Question

Surgical Instrumental:

Explain displays for wrapped items,

uncovered items, peel pouches,

dental drills.

Answer 1

Sterilization in the Dental Practice

The decontamination of reusable dental instruments includes:

• cleaning

• thermal disinfection, if a washer-disinfector is available

• rinsing

• drying

• inspection for dryness, functionality and cleanliness

• wrapping before sterilization when using a vacuum sterilizer

• sterilization

• wrapping after sterilization when using a non-vacuum sterilizer

Sterilization is an essential step in the reprocessing of reusable dental instruments that have become contaminated, or are potentially contaminated, with saliva, blood or other biological fluids. This includes dental handpieces. The aim of sterilization is to break the chain of potential cross-infection between patients by killing micro-organisms, including spores. However, prion proteins are not fully deactivated by the sterilization process. Therefore, effective instrument cleaning is particularly important to physically remove contamination, including prion proteins, prior to sterilization. Sterilization using a steam sterilizer is recommended as the most efficient, cost effective and safe method of sterilizing dental instruments in primary care dental practices. The sterilization process must be validated to ensure that instruments are reliably and consistently sterilized using predetermined and reproducible conditions. To kill microorganisms, the instruments need to be exposed to steam at a specified temperature for a specific holding time. Although other options exist, the preferred temperature-pressure-time relationship for all small steam sterilizers is 134–137°C, 2.1–2.25 bar guage pressure for at least a 3 minute holding time. It is preferable to use reusable instruments that can withstand both an automated cleaning/ disinfection process and steam sterilization or to use single-use instruments. Reusable instruments that cannot withstand steam sterilization must be decontaminated as recommended by the instrument manufacturer.

Wrappers come in different sizes so that items can be completely covered without leaving an excess of material that makes packaging cumbersome or causes steam to pool. Improper packaging can result in ineffective sterilant penetration into the package, wet packs, and inability to open the package aseptically.

The correct technique to use when wrapping with flat wraps is to make sure the first fold completely covers the package all the way to the bottom of the instrument set, not just over the top of the set .The packaging should be snug to the instrument set. If the wrapper is too loose, it can create water puddles that result in wet packs or may leave openings that can cause contamination. If the package is too tight, it could hinder the sterilant from entering and leaving the package.

If there are any holes in the instrument set packaging, the packages are contaminated and cannot be used. The following practices can be used to avoid holes in packaging:

• Reduce the amount of instruments in a set. Heavy instrument sets are a common cause of packaging tears.

• Use the correct packaging weight. Heavy instrument sets require thicker packaging.

• Place corner protectors or tray liners between the instrument set and packaging to reduce holes that occur when instrument sets with sharp corners cut the wrapper.

• Place transport trays under the instrument set to facilitate handling after sterilization and avoid tears.

• Store heavy instrument sets on the easy to reach middle shelves rather than on very low or very high shelves. This provides for easy handling by the staff and prevents dragging the instrument set, which could cause tears.

• Store each instrument set on its own shelf, and do not stack instrument sets. Stacking can damage the wrapper material.

Sterilization of uncovered items

An uncovered cycle (sometimes called flash sterilization) is a method for sterilizing uncovered patient care items for immediate use. Uncovered sterilization should be used only under certain conditions:

1. Thorough cleaning and drying of instruments precedes the uncovered sterilization cycle.
2. Mechanical monitors are checked and chemical indicators used for each cycle.
3. Care is taken to avoid thermal injury to dental workers or patients.
4. Items are transported aseptically to the point of use to maintain sterility.

Peel Pouches

Peel pouches are designed for packaging small, lightweight instruments. Not all paper-plastic peel pouches are validated for double pouching, so it is important to check with the manufacturer before double pouching.

If double pouching is permitted, pouches must be placed plastic to plastic for complete visibility, without any folds. If the internal chemical indicator is visible through the package, an external chemical indicator is not required.

Because the plastic side of the package is the stronger side, labeling is done there. Paper-plastic peel pouches should not be placed into an instrument set regardless of whether the set is wrapped or in a sterilization container. Placing paper-plastic peel pouches inside can obstruct air removal, steam contact, and drying. Steam cannot penetrate the plastic side of the pouch and thus prevents the sterilant from reaching all surfaces inside the package.

The sterilant enters and exits the package from the paper side. When the package is loaded onto the sterilizer cart, it must be loaded on its side to permit the sterilant to both enter and exit. As with all types of packages, these too must be loaded loosely so that the sterilant can circulate. Paper-plastic peel pouches can be loaded into baskets to hold them up. There are also holders designed specifically to sterilize these packages on their side.