“EVALUATION OF VARIOUS
STERILIZATION PROCESSES OF
ORTHODONTIC INSTRUMENTS USING
BIOLOGICAL INDICATORS AND
CONVENTIONAL SWA...
INTRODUCTION

www.indiandentalacademy.com
• With the introduction of implants and
Orthognathic Surgery, and its growing
popularity the necessity for sterilization
h...
•

Most commonly used Infection Control
methods are:

1. Disinfection.
2. Sterilization.
•

Disinfection reduces microbial...
•
1.

How much effective or efficient is the sterilization
procedure can be monitored by using:Chemical Indicators.

2.

L...
• Conventional microbiological culture method can
determine the effectiveness of sterilization process by
spore growth whi...
• Biological Indicators consist of ampules or strips
enclosed in glassine envelope that contain a known
quantity of Bacill...
Aims And Objectives:

www.indiandentalacademy.com
1. Comparative evaluation of control and experimental groups by
sterilization of orthodontic instruments using:
– Autoclav...
REVIEW OF LITERATURE

www.indiandentalacademy.com
•

In 1857 Pasteur Louis introduced techniques of sterilization and
developed the steam sterilizer, Hot-Air Oven and Autoc...
•

Miller C.H., Sheldrake M.A. (1990) performed a study to compare
immediate and delayed incubation on the ability of Biol...
•

•
•

Palenik C.J.,Burke F.J.T, Coulter W.A., Cheung S.W. (1999)
emphasized the importance of improving and monitoring a...
MATERIALS AND METHODS

www.indiandentalacademy.com
Uniclave Mini Autoclave
Hot Air Oven

Ultra Sonic Cleaner

www.indiandentalacademy.com
Ethylene Oxide Sterilizer

Incubato...
Sets of Hinged & Non Hinged
Instruments

Armamentarium

Biological Indicator Strips

www.indiandentalacademy.com

Biologic...
METHODS

Instrument Contamination of Experimental Group

Instruments Precleaning

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• One set was not passed through sterilization
process and was directly send to microbiology
lab for culture test which co...
Control Group Procedure

Instrument Contamination

Precleaning

Swab

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METHOD USED FOR STERILIZATION USING STEAM AUTOCLAVE

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Crushing of Ampules

During Incubation

• The crushed ampule was kept inside the incubator along with crushed control
www....
STEAM AUTOCLAVE SWAB PROCEDURE

• After the sterilization cycle swab of Experimental Group of instruments was taken
along ...
METHOD USED FOR STERILIZATION USING ETHYLENE OXIDE
STERILIZER

• The sterilization cycle of Ethylene Oxide sterilizer was ...
Crushing of Ampules

During Incubation

• Biological Indicator was crushed along with Control Biological Indicator
and was...
Ethylene Oxide Swab Procedure

• After the sterilization cycle swab of Experimental Group of instruments was
.
taken along...
METHOD USED FOR STERILIZATION USING
HOT AIR OVEN

• Sterilization cycle for Hot Air Oven was 1710C for one hour.
•The spor...
HOT AIR OVEN SWAB PROCEDURE

• After the sterilization cycle swab of Experimental Group of instruments was
taken along wit...
METHOD USED FOR COLD STERILIZATION

•Biological Indicators are not available for Cold Sterilization, no Indicators were us...
LABORATORY PROCEDURE

Incubation of Culture Medium
Heating of Platinum Loop

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Inoculation of Pl...
Steraking of Control Group

Steraking of Experimental Group

After Streak Method
www.indiandentalacademy.com

During Incub...
AFTER INCUBATION OF BIOLOGICAL INDICATORS

• After 24 hours of incubation both the Biological Indicators (Control and
Expe...
AFTER INCUBATION OF SPORE STRIPS

Before Incubation

After Incubation

• After one week of incubation of spore strip for H...
AFTER INCUBATION OF AGAR MEDIUM

Steam Autoclave

Ethylene Oxide

Hot Air Oven

• After 48 hours of incubation of Agar med...
AFTER INCUBATION OF AGAR MEDIUM

10 minutes

10 hours
Cold Sterilization

• After 48 hours of incubation of Agar medium, s...
GROWTH FOUND IN THREE EXPERIMENTAL GROUP

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RESULT

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•

Comparative evaluation of Conventional Laboratory Method
with Biological Indicators
Method

• One group out of
fifteen ...
• Evaluation of spore growth in Cold sterilization by Conventional
Laboratory Method

Monitoring
Method
Conventional Labor...
GRAPH I

Comparison of Conventional Lab Method with Biological Indicators
15 15
No. of groups free of
spores

15

15
14

1...
GRAPH II
Number of Groups Free of Spores by Cold Sterlization

15

15

16
14
12
10
No. of Grs. Free of
8
Spores
6

Spores ...
DISCUSSION

www.indiandentalacademy.com
•

The study showed that all spores were killed when sterilization process was
monitored by Biological Indicators, but Con...
CONCLUSION

www.indiandentalacademy.com
1.

All methods of sterilization showed complete sterilization of
instruments when monitored with Biological Indicators.

...
www.indiandentalacademy.com
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Evaluation of various /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Evaluation of various /certified fixed orthodontic courses by Indian dental academy

  1. 1. “EVALUATION OF VARIOUS STERILIZATION PROCESSES OF ORTHODONTIC INSTRUMENTS USING BIOLOGICAL INDICATORS AND CONVENTIONAL SWAB TEST METHOD” -A COMPARATIVE STUDY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION www.indiandentalacademy.com
  3. 3. • With the introduction of implants and Orthognathic Surgery, and its growing popularity the necessity for sterilization has increased manifold. • It has been found that Orthodontists have second highest incidence of Hepatitis B among Dental professionals. www.indiandentalacademy.com
  4. 4. • Most commonly used Infection Control methods are: 1. Disinfection. 2. Sterilization. • Disinfection reduces microbial contamination but is generally less lethal to pathogenic organisms than sterilization and does not remove all the vegetative spores. • Sterilization destroys all forms of microorganisms including viruses, bacteria, fungi, and spores. www.indiandentalacademy.com
  5. 5. • 1. How much effective or efficient is the sterilization procedure can be monitored by using:Chemical Indicators. 2. Lab culture method. 3. Biological Indicators. • Most frequently used method for checking the effectiveness of sterilization is the Chemical Indicators. They are available in form of strips. • Their drawback is they only assure that the instruments have been exposed to sterilization cycle; they don't verify that complete sterilization has occurred and all vegetation has been destroyed. www.indiandentalacademy.com
  6. 6. • Conventional microbiological culture method can determine the effectiveness of sterilization process by spore growth which can be seen by naked eye. • Drawback of this procedure is that it requires lots of skill to determine the spore growth, even air borne contamination can affect the result of the culture method. And about 48 to 72 hours for spores to grow on culture medium. • Biological Indicators have been stated that they can provide a better method of verifying the effectiveness of sterilization procedures. www.indiandentalacademy.com
  7. 7. • Biological Indicators consist of ampules or strips enclosed in glassine envelope that contain a known quantity of Bacillus Stearothermophilus and /or Bacillus Subtilis spores. • Biological Indicators for monitoring Steam Autoclave or Chemical Vapor sterilization contain spores of Bacillus Stearothermophilus (Geobacillus Stearothermophilus). • Biological Indicators for monitoring Dry Heat or Ethylene Oxide sterilization contain spores of Bacillus Subtilis (Bacillus Atrophaeus). www.indiandentalacademy.com
  8. 8. Aims And Objectives: www.indiandentalacademy.com
  9. 9. 1. Comparative evaluation of control and experimental groups by sterilization of orthodontic instruments using: – Autoclave sterilizer – Hot air oven sterilizer – Ethylene oxide sterilizer • • Control Group: The contaminated instruments were ultrasonically cleaned and air dried but was not processed through different sterilization procedures. Experimental Group: The contaminated instruments were ultrasonically cleaned and air dried and was processed through different sterilization procedures. 2. To compare the efficiency of various sterilization procedures using conventional spore monitoring method i.e. by using swab test and biological indicators. 3. To determine the efficiency of Cold Sterilization by using Bioclenz-G (2% Glutaraldehyde) solution. www.indiandentalacademy.com
  10. 10. REVIEW OF LITERATURE www.indiandentalacademy.com
  11. 11. • In 1857 Pasteur Louis introduced techniques of sterilization and developed the steam sterilizer, Hot-Air Oven and Autoclave. • Council on Dental Therapeutics (1973) accepted Glutaraldehyde (cidex) as a disinfecting and sterilizing agent. • Matis B., Sellers R., and Christen A.(1980) did a study to determine permeability of protective covering of Biological spore monitor to formaldehyde. It was recommended that chemical vapor sterilizer should be avoided with layering of packages of instruments. • Skaug N (1983) did a survey to determine the sterilization procedures used by Oral Surgeons in Norway. The instruments were sterilized using Steam Autoclave at 1210C or 1340C; and Dry Heat Oven sterilizer. The sterilization procedures were monitored using Biological Indicators. • Field E.A., Field J.K., Martin M.V.(1988) conducted a study to test the physical effectiveness of TST (Time, Steam, and Temperature) strips for monitoring autoclave sterilization. www.indiandentalacademy.com
  12. 12. • Miller C.H., Sheldrake M.A. (1990) performed a study to compare immediate and delayed incubation on the ability of Biological Indicators to detect sterilization failures. The result showed that appropriate Biological Indicator can detect sterilization failure after immediate and after delayed incubation of seven days. • Hohit William F., Miller Chris H., Neeb M John., Sheldrake A. Margle (1990) performed a study to determine whether Orthodontic instruments and bands contaminated with blood or saliva and bacterial spores can be sterilized by Steam, Chemical Vapor, or Dry-Heat sterilizer. All the three types of sterilization was equally effective. • Hastreiter J. Richard et. al (1991) Suggested that Biological Indicators were useful in monitoring sterilization performance only when sterilization procedures are performed consistently and competently by well trained staff using adequately maintained instruments. www.indiandentalacademy.com
  13. 13. • • • Palenik C.J.,Burke F.J.T, Coulter W.A., Cheung S.W. (1999) emphasized the importance of improving and monitoring autoclave performance. According to authors Biological monitors are the main guarantee of sterilization for two reasons: They can simultaneously monitor the interaction of all sterilization parameters (temperature, pressure, time) which no gauge, thermocouple or chemical monitor can accomplish. They can measure the sterilization process within an individual pack, tray, or instrument grouping. The reason for failure of Biological Indicators was related to human error, such as improper wrapping and /or loading of an Autoclave. www.indiandentalacademy.com
  14. 14. MATERIALS AND METHODS www.indiandentalacademy.com
  15. 15. Uniclave Mini Autoclave Hot Air Oven Ultra Sonic Cleaner www.indiandentalacademy.com Ethylene Oxide Sterilizer Incubator
  16. 16. Sets of Hinged & Non Hinged Instruments Armamentarium Biological Indicator Strips www.indiandentalacademy.com Biological Indicator Ampules
  17. 17. METHODS Instrument Contamination of Experimental Group Instruments Precleaning www.indiandentalacademy.com
  18. 18. • One set was not passed through sterilization process and was directly send to microbiology lab for culture test which comprised the Control Group. • The other set of instruments were passed through different sterilization cycles which comprised the Experimental Group. • Each group was divided into Medium load (containing 15 sets of instruments) and Heavy load(containting 30 sets of instruments). • Each group was tested 15 times each for medium and heavy load. www.indiandentalacademy.com
  19. 19. Control Group Procedure Instrument Contamination Precleaning Swab www.indiandentalacademy.com
  20. 20. METHOD USED FOR STERILIZATION USING STEAM AUTOCLAVE www.indiandentalacademy.com
  21. 21. Crushing of Ampules During Incubation • The crushed ampule was kept inside the incubator along with crushed control www.indiandentalacademy.com Biological Indicator at temperature of 560C for 24 hours
  22. 22. STEAM AUTOCLAVE SWAB PROCEDURE • After the sterilization cycle swab of Experimental Group of instruments was taken along with swab of Control Group of instruments and was processed for Lab Culture. www.indiandentalacademy.com
  23. 23. METHOD USED FOR STERILIZATION USING ETHYLENE OXIDE STERILIZER • The sterilization cycle of Ethylene Oxide sterilizer was 8 hours at 550C www.indiandentalacademy.com
  24. 24. Crushing of Ampules During Incubation • Biological Indicator was crushed along with Control Biological Indicator and was incubated for 24 hours at temperature of 370C www.indiandentalacademy.com
  25. 25. Ethylene Oxide Swab Procedure • After the sterilization cycle swab of Experimental Group of instruments was . taken along with swab of Control Group of instruments and was processed for Lab Culture. www.indiandentalacademy.com
  26. 26. METHOD USED FOR STERILIZATION USING HOT AIR OVEN • Sterilization cycle for Hot Air Oven was 1710C for one hour. •The spore strips were incubated in Soyabean Casen Digestive Culture Medium at 370C www.indiandentalacademy.com for one week.
  27. 27. HOT AIR OVEN SWAB PROCEDURE • After the sterilization cycle swab of Experimental Group of instruments was taken along with swab of Control Group of instruments and was processed for Lab Culture. www.indiandentalacademy.com
  28. 28. METHOD USED FOR COLD STERILIZATION •Biological Indicators are not available for Cold Sterilization, no Indicators were used. •Swab of Experimental Group & Control Group of instruments was taken for determining www.indiandentalacademy.com the spore growth.
  29. 29. LABORATORY PROCEDURE Incubation of Culture Medium Heating of Platinum Loop www.indiandentalacademy.com Inoculation of Platinum loop
  30. 30. Steraking of Control Group Steraking of Experimental Group After Streak Method www.indiandentalacademy.com During Incubation
  31. 31. AFTER INCUBATION OF BIOLOGICAL INDICATORS • After 24 hours of incubation both the Biological Indicators (Control and Experimental Group) were removed from the incubator and was checked for change in colour of culture medium. If culture medium changes color it indicates presence of spores or sterilization failure. If there is no change in www.indiandentalacademy.com colour, it indicates no spore growth and sterilization was proper.
  32. 32. AFTER INCUBATION OF SPORE STRIPS Before Incubation After Incubation • After one week of incubation of spore strip for Hot Air Oven sterilizer change in turbidity of the culture medium was checked in both Control and Experimental Group. If the culture medium becomes turbid it indicates sterilization failure. No change in turbidity indicates proper sterilization. www.indiandentalacademy.com
  33. 33. AFTER INCUBATION OF AGAR MEDIUM Steam Autoclave Ethylene Oxide Hot Air Oven • After 48 hours of incubation of Agar medium, spore growth was determined. www.indiandentalacademy.com • The spore growth can be seen with the naked eyes
  34. 34. AFTER INCUBATION OF AGAR MEDIUM 10 minutes 10 hours Cold Sterilization • After 48 hours of incubation of Agar medium, spore growth was determined. • The spore growth can be seen with the naked eyes www.indiandentalacademy.com
  35. 35. GROWTH FOUND IN THREE EXPERIMENTAL GROUP www.indiandentalacademy.com
  36. 36. RESULT www.indiandentalacademy.com
  37. 37. • Comparative evaluation of Conventional Laboratory Method with Biological Indicators Method • One group out of fifteen groups in Steam Autoclave showed spore growth in heavy load • In Dry Heat sterilization one group both in medium load and heavy load showed spore growth from all the fifteen groups of Monitoring Sterilization Procedure Load Conventional Laboratory Method Biological Indicator Method Number of Samples (n) Dry Heat Oven Ethylene Oxide Spore Absent Spore Present Spore Absent Medium Load 0 15 0 15 15 Heavy Load Steam Autoclave Spore Present 1 14 0 15 15 Medium Load 1 14 0 15 15 Heavy Load 1 14 0 15 15 Medium Load 0 15 0 15 15 Heavy Load 0 15 0 15 15 www.indiandentalacademy.com
  38. 38. • Evaluation of spore growth in Cold sterilization by Conventional Laboratory Method Monitoring Method Conventional Laboratory Method Time Duration Spore Present 10 Minutes 15 10 Hours 0 Spore Absent 0 Number of Samples (n) 15 15 15 15 • Instruments dipped in Bioclenz-G solution for 10 minutes of cycle showed spore growth .Whereas instruments dipped for 10 hours of cycle showed no spore growth. www.indiandentalacademy.com
  39. 39. GRAPH I Comparison of Conventional Lab Method with Biological Indicators 15 15 No. of groups free of spores 15 15 14 15 14 15 15 15 15 15 14 10 5 0 Medium Heavy Medium Heavy Medium Heavy Steam Sterilizer Dry Heat Sterilizer Ethylene Oxide Sterilzer Experimental Group of conventional lab method Experimental Group of Biological Indicators • Spore growth was seen in three of the groups tested by Conventional Lab Method, in comparison with no spore growth in groups tested by Biological Indicators in Steam ,Dry Heat & Ethylene Oxide sterilization. www.indiandentalacademy.com
  40. 40. GRAPH II Number of Groups Free of Spores by Cold Sterlization 15 15 16 14 12 10 No. of Grs. Free of 8 Spores 6 Spores Present Spores Absent 4 2 0 0 0 10 Minutes 10 Hrs. Time duration • Spores were present in all the groups tested for 10 minutes cycle, in comparison to no spore growth in any of the groups tested for 10 www.indiandentalacademy.com hour cycle.
  41. 41. DISCUSSION www.indiandentalacademy.com
  42. 42. • The study showed that all spores were killed when sterilization process was monitored by Biological Indicators, but Conventional Swab Test showed spore growth in three experimental groups- One in Steam Autoclave and two in Hot Air Oven. This could probably due to Air Borne contamination or contamination of Swab and Culture while transferring. • Instruments dipped in Bioclenz-G solution for 10 minutes of cycle showed spore growth, whereas instruments dipped for 10 hours of cycle showed no spore growth. • Biological Indicators can be considered as the reliable method to check the sterilization efficiency as the spores present on them are highly resistant and the inactivation of the spores determines the sterilization efficiency. • Bioclenz-G solution (2%Glutaraldehyde) can be used for sterilization if instruments are dipped in the solution for 10 hours. • Just by Ultrasonically cleaning the instruments sterilization cannot be achieved. The debris, saliva, and blood may be cleaned and not visible to naked eye. But it does not ensure eradicating all microorganisms not visible to naked eye as can be seen by 100% spore growth of instruments of control group. • The disadvantage of Biological Indicators or its limitations is that it is not www.indiandentalacademy.com available to check or monitor all types of sterilization procedures.
  43. 43. CONCLUSION www.indiandentalacademy.com
  44. 44. 1. All methods of sterilization showed complete sterilization of instruments when monitored with Biological Indicators. 2. One group of heavy load in Steam Autoclave and one group each of medium load and heavy load in Hot Air Oven sterilizer showed sterilization failure when monitored with Conventional Swab Test Method. 3. The efficiency of Conventional Swab Test Method in monitoring sterilization is questionable as the results can vary due to Air Borne Contamination and Human Error. 4. The Biological Indicator is the more reliable and accurate method for monitoring sterilization. 5. American Dental Association recommends weekly spore testing of dental office sterilizer to determine the sterilization efficiency. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com

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