Instrument Processing and Sterilization Flashcards
Classification of patient care items
patients care fall in three classification
- Critical: used to penetrate soft tissue or bone. They should be heat sterilzed because they pose the greatest risk of transmitting infection.
for example: critical included forceps, scalpels, bone chisels, scalers and burs.
- semicritical: contact mucous membranes, bone and bloodstream, but do not penetrate soft tissues. they have lower risk of disease transmitting
Noncritical: only intact skin so they pose the lowest risk if transmission of infections. Example x-ray unit tube bead.
personal protective equipmemnt
included gloves ,mask, eyewear, clothing must be worn when processing.
The sterilization area should meet critial lised
- Be only for instrument processing
- be its own space ways from dental laboratory
- not be part of a high traffic area
- not have outside doors or window because dust might enter area
- have good air circulation to control the heat generated by sterilizers
- be of proper size for all equipment and supplies with multiple running water, flush high speed
-have a depp basin sink with hands free control for instrument
-have flooring that is a seamless, hard surface.
workflow pattern
CDC lists four basic area that govern the pattern of workflow
- receiving, cleaning, and decontamination
- preparation and packaging
- sterilization
- storage
Worlflow should allow dental team members to process instrument from dirty to clean to steriles to storge without ever “doubling back” if area is small you can use signs like
- Contaminated area
-precluding area - cleaned items area
- sterilization area
Contaminated area
Contaminated instrument are brought into the Contaminated instrument receiving area. any items that are remaining on the trays should be discarded as Contaminated waste.
- should wear PPE
preparation and packaging area
In a area set aside for preparation and packaging cleaned and should be dried and placed into sets or trays then wrapped or placed in sterilization package.
Instruments can be precleaned in one of three ways
- hands scrubbing
-Ultrasonic cleaning
- washing machine
Holding solution
The instruments that cannot be cleaned immediately after procedure should be placed in a holding solution to prevent the dying of body fluids, blood or other debris on instruments.
An enzymatic solution that help to dissolve organic debris.
- dishwasher detergent makes a good holding solution because it is cost effective , low foaming.
-disinfectant is costly, do it should not be used as a holding solution.
the holding solution should be changed at least twice daily or if the solution becomes cloudy.
Hand scrubbing
is effective only if is performed properly
rules:
- wear goggle type eyewear and gloves and PPE
- clean only few instruments at a time
- use only a long handled brush with hand guard or wide surface
- air dry or thick towel. to decrease the risk of accidental injury never rub or all iinstruments in a towel.
Ultrasonic cleaning
A cleaning system that used sound waves transmitted through a liquid to loosen debris, These cleaners also reduce the risk of cuts and punctures to hands during cleaning process.
sound waves are outside the range of human hearing. The cleaning time can vary from 5 to 15 minutes depending upon type of material.
Cavitation: formation of bubbles in liquid.
Ultrasonic cleaning
-each machine usually has solution. to prevent damage to the machine or instrument
- some Ultrasonic solution have enzyme activity
- some Ultrasonic solution have antimicrobial activity
- plain disinfectants should not be used in Ultrasonic cleaner
Ultrasonic cleaner care and testing
- each time the Ultrasonic solution is changed, the pan and lid should be rinsed with clean water then dried.
if not functional correctly check if machine hold 5 by 5 inch sheet of lightweight aluminum. RUn 20-30 sec
Automated washers
are similar to household dishwashers in how they work. but these units must be approved by the us food and drug administration.
The machine used a combination of hot recirculating water and detergents to move organic material. Also it dries the instruments.
Packaging of instruments
instruments should be wrapped or placed in packages for sterilization. these package protect them from becoming contaminated after sterilization and before use.
if instrument are not package they might be exposed to external environment in which they could be easily become contaminated.
Using packaging materials, instruments can be grouped.
Packaging materials
sterilization packaging materials must be FDA approved. only sterilization packaged should be used. autoclave cannot sterilize instrument wrapped in paper or in freezer.
Sterilization monitoring
microorganisms cannot be seen with naked eyes, so determining whether instrument are sterile is important
- physical: involves monitoring the gauges and reading on sterilizer and recording tempture , pressure, exposure time.
- chemical:
- biological: only true method to determine sterilization has been reached an whether all bacteria and endorsee have been killed. weekly biological test recommends.
Biological indicators: contain harmless bacterial
three Bls will be used in each test
Methods of sterillization
kills all microbial forms bacterial spores
three common forms of sterilization
- stream under pressure (atoclaving)
- unsaturated chemical vapor
- Dry heat
Steam Autoclave sterilization
- involves heating that kills microorganisms
Autoclave operation cycles
four cycles
- heat up
- sterilization
- depressurization
- drying
recommended temperature is 250 f and 121 c and pressure 15 or 30 pounds per inch for 20 minutes
