Sterilization

    Dirty vs Clean Side Autoclave & Statim Intro Cold Sterile Ultrasonic Introduction

 Scrubbing and Sterilization

Infection control in the office is the process of protecting staff, doctors, and patients from the spread of infectious disease. These efforts are informed by at least three sources: 1) State Law 2) OSHA, Occupational Safety and Health Administration 3) Best practices guidelines, which reflect the best in current scientific research

Infection Control

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The near constant exposure of staff and patients to blood, saliva, and aerosol from hand pieces as well as smoke plumes from lasers make the need critical for an excellent infection control process. Sterilization is the process by which all forms of microorganisms; viruses, bacteria, fungi, and spores  are destroyed on inanimate objects. This can be accomplished through autoclaving (steam pressure), prolonged dry heat, chemical vapor, ethylene oxide gas, ionizing radiation or immersion in chemical sterilants. It is very important to follow manufacturer recommendations for use, including dilution, contact time, and shelf life.

Each Aspire Surgical sterilization room has designated clean and dirty sides. Please make sure you are aware of these areas when unfamiliar with an office. It is critical that cross contamination is not occurring for staff and patient safety. No foods or liquids are allowed in the sterilization rooms or refrigerators. The dirty side is just what the name signifies, dirty and contaminated. No sterilized or disinfected items are to be placed or prepped in this area. The clean side is just what the name signifies, clean. However, it is not considered sterile, it should be consistently disinfected to ensure cleanliness.

Dirty versus Clean Side

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Caption: : Sterilization flow

1- Clean blood and debris from instruments using a brush. Watch for sharps. 2- Place instruments into ultrasonic with enzymatic for a full cycle. 3- Once done shaking, rinse instruments thoroughly. 4- Wrap instruments appropriately with a sterilization indicator. 5- Place pouch in autoclave paper side up, do not over pack. 6- Let run for a full cycle and let cool before handling.

Sterilization procedure

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Wear protective eyewear and puncture resistant gloves as well as protective clothing. Clean only one or two instruments at a time. Use only a long-handled brush. Suction tips: Please use a pipe cleaner to clean the inside of suction tips, they can have build of dried blood that is not easily cleaned without the use of a pipe cleaner. Suction tubing: Please allow suction tubing to soak for about 5-10 minutes in soapy water or enzymatic solution to allow break down of blood and debris. Once the soak period has ended flush the tubing with running water until there is no debris or discolored water exiting. Hand piece care: Aspire Surgical hand-pieces rotate a speed of up to 80,000-100,000 revolutions per minute (RPM). Blood, saliva, tooth fragments, bone fragments, as well as restorative material may lodge in the head of the hand-piece where they may retain and transfer to another patient.

Hand scrubbing precautions and guidelines

DO NO SUBMERGE hand pieces. Place the handpiece into the lubricator, close the door and start the cycle.  Once lubricated, wipe down hand piece surfaces with an alcohol swab or Sani-wipe to clean and disinfect. Hand scrub and ultrasonic the metal and plastic bur guard. The metal bur guard and hand piece can be packaged together. The plastic bur guard will then go into the gluteraldehyde/cold sterile.

Handpiece sterilization

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The ultrasonic cleaning uses cavitation bubbles induced by high frequency pressure (sound) waves to agitate liquid. The agitation produces high forces on contaminants adhering to metals, plastics, glass, rubber, and ceramics. This action also penetrates blind holes, cracks, and recesses. The time may vary from 5 to 15 minutes, depending on the amount and type of material on the instruments. The combination of mechanical cleaning of the bursting bubbles combined with the chemical action of the ultrasonic cleaner (each office with use some type of enzymatic cleaner) visibly cleans the instruments. Once the cycle is finished, rinse the instruments thoroughly under running water to remove excess cleaner Allow the instruments to air-dry or carefully pat them with a thick towel. Never rub or roll the instruments in the towel because of the risk of accidently injury.

Ultrasonic Cleaner

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The autoclave and Statim both use steam pressure and prolonged dry heat for sterilization, these sterilizers operate approximately 320-375 degrees Fahrenheit. There are several cycles that can be used to sterilize items; the most often cycles used are: unwrapped and packaged cycles. It is essential that these cycles run through it’s drying time. Unwrapped – This cycle is used for FLASH STERILIZATION. It may only be used on instruments that are placed in the chamber UNWRAPPED. Flash sterilization should ONLY be used for instruments that are to be used promptly upon removal from the sterilizer. It is critical in this cycle to include a steam indicator strip to ensure the cycle performed correctly. Packaged – This cycle is used for instruments wrapped or pouched in sterilization pouches. Sterilization pouches have steam process indicators that signify the cycle performed correctly. It is strongly recommended to use a steam indicator strip as well to ensure the cycle performed correctly.  

Autoclave and Statim

Surgical Hand-piece Sterilization Only steam sterilization and chemical vapor sterilizers are recommended for hand pieces because the sterilization temperature in hand pieces should not exceed 375 degrees Fahrenheit. Unless they will be used immediately after sterilization, hand pieces should be packaged in bags, wraps, or pouches to protect them from contamination before use. NEVER run a hand piece “hot” out of the sterilizer, and avoid rapid cool downs such as running the hand piece under cold water.

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Caption: : Autoclave: Run on pouches or packs

Caption: : Statim: Run on wrapped or unwrapped

Cold sterile is used for rubber or plastic products that are not able to withstand the high heat used in steam sterilization. Cold sterile takes 24 hours of immersion. Items placed in cold sterile for 24 hours must removed daily before anything “dirty” is placed back in the solution. Cold sterile will last typically 28 days before it must be changed. Biofilm can be found where moisture and suitable solid surfaces exist. Biofilm forms a layer of slime. An example of where biofilm can accumulate is waterlines, i.e. irrigation lines on the Bien Air consoles. To reduce biofilm please trim about 1-2 cm of the irrigation lines after each surgery and replace them regularly.

Cold Sterile (Gluteraldehyde)

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Daily: Clean External Surfaces & Gasket A) Wash exterior of sterilizer according to your facility’s procedure for clinical contact surfaces. Use only quaternary disinfectants to disinfect unit. See User Guide for more information. B) Examine door gaskets for damage. Clean gaskets and mating surfaces with a damp cloth. Weekly: Clean Internal Surfaces A) Drain water from the reservoir using drain tube on front of unit. B) Remove trays, rack, and plate. Wash removed items and inside chamber with mild soap or Speed-Clean and water**. C) Refill reservoir with clean distilled water.

Autoclave and Statim maintenance

Monthly:  Flush System A) With a cooled chamber, drain reservoir and fill with clean water**. Add one ounce of Speed-Clean sterilizer cleaner directly to the bottom of chamber. B) Run one Pouches cycle. C) Press Stop button when Dry Cycle begins. D) Drain reservoir and refill with clean water**. E) Rinse by running one Unwrapped cycle. Press the “Stop” button when the drying cycle begins. F) Drain and refill reservoir with clean water**, then allow sterilizer to cool.

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