Clinical Foundations - Week 10 PP

Question 1

Reprocessing Steps

Answer 1

1. Transport
2. Cleaning
   a) Rinsing
   b) Drying
   c) Corrosion Control
   d) Inspection
3. Packaging
4. Sterilization
5. Storage
6. Delivery
7. Quality assurance

Question 2

How do we know what we are doing is
effective?

Question 3

• What is our assurance that sterilization
  procedures are working?

Question 4

How can we assure patients that we are
providing them with the best possible care?

Question 5

Forms of Monitoring

Answer 5

To ensure the condition of sterility, three forms of monitoring are used:

1.Phyisical/Mechanical (cycle, temp and pressure)
2. Chemical (heat sensitive, colour changes)
3. Biologic

Question 6

Physical Mechanical Monitoring

Answer 6

• Displayed data on the sterilizer as each cycle progresses
  -Physical printout or electronic data / digital
  -Any cycles that fial to reach “cycle complete” will require all insruments to be repackaged

Question 7

Chemical Monitoring - 6 types/classes

Answer 7

Process Indicators
-Placed outside instrument packages
-They respond to a signle change not combination of pressure, temperature, or time
-Indicication that item whent through sterilizer
-Does not indicate if instruments are sterile inside the package

Process Integrators
-Plced inside the instrument packages
-They respond to a combination of pressure, temperature, and time
-Process integrators are also known as multiparameter indicators
-All sterilization factors are integrated

Question 8

Chemical Monitoring

Answer 8

Involves the use of a heat-sensitive chemical
that changes color when exposed to certain
conditions
* Does not prove sterilization has been achieved
* 6 classes

Question 9

Chemical Monitoring - Class #1

Answer 9

Single Variable:

Responds to temperature or time

External! “Steam to Cocoa”

Question 10

Chemical Monitoring - Class #2

Answer 10

indicates rapid and even penetration of steam and adequate aire removal

Example: Bowie Dick test used on pre-post vaccum (dynamic air removal) steam sterilizers

Question 11

Chemical Monitoring - Class #3

Answer 11

responds to a single parameter (not used in dentistry)

-Pressure or Steam heat

Question 12

Chemical Monitoring - Class #4 - multiparameter integrator

Answer 12

Placed internal (inside the self-sealing pouch)
-Heat and pressure or heat and steam

Question 13

Chemical Monitoring - Class 5

Answer 13

Integrating Indicator

-Time
-Temperature
-Presence of Steam

Question 14

Chemical Monitoring - Class 6 - Emulating Indicator

Answer 14

-Time
-Temperature
-Steam &
-Pressure

Can be used with specified sterilization cycle (eg.. 10 min, 18 min, 40 min)

Question 15

Biological Monitoring (BI) - 3M Attest Auto-reader 490 for Steam Sterilizers

Answer 15

The 3M™ Attest™ Auto-reader 490 is
designed to incubate and automatically read
3M™ Attest™ Super Rapid Readout
Biological Indicators 1492V at 56°C for a
final negative fluorescence reading

• Takes 1 hour for Midmark
• Test should be negative - no spores detected (positive will have presense of spores)

Other Biological indicators (BIs) are NOT compatible with this device and cannot be used

Question 16

PCD (Process challenging device)

Answer 16

is assembled and
placed in the least favorable to sterilization (cold point) - Closest to FRONT of door

Question 17

Control Vial

Answer 17

• is not sterilized
  -is activated to verify the viability of the test indicator itself
  (+) Spores are detected
  The anticipated results of the sterilized BI testing shall
  be negative (spores are not detected) (-)
• All instruments must be quarantined until sterilized BI
  results are negative. (-) This takes 60 minutes or
  less

Question 18

Biological Monitoring (BI)

Answer 18

Complete BI test with full load, including test cassette

BI challenge pack or PCD placed the 1st full load of the day.

Cycle used at SAIT: “Handpieces”

Question 19

Complete BI test with full load, including test cassette

Answer 19

Placement of the BI Challenge pack /Test Pack and Class 5 Chemical Strip

Cassette with instruments is never used on patients

Class 5 indicator strip used

BI vial is placed in the center (toughest area to reach)

Label vial with sterilizer number used and date

Question 20

Quarantine

Answer 20

-All Instruments must be quarantined until the BI reading is negative (-) no spores are detected
-At Sait the BI Vials are kept all day

Question 21

Biological Indicator (BI) Failure

Answer 21

Positive for spores result in positive (+)

Question 22

Biological Indicator Faillure

Answer 22

• BI tests positive; follow CDSA IPC Standards
• Items from suspect loads dating back to the last negative
  -BI test should be recalled, re-wrapped, and re-sterilized
  (remove from quarantine)
• Repeat BI test

1. Test results are negative and chemical and mechanical monitoring is adequate the sterilizer may be put back into service.
2. Test results are positive, and chemical and mechanical monitoring is adequate the sterilizer
   should remain out of service until it has been inspected, repaired, and re-challenged with BI tests in (3) three consecutive empty chamber sterilization
   cycles.

Question 23

Quality Insurance - Tracking Instruments

Answer 23

✓ Ensure BI was done for the day

✓ Ensure Mechanical/ Digital print – Cycle Complete
-package integrity
-dryness
-presence of label
-date, sterilizer number, cycle number, initials

✓ The correct change in an external chemical indicator
✓ Intact seal if used and evidence of potential contamination

Question 24

Logbooks

Answer 24

“Results of All monitoring must be recorded and retained as long as necessary for medical legal purposes”

-Digital
-Analog
-Keep track and record everything!!