Easi-Sterilise Information session for Clinicians

1. Easi-Sterilise Information session for Clinicians “Getting it right, every step of the way”

2. Why are we here? • Patient and staff safety • Directives from QH EMT for rapid implementation of education and training following incidents • Implementing a continuous quality improvement program • Acknowledge an absence in effective communication when changes are made • To build on current level of knowledge in light of ever changing technology, standards, guidelines, advisories and legislation

3. Aim of this workshop Provide participants with an overview of the Easi Sterilise Standard Operating Procedures and outline the responsibility of the clinician in ensuring that items have been through the correct reprocessing and are able to be used safely for patient care.

4. Is to: Appropriately train and skill staff Provide information and resources so that step-by-step quality processes are consistently followed Assist in identifying gaps in knowledge and provide opportunities for improvement QH Commitment

5. SOPs & WSAs • To assist Oral Health facilities operationalise QH policy and guidelines • A resource for staff • Update and supersede the OH Critical Instrument Tracking (2003) • A framework to assist staff identify competence and areas where education and improvement may be needed • A resource to identify opportunities for improvement within the department that will require further education and training

7. 1.1 Standard Precautions Standard precautions are applied as a first-line approach to infection control. These form the basis for your decision-making and practice. Standard precautions are a set of guidelines based on the assumption that all blood and body fluids are potentially infectious.

8. 1.1 Standard Precautions In the context of sterilising practice and ALL the Standard Operating Procedures, standard precautions include: • Hand Hygiene • Hand cream – approved by infection control – not in packing area or handling of sterile stock • Personal Protective Equipment • Gloves • Face shields, hair protection, safety glasses and masks • Fluid resistant gowns/aprons • OHS Requirements

9. 1.2 Soiled Pickup Collection • Standard Precautions - PPE • Contaminated items - dedicated collection trolley/container • Keep instrument sets together • Secure sharps Collection containers are: • puncture-resistant • leak-proof and made of either plastic or metal • with a lid or liner that can be closed

10. 1.3 Sorting Prior To Cleaning Instruments and items sorted by; • Type • Method of cleaning e.g. Manual , ultrasonic, Instruments and items are checked for; • Completeness • Defects • Sharps or blades that have not been removed • Heavily soiled items • Single use only items must not be returned for reprocessing Report concerns to supervisor

11. Cleaning • Cleaning removes organic and inorganic soil, blood, fats etc which contain pathogenic micro-organisms • Gross Debris should be removed chairside • Cleaning minimises contamination levels of bioburden (number of micro-organisms) prior to sterilisation • For sterilisation to occur the aim is to have a low number of micro-organisms present on instruments

12. Cleaning Steam will not penetrate contamination left on instruments If the item is not clean it won’t be sterilised

13. 1.5 Pre Cleaning • Pre cleaning (initial cleaning) allows for the removal of visible blood, body fluids and debris from items prior to cleaning (definitive cleaning). Pre cleaning shall be undertaken as soon as possible (e.g. during and post procedure chairside). • If blood, proteins and other debris are allowed to dry or remain in crevices and joints, the instruments become very difficult to clean and are prone to stiffness and accelerated corrosion.

14. 1.5 Pre Cleaning • Pre cleaning can be performed by methods such as dry wiping, damp wiping or use of a commercially available single use only instrument sponge • Place the dry wipe, damp wipe or sponge on the bracket table and carefully wipe the instrument across the material

15. 1.6 Hand Cleaning For Immersible Items Drying – As per manufacturer’s instructions Drying cabinet Disposable low-lint cloth for hose, battery and external parts Air pressure gun (for removal of excess moisture) Disposable syringe

16. 1.6 Hand Cleaning For Immersible Items Problems associated with incorrect drying • Items should NOT be air dried/ dripped dry Good conditions micro-organisms multiply in 20-30 minutes • Wet packaging result in unsterile item • Can cause rusting, corrosion, pitting to the item

17. Handpieces handpieces outside surfaces cleaned using detergent wipe, rinsed by wiping dried slow speed motors outside surfaces cleaned using detergent wipe, rinsed by wiping, dried lubricated (manually or automatic) may need special adaptors Dried, wrapped & processed in a wrapped cycle

18. Special adaptors may be needed

19. Special adaptors may be needed • Ideally, handpieces and slow speed motors are cleaned and lubricated using mechanised cleaning equipment

20. Special adaptors may be needed

21. 1.8 Ultrasonic Cleaner Purpose Ultrasonic cleaning is a form of mechanical cleaning that uses high frequency ultrasonic waves (cavitation) that dislodges fine particles from the surfaces of instruments.

22. 1.8 Ultrasonic cleaner Ultrasonic cleaning is an effective cleaning method for instruments prior to the reprocessing

23. 1.9 Washer Disinfector Machines • Batch and continuous type washer disinfectors clean and remove bio burden/micro-organisms (blood and debris) • Thermal (high level) disinfection using time at temperature – final rinse • Means the cleaning process is verifiable • Lumened items still require Flush brush Flush • Unlock and open items • Use appropriate washer baskets/inserts • Keep sets together

24. 1.9 Washer Disinfector Machines REPORT IMMEDIATELY: Cycle parameters not meeting set requirements or variations to cycle parameters – failed cycles Items that appear dirty or stained are returned to the cleaning area for recleaning/destaining Excess water – check the following: the machine temperature, amount of rinse aid going into the machine or the way in which the machine was loaded Damaged instruments

25. 1.9 Washer Disinfector Machines Releasing the load and unloading the washer disinfector Authorising release of the load occurs on completion of washer disinfector cycle and prior to opening the door. Check cycle parameters have been met and print out/log (or equivalent) is signed Care opening the doors due to heat and moisture Inspect load not become dislodged or displaced Avoid injury and damaging the equipment/instruments

26. Washer disinfector printout

27. Section 2 Packaging and Wrapping Procedures

28. 2.1 Organisation Of Packing Area Organised packing area ensures a clean, safe work working area that reduces the risk of equipment damage/loss and unsafe work practices.

29. 2.2 Assembly Of Instrument Trays And Hollowware Prepare equipment for sterilization: Check multi-part equipment / instruments • can be assembled and functioning • then disassembled or loosely assembled for sterilisation as per manufacturers instructions • Hinged or ratchet instruments are opened and unlocked • Sharp items protected with a tip protector or enclosed in a cassette

30. 2.2 Assembly Of Instrument Trays And Hollowware • When packaging hollowware sets: • Openings are to face in the same direction, • Hollowware should not be able to move, and • If hollowware is nestled - insert separators • Individual packs do not include combinations of hollowware, instruments, gauze dressings, drapes or tubing

31. 2.3 Wrapping and Packaging Provides a protective barrier against sources of potential contamination. Wrapping/packaging methods must facilitate aseptic removal of contents

32. 2.3 Wrapping, Packaging & Labelling • Wrapped items • The method shall be envelope fold or square fold technique • The type and method of wrapping and packaging is facility specific • Check prior to use the wrapping material is not damaged or expired • The class 1 chemical indicator tape used for sealing will be specific to the mode of sterilisation (pressure sensitive, non-toxic and adhere to clean surface) • Ensure tape is adhered to wrapping/packaging material 

33. 2.3 Wrapping, Packaging & Labelling • Flexible packaging materials • Check for damage and expiry date • Correct size pouch for contents • Hollowware openings are against non-laminate surface • Any writing required should be done on the outer parameter of the flexible packaging material. • Self sealing pouches must be sealed by folding the flap along perforation/dotted line as indicated by the manufacturer. • Pouches shall only be filled up to ¾ of the overall space, allowing approximately 5 cm seal area

34. 2.3 Wrapping, Packaging & Labelling • Labelling of packs: • All packs, bags, pouches and wrapped items must be labelled if contents are not visible • Use a non-toxic, water resistant, felt tipped marking pens and rubber stamps using similar ink or pre-printed tape • Writing on wrapping could damage the integrity of the material

35. 2.3 Labelling To occur prior to the sterilizing process utilising: • Batch labels (piggyback) • Details on the batch label gun must be checked and updated for each sterilizer cycle. The minimum information required on each label must include; • Date of sterilization • Sterilizer number • Sterilizer cycle number

36. Blue = Unprocessed Sterilizer number

37. Colour interpretation chart

38. 2.4 Using and Reloading Batch Label Gun • Upper adjustable print display - Setting the date and the steriliser number • Date must appear as DD(space)MM(space)YY starting from the far left • The sterilizer number must be positioned to the far right

39. White mark (R) Side - Steriliser number (L) Side Date - dd mm yy Steriliser cycle number White mark

40. Chemical Indicators • Class 1 – Process indicator – exposure to a sterilisation process – shows processed/unprocessed e.g sterilising tape, external chemical indicators. • Class 2 – Specific tests e.g Bowie Dick type test • Class 3 – Single parameter – critical parameter e.g. dry heat • Class 4 – Multi parameter eg. Time at Temp. • Class 5 – Integrating indicator – time temp and moisture • Class 6 – Emulating indicator (cycle verification) – eg. 134°C @ 3.5 min

42. Chemical Indicators do not indicate sterilization • Written information about the indicators shall be obtained from the supplier covering: (a) How to interpret indicator results. (b) The factors affecting end-point colour change during storage of sterilized items. (c) The sterilization conditions that the indicator will detect. (d) The storage requirements and shelf-life of the indicator itself.

43. Packaging Instruments & Class 1 Chemical Indicators

44. Packaging Instruments

45. Dental Instruments • Sterile at point-of-use • must be stored to maintain sterile conditions • must be tracked when used Extraction instruments

46. The way we were……

47. Section 3 Sterilising

48. 3.1 Batching & Recording of a load prior to sterilisation • MUST HAVE DOCUMENTED EVIDENCE OF ALL ITEMS of a sterilising process = tracking/tracing proof • Assists in the recall of an item/load • Recording of load contents assists in compiling of statistical data on production volume

49. Warning: Do Not Store Unprocessed Items In The Sterilizer • The sterilization cycle shall be commenced immediately after loading. • Warm, moist atmosphere of the chamber can lead to— • (a) release of unprocessed items for use; • (b) contamination of packaging by condensate; • (c) an increase in bioburdenon unprocessed items; and • (d) the deterioration of: • (i) chemical indicators, packaging and labelling; and • (ii) adhesive of self seal pouches, labelling and sterilizing tape.

50. . Downward Displacement Validator Plus Steriliser bench top class N downward displacement autoclave capable of processing both wrapped and unwrapped loads