Instrument Reprocessing Raghunath Puttaiah, BDS, MPH Dental - Innovative Devices & Educational Solutions www.dental-ideas.com

Basic Rules in Reprocessing Always clean instruments before sterilization Sterilization required for Critical and Semi-critical items Only disinfect if equipment cannot be sterilized Heat or heat + chemical methods superior to chemical immersion methods Weekly sterilization monitoring Test ultrasonic machine monthly Take good care of reprocessing equipment

Adaptation of Spaulding’s Classification to clinical surfaces Critical* Semi-critical surfaces* Non-critical surfaces Environmental surfaces * These items enter the oral cavity and must be single- use-disposable or sterilized

PPE required for reprocessing + Eyewear + Mask + Gown + Utility Gloves

5a. Manually clean and rinse only if sonication has not Reprocessing Cycle Separate instruments From waste Immerse in Holding solution 3. Sonicate instruments 1a. Sharps and Regulated Waste 7. Sterilization and use 4. Rinse instruments 1b. Non-regulated waste 6. Dry and bag for sterilization 5. Inspection of instruments 5a. Manually clean and rinse only if sonication has not achieved cleaning Sterilization monitoring to be done weekly

Manual cleaning Don’t do this Manual scrubbing instruments to be done only if visible debris seen after sonication. It should be done with a long handle brush while wearing utility gloves

Types of ultrasonic solutions Non Ionic Detergents Cationic Detergents Anionic Detergents Enzymatic Solutions The Same can be used as a holding solution Some solutions can be corrosive

Foil test for efficacy of the ultrasonic cleaning process Part of the foil that was not submerged in the bath Uniformly pitted area that was submerged in the bath

Common methods of sterilization in dentistry Autoclave Chemiclave Rapid heat transfer

Dry Heat Sterilization using Dry Heat: Slow Fast Rapid Heat Transfer Temp 1600C (3200F) 1700C (3400F) 1900C (3750F) Time 120 minutes 60 minutes 6-12 minutes* *6 minutes for unpackaged, 12 minutes for packaged

Sterilization Steam Under Pressure STERILIZATION USING AUTOCLAVE Temperature 1210C (2500F) Pressure 15 psi Time* 15-20 minutes Temperature 1340C (2730F) Pressure 30 psi Time* 3-5 minutes * Does not include warm-up / drying / cool-down time

Steam Under Pressure Warm-up time Sterilization Time Drying+Cooldown <--------------------60-90 minutes---------------------> Packaging material must allow penetration of steam paper, plastic, surgical muslin Do not use closed metal or glass containers

Unsaturated Chemical Vapor Temperature 1310C (2700F) Pressure 20 psi Time 30 minutes Packaging materials: allow vapors to precipitate on item surface vapors must not react with packaging no contact of plastics with side of sterilizer Perforated Metal Trays Are Ideal Solid Trays, Sealed Glass Jars are BAD

Sterlization Monitoring All sterilizers that are used must be monitored at least weekly For Dry Heat Sterilizers Bacillus subtilis For Autoclaves and Chemiclaves Bacillus stearothermophilus

Sterlization Monitoring

Outcomes of monitoring Successful- No growth Failure - b. subtilis Failure - b. stearothermophilus