Sterilization & Procedure for proper use of Autoclave and Statim Thanhvan Chu Vy Tran Libby Ogro Julie Rann
Sterilization Destroys all forms of microbial life (especially sporicidal) Carried out in health-care facilities by physical or chemical methods [CDC, p.8] The ADA and CDC suggest autoclaving as the best sterilization method for materials exposed to body fluids [Hashemipour MA, p.487]
Methods of Sterilization Steam Autoclave Sterilize with steam under pressure Dry Heat Oven Insulated, oven like chamber Chemical Vapor Sterilizes with chemical vapor: formalin, alcohol, ketones Ethylene oxide Sterilize with ethylene oxide. Mainly use in hospital
Instrument Classification Category Definition Process Example Critical Penetrate soft tissue or bone * Sterilization Semicritical Contact mucous membranes or nonintact skin * Sterilization * High-level of Disinfection Noncritical Contact intact skin * Low-Intermediate level of Disinfection [Darby, 113]
Sterility Assurance Chemical Indicators Multiparameter Indicator (Integrators) Biologic Indicators (spore test) * Determine the present of one parameter, such as Heat or Steam. Outside package. * Distinguish between sterilized and unsterilized packages * Not an effective indicator * Indicated more than one parameter * Place within the packages * Higher level of sterilization assurance * Indicated a successful of sterilization process * Use non-pathogenic spores * Placed in sterilizer with a load of instruments [Darby, 114], [Palenik, 583-584]
Packaging Full PPE + heavy duty utility gloves to prevent puncture. Instruments must be dry to prevent corrosion. Pre-wrapped using appropriate pouches + strip indicator. Seal with indicator tape. Date + sterilizer number.
Storage Instruments must be stored in dry conditions away from excessive heat and moisture [Dental Nursing, p.429]. Avoid contamination (including aerosol) during storage. Designated storage area: as far as possible from treatment area. Must be stored above floor level, away from direct sunlight and water, in a cool dry environment. Limiting within 21-30 days. If unused within these periods, must be fully reprocessed.
Autoclave Procedure Wearing full PPE & using paper towel, Plug in / Turn on autoclaves Open door to check water level if low, fill with distilled water to green zone Label tape on packs with the date & autoclave # Place in autoclave tape side down (cloth packs) plastic side down (paper pouches) don t overlap Close door ON - PACKS - START (for packs and pouches) ON - POUCHES - START (for just pouches) Flip sign to say Clean *Make sure you don t start any cycles after the posted time* [Spragge, 2-25]
Autoclave Settings Setting Packaging Temp Pressure Sterilization Dry Pouches Just pouches 270 27.1 psi 5 min 30 min Packs Packs (cloth) or pouches + packs 250 15 psi 30 min 30 min [Spragge, 2-25]
Autoclave Distribution When dry, remove packs (with clean hands) Check tape for black stripes indicating sterile Place in corresponding cubby End of day Unplug autoclave #1 Turn off autoclave #2 and #3 [Spragge, 2-25]
Statim What is it? Statim 2000 G4 by SciCan Dental Autoclave for flash sterilization PPPD technology Advantages: Fast instrument turn-around time/reduces instrument investment Good for emergencies Takes unwrapped instruments Gentle Disadvantages: Small Instrument heat Aseptic transfer to point of use [Association for the Advancement of Medical Instrumentation, 1-2] [Bjerke, 24-26],
Statim Procedure Wearing full PPE and using paper towel, plug in and power on Statim Check water level indicator or fill level Remove cassette, open and load do not mix pouches and unwrapped instruments make sure instruments or pouches do not touch Insert cassette until it clicks. Check the display to ensure it is loaded correctly. Choose the correct cycle Press the start icon Wait for cycle to complete Confused? Forgot instructions? Look up! [Spragge, 2, 28-33]
Statim Settings Statim 2000 G4 Unwrapped Wrapped Rubber Sterilization time 3.5 min 10 min 15 min Sterilization temp. 135 C 135 C 121 C Total cycle time 6 min 14 min 20 min * Air dry only cycle is not a sterilization cycle. [Scicanusa, 8]
Sterilization Room Note Do not start autoclaves, Miele or Laundry after 3:00 pm Deionized Water for Autoclaves o Now in the darkroom in a big jug o When that jug is half full please: Fill the smaller containers in the lower cabinet under autoclave # 3 with water from the big jug. Notify Truc if the water is half gone o You MUST use deionized/ distilled water in the autoclave
Legal and Ethical Improper Sterilization Ethical Violation: Maleficence Beneficence Veracity Universality, Complementarity Legal Violation: Unprofessional conduct by a person licensed: License revoked Fine charged
References 1. Hashemipour MA, Mozafarinia R, Mirzadeh A, Aramon M, Nassab SG. Knowledge, attitudes, and performance of dental students in relation to sterilization/disinfection methods of extracted human teeth. Dent Res J 2013;10:482-8. [Internet]. Available from: http://library.foothill.edu:2195/eds/pdfviewer/pdfviewer?sid=b227c41d-a5fb-4139-a703-9b1b2ec9f2a6%40sessionmgr4001&vid=3&hid=4103 2. Sterilization and disinfection of dental instruments. Dental Nursing [serial online]. August 2009;5(8):428-430. Available from: Dentistry & Oral Sciences Source, Ipswich, MA. 3. Bjerke N B. Cut down sterilization turnaround time. Nurs Manage. 2004 Nov;35:24-26. 4. Association for the Advancement of Medical Instrumentation. Immediate-Use Steam Sterilization [Internet]. Available from: https://www.aami.org/publications/standards/st79_immediate_use_statement.pdf
References 5. Palenik C, Burke F, Coulter W, Cheung S. Improving and monitoring autoclave performance in dental practice. Br Dent J. 1999 Dec 11;187(11):581-584. 6. Centers for Disease Control and Prevention [Internet]. Atlanta, GA. December 29, 2009.Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. [Cited on 2014 November 18]. Available from: http://www.cdc.gov/hicpac/disinfection_sterilization/toc.html 7. Darby, Michele L, and Margaret M. Walsh. Dental Hygiene: Theory and Practice, 4th edition. St. Louis, Mo: Saunders/Elsevier, 2015. Print. 8. Spragge P, Chan P, Yamamoto J. Foothill College Dental Hygiene Clinic Manual. Los Altos Hills, CA. 2014-2015. Section 2, p. 2-23 2-34. 9. Scican Usa. The New Generation STATIM, the G4 Series [Internet]. Available from:http://www.scicanusa.com/site/scicanusa/assets/pdf/scican_statim_g4_usa_2012.pdf
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