Volume 7 • 2020 • Issue 4

‘Immediate Use Steam Sterilization, shortened as IUSS’, is used only for emergency situations. A shortage in inventory of instruments is not considered an emergency. If IUSS must be used, the cycle requires verification with a Type 5 integrator or Type 6 emulator plus monitoring and documentation of the cycle parameters. IUSS is not used for instrumentation associated with dental implants. Step 9: Sterilization •  For heat tolerant instruments and devices, steam sterilization is used. Processes such as boiling, ultraviolet light, use of hot beads, chemiclaves, and dry heat are no longer recognized as appropriate methods of sterilization for Canadian health care, largely because there is no routine or recognized method to monitor and verify sterility using methods other than steam. •  The simplest way to manage reprocessing in dentistry is to reprocess all instruments or devices that are heat tolerant. All critical dental instruments and devices are those entering sterile body cavities or touching bone and must be sterilized. All semi-critical dental instruments and devices are those that touch mucous membranes or non-intact skin and if heat tolerant, must be sterilized. Any items that are not heat tolerant and can be immersed should be sterilized with chemical sterilants as per MIFUs. Instruments or devices that could be termed non-critical (such as rubber dam frames) should be sterilized because there is potential for cross-contamination as a result of the nature of the use of the instrument. Similarly, any instrument or device used for laboratory procedures that can be reprocessed according to MIFUs must be sterilized or considered as one-time use items. •  Refer to instrument MIFUs prior to purchasing instruments and devices to ensure that MIFUs are available and to clarify MIFUs in the event that your office is unable to provide the parameters that are required by the manufacturer for sterilization of the medical device. Not all instruments and devices are sterilized using the same cycle parameters—there is no “one size fits all” in sterilization, especially for those instruments or devices that are slightly more complex and for those with lumens. NOTE: Be cautious of MIFUs for long surgical suctions with very narrow diameter lumens that do not provide detailed instructions for cleaning and extended sterilization cycles. •  Know or determine the type of sterilizer(s) that are used in your practice as this will determine which parameters to follow for MIFUs when sterilizing. Sterilizers differ with respect to how air is removed from the chamber, categorized as gravity or dynamic. Gravity sterilizers, as the name implies, replaces air passively with steam. Dynamic sterilizers are either pre-vacuum or steam flush pressure pulse (SFPP) types. Dynamic sterilizers are preferred, as gravity sterilizers have been found to be an unreliable The simplest way to manage reprocessing in dentistry is to reprocess all instruments or devices that are heat tolerant. sterilization method for dental handpieces, especially surgical handpieces. 3 •  The following cycle parameters will assist offices in determining the type of sterilizer that is being used: Gravity is 121°C x 30 minutes or 132°C x 15 minutes; Dynamic is 132°C x 4 minutes or 135°C x 3 minutes and requires use of a daily air removal test; and SFPP is 132°C x 4 minutes or 135°C x 3 minutes and does not require a daily air removal test. •  Pre-vacuum sterilizers evacuate the chamber and the pressure falls to below atmospheric pressure. Because of this, if pockets of air remain prior to steam being introduced, the air will act as a barrier to the steam. An air removal test using a Type 2 chemical indicator (frequently referred to as a “Bowie‑Dick test”) is used to test the sterilizer in an empty chamber either as the first procedure daily or if the sterilizer is run 24 hours a day, at the same time each day. The chamber pressure in SFPP sterilizers does not fall below atmospheric pressure; therefore, an air removal test is not required. •  Sterilizers also have MIFUs. The MIFU for each specific sterilizer must be followed for loading including the total weight allowed for entire loads as well as the weight distribution. •  Allow the sterile packages to dry fully as part of the sterilizer cycle. They must also be cooled to at least room temperature before handling to avoid condensate forming within the packages. Do not remove packages from the sterilizer until they reach room temperature. If hot packages must be removed, then they should be removed with the entire rack so that individual packages are not handled. MIFUs that suggest that packages may be removed before they are cool should be questioned. Neither fans nor running instruments under cool water is an acceptable way to cool packages to room temperature (see the next bullet point). •  Packages that are wet coming out of the sterilizer are considered failed packages as wicking can occur and contaminate the contents. Premature cooling can cause condensate to form (for example, from use of a fan or removing hot packages with cool hands or cool gloved hands). •  Sterilizers require routine cleaning. Document when the sterilizer is cleaned and keep a copy of this record. Infection Prevention and Control at the Dental Office S upporting Y our P ractice 25 Issue 4 | 2020 |