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By:

Mohit Gupta,
Roll No.:45
Mohit Verma,
Roll No.:46
STERILIZATION:
It is the process by which the article, a surface, or
medium is freed of all microorganisms including viruses, bacteria, and
spores, fungi both pathogenic and nonpathogenic.

DISINFECTION:

Process of destruction or removal of organism, capable of


giving rise to infection. These are capable of killing vegetative bacteria, fungi,
viruses and bacterial spores.

ANTISEPSIS:

Destruction or inhibition of microorganism in living tissues


thereby limiting or preventing harmful effects of infection. A disinfectant
applied to a living tissue is antiseptic
STEPS IN STERILIZATION
 Presoaking
 Cleaning
 Corrosion control
 Lubrication
 Packaging
 Sterilization
 Sterilization monitoring
PRESOAKING:

Keeping the instrument in holding solution i.e. mild detergent or


instrument disinfectant or sterilant.
IMPORTANT: Not to presoak for more than few hours as the
chances for corrosion of non stainless items.
Wearing of gloves and protective eyewear is advisable to
prevent contamination from splashing of solution.

CLEANING:

Cleaning is basic step for all decontamination.


Patient debris and body fluids must be
removed from instrument before sterilization. It is
of two types:
o Hand scrubbing
o Ultrasonic cleaning
Ultrasonic cleaning involves cleaning in a solution so
it advisable to be used over hand scrubbing as hand
scrubbing can cause any puncture in skin and can
contaminate the operator.  ULTRASONIC CLEANING INSTRUMENT
Corrosion control and lubrication
 Always dry cleaned instrument to be processed through a dry heat,
chemical vapor or ethylene oxide gas sterilizer. Drying reduces chances of
corrosion.
 A rust inhibitor can be applied to non stainless items to be processed
through steam autoclave

Packaging:
 Instruments should be prepackaged before processing through a sterilizer
so they will protected from contamination after sterilization.
 Unwrapping instrument at chair side in front of patient can help build
patient confidence about cleanliness of clinic.

Sterilization monitoring:
 Sterilization can be monitored by chemical indicator i.e. color change but
effectiveness cannot or can be biologically monitored by routine spore
testing.
AGENTS OF
STERILIZATION
Physical Agents Chemical Agents
 Sunlight  Alcohols
 Drying  Phenols and phenolic
 Heat compounds
 Filtration  Halogens
 Radiation  Heavy metals and their
 Low temperature salts
 Dyes
 Desiccation
 Quaternary tertiary
compounds
 Aldehydes
 Gases
SUNLIGHT

 Ultraviolet rays with heat rays cause


germicidal activity.
 It is employed for sterilization of water in
tanks, rivers, lakes.

DRYING

 Drying has deleterious effect on many


bacteria. Spores are unaffected by drying.
HEAT

 Reliable, certain, rapid, most important,


widely used method of sterilization and
leaves no potentially harmful residues. It is
of two types:
 Dry heat
 Wet heat
DRY HEAT

 Killmicroorganism by destructive oxidation


of essential cell constituents.
 Dry heat at 1000C for 60 minutes and 1150C
for 60 min kill all vegetative bacteria and
spores respectively.
 Spores can be killed by dry heat at 1600C for
1 hour or 1800C for 20 minutes.
 Dry heat is less efficient
METHODS OF DRY HEAT
Red heat:
Inoculating loops, wires, points of forceps and spatulas in
Bunsen burner flame till red hot

Flaming:
Scalpel blades, needles, mouths of culture tubes, bottles,
glass slides, cover slips, by passing through Bunsen flame
without red hot

Incineration:
 Soiled dressing and pathological
materials are burned to ash and
are physically destroyed

Incineration
plant
HOT AIR OVEN:

For glassware, metal instruments, sealed materials,


swab sticks are sterilized. It is not suitable for fabrics. It
is electrically heated and fitted with thermostat that
maintains chamber air at chosen temperature and fan
than distributes hot air in chamber. It should not be
overloaded and space must be left for circulation of air
through load. Holding time in hot air oven is 1 hour at
1600C or 20 minutes at 1800C

Hot Air
Oven
WET HEAT

It causes denaturizing and coagulation of


proteins. It works on the principle that steam
condenses on cooler surface, release latent heat
and raises temperature of surface. If spores
present, steam condenses on them and
increase their water content leading to
hydrolysis and breakdown of proteins.
Method of wet heat
At temperature below 1000C
 Heat labile liquids may be disinfected NOT STERLIZED by heating
below 1000C

 Pasteurization of milk and butter is done. The temperature employed


is 630C for 30 minutes {holder method} or 720C for 20 seconds {flash
method} and followed by cooling to 130C or lower. Non sporing
organisms are destroyed. However Coxiella burnetii, causative agent
of Q fever survives.

 Ultra pasteurization: Milk is bought in contact with steam at 1400C for


1-2 seconds. Milk is flash cooled by application of a slight vacuum,
serves dual purpose of removing excess water in milk from condensing
steam.

 Heat labile fluids such as serum, is disinfected by heating at 560C for 1


hour. If temperature rises above 590C it will coagulate.
At temperature of
1000C
Boiling at 1000C:
 It is done for 10-30
minutes. Kill vegetative
bacteria and spores but is
inactive against viruses. It
is not recommended for
sterilization of instruments
for surgical procedure as it
is ineffective against many
bacterial and fungal
spores. It is useful for
reducing viable levels if no
better method is available.
Steam
Sterilizer
Free steam at 100 C: 0

Tyndallization:
 It is a lengthy process designed to reduce
the level of activity of sporulating bacteria
that are left by a simple boiling water
method.
 Complete sterilization is ensured after an
exposure of 1000C for 20 minutes on three
consecutive days. This process is also
called as intermittent sterilization.
 The three incubating periods are to allow
heat resistant spores surviving previous
boiling periods to germinate to form heat
sensitive vegetative stage, which can be
killed by next boiling step.
 This is effective because many spores are
stimulated to grow by heat shock. This
procedure only works for media that
supports bacterial growth. TYNDALLI
ZATION
At temperature above
1000C
AUTOCLAVE:

 Steam above 1000C or saturated steam more


efficient and effective, fast and reliable
sterilizing agent than hot air.
 It provides greater lethal action. Quicker in
heating up the exposed article.
 It penetrates easily pores material like cotton
wool stoppers, papers, cloth wrapper, surgical
linen, and hollow apparatus.
 It operates on time temperature relationship.
 Higher temperature ensures more rapid killing.
Standard temperature/pressure is 1210C/15psi
for 15 minutes.
 Longer times are needed for longer loads, large
volumes and dense materials.
 Autoclaving is ideal for sterilizing biohazadous
waste, surgical dressing, glassware, and micro
media. liquid, instruments
 Plastics and fiber optic endoscopes cannot
withstand autoclaving.
 When proper condition and time are employed,
no living organism survives a trip through
autoclave.
Parts Of
Autoclave
 Autoclave is an effective sterilizer because an
autoclave is a large pressure cooker; it operates by
using steam under pressure as the sterilizing agent.
 High pressures enable steam to reach high
temperatures, thus increasing its heat content and
killing power. Most of the heating power of steam
comes from its latent heat of vaporization. This is the
amount of heat required to convert boiling water to
steam. This amount of heat is large compared to that
required to make water hot.
 For example, it takes 80 calories to make 1 liter of
water boil, but 540 calories to convert that boiling
water to steam. Therefore, steam at 100º C has
almost seven times more heat than boiling water.
Steam is able to penetrate objects with cooler
temperatures because once the steam contacts a
cooler surface it immediately condenses to water,
producing a concomitant 1,870 fold decrease in
steam volume. This creates negative pressure at the
point of condensation and draws more steam to the
area. A condensation continues so long as the
temperature of the condensing surface is less than
that of steam.
 These properties ensure rapid heating of surfaces,
good penetration of dense materials, and
coagulation of proteins.
 Autoclave is essentially a double jacketed steam chamber equipped
with devices which permit the chamber to be filled with saturated
steam and maintained at a designated temperature and pressure for
any period of time.
 In operation of an autoclave it is absolutely essential that the air in
the chamber be completely replaced by saturated steam. if air is
present , it will reduce the temperature obtained within the chamber
substantially below that which would be realized if pure saturated
steam were under the same pressure. It is not the pressure that kills
the organisms but the temperature of the steam.
FILTRATION
 Clear liquids that would be damaged by heat,
irradiation or chemical sterilization can be
sterilized by mechanical filtration.
 Commonly used for sensitive pharmaceutical
and protein solution in biological research.
 Filter with pore size 0.2micrometres will remove
bacteria.
 If viruses must also be removed a much smaller
pore size around 20nanometer is needed
A typical set-up in a microbiology
This water filter for laboratory for filtration sterilization of
hikers and backpackers medium components that would be
is advertised to denatured or changed by heat
"eliminate Giardia, sterilization. The filter is
Cryptosporidium and placed (aseptically) on the glass
most bacteria." The platform, then the funnel is clamped
filter is made from 0.3 and the fluid is drawn by vacuum into
micron pleated glass a previously sterilized flask. The
fiber with a carbon core. recommended size filter that will
exclude the smallest bacterial cells is
0.22 micron.
RADIATION
Inactivation of microorganisms occurs either through
direct ionization of a vital cellular molecule (DNA, key
enzyme, etc.) or indirectly through the reaction of the free
radicals produced in the cellular fluid.
It includes electron beams, X-rays, Gamma Rays,
subatomic particles.

Gamma Rays:
These are commonly used as they are very penetrating.
Used for syringes, needles, cannulas. It requires bulky
shielding for safety of operator. Require storage of
radioisotope (Co-60) which continuously emits gamma
rays.
Its disadvantage is that it cannot be turned off and always
present a hazard in area of facility.
Electron Beam:
 These are commonly used. It uses an on-off technology.
It provides a much higher dosing rate than gamma or X
rays. Due to higher dose, less exposure time is needed
and thereby any potential degradation is reduced.
Limitation of electron beams is that they are less
penetrating than gamma rays or X rays

X Rays:
 These are less penetrating and require longer exposure.
Require less shielding. It is generated by X ray machine
that can be turned off when not in use.
Ultraviolet Lamps:

 It is useful for sterilization of surface and


some transparent objects. Many objects
that are transparent to visible light absorb
UV. UV irradiation is routinely used to
sterilize the interior of biological safety
cabinets but ineffective in shaded area
including areas under dirt.

NOTE: in some parts of Europe, fruits and


vegetables are irradiated to increase their
shelf life up to 500%. The practice has not
been accepted in US. UV light can be used
to pasteurize fruit juices by flowing the
juice over a high intensity ultraviolet light
source.
Ultraviolet radiation
chamber
LOW TEMPERATURE
 Most organisms grow very little or not at
all at 00C.
 Perishable foods are stored at low
temperature to slow down the rate of
growth and consequent spoilage.
 Low temperatures are not bactericidal.
DESICCATION
 Desiccation of microbial cell causes a cessation
of metabolic activity, followed by decline in total
viable population.
 The time of survival of microorganisms after
desiccation varies depending on factors like kind
of microorganism, material in or on which the
organisms are dried, completeness of drying
process, and physical conditions etc.
 Species of gram negative cocci such as
gonococci and meningococcal are very sensitive
to desiccation.
 Streptococci are much more resistant.
ALCOHOLS
Most commonly used is ethyl alcohol in
concentrations between 50-90%, effective against
vegetative or non spore forming cells,
For practical application 70% concentration is used.
Methyl alcohol is not used in practice, only used for
fungal spores, and is highly poisonous as fumes may
cause injury to eyes.
Ethyl alcohol is used for reducing micro flora of skin
It is used for disinfection of clinical oral thermometers
ALCOHOLS contd.

Concentration above 60% is effective against


viruses
The higher alcohols- propyl, butyl, amyl and
others are more germicidal than ethyl alcohol
Propyl and isopropyl alcohols in concentrations
ranging from 40-80% are bactericidal for
vegetative cells.
Alcohols are protein denaturants and this
property accounts for antimicrobial activity.
Alcohols also damage lipid complexes in cell
membranes, and are also dehydrating agents.
PHENOLS AND PHENOLIC

COMPOUNDS
1st used as disinfectant by Sir Joseph Lister in 1880’s in England.
 Used to reduce infection of surgical wounds and surgical incisions.
 Phenol and phenolic compounds are very effective disinfectants.
 A 5% aqueous solution of phenol rapidly kills the vegetative cells of
microorganisms.
 Phenol, o-Cresol, m-Cresol, p-Cresol, o-Phenylphenol,
hexylresorcinol, hexacholophene are commonly used as
disinfectants
 Hexylresorcinol is a derivative of phenol having high bactericidal
activity and is employed as general antiseptics.
 Phenolic substances are bactericidal or bacteriostatic depending on
concentration
 Bacterial spores and viruses are more resistant than vegetative cells.
 2-5% aqueous solution is used to disinfect materials like sputum,
urine, feces, contaminated instruments, utensils
 Mode of action of these compounds are they act by disruption of
cells, precipitation of cell protein, inactivation of enzymes and
leakage of amino acids from cells.
HALOGENS
 Chlorine and iodine are halogens commonly used as
disinfectant.
 These are bactericidal and sporocidal.
 IODINE is one of the oldest and most effective germicidal
agents.
 Pure iodine is bluish black crystalline element having a
metallic luster.
 It is slightly soluble in water but readily soluble in alcohol
 Iodophores are mixture of iodine with surface active agents
which act as carriers and solubilizer for iodine. Having an
additional advantage of non staining and low irritant
property.
 Used for disinfection of skin, water, air and sanitization of
food utensils.
 Iodine is oxidizing agent, accounting for antimicrobial
activity
 CHLORINE another widely used disinfectant.
 The compressed gas in liquid form is universally
employed for purification of municipal water supplies.
 Available as hypochlorite (calcium hypochlorite, sodium
hypochlorite) and chloramines
 Chloramines used as disinfects, sanitizing agent or
antiseptics.
 Chlorine compounds are widely used in water treatment,
in food industry, for domestic uses and in medicine.
 Solution of sodium hypochlorite of a 1% concentration is
used for personal hygiene and as a household
disinfectant.
 Formation of hypochlorous acid forms the basis of
antimicrobial action.
HEAVY METALS AND
THEIR SALTS
 Most effective are mercury, silver, and copper.
 Mercuric chloride, mercurous chloride, silver
nitrate, silver lactate, silver picrate, copper
sulfate are the salts having antimicrobial activity
 They combine with cellular proteins and
inactivate them.
 High concentration of salts of heavy metals like
mercury, copper and silver coagulate
cytoplasmic proteins, resulting in damage or
death of cell.
DYES
 Triphenylmethane and Acridine dyes are used.
 Interfere with cellular oxidation processes.
 Both are bacteriostatic in high dilutions but have low
bactericidal activity
 Much active against gram positive than gram negative
 Acridine dye includes acriflavine, proflavine, euflavine,
aminacine.
 Used in treatment of burns and wounds
 Used for Ophthalmic application
 Used in bladder irrigation
QUATERNARY TERTIARY
COMPOUNDS
 It includes cationic detergents having high
bactericidal activity against gram positive bacteria
 Mode of action is by denaturizing of proteins,
interfere with glycolysis, and membrane damage
 Used as skin disinfectant, as a preservative in
ophthalmic solutions and in cosmetic
preparations.
ALDEHYDES
 Low molecular weight compounds are anti microbial.
 Include formaldehyde and gluteraldehyde
 Highly microbicidal and both have the ability to kill spores.

 FORMALDEHYDE simplest compound, and is a gas


which is stable in high concentrations and elevated
temperatures.
 Fumes of formaldehyde are noxious; they are irritating to
tissues and eyes.
 Used in sterilization of instruments, used for disinfection
and sterilization of enclosed areas

 GLUTERALDEHYDE more effective than formaldehyde


 Effective against vegetative bacteria, fungi, bacterial and
fungal spores and viruses.
 Used in medical field for sterilizing urological instruments,
lensed instruments, respiratory therapy equipments
GASEOUS AGENTS
 Gaseous sterilization is effective and is employed for
substances that are destroyed by heat.
 Ethylene oxide, beta-propiolactone, formaldehyde, ozone
are employed as gaseous agents.
 Ethylene oxide is a colourless gas soluble in water. It is
highly lethal to all kinds of microbes including spores and
tubercle bacilli. Plastic and rubber articles, blankets,
pharmacy products, complex apparatus such as heart
lung machine, dental equipments, books, etc. Inhibition
produced is irreversible, resulting in enzyme modification
and inhibition of enzyme activity.

Ethylene
Oxide
gas
chamber
 Beta-propiolactone is a condensation product of ketane and
formaldehyde known as betapropiolactone with boiling point of
1630C. it has low penetrating power but effective for fumigation
purposes than formaldehyde. Limitation is that it is carcinogenic
therefore 0.2% BPL is used.

 Ozone is used in industrial settings to sterilize water and air as


well as disinfectant for surface. It oxidizes most of organic matter.
But it is toxic and unstable gas, so it is not practical to use in
many settings. It has been recently approved for use in US. It
uses oxygen that is subjected to an intense electrical field that
separates oxygen molecules into atomic oxygen, which combines
with other oxygen molecules to form ozone. Los Angeles has one
of the largest municipal ozone treatment plants in world.

OZONE
GAS
CHAMBER
Low temperature gas plasma (LTGP)
used as an alternative to ethylene
oxide. It uses a small amount of liquid
hydrogen peroxide which is energizes
with radio frequency waves into gas
plasma, leading to generation of free
radicals and other chemical species
which destroy organisms

An LTGP sterilizer that


pumps vaporized H2O2 into
the chamber.
DISINFECTION
 Disinfection describes a process that eliminates many
or all pathogenic microorganisms on inanimate
objects, with the exception of bacterial spores.
 Disinfection can be accomplished by a number of
means that include heat and chemicals.
 Terminology, which has been adopted by the Center
for Disease Control (CDC) and is now widely used,
describes disinfectants in terms of their activity as set
out below:
 High-level disinfectants:
These are chemical sterilants, which when used for a
shorter exposure period than would be required for
sterilization, kill all microorganisms with the exception of
high numbers of bacterial spores.

 Intermediate-level disinfectants:
These may kill mycobacterium, vegetative bacteria,
most viruses, and most fungi but do not necessarily kill
bacterial spores.

 Low-level disinfectants:
These may kill most vegetative bacteria, some fungi,
and some viruses.
SPAULDING'S
CLASSIFICATION
 In 1968 Earle Spaulding devised a rational approach to
disinfection and sterilization.
 This is now referred to as Spaulding's classification and
it has been refined and retained over the years because
it is so clear and logical.
 Spaulding believed that instruments and equipment
should be cleaned and reprocessed according to the
level of risk associated with their intended use.
 The three categories he described were critical, semi-
critical and noncritical as in the table below.
FACTORS IMPACTING ON
STERILIZATION &
DISINFECTION
There are a number of factors that may nullify or limit the
efficacy of sterilization and disinfection processes. These
will be discussed in the next section and include:
prior cleaning of the object
the organic load present
the type and level of microbial contamination
the concentration of, and exposure time to, the biocide
the nature of the object (e.g., crevices, hinges, lumens)
the temperature and pH of the process
FACTORS
 Exponential relationship between the number of organisms killed
and the time taken to kill them.
 Microorganisms vary greatly in their resistance to chemical
biocides.
 More concentrated the biocide the greater its efficacy and the
shorter the time necessary to kill all the microorganisms
 Activity of most biocides increases as the temperature increases
 The production of thick masses of cells and extracellular materials
or biofilms can protect microorganisms from the cidal action
of biocides.
 Biofilms are microbial masses attached to surfaces that are
bathed with liquids. A biocide must saturate or penetrate the
biofilm matrix before it can kill the microorganisms within it.
 An increase in pH improves the antimicrobial activity of some
agents as with glutaraldehyde, but decreases the activity of
others such as hypochlorite's.
 Relative humidity influences the activity of gaseous agents such
as ethylene oxide.
 Water hardness reduces the rate of kill of some biocides
because divalent cations such as magnesium and calcium
interact with soap to form insoluble precipitates.
 Organic matter such as serum, blood, pus or faecal material may
interfere with the activity of biocides in at least two ways.
 Sterilize or disinfect an item it must be exposed to the
appropriate concentration of biocide for a certain minimum
contact time. All surfaces of the item must come in contact with
the biocide for that period of time.
NEW METHODS OF
STERLIZATION
Table 1. New methods in disinfection and sterilization
Process Agent Regulatory agency action

Disinfection Ortho-phthalaldehyde (Cidex OPA) FDA cleared, October 1999


Antimicrobial coating (Surfacine) Not FDA/EPA cleared

Superoxidized water (Sterilox) Not FDA/EPA cleared

Sterilization Liquid sterilization process (Endoclens) Not FDA cleared


Rapid readout ethylene oxide biological Not FDA cleared
indicator (Attest)
New plasma sterilizer (Sterrad 50) FDA cleared, January 1999
Ortho-phthalaldehyde
 It is a clear, pale-blue liquid (pH, 7.5), which typically
contains 0.55% OrthoPhthalaldehyde
 OPA has demonstrated excellent microbiocidal activity
in in vitro studies
 OPA has several potential advantages compared with
glutaraldehyde. It requires no activation, is not a known
irritant to the eyes and nasal passages, has excellent
stability over a wide range of pH (pH 3-9), does not
require exposure monitoring, and has a barely
perceptible odor. Like glutaraldehyde, OPA has
excellent material compatibility.
Surfacine: A New
Antimicrobial
Surfacine is a new, persistent antimicrobial
agent that may be used on animate or
inanimate surfaces.

Ethylene Oxide (EO)


Rapid Readout
A new method designed for rapid and
reliable monitoring of EO sterilization.
Indicates an EO sterilization failure by
producing a flourscene change and a visual
pH color change
Superoxidized Water

The concept of electrolyzing saline to create a


disinfectant is appealing because the basic materials,
saline and electricity, are cheap and the end product
(water) is not damaging to the environment. A
commercial adaptation of this process, Sterilox, is
available in the United Kingdom. The mode of action is
not clear but probably relates to a mixture of oxidizing
species. The main products are hypochlorous acid at a
concentration of approximately 144 mg/L and free
chlorine radicals. The solution has been shown to be
nontoxic to biological tissues.
Endoclens: A New Liquid
Chemical Sterilization
System
The system is designed to provide rapid,
automated, point-of-use chemical sterilization
of flexible endoscopes and consists of a
computer-controlled endoscope- reprocessing
machine and a new, proprietary liquid sterilant
that uses performic acid.
Hydrogen Peroxide
Plasma
 Alternative technologies to sterilize temperature-sensitive
equipment are being developed.
 A new hydrogen peroxide plasma sterilizer, the Sterrad 50,
was recently cleared by FDA. It is a smaller version (44-L
sterilization chamber) of the Sterrad 100 (73-L sterilization
chamber), cleared in 1991. The Sterrad 50 contains a
single shelf for placement of instruments to be sterilized
within a rectangular chamber, whereas the Sterrad 100 has
two shelves and a cylindrical chamber.
 The operational design of the two sterilizers is similar
except that the Sterrad 50 consists of two hydrogen
peroxide vapor-diffusion stage-plasma cycles.
 The sterilization cycles of the Sterrad 50 and Sterrad 100
are 45 minutes and 72 minutes, respectively.
ANTIBACTERIAL SOAP
 Antibacterial soap is any cleaning product to which active
antibacterial ingredients have been added. These
chemicals kill bacteria and microbes. They do not kill
viruses.
 Many, or even most, liquid hand and body soaps contain
antibacterial chemicals. Triclosan is a common
ingredient, as is alcohol. Since there is a great variety of
bacteria, effectiveness against any given type of
bacterium does not ensure that it is effective against
unrelated types.
 Some soap contains tetra sodium EDTA which is a
chelating agent that sequesters metals that the bacteria
require in order to grow. Other microbes also require
metals and so it is actually an anti-microbial agent that is
widely used even as a preservative. It appears to be fairly
harmless in the environment.
 Infectious dental patients are often undetected.
 Sterilization provides a method of instrument recycling that can be
monitored and documented to show that conditions for control of
disease transmission were indeed established.
 Because most instruments contact mucosa and or penetrate oral
tissues, it is essential that reuses instruments be thoroughly cleaned
and sterilized by accepted methods that can be routinely tested and
monitored.
 Heat sterilization takes less time than high level sporicidal disinfection,
which is required when heat or gas sterilization cannot be used.
 The four accepted methods of sterilization are:
 Steam pressure sterilization ( autoclave )
 Chemical vapor pressure sterilization ( chemiclave )
 Dry heat sterilization ( dryclave )
 Ethylene oxide sterilization
 Stainless steel instruments and mirrors used for operative,
endodontic, periodontics, or dental hygiene procedures can be
sterilized by any accepted methods.
 Both high speed and low speed headpieces are best autoclaved.
 Burs can be safely sterilized by dry heat or chemical vapour in
chemiclave or in gas sterilizer, but they may rust or corrode if not
protected from steam in autoclave.
 Patient load, turnaround time for instrument reuse, size of
instrument inventory and instrument variety, and instrument
quality must all be balanced against the type and size of
sterilizer selected and number of auxiliary personnel employed.
 Dirty areas which cannot be disinfected easily between patients
or which are not practical to disinfect between patients such light
handle and switches, dental unit switches, ultrasonic handle,
control buttons on the dental chair can be covered with clear
plastic wrap (cling film) or impervious plastic sleeves.
 Such covering become contaminated by splatter and direct
contact with gloved hands, the covering should be disposed
of (wearing gloves) into hazardous waste bags and replaced
between patients.
 If impermeable plastic coverings are not employed then a
surface disinfectant should be used to disinfect these items
and surfaces between patients.
 At the end of the clinical session all work surfaces whether
within the clean or dirty zones need to be thoroughly
cleaned and disinfected.
 Wearing of heavy duty household gloves offers greater
protection to the skin when using chemical disinfectants.
 Protective eyewear and masks should be worn during
environmental cleaning to protect the staff from exposure to
hazardous chemicals and infectious material.
Dental chair covered with
plastic sheet to prevent
Preventing
contamination
during X-ray
taking
Before and during patient treatment

 Designate dirty zones (likely to be contaminated during dental


treatment) from clean zones
 Clean zones: Cabinets, surgery drawers, radiographs, patients notes,
computer keyboards and pens are clean zones and should not be
touched with contaminated gloved hands or instruments
 During patient treatment impervious clinical sheets or plastic sheaves
should cover all work surfaces that cannot be readily disinfected
between patients
 Items can be passed into "dirty zones" but contaminated items should
not be passed out into "clean zones"
 Storage containers of dental materials should not be placed in the "dirty
zone"
 Remove cling film/plastic sheaves and disinfect "dirty zones" between
patient
 At the end of a working session all surfaces should be thoroughly
cleaned and disinfected using alcohol spray/wipe or proprietary
antimicrobial disinfectant spray/wipe
 Cleaning of spittoons : Clean outer surface first. Inner surface of bowl-
add (metered) dose of non-foaming disinfectant, wipe evenly around
inside of bowl, leave for time interval specified by manufacturer for
disinfectant to destroy microorganisms, rinse with bowl flush and then
discard disinfection cloth as hazardous waste
 Suction apparatus, aspirators, drains and spittoons should be
flushed daily with a non-foaming disinfectant/ detergent (e.g.
Tridaclens, Dekaseptol or Orotol) according to the manufacturer's
instructions.
 Trap filters must be removed and cleaned on a daily basis. Rinse
thoroughly before replacing. Bleach or hypochlorite should not be used
as they rust metal. Replace with new filters as specified by the
manufacturer.
 Dental unit waterlines should be drained down at the end of the day and
purged with a biocide for the time recommended by the manufacturer
 Work surfaces should be kept clear overnight
DENTAL IMPRESSIONS:

Dental impressions become contaminated


with saliva, blood and oral bacteria. Less
commonly they may become contaminated
with respiratory pathogens, which are
coughed up into the mouth from the lungs.
For example, impressions taken on a patient
previously diagnosed with tuberculosis were
found to harbor the causative agent
Mycobacterium tuberculosis .
 All impression must be cleaned and disinfected
before being sent to the laboratory.
 Wear gloves, mask, goggles /visor
 All impressions should be rinsed thoroughly in
running water to remove all visible signs of
contamination.
 Use a disinfectant that is compatible with
impression material. Immerse the impression in
the disinfectant for the specified time. Avoid spray
disinfectants, which are less effective and may
create an inhalation risk. Rinse off the disinfectant
with water.
 
IMPRESSION TRAYS:
 Commercially manufactured plastic impression
trays are for single patient use only. Do not clean
or reprocess then for subsequent reuse. After
single use they should be disposed of as clinical
waste by the practice or the dental laboratory.
 Metal impression trays are reusable and should
be thoroughly cleaned, immersed in an
ultrasonic bath or processed in a thermal washer
disinfector and then steam sterilized.
Instrument tray to hold the instruments during sterilization
The following table is adapted from ACCEPTED
DENTAL THERAPEUTICS AND DENTIST’S DESK
REFERENCE:
MATERIALS, INSTRUMENTS AND EQUIPMENT.

(++) Effective and preferred method.


(+) Effective and acceptable method.
(-) Effective method, but risk of damage to
materials.
(- - -) Ineffective method with risk of damage to
materials.
S. No. Item Steam sterilizer Dry heat Chemical Ethylene Other methods
oven vapour oxide
1. + + + ++
Angle attachments
2. Burs

Carbon steel - ++ ++ ++

Steel + ++ ++ ++

Tungsten-carbide + ++ + ++

3. Condensers ++ ++ ++ ++

4. Dappen dishes ++ + + ++

5. Endodontic instruments Hot salt or glass bead sterilizer


for 10-20 seconds at 2180C

Stainless steel handles + ++ ++ ++

Stainless with plastic handles ++ ++ - ++

6. Fluoride gel trays

Heat resistant plastic ++ --- - ++

Non heat resistant plastic --- --- - ++ Discard ++

7. Glass slabs ++ ++ ++ ++
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
8. Hand instruments

Carbon steel - ++ ++ ++ Steam autoclave with


chemical protection

Stainless steel ++ ++ ++ ++

9. Hand pieces Autoclave preferably

Autoclavable ++ - + ++ Combination synthetic


phenolics or
Contra angles - - - ++ iodophores(-)

Nonautoclavable - - - ++

Prophylaxis angles + + + +

10 Impression trays

Aluminum metal ++ + ++ ++

Chrome plated ++ ++ ++ ++

Custom acrylic resin --- --- --- ++

Plastic --- --- --- ++ Discard ++

11 Instruments in packs ++ + small packs ++ ++ small packs


S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
12 Instrument tray setups

Restorative or surgical + Size limit + + Size limit ++ Size limit

13 Mirrors - ++ ++ ++

14. Needles disposable --- --- --- --- Discard++

15. Nitrous oxide

Nose piece ++ --- ++ ++

Hoses ++ --- ++ ++

16 Orthodontic pliers

High quality ss ++ ++ ++ ++

Low quality ss - ++ ++ ++

With plastic parts --- --- --- ++

17. Pluggers ++ ++ ++ ++

18. Polishing wheels and disks

Gamet and cuttle --- - - ++

Rag ++ - - ++

Rubber + - - ++
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
19 Prostheses, removable - - - +

20 Rubber dam equipment

Carbon steel clamps - ++ ++ ++

Metal frames ++ ++ ++ ++

Plastic frames - - - ++

Punches - ++ ++ ++

21. Stainless steel clamps ++ ++ ++ ++

22 Rubber items

Prophylaxis cups - - - ++ Discard ++

23 Saliva evacuators, ejectors

Low melting plastic - - - ++ Discard++

High melting plastic ++ + + ++

24 Stones

Diamond + ++ ++ ++

Polishing ++ + ++ ++

Sharpening ++ ++ ++ -
S. No. Item Steam Dry heat oven Chemical Ethylene oxide Other methods
sterilizer vapour
25 Surgical instruments

Stainless steel ++ ++ ++ ++

26 Ultrasonic scaling tips + --- --- ++

27. Water air syringe tips ++ ++ ++ ++

28 X-ray equipment

Plastic film holder ++ --- + ++

Collimating - --- --- ++


DISINFECTANTS AND ANTISEPTICS
IN DENTISTRY
S.No Type of disinfectant/antiseptic Proprietary name Use in dental surgery
1.
CHLORHEXIDINES
Chlorhexidine gluconate liquid 4% Hibiscrub surgical scrub Hand washing

Chlorhexidine 2.5% / 70% alcohol solution in a glycerine base Hibisol hand rub Hand rub

Chlorhexidine 0.5% in 70% alcohol Alcoholic chlorhexidine Skin disinfection prior to peri-oral
biopsy, implant surgery and periodontal
surgery
2.
IODOPHORS
Povidone iodine 7.5% solution Betadine surgical scrub Hand washing

3.
ALCOHOLS
Alcohol gel/solutions Purell, Sterillium, Desderman Hand rub

70% Isopropyl alcohol wipes Azowipes or Cliniwipes Surgery hard surface disinfection or
external surface of handpieces

Ethanol and 1-propanol alcohol spray Mikrozoid Surgery hard surface disinfection

4.
TRICLOSAN
Triclosan 2% Aquasept Hand disinfection
References:

 Microbiology book by Michael J pelczar, JR;


E.C.S.Chan; Noel R. Krieg
 Microbiology book by Ananthanarayan
 Microbiology book by C.P.Baweja
 Sturdevant’s art and science of Operative
Dentistry
 General surgery book by Bailey and Love
 Internet source via pubmed.com and
winkipedia.com