Strerilization by Dr.Anam Iqbal

PRESENTER : ANAM IQBAL

bds final year

SCENARIO : CLASS PRESENTATION

‘COURAGE IS WHAT IT TAKES TO STAND UP AND SPEAK…

COURAGE IS ALSO WHAT IT TAKES TO SIT DOWN AND LISTEN ‘

¬¬¬JOHN.F.KENNEDY

PRACTICING SAFE…DELEVERING SAFEST

S T E R I L I Z A T I O N

STERILIZATION

DISINFECTION

SANITATION

DECONTAMINATION

ANTISEPSIS

COMMON TERMS…

PROPHYLAXIS

HOW TO ACHIEVE

Chain of Infection

Pathogen

Source

ModeEntry

Susceptible Host

SIMPLE IS THE ANSWER !!

STANDARD PRECAUTIO

NS

STERILIZATI0N

Hand washing

Use of barrier techniques

Patient care equipment

Environmental surfaces

Injury prevention

Elements of Standard Precautions

Both patients and dental health care personnel (DHCP) can be exposed to

pathogens

Contact with blood, oral and

respiratory secretions, and contaminated

equipment occurs

DOUBLE-EGDED SWORD !!

Potential Routes of Transmission of Bloodborne PathogensPatient DHCP

DHCP Patient

Patient Patient

Modes of Transmission

Direct contact with blood or body fluids

Indirect contact with a contaminated instrument or surface

Contact of mucosa of the eyes, nose, or mouth with droplets or spatter

Inhalation of airborne microorganisms

STERILIZATION

MANUAL /ULTRASONICCLEA

NING

PACKING AND

STORAGE

AUTOMATED

CLEANING

Critical and semi-critical items should be wrapped in separate pouches

Hinged instruments opened and unlocked

A chemical indicator kept inside pack Wear heavy-duty, puncture-resistant

utility gloves

Preparation and Packaging

MANUAL CLEANING

Soak until ready to clean Wear heavy-duty utility

gloves, mask, eyewear, and protective clothing

Ultrasonic baths used for files/burs

AUTOMATED CLEANING

HEAT-BASED STERILIZATION

MOIST HEAT

Autoclave

Chemiclave

DRY HEAT

Rapid

Prolonged

MODE: MICROORGANISMS KILLED BY PROTEIN COAGULATION

RNA & DNA BREAKDOWN RELEASE OF INTRACELLULAR CONTENTS

AUTOCLAVING

ADVANTAGES DISADVANTAGES

1.Quick turn around time for instruments.

2. Excellent penetration of packages.

3. Does not destroy cotton or cloth products.

4. Sterilization is verifiable.

1. Materials must be air dried at completion of the cycle.

2. Certain metals may corrode or dull, antirust, pre-treatment may be required. Most stainless steels are resistant to autoclave

.

STERILIZATION CYCLES

10 lb Pressure (115.5 deg. C)...30

minutes

15 lb Pressure (121.5 deg. C)...20

minutes

20 lb Pressure (126.5 deg. C)...

15 minutes

PRINCIPLE: Chemiclave sterilization uses some water to catalyze the destruction of all microorganisms in a relatively short time, water saturation is not necessary.

kills microorganisms by destroying vital protein systems.

UNSATURATED CHEMICAL VAPOUR

uses a solution containing alcohols, acetone, ketone, formaldehyde

water content is well below the 15%level that causes rust and corrosion.

heated to 132° C (270° F) at 20 lbs/sq inch , sterilization occurs in 20 minutes

STERLIZATION CYCLE

ADVANTAGES DISADVANTAGES

1. Not corrosive to metals.

2. Relatively quick turnaround time for instruments.

3. Load comes out dry.

4. Sterilization is verifiable.

1. Vapor odor may be offensive, requiring increased ventilation.

2. Special chemicals must be purchased and inventoried.

3. Heat-sensitive materials can be destroyed.

PRINCIPLE :

Dry heat kills microorganisms primarily through an oxidation process.

Protein coagulation also takes place, depending on the water content of the protein and the temperature of sterilization

PROLONGED DRY HEAT

Dry heat is very slow to penetrate instrument loads.

It sterilizes at 160° C (320° F) in 30 minutes, but instrument loads may take 30 to 90 minutes to reach that temperature.

To provide a margin of safety, instruments must be sterilized at 160° C (320° F) for 2 hours

STERLIZATION CYCLE

ADVANTAGES DISADVANTAGES

1. Large load capability.

2. Complete corrosion protection for dry instruments.

3. Low initial cost of equipment.

4. Sterilization is verifiable.

1. Slow instrument turnaround due to poor heat exchange.

2. Sterilization cycles not as exact as in moist heat sterilization.

3. Dry heat sterilizer must be calibrated and monitored.

Damaging at high temperatures

MODE: This device is a metal crucible that heats a

transfer medium of glass beads or salt. The transfer medium heats the endodontic

instrument through heat convection and kills any adherent microorganisms

Rapid dry heat

At a temperature of 220° C (428° F), contaminated endodontic instruments require 15 seconds to be sterilized.

Endodontic chairside sterilizers often need extensive warm-up times; some require 3 hours to reach full operating temperature.

process should be used only as a backup to the OTHER described methods of bulk sterilization.

CYCLE

ADVANTAGES DISADVANTAGES

1. Small and convenient to use.

2. Serves as an emergency backup to other methods of sterilization

1. Only instruments of small mass can be sterilized.

2. Only a few instruments can be sterilized at one time.

3. Sterilization is non verifiable.

ETHYLENE OXIDE GAS

ADVANTAGES DISADVANTAGES

1. Operates effectively at low temperature.

2. Gas is extremely penetrative.

3. Can be used to sterilize sensitive equipment such as dental handpieces.

4. Sterilization is verifiable

1. Gas is potentially mutagenic and carcinogenic.

2. Requires an aeration chamber.

3. Cycle time lasts many hours (16-18 hrs).

4. Usually only hospital based.

HEAT SENSITIVE INSTRUMENTS Instruments contaminated with blood or saliva must remain submerged in glutaraldehyde long enough for spore forms to be killed.

Sterilization may take 6 to 10 hours, depending on what product is used.

GLUTARALDEHYDE SOLUTIONS

ADVANTAGES DISADVANTAGES

1. Sterilizes heat-sensitive equipment.

2. Is relatively non corrosive and nontoxic

1. Requires long immersion time.

2. Has some odoUr, which may be objectionable, especially if solution is heated

Sterilization Monitoring Types of Indicators

Mechanical ◦Measure time, temperature, pressure

Chemical ◦Change in color when physical parameter is

reached Biological (spore tests)

◦Use biological spores to assess the sterilization process directly

DISINFECTION

IODOPHORS

HYPOCHLORITE

DISINFECTION

NEGATIVES POSITIVES

IODOPHORS

LA INJECTION

ISOLATION

ACCESS PREPARATION CANAL PREPARATION IRRIGATION

BTURATION

o

ENDODONTIC INSTRUMENTATION

SEMI-CRITICA

CRITICAL

CRITICAL/Non-CRITICAL

CONTAMINATIONDECONTAMINATION

WHY CLEAN INSTRUMENTS ..?

Study on presence of debris and metallic defects on the surfaces of endodontic files and reamers 11,15,19,20 was carried

These impurities , are lost from the metallic surface of the files during instrumentation, may preclude untwisting of the instruments or blockage the canal.

CLEANING BEFORE USE

These debris or defects can be transferred via instruments to the root canal during chemomechanical preparation or it

may be progressively lost from the metallic surface of files during use

Same instrument is reinserted many times in the root canal.

It is clear that necrotic tissue must be eliminated of files to avoid possible transport of this septic/toxic material to the periapical region setting up an acute reaction.

The pulp tissue when not removed from the surface of files, may extrude from canal to periapex, possibly compromising the outcome and causing flare-ups.

CLEANING DURING USE

The accumulated debris retards cutting of dentin by instruments blades and

predisposes the instrument to breakage. Its elimination prevents clogging of the

canal with dentin chips To prevent cross-contamination between

patients

CLEANING AFTER USE

Cotton rolls, gauze sponges, hand brushes, rubber dam sheet, ultrasonic cleaner

HOW TO CLEAN ??

Disadvantages of the brushes : time consuming and the effectiveness

depends greatly on the dedication of the assistant.

Ultrasonic cleaners have the advantage of being faster, easier in cleaning, besides reduces the direct handling of contaminated instruments

AUTOCLAV

DRY HEAT OVEN

CHEMICAL VAPOUR

ETHYLENE OXIDE

DISINFECTION

STEEL BURTUNGSTEN-CARBIDE

++

++++

++++

++++

++

BROACHES ++ + + ++ +

REAMERS & FILES

++ + + ++ +

HAND-PIECES

++ - ++ ++ -

ULTRASONIC SCALER

++ ++ ++ ++ -

IRRIGATION SYRINGE

- - - - -

SALIVA EVACUATOr

- - - ++ _

RUBBER ITEMS

- - - ++ -

MIRROR,PROBE,LOCKING FORCEP

++ ++ ++ ++ -

SPECIAL CONSIDERATIONS

HEAT STERILIZATION RECOMMENDED

Handpieces that cannot be heat sterilized should not be used. Chemical disinfection is not recommended. Handpieces can be sterilized by steam,

chemical vapor, and ETO. Should not be sterilized with dry heat

HAND-PIECE STERLIZATION

Immersing gutta-percha cones in 5.25% sodium hypochlorite

(full-strength household bleach) for 1 minute is very effective in killing vegetative microorganisms and spores

GUTTA -PERCHA CONES

Sterile Irrigating Solutions

Use sterile saline or sterile water as a coolant/irrigator when performing surgical procedures

Use devices designed for the delivery of sterile irrigating fluids

Devices Attached to Air and Waterlines

Clean and heat sterilize intraoral devices that can be removed from air and waterlines

Do not use liquid germicides or ethylene oxide

Microbial biofilms form in small bore tubing of dental units Biofilms serve as a microbial reservoirPrimary source of microorganisms is municipal water supply

Available DUWL Technology

Independent reservoirsChemical treatmentFiltrationCombinationsSterile water delivery systems with reverse osmosis

Components of Devices Permanently Attached to Air and Waterlines

Do not enter patient’s mouth but may become contaminated

Use barriers and change between uses

Clean and intermediate-level disinfect the surface of devices if visibly contaminated

Saliva Ejectors

Previously suctioned fluids might be retracted into the patient’s mouth when a seal is created

Do not advise patients to close their lips tightly around the tip of the saliva ejector

Preprocedural Mouth Rinses

Antimicrobial mouth rinses prior to a dental procedure

◦Reduce number of microorganisms in aerosols/spatter

◦Decrease the number of microorganisms introduced into the bloodstream

Use date- or event-related shelf-life practices

Examine wrapped items carefully prior to use

When packaging of sterile items is damaged, re-clean, re-wrap, and re-sterilize

Store clean items in dry, closed, or covered containment

Storage of Sterile and Clean Items

significant decrease in angular deflection values exists for stainless steel endodontic files having undergone ten cycles of autoclave sterilization versus files having undergone only two or five similar cycles.

EFECT OF REPEATED STERILIZATION….

Instrumentpreparation

packaging of

instruments.

loading of the

sterilizer

chamber.

temperature in

the steriliza

tion chamber

.

timing of the

sterilization

cycle.

Equipment

malfunction.

STERILIZATION FAILURE…

LOOP-HOLES IN OUR PRACTICE..

CLING FILM

INJECTION SYRINGES

HAND WASHING

OVER-WEAR

GLOVESEYE

PROTECTION

FILES

INSTRUMENT COOLING

Concentration of HBV in Body Fluids

High Moderate Low/Not Detectable

Blood Semen Urine Serum Vaginal Fluid Feces

Wound exudates SALIVA Sweat Tears

Breast milk

Infection Control Program Goals

Provide a safe working environment◦Reduce health care-

associated infections ◦Reduce occupational

exposures

TTHTHANK YOU..

I KNEW YOU ALL ARE SO COURAGEOUS