You are on page 1of 117

Infection control in the

dental clinic

By
Hesham
Dameer

As a matter of fact, the dentist, dental


assistant, dental hygienist and dental
technician are at risk of exposure to disease
agents through contact with blood or other
potentially infectious materials. So by
studying and by carefully following the
infection control and safety guidelines, all
the team work can minimize the risks of
disease transmission to himself and to the
patients in the dental office.
All practitioners should incorporate
recommended CDC , ADA and OSHA infection
control guidelines into their daily practice .

CHAIN OF INFECTION
All links must be connected for infection
to take place

Pathogen

(sufficient virulence
& adequate numbers)

Susceptible Host

(i.e., one that is not immune)

Entry
(portal that the
pathogen can
enter the host)

Source

(allows pathogen to
survive & multiply)

Mode
(of transmission
from source to host)

Definitions:
CDC:
Center of Disease Control and Prevention .
ADA:
American Dental Association.
ADAA:
American Dental Assistants Association.
OSHA:
Occupational Safety and Health Administration.
OSAP:
Organization for Safety and Asepsis Procedures.
EPA:
Environmental Protection Agency.
FDA :
Food and Drug Administration.
NIOSH:
National Institute for Occupational Safety and

Why , Who and what

Why is infection control necessary in dentistry ?


Dental staff and patients may be exposed to a wide variety of
pathogenic microorganisms .
Who is responsible for infection control in the
dental office ?
Each member of the dental team must follow the
recommended guidelines .
What should be done to prevent the transmission of
disease in the dental office ?
The most effective ways to prevent the transmission of
diseases includes :

1) Hand washing
2) Gloves
3) Face masks
4) Protective eye wear
5) protective clothing

Diseases Transmission in Dental Office


Diseases Transmission in Dental Office
The dental office should have an infection control program to
prevent the transmission of disease from the following :
Patient to dental team
Dental team to patient
Patient to patient
Dental office to community ( include dental teams family )
Community to dental office to patient

To prevent such infections, following is a list of all those


procedures and precautions that together constitute infection
control. These guidelines should be followed each time
treatment is performed because we are never certain of the
patient's status, either because they themselves do not know
or because they have chosen not to inform their healthcare
providers of their condition. Following these guidelines for
every patient is called "Standard Precautions".

Standard Precautions

1. IMMUNIZATION
2. PATIENT SCREENING
3. HAND WASHING
4. BARRIER TECHNIQUES Personal Protective Equipment (PPE)
Rubber dam, Pre-procedural rinsing
5. NEEDLE & SHARP INSTRUMENT SAFETY
Occupational Exposure To Blood/Body Fluids
7. SURFACE DISINFECTION
8. radiographic asepsis
9. laboratory asepsis
10. infectious dental waste management & disposal

Modes of Diseases Transmission

Direct contact with blood or body


fluids
Indirect contact with a
contaminated instrument or surface
Contact of mucosa of the eyes,
nose, or mouth with droplets or
spatter
Inhalation of airborne
microorganisms

A) Infection Control during the

Pretreatment Period
It is the period of protective
equipment :
An essential pretreatment procedure is the
preparation of all personnel involved in
patient care. This includes the utilization of
personal protective equipment (gown,
eyewear, mask and gloves) and hand
hygiene.

Infection Control During the Pretreatment


Period
The process of infection control begins during the
period of preparation for clinical treatment. Paying
attention to infection control at this time has several
payoffs. In addition to reducing the risk of
transmission of infectious agents during patient care,
thinking ahead will make the treatment session more
efficient and will also make the post treatment
infection control process easier and more effective.
1. Remove unnecessary items from the dental
procedure area : The dental procedure area
should be arranged to facilitate a thorough
cleaning following each patient.
2. Preplan the materials needed during
treatment.
Set out all instruments, medications, impression

3. Utilize disposable items whenever possible :

The use of disposable items saves time


during cleanup and decontamination and
solves the problem of proper reprocessing.
4. Use prearranged tray set-ups for routine or
frequently performed procedures.
Helps to eliminate the need to go into cabinets once
you have started a procedure.
5. Use individualized, sterilized bur blocks for
each procedure
. Using individualized bur blocks containing only the
burs required for that procedure helps to eliminate
the contamination of other, unneeded burs and to
make clean-up easier.

6. If indicated, have the rubber dam setup on


the tray.
When a rubber dam will be used during a clinical
procedure, it also should be included on the tray
setup. In addition, include those items needed for
high-velocity evacuation.

7. Identify those items that will become


contaminated during treatment.
While preparing the dental procedure area prior to
beginning a clinical procedure, consider which items
will become contaminated during treatment.
Examples of such surfaces include countertops, light
handles, X-ray unit heads, tray tables etc. Decide
whether to use a barrier, e.g., plastic wrap to prevent
contamination of these surfaces and items or to
disinfect them when the procedure is complete.
8. Review patient records before initiating
treatment and place radiographs on the view
box.
Do not leave the record on the countertop or handle
it after beginning treatment. Place the record in a
drawer or out of the dental procedure area, so that it
doesnt become contaminated. Entries into the record

9. Prepare personnel involved in patient care.


An essential pretreatment procedure is the
preparation of all personnel involved in patient care.
This includes the utilization of personal protective
equipment (gown, eyewear, mask and gloves) and
hand hygiene.

A .Handwashing and hand care :


According to the U.S. Centers for
Disease Control (CDC) , hand washing is
the single most important procedure for
preventing the spread of infection. So , you
must wash your hands each time before
you put on gloves and immediately after
you remove gloves . Handwashing is also
required if you touch contaminated
instruments or surfaces during working .
We should always use liquid soap during
handwashing . Bar soap should never be
used because it may transmit
contamination .

Hands Need to be Cleaned


When

Visibly dirty
After touching
contaminated objects
with bare hands
Before and after
patient treatment
(before glove
placement and after
glove removal)

Personal protective
equipment ( PPE )

OSHA requires the employer to provide


employees with appropriate personal
protective equipment .

Examples of PPE :
1- Protective clothing
2- Surgical masks
3- Face shields
4- Protective eyewear
5- Disposable patient treatment gloves ,
and

These PPE must be used


whenever you :
Performing tasks that could
produce splash or spatter .
Any contact with body fluids
Perform other clinical activities
that require handling
contaminated items e.g.
radiographs , impressions ,
dentures or contaminated

We will study 4 aspects of


each one of these
equipments :

The purpose of using .


Types .
Guidelines for the use .
Requirements .

1) Protective clothing :

Purpose : to protect the


skin and underclothing
from the exposure to
saliva , blood , aerosol ,
and other contaminated
materials .
Types
1) Laboratory coats

2) Gown

3) Surgical scrubs

Guidelines for the use of protective clothing


1) It should not be worn out of the office for
any reason .
2) Change these work clothes at least daily, or
more often if soiled, especially if they become
visibly contaminated with blood.
3) It must not be worn during eating or in
resting rooms .
4) It should be washed and laundered
separately .
Protective clothing requirements :
1) Should be made of fluid-resistant material
( cotton , cotton/polyester, or disposable
jackets or gowns .

2) Protective masks :
Purpose the mask worn over the nose and
mouth to protect the person from inhaling
infectious organisms spread by the aerosol
spray of the handpiece or air-water syringe .
Types the two most common types of masks
are the dome-shaped and flat types .

The dome-shaped

Flat types

Guidelines for the use of protective masks :


Masks should be changed for every patient or
more often, particularly if heavy spatter is
generated during the treatment or if the mask
becomes damp.
Masks should be handled by touching only the
side edges to avoid contact with the more
heavily contaminated body of the mask.
Masks should conform to the shape of the
face .
Masks should not contact the mouth when
being worn because the moisture generated
will decrease the mask filtration efficiency .
Requirements : masks should be at least with
95% filtration efficiency to remove particles 3

3) Protective eyewear :
Purpose eyewear is worn to protect the eyes
against damage from :
Aerosolized pathogens .
Flying sharp debris such as scrap amalgam
and tooth fragments .
Splattered solutions
Caustic chemicals
Guidelines for the use of protective eyewear :
1) OSHA requires the use of eyewear with both
front and side protection ( solid side shields ) .
2) Members who wear correction glasses or
contact lenses must wear protective eyewear
with a side shields or a face shield .

3) It must be cleaned
and decontaminated
after each treatment or
patient visit according to
the manufactures
instructions .
Types :
Two types of protective
eyewear used during
patient care :
1) Glasses with
protective side shield ,
and
2) Clear face shields .

Face shields :
a chin-length plastic face
shield that protects your
eyes, nose, and mouth from
spatter may be worn and
replace the protective
eyewear .However , a shield
cannot replace the mask
because it does not protect
against inhalation of
contaminated aerosol

Face shield worn in addition to the mask

Patient eyewear :
Patients should be provided with protective
eyewear because they may subjected to eye
damage from :
1) Handpiece spatter
2) Splashed dental materials
3) Airborne bits of acrylic or tooth
fragments

4) Gloves :
Purpose :
Gloves must be worn by the dentist , dental
assistant , and dental hygienist during all
dental treatment to avoid contact with the
patients blood , saliva , or mucous
membranes or with contaminated items or
surfaces .
Types :
The type of gloves used in dental
practice
should be determined by the
various procedures that are performed in the
practice as follow :
1) Examination gloves usually are latex or
vinyl . These are the gloves most frequently

Examination gloves are


inexpensive , available in a
range of sizes from extra
small to extra large , and
are ambidextrous ( used for
both right and left hands ) .
These gloves are nonsterile
and serve only as a
protective barrier for the
wearer .
Examination gloves

2) Overgloves are made of lightweight ,


inexpensive , clear plastic . Overgloves may be
worn over contaminated
treatment gloves ( overgloving ) to prevent
contamination of clean objects ( telephone ,
pen ,opening drawers and cabinets ) that may
be handled during treatment . Overgloves are
discarded after a single use .

To prevent contamination , an
Overgloves is worn while using a
pen .

3) Sterile surgical gloves


are used
during surgical
procedures such as oral surgery or periodontal
treatment .
Sterile surgical gloves are supplied in specific
sizes and
prepackaged unites to maintain sterility before
use surgical
.
Sterile
gloves

4) Utility gloves are made from a punctureresistant , heavy material which are not used
for direct patient care . Utility gloves may be
washed , disinfected , or sterilized and reused
and must be discarded when they become old .

Guidelines for the use of gloves :


All gloves used in patient care must be
discarded after
a single use.
Torn or damaged gloves must be replaced
immediately .
Do not wear jewelry under gloves because , it
may tear
the gloves .
If the procedure is long , change the gloves
each hour .
Contaminated gloves should be removed
before leaving
the chair side during patient car.
Hands must be washed after glove removal

5) Non-latex containing gloves occasionally ,


the health care providers or patients may
experience serious allergic reactions to latex .
The person who is sensitive to latex can
substitute with gloves made from
vinyl , nitrile and other non-latex containing
materials .

Hand dermatitis that


developed from wearing
latex gloves.

B) Infection Control during the


treatment Period
(Chairside Infection Control ) :
The infection control procedures
described in the previous period will
help you to reduce the risk of
transmission of infectious agents.
During treatment there are
additional precautions that can be
taken to further reduce infection
1)
Use care when receiving,
risks.
handling, or passing sharp
instruments.
2) Take
special precautions with
syringes and needles.
3) Use a rubber dam whenever
possible.

4) Avoid touching unprotected switches, handles


and other equipment once gloves have been
contaminated.
5) Avoid entering cabinets once gloves have been
contaminated.

c) Infection Control during the PostTreatment Period


After patient treatment , dental unite and
treatment room surfaces are likely to become
contaminated with saliva or by aerosol
containing blood . Also a primary source of
cross-contamination occurs when a
member of the dental team touches surfaces
with contaminated gloves .
The laboratory studies have proved that
microorganisms may survive on environmental
surfaces for long time . For example,
Mycobacterium tuberculosis may survive for
weeks .

Dental treatment room


surfaces :
Dental treatment room surfaces are classified
as either :

Clinical contact surfaces or


General housekeeping surfaces .
Clinical contact surfaces are those that
are touched by contaminated hands ,
instruments or by spatter during
treatment . It should be cleaned and
disinfected between patients .
All the other surfaces , such as the walls
and floors , are considered general

Clinical contact surfaces :


The clinical surfaces can be classified into
three categories :
A) Touch surfaces : are directly touched
and contaminated during treatment
procedures . Touch surfaces include ;
Dental light handles
Dental unite controls and
Chair switches

B) Transfer surfaces :
are touched by contaminated instruments
such as instruments trays .

C) Splash , spatter , and droplet


surfaces : countertops are a major
example .
Touch and transfer surfaces should be either
barrier-protected or cleaned and disinfected
between patients . In the same time , splash ,
spatter , and droplet surfaces should be cleaned
at least once daily .

Dealing with surface contamination


The goal of the two methods to deal with
surface contamination are :
1- To prevent the surface from becoming
contaminated
by the use of a surface barrier .
2- To preclean and disinfect the surfaces
between
Patients .
Each method has advantages and
disadvantages , and most dental offices use a
combination of surface disinfection and surface
barriers .

Surface barriers :
Surface barriers are
used to prevent
contamination on the
surface underneath .
All the surface barriers
should be resistant to
fluids in order to
prevent microorganisms
in saliva , blood , and
other liquids from
soaking through the
barrier and reach the
surface underneath .

Chair Drapes

Film Dispenser

Some plastic bags are specially designed to


the shapes of the dental chair , air-water
syringe , and light handles .

Sticky tape as a plastic barrier is frequently


used to protect smooth surfaces , such as
electrical switches on chairs and x- ray unite

Infection Control During the


Post-Treatment Period
1. Continue to wear personal protective
equipment during clean-up: After patient
care is completed, begin the cleaning and
disinfection process by removing
contaminated gloves used during treatment,
wash your hands and use the utility gloves
before beginning the clean up. Continue to
wear protective eyewear, mask, and gown.
2. Remove all disposable barriers : All of the
barriers placed before treatment, including
light handle covers and countertop barriers,
should be removed.


Cleaning and disinfection of the dental
treatment room surfaces are important
components in an effective infection control
program .
Precleaning
Precleaning means that all contaminated
surfaces must be precleaned before they can
be disinfected . Precleaning reduces the
number of microbes and remove blood ,
saliva , and other body fluids .
Precleaning techniques are most
effective when used on contaminated surfaces
that are smooth and easily accessible for
cleaning .

Materials used for precleaning regular soap


and water always used for precleaning .
However , a disinfectants that can cleans as
well as disinfect are present today .
Disinfection
Disinfection is directed to kill disease-causing
microorganisms that remain on the surface
after precleaning .
N.B always do not confuse disinfection with
sterilization . Sterilization is the process in
which all forms of life organisms are
destroyed .
The term disinfectant is used for chemicals
that are applied for cleaning surfaces , such as

Disinfectants
Disinfectants are chemicals that destroy or
inactivate most species of pathogenic
( disease-causing ) micro-organisms . In
dentistry , only those products that registered
with the U.S Environmental protection Agency (
EPA ) with tuberculocidal action should be used
to disinfect dental treatment areas .
Ideal surface disinfectant
The ideal surface disinfectant must be rabidly
kills a broad spectrum of bacteria , has residual
activity , minimal toxicity , odorless ,
inexpensive and does not damage surfaces to
be treated .

Disinfectant such as :
Iodophors :
Iodophors are EPA-registered hospital
disinfectants with tuberculocidal action .
It is recommended for disinfecting surfaces
after dental treatment .
Iodophors are usually effective within 5 to 10
minutes .
Non-irritant and non-toxic .
Unstable solution must be changed
regularly .
Because they contain iodine , iodophors may
corrode or discolor certain metals and
temporarily may cause red or yellow stains on

Synthetic phenol compounds :


Are EPA-registered intermediate-level hospital
disinfectants with broad-spectrum activity
( can kill a wide rang of microbes ) that used
for surface disinfection .
Phenol can be used on metal , glass , rubber ,
or plastic .
They also may be used as a holding
solution for instruments , however , phenols
leave a residual film on treated surfaces .
Synthetic phenol compounds must be
prepared daily .
Non irritant , non-toxic and non-corrosive .

Sodium hypochlorite :
Sodium hypochlorite is a fast-acting , economic
and broad-spectrum intermediate-level
disinfectant .
Disinfectant effect observed after 10 minutes .
The Centers for Disease Control and prevention
( CDC ) currently recommended the use of up
to 1 100 dilution of sodium hypochlorite for
surface decontamination .
The disadvantages
Unstable solution need daily preparation .
It has a strong and unpleasant odor .
Irritant for skin and eyes .
Corrosive for some metals .

Alcohol :
Ethyl alcohol and isopropyl alcohol have been
used over the years as skin antiseptics and
surface disinfectants . However , alcohol are not
effective in the presence of blood and saliva
droplets because of the rapid rate of
evaporation will limits the antimicrobial activity
of alcohol . In addition , alcohols are damaging
to certain materials , such as plastics and vinyl .
The American Dental Association ( ADA ) ,
CDC , and OSAP do not recommend alcohol as
an environmental surface disinfectant .

Chlorine dioxide :
Chlorine dioxide can be used as an effective ,
rapid-acting , environmental surface
disinfectant ( 3 minutes ) or as a chemical
sterilant ( 6 hours ) .
The disadvantages
(1) it must be prepared fresh daily .
(2) it is corrosive to aluminum containers

Classification of instruments and


equipment :
According to the Centers for Disease Control
and Prevention, dental instruments are
classified into three categories depending on
the risk of transmitting infection.
1) Critical instruments are those used to
penetrate soft tissue or bone and should be
sterilized after each use. Sterilization is
achieved by steam under pressure
(autoclaving), dry heat, or heat/chemical vapor
.

2) Semicritical instruments
are those that do not penetrate soft tissues or
bone but contact oral tissues, such as
amalgam condensers, air/water syringe , tips
mirrors, intraoral radiography accessories,
digital radiography sensors, and other dental
high-technology instruments . These devices
should also be sterilized after each use. In
some cases, however, high-level disinfection is
appropriate. A high-level disinfectant is
registered with the U.S. Environmental
Protection Agency (EPA) as a
"sterilant/disinfectant" and must be labeled as
such.

3) Noncritical instruments
are those that come into contact only with
intact skin such as external components
of X-ray heads. Such devices have a
relatively low risk of transmitting infection
and, therefore, may be reprocessed
between patients by intermediate-level or
low-level disinfection.

Managing contaminated
sharps :
Contaminated needles and other disposable
sharps , such as scalpel blades , orthodontic
wires , and broken glass must be placed into
a sharps container .
OSHA , CDC and the EPA classify sharps as
infectious waste .
According to OSHA regulations , disposable
sharps must be placed in a puncture
resistant , closable , and color-coded or
labeled with the biohazard symbol container
immediately after use .

Biohazard symbol

Proper processing of contaminated


dental instruments in a six-steps process
as :
1) Transport : transport contaminated
instruments to the processing area .
2) Cleaning : clean instruments with a handfree , mechanical process such as an ultrasonic
cleaner or instrument washer.
3) Packing : warp/package instruments in
appropriate materials containing an external
process indicator .
4) Sterilization : place the packages in a single
layers or in
racks to increase circulation of the sterilizing
agent

5) Storage: Store instruments in a clean , dry


environment in a manner that maintains the
integrity of the package . Rotate packages
so that those with the oldest sterilization date
will be used first .
6) Delivery : deliver packages to point of use
in a manner that maintains sterility of the
instruments until they are used . Inspect
each package for damage .

Holding solution :

If the instruments can't be cleaned


immediately after procedures, they should be
placed in a holding solution to prevent drying
of blood and debris on the instruments .

A holding solution is a
liquid disinfectant/sterilizing solution used to
soak contaminated instruments before they are
cleaned and sterilized. It has the purpose to:
Decrease infectious microbes on instruments .
Loosen and minimize debris before scrubbing
or

The holding solution must be:


Non-corrosive liquid,
Of low cost,
Non-staining and
Readily available.
The holding solution should be changed at least
twice daily

It is important to use a covered container with a


separate instrument basket to ensure complete
immersion.
Remember , a holding solution is necessary
only when contaminated instruments cannot be

The holding solution

Precleaning and packaging instruments


Precleaning is done in three ways:
- Hand scrubbing
- Ultrasonic cleaning
-Instrument washing machine

Hand scrubbing

This method is unfavorable because it


requires direct hand contact with the
contaminated instrument and accidental
injury from these contaminated items may
happen.
During hand scrubbing we must follow the
following precautions
1- Wear eye wear and puncture-resistant
gloves (P.P.E ) .
1- Clean only one by one .
2- Use only a long-handled brush .
3- Do not immerse items in soapy water or

Ultra-sonic cleaning
Ultrasonic cleaning is recommended in place
of hand-scrubbing in order to reduce direct
staff contact with contaminated instruments.
The ultrasonic cleaner works by producing
sound waves which causes formation of
bubbles in liquid . The bubbles are too small
to be seen .
The mechanical cleaning action of the
bubbles combined with the chemical action of
the ultrasonic solution removes the debris
from the instruments .
Instruments should be processed in the
ultrasonic cleaner until they are visibly clean .

Automated
washer
It looks similar to a
household dishwasher.
It uses a combination of
very hot water together
with a detergent to
remove the organic
material. It is
considered as
disinfector because it
subjects the
instruments to a level
of heat that kills most

Packaging instruments
Before sterilization the instruments must be
packaged to protect them from becoming
contaminated after sterilization .
They can be contaminated by aerosols in the
air , dust , or contact with nonsterile
surfaces .
An additional advantage to packaging
instruments is that they can be grouped into
.special setups

Sterilization monitoring

Sterilization monitoring
Because sterilization failure can occur at any
time, it is critical to determine that dental
instruments are properly sterilized or not
because microorganisms can not be seen by
.naked eye
Nowadays, three forms for sterilization
:monitoring are used

PHYSICAL
CHEMICAL
BIOLOGICAL

:Physical monitoring
Physical monitoring of the
sterilization process
involves looking at the
gauges and readings on
the sterilizer and recording
the temperatures,
pressure, and exposure
time. Remember that the
temperature recorded is
for the chamber, not the
inside of the pack.
Therefore, problems with
overloading or improper
packaging would not be

Chemical monitoring:
Chemical monitoring involves the use of heatsensitive chemicals that change color when
. exposed to certain conditions
The two types of chemical indicators are
process
indicators and process integrators.
Process indicators
This is used externally outside the
instruments packages like autoclave tape and
color change marking. Its aim is to determine if
the package is processed or not.
They simply identify instrument packs that

They do not measure the duration or the


pressure. They are useful only in
distinguishing between packages that were
processed and those that were not processed.
This can prevent accidental use of
unprocessed instruments.

Process integrators
Process integrators are placed inside
instrument packages. They respond to a
combination of pressure, temperature, and
time. All sterilization factors are integrated.
Examples of process integrators include
strips, tabs, or tubes of colored liquid.

Biologic monitoring
This is the best way to determine if
. sterilization has occurred
Biologic monitoring , or spore testing, is the
only way to determine if sterilization has
occurred. The CDC, American Dental
Association recommend at least weekly
.biologic monitoring of sterilization equipment
Biologic indicators (BIs), also known as spore
tests, are vials or strips of paper that contain
harmless bacterial spores (spores are highly
.resistant to heat)
:Method
Three BIs are used in testing. Two BIs are
placed inside instrument packs, and the

The third strip is set aside as a control. After


the load has been sterilized, all BIs are
cultured. If the spores survive the sterilization
cycle (a positive culture), a sterilization failure
has occurred. If the spores are killed (a
negative culture), the sterilization cycle was
.successful

Sterilization in the dental office :


The three most common forms of heat
sterilization in the dental office are :
Steam sterilization,
Chemical vapor sterilization, and
Dry heat sterilization.

1) Steam sterilization : involves


heating water to generate steam,
producing a moist heat that rapidly
kills microorganisms. As the steam
completely fills the sterilizing
chamber, the cooler air is pushed out
of an escape valve, which then closes
and allows the pressure to increase
which increase the temperature
reaches up to 120 C which is higher
than boiling water . It is the heat, not
the pressure that actually kills the
microorganisms.

A disadvantage of steam sterilization is that


the moisture may cause corrosion on some
high-carbon steel instruments. Distilled water
should be used in autoclaves instead of tap
water, which often contains minerals and
impurities. Distilled water can minimize
corrosion and pitting.
0peration cycles :
Dental office steam sterilizers usually operate
through four cycles :
1) heat-up cycle
2)
sterilizing cycle
3) depressurization cycle
4) drying
cycle

Flash Sterilization
involves sterilizing unpackaged instruments
using short exposure times. The instruments
are placed in the chamber unwrapped. The
sterility of the instruments is defeated
immediately when the instruments are
removed from the sterilizer.
Flash sterilization should be used only for
instruments that are to be used promptly on
removal from the sterilizer.

Dry-heat Sterilizers
Dry-heat sterilizers operate by heating air and
transferring that heat from the air to the
instruments. This form of sterilization requires
higher temperatures than steam or chemical
vapor sterilization . temperature ranges
between (160 C to 190 C) .
The total cycle time :
placing instruments in oven, heating to 170 C,
timing for 1 hour, and then cooling it from 2
2.5 hours .
The advantage of dry heat is that the
instruments will not rust if they are thoroughly
dry before they are placed in the sterilizer.

Chemical liquid sterilization

Used for some types of plastics items that can


damaged by heat such as some rubber dam
frames , shade guides , and x-ray film-holding
devices .
A liquid sterilizer such as 2% to 3.4%
Glutaraldehyde must be used for sterilizing
these items .
Sterilizing in Glutaraldehyde requires a 10
hours contact time, but if it is less than 10
hours, it is only disinfection, not sterilization .
Glutaraldehyde must be used full strength
( not diluted (

STERILIZATION FAILURE

Several factors can cause the sterilization


.process to fail

Examples of common mistakes include :


overloading of sterilizer chamber .
lack of separation between packs or trays in
the chamber .
wrong packaging material for method of
sterilization .
more than two layers of wrap, inhibiting
penetration .
sterilizer timer malfunction .
improper cleaning of items to be sterilized.

Sterilization of hand pieces is


recommended whenever possible

Hand pieces that are designed for steam


sterilization between uses are preferred. When
a hand piece cannot be heat or steam
sterilized, chemical disinfection can be used as
an alternative.

Best
wishes for
you
Dr. Hesham Dameer

Ase
el