Packs, pouches, and cassettes are sometimes wet after completing the sterilization process. This is a problem usually associated with the use of paper or paper/plastic wraps in the steam autoclave. Micro organisms can be drawn through wet paper if touched. Also, wet paper has a tendency to rip or tear. It is best to minimize the handling of wet items until they have had an opportunity to dry.Many steam autoclaves have drying periods that follow sterilization cycles.Items processed in all types of heat sterilizers are hot when ready to be removed.Hot items should be allowed to cool slowly. Exposure of hot items to cold air (e.g., from an air vent or window) should be prevented to avoid forming condensation. Using a fan or a blower to either dry or cool processed items should be avoided because it increases the chances of contamination. It is best to dry and/or cool instruments as a group; handling a tray full of packs instead of individual items.
If instruments have been processed unwrapped or unpackaged (acceptable only for one or few instruments processed through a "flash sterilization" cycle), they must be immediately covered or somehow protected from air contamination and touching contaminated surfaces prior to use.Cool and dry instrument packs are ready to be properly stored. If the organization of the sterilization processing area is correct, the chances of mixing sterile items with those waiting to be processed approaches zero. External chemical monitors (e.g., autoclave tape) also help to identify processed packs.
Instruments should be moved gently with clean, dry gloved hands. Packs should be handled as little as possible. Avoid using tongs because they can damage the wrapping materials. Sterile packs need to be protected from dust or moisture contamination. Cabinets and drawers are useful. However, packs on trays or tabletops need to be covered by plastic sheets. Only cool, dried packs should be placed into cabinets and drawers or be covered by plastic.Ideally, sterile packs should be stored in dry, low-dust, enclosed areas away from sources of contamination. Moisture is the enemy of stored sterile packs. Packs should be stored without crowding, crushing, or compression.
If instruments have been processed unwrapped or unpackaged (acceptable only for one or few instruments processed through a "flash sterilization" cycle), they must be immediately covered or somehow protected from air contamination and touching contaminated surfaces prior to use.Cool and dry instrument packs are ready to be properly stored. If the organization of the sterilization processing area is correct, the chances of mixing sterile items with those waiting to be processed approaches zero. External chemical monitors (e.g., autoclave tape) also help to identify processed packs.
Instruments should be moved gently with clean, dry gloved hands. Packs should be handled as little as possible. Avoid using tongs because they can damage the wrapping materials. Sterile packs need to be protected from dust or moisture contamination. Cabinets and drawers are useful. However, packs on trays or tabletops need to be covered by plastic sheets. Only cool, dried packs should be placed into cabinets and drawers or be covered by plastic.Ideally, sterile packs should be stored in dry, low-dust, enclosed areas away from sources of contamination. Moisture is the enemy of stored sterile packs. Packs should be stored without crowding, crushing, or compression.
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| U-V Chamber |
The length of time a sterile pack can be stored successfully depends on how well the packaging materials were applied and maintained. Any factor that compromises pack integrity negatively impacts storage time.From a practical perspective, extended storage time probably affects only a limited number of packs; like those that contain special instruments (e.g., crown removers, lip retractors, or some surgical instruments). Of greater importance is the avoidance of moisture, protection of wrapping integrity, and rotation of stock ("first in, first out"). If a pack becomes wet, torn, cracked or punctured, its shelf life immediately becomes zero.It would be best if sterile packs were opened chair side. Ideally, no sterile packs should be stored in an operatory. Materials are moved in, opened, used, and returned to the instrument recycling area. Items stored in operatory drawers or cabinets are easily contaminated during retrieval by soiled fingers or from aerosols or spatter.
All sterile packs should be inspected chair side prior to use. They should be opened without touching the contents. Movement of instruments (e.g., on the bracket table) should be accomplished with the use of forceps. Instruments in cassettes usually are arranged in a manner that facilitates their use (or sequence of use). Once instruments are unwrapped they must be used immediately.Now we come to the specific considerations and applied aspects in dentistry: Firstly,The dental chair and delivery system. The chair should be smooth and seamless.The greatest potential for cross contamination is from chair mounted control.Disposable covers should be used as far as possible.
The delivery system gas a panel susceptible to infection retention and spread.Control should be seamlessly integrated or can be remote controlled. The entire unit should be covered with disposable covers where possible and disinfected and wiped between patients on exposed surfaces.Next comes X- ray unit, an integral part of all practices it is subject to heavy contamination. Single disposable plastic wraps minimize infection spread. Also disinfectants can be used on the surfaces. Film holders, bite block and processing units which are all subject to high contamination should be routinely disinfected and sterilized.
Tubing and hosing including suction and delivery hose can harbor infection. Suctions systems should be routinely washed with water and disinfectants while hand piece and air water syringe tubing should be having retraction devices. Outer surfaces with connector assembly should be washed with detergent and disinfected by immersion.Next comes water system asepsis. Firstly water and oral fluid fraction should be avoided using anti retraction valves, repositioning of internal 'O' ring or upgrading version. Periodic checks should be made. Secondly water lines should be flushed for minimum of 20-30 secs between patients and running disinfectants regularly through them. Microbial biofilm contamination of dental water lines is a reality and can be limited by use of regular use of disinfectants like iodophores and sodium hypochlorite. Biocide solution , filters and dedicated water systems for an infection control are recommended.
Lastly a small look at recommended and available procedures for sterilizing and disinfecting specific dental armamentarium-burs can be autoclaved, dry heated,chemiclaved or chemically sterilizes. Endo instruments are sterilized with glass bead sterilizer. Pliers, cement spatulas etc can be flamed. Metal instruments can be autoclaved or dry heated or chemically sterilized. Glass slabs and dapen dishes may be chemically sterilized with thimeroseal (merthiolate) while gutta percha can be sterilized with sodium hypochlorite, impressions can be disinfected with glutraldehyde or other chemicals. Also note numerous items are recommended for disposable use in a single use and throw fashion. Disposable equipment should be used where practical and feasible. Also the barrier methods and plastic or other disposable covers should be used for complex devices or straight surfaces.Another specific consideration is universal precaution to be employed in treating a known infectious patient along with straight personal barrier protection, use of disposables and of artificial sterilized units should be mandatory. Special considerations should be made in use of hepatitis and HIV infected patients. Barrier techniques like double gloving etc should be used. Sharps should be ultra cautiously handled and disposable kits and armamentarium should be performed. Stringent sterile precautions should be called for while dealing with known infectious cases so as to maintain absolute asepsis in the operatory and ensure protection to personal and patients.
All sterile packs should be inspected chair side prior to use. They should be opened without touching the contents. Movement of instruments (e.g., on the bracket table) should be accomplished with the use of forceps. Instruments in cassettes usually are arranged in a manner that facilitates their use (or sequence of use). Once instruments are unwrapped they must be used immediately.Now we come to the specific considerations and applied aspects in dentistry: Firstly,The dental chair and delivery system. The chair should be smooth and seamless.The greatest potential for cross contamination is from chair mounted control.Disposable covers should be used as far as possible.
The delivery system gas a panel susceptible to infection retention and spread.Control should be seamlessly integrated or can be remote controlled. The entire unit should be covered with disposable covers where possible and disinfected and wiped between patients on exposed surfaces.Next comes X- ray unit, an integral part of all practices it is subject to heavy contamination. Single disposable plastic wraps minimize infection spread. Also disinfectants can be used on the surfaces. Film holders, bite block and processing units which are all subject to high contamination should be routinely disinfected and sterilized.
Tubing and hosing including suction and delivery hose can harbor infection. Suctions systems should be routinely washed with water and disinfectants while hand piece and air water syringe tubing should be having retraction devices. Outer surfaces with connector assembly should be washed with detergent and disinfected by immersion.Next comes water system asepsis. Firstly water and oral fluid fraction should be avoided using anti retraction valves, repositioning of internal 'O' ring or upgrading version. Periodic checks should be made. Secondly water lines should be flushed for minimum of 20-30 secs between patients and running disinfectants regularly through them. Microbial biofilm contamination of dental water lines is a reality and can be limited by use of regular use of disinfectants like iodophores and sodium hypochlorite. Biocide solution , filters and dedicated water systems for an infection control are recommended.
Lastly a small look at recommended and available procedures for sterilizing and disinfecting specific dental armamentarium-burs can be autoclaved, dry heated,chemiclaved or chemically sterilizes. Endo instruments are sterilized with glass bead sterilizer. Pliers, cement spatulas etc can be flamed. Metal instruments can be autoclaved or dry heated or chemically sterilized. Glass slabs and dapen dishes may be chemically sterilized with thimeroseal (merthiolate) while gutta percha can be sterilized with sodium hypochlorite, impressions can be disinfected with glutraldehyde or other chemicals. Also note numerous items are recommended for disposable use in a single use and throw fashion. Disposable equipment should be used where practical and feasible. Also the barrier methods and plastic or other disposable covers should be used for complex devices or straight surfaces.Another specific consideration is universal precaution to be employed in treating a known infectious patient along with straight personal barrier protection, use of disposables and of artificial sterilized units should be mandatory. Special considerations should be made in use of hepatitis and HIV infected patients. Barrier techniques like double gloving etc should be used. Sharps should be ultra cautiously handled and disposable kits and armamentarium should be performed. Stringent sterile precautions should be called for while dealing with known infectious cases so as to maintain absolute asepsis in the operatory and ensure protection to personal and patients.
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