Transcript Dry heat sterilization

Sterilization
Sterilization stages
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 disinfection
 presterilizing cleaning
 sterilization
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Disinfection and
presterilization cleaning
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Disinfection is the killing of many, but
not all microorganisms. It is a process
of reduction of number of
contaminating organisms to a level
that cannot cause infection, i.e.
pathogens must be killed. Some
organisms and bacterial spores may
survive.
Sterilization is the killing or removal of
all microorganisms, including bacterial
spores which are highly resistant.
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Sterilization is an absolute term, i.e.
Disinfection in health care center includes:
1. Mechanical disinfectants (removal of
microorganisms from objects or disinfection
by shaking, rubbing, ventilation, laundry,
washing, cleaning).
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2. Physical disinfectants (disinfection
by exposure to physical agents: UV
radiation, dry heat, steam, boiling).
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3. .Chemical disinfectants (halogens
and, oxygen-containing, surfaceactive agents, guanidines
aldegidosoderzhaschie, alcohols,
phenol, acid).
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Among disinfection measures, the
effectiveness of which is provable,
chemical disinfection is the least
important. More important is, for example,
the accuracy of medical staff, patients and
quarantine use sterilized tools and
material.
(I.F. Vetkina)
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With all the variety of disinfectants, the
number of components within them is very
limited. The drug composition includes active
ingredients such as halogens, alcohols,
peroxides, phenols, quaternary ammonium
compounds, aldehydes, tertiary amines, acid.
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Note that each of these compounds
has a specific spectrum anti-microbial
activity, which determines the
effectiveness of the disinfectant
produced based on this compound
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Some cases, a combination of several
chemical agents allows to expand the
antimicrobial spectrum of activity of the
drug (synergistic effect or potentiation),
however, is determined by the action
provided by the main chemical substances
in this preparation.
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Active
substance
Gram(+) /gram(-)
bacterium
Fungus
Mycobac
teria
Enveloped/noneveloped
virus
Glutaraldehy
de
Alcohols
Phenols
Ammonium
compound
Guanidine
Peroxide
compounds
Iodine
-overall
effectiveness
- limmited
effectiveness
- No effect
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Modern disinfectant shall conform to a few
basic requirements, without which the
implementation of any drug can not be
recommended for use:
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1. Microbiological efficacy
2. The safety for use as a for the staff and
patients
3. Compatibility with the processed materials
4. economy
5. The degree of resistance to the organic load
(e.g., blood)
6. speed (the desired exposure)
7. The presence of smell
8. The absence of flammability and explosivity
9. easy to make, use, disposal.
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With regard to the health center
depending on the type or nature of the
devices treated surfaces need to use
different decontamination technologies and
various disinfectants. That is why it has
difficult problems with selecting optimal
disinfectants based their action spectrum,
safety, and cost of the object type.
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A rational approach to disinfection and
sterilization of instruments and means
of care for patients was developed in
1968 by the American scientist
I.H.Spoldingom.
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I.H.Spolding offered to share health
products and tools into 3 categories
depending on the risk of infection
associated with the use thereof:
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1) critical - penetrating through the cover
in the body's tissues
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2) half-critical - in contact with intact
mucous membranes and intact skin
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3) non-critical - only contact with
intact skin.
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Depending on this, the respective
medical devices shall be sterilize or
disinfect different levels - high,
intermediate, low levels.
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The high-level disinfection is meant
disinfection at which destroyed pathogenic
and opportunistic pathogenic microorganisms
(viruses, including the causative agents of
parenteral hepatitis, HIV, bacteria,
including Mycobacterium tuberculosis, fungi
of Candida and dermatophytes), and the
number of spores is reduced.
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The main active ingredients
included in the modern
disinfectants
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Chlorine-containing drugs. They have a
wide antimicrobial spectrum of activity
(although prolonged use of drugs on the
basis of chlorine in health centers has
resulted in microbial resistance to these
drugs). These drugs have a number of
drawbacks. All products containing chlorine,
have a pattern: the drug acts faster and
wider than its spectrum of antimicrobial
activity, the higher the corrosion of
materials
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Iodine-containing drugs. Have a wide
spectrum of antimicrobial activity, but
have no effect on bacterial spores. A
significant disadvantage of using an iodine
solution is a tanning and cauterizing effect
on the tissues of the body and
development of hypersensitivity (other
than iodine-containing water-soluble
polymer compositions (iodophors).
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Alcohols. The most common components
of antiseptics. There are about 14 kinds of
alcohols, but mostly used in medicine,
ethyl and isopropyl alcohols. All alcohols
have a wide antimicrobial spectrum
(except spores), quickly evaporate
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Phenol. One of the first disinfectants, but
at present pure form is not used because
of their toxicity. A feature of phenols is
their ability to create a residual film on the
surfaces to be disinfected.
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Quaternary ammonium compounds ("quats"),
such as benzalkonium chloride, are a large
group of related compounds. Some
concentrated formulations have been shown to
be effective low-level disinfectants.
Quaternary Ammonia at or above 200ppm plus
Alcohol solutions exhibit efficacy against
difficult to kill non-enveloped viruses such as
norovirus, rotavirus, or polio virus.[11] Newer
synergous, low-alcohol formulations are highly
effective broad-spectrum disinfectants with
quick contact times (3–5 minutes) against
bacteria, enveloped viruses, pathogenic fungi,
and mycobacteria. Quats are biocides that also
kill algae and are used as an additive in largescale industrial water systems to minimize
undesired biological growth.
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Aldehydes, such as formaldehyde and
glutaraldehyde, have a wide
microbiocidal activity and are
sporicidal and fungicidal. They are
partly inactivated by organic matter
and have slight residual activity.
Some bacteria have developed
resistance to glutaraldehyde, and it
has been found that glutaraldehyde
can cause asthma and other health
hazards, hence ortho-phthalaldehyde
is replacing glutaraldehyde."
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Hydrogen peroxide, a peracid. This group have a
broad spectrum activity, including the spore forms
of bacteria that allows their use for sterilization.
This is a very promising group, slightly toxic,
quickly decompose, do not have a specific smell,
are effective over a wide range of positive and
negative temperatures. Relatively new development
disinfectants - based composition of hydrogen
peroxide solutions with the addition of an organic
acid. Formed in a peracid composition significantly
improves the disinfecting activity of the drug,
since even spore forms of microorganisms are
inactivated within a few minutes.
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Tertiary amines (amphotensides). It is a new
type of disinfectant, the interest which is due
to their high microbiological reliability - they
are active against bacteria (including
mycobacteria), fungi and viruses that have low
toxicity and good detergent properties. Tertiary
alkylamines peculiarity is that they combine the
properties of surfactants and, under certain
conditions, the properties of the quaternary
ammonium salts. And due to the presence of
free amino groups and tertiary nitrogen atom
form an alkaline environment, thereby increasing
their antimicrobial activity, particularly in
combination with other substances.
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Main characteristics of disinfectants
and chemical sterilants that used in
healthcare (S.S.Block, 2001)
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Plastic
container.
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In addition to dental clinic disinfectants
needs water distiller
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Electric water distiller
ДЭ-4-2-"ЭМО"
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Mechanical cleaning of dental
instruments
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For manual cleaning must be at least 45
seconds to clear the tool
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Cleaning by ultrasound instrument
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High-quality cleaning effect is
achieved by the formation of fluid in
the ultrasonic cavitation - of impulses
of pressure that occur at the closing
of cavitation, impact and microflow
microflows cavitating cleaning solution
in the ultrasonic field at the surface
and the internal cavities of tools.
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
Provides guaranteed dental cleaning
(drills and other endodontic instrument),
surgical, microsurgical and cosmetology tool
from contaminants such as occult blood,
remains of dentin, filling material etc..
 It allows you to reduce the complexity and
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eliminate the risk of infection with viral
hepatitis and AIDS through the tool.
he average duration of the cleaning cycle is
less than 10 minutes.
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Ultrasonic
for cleaning small
tools (drills)
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Inside is catching net,
making it easy and safe to remove
instruments
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Ultrasonic
Processing Time
15 minutes
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To increase processing efficiency
with a large amount of tools, it is
desirable to place in pairs - one for
the cleaning solution, the other - for
distilled water for better cleaning of
the detergent solution.
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After a double cleaning tools are
extracted are dried and placed in the
chamber of the autoclave or drying
oven
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Quality control presterilizing
cleaning and work of the
autoclave and drying oven
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Quality control presterilizing cleaning
dental instruments includes:
1.Controlling the presence of blood using the
azopirami or amidopirini
2.Determination of cleaning agent residues by
Phenolphthalein tests
3.Control of the availability of the fat layers
using samples with Sudan III
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 Control daily subjected to 10% of
both processed products of the same
name (the party), but not less than
3-5 samples.
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Capacity is required to be
marked
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50/50
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Do not expose the hot checking tools
to keep working solution in bright light
or elevated temperature.
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Azopiram except for traces of blood
detects the presence of in the
products of residues of plant
peroxidases, oxidants, rust (iron
oxides and salts) and acids. In the
presence of the test products on rust
and chlorine oxidants observed
brownish coloring reagent, in other
cases - a pinkish-violet coloring.
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On a reamer founded traces of
biological contamination
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Suitability azopiram’s solution can be
checked, having put 2-3 drops of
solution on a napkin with blood. In the
case of purple or lilac coloring no
later than 1 minute, the reagent is
suitable for use. Otherwise, the
reagent can not be used.
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Coloring no later than 1 minute
reaction
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Reaction with Amidopyrine
For this sample used amidopyrine 5%
solution with 95% alcohol. This
solution can be stored for 1 month in
a refrigerator.
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Before the sample mixed equal volumes:
5% alcohol solution amidopirina
30% acetic acid solution
3% hydrogen peroxide solution
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Reaction with phenolphthalein
As the reagent of the sample using a
1% phenolphthalein solution in alcohol,
which contains 60 g of alcohol, 40 g
of distilled water and 1 g of
phenolphthalein.
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№
Name of the
reagent
Seeking
contamination
exposition
Coloring
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Azopiram
Blood, rust
1 min
Pink-lilac,
brown
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Amidopyrine
Blood
1 min
Blue-green
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phenolphtalein
Detergent
1 min
Pink
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Sudan III
The fat
layers
10 sec
Yellow
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Final sterilization of dental
instruments
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Methods of sterilization

heat (steam, air, glassperlenovy)
chemical (gas, chemical solutions )
radiation
plasma and ozone
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Glasperlenovy sterilizer
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The most common methods of sterilization
include:
steam
(Autoclaving)
air
chemical
(Dry heat sterilization)
(Gas, chemical solution)
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The steam can sterilized all
instruments and medical devices,
except for optical devices and
removable optical components, and
also some types of plastics.
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For this purpose, use an autoclave - an
apparatus for steam sterilization under
pressure of surgical dressings, instruments
for the decontamination of infected
material, surgical gowns, etc...
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Mobile autoclave
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Stationary autoclave
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Cotton balls are placed in kraft bags after
sterilization no more than 30 pieces.
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Dry heat sterilizer
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sterilization mode by air for glass and
metal tools:
Dry heat sterilizer (temperature –
180° C) - 60 minutes
Dry heat sterilizer (temperature –
160 ° C) - 150 minutes.
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Controlling the quality of sterilization:
bacteriological method of control
It is carried out by employees of
Biotest CGSEN once a quarter
chemical control method
Carried out by means termo
indicators for each sterilization.
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Changing color from white to brown
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Idication 180 С for
Dry heat sterilizer
Indication 130 С for
Autoclave
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контроль
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The indicators are placed at different
levels in the
autoclave or dry heat sterilizer, after
working cycle control tape pasted into
an accounting journal
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Dental saliva ejector after chemical
sterilization
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Dental mirror chemically sterilized,
sterilization by steam mirror surface is
damaged
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Features disinfection of
dental impressions
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Alginate impression
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Alginate impressions washed with
running water and placed for 10
minutes in a container with "CIDEX",
after the impression is repeatedly
washed with water and made plaster
model.
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Silicone oneside
impression
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Silicone impressions also washed with
water, and then disinfected with
0.1% within 10 minutes in a "dezoxon"
solution, washed with running water
and made jaws model.
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Gas sterilization method for the
endodontic, surgical instruments,
needles :
ethylene oxide;
formaldehyde
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Storage cabinets for tool with a UV
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irradiator
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The clinical part
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Personal protective
equipment and
appearance of a dentist
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стоматолог
санитарка
администратор
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Проводить стоматологические
манипуляции необходимо в
специальной униформе (костюме) с
длинным рукавом, из натуральных
тканей.
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