Undercover Boss: Sterilization Episode...licensed dental hygienist. Whether she is presenting a seminar, coaching individuals by phone, or working directly with the orthodontic team;

AAO Annual Session, 2013 – Philadelphia

2013 Jackie Dorst 904-206-4361 E-mail [email protected] www.JackieDorst.com

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Undercover Boss: Sterilization Episode

“Guidelines for Infection Control in Dental Health-Care Settings–2003” www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008 www.cdc.gov/ncidid/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf

State Board of Dentistry Patients OSHA Employee www.osha.gov

Centers for Disease Control Public www.cdc.gov

Sterilization

“Sterilization is a complex process requiring specialized equipment, adequate space,

qualified DHCP who are provided with ongoing training, and regular monitoring for

quality assurance.” CDC Guidelines, 2003

Integrated System

Instruments

Equipment

Room

Efficiency & Safety – transport instruments in a closed container

Cassettes or Trays

Instrument Set-ups

Archwire

Bonding/Banding

Debond/Deband

Retainer

Exam

Calculate Number of Cassettes & Instruments

Instruments in Set-Up Color Size of Cassette

Count # Procedures for 3 months # Days Worked = Average # Procedures Average # Procedures per day = # Cassettes # Cassettes X Instruments = # Instruments

Subtract existing instrument inventory after inventory and audit.

Thru-Put Time – time required for cleaning, packaging and sterilization

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

http://www.cdc.gov/ncidid/dhqp/pdf/guidelines/

http://www./

http://www.cdc.gov/



2

System

Instruments/Cassettes

Ultrasonic/Instrument Washer/Handpiece Cleaner

Sink

Wrap/Package

Sterilizers

Sterile Storage

Sterilization Room

Layout – straight, L-shape, U-shape, parallel counters

Flow – dirty – clean – sterile

One way

Central Sterilization – 5 Stations

1. Receiving, cleaning, decontamination

2. Rinse

3. Preparation & packaging

4. Sterilization

5. Sterile Storage

Ultrasonic - Aluminum Foil Test

Rinse after Cleaning

Instrument Washers

Preparation & Packaging

Chemical indicator inside pouch

Surgical Milk (Barrier Milk) anticorrosive and lubricant

Automatic Handpiece cleaner/lubricator – must have compressed air

www.ineedce.com SciCan Book, Page 11 Stamatic

Spalding Classification of Instruments

Critical

Semi Critical Non Critical

http://www.ineedce.com/



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Sterile Instrument Packaging

Pouches

Paper Bags

CSR wrap / autoclave tape

High temperature nylon – Nyclave

Internal Chemical Indicators – inside sterile instrument package

Clinical Parameters

Time

Temperature

Pressure (steam)

Indicators & Integrators

Class 1 – External Process Indicator

Class 2 – Bowie Dick Test

Class 3 – Single parameter indicator

Class 4 – Multiparameter indicator

Class 5 – Intergrating indicator

Class 6 – Emulating indicator

Instruments sterilized unwrapped are for “Immediate Use” only!

Sterilizers - FDA approved www.fda.gov/medicalDevices

Racks for Cassettes & Pouches improve steam penetration and drying

Autoclave types:

Gravity

Pulse (ie Statim)

Pre-vacuum (ie Bravo)

Bowie Dick Test

Pre-vacuum autoclaves

Tests for adequate vacuum

Test weekly?

Sterile Instrument Assurance

Chemical Indicators & Integrators

Biological Monitors

Mechanical

Spore Test Sterilizers

Once a week

Inside instrument package

Center of load

Last day of work week

Never test “cold” sterilizer

Keep results for 3 years



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“Instruments packs should be allowed to dry inside the sterilizer chamber before

removing and handling” CDC Guidelines, 2003

Sterile Storage & Clean Patient Care Items – prevent contamination of sterile package

Pass-thru cabinet

Drawers

Cabinets

Clinical Contact Surfaces – wipe, do not spray surfaces

Barriers or Disinfect

Disinfectants

2 Steps (clean and then disinfect)

EPA Registered

Intermediate Level (ie accelerated hydrogen peroxide)

Preventing Disease Transmission from Operatory Surfaces, Dr. Louis G. DePaola

www.ineedce.com/courses/1557/PDF/PreventingDiseaseTrans.pdf

It has to be clean before it can be disinfected or sterilized! (Stream-Wipe-Stream or Wipe-Discard-Wipe

Disinfectants

o Phenols

o Chlorines

o Iodophores

o Quats

o Accelerated Hydrogen Peroxides

Barrier Protected Semicritical Technology Equipment –

Cure Light, Sensors, Lasers, IntraOral Scanners

o Use FDA cleared barrier

o High rate of failure

o Clean & disinfect between patients

Liquid Chemical Sterilants “Cold Sterile Solutions”

www.osha.gov/Publications/glutaraldehyde.pdf

Registered by FDA as Sterilant

Risk for DHCW

Rinse with Sterile water

Do not use on noncritical patient care items or environmental surfaces

Test for efficacy

http://www.osha.gov/Publications/glutaraldehyde.pdf



5

Biofilm in Dental Unit Waterlines

<500 cfu/ml of heterotrophic bacteria for nonsurgical procedures

www.osap.org/displaycommon.cfm?an=1&subarticlelnbr=24

www.ada.org/prof/resources/topics/waterlines/art_cleaning_waterlines.pdf

ADA DUW Products & Testing Lists

www.ada.org/sections/professionalResources/pdfs/cleaning_waterlines4.pdf

Clean Water System

Self Contained Water System

Clean, Treat, Test

DentaPure www.dentapure.com

Under 200 cfu, FDA & EPA Approved

60 days or 40 liters DP40

1 year DP365

Surgical Irrigation

Sterile Saline or Sterile Water

Autoclavable Tubing or Disposable

Orthodontic Experts

“The best money you’ll spend is hiring a professional who knows what they’re doing. I had the idea and

knew what I wanted, but I didn’t know how to make it happen.” Dr. David Myers, Arkansas Interview about his new office “Hot Rod Orthodontic Office”

http://www.osap.org/displaycommon.cfm?an=1&subarticlelnbr=24

http://www.dentapure.com/



6

Training

AAO – Webinars, Distance Learning Program & Ortho Staff Study Club

Contact Barb Simon [email protected]

OSAP www.osap.org Membership – newsletter, website access, IC infobytes, June 2013

Symposium-San Diego

Workbook – “From Policy to Practice: OSAP’s Guide to the Guidelines”

Video – “If Saliva Were Red”

Interactive on-line CDC Guidelines IC training

OSHA and CDC Guidelines Training System and Workbook

mailto:[email protected]

http://www.osap.org/



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Speaker . . . In-Office Team Seminars

Study Groups

Dental and Orthodontic Societies

Local, State, National Meetings & Conferences

Appreciation Seminars for Referring Dentists

Dental Hygienist Luncheons and Seminars – “Sparkle!”

Trainer . . . Infection Control

Instrument Sterilization

OSHA Annual Updates

Patient Communication of Safety and Sterility

Consultant . . . Sterilization Design

OSHA Record Keeping and Manuals

Post Exposure Evaluation Protocol

Web Site posting on Sterilization

Clinical Image

About your speaker . . . Jackie Dorst, RDH, BS, is an international speaker, author and consultant on instrument sterilization, infection

prevention and OSHA safety. Her experience in dentistry, orthodontics, business, public speaking and research contribute to her energetic seminars based on scientific information applied to clinical orthodontic practice. Jackie is a microbiologist and licensed dental hygienist.

Whether she is presenting a seminar, coaching individuals by phone, or working directly with the orthodontic team; Jackie is passionate about helping the orthodontic team improve clinical efficiency and safety for patients and team members. Jackie has been a featured speaker at AAO meetings for eighteen years. Her speaking credentials include:

International Orthodontic Congress, Paris

The 3rd International Congress of Dental Technology, Yokohama

American Association of Orthodontists

American Dental Association

“Wired for Success”

The Gorman Institute

Organization for Safety & Asepsis Procedures, OSAP

OSHA certified to deliver training courses

Association for Professionals in Infection Control and Epidemiology, APIC

Academy of General Dentistry Clinician Graduate

Member of the National Speakers Association

Jackie Dorst

“Safe Practices” P.O. Box 15429, Fernandina Beach, FL 32035

904-206-4361 E-mail [email protected]

www.JackieDorst.com

Connect with your referring dentists and the entire dental team

by hosting one of Jackie’s fabulous

Appreciation Seminars!

http://www.jackiedorst.com/

Documents

Undercover Boss: Sterilization Episode...licensed dental hygienist. Whether she is presenting a seminar, coaching individuals by phone, or working directly with the orthodontic team;