Question

 Discuss what constitutes physical monitoring of sterilization and why it is important to monitor the sterilization procedures in a dental office. Include some specific examples of instrument processing techniques and why those techniques are particularly appropriate for that instrument and its uses.

Answer 1

Physical indicators include all devices used to assess cycle time, temperature and pressure. These include examining the sterilizers printout, if available, and by observation of the gauges or displays on the sterilizer. Although correct readings do not provide proof of sterilization, they can use as an indication that a sterilizer may be malfunctioning. Each cycle should be observed to ensure that numbers in the manufacturer-recommended target ranges are being achieved.

There are currently many different in-office and commercial mailout biological monitoring systems available for use. In-office monitoring may be more cost-effective with no delay between testing and the receipt of results but are technique-sensitive and require careful handling to achieve accuracy. Commercial mail services are convenient, need no equipment commitment, and the companies confirm the results. Still, they can be more costly, and there is a delay in receiving results due to mail delivery schedules. Each office should assess their needs to determine which system will work best for them, taking into consideration the need for daily monitoring. With all types of monitoring, manufacturers' instructions must be followed for proper use and storage. Indicators that are beyond the expiry date must be replaced and only used for the sterilizer type for which they are recommended.

Proper instrument sterilization involves a series of six steps. The process involves time, talent, and treasure. Offices need to perform quality control activities to measure sterilization effectiveness.

Most sterilization failures involve human error, such as overloading, improper cycle lengths, poor instrument cleaning, or incorrect wrapping.

Ultrasonic cleaning devices

An ultrasonic cleaner uses sound waves, that are outside the human hearing range to form oscillating bubbles, a process called cavitation. These bubbles act on debris to remove it from the instruments. Some manufacturers also use intermittent or sweeping sound waves to help improve the device's cleaning ability and to decrease the potential for hot spots in the ultrasonic bath. Specialized detergent formulations are available for the solutions in ultrasonic machines. When selecting a cleaning agent to use in the ultrasonic cleaner, always consider the effect on materials and instruments. Household products are inappropriate because they cause pitting, corrosion, rust or other damage to devices, and potentially to the ultrasonic chamber. Therefore, it is best to follow the manufacturer's instructions, thereby choosing a solution that is compatible with the unit and the instruments. The procedure for cleaning the instruments in the ultrasonic cleaner is as follows:

• Suspend instruments in the ultrasonic bath using a rack or basket fitted to the unit.
• Do not lay instruments directly on the bottom of the ultrasonic cleaner, as this can interfere with cleaning and cause damage to instruments and the ultrasonic machine.
• Avoid overloading the ultrasonic device, since that could inhibit its cleaning ability.

It is essential to follow the manufacturer's instructions for the ultrasonic cleaning cycle.

In general, the timer is activated for three to six minutes for loose instruments and ten to twenty minutes for instrument cassettes, and the timing is adjusted as necessary. While the ultrasonic device is running, the lid or cover should be kept on to reduce the release of aerosol and spatter into the area from the ultrasonic cleaner. Routinely replacing the cleaning solution in the ultrasonic machine is important, and is necessary at least once a day, more often with heavy usage.