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Chapter 8

Chapter 8. Instrument Processing. The Sterilization Center. Ideal Area: should be dedicated to instrument processing, separated from other areas, should not be part of a common walk way, should accommodate all the equipment

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Chapter 8

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  1. Chapter 8 Instrument Processing

  2. The Sterilization Center • Ideal Area: should be dedicated to instrument processing, separated from other areas, should not be part of a common walk way, should accommodate all the equipment • Deep sink, hands free controls for water and garbage. Flooring should be uncarpeted • Work Flow Pattern See Fig. 8-2, pg. 115 • Contaminated Area: where soiled instruments are brought in, disposable items discarded, instruments removed from the tray (if used), Area has sink, waste disposal, holding solution, ultrasonic cleaner, Fig 8-3,8-5 pg. 116 • Clean Area: contains instruments packaged that are sterilized and ready to be inspected, Fig. 8-4, pg 116

  3. Seven Steps to Instrument Processing • Pg. 114, Table 8-1 Discuss • Transport • Cleaning • Packaging • Sterilization • Storage • Delivery • Quality Assurance Program

  4. Precleaning and Packaging Instruments • Hand Scrubbing: least desirable, requires direct hand contact. Wear goggles, puncture resistant gloves, clean only two instruments at a time, long handled brush, keep instruments above water line, fully air dry or carefully pat dry, package • Ultrasonic Cleaning: loosens and removes debris from instruments by sound waves that are produced, reduces the risk of injuries. Wear utility gloves, mask, protective eyewear, use tongs for instrument removal. Times may vary from 5-15 mins, Use only formulas that are formulated for that one, fig. 8-6, pg. 117. If debris is tough to get off, use tartar and stain remover, Fig 8-7, pg 117 • Care of Ultrasonic: solution should be discarded once a day or when it becomes cloudy, wear protective equipment when changing solutions

  5. Precleaning and Packaging Instruments • Automated Washers: must be approved by FDA, Fig 8-8, pg. 118, use very hot water, detergents to remove materials on instruments, then dries them, then wrap and sterilize • Drying, Lubrication, and Corrosion Control: any thing made of carbon steel, will inhibit rust, rust inhibitors (sodium nitrate) are available in sprays or lubricants to control this, • Packaging: all instrument should be wrapped or packaged, protects after sterilization, if unwrapped they are immediately exposed to aerosols in the air, dust, improper handling, or contact with non- sterile surfaces • Packing Materials: come in a variety of shapes, sizes • Review Box 8-2 pg. 118, fig. 8-9, pg 119 • Never reuse wraps or packaging

  6. Methods of Sterilization • Sterilization destroys all forms of microbial, including bacterial spores • Reusable items that have come in contact with salvia, blood, mucous membrane must be heat sterilized. • 3 Common: Steam, unsaturated chemical vapor, dry heat See. Table 8-2 pg. 119 • Autoclave: to sterilize dental instruments, steam under pressure, Fig. 8-10, pg. 120, packing material includes: film pouches, paper wraps, cassettes, nylon tubing, sealed film. Moisture may cause corrosion on carbon instruments, uses distilled water • Operation Cycles: Heat up cycle, sterilizing cycle, depressurization, drying cycle, Box 8-3, pg. 120, Fig. 8-11 pg. 120 • Flash Sterilization: rapid heat transfer, steam, and unsaturated chemical vapor, Fig. 8-12, only used on unwrapped instruments • Chemical Vapor: similar to autoclaving, but uses a combination of chemicals (alcohol, formaldehyde, ketone, acetone, water) Fig. 8-13

  7. Methods of Sterilization • Dry Heat: by heating up air, transferring that heat from air to instruments, requires high temperatures, instruments will not rust with this method, two types are: static air and forced air • Static Air: like an oven, hot air rises, heat is transferred from nonmoving air to instruments, about 1-2 hours, very time consuming • Forced Air: rapid heat transfer, circulates hot air throughout the chamber, from the air to the instruments, reduces time for sterilization • Chemical Liquid: for plastic items, 2%-3.4% glutaraldehyde, takes soaking time of 10-24 hours

  8. Sterilization Monitoring • Three Forms: Physical, chemical, Biologic • Physical: use of simple check lists of factors (level of solution, temperature, pressure, time) • Chemical: external and internal, heat sensitive chemical that changes color, when conditions change. Types of indicators: process indicator( placed outside of packaged instruments, Ex. tape, arrows on packages, both will change color to indicate processed, fig. 8-15 pg. 123) Process Integrators (placed inside pouches/cassettes, strips, tabs or tubes of colored liquid, change color, fig.8-16 pg. 123) • Biologic Monitoring: (spore testing) done weekly with test strips, sent to lab for analysis of spores ( fig: 8-17, pg. 123) • Sterilization Failures: Table 8-3, pg. 124 discuss

  9. Procedure Review • Procedure 8-1 (Ultra Sonic Cleaner) pg. 125 • Procedure 8-2 (Autoclaving Instruments) 126 • Procedure 8-3 (Sterilizing Instruments: Chemical Vapor) pg. 127 • Procedure 8-4 (Dry Heat Sterilization) 128 • Procedure 8-5 (Chemical Sterilization) 128 • Procedure 8-6 (Biological Monitoring) 129

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