Effective and efficient infection control in the dental office is essential for the safety of patients and to ensure that productivity does not suffer. Infection control programs all include the cleaning and sterilization of reusable dental instruments and devices. Care must be taken by the dental healthcare professional to ensure that all instruments are cleaned prior to sterilization, and that this is carried out in a safe manner to avoid injury
Instrument Processing : Step by step! 1 - Clean the dental instruments manually or through mechanical means like a thermal washer disinfector or an ultrasonic bath. Infection Control Services says that dental instruments cannot be sterilized properly unless they are thoroughly cleaned beforehand. Cleaning can be accomplished by two automated approved methods:
Instrument washers- (which resemble a dishwasher but are made to clean instruments; regular dishwashers are not appropriate nor are they recommended)
Ultrasonic cleaners Always use a recommended ultrasonic solution. Also, establish a schedule for testing the effectiveness of the ultrasonic. To do this, simply dip several inches of a sheet of aluminum foil in the ultrasonic and turn on for 20 seconds. If the unit is functioning properly, the foil will be full of indentations and holes. If not, a repair is needed.
They may also be cleaned manually, but this presents more risk of an occupational exposure. If you must clean instruments manually,wear all PPE, use a scrub brush with a long handle,and scrub just a few at a time while holdingdeep in a sink. Rinse and inspect each instrumentbefore packaging. They should not have anydebris remaining.
2 - Afterward cleaning through eithermanual or mechanical means, thedental instruments should be driedwith a disposable cloth.
3 - Package the dried items into medical grade sterilization wraps or sterilization cassettes to prepare them for sterilization. They must be properly packaged before they are loaded into the heat sterilization unit.
4 - Sterilize the instruments using a heat, steam, or chemical process. Heat is the usual method used in a dental setting. Use sterilization equipment that is approved by theFood and Drug Administration fordental sterilization work and operate itaccording to the manufacturersspecific instructions.
5 - Storage the sterilized instruments in their intact packaging. According to the Centers for Disease Control, the packaging must remain sealed and undamaged in order to retain sterile nature of the instrument. If the packaging gets wet, tears or is damaged in some way, the instrument should be sterilized again through the same process.
Hand piece asepsis. sterilization between patients with acceptable methods that ensure internal as well as external sterility is recommended. For proper sterilization of hand piece, the manufacturer’s instructions must be followed.First, the hand piece should be flushed with water by running it for 20 to 30 seconds, discharging the water into a container.
Hand piece asepsis. If recommended by the manufacturer, use ultrasonic cleaner to remove any adherent material, otherwise, it should be scrubbed thoroughly with a detergent and hot water. Package for sterilization in steam or unsaturated chemical vapour following the manufacturer’s directions. If disinfecting a hand piece that cannot be heat sterilized, spray or saturate with disinfectant recommended by the manufacturer.
Method of sterilization Steam pressure sterilization (autoclave). Chemical vapor pressure sterilization (Chemiclave). Dry heat sterilization (Dryclave).
Steam pressure sterilization (autoclave) Time required 15 min time at 2500F (1210C) and 15 lbs of pressure (light load of instruments) Wrapped instruments – 7 min, 2730F (1340C) at 30 pounds of pressure. Preformed in a steam auto clave.
Steam pressure sterilization (autoclave) Advantages - Most rapid and effective method for sterilizing cloth surgical packs and towel packs Disadvantages – Items sensitive to elevated temperature cannot be autoclaved. - Tends to rust carbon steel instruments and burs. - Burs can be protected by submerging in anticorrosive agent- 2% sodium nitrite
Chemical vapor sterilization (chemiclave) Performed in a chemiclave - Operate at 2700F (1310C) at 20 lbs for half an hour. Advantages: - Carbon steeland burs are said to be sterilizedwithout rust.
Chemical vapor sterilization (chemiclave) Disadvantages: Items sensitive toelevated temperaturewill be damaged. Towels and heavy cloth wrappingmay not be penetrated to provideadequate sterilization. Only dry instruments should beloaded
Dry heat sterilization ( Conventional dry heat oven ) Heated at 320oF (1600C) for 30 min. Instruments should be packaged in foil wrap or nylon bags. Wrapped instruments : 3350- 3450 F for 60-90 mins. Short cycle high temperature dry heatOven :- Sterilization time reduced :6 min for unwrapped.12 min for wrapped. Temperature – 370 – 3750F