Holding solution

A holding solution is a liquid disinfectant/sterilizing solutionused to soak contaminated instruments before they are cleaned and sterilized. It has the purpose to:

• Decrease infectious microbes on instruments which cannot be cleaned and sterilized immediately
• Loosen and minimize debris before scrubbing or ultrasonic cleaning
• Minimize the physical handling of the instruments

It is important to use a covered container with a separate instrument basket to ensure complete immersion.

Instrument cleaning

A dishwasher is recommended as an excellent alternative to hand cleaning.
Advantages:

• Ideal for instrument trays and most plastic items
• Large containers
• Reusable cups
• No rinsing after initial cleaning
• Instrument trays dry on completion

When hand cleaning, protective eye wear, mask and utility gloves must be worn.

Ultrasonic cleaning has the advantage of less instrument handling and cleans more efficiently.
Use an ultrasonic solutionthat will remove blood, debris and cement, and which has disinfectant properties. Ultrasonic cleaning time:

• Instruments alone - 6-10min
• Instruments in perforated trays - 12 -20 min

Use aluminium foil test to check efficiency. When floated on the top of the solution the foil should show many small pits in a whorl pattern.

Instrument packaging

• Packaging material compatibility to different sterilizing types:

• Instrument pack shelf-life:

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Sterilizer

Sterilizer types: Autoclave, Chemclave, Dry heat oven

Indicators and monitors:
Note: Processing indicators sometimes called chemical indicators do not prove sterility.

There are External and Internal Chemical Indicators.

Chemical indicators which are used in heat sterilizers only indicate that a specific temperature has been reached for a specific time. these usually consist of special form of adhesive tape.

Physical indicators are: pressure gauges, Indicator lights, Buzzers, Timers.
Physical monitors are essential to ensure proper time, temperature and/or pressure, but do not prove sterility.

Biological monitors (Spore test) are designed to prove sterility, but may only be used in heat sterilizers. Heat sterilizers should be tested weekly.
Biological indicators (Spores): Bacillus stearothermophilus for autoclave and chemical vapour. - Bacillus subtilis for dry heat. Some biological indicators contain both spore types.

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Generally accepted methods of sterilization in dentistry:

Liquid instrument disinfection

For semi critical instruments.

Required disinfection level: Tuberculodical / high level hospital grade

Type of solution:

• SteriWise Agent
  

Attention need to be paid to manufacturers instructions regarding time and temperature.
Most products are effective at 20 Grd C for 20-45 min. Some require 25 Grd C for 90 min soaking time.

Most solutions may be reused for days and even weeks.

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Surface disinfection

Environmental surfaces and equipment, which do not contact the patient's tissue are non critical and may be disinfected at a lower level than semi critical items.
[However, environmental surfaces contacting patient's tissue are semi-critical and should be disinfected to the tubercolocidal level.]

Properties of an ideal surface disinfectant:
Broad spectrum, Fact acting, Unaffected by contaminants, Non-toxic, Non corrosive, Odourless, Easy to use, Residual effect, Economical.

Non Recommended surface disinfectants:
Alcohol, Hydrogen peroxide, Quaternay ammonium compounds, 2% Gluteraldehydes

Alcohol is ineffective against spores, has irregular virucidal activity, organic matter diminishes biocidal activity and evaporates rapidly.
Quaternay ammonium compounds are ineffective against Mycobacterium tuberculosis, hydrophilic viruses, gram negative organisms, pseudomonas, spores
2% Gluteraldehydes  have toxic residues and its fumes cause skin, eye, throat, nasal and chest symptoms and headaches.
 

Environmental barriers:
Keep equipment that is difficult to clean uncontaminated bt wrapping with barrier material.

Barrier materials: Plastic backed paper, Foil, Foil paper, Clear plastic wrap.

Items to be wrapped: Chair switches (both sides), Saliva ejector handles, High speed evacuator handle, 3 way syringe handle, Bracket table, tray, brackets, Light handle (both sides), the chair (if made of cloth)

X-Ray machine & darkroom:
Wrap high touch parts to prevent contamination
Rinse film in a disinfectant before developing and use over glowing for processing

• Recommended surface disinfectants:

Agent	Advantages	Disadvantages
SteriWise surface disinfectant	Broad spectrum Fast acting Prolonged residual activity Not-irritating to tissues Economical Easy to use	none
Bleach	Broad spectrum Inexpensive Does not stain Easy to use	May corrode metals May damage plastics and rubber Odour

• Recommended surface disinfecting technique:

1. Spray 2. Wipe 3. Spray 4. Air dry

• Specific disinfectant procedures:

Hand pieces (high speed)	autoclave at 135 grd C Do not use glutaradehyde, bleach, chlorine dioxide Flush water line Cleanse submerged with scrub brush Wrap in gauze Place in sealed bag 10 min Rinse and dry
Hand pieces (slow speed)	Autoclave barrel and contra angle if possible apply surface disinfectant: SteriWise Surface disinfectantor SteriWise wipes
3 way syringe	Flush remove tip and autoclave disinfect handle insert sterile tip apply wrap to upper portion of hose and handle
High speed suction/saliva ejector	Flush with water Remove tip and autoclave or discard Disinfect handle Insert sterile tip Apply wrap to handle and upper portion of plastic hose
Light handles	Disinfect morning and afternoon Apply wrap between patients
Instrument trays	Apply surface disinfectant Use wrap Wrap and autoclave with instruments
Other areas to be covered with wrap	Chair switches, X-Ray controls, View boxes switches, X-Ray tube head
Floors	Add SteriWise General Purpose Disinfectant to floor cleaning soap solution

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Infection control protocol for surfaces & equipment

Each morning:
1. Flush water lines 3 min
2. Disinfect surfaces and equipment (SteriWise surface Disinfectant)

Between patients:
1. Flush waterlines 15 sec
2. Disinfect handpieces, 3-way syringes, evacuators
3. Remove disposable covers
4. Disinfect  "high touch" areas

At the end of each day:
1. Flush water lines 3 min
2. Disinfect vacuum system (SteriWise Disinfection suction cleaner)
3. Disinfect equipment
4. Disinfect surfaces and floors

Weekly:
1. Disinfect inside drawers and cabinets
2. Disinfect floors of operatory, darkroom, laboratory
3. Clean and replace solids collector trap

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