Sterilization in orthodontics

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Sterilization in orthodontics

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com STERILIZATION IN ORTHODONTICS www.indiandentalacademy.com
  2. 2. INTRODUCTION  KNOWLEDGE AND PRACTICE OF METHODS USED FOR KILLING, REMOVING, OR EXCLUDING MICROORGANISMS IS THE KEY TO PREVENTION OF CROSS INFECTION IN THE DENTAL CLINIC. www.indiandentalacademy.com
  3. 3. STERILIZATION  Process by which all forms of microorganisms including viruses,bacteria fungi and spores over articles or surfaces are destroyed.  Articles that are free of living organisms are termed STERILE. www.indiandentalacademy.com
  4. 4. DEFINITIONS --•ASEPSIS-a condition free of germs from infection &any form of life. •DISINFECT-To free from infection by physical or chemical means. www.indiandentalacademy.com
  5. 5. •DISINFECTION-Is used to describe a process which reduces the number of contaminating microorganisms particularly those liable to cause infections,to a level which is deemed no longer harmful to health. www.indiandentalacademy.com
  6. 6. •ANTI SEPSIS-a term used to describe disinfectant applied to living tissue such as a wound. www.indiandentalacademy.com
  7. 7. MODES OF TRANSMISSION •FROM PATIENT TO PRACTITONER. •FROM PRACTITONER TO PATIENT. •FROM ONE PATIENT TO ANOTHER(CROSS INFECTION). www.indiandentalacademy.com
  8. 8. ROUTE OF TRANSMISSION 1. INOCULATION –accidental self injury with a contaminated needle,sharp insruments. microorganisms transmitted – HBV,HCV, HDV, HSV I ,HSV II, HIV, NEISSERIA GONORRHOEA, TREPONEMA PALLEDUM, CLOSTRIDIUM TETANI. www.indiandentalacademy.com
  9. 9. 2. INHALATION :INHALATION OF MICROORGANISMS AEROSOLIZED FROM A PATIENT’S BLOOD OR SALIVA OCCURS WHEN USING HIGH SPEED OR ULTRASONIC EQUIPMENT. Eg :VARICELLA ZOSTER ,CYTOMEGALOVIRUS ,RUBEOLA & MUMPS VIRUS ,RUBELLA VIRUS , MYCOBACTERIUM TUBERCULOSIS, CANDIDA ALBICANS. www.indiandentalacademy.com
  10. 10. AREAS OF INFECTION CONTROL •INFECTION CONTROL IN THE CLINICAL AREA. •INFECTION CONTROL IN THE LABORATORY SET UP. www.indiandentalacademy.com
  11. 11. INFECTION CONTROL IN CLINICAL AREA. •PERSONAL PROTECTION EQUIPMENTS(PPE). •ENVIRONMENTAL SURFACE CLEANING &DISINFECTION . •INSTRUMENT STERILIZATION. •DISPOSAL OF WASTE. www.indiandentalacademy.com
  12. 12. PERSONNEL PROTECTION EQUIPMENT (PPE) •Protective clothing. •Gloves. •Masks. •Protective eyewear. www.indiandentalacademy.com
  13. 13. CATEGORIES OF PERSONEL •CAT 1-personnel routinely performs tasks that involve exposure to blood or other potentially infectious materials. •CAT 2-are personnel who on occasion may perform tasks that involve exposure to blood and other potentially infectious materials. www.indiandentalacademy.com
  14. 14. PROTECTIVE CLOTHING •Primary function- Protect worker from exposure to contaminated materials •Fluid resistant. •Minimal skin exposures,ie.long sleeves. •Cuff of the sleeve covered by the band of the •glove. •High risk procedures need have at least knee length when seated. •Buttons ,zippers,should be hidden and not exposed. www.indiandentalacademy.com
  15. 15. GUIDE LINES •Protective clothing not to be worn outside the dental office. •Change at least daily. •Incase soiled, change immediately. •Remove while relaxing esp. in the cafeteria while eating or drinking. www.indiandentalacademy.com
  16. 16. GLOVES  Gloves should be used while touching ---- 1. Blood and body fluids. 2. Mucous membrane. 3. Non intact skin of the patient. 4. Items or surfaces soiled with blood or body fluids. www.indiandentalacademy.com
  17. 17. Types of gloves 1. 2. 3. 4. 5. Vinyl or latex sterile, single use surgical procedure. Vinyl or latex - non sterile, single use examination procedure. Rubber / plastic material - non sterile,multiple use - over gloving. Polyethylene - non-sterile,multiple use over gloving. Nylon glove – non sterile ,multiple use – using beneath gloves. www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. General precautions to be taken while using gloves      Wear gloves for all dental procedures Discard gloves whenever they have been contaminated. Do not leave the clinic or walk around wearing gloves. Wash hands after removing gloves. Used needles should not be recapped. www.indiandentalacademy.com
  20. 20. REPROCESSING OF GLOVES     Rinse your gloved hands thoroughly in a hypochlorite solution. Then in clear water to remove the disinfectant. Wash with soap and water and rinse thoroughly. Remove the gloves and hang them up by the cuffs to dry  Dust glove powder on the inside of the gloves .  Test for holes in the house before reuse.  Autoclave the gloves. www.indiandentalacademy.com
  21. 21. MASKS    Surgical masks / chin length plastic face shields must be worn to protect the face. Should have at least 95% filtration efficiency for particles 3-5 micrometer in diameter. Should be changed for each patient since its efficiency decreases as it traps moisture during dental procedures. www.indiandentalacademy.com
  22. 22. EYE PROTECTION  The eyes of a dental professional are particularly susceptible to physical & microbial injury by virtue of their limited vascularity and diminished immune capacities.  Eyes must be protected during operative procedures by spectacles. www.indiandentalacademy.com
  23. 23. HAND WASHING www.indiandentalacademy.com
  24. 24. •First scrub hands with warm water. •Get soap under the nails and clean with brush. •Rinse hands with cold water. •Wipe hands with paper towel or dry with warm air. www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. AGENTS OF HAND CLEANING •Substituted phenol preparations like chlorhexidine gluconate and parachlorometaxylenol (pcmx). •4% chlorhexidine & 3% PCMX are equally sufficient. •Both remain in the tissues in an active form for prolonged periods thus maintaining a residual activity for prolonged periods. www.indiandentalacademy.com
  27. 27. Method of sterilization  Moist heat (autoclaving)  Dry heat  Chemicals (chemiclaving) (hot air oven) www.indiandentalacademy.com
  28. 28. Moist heat •Moist heat denatures & coagulates the protein of microbes. •Better than dry heat because of its higher efficiency of penetration. •Due to latent heat of vaporization present in moist heat. www.indiandentalacademy.com
  29. 29. TYPES OF AUTOCLAVES POROUS LOAD AUTOCLAVES : 1. Autocycled high pressure vacuum models  .  Air is evacuated from the metal chamber by vacuum suction.  1210 C , AT 20 lb pressure for 30 min.  Towels ,suture materials,cotton rolls, rubber gloves ,root canal instruments. www.indiandentalacademy.com
  30. 30. SMALL BENCH TOP AUTOMATIC AUTOCLAVE  Work on the principle of downward displacement of air as a consequence of steam entering at the top of the chamber.  Temp of 136oc ,at 32 lb pressure for 5 min www.indiandentalacademy.com
  31. 31. STERILIZATION CYCLE Temperature Time Pressure Unwrapped instruments 134oc 3 min 30 psi Wrapped instruments 1210c 15-20 min 15 psi www.indiandentalacademy.com
  32. 32. DRY HEAT  Less effective than moist heat  Higher temperatures ,longer periods &longer heating up time required for sterilization (45 min to reach 160oc).  Should have a time clock on the door ,so items cannot be added or removed during the cycle & a fan to distribute the heat evenly. www.indiandentalacademy.com
  33. 33. CHEMICAL STERILIZATION  Combination of formaldehyde,alcohol,acetone,ketone &steam at 20 psi serves as an effective sterilizing agent.  biocidal action of formaldehyde depends on its alkylation of microbial nucleic acids,which control protein synthesis.  Takes longer time than an autoclave (30 min)for packaged instruments (shorter than hot air oven) www.indiandentalacademy.com
  34. 34. Advantage of chemiclave :  Shorter cycle  Lack of corrosion of instruments /burs.  Adequate ventilation must be provided in order to expel the residual fumes released on opening the chamber at the end of the cycle. www.indiandentalacademy.com
  35. 35. Ethylene oxide gas sterilization.  A flammable ,explosive and toxic gas to which all types of microbes are susceptible.  Biocidal activity is due to alkylation and hence causes denaturation of microbial nucleic acid.  Biocidal activity increases in the presence of moisture.  Plastic ,metal,rubber or cloth can be sterilized without damage.  Equipment is costly & gas is toxic. www.indiandentalacademy.com
  36. 36. STERILIZATION BY GAMMA IRRADIATION :  Used for needle,sutures ,gloves etc GLASS BEAD STERILIZATION :  Heating glass beads in a chamber into which instrument is inserted for 10-30 sec.  2100c –230 0c .  Suitable for very small instruments like www.indiandentalacademy.com R.C.T instruments ,burs ,pliers etc.
  37. 37. Water boilers… •does not achieve sterilization as many spores can with stand it. •Cross infection from contaminated water containing bacterial spores not killing by boiling. www.indiandentalacademy.com
  38. 38. Monitoring sterilization Three forms  physical monitoring.  Chemical monitoring.  Biological monitoring. www.indiandentalacademy.com
  39. 39.  PHYSICAL MONITORING :Refers to periodical observation of displays or gauges on the sterilizer during a cycle to ensure the sterilization process. www.indiandentalacademy.com
  40. 40. Chemical monitoring. 1. 2. Two types are available process indicators :- consist of colour changing material (liquid /paper) which changes color upon exposure to appropriate sterilization cycle. TST strips (TIME ,STEAM,TEMPERATURE) change color when all parameters have been adequately achieved in the sterilization cycle. www.indiandentalacademy.com
  41. 41. BIOLOGICAL MONITORING.  Indicator used are heat resistant bacterial spores (bacillus stearothermophillus ,bacillus subtilis )  If the spores are killed ,then less resistant microbes are killed more readily and sterility is achieved. www.indiandentalacademy.com
  42. 42. Classification of instruments to be sterilized  Critical  Semi critical  Non- critical www.indiandentalacademy.com
  43. 43. Critical  Surgical other instruments used to penetrate soft tissue / bone.  Should be sterilized after each use. eg :-forceps ,scalpels,bone chisels,scaling instruments,surgical burs. www.indiandentalacademy.com
  44. 44. Semi critical  Instrument that do not penetrate soft tissue / bone but contact oral tissues. eg :-mirrors ,plastic instruments,burs etc. www.indiandentalacademy.com
  45. 45.  Non critical :Items which do not come into contact with body fluids. eg:-light cure tips,glass slab,cement spatula,orthodontic pliers,dapen dish. www.indiandentalacademy.com
  46. 46. Procedure before sterilization •Pre soaking of instruments. •Pre sterilization cleaning • manual • ultrasonic www.indiandentalacademy.com
  47. 47. Presoaking •Keeps instruments wet. •Prevents drying of saliva &blood on the instruments. •Facilitating easy cleaning. •solution used may be phenol or gluteraldehyde. www.indiandentalacademy.com
  48. 48. Pre sterilization cleaning. 1. 2.     Manual cleaning Ultrasonic cleaning :Employ piezo-electric oscillators situated underneath S.S enclosures to create oscillations in a fluid filled tank. Oscillations are transformed into a series of high frequency sound waves, which cause intense microscopic cavitation in the fluid. Large number of these tiny bubbles collapse creating minute vacuum areas which are responsible for the scrubbing effect. 2 – 20 min www.indiandentalacademy.com
  49. 49. ADVANTAGE OF ULTRASONIC CLEANING OVER MANUAL CLEANING •Increased efficacy. •Reduced danger of aerosolization. •Reduced incidence of instrument injuries. •Increased tarnish removal and cleanliness. •Reduction in manual labour. www.indiandentalacademy.com
  50. 50. Sterilization trays Three types 1. Fully closed system.(with individually packed items in commercially available sterilization bags) 2. Perforated trays.(with fitted covers wrapped with sterilization paper) 3. Open tray system.(sealed with a see through sterilization bag) www.indiandentalacademy.com
  51. 51. Cold sterilization    process of disinfecting instruments / equipment by using a liquid chemical germicide is called cold sterilization. Used for heat sensitive instruments. Aseptic rinsing with sterile water and drying should follow this disinfection process. www.indiandentalacademy.com
  52. 52. Disinfectants used in dentistry     Glutaraldehydes. Chlorine compounds. Iodophors. Synthetic phenolics. www.indiandentalacademy.com
  53. 53. Chemical disinfectants effective in inactivating HIV  SODIUM HYPOCHLORITE (0.1 -0.5%)  CHLORAMINE 2% (TOSYL CHLORAMIDE SODIUM)  ETHANOL 70%  2 –PROPANOL 70% (ISOPROPYL ALCOHOL)  PROVIDONE IODINE 2.5%  FORMALDEHYDE 4%  GLUTARAL 2% (GLUTARALDEHYDE)  HYDROGEN PEROXIDE 6% www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. GLUTARALDEHYDE  20 min. immersion in a 2% alkaline glutaraldehyde solution - disinfection.  6 -10 hours immersion – sterilization. properties :-  high biocidal activity.  Broad antimicrobial spectrum within 10-30 min.  Sporicial after 7-10 hrs. of exposure at room temperature.  Noncorrosive.  Penetrates blood, pus & organic debris.  Induces severe tissue irritation upon prolonged contact.  Discolors nickel coated impression trays & carbon steel www.indiandentalacademy.com
  56. 56. Quaternary ammonium compounds. Advantages : Bactericidal against gram positive bacteria.  Non –irritating.  Economical.  Pleasant odor. Disadvantages:-  inactivated by organic matter.  Can sometimes support gram negative bacteria.  Easily inactivated by presence of anionic detergents, soaps &hard water. www.indiandentalacademy.com
  57. 57. Chlorine compounds Advantages : Rapid antimicrobial action.  Effective in dilute solution.  Economical  Sodium hypochlorite is useful as a broad spectrum bactericidal, virrucidal, tuberculocidal surface disinfectant. www.indiandentalacademy.com
  58. 58. Disadvantage:•Sporicidal effects noted only at high concentration. •Prepared solution has only limited shelf life. •Activity diminished by presence of organic matter & altered pH  Unpleasant odor  Irritates skin &eyes.  Can degrade plastic & rubber coated instruments. www.indiandentalacademy.com
  59. 59. Chlorine dioxide Advantages : Instrument and environmental surface disinfectant /sterilant  Rapid 3 min. disinfection ,6 hrs. sterilization.  Non-irritating and non-toxic. Disadvantage:-  Must be prepared daily  Does not readily penetrate organic debris.  Only 24 hrs shelf life. www.indiandentalacademy.com
  60. 60. Iodophors Advantages:1. Broad spectrum disinfectant, especially effective against heavy viral contamination. 2. Biocidal activity occurs within 3-30 min. 3. Effective in dilute solution. Disadvantages:1. Not a sterilant. 2. Unstable at high temperature. 3. Must prepare daily. 4. Inactivated by hard water. 5. May discolor some light colored surfaces. www.indiandentalacademy.com
  61. 61. Alcohols (70% isopropyl alcohol &70% ethyl alcohol) Advantages :1. Rapidly bactericidal against most gram positive & gram negative bacteria. 2. Active against many lipophilic viruses 3. Economical. Disadvantages :1. Ineffective against bacterial spores. 2. Diminished activity in organic matter and tissue debris. 3. Bactericidal activity diminished greatly. www.indiandentalacademy.com
  62. 62. Synthetic phenols  They act as a protoplasmic poison which precipitate the protein and destroy the cell wall. Advantages:- 1. synergistic effect instead of additive. 2. Broad antimicrobial spectrum. 3. Can be used on metal, glass, rubber &plastic. 4. Less toxic & corrosive. 5. Economical. Disadvantages:1. Not a sterilant 2. No re-use life. 3. Irritates skin & eyes. www.indiandentalacademy.com
  63. 63. Two methods of surface asepsis. • Cleaning & disinfecting the contaminated surface. • Preventing the surface from becoming contaminated. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. Surface cover. • Materials impervious to moisture. • On surfaces difficult to clean. • To be changed between patients. (impervious- backed paper, aluminium foil / plastic covers ) www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67. www.indiandentalacademy.com
  68. 68. Spray – wipe spray technique. • Spray the surface. • Wipe in systematic pattern contacting each surface at least twice. • Spray again. • Allow solution to dry and then wipe in 10 minutes for proper disinfection. www.indiandentalacademy.com
  69. 69. www.indiandentalacademy.com
  70. 70. • The disinfectant used must be a hospital level disinfectant ie.it should inactivate the Polio 2 virus and Mycobacterium Tuberculosis . • Isopropyl alcohol and quaternary ammonium compounds are not recommended as they achieve less level of surface wettability compared to that of water based disinfectants. www.indiandentalacademy.com
  71. 71. Disinfecting dental equipments. • Hand piece • 3 way syringe tips • HVE tips • aspirators www.indiandentalacademy.com
  72. 72. Hand pieces • Most are autoclavable. • Depends on manufacturers guidelines. • Prior cleaning and lubrication is mandatory. • Hand piece is placed in autoclavable pouch with TST strips. www.indiandentalacademy.com
  73. 73. Steps for proper sterilization of hand pieces. • Decontamination inside n outside. • Rinse . • Flush lines. • Dry . • Sterilize . • Lubricate and run hand piece. • Bag wrap. www.indiandentalacademy.com
  74. 74. Suck –back devices / check valves on hand pieces  Suck –back devices prevent any residual water left in the line from the previous patient, from going into next patient’s operating field when the procedure starts.  Check valve is a simple gadget that will tell you immediately if any retained water is coming back out of the hand piece.  Both these devices can be fitted on to an older hand pieces. www.indiandentalacademy.com
  75. 75. www.indiandentalacademy.com
  76. 76. www.indiandentalacademy.com
  77. 77. Three way syringe tips / high velocity evacuation tips / aspirators    3 –way syringe should be treated in the same manner as hand piece. HVE tips –metal tips are autoclavable. Plastic tips must be disposed off after single use. Aspirators –disinfectant flushes for the aspirators should be done after each patient. www.indiandentalacademy.com
  78. 78. Sterilization & disinfection of individual articles. Disinfection of dental impressions :ALGINATE:-iodophores / glutaraldehyde – 15 min. LYSOL spray – 10 min. www.indiandentalacademy.com
  79. 79. Burs ethylene oxide 4-12 hours autoclave. carbon steel instruments chemical vapour---20 min at 270 °f ethylene oxide ----4-12hours dry heat oven---60-120 min at 320°f tungsten carbide instruments chemical vapour---20 min at 270 °f dry heat oven---60-120 min at 320°f www.indiandentalacademy.com
  80. 80. Corrosion of instruments. corrosion is an electrolytic process in which the contact of two dissimilar metals sets up a potential difference resulting in an electron flow.This flow leaves behind reactive ions that readily combines with atmospheric oxygen to form oxides (rust). Corrosion resistance of orthodontic grade steel is directly proportional to its carbon content and the chromium content ( PASSIVATION EFFECT) www.indiandentalacademy.com
  81. 81. Sterilization in orthodontics. David Drake(1997)JCO    Plastic items & heat sterilizable cheek retractors – immerse in procide (strelalization solution whish turns milky after autoclaving) Hand pieces & photographic mirrors – sterilized in a kavo-klave Plier racks & instruments are placed in a wire basket & run through an ultrasonic cleaner containing rust inhibiting non-ionic multipurpose ultrasonic cleaner . www.indiandentalacademy.com
  82. 82.      Ultra-sonic solution should be changed daily & covered during cleaning to reduce aerosols. Dried blood must be scrubbed off & repeat ultrasonic cleaning . Heavy duty nitril gloves are required for handling contaminated instruments. After cleaning instruments are dipped in a sodium nitrite rust inhibitor Auto clave for 20 min &20 min for cooling. www.indiandentalacademy.com
  83. 83. STERILIZATION OF NiTi WIRES  Heat sterilization is the most reliable method - (Steam autoclaving at 1210C,15-20psi for 20 min)  Chemical sterilization are corrosive &attack metals immersed in them (2% acidic Glutaraldehyde) • STERILIZATION OF ORTHODONTIC BANDS:-15 SECONDS OF GLASS BEAD STERILIZATION.(SMITH et www.indiandentalacademy.com al 1986 AJO)
  84. 84. CAUSES OF STERILIZATION FAILURE (GEORGE 1993 JCO)  CYCLE TIME TOO SHORT  TEMPERATURE TOO LOW  FAILURE TO PREHEAT  FAULTY STERILIZER  INTERRUPTING OF CYCLE  OVERLOADING OF CHAMBER  INADEQUATE STAFF TRAINING  IMPROPER PRECLEANING, PACKAGING  FAILURE TO USE BIOLOGICAL INDICATOR TESTING. www.indiandentalacademy.com
  85. 85. Disposal of waste •Its should be disposed in tamper proof containers/ boxes. •Its should be labeled as BIOHAZARD. •Should be in tune with the existing laws of the area. •Sharp material should be stored in hard walled leak proof containers ,red in color. www.indiandentalacademy.com
  86. 86. www.indiandentalacademy.com
  87. 87. Color coding for waste disposal •Yellow --- waste for incineration . •Yellow with --- waste for land fill . black stripes •Light blue--- for autoclaving before disposal •Red ---human anatomical wastes. •Black ---normal household wastes. www.indiandentalacademy.com
  88. 88. www.indiandentalacademy.com
  89. 89. CONCLUSION PREVENTION IS BETTER THAN CURE www.indiandentalacademy.com
  90. 90. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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