- Aldehydes
- Hydrogen peroxide
- Peracetic acid
Describe instrument decontamination in NI
- Thermal disinfection in washer disinfector
- Involves exposing all surfaces of the load to water heated between 80 and 95 degrees C for required holding time
What regulations govern decontamination in primary care dental practices?
HTM 01-05 (Pel 13 13)
Give a summary of the requirements in Pel 13 13
- Separate decontamination room
- Evidence of correct workflow
- Automated cleaning
- Correctly applied processes
- Training of staff and defined roles
- Testing of equipment
What 5 things should be periodically checked to ensure compliance with Pel 13 13?
- Facilities
- Process
- Training
- Equipment validation etc
- Quality management
What is the manager with regards to Pel 13 13?
Person ultimately accountable for operation of LDU, usually practice principal partner
Name 6 defined roles with regards to LDU (2 of which the manager appoints)
- User*
- Decontamination lead
- Operator*
- Authorising engineer
- Microbiologist
- Control of Infection offer
What is the role of the user?
- Person responsible for the day to day management of the decontamination equipment
Name 4 main responsibilities of the user
- Certify sterilizers fit for use
- Hold all documentation relating to decontamination equipment
- Ensure periodic testing / maintenance / records retained
- Appoint and ensure training of operators
What is the role of the operator in the LDU?
This is the person with the authority to operate decontamination equipment
Name 5 main duties of the operator
- Daily and weekly tests washer disinfector / sterilizers
- House keeping duties
- Segregation and safe disposal of single use items
- Manual cleaning of reusable devices
- Safe use of all decontamination equipment
Describe a CDU
- Central decontamination unit
- Governed by specific regulation and guidance
- Processes for other users
Describe an LDU
- Local decontamination unit
- Standards set by HTM01 05 (Pel 13 13)
- Process only for use by the same entity
What are the components of LDU design?
- Dirty area set down, with dirty to clean workflow with clear segregation
- Surfaces should be continuous and easily cleaned
- Air movement should be from dirty to clean with external input
- Separate hand washing facilities
- PPE station
- Clean area for storage and administration
Name 5 examples of single use items
- PPE
- Matrix bands
- Endodontic files
- Steel burs
- Single use diamond burs
Describe how instruments should be moved from surgery to LDU
- Safety lockable lidded boxes
- Clean and dirty zones
- Position in the surgery
- Technique for moving
What is stage 1 decontamination?
Cleaning
What are the functions of cleaning during decontamination?
- Greatly reduces bioburden on device
- Removes organic contaminants which could provide protection for microbes during sterilisation
- Essential to maximise chances of item finishing sterilized
Give 4 reasons why enzymatic enzyme detergents are best suited for dental instruments
- Remove proteinaceous bioburden
- Dissolve mineral encrustation
- Remove stains
- Allows lower temperatures and shorter periods of mechanical cleaning to be employed
Describe how cleaning is physically carried out
- May be manual or automated
- Manual no longer acceptable routinely but may be used as backup
- Automated is washer disinfector
Describe how manual cleaning is carried out
- Specific detergent with specific volume of <45 degree water
- PPE used
- Wash below the water line to avoid aerosol
- Long handled nylon bristle brush
- Keep kits together and be aware of Sharps
- Rinse in separate sink with RO water
What is stage 2 decontamination?
Disinfection
Name 3 types of disinfection
- High
- Intermediate
- Low
What is the biggest difference between disinfection and sterilization?
Lack of sporicidal power
What are 5 parts of the cycle within a washer-disinfector?
Cleaning - Cold rinse to prevent coagulation, rinse to encourage germination and kill off at higher temps
Detergent - Antiprotein low temp, antilipid high temps
Rinse - High water flow
Disinfection - Inactivation of viruses >90 degrees
Drying
Name 2 items in particular which may be problematic for washer disinfectors
- Burs
2. Handpiece (lumen)
Name 3 things to inspect when checking if washer disinfectors have worked properly
- Clean from visible debris
- Functional
- Good repair / No rust areas
Describe wrapping before sterilisation
- Clean hands or gloves
- Specific sterilisation bags with exp date
- Instruments should not touch in the package
- Ensure sealed across opening and place in rack ready for sterilisation
