Clinical Foundations - Outcome 6 Flashcards
One-way movement of reprocessing room
Reprocessing room must have one-way movement of instruments through the reprocessing process, from dirty to sterile.
Following these standards will ensure the health and safety of healthcare personnel and patients. Instrument Reprocessing requires multiple steps to achieve sterilization:
Contaminated critical and semi-critical instruments and devices must be taken directly to reprocessing room.
These steps include Precleaning (disassembly, and sorting), cleaning, rinsing, drying, physical inspection, corrosion reduction/lubrication, reassembly packaging, steam sterilization, cooling/drying, storage, and delivery.
PPE worn during instrument preparation:
Gown, utility gloves, mask, eye protection
PPE worn during packaging:
exam gloves, mask & eye protection
PPE worn during sterilization process
clean hands (no gloves), except with loading (wear exam gloves, mask, eye protection)
Workflow pattern for reprocessing
Instrument preparation > Packaging > Sterilization Process
Classification system for dental devices based on a modified Spaulding classification
Critical Items - used to penetrate soft tissue or bone
Semi-Critical Items - only touch mucous membranes or non-intact skin. Should be sterilized or if it is heat and moisture sensitive, it can be disinfected with high-level disinfection.
Non-Critical Items - contact only intact skin. Must be cleaned or disinfected if contaminated. These can also be covered with a barrier.
Every dental device will be classified by the dental assistant using these categories and then reprocessed accordingly. Handpieces are considered a critical item
Instrument Reprocessing Area
Every dental office must have a designated reprocessing area that includes sections for cleaning, packaging, sterilization, and storage of sterile devices
Instrument Reprocessing Area Requirements
-Ideally, these sections should be separated by walls or partitions to direct the flow from one to the other and minimize spray and splatter generated during reprocessing.
-The instrument reprocessing area should be centrally located with easy access from patient care areas.
-It must have a one-way workflow that proceeds from a contaminated or ‘dirty’ zone to a cleaned zone, to a sterile zone, and finally into the storage zone.
-It must have ventilation.
-Hand hygiene stations must be available.
-The surfaces, such as countertops and floors must be easily cleaned.
Detailed Instrument Reprocessing Steps
- Transport: Contaminated instruments must be transported to the reprocessing area in a manner that minimizes the risk of exposure to contaminants.
- Cleaning: Before any sterilization or disinfection procedure, cleaning is an essential step to reduce the number of microorganisms present and remove blood, saliva, and other materials that may insulate microorganisms from the sterilizing agent. This can be done by manually scrubbing, or with an instrument washer or an ultrasonic cleaner.
-Rinsing: The instruments must be rinsed if manual cleaning or ultrasonic cleaning is performed.
-Drying: Instruments must be thoroughly dried to ensure proper sterilization in an autoclave if manual or ultrasonic is used.
-Inspection: After cleaning and drying, the instruments must be physically inspected to ensure all debris has been removed.
-Corrosion reduction/lubrication: To maintain proper function some instruments must be lubricated regularly.
*hinged instruments must be lubricated to maintain proper function (i.e., milk bath).
*handpieces are lubricated according to manufacturer’s instructions
- Packaging: Packaging is used to deliver instruments to the patient in a sterile condition. It will also prevent instruments from cross-contamination during storage, or when they are transported from one area to another.
- Sterilization: There are several processes to ensure that microorganisms from a patient procedure are not carried to the other patients or to dental personnel. The most efficient are sterilization processes that kill all forms of life on an instrument.
- Storage: Instrument sterility must be maintained until the sterilized packs, pouches, or cassettes are opened for use at the chairside. Instruments must be labeled with the sterilizer number, load number of that sterilizer, and sterilization date. Instruments must be stored in a clean, dry location in a manner that prevents contamination or damage.
- Delivery: Instrument sterility must be maintained until the sterilized packs, pouches, or cassettes are opened for use at the chairside. Reprocessed dental instruments or devices must be inspected for integrity upon opening the instrument or device pack or cassette at the point of use. The results of the internal chemical indicator must be validated prior to the use of dental instruments or devices
- Quality assurance: To ensure instrument sterility, a program of monitoring using biological and chemical indicators is used in reprocessing. A quality assurance program also includes training, record keeping, and maintenance.
Pre-cleaning and Cleaning Dental Devices
Pre-cleaning and cleaning is the removal of visible soil, organic and inorganic contamination from a device or surface, using either the physical action of scrubbing with a surfactant or detergent and water or an energy-based process (e.g., ultrasonic cleaners or thermal washers) with appropriate chemical cleaning agents. The action of sterilization cannot occur unless cleaning has occurred .
Basic Principles of Pre-Cleaning & Cleaning
The manufacturer’s directions for the cleaning and decontamination of dental instruments or devices must be followed with special attention paid to the working end of instruments on which dental material can become fixed.
Decontamination begins at the point of use with gross debridement done in the clinic operatory on handpieces and instruments which have visible debris.
Contaminated critical and semi-critical dental instruments and devices must be taken directly to the area designated for receiving contaminated devices and if required, initial disassembly completed.
If dental instruments and devices cannot be cleaned immediately after use, the instruments or devices must be kept moist in a transport container using a holding solution or spray specifically intended for this use. This can also be a damp towel or cloth over the instruments to keep debris from drying on.
Long-handled brushes will be used when handling or manually cleaning contaminated instruments and devices.
Reusable dental instruments must be cleaned with an instrument detergent or enzymatic product that is used according to the manufacturer’s instructions.
Automated cleaning equipment (e.g., ultrasonic cleaners, instrument washers) must be operated and maintained according to manufacturer’s instructions.
Devices requiring hand cleaning by manufacturer’s directions (i.e., Ultrasonic scaler tip/ hub must be brushed beneath the surface of the cleaning solution using a long-handled brush to prevent spreading of contaminated aerosols.
Cleaning accessories (e.g., long-handled brushes) must be disposable or thoroughly cleaned and high-level disinfected or sterilized between uses.
After cleaning (if manual cleaning or ultrasonic was used) the instruments must be thoroughly dried on lint-free towels
Pre-Cleaning of Instruments - in operatory
-Pre-cleaning is done in the operatory to remove visible debris. This can be done with a disinfectant wipe or a wet gauze 2X2. An example of this would be to use a disinfectant wipe or gauze to remove dental materials residue from the slow-speed handpiece after a hygiene appointment for example
Cleaning Methods
Instruments must be cleaned prior to disinfection or sterilization. Three ways are available: washer/disinfectors, ultrasonic cleaning or manual cleaning,
Automated Washer
Washer/disinfectors operate very much like household dishwashers. However, they must be approved for dental use. The advantage of these is their capacity to hold more instruments and to complete a dry cycle. This is a preferable method of cleaning the instruments. Critical and semi-
critical medical devices shall be cleaned using an automated process whenever possible
Ultrasonic Cleaning
Ultrasonic energy initiates a process known as cavitation. It is a very efficient cleaning process that is far superior to any other currently in use. It is safer than manual cleaning because there is less handling of instruments decreasing possibilities of cuts and finger nicks and also the spatter of debris generated by brushing. Make sure all items are completely immersed. It is important to note that this is a cleaning method to remove debris from instruments and does not sterilize or disinfect instruments. Thorough rinsing is necessary to remove the loosened soil and detergent
Manual Cleaning of instruments
Manual Cleaning of instruments
Instrument packaging
The packaging is used to deliver instruments to the patient in a sterile condition. It will also prevent instruments from cross contamination during storage, or when they are transported from one area to another. Before an instrument is packaged, they must be cleaned, rinsed, dried, and inspected