Routing in the sterilization room - Aftercare and maintenance
Routing in the sterilization room
For a good working environment, a lot of space is generally needed. Also in the sterilization room lubrication contamination must be prevented by good logistics. There must therefore be a strict separation between the dirty zone (marked with red) and the clean zone (marked with green). This separation must be recognizable for every user of the sterilization room at a glance. For example, the routing from dirt to clean, cleaner, clean can be accentuated even more with red and green color strips on the wall above the worktop.
The routing of the instruments in the sterilization space passes through various devices, which must be arranged in the order described below. This ensures the routing from dirt to clean.
First, a description is given of the routing of the standard equipment and equipment of a sterilization area, as indicated by the Infection Prevention guideline in oral care practices (April 2016). (Thermodesinfector, hand and corner piece cleaner and steam steriliser also called autoclave.) Name with letter A.
A 'Dirty side' of the sterilization area. B 'A double' thermodisinfector is not a luxury in a larger practice. Located between the 'dirty and the clean side' in the sterilization room. C 'Clean side' of the sterilization area
This is followed by a description of an alternative equipment and device for the situations in which, unexpectedly, the basic equipment could not yet be available. (Ultrasonic cleaning device, chemical disinfection method, autoclave.) Designation with the letter B.
Routing with standard equipment and equipment
A1 A parking space where the dirty trays enter. They have to be able to stay there for a while, before there is an opportunity to clear them. The processing of dirty trays can be done immediately after each treatment or, better and more efficiently, by just 'saving' and then taking a number of them at the same time.
Processing a number of dirty trays at the same time offers many advantages: you are only 'gone' out of the treatment room once and combined actions always take less time than separate actions. The best would be a separate circulation / sterilization assistant, which handles all the dirty instruments and provides the reconditioning.
A2 Thermodesinfector for mechanical cleaning (by the power of the water sprayers) and thermal disinfection by heating to a minimum of 93 ° C for 10 minutes. Cleaning of instruments is preferably done in a thermodesinfector.
Vario TD program is 93 ° C-5 min according to the guidelines. This is the program that we generally use in the Netherlands. 93 ° C-10 min is a program in accordance with the German RKI guidelines in case of an outbreak of an epidemic. Both programs are used and are in accordance with the applicable guidelines.
There is also a thermodisinfector with integrated hot air drying: 'Drying Plus'.
Only use thermodisinfectors that comply with NEN-EN-ISO 15883-1-2.
In a thermodesinfector, use specific adapters (approved by the manufacturer and part of the CE on the device) for cleaning and disinfecting hollow instruments.
Only instruments that are not resistant to moisture, high temperatures or the chemicals of the thermodesinfector, and for which there is no alternative that can withstand this, can be manually cleaned and chemically disinfected.
A3 Hand and corner piece cleaner for cleaning, disinfection, sterilization (and lubrication) of the corner pieces.
A4 Autoclave equipped for the tasks to be performed concerning packaged, hollow or solid instruments.
Instruments that are removed from a previously mentioned device must always be stored in a place that is in the direction (routing) from the dirt to clean, cleaner and clean.
After the last link in the reconditioning process, the clean instruments end up on the cleanest side of the sterilization room. On this clean side, a central storage facility can be arranged for, for example, extraction tongs, hand and corner pieces, surgical instruments and consumables.
The treatment trays can also be covered and stored on the clean side for the next round of use.
The safety of the staff benefits greatly from the use of a thermodisinfector, due to the lower risk of splash and puncture injuries compared to the use of manual cleaning and disinfection. In addition, chemical disinfection is insufficient for the dental instruments (category B: semi-critical) and will always have to follow the extra procedures for the sterilization process.
Place to put the dirty trays down
Hand and corner piece cleaner
Steam steriliser (autoclave)
Routing with alternative equipment and equipment (second choice!)
In the unlikely event that there is no thermodesinfector present, the reconditioning of semi-critical instruments is completed as follows:
B1 Parking space for the dirty trays.
B2.a Ultrasonic cleaning device for hard to clean instruments. Prior to this, the instruments should preferably be rinsed, because otherwise the ultrasonic liquid quickly reaches a very high degree of contamination and can function as a source of contamination.
The higher the vibration frequency is set the greater the cleaning power in narrow channels or in hard to reach places.
Ultrasonic cleaning device
Bin with insert for chemical disinfection
Assistina for corner piece cleaning and lubrication
- The water must first vibrate for 10 minutes without instruments to expel the dissolved gas from the water. (This gas impedes the operation of the ultrasonic sound waves.)
- The water must be provided with a special detergent to keep the loosened dirt in solution.
- In the event of visible contamination of the liquid or in any case daily, clean liquid must be produced.
- The amount of liquid in the ultrasonic cleaning device affects the working force. The more water, the less good the cleaning, because the energy has to be distributed over more water. For safety, keep an eye on the minimum amount of water required!
- Rubber and soft plastic absorb the vibration energy and must not enter the ultrasonic cleaning device. They also influence the cleaning negatively of simultaneously different metal instruments.
B2.b Bake with chemical disinfectant.
The disinfectant should preferably be dosed in liquid form, because dosing powder entails a lot of health risks.
After sufficiently long contact time rinse all the instruments with clean water, dry and clean the trays of the autoclave.
During all operations around the ultrasonic cleaning device and the subsequent processing of instruments in a disinfectant, always use sturdy disposable gloves, a mouth-nose mask and protective glasses!
Sturdy disposable gloves
If there is also no hand and corner piece cleaner for the total treatment of the rotating (dynamic) instruments, two alternative 'B-routes' are possible:
B3.a The corner pieces can be placed on special connectors in the thermodisinfector (if present).
The filters of these connectors must be replaced very regularly for sufficient cleaning and disinfecting operation of the machine.
B3.b Assistina and the DAC (with uncoupled oil line) for internal cleaning of the corner pieces by removing all contaminated oil with compressed air. In principle, the corner pieces must be oil-free to ensure sufficient access for the steam during autoclaving.
The hand spraying of the corner pieces is also not powerful enough to remove all the dirt from the thin oil pipes and the remaining dirt caked during the sterilization process.
After this, sterilization of the corner pieces must always be followed!
B4 Class B autoclave (see basic equipment and equipment).
Hand and corner pieces do not have to be packed in the autoclave according to the directive under normal use (category B: semi-critical). However, the chosen program must be for packaged instruments, because of the hollow spaces in the corner pieces!