LO 6 Flashcards
Describe sterilization monitoring
- The goal of sterilization is to kill all forms of microbial life on processed items
- Absolute sterility impossible to achieve
- This “sterility assurance level” is achieved with proper monitoring
In what 7 scenarios do sterilization failures occur?
- Not all surfaces exposed for sufficient length of time
- Instruments not properly cleaned beforehand–debris can insulate organisms from sterilizing agent.
- Incorrect or excessive packaging material used.
- Sterilizer overloaded or packages not properly separated.
- Equipment malfunction e.g. sterilizer timer gives misreading
- Improper/insufficient temperature
- Improper method e.g. water used in dry-heat sterilizer
What are the 3 forms of sterilization monitoring?
- Biologic (spore tests) - Use biological spores to assess the sterilization process directly
- Chemical - Change in color when physical parameter is reached
- Mechanical - Measure time, temp, pressure
Describe biological sterilization monitoring
- Also called “spore testing” (Geobacillus stearothermophilus)
- Most frequently used method
- Spores death - ensure overall thoroughness
- spores strips, processed through sterilizer, removed and placed in culture medium to determine vitality
- Daily spore testing recommended for each sterilizer in a dental office
- “in office” or “mail-in” from private company)
What is the bacteria used in biologic (spore testing) sterilization monitoring?
Geobacillus stearothermophilus
When should you spore test sterilizers?
- Once per day (recommended)
- Whenever a new type of packaging material or tray is used
- After training of new sterilization staff
- During initial use of a new sterilizer
- First run after a repair
- After any other change in sterilizing procedure
If the biological monitoring fails to kill spores (positive test), this requires _________
immediate action
Describe chemical monitoring
- Heat-sensitive chemicals that change color
- Some examples are: autoclave tape; special markings on pouches and bags; chemical indicator strips; tabs, packets or tubes of colored liquid
What are the 2 main types of chemical indicators?
- Color-changing strip–does not guarantee sterilization has been achieved (autoclave tape, markings on bags)
- “Integrated” indicator -changes color or form slowly in response to combination of time, temperature and presence of steam; placed inside packages to guarantee sterilization has occurred
Describe mechanical monitoring
- Involves observing and recording sterilizing temperature, pressure and exposure time via gauges and displays on sterilizer
- Can print out
- Permanent monitoring record
- Monitor conditions inside sterilizer but not necessarily inside instrument packages i.e. not guarantee sterilization has been achieved
_______ items should be cleaned and sterilized by heat
Critical and semi-critical
Semi-critical items that are ________ should at minimum be cleaned and treated with a high-level disinfectant
Heat sensitive
________ items should be cleaned and treated with a low-level or intermediate disinfectant. If you can see ______ on an item, use med-level instead.
- Non-critical
- Blood
Describe critical instruments
- Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth)
- Heat sterilize between uses or use sterile single-use, disposable devices
- Examples include surgical instruments, scalpel blades, periodontal scalers, and surgical dental burs
Describe semi-critical instruments
- Contact mucous membranes but do not penetrate soft tissue
- Heat sterilize or high-level disinfection
- Examples: Dental mouth mirrors, amalgam condensers, impression trays and dental handpieces (special case; SHOULD be sterilized due to internal parts)
Describe non-critical instruments
- Contact intact (unbroken) skin which serves as an effective barrier to microorganisms
- Low-risk to transmitting infections
- Clean and disinfect using a low to intermediate level disinfectant
- Examples of instruments in this category include X-ray head/cones, stethoscope and blood pressure cuff
How should processed instruments be dried and cooled?
- Packaged instruments - allowed to dry and cool down in sterilizer before handling
- Unpackaged instruments - should be covered immediately to prevent possible contamination from air
What are the 3 elements of handling processed instruments?
- Drying and cooling
- Storage
- Opening of instrument packages
How should processed packages be stored?
- Store in covered or closed cabinets, protected from sources of contamination. (Away from Sewer & Water pipes; Few inches away from ceilings & floors; heat; sinks)
- Unwrapped instruments: no shelf life (use right away)
- Wrapped instruments: should be used in order of the oldest sterilized packs first! (first in, first out)
How should processed instruments be opened?
- Opened only at chair side
- When opening do not touch the instruments inside
- Packages should be opened with clean, ungloved hands after the client has been seated. Only then, glove just before first contact with the client’s mouth
- This prevents contamination with the glove with any microorganisms on the outside of the packaging
Describe processing of dental handpieces and other devices attached to air and waterlines
- Clean and heat sterilize intraoral devices that can be removed from air and waterlines
- Follow manufacturer’s instructions for cleaning, lubrication, and sterilization
Describe handpiece asepsis
- Clean, package, and sterilize by heat
- Processing between clients - High-speed handpieces; Reusable prophylaxis angles; Slow-speed handpiece motors
Describe the relationship between instrument sharpening and infection control
- Difficult to manage from an infection control point of view.
- Presents a risk for disease spread through accidental punctures
- The greatest safety is achieved by cleaning, sterilizing, sharpening, and re-sterilizing
Instrument processing can cause ________ to instruments. ________ instruments are the least affected by corrosion, but many dentists prefer _________ instruments because they retain sharp edge longer
- Damage
- Stainless steel
- Carbon steel
What sequence of steps should be followed for instrument processing?
- Remove items from the operatory
- Use holding solutions if needed
- Clean by automated or manual method
- Package
- Sterilize
- Store
What are the 2 types of dental environmental surfaces related to disease spread?
- Clinical contact surfaces - High potential for contamination with blood, saliva, other infectious material
- Housekeeping surfaces - do not come into contact with hands or devices, Limited risk of disease transmission
Some barriers are designed especially to the shape of items such as ________
- dental chair
- air-water syringe
- hoses
- pens
- light handles, etc.
List ways operatory design and equipment selection can reduce disease spread
- Keep surface areas to a minimum
- Smooth construction with very little knobs, crevices and hooks
- Chairs and stools should have as little seams and buttons as possible
- Controls should be easy to disinfect
- Tubing should not be coiled or mechanically retractable
- Sink faucets should be foot, knee or forearm controlled
- Paper towel dispenser should be designed so they do not have to be touched
- Plastic lined waste containers recessed under the cabinet with opening on the countertop
- All surfaces should be compatible with disinfectants and detergents
- Vinyl chairs, plastic laminate cabinets opposed to wood
- Vinyl flooring and smooth walls for easy cleaning
- Carpet not recommended
What are the types of general antimicrobial chemicals to be used on/in the body?
- Antibiotics- killing microorganisms in or on the body
- Antiseptics- killing microorganisms on skin or other body surfaces
What are the CDC levels of disinfectants?
- Sterilant - Destroys all mo’s, including high numbers of spores. Immersion only.
- High level - Destroys all mo’s with the exception of high numbers of spores; NOT on environmental surfaces
- Intermediate level - inactivates and destroys, vegetative bacteria, most viruses and most fungi, but not bacterial spores. Clinical contact surfaces and noncritical surfaces with visible blood.
- Low level - Kills most bacteria, some fungi, and some viruses. NOT M.tuberculoisis; Clinical contact surfaces and houskeeping
A _________ kills bacterial spores, meaning it is a sterilant
Sporicidal chemical
A chemical that kills M. Tuberculosis is considered _________
Tuberculocidal
What is the importance of precleaning?
- Precleaning reduces the number of contaminating microorganisms and the blood or saliva present and facilitates action of the disinfecting chemical.
- Spray-wipe-spray (using a liquid disinfectant/cleaner) ; leave disinfectant on surface long enough to be tuberculocidal (usually 10 min.)
- Wipe-discard-wipe; (using a disinfectant towelette)
- Very important the product label
What products are used for chairs and clinical surfaces?
- Disinfectant wipes are used for dental unit disinfection.
- CNIH uses Optim 33 - Intermediate disinfectant, Cleaning and disinfection in one solution, Contact time – 1 min
What is the EPA standard for drinking water?
- No more than 500 CFUs/ml
- CLU = colony forming unit
- This is the standard for water in dental unit lines as well as drinking water
Due to biofilm formation within waterlines, it is not uncommon for the water exiting dental handpieces to contain __________ CFUs/ml
100,000
What are the two types of microbe communities in water lines?
- Planktonic (free-floating)
- Biofilm (sessile, attached)
What are the two most common types of bacteria in water lines?
- Pseudomonas
- Legionella
What are the factors that influence the formation of biofilm in dental unit water lines?
- Water stagnates (flow rate is low in tubing)
- Small-diameter tubing (large surface-to-volume ratio, giving bacteria greater chance to contact and attach to walls)
- Bacteria are continually present; providing pioneer bacteria for biofilm formation
- Contamination of water line openings or retraction through handpiece or A/W syringe
- Waterborne bacteria entering system have ability to attach to surfaces facilitating biofilm formation
- Incoming water brings nutrient source to developing biofilm
- Bacteria that attach to tubing walls multiply to increase mass of biofilm
- As water flows by biofilm, it picks up bacteria from the biofilm and carries it through the handpiece or A/W syringe , scalers etc.
Oral biofilm reforms _________ while dental unit water line forms ___________
- immediately after brushing
- More slowly (a few hours)
What are the CDC recommendations for reducing microbes in water lines?
- Discharge water and air for a minimum of 20-30 seconds after each patient from any dental device connected to a water system that enters the patient’s mouth (handpieces, ultrasonic scalers, A/W syringe)
What water should be used for irrigation during dental surgeries?
Sterile water - either Hand irrigation with sterile water or a sterile water delivery system
How can you reduce sprays and splatter?
- The use of the HVE
- Evacuation also helps reduce Exposure —patient from the waterborne microorganisms
What are DUWQ (dental unit water quality) technologies?
- Procedures designed to improve the quality of water - e.g. Independent reservoirs, Decontamination and Antimicrobial Agents, Filtration, Sterile water delivery systems
_________ allows for the use of decontaminating or cleared antimicrobial agents for cleaning water lines.
Independent Water Reservoirs - Clean the bottles with soap and water every day.
Describe Decontaminating and Antimicrobial Agents
- Agents are available for using independent water reservoirs to disturb biofilm development
- Must be registered by the Environmental Protection Agency
- Agents can be periodically placed inside the bottles and flushed through water lines
Untreated dental units produce water that is below the standard for drinking water, so _________ should be done periodically
Monitoring of levels
Describe Microfiltration Cartridges
- Disposable microfiltration cartridges can be used to decrease dental waterline contamination
- They do not decrease the colonization in the waterline, but filter the microbes before they exit the line into the patient’s oral cavity. Therefore, filters are often used in combination with antimicrobial agents.
What is a break in water notice?
- Break in water line causing contamination
- No patients should be seen until the water problem is solved
- Need to contact manufacturer of dental units and determine how to disinfect and flush inside of unit water lines after “all clear” notice is given
- If no directions, guideline is to flush lines and faucets for 1-5 minutes
