1. Instrument Processing DA 116 Infection Control

2. Instrument Contamination Levels:
1. Critical
2. Semi-Critical
3. Non-Critical

3. Heat sterilize all these instruments
Critical Instruments
Instruments that touch bone or penetrate soft tissue.
Ex. Forceps, scalpels, scalers, dental burs
After each use:
Heat sterilize all these instruments

4. Semi-Critical Instruments
Instruments that will touch mucous membrane or nonintact skin but do not penetrate soft tissue or bone
mirrors, amalgam condensers, x-ray film and digital sensor holders
and high and low speed handpieces
Use high-level disinfection with all lab materials used in the mouth
After each use:
Sterilize all that are heat resistant
Use disposable items or high-level disinfection/cold sterilant on others
***Do not reprocess or reuse any disposable items!

5. Non-Critical Instruments
Non-critical instruments are those that come into contact only with intact skin
Ex. X-ray Heads, Light handles, BP cuff
Use intermediate or low level disinfection agent
Floors and walls: okay to clean if no
blood contamination
If an item is visibly contaminated
with blood, choose intermediate
level disinfection

6. Transporting Items to Sterilization Center
Holding Solutions for used instruments:
Transport contaminated Instruments
In operatory or (more commonly) sterilization center
Enzymatic properties
Prevents debris from drying and becoming difficult to clean
from the point of use
in a sturdy, solid container
to the initial receiving area of the sterilization area

7. Which do you think is the correct choice? 1 2
Instrument Processing Area
DHCP should process all instruments in a designated central processing area to more easily control quality and ensure safety (248). The central processing area should be divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. Ideally, walls or partitions should separate the sections to control traffic flow and contain contaminants generated during processing. When physical separation of these sections cannot be achieved, adequate spatial separation might be satisfactory if the DHCP who process instruments are trained in work practices to prevent contamination of clean areas (248). Space should be adequate for the volume of work anticipated and the items to be stored (248).
Which do you think is
the correct choice?
#2 is CORRECT! 1 2

8. Sterilization Center Instrument processing area
well-designed and conducive to accomplishing the multiple steps to achieve sterilization or high-level disinfection.
DIRTY: receiving and decontaminating rinsing drying packaging
CLEAN: sterilization sterile storage

9. Pre-Cleaning Basic first step of decontamination Mechanical methods
remove bioburden from instruments
Place dental burs in a bur basket before placing them in the ultrasonic cleaner
Mechanical methods
Ultrasonic cleaner
Cavitation (ultrasonic sounds waves create bubbles that implode cause an unseen scrubbing action)
10 minutes
Change solutions daily
Aluminum Foil test
Instrument Washer

10. BE CAREFUL!
DO THIS!
NOT THIS!

11. Instrument Washer

12. Dental Handpieces
Require special handling due to internal mechanical parts
Flush for seconds at chairside
Remove bur
Clean outer surface with handpiece wipe
Lubricate according to manufacturer’s instructions
Wipe off excess lubricant
Package and heat sterilize
Some handpieces must be lubricated after sterilization; check manufacturer’s directions
Manual and automatic methods are available

13. Packaging Paper Pouches Cassettes
Permeable so steam can reach instruments
Appropriate for specific sterilizer
Plastic or metal
Perforated so steam can penetrate
Less instrument handling reduces risk of percutaneous injury
Can go into ultrasonic and autoclave
Must be wrapped for autoclave and storage

14. Loading the Sterilizers
Wrap securely
Hinged instruments open
Do not overfill

15. Methods of Sterilization:
Process by which all forms of organic life are destroyed by physical or chemical means
Steam under pressure Autoclave
Dry Heat Sterilization
Chemical under pressure (Chemical Autoclave or Chemiclave)
EPA registered disinfectant/sterilant; also called “cold sterilization” least preferred method
Always best to use heat sterilization

16. Monitoring the Sterilizer
Chemical
Treated indicator (inside package) or tape (outside package)
Indicates that items have gone through the sterilization process
DOES NOT GUARANTEE STERILITY
Biological (weekly per CDC)
Live bacterial spores
Autoclaves/chemical vapor:
Bacillus Stearothermophilus or Geobacillus Stearothermophillus
Dry heat/ethylene oxide:
Bacillus Subtilis or bacillus atrophaeus
Mechanical
Monitor gauges for times, temperatures, cycles
Check and keep print-outs if available

17. Storage Keep sterile items and disposable items
Covered, enclosed area (not under a sink)
Keep packages/cassettes wrapped and unopened until use
Do you need to re-sterilize?
Per CDC, wrapped items are
sterile indefinitely
Re-sterilize if it becomes
contaminated (i.e. wet, torn)
Some offices date each package
and rotate use according to dates