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STERILIZATION AND

DISINFECTION

IMPORTANCE
To prevent cross infection.
Impossible to exclude all microbes from all
surfaces but it can be controlled.
Better to use disposable things as required as
possible , but
it is difficult to use certain
instruments only once because of its expensive
nature.
Certain
instruments
should
be
sterilized
compulsorily for treatment needs and prevention
of diseases.

Terminologies
Sterilization The process of making an article
free of microorganisms including both vegetative
and sporic forms.
Disinfection The process that kills pathogenic
microorganisms but cannot usually kill bacterial
spores.

Mechanism of action
Antimicrobial agent acts by
1. Protein denaturation.
2. Damage to cell membrane.
3. Inhibition of enzymes.
4. Alteration of nucleic material.

Monitoring of Sterilization
TWO TYPES
1. Process indicators.
2. Biologic indicators.
Process indicators
strips, tape or paper products marked with
special ink that changes colour with exposure to
heat steam or chemical vapour.
Ink changes colour when item being processed
have been subjected to sterilizing condition.

Biologic Indicators

Preparation of non pathogenic bacterial spores


that serve as challenge to specific method of
sterilization.
Bacterial spores attached to a paper strip within
biologically protected packet.
Spore packet is placed between instrument
packages . After sterilization cycle spore strip is
cultured for specific time and sterilized condition
is met when all spores fail to germinate and
proliferate.
Lack of culture growth indicates sterility.

CLASSIFICATION OF
INSTRUMENTS
Critical
Instruments that touches bone and soft tissues.
eg;surgical scalpel,burs etc .should be sterilized
compulsorily.
Semi critical
Instruments that touches only mucosal tissues but
not bone.eg; Mouth mirrors. should be sterilized.
Non critical
Instruments comes in contact with intact skin .
e.g.; x_ray head.can be disinfected.

Methods of sterilization
Moist heat
Dry heat
Chemiclave

Moist heat
More preferable and more reliable
method.
Commonly used method.
Pressure cooker principle in which the
increased pressure allows steam to attain
higher temperature needed to kill bacterial
spores.

It denaturates and coagulates the protein of microbe


and is better method of sterilization due to its higher
efficiency of penetration and faster microbicidal
action than dry heat. This is due to latent heat of
vapourisation
Standard parameters 121 c at 15 psi for atleast 15 minutes.
132 c at 30 Psi for 3-7 minutes.
Instruments should be wrapped and packed in
muslin, cloth, paper ,nylon or steam permeable
plastic.

Advantages:
Most efficient and reliable.
Simple to operate.
Flexibility of packaging ,loading and cycles.
Disadvantages:
Non stainless steel instruments may rust.
Low melting rubber and plastic cups cannot be
used.
Instruments that retain moisture take time to dry
and prolongs cycle.

Materials sterilized
Heavy duty rubber gloves.
Rust resistant instruments.
Heat resistant plastics.
Dressings.
Hand pieces.

Dry heat sterilization


Hot air ovens are used as sterilizing
devices.
Exposure to one hour at 170 c.
Kills microorganisms by coagulation or
oxidation of proteins.

Advantages
Does not rust instruments.
Not affect moisture sensitive compounds.
Low cost equipment.

Incineration
Burning of contaminated cloth, gauze,
paper and organic debris on instruments
is an effective method for destroying
microorganisms.
Instruments sterilized are
Bacterial inoculation loops.
Burs.
Dental broaches.

Boiling water
Method of disinfection.
Kills by denaturation of proteins.
Recommended conditions are 10 min
exposure to actively boiling water.
Not kills sporic forms.
Addition of 2%sodium carbonate to water
potentiates sporicidal effect.

Chemical Disinfectants
Commonly used are
Gluteraldehyde
Iodophors
Chlorine compounds
Formaldehyde

CHEMICLAVE

Disinfection of various Impression


materials
Impression compound- Iodophors or
chlorine compounds.
Alginate-0.1% sodium hypochlorite for 10
sec or iodophors.
Zinc oxide eugenol- 0.1% sodium
hypochlorite for 10 sec or iodophors.
Polysulphide
rubber
base

2%
gluteraldehyde for 10 min.

Poly ether chlorine compounds.


Silicon rubber- 2% gluteraldehyde ,chlorine
or iodophors.
All impression materials should be washed
with running water before disinfection.

Secondary impression disinfection zinc


oxide eugenol 2% alkaline gluteraldehyde
or iodophors.
Occlusal rims washed in running tap water
immersed in 2% gluteraldehyde for 10 min
and rinsed.

Sterilization and Disinfection in


Complete Denture
Two steps
Pre operative protections
Post operative protections
In pre operative
Aseptic clinical environment.
Instrument sterilization.
Personal protection and patient care.

Aseptic clinical environment


Clinic should be well air conditioned.
Plastic bags are used to cover dental chair,
dental unit and light handles.
Clean the dental unit with detergent and
water an disinfect with 0.5% sodium
hypochlorite or 2% gluteraldehyde.

Instrument sterilization.
Dental mirrors- detergent and water ,autoclaving
and stored in covered packs.
Gloves disposable
Impression trays cleaned thoroughly with
detergent and wiped with alcohol sponge to
remove stubborn stains prior to heat sterilization,
wrap with suitable cloth and autoclave.

Personal protection and patient care


Disposable gloves, masks, gowns and
head cap , sterile footwear.
Wash hands before an after every
procedure with antiseptic solution.

Post operative protection


Disinfection of primary impressionimpression compound and alginate
impressions cleaned with one half inch
bristles and microbial detergents, immerse
in chlorine or iodophors for an ideal time of
3 min.
0.1% sodium hypochlorite for 10 sec.

Disinfection of Gypsum products and


secondary impression
Gypsum products
Disinfected by 0.5% Calcium hypo chlorite
with the water.

Secondary impression
Disinfected by immersing in 2.0% Alkaline
glutaraldehyde or iodophors.

Denture Asepsis washed with germicidal


soap, rinsed , dried , and placed in bath
containing 2% gluteraldehyde or 0.525%
solution of sodium hypochlorite for 10 min.

Sterilization and Disinfection in


F.P.D.
Instruments used are
Diagnostic and cutting instruments - Cleaned
with detergent and autoclaved.
Burs diamond burs clean with metallic brush
and detergent and autoclaved.
Steel and carbide burs clean with metallic
brush and detergent and dry heat.

Hand pieces wrapped with cloth and


autoclaved .chemical vapour sterilization.
Finishing stones steam autoclave or dry
heat or chemiclave.
Wax ultrasonic radiation for 18 min.

Sterilization and Disinfection of


R.P.D.
Instruments used are
Diagnostic instruments cleaned with detergent
and autoclaved.
Impression materials disinfected with either
gluteraldehyde or chlorine compounds.
Finishing stones steam autoclave or dry heat.
Metals sterilized and disinfected with
gluteraldehyde.
Acrylics iodophors.
Pattern waxes ultrasonic radiation for 18 min.

Pathways of Cross-Infection
Every dental office's infection control program must
address preventing (or at least minimizing) the spread of
microorganisms. Generally, organisms can be spread in
three ways:
1.Direct contact. The touching of human tissues or
contacting blood or saliva by exposed skin and mucous
membranes.

2.Via droplets or aerosols. Spray, spatter,


and aerosols can be released during
treatment and could be inhaled or make
contact with the eyes of a dental
healthcare worker.

3.Indirect contact. Indirect contact involves


microbial spread through contaminated
instruments,
equipment,
or
inert
environmental surfaces that are touched
by an individual.

Infection Control Basics


1.Use of protective strategies such as
Personal Protective Equipment (PPE) and
immunizations.

2.Use environmental barriers.


Work
surfaces and equipment can be covered
with plastic sheets, tubes, and bags or
aluminum foil to facilitate clean up
procedures and to protect these surfaces
from contamination throughout the work
day.

3.Use
of disinfection
techniques.
Destroying
or
removing
most
microorganisms
from
non-sterilizable
surfaces through the application of
antimicrobial chemicals and thorough wiping
of contaminated surfaces is an effective
infection control strategy.

4.Use of sterilization techniques. Reusable


dental instruments and equipment must be
cleaned, packaged, and sterilized usually
through the application of heat in a
sterilization device such as an autoclave or
dry heat sterilizer to ensure that all
microorganisms are destroyed.

5.Proper management of medical waste.


Medical waste such as bulk blood (and
saliva), used "sharps," patient tissues, and
heavily soiled disposable items can be
neutralized through sterilization of the waste
in-house or disposed of by an approved
medical waste disposal company.

Infection control measures in Aids


and Hepatitis
Infection control procedures
Removal of debris instruments are first put
through one of the following procedures to
remove debris such as blood and saliva.
Thermal disinfector most instruments are put
through this which effect as high temperature
dish washer.
Assistina all dental hand pieces are cleaned
externally then placed in the assistina which
cleans hand pieces internally and lubricates
them.

Ultrasonic Cleaner - All instruments which cannot


be placed into the Thermal Disinfector are placed
in the ultrasonic unit which cleans by using
ultrasonic vibration.

Stage 2. packaging of instruments


Instruments are placed in autoclave pouch
which is sealed with a hot sealer.

Stage 3.
Autoclaving instruments are subjected to
steam under pressure and held in this
environment for seven minutes kills bacteria
and spores also.

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