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Background/PurposeWe describe an investigation of an incident of failed sterilization procedure in a dental clinic. We aim to illustrate the principles in performing such investigations and to highlight some of the important checkpoints in sterilization procedures. MethodsIn response to this incident, proper sterilization of all equipment was performed immediately. On-site investigation was conducted by the investigation panel to identify the cause and risks, to coordinate post-exposure management in affected patients, and to make recommendations to prevent similar occurrence of such incidents in the future. ResultsThe incident was due to a rare lapse of monitoring during the autoclaving cycle. A total of 127 sources and 250 exposed patients were identified within 24 hours of the discovery of the incident for risk assessment and testing for blood-borne viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). A protocol was devised to manage the exposed patients against HBV, HCV, and HIV. Immunization and hyperimmune globulin for hepatitis B, and tetanus toxoids were given to the exposed patients where indicated. Exposed patients were followed-up for 6 months. We came to the decision that dating of instrument packages and signed documentation of each autoclave printout, color change of chemical indicators of each load and daily autoclave performance should be made mandatory with immediate effect. ConclusionRapid response is extremely crucial in minimizing the impact of this incident and relieving the anxiety of the affected patients. Proper recording and documentation of autoclave cycles and regular auditing should be enforced to prevent similar incidents. Keywordsautoclave clinic dental sterilization Cited by (0)Copyright © 2013 Published by Elsevier (Singapore) Pte Ltd. Before the invention of the microscope, the cause of infectious disease was a mystery. No one knew that unseen microorganisms such as bacteria and viruses were to blame for smallpox, typhus and the plague. Once pathogens were identified as the cause of infection in the late 1800s, the challenge then became to control or eliminate them in medical environments, and the concept of sterilization was born. Today it remains a necessary step in the infection control procedures used to keep patients safe, and it all begins with the autoclave. What Is an Autoclave?Autoclaves are electric or gas powered sterilizers. Invented by Charles Chamberland in 1884, they come in all shapes and sizes and are used throughout the industry wherever sterile components are needed. The world’s largest autoclave, designed to create composite parts for Boeing aircraft, weighs more than 500 tons and has a volume of more than 80,000 cubic feet. In medical offices, countertop autoclaves are used to kill dangerous microorganisms on shared medical equipment such as instruments, textiles, and bandages. How Does an Autoclave Work?An autoclave works like a pressure cooker. It uses pressurized steam or other inert gasses to eliminate pathogens. Why is pressurization critical? Boiling, for example, is a disinfection process that kills most microorganisms, but not all of them. Because medical environments harbor significant pathogens, equipment shared by medical patients, needs to be sterilized, or made pathogen-free. This is something only the high temperatures in an autoclave can achieve. Water boils at 212 °F, and it can’t get any hotter. But when water vapor, or steam, is captured and pressurized, it can reach temperatures of over 250 °F that are capable of killing virtually all microorganisms and their spores. Benefits of AutoclavesWhile other sterilization methods are available, none are as quick, inexpensive, or reliable as autoclaves. The benefits of an autoclave include speed, efficiency, reasonable cost, and ease of use. SpeedHot air can sterilize medical instruments, but because air is a poor conductor of heat, it can take hours to achieve the same results that an autoclave can do in minutes. At similar temperatures, it takes air sterilizers two hours to do what an autoclave can in a shorter period of time. In a fast-paced medical setting, speed counts. EfficiencyDisinfection reduces the number of harmful organisms from medical surfaces. Sterilization kills all pathogens, including the spores they use to reproduce. Spores are tough to kill. They have thick outer shells and chemical coatings that are impervious to boiling water and chemical disinfectants. They can tolerate extreme heat, cold, and dryness. Some can survive on hard surfaces for years. While disinfection is useful in a medical office for sanitizing surfaces, only sterilization guarantees that shared medical equipment won’t spread infection. Reasonable CostThe autoclaves in a medical office range in cost between $1,500 and $10,000 based on their size and features, but with proper care, they can last a lifetime. Energy usage is minimal and something kitchen pros value in pressure cookers. Office-size hot air sterilizers start at about $5,000, and energy use is significant. They’re also larger than autoclaves and require more space. Chemical sterilization solutions are an alternative to powered sterilization methods, but they’re somewhat less effective and can be cost prohibitive for all but limited use. And since not all materials are chemical tolerant, most medical offices need to have an autoclave, as well. Easy to UsePressurized steam reaches deep. Medical instruments can be sterilized in packs while still assembled. Because the ingredients in chemical solutions must remain in exact proportions to be effective, they require careful mixing. No additional water can be added, so medical instruments must be scrubbed and dried before they can be sterilized. Autoclaves leave less room for error. How Do Medical Assistants Use Autoclaves?Medical assistants are typically responsible for the sterilization of shared medical equipment. Knowledge of infection control principles is a must. Before an instrument that’s been in contact with one patient’s body fluid can be used on another patient, it needs to be scrubbed, wrapped, and sterilized. While the use of presterilized and disposable supplies has reduced the autoclave’s role, it’s still the gold standard for sterilizing instruments like forceps, scissors, and other reusable items. As part of a quality infection control program, medical assistants also calibrate and maintain autoclaves to ensure they’re doing their job. Checking the integrity of gaskets and door locks is important for safety, as leaks could impact performance. Some models are manual and require more attention, while others are computerized and have internal temperature and pressure monitors that warn users of irregularities. Testing can be as simple as running preprogrammed diagnostic routines and sealing instrument packs with autoclave tape. Autoclave tape looks like regular masking tape, but it changes color when it’s been exposed to the temperature required for sterilization. It’s a quick and simple safeguard. Autoclaves are also subject to the same type of regulations that affect equipment used in public service. Like restaurant dishwashers that are inspected to ensure they reach temperatures hot enough to kills germs, autoclaves are required to be checked and maintained. Medical assistants should log quality control activities for safety and arrange for servicing by the manufacturer at recommended intervals. Autoclave SafetyAutoclaves can be dangerous when they’re not used properly, so safety training is essential. A medical assistant should be safe and guard against burns, cuts, puncture wounds, and infections. BurnsBefore opening an autoclave, steam must be fully vented. Failure to allow it to escape can result in scalding when the door is opened. Most autoclaves have a built-in locking mechanism to prevent the door from being opened until the interior has reached a safe temperature. Anyone using the device should be familiar with its safety features. While most of today’s autoclaves are designed with outer wall insulation, models that are even a few years old can have walls and doors that get as hot to touch as a stovetop burner. Cuts and Puncture WoundsAutoclaves should never be used to sterilize items that may break when heated, such as regular glass or delicate plastics. Extreme care is required when handling packets that contain sharp items like reusable needles or blades. Double-wrapping and labeling packets with potentially hazardous contents reduces injuries. InfectionsA malfunctioning autoclave can leave potentially infectious materials on instruments. Handling them without awareness can lead to accidental infection. In addition to sterilizing instruments, large medical practices may also use an autoclave to sterilize medical waste. The use of appropriate personal protective equipment—including gloves, goggles, and aprons—helps protect users against exposure. Other general rules for safety include
Final ThoughtsWhile some doctors’ offices are turning to outside sources for the sterilization of their equipment, most still have autoclaves. It’s a vital piece of equipment medical assistants will regularly use to decrease the spread of disease causing germs and protect the health of their patients. Did learning about an autoclave interest you? Ready for an exciting new career in the medical assisting field? The Medical Assistant program at Hunter Business School prepares competent, entry-level medical assistants in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains required for professional practice. The Medical Assistant program provides hands-on experience in a real medical setting where you can foster professional relationships with actual patients. Medical Assistant students spend 160 hours in an externship in a professional medical work environment where they are supervised and taught in order to gain valuable on-the-job training. Contact us today to find out more about how to become a medical assistant on Long Island. How are surgical instruments are prepared for sterilization by a medical assistant?Instruments are placed in a surgical pack and exposed to steam under pressure. A sterilization indicator (required) such as autoclave tape or an indicator strip is used to identify instruments that have been sterilized.
What solution will a medical assistant use for cleaning instruments after surgery?Neutral pH detergent solutions that contain enzymes are compatible with metals and other materials used in medical instruments and are the best choice for cleaning delicate medical instruments, especially flexible endoscopes 457.
Which of the following is necessary when sterilizing item using an autoclave?Three factors are critical to ensuring successful steam sterilization in an autoclave: time, temperature and steam quality.
Which one of the following is the primary method for sterilizing instruments and equipment?Moist heat sterilization is carried out using clean dry saturated steam at high temperature and pressure for a specific time in the absence of air. This is the most practical and commonly used method to sterilize surgical instruments tolerant to heat and moisture.
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