Overview of Decontamination Process

Question 1

What are the reasons for cleaning and disinfecting instruments before sterilisation?

Answer 1

Legal requirement

Preserve function- biological matter can clog instruments

To remove biological contamination-
-> minimises the spread of infection/cross-contamination (could lead to mis-diagnosis)

So that it is safe to inspect

-> this allows steam to clean devices properly

Question 2

What are the requirements of the container for transporting used instruments?

Answer 2

 Durable
 Leak proof
 Rigid sided
 Colour coded/clearly marked
 Tight-fitting lid

Question 3

What daily tests should be carried out for AWD?

Answer 3

Check spray arms rotate and are not blocked

Check filter/strainer for debris and contamination from instruments

Check door seal for damage and cleanliness

Check chemical and water level- replenish

Verify condition of load carrier

Record disinfection temp of first cycle

Question 4

How should AWD be loaded (this should be established at validation)?

Answer 4

No overlapping of instruments

Do no overload machine

Assemblies should be disassembled

Restorative materials should be removed beforehand

Forceps should be open at hinge and positioned so they will remain open

Question 5

What are the stages of AWD cycle?

Answer 5

Flush
Wash
Rinse
Disinfection
Drying

Question 6

What is the function of using an illuminated magnifier when inspecting instruments?

Answer 6

Can verify if AWD was successful

Can identify if contamination still present

Can verify functionality of instruments
-> if damaged can be sent for repair

Question 7

What happens if contamination is still present on instruments that have been through AWD?

Answer 7

They are manually cleaned and processed through ultrasonic
-> removes dried-in or gross contaminants

Question 8

What are the recommendations for manual cleaning?

Answer 8

Water should be <35

pH neutral or enzymatic detergent is used
-> amount depends on volume of water
-> Follow manufacturers instructions

Use long handled soft bristled brush

Use separate sinks for washing and rinsing

Question 9

What are the 2 methods of manual cleaning?

Answer 9

Immersion

Non-immerion
-> required for handpieces as they should not be immersed

Question 10

What is used following manual cleaning?

Answer 10

Ultrasonic bath

Question 11

What are the recommendations when using ultrasonic bath?

Answer 11

Fill to required level

Degas before use

Load as for AWD

*do not process handpieces using this

Question 11

What are the recommendations when using ultrasonic bath?

Answer 11

Fill to required level

Degas before use

Load as for AWD

*do not process handpieces using this

Question 12

Why are instruments reprocessed through AWD following manual/ultrasonic cleaning?

Answer 12

Disinfection stage makes it safe for staff to handle and inspect

Question 13

What temperature and pressure banding are achieved by sterilisers? (type N, S, B)

Answer 13

134-137 degrees for minimum hold time of 3 mins

Pressure equivalent gauge (from atmospheric) 2.05 – 2.35 bar
-> required to reach temperature

Pressure equivalent absolute (from absolute zero) 3.05 – 3.35 bar

Question 14

What additional tests are needed for Type B sterilisers?

Answer 14

Bowie dick- steam penetration
-> daily

Air leakage test- weekly

Air Detector function test- weekly

Question 15

How does a steriliser work?

Answer 15

Purified water is introduced into chamber and heated
-> when it boils and turns to steam pressure in chamber increases

Question 16

What is a type N steriliser known as?

Answer 16

Gravity displacement

Question 17

What can be processed by type N steriliser?

Answer 17

Rigid steel instruments

Cannot process wrapped, channelled or lumened instruments

Question 18

What is a type B steriliser known as and why?

Answer 18

Vacuum capable or porous load
-> active air removal in initial stage creates vacuum in chamber
-> this means no air in chamber allowing steam to flow in from generator

Question 19

What happens in type B steriliser when sterilisation is finished?

Answer 19

Machine draws another vacuum for drying
-> Allows water to vaporise at Lower temp

Question 20

What can be processed by type B steriliser?

Answer 20

Wrapped (ensure no damage to these), channelled and lumened instruments

Porous loads- cotton swabs

Question 21

What is different about instruments processed by type N and type B?

Answer 21

Type B- wrapped instruments, sterile at point of use

Type N- sterilised only, should be wrapped as soon as possible

Question 22

How should wrapped instruments be stored?

Answer 22

Environmentally controlled atmosphere free of moisture and contaminants

Question 23

What are the safety considerations when decontaminating instruments?

Answer 23

Are instruments being transported correctly

Are we wearing PPE

Are items being disposed of in correct waste stream

Are single use items managed correctly

Are we storing sterilised items correctly

Question 24

What are the considerations regarding staff in an LDU?

Answer 24

Do staff understand key stages of process

Are staff trained to use equipment

Have staff been supplied with PPE

Do staff know how to work safely
-> are they aware of dangers

Question 25

What are the considerations regarding records of decontamination process?

Answer 25

 Do we have training records for all staff on
all equipment and processes
 Do we have machine printouts and cycle data
 Are our validation and testing records up to date
 Are we maintaining a maintenance register for our equipment
 Are we recording faults and failures

Question 26

What are the considerations regarding compliance with standards when carrying out decontamination?

Answer 26

Are we following the correct and most
up to date guidance (SHTM 01 – 01):

 Can the equipment consistently achieve the set-points (temperature, chemical, pressure, time)
 Has it been produced in line with the relevant standards (MDR)
 Does my test partner comply with the guidance (SHTM 01 -01)
 Do they test my equipment in-line with the required standards (BS EN)

Question 27

Sinners Circle:

Answer 27

Time

Chemical

Energy

Temperature

Water