Issue Sterilisasi dan

Disinfeksi pada Pelayanan

Gigi dan Mulut
Ammar Widitaputra
Curriculum Vitae
• Nama : Ammar Widitaputra
• Tempat Tanggal Lahir : Malang, 04 Oktober 1987
• Alamat : Medokan Ayu – Surabaya
• Nomor Handphone : +628123381269
• Email : ammar.widitaputra@gmail.com

• Farmasi Apoteker – Universitas Airlangga tahun 2010

• Kepala Instalasi Sterilisasi dan Binatu RSUD Dr. Soetomo Surabaya 2016- sekarang
• Ketua Umum Himpunan Sterilisasi Sentral Indonesia (HISSI) 2019 – sekarang
Apakah anda melakukan sterilisasi
menggunakan alat ini?
 Dental Instrument and Device Sterilization
and Disinfection Practices
Original article
Dental instrument and device sterilization and disinfection practices
Author links open overlay panelI.GurevichabR.DubinabB.A.Cunhaab
https://doi.org/10.1016/S0195-6701(96)90040-7Get rights and content

Abstract
Dental instruments and devices require sterilization or disinfection. An evaluation of the implementation of such processes was undertaken.
Eleven thousand questionnaires on methods used to sterilize and disinfect dental instruments were sent to dental practices and 1391 (13%) were returned
for evaluation.
68% of respondents believed they were sterilizing their instruments, however, some of the liquid chemical products used were not suitable for sterilizing
instruments,
and 12% of respondents used incorrect contact times.
49% of respondents did not challenge autoclaves with biological spores to check their function at an acceptable frequency.
There were similar product and timing problems when a high-level liquid chemical disinfection was attempted.
Although the return sample was small, problems were identified that can and should be corrected.
This study demonstrates that the potential for person-to-person transmission of infectious agents such as the human immunodeficiency virus (HIV) and
hepatitis B and C viruses via inadequately sterilized dental instrument exists depending on the prevalence of HIV in the dental practice area.
Klasifikasi Spaulding
• Pemrosesan peralatan dental berdasarkan klasifikasi Spaulding

o Critical
o Semi Critical
o Non Critical

• Tergantung pada penggunaan dan potensial resiko penyebaran infeksi

Critical
Semi Critical
Non-Critical
Single Use/ Disposable
• Penggunaan pada satu pasien pada satu prosedur.
• Biasanya tidak tahan panas.
• Sulit dilakukan pembersihan.
• Jangan melakukan pemrosesan ulang.

• Contoh: syringe needles, prophylaxis cups, and plastic

orthodontic brackets.
Pentingnya Pembersihan dan Area Pemrosesan
• All instruments that may have come into contact with any bodily
fluids must be meticulously cleaned before sterilization.
• It is essential that a dedicated decontamination area be identified in
the practice and designed to allow a dirty to clean flow of
instruments.
Dental Office Decontamination Area
Area Pemrosesan Instrumen
• Area khusus untuk menjaga kualitas dan memastikan keamanan.
• Pembagian area:
• – penerimaan, dekontaminasi dan pembersihan.
• – persiapan dan pengemasan.
• – sterilisasi.
• – penyimpanan.
• Alur satu arah, dari area kotor ke area bersih ke area steril
Mekanisme Pemrosesan Instrumen
• Ikuti instruksi pabrikan pada semua langkah, pembersihan,
pengemasan, disinfeksi hingga sterilisasi instrumen dental.
• Letakkan instruksi pabrikan dekat area pemrosesan.
• Gunakan alat dan bahan pemroses yang terdaftar.
• Lakukan training yang diperlukan dalam melakukan pemrosesan.
Pembersihan

• Pembersihan adalah langkah pertama dalam pemrosesan instrumen

• Lakukan pembersihan segera, jangan biarkan kotoran mengering
• Pembersihan yang kurang baik menyebabkan darah dan kotoran lainnya
tertinggal dan menggagalkan proses disinfeksi/ sterilisasi

• Cleaning is accomplished by manual cleaning with cleaning chemicals

(detergent) and water, brushing or flushing, or by using ultrasonic and or
washer disinfectors to remove foreign material
• Cleaning is the removal of visible soil (e.g., organic and inorganic material)
from objects and surfaces and normally is accomplished manually or
mechanically using water with detergents or enzymatic products.
Klorida berbahaya untuk instrumen!
Pembersihan Mekanis

Ultrasonic Washer Washer Disinfector

Preparation and Packaging
• Instrumen dikemas sebelum disterilkan
• Instrumen harus kering sebelum dilakukan
pengemasan
• Ikuti rekomendasi pabrikan dalam pengemasan
• Instrumen dalam keadaan terbuka
• Instrumen dalam keadaan terbongkar
• Kemasan sesuai dengan instrumen dan metode
sterilisasi
• Berikan indikator pada bagian dalam dan beri
label pada kemasan
• Label nomor mesin, nomor siklus/lot, tanggal
proses dan tanggal expired
Sterilisasi
• Sterilisasi adalah proses penghilangan
semua jenis mikroorganisme,
termasuk spora bakteri (e.g.
Clostridium, Bacillus)
• Dry heat sterilization and chemicals
are not recommended for the routine
sterilization of dental instruments and
equipment.
• Ultraviolet light and boiling water do
not sterilize instruments and must not
be used
Gravity Displacement Autoclaves (1)
• Uap air dimasukkan untuk
mendorong udara keluar dan
tekanan – suhu dinaikkan.

• Suhu dinaikkan hingga 121°C pada

tekanan 15 psi dan dijaga selama
15-45 menit

• Untuk sterilisasi cairan dan

instrumen dalam kemasan yang
dapat ditembus oleh uap.
Gravity Displacement Autoclaves (2)
High-Vacuum/ Pre Vacuum Autoclaves (1)
• Pertama udara dikeluarkan dengan proses
vakum dan uap dimasukkan.
• Proses lebih cepat dan penetrasi lebih baik.
• Suhu dan tekanan lebih tinggi; 134°C pada
30 psi
• Waktu sterilisasi 3 (tiga) menit
• Tidak cocok untuk sterilisasi cairan.
Kemasan dapat pecah karena proses vaku.
• Pilihan utama sterilisasi instrumen, BMHP
steril dan linen.
 Sub-atmospheric Fractionated Vacuum Sterilization Process

Over-
pressure pressure temperature
[bar] [bar] [°C]

3 4 temperature 134

pressure

BDS-Test 3,5 min

2 3

70

2 fractionated vacuum
1

0 1 20
5 10 15 20 25
time [min]
warming-up- sterilization cooling drying
time
-1 0 air-removal
Bench Top Autoclave
Liquid Chemical Sterilant or Disinfectants
• Hanya untuk sterilisasi bahan yang tidak tahan panas

• Sangat toksik
• Ikuti rekomendasi pabrikan; pengenceran, waktu perendaman dan suhu serta
informasi keamanan lainnya
• Lebih baik menggunakan peralatan tahan panas atau alternatif single use/
disposable

• Although they have sporicidal activity, it is difficult to control the process and
there is a risk of contamination during the rinse to removal residual
chemicals before patient use.
• In addition, items cannot be packed and stored, but must be used
immediately after rinsing.
Glutaraldehyde
• 2%
• 20 – 90 menit
• 20 – 25 oC

• Cold sterilization claim

• 10 jam

• Bau menyengat
• Perlu aktivator
• 14 – 28 hari
Waspadalah!
Metode Sterilisasi Terlarang
• Merebus/ Godokan
• Ultraviolet irradiation
• Chemiclave
• Microwave oven
• Glass Bead Sterilizer
(dental)

APSIC, Asia Pacific Guidelines for Disinfection & Sterilization

Sterilisation Process Monitoring
• Indikator digunakan untuk memantau proses sterilisasi.

• Berbagai macam pemantauan:

• Mechanical monitoring

• Chemical monitoring

• Biological monitoring

• Dilakukan dokumentasi proses

Monitoring Fisik/ Mechanical Monitoring
• Gunakanlah monitoring fisik
untuk semua load
• Verifikasi dimana setiap
parameter dalam siklus sterilisasi
telah tercapai.

• Grafik
• Gauges
• Printouts
• Digital displays

AAMI ST79 A1:2017 Recommended Practices:

Indikator Kimia
Tipe Kode Fungsi Contoh

1. e1 Exposure Indikator tape

Strips
2. s2 Special test Bowie Dick test

3. i3 Internal Temperature tubes

Satu variable

4. i4 Internal Strips
Multi variable

5. i5 Semua variabel, korelasi dengan Indikator Biologis Strips

6. i6 Semua variabel Strips

Biological Indicator
Penyimpanan
• Menjaga barang tetap steril hingga
digunakan
• Mencegah kontaminasi silang
• Manajemen inventaris dan
pencegahan infeksi

• Rak bebas debu

• Barang steril tidak diletakkan di
lantai
• Jarak dari lantai 20 cm
• Jarak dari langit-langit 25 cm
• Jarak dari dinding 5 cm
Check before Use
• Indikator kimia eksternal
• Indikator proses - autoclave tape
• Membedakan instrumen yang sudah diproses
dengan yang belum diproses
• Mengamankan / mengunci kemasan
• Memberi label kemasan

• Selalu periksa indikator eksternal dan

internal untuk memastikan terjadi
perubahan warna sebelum menggunakan
instrumen steril.

• Jika indikator tidak berubah, jangan

digunakan
Special Items - Handpiece
• Follow manufacturer’s instructions to safely reprocess dental
handpieces and accessories (e.g., low-speed motor, reusable
prophylaxis angles).
• Clean and heat sterilize between patient uses.
• Do not subject the handpiece to high-level disinfection and do not
simply wipe the surface with a low-level disinfectant.
Autoclave sterilization of dental handpieces:
A literature review
• Review J Prosthodont Res. 2020 Jul;64(3):239-242. doi: 10.1016/j.jpor.2019.07.013. Epub 2019 Aug 12.
• Jun-Ichi Sasaki 1, Satoshi Imazato 2Affiliations expand
• PMID: 31416709 DOI: 10.1016/j.jpor.2019.07.013

• Abstract
• Purpose: The present review aimed to investigate autoclave sterilization of dental handpieces based on available studies.
• Study selection: The sterilizing efficiency of dental handpieces with autoclave is mainly affected by the types of apparatus (N, B, and S), the packaging
with sterilizing pouch, cleaning, and lubrication. These subjects were reviewed based on the in vitro experimental studies.
• Results: Dental handpieces can be sterilized, including inactivation of heat-resistant bacterial spores, with type B or type S sterilizers, regardless of the
use of a sterilization pouch. In contrast, although type N autoclaves are capable of sterilization of general bacteria such as Streptococcus salivarius
even in a sterilization pouch if instruments are washed beforehand, complete sterilization of the wrapped handpiece is not always achieved.
Therefore, to achieve sterilization efficiency with type N autoclaves, processing without any packaging is recommended. As regards cleaning of
handpiece, although contamination decreases with irrigation and wiping of handpieces, all reports concluded that these treatments alone do not
achieve complete decontamination of reusable handpieces.
• Conclusion: Although type B and type S autoclaves allow us to sterilize the dental handpieces, it is important to realize that complete sterilization of
the handpiece is not always achieved by type N autoclave. Understanding autoclave processing of handpieces is essential for dental practice to deliver
the safe dental care.
• Keywords: Autoclave; Cleaning; Dental handpiece; Lubrication; Sterilization.
Lingkungan Kerja
• Permukaan atau peralatan yang tidak melakukan kontak dengan
pasien secara langsung. Non Kritis
• Dapat terkontaminasi, dapat berperan sebagai reservoir.
• Perlu pembersihan dan disinfeksi tingkat rendah
Lingkungan Kerja Klinis dan Non Klinis
Rekomendasi Pembersihan Umum
• Menggunakan APD, sarung tangan tebal, masker, face shield
• Pembersihan sebelum disinfeksi
• Disinfektan di area kerja menggunakan produk terdaftar, ikuti rekomendasi
penggunaan
• Jangan menggunakan bahan kimia sterilant atau disinfektan tingkat tinggi

• Alkohol
• Klorin
• Ammonium Quartener

• Area klinis pembersihan setiap bergati pasien

• Area non klinis pembersihan rutin, disinfeksi apabila terdapat kontaminasi
Surface Barriers
• Barriers protect clinical contact surfaces, especially those that are
difficult to clean (e.g., switches on dental chairs, computer
equipment).
• Change barriers between patients.
Which disinfectants kill the COVID-19 virus?
• The Occupational Safety and Health Administration notes the following regarding
disinfectant efficacy for COVID-19:
• At this time, there is no EPA-approved list of disinfectants effective against COVID-19.
EPA does not categorize disinfectants as hospital- or commercial-grade or keep a list of
EPA-registered antimicrobial products registered for use in healthcare facilities. As a
result, products effective at inactivating the virus must be determined based on data
associated with inactivating similar or hardier (i.e., more difficult to inactivate) viruses.
COVID-19 is a coronavirus and highly susceptible to inactivation by many commonly used
disinfectants. Currently, OSHA recommends following SARS disinfection practices for
environmental areas contaminated with COVID-19.
• The CDC advises the use of EPA-registered chemical germicides that provide low- or
intermediate-level disinfection for SARS during general use (surface and noncritical
patient-care equipment) because these products inactivate related viruses with similar
physical and biochemical properties. CDC's Guideline for Disinfection and Sterilization in
Healthcare Facilities, 2008 provides information on the effectiveness of germicides on
coronaviruses.
Terima Kasih