Clinical Foundations - Week 6 PP

Question 1

Sterilization is a process intended to…

Answer 1

Sterilization is a process intended to kill all
microorganisms and is the highest level of microbial

One of the most important responsibilities of the dental
assistant is to process contaminated instruments for reuse

Question 2

Classification of Instruments

Answer 2

-Critical Instrument - penetrates soft tissue or bone
-Semi Critical Instruments - touches intact mucous membrane or non-intact skin
-Non Critical Instruments - contacts skin only

Introduced by Dr Spaulding

Question 3

Instrument Processing Area

Answer 3

Should be centrally located in the office to allow easy access from all patient care areas
◦ Dedicated only to instrument reprocessing
◦ Physically separated from operatories and laboratory
◦ Not be part of a common walkway
◦ Hands-free control when possible
◦ The flooring should be an uncarpeted, seamless, hard surface
* Work flow: proceed in a single loop, from dirty to clean to sterile to storage, clear signage

Question 4

PPE When Processing Instruments

Answer 4

• You must always use PPE when processing instruments
• This includes utility gloves, mask, eyewear, and
  protective clothing (gown)
• Dental assistant must known what type of PPE or
  absence of it is acceptable when reprocessing instruments

Question 5

Reprocessing Steps

Answer 5

1. Transport
2. Cleaning
   a) Rinsing
   b) Drying
   c) Corrosion Control
   d) Inspection
3. Packaging
4. Sterilization
5. Storage
6. Delivery
7. Quality assurance

Question 6

Step 1 of Reprocessing - Transport

Answer 6

Proper PPE must be worn during transport. A proper rigid, leakproof container must also be used to transport contaminated items.

Exposure can occur through percutaneous injury (eg. needle sticks, cuts) or contact with the mucous membranes of the eyes, nose or mouth

Question 7

Important info about reprocessing

Answer 7

All instruments must be cleaned at the point of use (2 x 2 gauze)
Before leaving operatory with contaminated
instruments you must check working ends for visible debris
* When not able to start reprocessing immediately

Question 8

Step 2: Cleaning

-Instruments may be precleaned in one of three ways:

Answer 8

Instrument-washing machine - thermal disinfector

Ultrasonic cleaning

Hand scrubbing (manual cleaning of debris) followed with ultrasonic or thermal

Question 9

Manual Cleaning

Answer 9

-Used to remove visible debris
-If Thermal available - use as a cleaning method after initial manual clean
if Thermal not available - use ultrasonic method after initial manual clean

Question 10

Rinsing Instruments

Answer 10

The instruments must be rinsed if manual cleaning or ultrasonic cleaning is preformed

-Rinsing is completed to remove residue of cleaning chemical and remove any loose debris

• Cold tap water is mixed with cleaning chemical (medical/dental grade approved not household detergent)

Question 11

Drying Instruments

Answer 11

Never rub or roll instruments while they are in a towel because of the risk of accidental injury

Use thick cotton towels, often multiple layers to avoid accidental injury. Pat dry.

Question 12

Inspection of Instruments

Answer 12

Inspect all instruments prior to assembly
-broken working ends?.. sterilize and recycle

bent working ends?… sterilize and recycle

corroded working ends?… use lubrication

mirror heads condition poor?.. sterilize, recycle, replace to new

any left over debris?.. clean again

Always place instruments in order of use! From left to right

Question 13

Lubrication and Corrosion control

Answer 13

-Instruments and burs made of carbon steel will rust during steam
sterilization ( use milk bath)
* Hinged instruments should be immersed in a rust inhibitor prior to
sterilization. ( milk bath)
* Dental handpieces must be lubricated after each use

Question 14

Step 3: Packaging

The preparation and packaging area should consist of:

Answer 14

1. Counter space and storage space for sterilized instruments
2. Fresh disposable supplies: double wrap,
   pouches

Clean instruments are not sterile and could harbor pathogens- wear PPE

Question 15

Step 4: Sterilization

Answer 15

-Sterilization destroys all microbial forms, including bacterial spores

-Sterile is an absolute term; there is no “partially sterile” or “almost sterile”

All reusable items (critical and semicritical instruments)
that come into contact with the patient’s blood, saliva, or mucous membranes must be heat sterilized

Question 16

Step 5: Storage of Dental Devices

Answer 16

Store all sterile devices in a way that ensures they
remain sterile until point of use
* Shelf life of sterile packages is “event related”
* Never store sterilized instruments open in a drawer or storage container

Question 17

Step 6: Delivery of Dental Devices

Answer 17

Dental devices must be inspected for integrity upon opening the instrument or device pack at the point of
use.
* Once the sterilization container has been opened, the sterilization of the instruments is compromised.
* Handle with clean hands !

Question 18

Step 7: Quality insurance
How do we know instruments used are safe and sterile
to use?

Answer 18

• Sterilization monitoring is mandatory
• It is critical that dental instruments be properly
  sterilized?
• Currently, three forms of sterilization monitoring are used
  ◦ Biologic
  ◦ Physical
  ◦ Chemical