should be dated and stored utilizing shelf-life practices. Event-related practices observe that the packages should remain sterile indefinitely unless an event (such as a tear or moisture) causes them to become contaminated. If Immediate-use steam sterilization Immediate-use sterilization (historically termed “flash sterilization”) is a process designed for the steam sterilization of wrapped or unwrapped instruments or patient-care items for immediate use. Immediate-use sterilization should be used only under certain conditions: (1) thorough cleaning and drying of instruments precedes the sterilization; (2) mechanical monitors are checked, and chemical indicators used for each cycle; (3) care is taken to avoid thermal injury to dental personnel or patients; and (4) items are transported aseptically to the point of use Sterilization monitoring Effective sterilization monitoring includes a combination of mechanical, chemical, and biological monitoring. Mechanical techniques include assessing cycle time, temperature, and pressure to ensure that the parameters for sterilization have been met. Historically this was performed by observing gauges or displays on the autoclave; however, newer devices may have technology to connect to the manufacturer via internet and cycle faults may be detected before the dental team notices. Chemical indicators are referred to as internal (enclosed within a cassette or a package) or external (on the outer surface of a cassette or package) and are designated as single-parameter (provides information regarding only one sterilization parameter such as time or temperature) or multiparameter. Multiparameter indicators are more chemically sensitive and assess the physical conditions (time, temperature and, sometimes pressure) during the sterilization process and chemical “integrators” assess all parameters for sterilization. Internal chemical indicators should be placed within each package or cassette to visualize whether the sterilizing agent has reached the instruments inside. An external chemical indicator should be placed on the outside of the package if the internal indicator cannot be seen. All mechanical and chemical indicators should be checked at the conclusion of the sterilization process. These results do not guarantee that sterilization has taken place but may be a first indicator of a sterilization problem. If either mechanical or chemical indicators demonstrate deficiencies, the load should not be used until it is reprocessed with correct parameters. Environmental infection prevention and control Housekeeping surfaces and clinical contact surfaces are the two primary types of surfaces recognized in the hygiene operatory. Housekeeping surfaces pose a limited risk of disease transmission because, typically, they are not touched directly during the delivery of dental care. Clinical contact surfaces pose a higher risk of disease transmission because they are very likely to be contaminated with blood and other infectious materials transferred by frequent touching with contaminated hands, gloves, devices, or instruments or by spatter generated during the dental procedure (CDC, 2019a). Housekeeping surfaces include floors, walls, and sinks. These surfaces should be cleaned routinely with a detergent and water. If the surface has been contaminated with blood or other potentially infectious material, then an intermediate-level disinfectant should be used after cleaning.
packaged instruments are contaminated, they should be reprocessed entirely, including cleaning, drying, packaging, and sterilization. If a package becomes wet, it should be repackaged and resterilized. to maintain sterility. Implantable devices should not be sterilized unwrapped. Autoclave manufacturer’s instructions should be consulted for specific cycle parameters for unwrapped instruments. If instruments sterilized unwrapped, they must be handled aseptically during removal and transportation and used immediately. Unwrapped instruments should not be stored for future use because it permits exposure to dust, airborne organisms, and potential contamination before use on a patient (CDC, 2016j). Biological indicators (BIs) are the most effective technique for monitoring the sterilization process because they directly assess the killing of bacterial spores. Biological monitoring should be done at least weekly on each sterilizer. Manufacturers’ instructions should determine the placement of each BI within the sterilizer. A control BI (from the same lot as the test BI) should not be processed through the sterilizer but should be incubated with the test BI. The control BI should have a positive result, indicating bacterial growth, whereas the test BI should have a negative result. Sterilization records must be maintained in accordance with state and local regulations (CDC, 2018b). If a positive spore test occurs while other indicators reveal that the sterilizer is functioning correctly, the spore test should be repeated immediately. The operator should make sure that the sterilizer is loaded correctly, and then repeat the same cycle that produced the failure. If the repeat test also fails, the sterilizer should be removed from service and records reviewed since the last negative BI test. Most failures are due to operator error; thus, it is important to review operating procedures with all personnel who operate the sterilizer including packaging, loading, and operating procedures. If operator error is not a factor, then the sterilizer should be taken out of service until it can be inspected and repaired. The sterilizer should then be tested with three consecutive empty sterilization cycles. If the repeat tests are negative and other monitoring indicates sufficient processing, the sterilizer may be put back into service (CDC, 2016k). As instrument packages are labeled with the date, sterilizer, and cycle load, instruments processed since the BI failure may be readily retrieved, repackaged, and resterilized. Clinical contact surfaces can serve as reservoirs of microbial contamination and include frequently touched surfaces such as light handles, unit switches, drawer knobs, dental radiography equipment, and clinical countertops. Preparation of a clinical contact surface may be a one- or two-step process including cleaning, followed by disinfection. When choosing products, read the label instructions to ensure that the cleaning or disinfecting product is correct for the task and that the product is compatible with the surface to be disinfected. Products used for environmental disinfection are generally available in a spray or premoistened towelette form. In a two-step cleaning product, the initial cleaning removes most of the bioburden and is a critical step in the disinfection process. The surface must then be disinfected using an EPA-registered intermediate-level disinfectant with a tuberculocidal claim. The surface must remain moist for
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