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In
today's world, the need for infection control has never been
greater. The patients and the health care professionals
have become more concerned about the transmission of pathogenic
organism then ever before. Controlling microbial contamination
through sterilization has long been considered the most essential
component of an infection control program. The result
of proper instrument sterilization is the protection of the
patient, and the health care professional from various infection
diseases. The
focus on infection control has sharpened.
Since
infections increase the severity of illness, complicate recovery,
and prolong inpatient stays they raise the cost of care.
The ever growing expense of health
care has focused providers' attention on reducing costs.
Often this means re-sterilizing and re-using expensive plastic
items that might otherwise be discarded.
Instruments must
be sterilized between usage. There are several types
of sterilization equipment. Steam sterilizers (autoclaves),
dry heat sterilizers, heated chemical vapor sterilizers,
and gas sterilizers.
Dry Heat
The dry heat sterilizers
employ higher temperatures to destroy microorganisms.
They are considered effective and safe for metal instruments
because the process does not dull instrument edges or rust/corrode
the instruments.
There are two kinds of
'Dry heat sterilizers'. The traditional 'toaster oven'
style that is slow and take an hour to sterilize at 320f (160c),
or the COX Rapid Heat Sterilizer which is using a patented
forced air and baffle system technology to sterilize in 6
minutes at 375f (190c). CDC
guidelines calls for weekly monitoring the working of the
dry heat sterilizer by doing a weekly spore test.
Steam Sterilizer
Steam
sterilizers will allow you to sterilize a wide range of materials.
Temperature, pressure, and time are the main factors of this
process. The higher the temperature, the greater the
pressure and the shorter the sterilization cycle. Maximum
temperature will rise to 273f (133c). Steam sterilization
, however, may cause unprotected instruments to corrode and
unprotected cutting edges to dull. Furthermore, excess
water in the steam can provide a portal for microorganism
to penetrate wet instrument packages. Steam sterilizers
(autoclaves) are the most popular method of sterilization
and are made and sold throughout the world. There are
several steam sterilizers sold in the USA, and many more through
the rest of the world. In the table top environment, chamber
sizes ranges from 6" (15.24 cm) diameter x 14"
(35.56 cm) deep, to 15" (38.1 cm) diameter x 26" (66.04 cm)
deep. CDC guidelines calls for weekly monitoring the working of
the steam sterilizer by doing a weekly spore test.
Heated
Chemical Vapor Sterilizers
These
type of sterilizers also offer relatively short cycle times.
Metal instruments can be processed with minimal rust or corrosion,
and cutting edges remain sharp; however, instruments must
be dried completely before processing. The sterilizer
requires a special solution; and heat sensitive plastics
may be destroyed. In addition, the unit must be
placed in a well ventilated area to diffuse the chemical odor.
CDC guidelines calls for weekly monitoring the working
of the chemical sterilizer by doing a weekly spore test.
Not
sterilizers or sterilization methods.
Chemical
Solution
Liquid
disinfectants, such as glutaraldehyde, are widely used in
health care facilities. They have short, inexpensive
disinfection cycles. However, gIutaraldehyde can not
be used for all medical materials. Typical cycle times
and concentrations only provide disinfecting, which can fail
to kill resistant microorganisms. The solutions are
highly corrosive and toxic; since they come in liquid
form, they can not be used with barrier packaging. The
moment an instrument is removed from the liquid, its sterility
is compromised. Immersion in a liquid steriliant is
not recommended because sterilization by liquid chemicals
can not be monitored biologically. In addition, instruments
disinfected by liquids must be handled aseptically, rinsed
in sterile water, and dried with a sterile towel. Furthermore,
instruments immersed in liquid sterilants are not wrapped
and, therefore, must be used immediately or stored in a sterile
container, according to the American Dental Association Councils
on Scientific Affairs and on Dental Practice's "Infection
Control Recommendations for the Dental Office and the Dental
Laboratory," presented at the 1996 OSAP Scientific Forum.
Glass
Bead Sterilizers
Glass
bead sterilizer have long been employed for instruments re-used
on the same patient at a single appointment; however,
they are not suitable for terminal sterilization of instruments
prior to re-use on other patients. The reason they are
not effective is that there isn't a way to test the temperature
throughout the cycle. In fact, glass bead sterilizers
are not FDA approved, and any new machines must receive pre
market approval, according to Dr. Janie Fuller with the infection
control devices branch of the U.S. Food & drug Administration.
