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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