Sterilization and proper use of Autoclaves By (alphabetical order) Sarah Coulter Jessica Indalecio Shirley Neuebaumer Xin Xie
What is Sterilization? Destroys all living organisms, including highly resistant bacterial spores. Offers highest level of assurance that no pathogenic organisms remain on instruments and devices. Stops the transfer of microorganisms from one client to a subsequent one by destroying them.
Sterilization of dental instruments Definition Critical Semi-critical Noncritical Penetrate soft tissue or bone Contact mucous membranes or non intact skin Contact intact skin Process Sterilization Sterilization or high-level disinfection Low- to intermediatelevel disinfection
In the real world of dental practice! In 1998, a study in the UK shows that among 401 dental offices participating in an autoclave performance survey, 73.1% checked their autoclave routinely. And only 5 (1.2%) used a spore test.[1]
Why autoclave?/quiz time! Safe, no chemical vapor involved! Efficient! Kills both bacteria and spores! Easy handling Q: What is wrong with the lady? Q: What is the difference between sterilization and disinfection?! Sterilization kills all microbes while disinfection reduces the amount.
Midmark Autoclave Procedures for proper use
Preprogrammed Settings Setting Packaging Temperature Pressure Sterilization Dry Pouches Pouches 270º F 27.1 psi 5 min 30 min Packs Packs ~ or ~ pouches and packs 250º F 15 psi 30 min 30 min Reason: To avoid operator error! Before first use: Sterilize new instruments.! New instruments from manufacturer not sterile ( J Can Dent Assoc. 2009)
Loading and Unloading " PPE, including utility gloves " Load packages face down " Paper towel to touch outside of autoclave " Water level in green zone (distilled) " Start/change sign to clean " End of cycle, oven mitts or clean hands " Put in cubbies " End of day- Proper clean/dirty sign on top " Unplug/ power off! Don t leave clinic until cycle complete!
Storage! Drying stage complete to be sterile! Don t open door! o Dampness microbial growth! Loosely stored, clean dry cubby or open shelving! Away from direct sunlight, heat, waste and water
Maintenance Weekly- Mail Spore test to testing company Thursdays Monthly- Flush " Drain, fill distilled water + 1 oz speed-clean Sterilizer Cleaner " Run POUCH cycle (no instruments) " Drain reservoir, cool " Refill distilled water " Run UNWRAPPED cycle " Drain reservoir, cool " Clean gaskets- Clean Sterilizer Cleaner + distilled water, brush
Occupational Safety with Autoclave! Protection through use of PPE! Protective Eyewear! Surgical Mask! Gown! Heavy-Duty Utility Gloves! Protect from exposure to bloodborne pathogens
Cassette Impact on Safety! Cassettes allow instruments to remain intact through entire sterilization process! Reduce risk of accidental injury to user! Permits sterilization process through the holes in the cassette
Avoiding Cross-Contamination! Utility gloves contacting the autoclave handle or buttons will contaminate the system! Precautions should be taken to avoid cross-contamination! Use paper towel to contact the autoclave
Undercover Bosses- Dental Edition (Foothill College)! http://www.youtube.com/watch?v=1qgynqedg64! http://www.youtube.com/watch? v=1qgynqedg64&feature=youtube_gdata
Legal and Ethical Considerations! What ethical principles did the employee violate? Legal considerations: Lawsuits against dentists regarding the spread of infectious diseases such as HIV and hepatitis.! Reusing needles and improperly sterilizing instruments! Genetic testing for viral strains
What are all the ethical principles we learned?! Veracity! honesty in our interactions with patients, insurance companies and colleagues! Justice! just and fair treatment for all! Autonomy! self-determination (Informed consent, HIPAA)! Beneficence! duty to benefit patient
! Maleficence! Do no harm! Universality! Did we come to the same conclusion?! Complementarity! Follow the Golden Rule! Responsibility! I didn t know is not acceptable. Ethical Principles
Having fun using the autoclave!
References! Bettencourt J, Chan P, Draper C, Kornegay C, Spragge P, Yamamoto J. Foothill College Dental Hygiene Clinic Manual. Los Altos Hills, CA. 2013-2014. Section 2, p. 2-24 2-27.! Dental burs and endodontic files: Are routine sterilization procedures effective? Morrison A., Conrod S., Dental burs and endodontic files: are routine sterilization procedures effective? J Can Dent Assoc. [Internet]. 2009 [cited 2013 Oct 1]; 75(1): e39.! Instrument management: Cleaning and sterilization in the dental setting. Johnson R., Quinn B. Dental Nursing. [Internet]. 2010 [cited 2013 Nov 1]; 6(9): e504 509
References! Centers for Disease Control and Prevention [Internet]. Atlanta, GA: National Center for Health Statistics. July 10, 2013. Infection Control Frequently Asked Questions - Sterilization Monitoring [cited 2013 Nov 1]. Available from http://www.cdc.gov/ Oralhealth/InfectionControl/faq/sterilization_monitoring.htm! Burke FJT, Coulter WA, Cheung SW, Palenik CJ. Infection Control Autoclave performance and practitioner knowledge of autoclave use: A survey of selected UK practices. Quintessence Int I998;29:23l-238! Viana A. C. D., Gonzalez B. M., Buono V. T. L., Bahia M. G. A. Influence of sterilization on mechanical properties and fatigue resistance of nickel-titanium rotary endodontic instruments. International Endodontic Journal [Journal]. 2006 [cited 2013 November 3]; 39(9)
References! Scheutz, F., Reinholdt, J. Outcome of sterilization by steam autoclaves in Danish dental offices. Scandinavian Journal of Dental Research [Internet] 1998. [cited 2013 Oct. 2]; 96:[167-170].! Adkins, S. Dentist in Springettsbury put patients at risk for Hepatitis, HIV, state says [internet]. York Daily Record; 2013 June [cited 2013 November 30] Available from: http://www.ydr.com/ci_23386397/state-springettsbury-dentist-put-patients-at-riskhepatitis! Zimmerli M., Widmer AF., Dangel M., Filippi A., Frei R., Meyer J. Methicillinresistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry? Clin Oral Invest. 2009 [cited 2013 July 12]; 13(4): 369-73.