STERILIZATION AND DISINFECTION OF DENTAL INSTRUMENT  Horizontal or Gravity displacement or N type

 The most basic form and is suitable for sterilizing the most common
STERILIZATION
laboratory media, including steel utensils, glassware, and bio-
 Describes a process that destroys or eliminates all forms of microbial hazardous waste
life and is carried out in health- care facilities by physical or  Gravity-induced autoclaving involves pumping steam into the
chemical methods autoclave chamber, which displaces the ambient air and forces it out
 killing and removal of all micro‐organisms including bacterial of exhaust valves so that the remaining steam can sterilize the
spores contents.
 3 to 30 minutes at 121°C to 132°C
The four accepted methods of sterilization in dental offices
S TYPE VACUUM
 Steam pressure sterilization
 Chemical vapor sterilization  Autoclaves of this class have a vacuum pump, which makes it
 Dry heat sterilization possible to completely remove the air from the chamber before
 Ethylene oxide sterilization starting the sterilization process. However, only a single-stage pre-
vacuum is used here; it is less effective than the vacuum used in class
STEAM PRESSURE STERILIZATION (AUTOCLAVE) B autoclaves.
 Appropriate for sterilizing large or porous items
 Moist heat in the form of saturated steam under pressure is the
most widely used and the most dependable B TYPE VACUUM
 Nontoxic, inexpensive, rapidly microbicidal, sporicidal, and rapidly
heats and penetrates fabrics  Class B autoclaves enable the sterilization of both wrapped and
 MoA: destroys microorganisms by the irreversible coagulation and unwrapped instruments, no matter their type and complexity. The
denaturation of enzymes and structural proteins fractionated vacuum reduces the air in the sterilization chamber
through repeated evacuation and steam injection. This process
CLASSIFICATION SUTABLE FOR USED BY permits the sterilization not only of solid and porous instruments, but
PROCESSING also of complex hollow body instruments with narrow lumen such as
N Type (Downward Unwrapped solid surgical hand pieces and endoscopes.
Displacement) instrument for  15 minutes at 121°C
immediate use
S Type (Vacuum) Suitable for naked and Medical Surgeries CHEMICAL VAPOR STERILIZATION (AUTOCLAVE)
single wrapped solid Podiatrist
and hollow items Tattooist  Chemiclaves utilize unsaturated chemical vapor for sterilization,
Body Pierces typically for 20 minutes at 132°C (270°F)
B Type (Vacuum Unwrapped and Dentist  The chemical vapor is produced using a proprietary formaldehyde
wrapped solid and Plastic surgeons and-alcohol formulation that is water-free.
hollow instruments. Day surgeries  Not recommended for heat-sensitive instruments

Porous loads, e.g. DRY HEAT STERILIZATION (DRYCLAVE)

drapes & gowns
DOWNWARD DISPLACEMENT
  This method should be used only for materials that might be  Formaldehyde steam
damaged by moist heat or that are impenetrable to moist heat (e.g.,  Gaseous chlorine dioxide
powders, petroleum products, sharp instruments).  Vaporized Peracetic acid
 The most common time-temperature relationships for sterilization
IONIZING RADIATION
with hot air sterilizers are 170°C (340°F) for 60 minutes, 160°C
(320°F) for 120 minutes, and 150°C (300°F) for 150 minutes.  Primarily by cobalt 60 gamma rays or electron accelerators, is a low-
temperature sterilization method that has been used for a number of
STATIC-AIR TYPE
medical products
 Oven-type sterilizer
NON-IONIZING RADIATION
 Heating coils in the bottom of the unit cause the hot air to rise inside
the chamber via gravity convection  Uses longer wavelength and lower energy. And hence lose the ability
 Much slower in heating, requires longer time to reach sterilizing to penetrate substances, and can only be used for sterilizing surfaces
temperature, and is less uniform in temperature control throughout  Eg. infrared radiation is used for rapid mass sterilization of
the chamber than is the forced-air type prepacked items eg. Syringes, catheters.
 1-2 hours at 160°C  UV radiation is used for disinfecting enclosed areas like operation
theaters, laboratories but not effective against RNA viruses
FORCED-AIR TYPE
LIQUID CHEMICALS
 Mechanical convection sterilizer
 Equipped with a motor-driven blower that circulates heated air
throughout the chamber at a high velocity, permitting a more rapid Liquid Chemical Sterilization Claim
Hydrogen Peroxide (7.5%) 6 hours @ 20°C
transfer of energy from the air to the instruments
Peracetic Acid (0.2%) 12 minutes @ 50-56°C
 6-12 mins at 190°C
Glutaraldehyde 10 hours @ 20-25°C
ETHYLENE OXIDE “GAS” STERILIZATION (≥2.0%)
OPA (0.55%) None
 ETO is a colorless gas that is flammable and explosive. The four Hydrogen Peroxide / 3 h @ 20°C
essential parameters (operational ranges) are: gas concentration Peracetic Acid
(450 to 1200 mg/l); temperature (37 to 63°C); relative humidity (7.35%/0.23%)
(40 to 80%)(water molecules carry ETO to reactive sites); and
exposure time (1 to 6 hours)
OTHER STERILIZATION METHODS  Cold sterilization
 Several FDA-cleared liquid chemical sterilants include indications for
 Ionizing radiation sterilization of medical devices.
 Non-ionizing radiation
 The indicated contact times range from 3 hours to 12 hours.
 Liquid chemicals
 Microwave MICROWAVE
 Glass bead sterilizer
 Vaporized Hydrogen peroxide
 Ozone
  Microwaves are radio-frequency waves, which are usually used at a
frequency of 2450 MHz. The microwaves produce friction of water
molecules in an alternating electrical field.
 The microwaves produced by a "home- type" microwave oven (2.45
GHz) completely inactivate bacterial cultures, ycobacteria, viruses,
and G. stearothermophilus spores within 60 seconds to 5 minutes
depending on the challenge organism
GLASS BEADS STERILIZER
 Uses small glass beads (1.2-1.5 mm diameter) and high temperature
(217 °C -232°C) for brief exposure times (e.g., 45 seconds) to
inactivate microorganisms
OZONE
 The sterilizer creates its own sterilant internally from USP grade
oxygen, steam-quality water and electricity; the sterilant is converted
back to xygen and water vapor at the end of the cycle by a passing
through a catalyst before being exhausted into the room. The
duration of the sterilization cycle is about 4 h and 15 m, and it occurs
at 30-35°C.
VAPORIZED HYDROGEN PEROXIDE (VHP)
 VHP offers several appealing features that include rapid cycle time
(e.g., 30-45 minutes); low temperature; environmentally safe by-
products (H2O, oxygen [O2]); good material compatibility; and ease
of operation, installation and monitoring.
 VHP has limitations including that cellulose cannot be processed;
nylon becomes brittle; and VHP penetration capabilities are less than
those of ETO.
FORMALDEHYDE STEAM
 Low-temperature steam with formaldehyde is used as a low-
temperature sterilization method in many countries, particularly in
Scandinavia, Germany, and the United Kingdom.
 The process involves the use of formalin, which is vaporized into a
formaldehyde gas that is admitted into the sterilization chamber.
 Formaldehyde is a mutagen and a potential human carcinogen.
GASEOUS CHLORINE DIOXIDE
 As the chlorine dioxide concentration increases, the time required to
achieve sterilization becomes progressively shorter. For example,
only 30 minutes were required at 40 mg/l to sterilize the 10 B.
atrophaeus spores at 30° to 32°C.
VAPORIZED PERACETIC ACID
 The sporicidal activity of peracetic acid vapor at 20, 40, 60, and 80%
relative humidity and 25°C was determined on Bacillus atrophaeus
spores on paper and glass surfaces.
 No vaporized peracetic acid system is FDA cleared.
DENTAL RADIOGRAPHY
 CDC(MMWR),dec19,2003vol.52
 Contamination of working area occurs from saliva.
 X-ray tube head, exposure selector and timer button are likely to get
contaminated by saliva.
Precaution to be taken up :
1. Put on gloves.
2. Place the film packets and film holders in special tray.
3. Contaminated films(exposed films) to be placed in separate tray.
 Film holding device to be rinsed in running water to remove saliva.
 Metallic part to be autoclaved.
 Plastic attachments to be kept in chlorhexidine solution.
 Wipe the x-ray tube head, exposure selector, timer button and film
packets with detergents.
 Tube can be wrapped in disposable plastics.
 Film packets to be discarded in yellow bags.
Disinfection of DENTAL CASTS
 CDC(MMWR),dec19,2003vol.52
 Spraying until wet or Immersing in a 1:10 dilution of sodium
hypochlorite or an iodophor then rinse
 Casts to be disinfected should be fully set (i.e. stored for at least 24
hours)
ADA recommends use of:
 Chlorine compounds
 Iodophors
 Combination of synthetic phenols
 Glutaraldehyde.
Disinfection of PROSTHODONTIC INSTRUMENTS
 CDC(MMWR),dec19,2003vol.52
 Disinfect instruments like articulators, wax knives, spatula, shade
guide, acrylic bur etc.
 Custom impression trays, base plates, occlusal rim and all other
prosthesis must be disinfected, after construction & before use in
patient.
 Articulators, casts, base plates to be disinfected by 1:10 chlorine
solution following each session or before returning to laboratory.
 Dentures washed & soaked in sodium hypochlorite for 5 mins before
delivery.
ROTARY INSTRUMENTS – BURS
 Diamond and carbide burs: After use they are placed in 0.2%
gluteraldehyde and sodium phenate (Eg. Sporicidin) for at least 10
minutes, cleaned with a bur brush or in an ultrasonic bath.
 Sterilize in an autoclave or dry heat
 Steel burs: May get damaged by autoclaving. Can be sterilized by
using a chemical vapor sterilizer or glass bead sterilizer at 230°C for
20-30 seconds.
ENDODONTIC INSTRUMENTS
 Glass Bead or salt sterilizer (10 minutes) is the best option, but they
do not sterilize the handle
 Dry heat is used for 218°C in 15 secs, with instruments in closed
metal or perforated metal boxes.
 Gutta percha points are pre-sterilized.
 Contaminated points are sterilized by 5.25% sodium hypochlorite.(1
min immersion). Then rinse with hydrogen peroxide & dry it.
ULTRASONIC SCALERS
 Rinse cleaned inserts thoroughly in warm water to remove all
chemicals.
 As a final rinse, replace the insert into the scaler hand piece and
operate the scaler for 10 seconds at the maximum water flow setting
to flush out any retained chemicals
 Dry inserts completely with air syringe
 Ethylene Oxide is the preferred method of choice
STORAGE
 Storage times for sterile packs are dependent on the porosity of the
wrapper and the condition of the storage space.
 Heat-sealed and plastic peel pouches have been reported to remain
sterile for up to 9 months after sterilization.
 The items should remain sterile until some event causes them to
become contaminated (e.g. a tear in packaging, packaging becomes
wet, seal is broken).
 Contamination events can also include air movement, humidity,
insects, flooding and temperature.
 Sterile supplies should be stored at least 8 inches from the floor, 5
inches from the ceiling (18 inches from a sprinkler head), and 2
inches from walls to allow for adequate air circulation and fire codes.
MONITORING
 Sterilization procedures should be monitored routinely by using a
combination of mechanical, chemical and biological indicators
MECHANICAL INDICATORS
 Mechanical sterilization indicators include the daily assessment of
cycle time, temperature and pressure. These parameters can be
assessed by examining your sterilizer’s cycle printout or gauges.
CHEMICAL INDICATORS
 Chemical indicators usually are affixed on the outside of each pack
and are either heat-or chemicalsensitive inks that change color when
one or more sterilization parameters (e.g., steam-time, temperature,
and/or saturated steam; ETO-time, temperature, relative humidity
and/or ETO concentration) are present
BIOLOGICAL INDICATORS

 Biological indicators are recognized by the CDC and many other

organizations to be the ideal monitor of the sterilization process
because they use the most resistant form of microorganisms.
 Steam and low temperature sterilizers (e.g., hydrogen peroxide gas
plasma, peracetic acid) should be monitored at least weekly with the
appropriate commercial preparation of spores.

STERILIZER SPORE USED

Steam sterilization, hydrogen G. stearothermophilus (incubated at
peroxide gas plasma, and liquid 55- 60°C)
peracetic acid
ETO and dry heat B. atrophaeus (incubated at 35-
37°C)

Biological indicators

 If the mechanical (e.g. time, temperature, pressure) and chemical

(internal and/or external) indicators suggest that the sterilizer was
functioning properly, a single failed spore test does not indicate
sterilizer malfunction, but the spore test should be repeated as soon
as possible.