Sterilization and Disinfection

CONTENTS
INTRODUCTION DEFINITIONS PATIENT CARE ITEMS INFECTION CONTROL MEASURES PHYSICAL METHODS OF STERILIZATION

STERILIZATION CONTROL
REFERENCES

Introduction

Why Is Infection ControL Important in Dentistry?

Chain of Infection
Pathogen Susceptible Host Source

Entry

Mode

Definitions
Sterilization - a process that destroys or eliminates all forms of microbial life and is carried out in health-care facilities by physical or chemical methods.

CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

 Disinfection - a process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects .

CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

Antiseptics

95% ethanol

4 % chlorhexidine gluconate

10% Povidone iodine

DISINFECTANT
High-level disinfection

2% 2% Glutaraldehyde

7.5% H2O2

Intermediate level disinfection

Phenol 0.2 3%

Low-level disinfection

3% H2O2

Quat. Ammonium compounds .1 2%

PATIENT CARE ITEMS

SEMI NON CRITICAL CRITICAL CRITICAL

Earle H. Spaudling (1968)

CRITICAL ITEMS

Semi-critical iTEMS

NON CRITICAL ITEMS

NON CRITICAL CONTACT SURFACE

CLINICAL CONTACT

HOUSEKEEPING

CLINICAL CONTACT SURFACE

 Barrier protective coverings (e.g., clear plastic wraps)

HOUSE KEEPING SURFACE

Infection control measures

IMMUNIZATION FOR VACCINE PREVENTABLE DISEASES HAND WASHING AND GLOVING PROTECTION AGAINST AEROSOL AND SPLATTER INSTRUMENT PROCESSING SURFACE ASEPSIS MANAGEMENT OF SHARPS / WASTE PRODUCTS ASEPTIC TECHNIQUES

OSHA Bloodborne Pathogens standard (2003)

A written exposure control plan, to be updated annually. Use of universal precautions.

Consideration, implementation, and use of safer, engineered needles and sharps.

work practice controls and appropriate personal protective equipment.

 Hepatitis B vaccine provided to exposed employees at no cost. Medical follow-up in the event of an exposure incident.

Use of labels or color-coding for items such as sharps , contaminated laundry.

Employee training. Proper containment of all regulated waste

Universal Precautions
Infection control and Safety procedures recommended by CDC (1986,1993) All human blood and certain body fluids are treated to be infectious for HIV ,HBV and blood borne pathogen.

CDC 1996

Hand hygiene
WHO (2009)

Hand washing Antiseptic handwash

Alcohol hand rub

Efficacy of Hand Hygiene Preparations in Reduction of Bacteria

Good
Better Best

Plain Soap

Antimicrobial soap

Alcohol-based handrub

HANDWASHING

Personal Protective Equipment

Gloves Masks Eyewear, Face Shields

protective clothings

Gloves
Examination and surgical.

latex , vinyl, nitrile. powdered, non-powdered, sterile, non sterile.

Latex Gloves
Best fit
Mid-range barrier protection.

Latex Allergy

Type I hypersensitivity to natural rubber latex proteins. latex-free kits available (dental and emergency)

Vinyl Gloves
Standard barrier protection Latex-free Less durable

Less tactile for sensitive work

NITRILE GLOVES
Protein-free, latex free High barrier protection Chemical resistant

Puncture resistant

HOW TO DON STERILE GLOVES

MASK
FDA recommends a surgical-type mask - with > 95 % bacterial filtration efficiency .

AEROSOL
TERM AEROSOL USED BY MICIK RE et al 1969

Stephen k. Harrel Aerosol and splatter in dentistry jada ,2004

Protection against aerosol and splatter

PERSONAL PROTECTION BARRIER Pre procedural rinse Rubber dam High volume evacuation (HVE) high efficiency particulate air (HEPA) filter

Instrument processing

CLEANING

Manually (Hand scrubbing)

mechanical unit (e.g. ultrasonic cleaners , washer disinfectors)

Manual Cleaning

Ultrasonic cleaners

Washer-sterilizers

Methods of sterilization
Physical Agents
SUNLIGHT DRYING
Dry Heat

HEAT
moist heat

Radiation

 Filtration
Hydrogen Peroxide Gas Plasma Ozone

II) CHEMICAL
Phenols and cresols Halogens Metallic salts Aldehydes Alcohols Dyes Vapour-phase disinfectants Surface active disinfectants

SUNLIGHT
Sterilization of water in tanks, river and lakes.

Drying
Freeze drying (lyophilization) .
SPORES unaffected.

Dry Heat Sterilization

 Red heat :

inoculating wires and loops, points of Forceps and spatulas.

Flaming :

scalpels blades, needles, culture tubes, glass slides.

incineration
Destroying contaminated materials such as soiled dressings and pathological materials.

Glass bead sterilizer

root canal instrument sterilization- 218-246 C for 5 to 10 sec.

Dry heat sterilizer

static air

forced air

Hot air oven

1000 c for 60 min. - kill all vegetative bacteria

1600 c for 60 min. or 1800 c for 20 min.- kills bacterial spores.

MOIST HEAT

Moist heat is divided into 3 forms

At temp. below 1000C : At 1000 c At temp. above 1000 c

at temperature below 100 0 C

PASTEURIZATION
( louis pasteur 1864)

HOLDER METHOD : 630 C for 30 min(low temp. long time) FLASH METHOD : 720 C for 15 sec. ,{high temp. short time(HTST)} followed by rapid cooling below 13c

 Steam Pasteurization irradiation Pasteurization

Ultra pasteurization
Ultra-High Temperature Pasteurization.

Moist heat at 1000 C

a) Boiling at 100 0 C

b) Steaming at 1000 C
Tyndallization
An exposure of 1000 C for 20 min. on three consecutive days is employed.

Moist heat at above 100 0C/ saturated steam under pressure:

MECHANISM : When steam comes in contact with a cooler
surface it condenses to water and gives up its latent heat to that surface, which denature microbial proteins.

STERILIZATION TIME :
115 C, 10 lb/in2 for 45 min 121C, 15 lb/in2 for 15-20 min 134 C, 30 lb/in2 for 3 min

Types of steam sterilizer /autoclave

Dynamic air removal (Pre vacuum) Gravity Sterilizer steam-flush pressure-pulse .

AUTOCLAVE

Packaging material for steam sterilization

Porous Fabric, sealed films ,paper pouches ,nylon tubings, sterilizing wrap or paper wrapped cassette.

Sterilization control
Physical
(time, temp.,
pressure)

Biological (spore tests,

BI s) .

Chemical
(indicator strips)

Biological indicators
spore tests, BI s CDC recommends weekly biologic monitoring of sterilization equipment.

Chemical indicators
CLASS I : Process Indicators autoclave tape Indicator labels

CLASS II :
Indicator for Use in Specific Tests EXAMPLE Bowie-Dick test

CLASS III :
Single Variable Indicator ( temperature) Eg. Temperature tubes . internal indicator strips .

CLASS IV :
Multi-variable Indicator
EXAMPLE internal indicator strips

CLASS V :
Integrating Indicator reacts to all critical parameters in the sterilization process ,and has stated values that correlate to a BI . Internal indicator strips

Flash Sterilization

sterilization of unwrapped instruments for immediate use.

NON IONIZING RADIATION

U.V RADIATION
D.N.A is target . Bridge ( 1973)
Disinfection of labs, wards, O.T.

IONIZING RADIATION
cobalt 60- Gamma rays cosmic rays. Sterilization of pre packed disposable items-plastic syringes, culture plates.

Filtration
Earthenware Asbestos Membrane Sintered syringe

Ozone
FDA clearance (2003). Compatible with stainless steel, titanium, ceramic, glass, silica, Teflon, silicone, and acrylic.

Hydrogen Peroxide Gas Plasma

Jacobs and lin (1987) combined use of hydrogen peroxide gas and the generation of free radicals . plastics, electrical devices, and corrosion-susceptible metal alloys

REFERENCES
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Best Practices for Cleaning, Disinfection and Sterilization of Medical Devices in All Health Care Settings 2010. Pediatric dentistry 3rd ed. Damle.

Textbook of Microbiology by Anantnaryan.

Community Dental Health 5TH ED. George m Gluck.

 Disinfection and sterilization of dental instruments 1995. Safety Standards and Infection Control By Ellen Roberta Dietz. Stephen k. Harrel Aerosol and splatter in dentistry jada ,2004

THANK YOU