Purpose Team Roles and Responsibilities System Requirements Reliably providing sterile instruments for patients is a vital component in the Trusted Care environment. Instrument processing is a critical element of Infection Prevention and Control (IC) standard precautions. The processing (cleaning and sterilization) of instruments and devices is an important step in preventing the spread of disease to patients and dental health care personnel (DHCP). The Instrument Processing Training is a written guide to provide each Dental Treatment Facility (DTF) with standardized training to enhance Trusted Care and achieve Zero Harm. This training is a resource so that: Instrument Processing Technicians (IPTs) process instruments safely and effectively Dental assistants/medical technicians prepare instruments for transport to instrument processing center Instrument Processing Technicians (IPTs) Process instruments in-accordance-with (IAW) national and local standards, Centers for Disease Control and Prevention (CDC), other Federal guidelines and manufacturer s Instructions-for-Use (IFU) Monitor cleaning, disinfection and sterilization processes Dental Assistants/Medical Technicians Prepare instruments for processing Transport to instrument processing center IPTs performing instrument processing require access to the following: Dental Instrument Processing Center (DIPC) or Central Instrument Processing Center (CIPC) with appropriate equipment and supplies Manufacturers IFU Knowledge Exchange (Kx) Dental Evaluation and Consultation Services (DECS) website (https://kx.afms.mil/kj/kx2/decs/pages/home.aspx) Air Force Medical Service (AFMS) DECS public website (http://www.airforcemedicine.af.mil) Other IC resources (i.e., CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care - 2016, CDC Guidelines for Infection Control in Dental Health-care Settings 2003, Air Force Instruction 44-108 Infection Prevention and Control Program, USAF Guidelines for Infection Prevention & Control in Dentistry and Occupational Safety and Health Administration Bloodborne Pathogens Standard) 1
Training Algorithm The Instrument Processing Training algorithm is shown in Figure 1 [a], [b], [c], [d], [e], [f] and [g]. Figure 1 [a]. 2
Figure 1 [b]. 3
Figure 1 [c]. 4
Figure 1 [d]. 5
Figure 1 [e]. 6
Figure 1 [f]. (Dry Heat) 7
Figure 1 [g]. (Dry Heat) 8
Execution Guide Symbol Key Do Not (text outlined in red) STOP Stop and reassess Execution Guide: Corresponding Section on the algorithm Notes (text outlined in blue) I I. Steam Sterilizer Start-Up Procedures A. The IPT does the following for steam sterilizers: 1. Turns on all sterilizers to be used for the day. 2. Runs warm-up cycle (Prevacuum [Prevac] sterilizers only [see Table 1]). Gravity displacement steam sterilizers (i.e., table-top models) are not dynamic air-removal sterilizers and do not require this test (see Table 2). 3. Runs a daily dynamic air-removal test (e.g., Bowie-Dick test) in a warm chamber (PREVAC ONLY). 4. Runs weekly vacuum leak cycle test (PREVAC ONLY). This is required in select sterilizers. 5. Records results of the dynamic air-removal and vacuum leak cycle test on the Air Force Dental Service (AFDS) Sterilizer Load Release Document (see attachment 1 in the USAF Guidelines for Infection Prevention and Control in Dentistry). Table 1 9
Table 2 6. Ensures detergents and other supplies required by the manufacturer are adequately stocked. 7. Runs a verification test for automated cleaning equipment at least weekly (e.g., foil or commercial test for ultrasonic cleaner and commercial test for washer disinfector [see Table 3]). Table 3 II II. Pre-Cleaning and Transport of Instruments A. The dental assistant/medical technician does the following: 1. Pre-cleans instruments at the point of use. a. Removes gross debris (e.g., bioburden, cement and impression material) during the procedure to aid in effective reprocessing. Use gauze wet with water or an alcohol pad before debris dries. b. Ensures instruments are free from gross contamination before transport to instrument processing center. 10
2. Prepares instruments for transport. a. Removes/replaces instruments and devices that are broken, damaged or defective (i.e., broken cassettes, cracks, misalignments, dull cutting edges). Follow local policy for instruments that require disposal or repair. b. Uses a rigid container that is leak-proof, puncture-proof and red or contains a biohazard label. c. Uses a pretreatment spray, gel or foam on the instruments before transport to prevent the drying of blood and/or other contaminates on the instruments. Follow manufacturers IFU regarding rinsing. d. Disinfects the outside of the transport container before leaving the treatment room. 3. Transports instruments to decontamination area in Instrument Processing Center. III A III. Instrument Cleaning/ Decontamination A. The IPT does the following: 1. Reviews manufacturer s IFU for proper cleaning, decontamination (decon), sterilization and disassembly procedures for all items. 2. Dons appropriate PPE, including puncture resistant gloves, fluid resistant gown over scrubs, face mask/shield and hair cover. 3. Sorts and disassembles contaminated instruments. a. Open and unlock hinged instruments. Cleaning and sterilization must reach all surfaces. b. Separate instruments that need special handling (i.e., handpieces and burs). 4. Removes/replaces instruments and devices that are broken, damaged or defective (i.e., broken cassettes, cracks, misalignments, dull cutting edges). Follow local policy for instruments that require disposal or repair. Note: Have a copy of the local Instrument IFU Quick Reference (See the USAF Guidelines for Infection Prevention & Control in Dentistry for additional information) posted in both decontamination and cleaning/sterilization areas. Ensure manufacturers IFU are easily accessible by electronic means or hard copy. III B III B1 B. Has pre-cleaning been effectively completed? 1. IF YES: The IPT selects the appropriate cleaning method and does the following: a. For automated washer/washer-disinfector. DO NOT stack rigid container systems (e.g., cassettes and Aesculaps) i. Selects appropriate automated washer/washer-disinfector solutions (e.g., detergent and lubricant) IAW manufacturer s IFU. Consider assistance from Biomedical Equipment Technicians (BMETs). ii. Ensures detergents and other solutions required by the manufacturer are present for each cycle. iii. Loads automated washer/washer-disinfector in the following manner: Place empty containers on their side so they do not collect water during the cycle Place rigid container systems (e.g., cassettes and Aesculap baskets) on washer racks in single layers only 11
III B2 Place instruments on washer racks so the instrument orientation does not impede the rotation of the washer spray arms during the cycle b. For ultrasonic cleaning DO NOT reach into ultrasonic units. Use strainer-type baskets to lift instruments out i. Selects appropriate ultrasonic solutions (i.e., enzymatic cleaners) IAW IFU. ii. Cleans instruments, at a minimum, for the time stated in instrument s IFU. iii. Rinses instruments after ultrasonic use IAW manufacturers IFU. c. For manual cleaning DO NOT use manual cleaning methods when ultrasonic cleaner or washer-disinfector methods are available and can be followed IAW IFU. 2. IF NO: The IPT removes any gross debris and/or bioburden that may still remain on instruments. Return to Section III B1 (selects appropriate cleaning method and re-cleans). IV. Instrument Inspection DO NOT place new instruments into the sterilizer before they are cleaned via manual, ultrasonic or automated washer/washer-disinfector methods. A. When the instruments have completed the decontamination/cleaning phase, they are ready for inspection. Note: Inspect instruments after decontamination to ensure instruments are free of debris, corrosion and defects. Instruments failing the inspection process are returned to the decontamination area to be re-cleaned or replaced with clean instruments. IV B IV C IV C2 V A V A1 B. The IPT does the following: 1. Dons appropriate PPE: a. Wears head cover. b. Wears puncture resistant gloves when handling instruments that have been cleaned by manual or ultrasonic techniques because these instruments have not been disinfected. c. Uses clean bare hands when handling instruments that have appropriately completed thermal disinfection through the automated washer/washer-disinfector cycle. 2. Visually inspects instruments to ensure effective cleaning has occurred and that instruments are sharp and in working condition before instruments are prepared for the sterilization process. a. Additional light and magnification may be used. b. Ensure instruments are dry. If they are not, dry instruments IAW IFU. C. Are instruments free of bioburden/debris? 1. IF YES: The IPT proceeds to Section V (Instrument Prep). 2. IF NO: The IPT removes debris and repeats the cleaning process. Return to Section III B2. V. Instrument Prep For Steam Sterilization A. The IPT verifies that the instruments are completely dry ( Are instruments dry? ). 1. IF YES: The IPT does the following: a. Dons appropriate PPE for instruments that are not disinfected. 12
b. Assembles instruments and devices into sets: i. Rigid container systems (i.e., cassettes and Aesculap baskets). ii. Paper-plastic pouches. c. Ensures all instruments are opened, unlocked and disassembled IAW IFU. d. Places tip protectors on instruments likely to puncture packaging material (optional). e. Inserts miscellaneous items as appropriate (e.g., cotton balls/rolls). f. For Cassettes i. Place Class 5 Chemical Indicator (CI)/integrator into each cassette (STEAM STERILIZATION ONLY). ii. When using multi-level cassettes/kits, place an integrator on each level (see Table 4). g. For Aesculaps i. Remove filter holders in Aesculap containers (top and bottom). ii. Place new filter in container and replace filter holders. iii. Place Class 5 CI/integrator into each Aesculap basket (STEAM STERILIZATION ONLY). iv. Place the Aesculap basket into the Aesculap container. v. Close and secure the Aesculap container with steam sterilization locks. Table 4 V A2 2. IF NO: The IPT dries instruments IAW manufacturer s IFU. Return to Section V A1 (prepare instruments for packaging). VI A VI A1 VI. Instrument Wrapping and Packaging For Steam Sterilization A. Are there instruments that need to be wrapped or packaged (i.e., instruments in cassettes or loose instruments)? 1. IF YES: The IPT selects appropriate packaging material and does the following IAW local policy and manufacturer s IFU: a. Wraps cassettes i. Use either a 2 single-layer or a 1 bonded double-layer wrapping technique. Single-layer wrapping technique - use 2 single-layer wrappers unless IFU states otherwise 13
Double-layer wrapping technique - use 1 bonded double-layer wrapper unless IFU states otherwise ii. Secure the wrap after wrapping the cassette with external Chemical Indicator (CI) tape. iii. Place CI tape so it is visible on every side of the cassette. iv. Initial each wrapped package. Only write on the CI tape or an affixed label. When using a marker, only choose a marker with nontoxic ink. b. Packs paper-plastic pouches DO NOT over pack the paper-plastic pouch. DO NOT fold paper-plastic pouches except along the fold or perforated fold line. Overfolding the self-seal tab blocks effective steam penetration. DO NOT write on paper side of paper-plastic pouch or on wrapping material. This may damage, puncture or otherwise compromise the integrity of the packaging. i. Select appropriate size pouch. ii. Use this method for small, lightweight items. iii. Pack bur blocks on edge so burs are visible (see Figure 2). iv. Place Class 5 CI/integrator into pouch. Figure 2. v. Peel off the self-seal tab, remove excess air and seal. vi. Write initials on plastic side once paper-plastic pouch is closed (see Figure 3). Figure 3. c. Packs nylon pouches (DRY HEAT STERILIZATION ONLY) i. Use a Class 3/single-variable chemical indicator (CI). The IPT initials the Class 3 CI. 2. IF NO: The IPT proceeds to Section VII (Package Labeling [e.g., Aesculaps]). VII VII. Package Labeling For Steam Sterilization A. The IPT does the following: 1. Labels the packages appropriately. When packages (i.e., cassettes, Aesculaps or paper-plastic pouches) or other contents within the package expire, an expiration date is needed in addition to the sterilization date. a. All labels (e.g., load stickers) include the following for steam sterilization: i. Sterilizer identification (ID) number: when using more than one sterilizer, each sterilizer must have a unique ID number. ii. Load number: identifies the sequential number of each load (e.g., first load of the day is #1, second load of the day is #2). iii. Sterilization date: using a Gregorian calendar date (e.g., 12 Jul 16) is preferable to using a Julian calendar date (e.g., 194) for ease of tracking and execution. Ensure the date is changed daily and the Gregorian date is formatted as in the example above. 14
VIII A iv. Expiration date is added to the above three items when: Manufacturer s IFU for items or packaging materials have an expiration date Manufacturer s IFU states the sterility will be maintained for a limited amount of time (e.g., some paper-plastic pouch manufacturer s IFU state once the pouch is sealed, sterility is maintained for up to 6 months, 1 year or 3 years, depending on the manufacturer). Check the package material IFU. b. Aesculap package label i. Ensure the external indicator dot on the steam sterilization lock is facing outward on both ends of the Aesculap container. Place the label/load sticker over one of the blue dots. VIII. Start Load Documentation For Steam Sterilization A. The IPT does the following: 1. Refers to instrument s IFU or the local Instrument IFU Quick Reference to ensure items with similar cycle variables (e.g., time and temperature) are grouped together for processing. 2. Sorts the instruments according to similar cycle variables. 3. Accounts for and documents the load contents on the sterilization log sheet. At a minimum include the description and quantity of load contents (e.g., 15-operative, 10-prophylaxis, etc.). Note: Print the sterilization log sheet on the back of the AFDS Sterilizer Load Release Document (see attachment 1 in the USAF Guidelines for Infection Prevention and Control in Dentistry) to make one sheet. When it is not possible to print the sterilization log sheet onto the back of the AFDS Sterilizer Load Release Document (e.g., log sheet is multiple pages or envelope style), attach the log and the AFDS Sterilizer Load Release Document together. 4. Completes line 1 of the AFDS Sterilizer Load Release Document before the clean packaged instruments are loaded into the sterilizer (see Figure 4). Annotate the date the load is sterilized, the load number and the sterilizer ID number for the load. Next, affix the load sticker in the area attach here. Each load receives a new AFDS Sterilizer Load Release Document. 5. Completes lines 2 and 3 of the AFDS Sterilizer Load Release Document (see Figure 4). Circle the type of sterilization cycle (e.g., prevac, or gravity). Then annotate the minimum temperature and time required for the load IAW the instrument s IFU. Line 1 Line 2 Line 3 Figure 4. 15
Note: Minimum temperature and time requirements may be exceeded unless prohibited by the IFU (e.g., Warning: do not exceed the minimum temperature requirements). VIII B VIII B2 VIII B2a VIII B2aii IX B. Have the dynamic air-removal/bowie-dick test and the weekly vacuum leak cycle test passed? 1. IF YES: The IPT proceeds to Section IX (Loading the Sterilizer). 2. IF NO: The IPT repeats the failed test IAW manufacturer s IFU. Refer to the manufacturer s IFU. a. Did additional test(s) pass? i. IF YES: The IPT proceeds to section IX (Loading the Sterilizer). ii. IF NO: DO NOT use the sterilizer. Take the sterilizer out of service until the problem is resolved. See the USAF Guidelines for Infection Prevention & Control in Dentistry for additional information. IX. Loading the Steam Sterilizer DO NOT over load the sterilizer (see Figure 5). DO NOT stack cassettes. A. Follow the sterilizer IFU for loading instruments. Instructions for loading cassettes and paperplastic pouches may vary depending on the sterilizer type (e.g., floor-size and table-top) and the manufacturer. The IPT does the following: 1. Orients all packages in the same direction allowing adequate space between each package (see Figure 6). Figure 5. Figure 6. 2. Positions packages so CI tape is easily visible on all wrapped packages (see Figure 6). 3. For perforated container systems (e.g., cassettes): a. Allows for maximum drainage of condensation - lie flat, parallel to the rack if possible (a common practice when utilizing table-top sterilizers). b. In floor-size sterilizers it is acceptable to load cassettes on edge. 16
2. For paper-plastic pouches: a. Place pouches in the chamber according to IFU. Placing pouches on edge often improves drying (see Figure 7). b. Whether flat or on edge, place paper side of one pouch facing the plastic side of the adjacent pouch. c. Load these and other lighter items on top rack. Figure 7. 3. Places a Process Challenge Device (PCD)/test pack into EVERY steam sterilizer load (see Table 5). Choose the appropriate PCD/test pack for the load and label it. a. Biological Indicator (BI) PCD/test pack: i. For the first load of the day/week use a BI PCD (this contains both the BI and the integrator). Note: BI qualification testing is required upon installation of sterilizers, after relocation, major repairs and sterilizer or processing malfunctions. See Tables 1, 5 and the USAF Guidelines for Infection Prevention and Control in Dentistry for more information about BI testing. b. Integrator PCD/test pack i. For each additional load use an integrator PCD (this contains an integrator only). c. Label the PCD with a load sticker containing the sterilizer ID number, load number and date of sterilization before placing into the sterilizer. Table 5 17
X X. Selecting Steam Sterilizer Cycles A. The IPT identifies the type of cycle that is most desirable for the instruments IAW the instrument s IFU. Steam sterilizers are either gravity displacement or prevac. Some steam sterilizers can run both gravity and prevac cycles. Review the sterilizer IFU to determine cycle types and refer to the USAF Guidelines for Infection Prevention and Control in Dentistry for more information. B. IPT does the following: 1. Selects the appropriate programmed cycle IAW the instrument s IFU. The programmed cycle may be displayed as a cycle number (e.g., cycle 1, cycle 2 or cycle 3). 2. Ensures cycle parameters are selected IAW the instrument s IFU for the load. a. It is important to verify the parameters (i.e., time and temperature), not only the clinic specific cycle number. Note: BI (e.g., spore test) can be cycle specific. Some BIs are made for specific cycles. Example: A one hour BI made specifically for a gravity displacement cycle at 270 F/132 C is invalid if used in a gravity cycle at 250 F/121 C. Additionally, the same BI is invalid if used in any prevac cycle. X C X C2 XI A C. Do the cycle time and temperature agree with the time and temperature requirements for the BI (e.g., spore test) and instruments IFU? 1. IF YES: Proceed to Section XI (Sterilization Cycle). D. IF NO: DO NOT use the sterilizer. Obtain the correct BI before using the sterilizer. XI. Running Steam Sterilizer Cycles A. The IPT does the following: 1. Starts the cycle: when cycle starts, the print-out records a cycle start time and date then the print out advances. 2. Initials the print-out (see Figure 8). STOP STOP, the IPT ensures the cycle has started before leaving the area and moving on to the next step. 3. Completes line 3 of the AFDS Sterilizer Load Release Document (see Figure 9). Figure 8. Line 3 Figure 9. 18
XI B B. When cycle ends the IPT does the following: 1. Verifies physical monitors (time and temperature) on print-out by identifying: a. Correct cycle b. Sterilization phase i. The first (S): start time and temperature ii. The first (E): end time and temperature c. Exhaust phase 2. The first (E) is a transition point. It represents the sterilization phase end and exhaust phase start. Highlights sterilization time, temperature and pressure (see Figure 10). 3. Initials print-out; this is the second time the print-out is initialed (see Figure 10). 4. Completes line 4 of the AFDS Sterilizer Load Release Document. Records the cycle end time (e.g., 08:56:05 [see Figure 10.]), the technician name and initials (see Figure 11). Figure 10. Line 4 Figure 11. 5. Completes lines 5-7 of the AFDS Sterilizer Load Release Document (see Figure 12). Records whether or not the physical monitors were met IAW IFU (see Figure 12 & 13). Line 5 Line 6 Line 7 Figure 12. 8:30:33 8:34:33 4 270.0 272.9 Figure 13. XI C XI C2 STOP C. Were the time and temperature requirements met? 1. IF YES: The IPT proceeds to section XII (Unloading the Sterilizer). 2. IF NO: REPROCESS THE LOAD if time and temperature requirements were not met, return to Section VI (Instrument Wrapping and Packaging) and evaluate sterilizer function (BMETs assistance may be required). 19
XII A XII. Unloading the Steam Sterilizer DO NOT remove packages from the sterilizer if condensation is visible. DO NOT touch packages during the cooling process. DO NOT allow items to cool in areas where air conditioning/cool air vents are in close proximity. DO NOT transfer warm items onto cold metal shelves or racks for cooling. A. The IPT does the following: 1. Opens the sterilizer door slightly to allow excess steam to escape. Items begin to cool within the sterilizer to reduce condensation formation. The minimum cooling time is 30 minutes (10 minutes for table-top sterilizers), but cooling may take up to 2 hours depending upon many factors (e.g., ambient temperature and humidity of the environment, sterilizer type, instrument design, etc.). 2. Verifies the external CIs (i.e., CI tape) and visible integrators have been properly exposed to steam and have changed color. All integrators may not be visible at this time. 3. Completes line 8 (see Figure 14.) of the AFDS Sterilizer Load Release Document. Line 8 Line 9 Figure 14. XII B XII B2 XII B3 XII B3a XII B3b STOP B. Did the external and internal CIs react appropriately to the critical parameters and change color? 1. IF YES: Proceed to Section XII B3 (Are the instruments in the sterilizer free from condensation?) 2. IF NO: REPROCESS THE LOAD if external and internal CIs did not react appropriately to the critical parameters and change color. Return to Section VI (Instrument Wrapping and Packaging). Repackage and re-sterilize instruments. 3. Are the instruments in the sterilizer free from condensation? a. IF YES: The IPT does the following: i. Removes PCD/test pack and verifies the integrator has changed appropriately. Attaches the processed integrator from the PCD/test pack to line 9 (see Figure 14.) of the AFDS Sterilizer Load Release Document. ii. Allows BI/spore test to cool after sterilization and before incubation. The PCD containing a BI is used daily or weekly according to local policy. iii. Unloads instruments from the sterilizer using a tray or cart. Allows packages to cool. b. IF NO: The IPT allows the packages to continue to cool within the sterilizer until they are free from condensation. Proceed to Section XII C ( Are Instruments cool to the touch? ). 20
Note: If the sterilizer alarm sounds while the sterilizer door is ajar and prevents the initial cooling process in the sterilizer consult with the BMETs or the manufacturer. It is important that instruments are not removed from the sterilizer if condensation is present. XII C XII C1 XII C2 XII D XII D1 XII D2 STOP C. Are instruments cool to the touch? 1. IF YES: The IPT inspects packages for the following: a. External/internal CIs that have appropriately changed. b. Moisture/wet packages. c. Tears, punctures or other damage. 2. IF NO: The IPT allows instruments to continue to cool outside of the sterilizer. Return to Section XII C1 (inspects packages). D. Are packages dry and damage free? Do packages have CIs that have changed appropriately? 1. IF YES: The IPT verifies additional sterilizer monitoring has been completed. Completes/verifies lines 10-13 of the AFDS Sterilizer Load Release Document (see Figure 15.) and records the results of the following daily/weekly: a. Daily dynamic air-removal test (e.g., Bowie-Dick). (PREVAC ONLY) b. Some manufacturers require vacuum leak cycle test. Refer to sterilizer IFU. (PREVAC ONLY) 2. IF NO: REPROCESS THE LOAD because package integrity has been compromised or steam did not reach the instruments. Return to Section VI (Instrument Wrapping and Packaging). Line 10 Line 11 Line 12 Line 13 Figure 15. XIII A1-3 XIII A4 XIII B XIII. Dry Heat Sterilizer-USED FOR CAD/CAM SLEEVE ONLY A. The IPT does the following: 1. Visually inspects the dry heat sterilizer chamber before turning sterilizer on. 2. Closes door ensuring handle is in the closed (horizontal) position. 3. Turns sterilizer on and allows it to warm IAW up to 375 F/190 C. 4. Completes Sections III and IV (Instrument Cleaning/Decontamination and Instrument Inspection). B. Are instruments dry? 21
XIII B1 XIII B2 XIII C2-3 XIII C4 XIII D XIII D1 XIII D2 XIII E XIII F XIII F1 XIII F2 XIII G 1. IF YES: The IPT does the following: a. Dons appropriate PPE. b. Assembles instruments and places them into nylon pouches. c. Labels the Class 3 CI with initials, sterilization date and expiration date if applicable. d. Places Class 3/single-variable CI into nylon pouch (DRY HEAT STERILIZATION ONLY). e. Annotates the following in the dry heat sterilizer log (supplied by the manufacturer). i. Sterilizer ID number ii. Load number 2. IF NO: The IPT allows instruments to dry IAW IFU. Return to XIII B1. C. The IPT does the following: 1. Reviews IFU or the local IFU Quick Reference. 2. Completes Line 1 of the AFDS Sterilizer Load Release Document. a. Affix a load sticker to the document. 3. Completes line 2 of the AFDS Sterilizer Load Release Document. 4. Loads the dry heat sterilizer. a. Place up to 8 nylon packages in the sterilizer on the instrument rack. b. Place packages so Class 3 CIs are easily visible. c. Place BI/spore test strip into a nylon pouch. d. Place the BI/spore test strip within a nylon pouch into the first load of the day/week IAW local BI/spore testing. D. Has a BI/spore test been selected that is specific to dry heat sterilization? 1. IF YES: The IPT does the following: i. Selects Cycle III for wrapped instruments. ii. Runs sterilizer. 2. IF NO: The IPT chooses the correct BI for dry heat sterilization. DO NOT use the sterilizer until the correct BI is obtained. E. The IPT does the following at cycle end: 1. Verifies the cycle completion a. Examine the display window, 12 C appears at cycle completion. b. Examine print-out if possible. 2. Completes line 4 of AFDS Sterilizer Load Release Document. F. Were the time and temperature requirements met? 1. IF YES: The IPT inspects for: i. CIs that have appropriately changed ii. Tears, punctures or other damage 2. IF NO: The IPT reprocesses the instruments and returns to Section VI (Instrument Wrapping and Packaging). G. The IPT does the following: 1. Opens sterilizer door and immediately removes the BI/spore test strip. 2. Starts the BI/spore test strip incubation process (mail-in or in-office). Follows the IFU. a. Ensure an appropriate aseptic technique is used. Contamination of the BI/spore test strip can cause a positive result. 22
3. Removes instruments from sterilizer and allow instruments to cool on the cooling rack. 4. Verifies CIs have changed appropriately. 5. Complete line 8 of the AFDS Sterilizer Load Release Document (see Figure 14). XIV XV XIV. Bulk Storage A. Store sterile instruments in a manner in which sterility is maintained. DO NOT stack cassettes. DO NOT place packages under heavy items that can crush or damage packages. 1. The IPT does the following: a. Limits access to instrument processing center. b. Rotates stock (first in, first out). c. Positions wrapped cassettes on edge. d. Stores instruments so external CI (e.g., tape) is easily visible. e. Monitors temperature and humidity according to the Association for the Advancement of Medical Instrumentation (AAMI) ST79. i. Temperature may be as high as 75 F/24 C. ii. Control relative humidity between 30% to 70%. B. The dental assistant/medical technician does the following: 1. Retrieves sterile instruments from areas marked/designated Sterile Instruments a. If there are no instruments in such areas STOP: i. Contact the IPT ii. DO NOT take instruments from the instrument processing center that are not labeled/designated Sterile Instruments. iii. DO NOT take instruments from the instrument processing center if they contain indicators/integrators that HAVE NOT turned the appropriate color. STOP 23
Acronyms and Initialisms AAMI AFDS AFMS BI BMET CI DECON DECS DHCP DIPC DTF EXP IAW ID IFU IC IPT Kx MTF PCD PPE Prevac USAF Association for the Advancement of Medical Instrumentation Air Force Dental Service Air Force Medical Service Biological Indicator Biomedical Equipment Technician Chemical Indicator Decontamination Dental Evaluation and Consultation Service Dental Health Care Personnel Dental Instrument Processing Center Dental Treatment Facility Expiration In Accordance With Identification Instructions for Use Infection Prevention and Control Instrument Processing Technician Knowledge Exchange Medical Treatment Facility Process Challenge Device Personal Protective Equipment Prevacuum United States Air Force 24