Overview of Decontamination Cycle & Process

Question 1

Describe the ideal flow line of a single room LDU

Answer 1

• dirty
  
  • wall mounted PPE
  • wash hand basin
  • dirty set down
  • wash sink
  • ultrasonic cleaner
  • rinse sink
  • RO water treatment
  • washer disinfector
• clean
  
  • inspection area
  • magnifying inspection lamp
  • dental handpiece cleaner lubricator
  • packaging
  • steriliser
  • cooling and dispatch
  • administration area

Question 2

What is the purpose of a flow line in a single room LDU?

Answer 2

to minimise the potential for cross contamination

Question 3

What are the 9 stages of the life cycle of a reusable dental instrument?

Answer 3

1. cleaning
2. disinfection
3. inspection
4. packaging
5. sterilisation
6. transport
7. storage
8. use
9. transport

Question 4

Provide examples of process verification

Answer 4

• steriliser tests
  
  • Bowie Dick test
    
    • steam penetration
  • Helix test
    
    • steam penetration
  • chemical indicator
    
    • steam penetration
• washer disinfector tests
  
  • test soil
    
    • cleaning efficacy
  • residual protein test
    
    • cleaning efficacy

Question 5

What information is included for an automatic control test of a washer disinfector?

Answer 5

• cycle number
• cycle selected
• disinfection hold temperature
• disinfection hold time
• cycle complete indication
• result of test
• certified fit for use

Question 6

Describe the criteria a container must meet to be suitable to carry contaminated instrumentation

Answer 6

• durable
• leak proof
• rigid sided
• colour coded or clearly marked
• tight fitting lid

Question 7

The first stage of the decontamination process is cleaning in the washer disinfector, what are the reasons for this?

Answer 7

• medico-legal requirement
• removal of biological matter
  
  • can impact functionality
• minimises cross contamination
  
  • e.g. misdiagnosis
• removal of biological substances
  
  • can prevent steam contact
• reduces risk when handling instruments

Question 8

How should load carriers be loaded with instruments?

Answer 8

• no overlapping or shadowing
• do not overload machine
• utilise the available load carrier
• all assemblies should be disassembled
• forceps should be open at the hinge
• restorative material must be removed

Question 9

What daily testing should be carried out for a washer disinfector?

Answer 9

• check spray arms/jets
• check filter/strainer
• check door seal
• verify chemical level
• verify load carrier
• record cycle data

Question 10

What are the 5 cycle specifics in a water disinfector?

Answer 10

1. flush
2. wash
3. rinse
4. thermal disinfection
5. drying

Question 11

What is the function of the flush stage of the washer-disinfector?

Answer 11

remove gross contamination

Question 12

What is the function of the wash stage of the washer-disinfector?

Answer 12

remove biological matter

Question 13

What is the function of the rinse stage of the washer-disinfector?

Answer 13

remove residue

Question 14

What is the function of the thermal disinfection stage of the washer-disinfector?

Answer 14

90-95 degrees for 1 minute to reduce the number of viable organisms

Question 15

What is the function of the drying stage of the washer difinfector?

Answer 15

remove excess moisture

Question 16

What does inspection of instruments look for after cleaning in the washer disinfector?

Answer 16

• using an illuminated magnifier
  
  • residual contamination
  • functionality of instruments
  • damage or corrosion

Question 17

If on inspection an instrument is damaged or corroded what must be done?

Answer 17

• repaired
• disposed of

Question 18

If on inspection an instrument is contaminated what must be done?

Answer 18

• reprocess

Question 19

What are the two methods of manual cleaning?

Answer 19

• immersion
  
  • solid instruments
• non-imerssion
  
  • handpieces

Question 20

What PPE must be work during manual cleaning?

Answer 20

• gloves
• heavy duty gloves
• apron
• face covering

Question 21

What are the requirements of manual cleaning?

Answer 21

• chemicals
• <35 degrees
• under surface of water
• soft bristles brush

Question 22

What are the issues associated with manual cleaning?

Answer 22

• splashing
• cross contamination
• sharps injuries
• human error

Question 23

What is the capability of an ultrasonic bath?

Answer 23

can remove stubborn/dried in/gross contamination

Question 24

What process do ultrasonic baths use to remove contamination?

Answer 24

cavitation

Question 25

Describe the process of an ultrasonic bath

Answer 25

- bath filled to required level - chemicals added as per manufacturers instructions - run de-gas cycle - load according to requirements

Question 26

What instruments cannot be processed through an ultrasonic bath?

Answer 26

handpieces

Question 27

What is the temperature and hold time for sterilisation?

Answer 27

134-137 degrees for 3 minutes

Question 28

What are the pressure gauge and pressure absolute for sterilisers?

Answer 28

- pressure gauge - 2.05-2.35 - pressure absolute - 3.05-3.35

Question 29

What are the daily checks that must be carried out for sterilisers?

Answer 29

- check load carrier and chamber - check door seal - fill feed water reservoir - drain used water reservoir - record cycle information

Question 30

Describe a type N-steriliser and what can and cannot be processed in one

Answer 30

- non-vacuum steriliser - gravity displacement - cannot process - wrapped items - channeled or lumened devices - can only process rigid instruments - as instruments cannot be wrapped they are not sterile - have 'been sterilised'

Question 31

Describe a type B-steriliser and what can be processed in one

Answer 31

- porous load or vacuum capable machine - can process wrapped instruments - can process channeled and lumened items - wrapped instruments are sterile

Question 32

What daily testing must be carried out for Type-B sterilisers?

Answer 32

- steam penetration test (adequate air removal) - Bowie Dick - Helix

Question 33

What weekly testing must be carried out for Type-B sterilisers?

Answer 33

- air leakage test - air detector function test

Question 34

What is the function of an air leakage test?

Answer 34

- verifies integrity of the chamber - ensures no leaks - ensure door seal and valve closure

Question 35

What is the function of an air detector function test?

Answer 35

verifies machines capability to recognise air in the chamber

Question 36

Why is it important to remove air when sterilising in a Type-B steriliser?

Answer 36

air will always be at a lower temperature which can prevent the steriliser reaching the time/temperature kill rate required for sterilisation

Question 37

Describe the criteria a container must meet to be suitable for transporting clean instruments

Answer 37

- durable - leak proof - rigid sided - colour coded or clearly marked - tight fitting lid

Question 38

How is safety ensured at all stages of the decontamination process

Answer 38

- safe transportation of hazardous material - use of PPE - protect unwrapped instrumentation - correctly mange single use equipment - store sterile instruments correctly

Question 39

What questions must be asked of staff at all stages of the decontamination process?

Answer 39

- are staff trained for each task and process? - is staff training documented? - is there a SOP in place? - has correct PPE been provided? - are there barriers to safe working

Question 40

How should sterile instruments be stored to remain sterile?

Answer 40

- temperature controlled environment - no fluctuations causing condensation - unlikely to encounter aerosol contamination - out of direct sunlight - unlikely to be damaged

Question 41

What records must be taken over all stages of the decontamination process?

Answer 41

- staff training records - cycle data for traceability - daily - validation and testing reports - quarterly testing - annual validation - asset register with maintenance intervals - faults, failures and diagnostics

Question 42

How can compliance be assured at all stages of the decontamination process?

Answer 42

- equipment produced in line with MDD - correct guidance followed - monitoring of equipment performance - CPD qualified and experience - follow most up to date standard and guidance