Question

Discuss what constitutes physical monitoring of sterilization and why it is important to monitor the sterilization procedures in a dental office. Include some specific examples of instrument processing techniques and why those techniques are particularly appropriate for that instrument and its uses.

Answer 1

Sterilization (or sterilisation) refers to any process that eliminates, removes, kills, or deactivates all forms of life and other biological agents (such as fungi, bacteria, viruses. Sterilization can be achieved through various means, including: heat, chemicals, irradiation, high pressure, and filtration. Sterilization is distinct from disinfection, sanitization, and pasteurization, in that sterilization kills, deactivates, or eliminates all forms of life and other biological agents which are present.

Sterilization is a process designed to kill all microbes. Because we can't actually test whether all microbes are killed during the sterilization process, the next best thing is to determine whether the process kills the most resistant microbe. If so, we may assume all others have been killed as well. The sterilization process also can be monitored by using chemical indicators (CIs) that change color or form when exposed to specific high temperatures or to the sterilizing conditions within a sterilizer. This is referred to as chemical monitoring (or process monitoring).

Infection control is vital to the safe, effective treatment of patients in the dental office. Proper sterilization procedures aren’t just good policy; they can help prevent disease, and even death.

Importance of Infection Control in Dental Office:

1. Prevents the growth of bacteria: Bacteria are among the fastest growing organisms in the world. And when they carry disease, the results can be deadly. But proper sterilization techniques in the dental office can stop them in their tracks. Frequently disinfecting tools and equipment kills bacteria.
2. Prevents spread of disease: Those bacteria can carry a host of diseases. The bacteria associated with periodontal disease can be spread through saliva. But there are other diseases that can be far more concerning such as tuberculosis, hepatitis, and HIV.
3. Prevents death: Bacteria often carry disease. Disease can cause illness and death. Healthcare associated infections are among the leading causes of death in the U.S.1 But they are easily preventable with proper infection control in medical and dental offices.
4. Protects staff: The prevention of patient-to-patient transfer of bacteria and disease is a top priority for dental professionals. But it’s also important to protect the dentist, dental assistants, hygienists, and other staff. Infection control helps keep the entire staff healthy.
5. Maintains practice reputation: One small mistake in infection control could have obvious health consequences. But if word gets out that your practice doesn’t follow proper procedures and puts patients in jeopardy, it could cost you your good reputation!

Steps to review for proper instrument sterilization

1. Cleaning instruments prior to sterilization

The CDC's (Centers for Disease Control and Prevention) official infection control guidelines state that instruments should be thoroughly cleaned to remove blood or other debris prior to sterilization. Blood or debris on the instruments can prevent steam or unsaturated chemical vapor from contacting the instrument surfaces to achieve sterilization. The use of enzymatic cleaning solutions will assist in cleaning the instruments.

2. Use and maintain the sterilizer according to the manufacturer's instructions

The manufacturer's instructions for use of the sterilizer must always be followed, or its effectiveness can be compromised. If unfamiliar with the proper operation of the sterilizer, consult the owner's manual or go to the manufacturer's website for this information, not only on the operation, but proper maintenance of the sterilizer.

3. Package all Instruments prior to sterilization

This recommendation from the CDC is the standard of care for patient safety. Packaging instruments is critical in maintaining the sterility of instruments until they are used, whether the instruments are placed directly into a sterilization pouch or in an instrument cassette that is wrapped or placed in a sterilization pouch. Extra instruments that may be stored in the treatment rooms may be contaminated if they are placed loose in drawers and not protected by packaging materials.

4. Place integrators in instrument packages

These are strips that monitor more than one of the parameters required to achieve instrument sterilization. These strips monitor the temperature, as well as penetration of the steam or chemical vapor into instrument packs. Although the sterilizer may be functioning properly, if instrument packs are overloaded or improperly positioned in the sterilizer, every package of instruments may not be sterilized. The only way to validate this is with an integrator.

5. Store instruments away from possible cross-contamination and moisture

Sterile instruments first must be left in the sterilizer until the packaging material has dried to prevent tears or punctures of wet materials and to prevent wicking of air contaminants into the packages. Appropriate storage areas for sterile instruments are closed cabinets or drawers, but not above the sterilizer or near a sink, where the packaging materials may become wet.

6. Spore test sterilizer(s) weekly

The CDC's Guidelines for Infection Control in Dental Health-Care Settings recommends that sterilizers be tested "at least weekly." Although the CDC guidelines are not regulations (e.g., OSHA), they are the recognized standards of care for patient safety. Spore testing can be accomplished with an in-office system or through an outside sterilization monitoring service.

7. Follow CDC protocols for trouble-shooting if a spore test fails

The first thing that must be done if a failure result or report occurs on a spore test is that the sterilizer must be taken out of service until the cause of the failure is determined. Simply following the failed test with another spore test, while using the affected sterilizer, is not appropriate. Sterilizer monitoring services, as well as in-office systems, have support services available for determining the cause of the failure.