Theory 1 Ch. 4 infection control: clinical procedures instrument recirculation/sterilization

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jackiedh
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32761
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Theory 1 Ch. 4 infection control: clinical procedures instrument recirculation/sterilization
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2010-09-05 09:57:00
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module 2
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  1. MOIST HEAT (STEAM AUTOCLAVE, MAGNICLAVE) MAY BE USED FOR:
    all materials EXCEPT oils, waxes, powders, and materials that are impervious to steam
  2. HOW IS STERILIZATION ACHIEVED?
    • by heat and moisture
    • (pressure only attains high temp)
  3. STERILIZATION DEPENDS ON THE PENETRATING ABILITY OF:
    • steam
    • (air must not be present)
  4. STEAM AUTOCLAVE TEMP, TIME, AND PRESSURE
    • 121 degrees c (250 f)
    • 15 minutes (30 min heavy load)
    • 15 psi
  5. MAGNICLAVE DRY MATERIALS AND LIQUID COOLING:
    • Dry = open door to release steam pressure, dries for 15 min
    • Liquids = reduce pressure slowly over 10-12 minutes to prevent boiling escape or fluids into the chamber
  6. ADVANTAGES OF A STEAM UNDER PRESSURE (AUTOCLAVE)
    • fast and efficient
    • many materials may be treated
    • most economical method of sterilization
  7. DISADVANTAGES OF STEAM UNDER PRESSURE (AUTOCLAVE)
    • may corrode instruments
    • not used for oils, powders, or waxes
  8. WHAT IS THE ACTION OF DRY HEAT?
    oxidation
  9. DRY HEAT CAN STERILIZE:
    • objects that cannot undergo the steam autoclave (oils, powders)
    • burs that may corrode can be placed in dry heat
  10. DRY HEAT ACTION:
    • heat that is conducted from the exterior surface to the interior of the object
    • must reach peak temp
    • any oil, grease, or debris will keep instruments from proper sterilization and act as an insulating agent
  11. DRY HEAT TEMP, TIME, PRESSURE
    • temp: 160 c (320 f)
    • time: maintained for two hours
    • 170 c (340 f)
    • time: maintained for one hour
    • NO PRESSURE!
    • (timing starts AFTER temp has been reached)
  12. ADVANTAGES OF DRY HEAT
    • for materials that cannot undergo steam pressure
    • well suited for sharp instruments (if not exceeding 160 c)
    • no corrosion
  13. DISADVANTAGES OF DRY HEAT
    • long exposure time
    • maintain high temp
  14. CHEMICAL VAPOR STERILIZER AGENTS:
    alcohols, formaldehyde, ketone, water, acetone heated under pressure producing a gas that is a sterilizing agent
  15. USE OF CHEMICAL VAPOR STERILIZER
    • not for materials altered by chemicals, heat sensitive, low melting plastics, liquids or heat sensitive handpieces i.e. bite block
    • chemical and pressure penetrate the object
  16. CHEMICAL VAPOR STERILIZATION TIME/TEMP/PRESSURE
    • 127 - 132 c (260 f - 270 f)
    • 20 to 40 pounds pressure
    • minimum 20 minutes after temp and pressure have been attained
    • longer time for heavier loads
  17. COMPLETED CHEMICAL VAPOR STERILIZATION LEAVES INSTRUMENTS:
    • dry
    • need short time to cool
  18. ADVANTAGES OF CHEMICAL VAPOR STERILIZATION
    • corrosion/rust free
    • short cycle
    • easy to operate and care for (refill every 30 cycles)
  19. DISADVANTAGES OF CHEMICAL VAPOR STERILIZER
    • ventilation needed in room, not a small one
    • odor
    • tightly wrapped, heavy or sealed packages will not permit penetration of formaldehyde and alcohol vapors
  20. THE DESTRUCTION OF MOIST HEAT ON MICROORGANISMS
    • inactivation of essential cellular proteins or enzymes
    • moist heat causes coagulation of protein
  21. DISINFECTANTS ARE CATEGORIZED BY THEIR:
    • biocidal activity = high, intermediate, or low level
    • the ability of the chemical disinfectant to destroy or inactivate organisms
  22. CHEMICAL DISINFECTANTS
    • surface
    • immersion disinfectants
    • immersion sterilants
    • hand antimicrobials
  23. HIGH LEVEL DISINFECTANT
    • inactivates spores in all forms (bacteria, fungus, viruses)
    • used as a disinfectant or sterilant
  24. INTERMEDIATE LEVEL OF DISINFECTION
    • inactivates all forms of microorganisms BUT NOT viruses
    • not a sterilant
  25. LOW LEVEL DISINFECTANT
    • inactivates vegetative bacteria and certain lipid-type viruses
    • do NOT destroy spores, tubercle bacilli, or nonlipid viruses
  26. HOW DISINFECTION WORKS:
    coagulation, precipitation, and oxidation of protein of microbial cells or denatures cell enzymes
  27. RECOMMENDED CHEMICAL DISINFECTANTS USED IN DENTISTRY:
    • glutaraldehydes
    • chlorine compounds
    • iodophores
    • complex phenolics
  28. GLUTARALDEHYDES (4 TYPES- IMMERSION, NOT USED ON COUNTERTOPS) NOT USED IN OUR CLINIC
    • high level disinfectant
    • 2% neutral
    • 2% alkaline
    • 2% alkaline with phenolic buffer
    • 2% acidic
  29. CHLORINE COMPOUNDS
    • chlorine dioxide-main ingredient
    • use life: 1 day
    • economic, hassle, corrosive

    • sodium hypochlorite- 5.25%
    • oxidation of cell wall and enzymes
    • uses water purification
  30. IDOPHORS
    • 1% iodine
    • releases slowly to disinfect
    • anti-microbial
    • surface disinfectant
    • mixed with distilled water
    • for: environmental surfaces (countertops)
  31. COMBINATION PHENOLICS (SYNTHETIC)
    • protoplasmic poison destroys cell walls
    • chemical disinfectant in lower concentrations
    • surface disinfectant-o-phenylphenyl 9% with o-benzyl-p-chlorophenol 1%
  32. GLUTERALDEHYDES (IMMERSION)
    • high level disinfectant
    • not a surface disinfectant due to toxic fumes
    • damage to nucleic acids and proteins
    • limitations: 28 day cycle, caustic to skin, eyes, bad to inhale
    • rinse very well in sterile water, can be corrosive and toxic
  33. CHEMICAL STERILANTS (IMMERSION)
    • are only used for items that cannot be sterilized by heat
    • limited used due to no spore testing available
    • can be contaminated over time
    • inefficient: needs to stay in solution 24 hrs
    • not recommended
    • rinse with sterile water
  34. CLASSIFICATION OF INANIMATE OBJECTS:
    • critical
    • semi-critical
    • non-critical
    • environmental
  35. CRITICAL
    • penetrates soft tissue or bone
    • needle, currette, explorer, probe
    • sterilize or dispose
  36. SEMI-CRITICAL
    • touch mucous membrane or oral fluids, does not penetrate
    • radiographic biteblock, ultrasonic handpiece, amalgam condenser, mirror
    • sterilize, high-level of disinfection when necessary
  37. NON-CRITICAL
    • does not touch mucous membranes, only contacts unbroken epithelium
    • light handles, certain x-ray machine parts, safety eyewear
    • cleaning and tuberculocidal, intermediate-level disinfection
  38. ENVIRONMENTAL
    • no contact with patient surfaces, or skin
    • countertops, equipment surfaces, housekeeping surface
    • cleaning and intermediate-low disinfection
  39. WHAT HAPPENS WHEN YOU SPRAY A DISINFECTANT AND DO NOT SCRUB?
    the agent will not penetrate or remove the film of microorganisms
  40. SEQUENCE FOR PREPARATION
    • agents used - iodophors, sodium hypochlorite, complex phenols
    • procedure - spray disinfectant, scrub vigorously, use wet gauze, spray and leave surface wet
    • unit water lines - biofilm can form in standing water lines. flush waterlines 2 minutes at the start of each day, run water through tubing 30 sec before and after pt.
  41. WHAT DOES AN ANTISEPTIC (MOUTHWASH) PROMOTE BEFORE GIVING AN INJECTION?
    decreases the risk of introducing septic material into the soft tissue from the needle of the mucosa penetrating into deeper tissues. the microorganisms on the surface can be carried into the tissue

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