1

Instrument ProcessingDA 116 Infection Control

2

Instrument Contamination Levels:

• 1. Critical

• 2. Semi-Critical

• 3. Non-Critical

3

Critical Instruments

– Instruments that touch bone or penetrate soft tissue.– Ex. Forceps, scalpels, scalers, dental burs

After each use:

Heat sterilize all these instruments

4

Semi-Critical Instruments

Instruments that will touch mucous membrane or nonintact skin but do not penetrate soft tissue or bone• mirrors, amalgam condensers, x-ray film and digital sensor holders and high and low speed handpieces• Use high-level disinfection with all lab materials used in the mouth

After each use:

Sterilize all that are heat resistantUse disposable items or high-level

disinfection/cold sterilant on others ***Do not reprocess or reuse any disposable items!

5

Non-Critical Instruments

• Non-critical instruments are those that come into contact only with intact skin – Ex. X-ray Heads, Light handles, BP cuff

Use intermediate or low level disinfection agent

Floors and walls: okay to clean if no blood contamination If an item is visibly contaminated

with blood, choose intermediate level disinfection

6Transporting Items to Sterilization Center

Holding Solutions for used instruments:

– In operatory or (more commonly) sterilization center

– Enzymatic properties– Prevents debris from

drying and becoming difficult to clean

Transport contaminated Instruments

– from the point of use – in a sturdy, solid

container – to the initial receiving

area of the sterilization area

7

• Instrument Processing Area • DHCP should process all instruments in a

designated central processing area to more easily control quality and ensure safety (248). The central processing area should be divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. Ideally, walls or partitions should separate the sections to control traffic flow and contain contaminants generated during processing. When physical separation of these sections cannot be achieved, adequate spatial separation might be satisfactory if the DHCP who process instruments are trained in work practices to prevent contamination of clean areas (248). Space should be adequate for the volume of work anticipated and the items to be stored (248).

Which do you think is the correct choice?

#2 is CORRECT!

2

1

8

Sterilization Center

• Instrument processing area – well-designed and conducive to accomplishing the

multiple steps to achieve sterilization or high-level disinfection.

DIRTY:receiving and decontaminatingrinsingdryingpackaging

CLEAN:sterilizationsterile storage

9

Pre-Cleaning

• Basic first step of decontamination– remove bioburden from instruments– Place dental burs in a bur basket before placing

them in the ultrasonic cleaner

• Mechanical methods– Ultrasonic cleaner

• Cavitation (ultrasonic sounds waves create bubbles that implode cause an unseen scrubbing action)

• 10 minutes• Change solutions daily• Aluminum Foil test

– Instrument Washer

10

BE CAREFUL!

DO THIS!NOT THIS!

11

Instrument Washer

• http://www.youtube.com/watch?v=2a6_OIsZQ7w

12

Dental Handpieces • Require special handling due to

internal mechanical parts• Flush for 20-30 seconds at

chairside• Remove bur• Clean outer surface with

handpiece wipe• Lubricate according to

manufacturer’s instructions• Wipe off excess lubricant • Package and heat sterilize• Some handpieces must be

lubricated after sterilization; check manufacturer’s directions

Manual and automatic methods are available

13

Packaging

Paper Pouches• Permeable so steam

can reach instruments• Appropriate for

specific sterilizer

Cassettes• Plastic or metal

– Perforated so steam can penetrate

• Less instrument handling reduces risk of percutaneous injury

• Can go into ultrasonic and autoclave

• Must be wrapped for autoclave and storage

14

Loading the Sterilizers

• Wrap securely• Hinged instruments open• Do not overfill

15

Methods of Sterilization:

• Process by which all forms of organic life are destroyed by physical or chemical means

• Steam under pressure Autoclave• Dry Heat Sterilization• Chemical under pressure (Chemical

Autoclave or Chemiclave)• EPA registered disinfectant/sterilant;

also called “cold sterilization” least preferred method

• Always best to use heat sterilization

16

Monitoring the Sterilizer

• Chemical– Treated indicator (inside package) or tape (outside

package)– Indicates that items have gone through the

sterilization process• DOES NOT GUARANTEE STERILITY

• Biological (weekly per CDC)– Live bacterial spores– Autoclaves/chemical vapor:

• Bacillus Stearothermophilus or Geobacillus Stearothermophillus

– Dry heat/ethylene oxide:• Bacillus Subtilis or bacillus atrophaeus

• Mechanical– Monitor gauges for times, temperatures, cycles– Check and keep print-outs if available

17

Storage

• Keep sterile items and disposable items – Covered, enclosed area (not under a sink)– Keep packages/cassettes wrapped and unopened

until use

• Do you need to re-sterilize?– Per CDC, wrapped items are

sterile indefinitely– Re-sterilize if it becomes

contaminated (i.e. wet, torn)– Some offices date each package

and rotate use according to dates