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Clean? Disinfect? Sterilize? What does it all mean??

Clean? Disinfect? Sterilize? What does it all mean??. DA 116 Infection Control. Instruments, supplies, equipment, surfaces After each patient treatment procedure is completed . Clean? (“pre-clean”). Basic first step of decontamination process

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Clean? Disinfect? Sterilize? What does it all mean??

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  1. Clean? Disinfect? Sterilize?What does it all mean?? DA 116 Infection Control

  2. Instruments, supplies, equipment, surfaces After each patient treatment procedure is completed

  3. Clean? (“pre-clean”) • Basic first step of decontamination process • Reduce the number of microbes and remove bioburden • Prevent debris from harboring microorganisms during sterilization process **if a surface is not CLEAN it cannot be disinfected** • Remove all disposables and contaminated items from operatory first • Use soap and water OR an EPA-registered product that cleans and disinfects

  4. Pre-Cleaning the operatory • PPE with utility gloves

  5. Pre-Cleaning Instruments preferred method: mechanical cleaning Ultrasonic Cleaner Instrument Washer

  6. Disinfect? • Afterprecleaning • NOTthe same as sterilization • Kills most disease-causing microorganisms, but not spores • Non-pathogenic microorganisms may remain on an object after disinfection • Use an EPA-registered hospital disinfectant with tuberculocidal, HIV, and HBV claims • Note: Hydrogen Peroxide is NOT an acceptable disinfectant

  7. Levels of Disinfection: • Low level disinfection: (actually cleaning) • Least effective. Does not kill spores or Tuberculosis • Intermediate level disinfection: • Kills TB, which is the most difficult to kill as spores • If you use a process that kills TB spores, you will also be able to kill other organisms that are easier to kill (HBV and HIV) • High level disinfection: • Kills some, but not all bacterial spores, including TB as well as other bacteria, fungi and viruses • Almost as effective as true sterilization but not as thorough

  8. Disinfectant Comparisonsnote: rubbing alcohol is NOT an approved disinfectant

  9. Disinfecting Sprays How to Use: For surface disinfection – use the 2 step method. • Clean by wiping surfaces thoroughly with disinfectant and paper towels or 4 x 4 gauze to remove all soils. • Disinfect by reapplying disinfectant, keeping surfaces wet for 10 minutes. Wipe off excess solution after contact time is completed. Place barriers.

  10. Disinfecting wipes How to Use: For surface disinfection – use the 2 step method. • To clean, remove one or more wipe towelettes and wipe surfaces thoroughly to remove all soils. Discard used wipe towelettes. • Remove one or more additional fresh wipe towelettes. Reapply disinfectant to previously cleaned surfaces for a 10 minute contact time.

  11. Additional Disinfecting Concerns: Radiography Dental Lab All items used in the mouth should be cleaned and soaked in a high level disinfectant before sending to the laboratory for processing. • Film holders and positioners for digital radiographs should be heat sterilized between patients, UNLESS they are disposable items. • Sensors for digital radiographs cannot be sterilized and should be covered with a new barrier sleeve for each patient.

  12. Sterilize? • Process by which all forms of life are completely destroyed • destroys all living microorganisms, including bacterial spores and viruses. Kills good and bad microorganisms, all life • After proper sterilization, no microorganisms will be alive • Heat or Liquid Chemical

  13. Steam under pressure Steam (autoclave) Flash (Statim)

  14. Rapid Heat Sterilization • AKA ‘Statim’ • Works like a convection oven, high temperature plus circulating steam • 375 F degrees (190C) 12 minutes for wrapped items • 375 F degrees (190C) 6 minutes for unwrapped items

  15. Autoclave: • Uses moist heat to sterilize • Steam under pressure is considered the sterilizing agent • 15 pounds of pressure per square inch • 250 degrees F (121 degrees C) • For 15-20 minutes for wrapped instruments • 30 minutes for porous materials • Avoid overloading or wrapping instruments too tightly • Steam must circulate to all surfaces

  16. Chemical Vapor Sterilizer

  17. Chemical Vapor Sterilization: • Combination of heat and unsaturated chemical vapor (produces hot vapors of alcohol and formaldehyde that act as sterilizing agent) • Chemicals used: alcohol, acetone, ketone, formaldehyde and distilled water • Advantage: • No corrosion or dulling of instruments • Instruments are dry at end of cycle • All instruments which can be autoclaved, can be chemiclaved • Disadvantage: needs well ventilated area due to odor • 270 F degrees (131C) 20-40 minutes 20 PSI pressure • Clean, rinse and dry instruments well before sterilizing; wrap loosely

  18. Dry Heat Sterilizer

  19. Dry Heat Sterilization: • “Baking” – high temperature is sterilizing agent • 320 F degrees (160C degrees) = 2 hours (120 minutes) • 340 F degrees (170C degrees) = 1 hour (60 minutes) • Advantage: no rust or corrosion or dulling sharp edges • Disadvantage: some plastics, gauze, impression trays cannot tolerate high temperatures, can cause damage • Instruments must be clean and dry prior to sterilization • Usually requires special metal instrument trays used during sterilization

  20. Glass Bead Sterilizer Ethylene Oxide Sterilizer

  21. Glass Bead Sterilizer: • *no longer OSHA accepted • Previously used chairside during endodontic procedures to sterilize files between canals – used on the same patient • Consists of glass beads, metal beads and salt • 450 degrees F, for 20-30 seconds • The set of files are then autoclaved between patients

  22. Ethylene Oxide Sterilizer • This is another chemical sterilization method • Considered a poisonous gas • Runs on a 10-16 hour cycle • Used in hospitals but not in dental settings

  23. Liquid Sterilant(cold sterilant or high-level disinfectant) • Glutaradehyde product

  24. Liquid Sterilants: • AKA “Cold Sterilants” • Destroys all microorganisms IF exposed long enough to the sterilant • Disadvantage: • Time consuming (10 – 16 hours) • No bacterial spore test available; May use a color monitor dip stick to test the strength • Whenever new item is added, time is reset to ten hours • Toxic chemicals: glutaraldehyde; • do not leave container uncovered • Advantage: • No packaging; will not harm heat sensitive items • Clean and dry everything before immersion; any water will dilute solution and lower effectiveness • After cycle, must rinse with sterile water; dry with clean towels, and wrap in clean packaging

  25. Sterilization Monitoring • Biological monitoring with spore tests: Liquid Disinfectant Monitoring: color monitor dip stick (not a spore test) • Process indicators

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