Spaulding’s Classification Of Instruments For Reprocessing

Please carefully read through each question posed. In your response, please use terms and phrases that you defined in your previous assessment. Reflect on your learning unit and your own research. Please aim to present 180 words for each response to fully demonstrate your knowledge in this area of study. A minimum of 150 words for each response is required. Please note: Where the word count is not met, your submission will be returned to you for re-working.

1. In your own words, describe the Spaulding classification. List and describe the three categories as devised by Spaulding as well as the level of risk, application, and processes associated with each category.

2. List at least three examples each of critical, non-critical, and semi critical items that you use in the dental surgery.

3. List how used items are prepared for strerilisation in an autoclave. Your response should include preparation of critical and semi-critical instruments using trays and/or cassettes and batch control identification measures. Be sure to provide the required BCI information that is recorded for each cycle as well as the importance of accurate record keeping.

4. There is a range of chemical indicators that can be stored inside packages or attached to the outside of the wrapped package prior to sterilisation. What are chemical indicators? List and describe the intended uses for the six chemical indicator types.

5. List three possible reasons why a pouch that has just been removed from a completed autoclave tray would be considered unsterile and needs to be reprocessed. In the event of the autoclave not functioning within regulation, how and to whom would you report and document the fault/malfunction?

6. Explain why you need to completely remove all blood, saliva, and other debris from instruments before sterilisation can take effect. Describe the methods that may be used in removing all debris prior to sterilisation, including the advantages and disadvantages of each. Which method/s lessen the chance of contamination via aerosol or splatter?

7. There are many different types of chemical waste produced at the dental workspace. These vary between types of equipment and specific cleaning product in use. Safety Data Sheets should be always be referred to when assessing risks. What information do SDS sheets contain?

Overview of Spaulding’s Classification System

Spaulding’s classification is an instrument classification system for instruments used for reprocessing of decisions. There were three classifications of instruments namely the critical, semi-critical and non-critical instruments. Critical equipment is those which normally enter the sterile tissue or the vascular tissue and often require sterilization.

They are first cleaned before sterilization. This is to ensure that the microbial life is devoid. Semi-critical, on the other hand, are objects that are in contact with the mucous membrane and often require a high level of disinfection after cleaning (McDonnell & Burke, 2011) High levels of disinfectants like hydrogen peroxide may be used in this case. This is to ensure that it is free from all microorganisms except the bacterial spore which are of low numbers. Non-critical are objects that are in contact with the intact skin and not the mucous membrane and often low levels of disinfection after cleaning. This is mostly done to kill the fungi, viruses and the vegetative bacteria (McDonnell & Burke, 2011) Sometimes they can only be cleaned.

Examples of critical, semi-critical and non-critical instruments

            Critical dental instruments include scalpel blades, extraction forceps, periodontal scalers, bone chisels, needles and surgical burs. In this case, the periodontal scaler is used in root planning and scaling. They are used in the removal of canals from the teeth. Calculus is one of the sterile tissue that is why it is classified as an example of critical instruments. Semi-critical dental instruments include amalgam condensers, water or air syringe, dental handpiece, dental mirrors and impression trays (McDonnell & Burke, 2011) For instance, amalgam condenser is an instrument that is used in condensing amalgam in cavities of natural teeth. It often comes in contact with the mucous membrane.

It is mostly used for condensing silver amalgam. Non-critical instruments include light arms or handles, dental x-ray equipment, chairside computers, chair switches, spatula and a dental chair (McDonnell & Burke, 2011) For instance, dental x-ray equipment is used by the dentist in knowing the dental structure of the patient. They can be in contact with the intact skin and not the mucous membrane.

Preparation of used items for sterilization in an autoclave

            Autoclave use high temperature and high steam to kill microorganisms. To achieve effective sterilization, the material must be saturated with steam. There should not be air pockets and insufficient steam or else sterilization will not be effective. To ensure maximum penetration of steam, solid materials should be packed loosely and waste should not be intentionally being compacted (McDonnell & Burke, 2011). All dental hand pieces should be cleaned according to the manufacturer's description. They must be sterilized after each patient.

Examples of Critical, Semi-Critical, and Non-Critical Instruments

Dental hand pieces should not be immersed in water at any cleaning stage. Exterior surfaces should be cleaned first followed by the internal surfaces. BCI is a mandatory requirement for all dental practices. The BCI recording should have the date of sterilization, cycle number, and the sterilizer identification number code. This helps in linking the surgical instruments to the sterilizing cycle, therefore, showing that all the critical and semi-critical instrument has gone through a certain sterilizing cycle. Sterilization should also not be assumed to have been achieved not unless the temperature and pressure of an autoclave are continuously measured automatically (McDonnell & Burke, 2011)

Chemical indicators

            These are indicators used to monitor critical variables during each sterilization process. These variables include temperature, time or even steam saturation. They can be applied either on the outside or the inside of the instrument. The six examples of indicators are process indicators, single-parameter indicators, indicators for use in the specific test, multi-parameter indicators, integrating indicators and emulating indicators (McDonnell & Burke, 2011).

Process indicators are often designed to react with one critical variable which is usually temperature. Indicators for use in a specific are often used to show the efficiency of penetration of steam and removal of air. Single-parameter indicators are used to show how a single sterilization process will change to an identified variable. Multi-parameter indicators are designed to react to two or more critical variables at a sterilization process. Integrating indicators are used for monitoring pack control. They are usually internal chemical indicators. Emulating indicators are used for sterilization cycle verification. They show the complete cycle by either showing the presence or absence of temperature during the process (McDonnell & Burke, 2011)

Reasons for pouch reprocessing

            A pouch may be considered sterile if it is a wet load. A load may be considered wet if it has moisture that is visible outside the pack, moisture inside the pack and the availability of water in the tray that contained the pack (McDonnell & Burke, 2011) . This is when the pack is considered to be unsterile. To avoid wet loads after sterilization, condensate should remain in contact with the material it had condensed on in each autoclave cycles or even the condensate should be separate from the material and finds its way to the drain. Other ways to avoid this maybe through proper maintenance of the autoclave in each cycle, not overloading the sterilizer and maintaining the humidity and the temperature of the sterile storage area. A log book should be used to track the operation and any abnormalities are noted. In case of any problem, it should be reported to the repair people as soon as possible. A note should be placed on the equipment so as to give a caution to others not to use the autoclave (McDonnell & Burke, 2011).

Sterilization Methods and Tips

The need to remove blood, saliva and other debris from instruments before sterilization

            Cleaning is the first step before sterilization and involves the removal of blood, proteins, microorganisms and other debris from the instruments (McDonnell & Burke, 2011).  This often prepares the instrument for safe handling and helps in infection control. This is achieved through the use of detergents. One method is the use of ultrasonic cleaner, and it uses sound waves of high frequency to provide agitation in a detergent to remove debris. It involves the use of enzymatic solutions to remove debris because of its effectiveness. In this, the potential of contamination is minimized (McDonnell & Burke, 2011).

Scrubbing the instrument using a detergent is also one method of removing the debris. This is the manual removal of debris from an instrument. manual cleaning is one advantage of flexibility because any type of instrument can be cleaned. The disadvantage is that the cleanliness of the instrument is often different from one worker to another. The worker is also prone to infection. The use of automatic washer is another method of cleaning. They use automatic cleaning machines. Ultrasonic cleaning lessens the chance of contamination (McDonnell & Burke, 2011).

The Information contained in the Safety Data Sheet

            SDS sheets provide information on the data used to identify the hazards. It is a document containing information about potential hazards for example fire, reactivity, environmental and health. It also provides information on how to work safely with certain chemical products (Ronald, 2012). For complete development of safety and health program, a safety data sheet should be the starting point. It contains product information, product name, suppliers and manufactures name and addresses, physical data, explosion and fire data explosion, chemical instability of a product, health effects of a product, first aid and preventive measures and lastly the preparation information. First aid measures include activities like the required treatment. It also contains information on how one can handle the substance in case of a spill (Ronald, 2012). Information on how the instrument can be cleaned or even sterilized is also contained in the Safety Data Sheet. Disposal and transport considerations are also included in the Safety Data Sheet (Ronald, 2012). 

References

McDonnell, G., & Burke, P. (2011). Disinfection: is it time to reconsider Spaulding?. Journal of Hospital Infection, 78(3), 163-170.

Ronald, J. W. (2012). Understanding a safety data sheet (SDS) in regards to process safety. Procedia Engineering, 45, 857-867.