Download 2017ICE Handout2

Infection Control Exam Preparation Course Outline -2017
Catherine A. Collier RDH, B.Ed, MS
The contents of this handout are intended to provide insight into the information that may be presented on
the IC Exam. This information has been selected by Catherine Collier, RDH, B.Ed, MS. Course participants
are responsible for researching additional course information reflecting this handout content. The author,
Catherine Collier, DOES NOT grant permission to copy or use this course information for teaching purposes
at any level other than course participation directly affiliated with either Professional Learning Services or
Catherine Collier.
Participants are required to print out and bring this handout to their scheduled course. All content will be
addresses on the day of the program.
The Infection Control Exam Blueprint
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10% Patient and Dental Healthcare Worker Education
20% Standard/Universal Precautions and the Prevention of Disease Transmission
10% Maintaining Aseptic Conditions
15% Instrument Processing
15% Aseptic Procedures
30% Occupational Safety
Agencies Involved:
The following agencies constitute who selects and enforces the regulations regarding Occupational Health and
Safety for dental healthcare workers.
1. Occupational Health and Safety Administration - OSHA
OSHA compliance is mandatory for all institutions
OSHA is the law regulator and authority
OSHA is concerned with the health and safety of the employee
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2. The Center for Disease Control – CDC
Centers for Disease Control and Prevention
Federal agency that investigates, identifies, reports, tracks and tries to prevent and control diseases
CDC is a part of the Department of Health and Human Services
CDC is a nationally recognized agency regarding issues concerning public health, e.g., workplace hazards,
infectious diseases, environmental health threats.
CDC establishes the guidelines and recommendations for infection control policies and procedures
CDC is part of the public health department, Its main concern is the health and safety of the patient
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3. Environmental Protection Agency - EPA
Federal agency that works to control and abate pollution in air, water, solid waste, pesticides, disinfectants,
radiation and toxic substances.
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4. Food and Drug Administration - FDA
An agency of the Department of Health and Human Service that is responsible for ensuring the safety and
effectiveness of food, drugs, cosmetics and medical devices
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Who is responsible to provide employee training:
The owner of the dental practice is responsible to provide training
Training should be conducted:
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Annually for all employees
For new employees prior to initial assignment
When a new product or new equipment is introduced into your practice
Office training can be conducted in various ways
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Purchase a DVD for team to view
Appoint a safety coordinator in your practice to train
Hire a person who is extremely familiar with the guidelines of OSHA and CDC ETC.
Attend a presentation or have an in office presentation and walk through assessment of equipment and supplies
Office Record Keeping For Employees
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Employee medical or accident reports records are kept for full, part time or former employees
A medical record is any record that holds the health status of an employee
Record is completed by a doctor or healthcare provider
Employees have the rights to access their record
Employees are entitled to a copy of their medical records
Employee records also include, but are not limited to:
 CE credits – valid for 3 years
 Certification courses
 License
 Malpractice Insurance
 Any certification the employee carries
 Records of required immunization or decline
 Results of medical testing, medical opinions and treatment
Employers should inform outside services of office policies and expect temps, interns or outside services to
comply with office policies
How to handle an office inspection:
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Ask inspector to present credentials
The following process should occur with an inspector:
Opening conference
Walk through assessment of the facility – Office Investigation
Closing conference reviewing the office findings
Results of inspection / Practice owners have the right to appeals findings
How to file for work related injuries
Work related injuries are considered accidents or injuries that occur in the workplace during the days and
times employees are assigned to be there. They are injuries that require the employee to seek medical
attention outside the office.
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Employers must establish a log for each facility
OSHA Log 300 will assist the employer and employee with how to properly recognize and file a work
related accident. Log 300 classifies work-related injuries and illness
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Log 301 The complete injury and illness Report
Log 300A Summary Report Post from Feb. -April
Documentation and Policies
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The record is legible to someone other than the writer
Entries should be written in black or blue ink
Do not skip lines, erase or white out info or changes
All entries should be dated
Sign all documents with full name and credentials
Document patient acceptance and refuse of treatment
Document any and all emergency situations that may occur for patient or employee
Document treatment received or refusal of post exposure or accident for patients or employees
Remember.. If you don’t write it down .. You never did it
Occupational Exposure Control Plan - OSHA CFR 1910.1030 –
Employers are required by OSHA to have a written Exposure Control Plan. An Exposure Control Plan
protects workers from exposures to blood and other body fluids.
ECP reduces exposure incident costs
ECP serves as a document to answer questions related to bloodborne pathogen
Exposure Control Plan should include the following information:
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List the current names of high or low risk employees
Must state their job classification and task descriptions
Must state the methods of compliance
Employees should receive training according to their job position and potential risk exposure
Employee Tasks and Work Restrictions
Employers should provide a comprehensive written policies manual regarding employees work
restrictions
Work restrictions/exclusions are limitations in professional duties as determined by policies set within the
dental practice setting
Restrictions/exclusions may be imposed on dental workers whose health status poses a high risk of
infection to patients, coworkers, or themselves
Every dental practice should have a written work restriction and exclusion policy which includes who
may implement restrictions and exclusions
Hazard Communication Program
Occupational Safety and Health Administration (OSHA) guideline requiring dental offices to develop and
implement a program to instruct all employees who might be exposed to hazardous materials in the safe
handling and disposal of those materials.
These materials include but are not limited to:
 Amalgam
 Composites
 Glass Ionomers
 Disinfectants
 Bleach
 Phenols/ alcohols
 Impression materials
 Developer/ Fixer
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Injectable/ OTC
Safety Data Sheet (SDS)
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Information provided by manufacturers of potentially hazardous products that must include:
Product identification
Chemical content
Hazardous ingredients
Physical data, fire and explosion information
Reactivity data
Health hazard data
Emergency and first aid procedures, spill or leak procedures
Labeling and storage information.
The New Hazard Communication Standard was previously known as "Employee's Right to Know,“
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Globally Harmonized System of Classification and Labeling (GHS).
Allows employees to understand the risks associated with and protections needed when working with hazardous
chemicals or drugs.
Required updates to chemical labels including the use of pictograms and signal words.
Material Safety Data Sheets will be updated and be referred to as Safety Data Sheets.
The purpose of SDS is to provide information on:
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The United Nation action on hazardous chemicals
Hazardous Chemicals in the workplace
Upkeep of equipment and supplies
Injuries that occur in the workplace
The user of the chemical product assumes liability for any misuse of products
Follow manufacturer’s directions for:
 Proper mixing
 Use/handling
 Storage and disposal
 Proper selection of personal protective equipment
 Effective ventilation
Secondary Container Labels Information
Dental Unit Waterlines
Bacterial growth in the dental unit waterline is encouraged due to:
 Size of tubing
 Surface material
 Speed of flow rate
 Intermittent flow rate
The rod- shaped, gram-negative bacteria Legionella pneumophilia is among the highest bacterial growth
found in the waterline. These bacteria are considered to be the cause of Legionnaires’ disease.
Available methods for treating the dental unit waterline:
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Utilize Isolated Water Supply - Isolates the dental unit water from the municipal water supply. Water supply is
filled and maintained by office staff
Utilize Chemical or Physical Treatments of the water supply
Flushing the waterlines for 20-30 seconds clears the waterlines of free-floating microorganisms
Utilize sterile water supply
Pros and Cons of having an isolated water supply
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Isolate the dental unit from the municipal water supply
Allow the practice to control the quality of water in the unit
Provide a way to introduce chemical agents to waterlines and permit the use of water of known microbiologic
quality
Cannot reliably improve the quality of dental unit water without additional chemical or mechanical treatment
against the biofilm
Improperly maintained systems could deliver water of worse quality than from a municipal source.
Pros and Cons of Chemical treatment of waterline
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May be time-consuming and technique-sensitive
Treatment involves purging the waterlines, adding a chemical to the water reservoir
Require strict compliance with the recommended treatment regimen
May be incompatible with dental equipment (the proper treatment protocol depends on the type and components
of the dental unit)
Continuous-release chemicals may be incompatible with various dental materials (for example, dental
Adhesives)
Pros and Cons of utilizing physical treatments
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Produces water that meets or exceeds drinking water standards
May include anti - retraction features
Are not labor intensive when placing and replacing
May require periodic chemical treatment of the post-filter segment of the waterlines to control biofilm
May be expensive, as each waterline requires a separate filter that must be maintained daily or weekly,
depending on the brand
Point of entry filters are a considerable investment and must be professionally installed
Pros and Cons of flushing the waterlines
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Helps to remove contaminants that may have been retracted during patient treatment
Clears away free-floating organisms in the water, temporarily reducing the number of microbes in treatment
water
Flushing is not recommended as a control method for dental water quality
Has only temporary effects (Biofilm bacteria continually break free and re-contaminate dental unit water during
the course of clinical treatment)
When used alone, has little effect on waterline contamination
Does not prevent or eliminate biofilm
Pros and Cons of utilizing sterile water delivery systems
Autoclavable, self-contained water systems with disposable or autoclavable tubing
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Bypass the dental unit's water line
Deliver sterile water to the patient
Used for oral surgery and implantology handpieces, ultrasonic scalers and retrofit devices for restorative
handpieces
Have autoclavable components which require sterilization between uses
Radiation Exposure Controls
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Provide film badges
Keep records of the test results
Provide lead aprons, goggles, gloves as needed
Dispose of lead aprons according to the EPA regulations
Radiation Warning Signs:
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Applies to facilities with x-ray machines
Survey the types of radiations used in the facility
Restricted areas to limit employee exposure
Rooms and equipment may need to be labeled with caution signs
Infection Control Practices and Policies
Goals of Infection Control is to break the chain of disease transmission
In order to stop the spread of an infectious disease dental healthcare workers need to :
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Maintain host resistance
Reduce or kill the number of organisms
Stop the path of an organism before it enters a host
Minimize or eliminate contact with blood and all body fluids
Infection Occurs when there is a place for an organism to live
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Mode of Transmission - a way to transfer the organism to the host
Causative agent - the presence of a dangerous organism
Susceptible Host – Employee is susceptible
Groups of Bacteria Include:
Gram negative bacteria – stain pink or red
Endotoxins – are a toxic substance in gram-negative bacteria
Gram Positive bacteria stain blue or purple
Shapes –
Cocci- spherical cells
Bacilli - Rod-shaped cells
Spiral - curved shaped cells
Endospores – one of the most resistant dormant structure formed inside bacterial such as Geobacillus, Bacillius, and
Clostridium
Factors which contribute to bacterial growth include:
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1. Oxygen
Obligated Aerobes – need oxygen to grow
Obligated Anaerobes – cannot tolerate oxygen
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2. Temperature –
Thermophiles 132 degrees F –158 degrees F, Most resistant to heat is G. Stearothermophilus
Mesophiles 71.6 degrees F – 133 degrees F
Psychrophiles 33.8 degrees F- 71.6 degrees F
3. Acidity 0 = high acidity – 14 high alkaline
Neutral is a pH of 7 - it is a balance between acid and base
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Nutrients - bacteria need proteins, polysaccharides, lipids and nucleic acid such as RNA/DNA to grow
Source of Bacteria
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Endogenous infections are caused by microorganism usually on the surface or inside the body
Ex. Caries, periodontial disease,
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Exogenous infections are caused by microorganisms that contaminate the body form an outside source
Ex. HBV, Strep throat, measles, chickenpox
Disease transmission occurs:
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Indirect contact with blood or OPIW
Indirect contact with contaminated objects
When mucous membranes contact splatter
Breathing airborne particles
Parenteral Exposure
Airborne Disease
Influenza – “The Best Mutator”
Symptoms of Influenza including 2009 H1N1 influenza, may have some or all of these symptoms:
Fever - not always
Cough
Sore throat
Runny or stuffy nose
Body aches /Headache/ Chills
Fatigue
Sometimes diarrhea and vomiting
The flu can infected and re-infected
 Type A Usually present in larger epidemics
 Type B Accounts for most hospitalizations
 Type C Mostly respiratory Illness
Virus can drift and subdivide thus making immunity difficult
Elimination of potential exposure to influenza includes:
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Deferral of treatment
Mask coughing individuals
Identify patients with influenza-like illness at check-in
Offer a facemask or tissues to symptomatic patients
Follow respiratory hygiene/cough etiquette
Reschedule non-urgent care – at least 24 hrs. wo/ fever or medications
Specific Recommendations for Dental Health Care
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Encourage seasonal influenza and 2009 H1N1 influenza vaccinations.
Consistent implementation of sick-leave policies and vaccination
Personal protective equipment (PPE)
Self-assess daily for symptoms
Stay home if ill or have family member that is ill
Separate ill patients from others whenever possible if evaluating for urgent care.
Patient-reminder calls to identify patients reporting influenza-like illness
Viral Infections:
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Herpes Virus “The Houdini of Viruses”
Common properties include:
 DNA coding
 Similar architectural structures
 Can remain dormant for the life of the host
Most Common Strains of Herpetic Viruses
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Herpes labilias - Human herpes virus 1 (HHV1) (HSV1)
Genital herpes - Human herpes virus 2 (HHV2) is also called herpes simplex virus 2 (HSV2)
Varicella-Zoster - Human herpes virus 3 (HHV3) causes chickenpox. Can cause a recurrent viral infection
such as herpes zoster or shingles
Epstein-Barr Human herpes virus 4 (HHV4) Major cause of infectious mononucleosis
Human herpes virus 6 (HHV) and 7 (HHV7)
HHV6 and HHV7 are so common that most of humankind has been infected at some point
HHV7 can also cause roseola
Human herpes virus 8 (HHV8) - Discovered in Kaposi's Sarcoma , Associated with AIDS
Hepatitis A “The Salad Bar Disease”
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Spread of filth or unsanitary conditions
Mostly related to socioeconomic development
Younger patient is usually asymptomatic, but can develop self-immunity to virus
Self- limiting disease - 1% of patients require liver transplant
Four inactivated vaccines are internationally available
Vaccines are safe and effective, long-lasting
Vaccines are NOT licensed for children less than one year of age.
Hepatitis B
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Is spread via percutaneously or permuscosally by infected body fluids
It can be passed on through birth – If mother is HBsAG and HBeAg there is a 70% change of the infant
contracting HBV
Sexual activities
Contact with contaminated needles or sharp objects
Hepatitis C “The Silent Epidemic”
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There is no vaccine for HCV
The virus can live in body 20 to 30 years
A small number of people with hepatitis C infection may develop liver cancer
Liver failure may occurs as a result of severe damaged by hepatitis C
Monitoring the Condition of The Liver
Who should be tested for HCV
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Illicit drug use
Unexplained or unusual liver function tests
Babies born to mothers with hepatitis C
Health care and emergency workers who have been exposed to blood or accidental needle sticks
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Hemophiliacs who were treated with clotting factors before 1987
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Long-term hemodialysis treatments
Blood transfusions or organ transplants before 1992
Sexual partners of anyone diagnosed with hepatitis C infection
Immunization
CDC Healthcare Vaccine Recommendation
Measles, Mumps , and Rubella – MMR
Varicella – Chickenpox
Tetanus, Diphtheria and Pertussis –Tdap
All dental Healthcare workers receive a baseline tuberculosis screening upon hiring regardless of the risk
classification of the facility
Flu vaccine is offered to increase prevention
Hepatitis B Vaccine
Provided during professional training
Offered to workers likely to contact blood or OPIW
Serologic test not necessary prior to vaccine
Needle stick exposure for unvaccinated person should lead to initiation of HBV
Immune Globulins are not a substitute for the vaccine
Always Report reactions to the vaccinations
Mild reactions such as soreness, headaches, and fever are common side effects of the flu vaccine
Severe reaction such as difficulty breathing, hives, or facial swelling, seek medical attention immediately.
Post Exposure Evaluation
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Report all incidents and accidents immediately to supervisor
Record all necessary data required for testing
Employees must receive a medical evaluation and follow up
Paper work must be completed and ready to go to evaluation facility
Source testing / employee testing
If needed post exposure treatment should begin within 2 hours of incident
Needle stick injuries Are Most likely to occur:
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Organize a product selection and evaluation team
Collect information from a dental “Safety Syringe and Needle Screening” form
Set priorities for product consideration
Safe handling of the device should be demonstrated by all employees that are required to use it
Needles and syringes are single patient use only
Rubber septum should be disinfected with alcohol prior to piercing
Sharps Safety:
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Prepare the patient and organize the work area with prevention in mind.
Keep exposed sharps in view and under your control.
Visually inspect for unprotected sharps in trays and waste receptacles.
Be responsible for the sharps you use.
Activate safety features. Dispose in sharps containers.
What to do if you suspect puncture:
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Remove glove immediately and fill it with water to check for penetration
Rinse with cool water and cover
REPORT IMMEDIATELY TO SUPERVISOR
Use OSHA form 300 to record and report
Report all incidents and accidents immediately to supervisor
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Record all necessary data required for testing
Employees must receive a medical evaluation and follow up
Paper work must be completed and ready to go to evaluation facility
Source testing / employee testing
If needed post exposure treatment should begin within 2 hours of incident
Utilize Bio-Hazard Stickers on the following items:
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On bags/containers of contaminated laundry
On bags/containers of regulated waste
On refrigerators and freezers that are used to store blood or OPIM
On bags/containers used to store, dispose of, transport, or ship blood or OPIM (e.g., specimen containers)
Sharps containers
Blood soaked gauze containers
When dried blood can flake off from a disposed item
When there are bloody gloves and sharps disposed in the container
Disposal of Anesthesia Carpules:
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Containing visible blood are considered as sharps medical waste.
Empty, unbroken without blood or anesthetic can be placed in trash for general waste disposal.
Broken with no visible blood or anesthetic are technically not medical waste but should be considered for
sharps container
With remaining anesthetic should be disposed of in a container properly labeled for transportation of
pharmaceutical waste to a medical waste incinerator
Use appropriate gloves for breakdown and disposal of sharp items and needles. Place contaminated items
in an appropriate leak-proof biohazards container.
Procedures and Prevention of Disease Transmission
Hand Hygiene - Resident and Transient Bacteria
Resident skin flora consist of microorganism that colonize the skin and become permanent residents
Can never be totally removed, but their numbers can be reduced
Resident flora can cause infection they are less likely to than transient
Transient Bacteria contaminate hands come from contact with contaminated surfaces
They do not live long or colonize or live long
Transient bacteria can contain disease producing microorganism
Proper Handwashing effectively removes transient bacteria and reduces resident bacteria.
Your skin serves as your biggest barrier of protection and is compromised if:
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Chapped, presence of dermatitis, abrasions or open wounds
Hands are washed too frequently
By exposure to hand care products and dental materials
Soaps, lotions and gloves should be compatible
Effective Hand Hygiene Protocol:
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Non-surgical hand washing = 15 seconds
When to wash hands with plain or antimicrobial soap:
Prior to putting on or after removing gloves
Before surgery to remove soil prior to using an alcohol hand rub
Before and after eating
After using the restroom
When hands are visibly dirty or contaminated, or when they are visibly soiled with blood or other body fluids
When to wash hands with an antimicrobial soap
Surgical handwashing = 2 minutes -includes arms
Surgical hand scrub/soap antisepsis should be performed before surgical procedures
Use either antimicrobial soap, or a combination of non-antimicrobial soap and water followed by an alcohol-based
surgical hand rub
The surgical hand scrubbing process differs significantly from the other hand hygiene procedures
Surgical hand soaps should contain one of the following ingredients:
Chlorhexidine, Iodine, Iodophors, PCMX. All are broad spectrum, persistent and fast acting.
Alcohol based hand rubs - 60%-95% ethanol or isopropanol alcohol. Should be considered in
addition to the surgical scrub. Also use if water-boil advisory is in effect.
Hand rubs do not contain detergents – 30 seconds
Selection of Personal Protective Equipment (PPE)
Personal Protective Equipment:
Should Fit properly
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Do not touch or adjust during procedure
Be removed and disposed of if visibly soiled or torn
Be worn in work related areas
Be disposed of according to waste regulations
When wearing PPE also consider:
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Do not eat or drink
Do not applying cosmetics
Do not handle contact lenses
1. Gloves
Gloves do not replace hand washing
They should fit properly to reduce cramping and possible injury
Gloves are for single use only, reuse and washing is unacceptable
Various reactions to glove materials include:
Irritant contact dermatitis is common among dental workers. Irritant contact dermatitis is caused by
physical irritation of the skin. It presents as dry, itchy, irritated areas of skin around the area of contact with
the offending agent
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Allergic contact dermatitis is a skin condition that can result from exposure to chemicals such as
methacrylates, glutaraldehydes and rubber manufacturing chemicals; this type of dermatitis often appears as
a rash beginning several hours or even days after contact
Any condition which compromises healthy skin increases the risk of percutaneous exposure to blood and
body fluids. In both cases, contact with patients should be limited and policies in place for appropriately
diagnosing, treating and managing conditions
Work restriction for employee with glove related reactions include:
Seek diagnoses for latex allergy and determine course of treatment. Implement strategies that will reduce the use and
contact with latex in the dental setting.
Latex hypersensitivity - level 1 is a potentially life-threatening allergy to the proteins contained in natural rubber
latex. Latex allergies are serious as they include a whole body reaction within minutes of exposure.
Common reactions include runny nose; sneezing; itchy eyes; scratchy throat; hives; and itchy, burning skin
sensations
Prevention of Latex Hypersensitivity include:
Competent patient medical history/ food allergies
Employees require testing to provide proof of latex allergy
Use powder free, latex free or low allergen latex products
Schedule patient in early part of the day
2. Mask and Face Shields
When selecting a mask for dental procedures consider the following features:
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Fluid Resistance
Submicron Particle Filtration Efficiency
Bacterial Filtration Efficiency
Breathability
Flame Spread
Mask selection is by procedure type
Bacterial filtration of 95% for a particle range of 3 µm to 5 µm in diameter
Mask should fit firmly around nose and mouth, no side openings
Always remove from elastic band or ear loops
Mask should be worn when wearing a face shield
3. Gowns
50/50% cotton polyester
60/40% fluid resistant
Long sleeves and high collar, use caution with scrubs
Fluid resistant gowns release debris on contact
Cotton polyester materials absorb matters and require laundering services
4. Protective Eyewear
OSHA requires employers provide safety glasses
It is the responsibility of the practitioner to use vigilantly and safely
Clean eyewear according to manufacturer’s instructions
Hand pieces could cause irreversible damage.
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Rotate at speed of 180,000 to 500,000 times per minute,
Can project particles at speeds up to 50 miles per hour.
Implement Work Practice and Engineering Controls
Work practice controls - Incorporates behaviors that serve to reduce injury or exposure
Single handed recapping
Incorporate cheek retractors
Immediate removal of burs at point of use
Sharp containers at point of use
Engineering Controls - The use of devices that eliminate or isolate a hazard
Needle recapping device – REVIEW ANNUALLY
Sharps container
Ultrasonic cleaners / Instrument washer
Instrument cassette
Preparing the operatory for patient care includes :
a.
Review medical history and note any restrictions. Check for any current of infectious diseases or
allergies. If necessary, postpone treatment because of a health issue.
b. Use a pre-procedural mouth rinse containing either Chlorhexidine gluconate, Essential oils, or
Povidone-iodine.
Pre-Procedural Mouth Rinses should contain antiseptic properties and have residual activity to reduce the
number of microorganisms:
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On the surface of oral tissue
Released through aerosols, spatter or direct contact
Introduced in the patient's bloodstream during invasive procedures
Pre-procedural mouth rinses should be unit dosed and given to patients in a disposable cup
c.
Clean and disinfect all clinical work surfaces in the operatory. Utilize barriers and surface
disinfectants
Disinfection
The process of killing pathogens by physical or chemical means; it does not destroy spores and resistant
viruses.
Surface disinfectants should be EPA approved and meet the following standards:
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Broad spectrum
TB kill claim – HIV/HBV kill claim
Time efficient
Contact time vs. Kill time
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Easy and safe to use
Shelf life vs. Use Life
d.
Utilize single - use items as much as possible.
e.
Keep housekeeping surfaces, such as floor and walls clean and sanitize
f.
Dispose of routine waste in lined receptacles in operatories
g.
Discard sharp related itme into sharps container in operatory
Preparing instruments for sterilization
Transportation of Instruments
Transport instruments to sterilization center in cassette, covered tray or instrument bin
Pre-cleaning
Pre-cleaning instruments is a critical step in processing instruments for sterilization. Proper fitting utility gloves
should be worn by employee when handling contaminated instruments.
Instruments should be places in an ultrasonic unit or unti designed to remove bio-burden load on instrument prior to
sterilization.
Use recommended ultrasonic solutions and test ultrasonic cleaner routinely to make sure it has the proper cavitation
strength to remove blood and bio-burdens.
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Proper pre-cleaning of instruments includes:
Pre - soak items immediately or clean
Do not allow to remain unattended
Dried blood and body fluids make cleaning difficult and increases the possibility of an exposure incidence
Wearing utility glove, lift the handles of the basket in the ultrasonic unit. Allow ultrasonic solution to drip back into
the bid. Then rinse instrument, pat dry and prepare for packaging. Instruments.
Packaging Instruments
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Use FDA approved materials
All packaging material should have an internal and external indicator
Make sure cassettes are closed and instrument tips are not sticking out
Cassettes must be properly wrapped
Avoid placing heavy instruments in bags
Avoid using closed containers or staples
Close pouched at the designated fold location
Avoid using paper/ plastic bags in dry heat sterilizer
Instrument Sterilization
Sterilization is a process that destroys all forms of microorganisms, including bacterial endospores.
Classification of Instruments for Sterilization:
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Critical – penetrates the mucous membrane requires sterilization. Have the greatest risk of transmitting infection
are
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Semi-critical – touches the mucous membrane requires sterilization or a minimum of HLD
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Non- critical - touches intact skin such as blood pressure cuff or x-ray head Requires HLD
Methods of Sterilization
Steam Sterilization gravity displaced, vacumn pump, positive steam flush
20-30 minutes 121F - 250 degrees F –Geobacillus Stearothermorphilus
Dry heat sterilization – Static air 60 – 120 minutes at 320 - 375degrees degrees F
Bacillus atriophaeus
Unsaturated Chemical Vapor sterilization Chemclave – 20 minutes at 270 degrees F –
Geobacillus Stearothermorphilus
Active ingredient is formaldehyde 0.23%
MONITORING STERILIZER
Mechanical - Record temp and pressure
Chemical - Use internal and external indicators
Biological - Spore testing
CDC recommends weekly testing
 Test when implant device is being sterilized
 When using a new packaging device or material
 After sterilizer has been repaired
 After sterilizer has been moved or relocated
If test results indicate a failed cycle take the unit out of use until problem for failure has been determined
All packages should be stamped with the date of sterilization. Facilities with more than one sterilization unit should
have a system in place for identification of the unit used for sterilization.
Unloading and storage of instruments
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Allow instruments to dry and cool completely in sterilizer
Do not touch moist packages with bare hands
Do not store wet packages in drawers or cabinets.
Stored all instruments wrapped unless they are for immediate use
Do not store near contaminated items
Instruments in bags stay sterile indefinitely
Proper disposal of waste
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Always check state and local regulations
All waste receptacles must be lined
General waste – PPE, slightly soiled cotton or gauze, barriers
Blood and saliva – dispose in sanitary sewer
Tissue – sanitary sewer
Teeth – sharps if no amalgam, or disinfect and give to patient
Operatory trash – regular waste
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