B- High temperature sterilization:

1-Dry heat sterilization:

a) Conventional dry heat oven:
*The dry heat sterilization reach above 160ºC for 30 minutes for
unwrapped instruments and 60 minutes or more for wrapped
instruments.
*Chambers are heated in such a way that allow air to circulate by
gravity flow.
*Packs of instruments must be placed at least 1 cm apart to allow
heated air to circulate.
a) Conventional dry heat oven:

Disadvantages:
I. Dry heat sterilization of hand piece is not recommended.
II. Without careful calibration, more sterilization failures are
obtained than any other type of sterilizers.
III. The only accurate calibration is by using an external
temperature gauge (pyrometer) attached to the
thermocouple wire.
B- High temperature sterilization:
1-Dry heat sterilization:

b) Short-cycle high temperature dry heat ovens:

*Oven circulates the air with a fan or blower that

reduces the total sterilization time to 6 minutes for
unwrapped instruments or 12 minutes for wrapped
instruments

*It utilizes a higher temperature of 180 °C.

Advantages of dry heat:
1. Carbon steel instruments and burs do not rust, corrode or
become dull if they were well dried before processing.
2. Rapid cycles are possible at high temperatures.

Disadvantage :
1. Not suitable for heat sensitive items.
2. Instruments are hotter and require longer time to cool.
3. Small capacity due to the required space that should be
present between instruments.
B- High temperature sterilization:
2- Hot salt/ glass “bead sterilizers”

• It utilizes temperature of 218 °C for 10-15

seconds.
• It was previously used to sterilize
endodontic files and reamers.
• Their effectiveness is inconsistent for
sterilization.
 B- High temperature sterilization:
3-Infra red rays:
Infrared rays sterilize by heat generation.
§ Articles to be sterilized are placed in a moving
conveyer belt and passed through a tunnel
that is heated by infrared radiators to a
temperature of 180oC for a period of 7.5
minutes.
§ Articles sterilized include metallic instruments and glassware.
§ It is mainly used in central sterile supply department.
v Chemical sterilization by low-temperature sterilization
and high-level disinfectants are used mainly for
plastic items that enter the mouth and cannot
withstand heat sterilization.
v As plastic cheek retractor, photographic mirrors and
similar heat sensitive devices
C- Chemical sterilization by low-temperature:
1-Ethylene trioxide gas (EtO):
It is used extensively in larger health-care facilities, such as
hospitals.
Heat- and moisture-sensitive items can be sterilized with EtO
without damaging effects.
It is impractical for private-practice dental care settings due
to:
1. The extended sterilization times (10 to 48 hours)
2. The hazardous vapors produced.
3. Handpieces cannot be effectively sterilized due to the
decreased penetration of EtO gas through small lumens.
There are certain precautions when using (EtO):

• Immediately after the cycle, the door should be opened

5-10 cm and the personnel should leave the area for
15minutes unless the sterilizer has a purge system that
forces the gas out of the chamber.
• The room should be ventilated for several hours at
relative humidity 50% and temperature 21°C.
• Monitoring of EtO exposure levels should be performed
periodically.
C- Chemical sterilization
Introduction to Low Temperature Plasma:
• Low temperature plasma sterilization was introduced to fill
the gap between autoclave: high temperature steam
sterilization (safest, fastest and least expensive) and EtO
gas sterilization, which leaves toxic residuals.
• It is a low temperature, non-toxic,
but fairly expensive sterilization
method.
• In this process, hydrogen peroxide
is activated to create a reactive
plasma or vapor.

• Plasma is ionized gas made up of ions and electrons. It is

often referred to as the fourth state of matter.
C- Chemical sterilization by low-temperature:
2- Hydrogen Peroxide Plasma Sterilization
(Sterrad ®)
• This system uses a completely new technology:
• It works by hydrogen peroxide, where it is vaporized into a
gaseous state.
• Once the gaseous state of hydrogen peroxide is achieved, an
electrical field is applied to it.
• This electrical field causes the gas to ionize forming what is
called gas plasma and thus free radical is formed.
• The operating temperature range of 45-50°C.
• Operating cycle times range from 45-70 minutes,
depending on size of system.
• It does not produce any harmful substances: water and oxygen are the
final products.
• It is compatible with a wide variety of materials, heat sensitive and
moisture sensitive|(items that can corrode).
• Items may be wrapped but only in polypropylene.

• Deep metal trays cannot be used.

• Cellulose (paper), linens, any material
that absorbs liquids cannot be
processed.
• Items to be sterilized must be
thoroughly cleaned and dry before
going into the chamber.

polypropylene bags
C- Chemical sterilization by low-temperature
3- VHP (Vaporized Hydrogen Peroxide) )

• It is also a product of Steris Corporation.

• It is different from the Sterrad system, in that it only uses hydrogen
peroxide in vaporized form for sterilization, while the Sterrad system
uses vaporized hydrogen peroxide to initiate the sterilization, and then
plasma (created by free radical energy) to complete the sterilization
process.
• In the VHP process, hydrogen peroxide vapor is injected into the
chamber via a series of pulses to sterilize packaged medical and
diagnostic devices.
• The cycle time is 2 hours and the operating temperature ranges from
30-40°C.
C- Chemical sterilization by low-temperature
sterilization
4- Liquid Peracetic Acid (Steris ®)
• This system uses a solution of peracetic acid which contains
acetic acid and hydrogen peroxide.
• It is safe for personnel.
• The system is fully automated with a rapid cycle time of 30
to 45 minutes at a temperature of 50-56°C.
• It is compatible with a wide
variety of materials
(plastics, rubber,),but not all
aluminum anodized coating
(becomes dull) and
moisture sensitive
instruments.
D- Chemical sterilization (High-level
disinfectants):
1- Glutaraldehyde 2-3% (Cidex and Cidex plus)
It is a liquid sterilizing agent that can kill bacterial spores in 6-10
hours.
Disadvantages:
1. Glutaraldehydes are irritating, sensitizing to skin and
respiratory passages.
2. Trays must be kept in a tightly covered, well-ventilated area.
3. Instruments are left in the solution up to 10 hours for proper
sterilization.
4. Wet and organic items dilute the solution.
5. Solutions have to be changed regularly.
6. It should not be used to sterilize critical instruments.
7. The effectiveness of these sporicidal chemicals cannot be
verified with biological indicators.
D- Chemical sterilization
2-Cidex OPA Solution (Alternative to Glutaraldehyde)
• Cidex OPA Solution provides high-level
disinfection in 12 minutes at room
temperature (20oC) .
• It is particularly active against
mycobacteria, including glutaraldehyde-
resistant strains of M. chelonae.
• The Cidex OPA Solution is replacing Cidex
and Cidex Plus due to their toxicity
concerns.
• Applications:
i. The item to be disinfected must be
thoroughly cleaned and dried before
immersion.
ii. After immersion, the item must be
rinsed thoroughly with sterile water
D- Chemical sterilization
3-Chlorine Dioxide:

• Chlorine Dioxide is a chemical liquid sterilization process.

• The process requires 6 hours of contact time at 25-30°C
to achieve sterilization.
• The presence of organic matter reduces activity.
• A processor converts a compound to ClO2 gas and this
gas is then exposed to the equipment in a sterilizing
chamber.
• It may corrode some materials.
D- Chemical sterilization
4-Ozone:
• Ozone sterilizes by oxidation.
• It penetrates membrane of cells causing them to explode.
• In this process, a generator is used to convert oxygen to ozone.
• The cycle time may be up to 60 minutes depending on the size of the
chamber or load of items to be sterilized.
• Due to ozone gas being corrosive, and it being able to damage
moisture sensitive equipment, there has not been much use of it in the
medical industry.
E- Radiation Sterilization:

Since radiation does not generate heat, it is termed "cold

sterilization".
Two types of radiation are used, ionizing and non-ionizing.
Non-ionizing rays are low energy rays with wavelength longer
than the visible light with poor penetrative power
Ionizing rays are high-energy rays with good penetrative
power.
E- Radiation Sterilization:
1-Ultraviolet rays
• UV rays inhibits DNA replication inducing mutations in cells
irradiated with a non-lethal dose.
• Microorganisms as bacteria, viruses, yeast, etc. that are exposed
to the effective UV radiation are inactivated within seconds.
• Since UV rays don’t kill spores, they are considered to be of use
in surface disinfection.
• UV rays are employed to disinfect hospital wards, operation
theatres, virus laboratories, corridors, etc.
E- Radiation Sterilization:
2-Gamma and Beta Sterilization
Gamma rays are electromagnetic
waves that have the ability to
penetrate a much greater distance
than beta rays before losing their

energy from collision.

• Ionizing radiation produces ions by knocking electrons out of atoms.
• The result is ionic energy that becomes converted to thermal and
chemical energy.
• This energy kills microorganisms by disruption of the DNA molecule,
therefore preventing cellular division and propagation of biologic life.
E- Radiation Sterilization:
2-Gamma and Beta Sterilization

• They have more penetrative power than electron beam but require
longer time of exposure.
• A dosage of 2.5 megarads kills all bacteria, fungi, viruses and spores.
• The product to be sterilized is exposed to radiation for 10 to 20
hours, depending on the strength of the source.
• The highest temperatures reached in gamma sterilization are usually
30-40°C.
• It is limited to commercial use only.
• Gamma radiation is popular for sterilizing before shipment and it can
be done through the packaging.
• It is used commercially to sterilize disposable petri dishes, plastic
syringes, antibiotics, vitamins, hormones, glasswares and fabrics.
Types of Ionizing Radiation
E- Radiation Sterilization

3-Electron-Beam Radiation
• In this process, the E-beam generator delivers a high dose
of electrons in a narrow beam at the items to be sterilized.
• The electrons from the E-beam generator have limited
penetrating power, less than gamma radiation.
• They are employed to sterilize articles like syringes, gloves,
dressing packs, food and pharmaceuticals.
• Sterilization is accomplished in few seconds.
• Disadvantage includes poor penetrative power and
requirement of sophisticated equipment.
• For example, a 10MeV Ebeam will penetrate about 5 cm of
a unit-density material.
E- Radiation Sterilization

4-X-Ray Sterilization

• This is a new developing process that is based on

obtaining X-rays through conversion of electron beams.
• The X-rays produced have the same penetrating
properties as the rays produced by Gamma .
• But with this, treatment is faster, more flexible, and more
environmentally friendly.
• X-rays offer excellent product penetration in sterilization,
thoroughly treating the surface and interior of a product.
4. Instrument Sterilization Monitoring
1- Mechanical Indicators show:
Cycle time, temperature and pressure
vBy using either:
A recording thermometer, circle graph or computer printouts
v If conditions were not met do not use sterilizer until the
problem is identified
v Drawbacks of Mechanical Indicators
1. Monitor one location in sterilizer
2. Do not monitor each pack or tray
3. Do not indicate complete
sterilization.
4. Instrument Sterilization Monitoring
2- Chemical Indicators (CI)

i. Monitor one or more of requirements: time,

temperature and pressure.
ii. Can be external or internal
iii. Give instant results
iv. Indicate proper conditions for sterilization were
present
v. If indicator did not change, do not use
 4. Instrument Sterilization Monitoring
Internal Chemical
External Chemical
Indicator
Indicator:
vPlaced inside each
vdistinguishes processed package, tray or container
from unprocessed pack vpaper strips or cards
vi.e.: labels the pack vvalidates steriliant
penetration
vcan measure all parameters

The picture can't be displayed.

4. Instrument Sterilization Monitoring
Internal Chemical Indicator
Advantages:
i. detects incorrect packaging
ii. incorrect loading
iii. malfunction of sterilizer
iv. easy to retrieve and read
Disadvantages:
i. Do not tell you that spores are killed
ii. Do not tell you that item is sterile
4. Instrument Sterilization Monitoring

Biological Indicators (spore tests)

vConfirm the ability of the sterilization process to kill microbial
spores

vIntegrate all the parameters of the sterilization process

vIt is the most critical test of the sterilization process
vCanadian Standard Association recommends the use of
biological indicators at least weekly for autoclave, daily for
chemiclave and for each load in hot air oven
4. Instrument Sterilization Monitoring

Both biological and chemical indicators

are recommended be used to monitor the
sterilization process.
 5. INSTRUMENTS STORAGE

vStorage of sterilized instruments in packages is

preferred to “loose” storage.
vThe safest and most efficient method is the use of
separate packs for each anticipated procedure.
5. Instrument Storage:
I. Event-related shelf life:
package and its contents
remain sterile unless the
packaging becomes wet or
torn provided that they are
kept in a clean, dry and
sterile firmly closed
cupboards or boxes.
II. Time-related shelf-life:
expiration date is placed on
each package
 Dental Unit Waterlines
• Most dental unit waterlines contain biofilm, which acts as a reservoir
of microbial contamination.
• Waterlines must be cleaned and disinfected in accordance with the
manufacturer’s instructions.
• All waterlines must be fitted with non-return (anti-retraction) valves
to help prevent retrograde contamination of the lines by fluids from
the oral cavity.
• Biofilm levels in dental equipment can be minimised by using a range
of measures, including water treatments using ozonation or
electrochemical activation.
 Dental Unit Waterlines
• Flushing lines (e.g. triple syringe and handpieces) after each patient
use, and flushing waterlines at the start of the day to reduce
overnight or weekend biofilm accumulation.
• Flushing each day has been shown to reduce levels of bacteria in
dental unit waterlines.
• Air and waterlines from any device connected to the dental water
system that enters the patient’s mouth (e.g. handpieces, ultrasonic
scalers, and air/water syringes) should be flushed for a minimum of
two minutes at the start of the day and for 30 seconds between
patients.
 Dental Unit Waterlines
• Sterile irrigants such as sterile water or sterile saline as a coolant are
required for surgical procedures such as dento alveolar surgery and
dental implant placement.
• When treating immunocompromised patients, it is recommended
that water from dental unit waterlines contain less than 200 colony
forming units per mL.
• Bacterial levels can be tested using commercially available test strips
or through commercial microbiology laboratories.
Hand piece asepsis:

v It should be sterilized between patients with

acceptable methods that ensure internal as well as
external sterility.
v It can be sterilized using the autoclave or the
chemiclave.
v Conventional and high speed hand piece should be
lubricated before and after sterilization.
v To avoid contamination of the oral cavity from this
lubricant, the handpiece should be rotated freely after
lubrication before placing any bur in it.
Hand piece asepsis:
v The inside lines of high speed hand pieces may become
contaminated when patient fluids retracted back through air-
water opening.
v If the hand piece is not properly processed, the retracted fluids
may enter the mouth of the next patient.
v Dental units manufactured after the middle 1980s have anti-
retraction valves already installed.
v Since these valves fail periodically, retraction must be
routinely checked and the valve replaced when necessary.
Safe injection practices
§ Needles should be capped prior to use.
§ Needles should be recapped as soon as possible
after use, and before removing the needles from the
syringe for disposal.
§ One needle may be used for multiple injections on the
same patient; however, the needle should be
recapped between each use.
§ Used needles should not be recapped by hand.
§ A one-handed scoop technique or a mechanical
device designed for holding the needle cap should be
used for recapping needles.
Safe injection practices:
§ Extreme caution should be used whenever
contaminated sharps are passed between DHCP,
such as during four-handed dentistry.

§ Needles, scalpel blades and other sharp items should

be placed in appropriate puncture-resistant
containers (safety box).
Post exposure Management

Wound Care
1. Clean wounds with soap and water
2. Flush mucous membranes with water
3. Application of non- irritant antiseptics or
disinfectants

• No evidence of benefit for squeezing puncture sites

Avoid use of bleach and other agents caustic to skin
 Summary

• Effective infection-control strategies are

designed to prevent disease transmission & must
occur as routine components of practice.

• Proper procedures can prevent transmission of

infections to patients and DHCP.
*