Hygiene And Infection

Questions: 1.Detail the process that you will take to Clean, Disinfect and or Sterilise each of these items. 2.List three possible reasons why a pouch that has just been removed from a completed autoclave tray would be considered unsterile and needs to be reprocessed?3.List 5 items for each Classification in the table below- your answer may include Instruments and other items used in the Dental Clinic. 4.Explain why you need to Completely remove all Blood Saliva and other Debris from Instruments before Sterilisation can take effect.5 Explain why Household Detergent is not recommended for use when Cleaning Instruments. Answers: 1.There are four basic areas through which all the instruments and materials used in dental treatment are processed in a single loop from dirty, to clean, to sterile and to storage without ever doubling back. Before proceeding with instrument processing, PPE should be worn which includes Nitrile utility gloves, protective clothing, protective eyewear and mask (Palenik CJ, 2001). The 4 cotton rolls, used gloves, used masks, prophylactic cup, patient treatment bib are disposed in yellow bags which are labelled as clinical waste. The rest of the contaminated instruments are taken to the sterilization/processing area. The instruments should be transported in a rigid, leak-proof and covered container. The instruments are cleaned using a hands free, mechanical process like ultrasonic cleaner or instrument washer (Cuny E Bednarsh H). Disinfect the instruments except high speed handpiece and contra-angle slow speed handpiece by dipping them in a disinfectant solution. Then the all the instrument are packed before sterilization. Both the hand pieces and the rest of the instruments can be sterilised in autoclave. Package the instruments. The instruments are sterilised in accordance with manufacturers instructions. After sterilization cycle, sterilizer is depressurised and the packs remain in the steriliser to dry. Chemical indicators are checked on each pack to make sure that the instruments are properly processed and sterile. Sterilise packs are kept in clean, dry area. 2.The three reasons a pouch that has been removed from a complete autoclave tray would be considered unsterile and will need to be reprocessed areWet loads wet instruments are an evidence that they are non-sterile and should not be used. Water or damp spots on the instruments prevents it from reaching the intended temperature of sterilization. Because the package has not subjected to the intended lethality, it is considered not sterile. Furthermore, it also increases post contamination risk because dampness is the optimal place for the bacteria to grow (Sandle T, 2015). Sterilizing parameter measurements are in doubt for sterilization to be considered successful, there are numerous parameters like temperature, pressure, time, material being sterilised and then there are individual models within sterilizer brands. The sterilizers require clearance from FDA before the manufacturer can begin selling them. The FDA does rigorous testing of these equipments to ensure an adequate margin of safety in each cycle type which is claimed by the manufacturer. Therefore, if the parameters are not met, the instruments are considered unsterile (Cuny E Bednarsh H). Packaging is not intact it means that the instruments were either not packed properly or they have not been subjected to the intended sterilisation cycle and are thus considered unsterile. 3.Critical instruments are those which penetrate the soft tissue/bone or come in contact with the blood stream/ enter the blood stream or comes in contact with/enter the normal sterile tissue. These instruments have to be sterilised after each use.The critical instruments in dental practice are :- Surgical instruments Bone chisels Scalers Surgical burs Forceps (ADA, 2009) Semi-critical instruments are those which do not enter into the soft tissue/bone but come into contact with the mucous membrane/ non-intact skin. These instruments also have to be sterilised after each use. The semi-critical instruments in dental practice are:- Mirrors Reusable impression trays Amalgam condensers Cheek retractor Dental handpiece (ADA, 2009) Non-critical instruments are those which come in contact with intact skin. These instruments/devices have low risk of transmitting any infection and can be reprocessed between patients by low/intermediate level of disinfection. The non-critical instruments in dental practice are:- External components of x-ray heads Blood pressure cuffs Pulse oximeter Computers Stethoscope (ADA, 2009) 4.There is a misconception in the mind of people that cleaning process is less important than sterilisation in order to avoid infection. But it is interesting to know that immediate and effective cleaning of instruments after use can eliminate 99.99% of bacteria. It also decreases the possibility of infection through uninjured hands to almost nil. Cleaning of the instruments has the same effect as disinfection in reducing the infection risk. And on the opposite side, improper and inefficient cleaning will cause some protein containing microbes to remain on the instrument. And this would make all the sterilisation and disinfection not sufficient and of no use. Liquid medicine used in any dental practice causes changes the properties of proteins and it causes protein to adhere to the instrument, which would become difficult to remove later by cleaning (ADA, 2009). 5.The household detergents was invented only for removing starch from the dirty dishes.so it can be expected to clean blood containing protein effectively. It should also not be used for cleaning the instruments because the agents used to give colour and fragrance to the detergent cause pitting, corrosion, rust to the instruments. These household detergents can also damage the ultrasonic chambers used to clean the instruments. References: Cuny E Bednarsh H, Instrument sterilisation in dentistry, RDH magazine, vol. 7, no. 4, https://www.rdhmag.com/articles/print/volume-27/issue-4/feature/instrument-sterilization-in-dentistry.html. [16 December 2016] Palenik CJ (2001), Dental instruments sterilization: a six-step process, The journal of contemporary dental practice, vol. 2, no. 1, pp. 84. Available from Pubmed [16 December 2016] Sandle T (2015), Ensuring sterility: autoclaves, wet loads and sterility failure, Available from https://www.ivtnetwork.com/article/ensuring-sterility-autoclaves-wet-loads-and-sterility-failures. [16 December 2016] ADA (2009), Sterilization and disinfection of dental instruments, American dental association, Available from https://www.ada.org/~/media/ADA/Member%20Center/FIles/cdc_sterilization.ashx. [ 16 December 2016] Fluent MT (2015), Instrument cleaning: why, who and how, Dental economics, vol. 105, no. 11. Available from https://www.dentaleconomics.com/articles/print/volume-105/issue-11/science-tech/instrument-cleaning-why-who-and-how.html. [16 December 2016] (2012), Batch labelling and recording of a load prior to sterilization, Oral health standard operating procedure, version 4, Available from https://www.health.qld.gov.au/__data/assets/pdf_file/0027/370467/oh_section3_sop.pdf. [16 December 2016]