Classifying Medical Instruments: Critical vs. Semi-Critical - Essay Sample

Introduction

Spaulding classification has been put in three surfaces, namely; critical where sterilisation is required for the objects that enter the normally sterile tissues and the vascular system of the patient's body. They include scalpel blades, bone chisel and periodontal scalers. The second category is the semi-critical, where a very high level of sterilization is required for the objects that contact the mucous membrane or the non-intact skin without penetrating the soft tissues. The semi-critical sterilisation kills all the high levels of spores carrying bacteria. These include dental mouth mirrors and amalgam condensers. The last classification is the non-critical category. This is where low-level sterilisation is carried out on the objects that come in contact with the intact skin. The mucous membrane is not touched with the objects under this category (Montagat, 2016)Critical, Non-critical, and Semi-Critical Items in the Dental Surgery

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Each category of classification has its unique instruments because of the complexity of the work to be done. There are instruments that will naturally not go deep into the tissues as they are designed to perform probably on the skin surface. Others are meant to be used deep into the tissues, and once they are exposed to the skin surface, they cause a lot of damage. Examples of instruments on the critical category are surgical items such as dental burs, bone chisel and scalpel blades. Items on the second category include things like dental hand pieces, water syringes and dental mouth mirrors. Instruments of the non-critical category are of two types; one is the clinical surfaces that are touched by gloved hands as they are likely to be contaminated during the clinical procedures and two housekeeping surfaces that are cleaned using detergent and water. These are items like pulse oximeters, blood pressure cuffs and x-ray heads (Riviere & Monteiro-Riviere, 2014).

Sterilisation in an Autoclave

Firstly, all the instruments to be autoclaved must be free from any form of residual matter such as blood. Additionally, the items must also be mineral deposits free and dry owing to the fact the mineral deposits or moisture might cause damage to the item or the sterilising machine. The procedure for sterilization is as follows;

First is to clean the item after its immediate use. Usually, it is recommended that they use Tauttner clean and simple ultrasonic system with an addition of Tauttner clean and simple enzymatic cleaning solution. After this, the items are rinsed for 30 seconds and dried. It is also crucial that one follows the manufacture's instruction on the next step of cleaning and lubrication items. Always separate items that are not made of similar materials such as stainless steel and carbon steel. Items under sterilisation must be done in an open place. When autoclaving, always ensure a sterilisation indicator is placed on each tray or inside the wrapper pack. Ensure that the items are kept apart during sterilisation. Place empty canisters upside down to avoid moisture accumulation. Always avoid overloading the autoclave machine. To allow steam circulation, place the trays at a distance of at least 1" apart. All wrapped items must be placed in such a way to allow penetration, circulation of steam and drying. During storage of autoclave items, it is proper to avoid stacking pouches for proper drying (Riviere & Monteiro-Riviere, 2014).

Chemical Indicators

A chemical indicator is a substance that is able to give a visible sign mostly by colour change, or presence or absence of a chemical species such as an acid or base.

The six types of chemical indicators are:

• Type 1 - process. These indicators are directly exposed to the process of sterilisation. They are used in the autoclave tape and the chemical indicator strips. Some are attached to the outside of packs. They are purposed to give a visual affirmation of the sterilisation process.
• Type 2 - specific use. These are for very specific test processes. They include Bowie-Dick test packs - these test for the removal of air in a pre-vacuum steam sterilisation cycle.
• Type 3 - single variable. It is used for a single variable in the autoclaving procedure. It is usually exposed to a disinfecting process at a stated value of the variable. It is in the form of a chemical pellet that melts as specified temperature. It indicates that the steam sterilisation process has reached a certain temperature that was specified.
• Type 4 - multivariable. These indicators perform multiple functions in the disinfecting process. They are also exposed to disinfection cycle at a stated value of the variable. They are in the form of chemical indicator tubes that change colour when exposed to a specified temperature for a given period in the autoclave machine.
• Type 5 - integrators. Deals with all the critical variables in a disinfecting process. The stated values must meet the requirements in the ISO for biological indicators series 11138. They are moving front indicators, and they determine al the critical process parameters.
• Type 6 - emulating indicators. These indicators include all the critical variables for the specified autoclave cycle process whose stated value is generated from the critical variable of the specific autoclave process. They include cycle-specific indicators which are placed inside the packs to indicate critical process parameters for specific autoclave cycle (STERIS Life Sciences).

Reasons why a pouch that has just been removed from a completed autoclave tray would be considered unsterile and to whom should one report faulty instruments

A possible explanation for this is: One, there was a possibility that the pouch was punctured in the whole process. It is always advised that the pouch should be in doubles for the sharp and heavy instruments. This will ensure the tear is only on the outer bag leaving the inner bag safe (Centres for Disease Control and Prevention, 2019).

Two, there is a likelihood that the pouch was not sealed properly during the storage process. Therefore, the air got into the bag, thus making the items inside the pouch unsterile.

Three, the sterile strip indicator did not change colour as was supposed to during the autoclave process (Centres for Disease Control and Prevention, 2019).

Why you need to altogether remove all blood, saliva, and other debris from instruments before sterilisation can take effect.

It is a critical stage in handling dental instruments for reuse is to clean dental instruments. The sterilisation method will not be efficient if debris is not removed from the tools as the steam or chemical vapour in a heat steriliser must touch the surface of the tool. Hand-scrubbing of tools can be an efficient technique of cleaning. However, it is dangerous in terms of puncture and/or potential for spattering. Only selective hand scrubbing of tools is recommended by the Centers for Disease Control and Prevention (CDC), using an ultrasonic instrument cleaner or instrument washer as the main technique of cleaning contaminated instruments (Dental Economics, 2011).

Using an ultrasonic cleaner is the most prevalent technique of cleaning tools I have observed in dental procedures. These devices use high-frequency sound waves in a detergent solution to generate agitation or cavitation for debris removal. The use of enzymatic alternatives in these processes improves the efficacy of the cleaning method, as these products are more efficient in blood removal from the instruments more than the general-purpose cleaners (Dental Economics, 2011).

What Information do SDS Sheets Contain?

A safety data sheet should contain information on:

Identification - should include the product name, other means of identification, the recommended use, restrictions on use and any emergency contact telephone numbers where applicable.

Hazard identification- must be explicitly specified including class, category and the subcategory of the substance mixture. The hazard should be identified physically, and for the health hazards, it is likely to cause. The label elements should also be indicated having attached the symbol/image, the signal word, hazard statements and the statements of precaution

Composition information- given that the product is hazardous, it must contain the chemical name, common name, chemical abstracts service registry number and any other unique identifiers, chemical impurities and stabilising solvents. For substances in a mixture give its name, common name and CAS registry and the concentration.

First-aid measures should be indicated by specific route of exposure that is; ingestion, inhalation, skin and eye contact. Important symptoms effects , and the immediate medical attention that should be administered (CCOHS, 2015).

Other inclusions are fire-fighting measures, handling and storage, personal protection, physical and chemical properties and disposal conditions (CCOHS, 2015).

References

CCOHS. (2015). WHMIS 2015 - Safety Data Sheet (SDS) . Retrieved from Canadian Center for Occupational Health and Safety, CCOHS: www.ccohs.ca/oshanswers/chemicals/whmis_ghs/sds.html.

Centres for Disease Control and Prevention. (2019, April 4). Sterilizing Practices. Retrieved August 2nd, 2019, from Centres for Disease Control and Prevention: www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterilizing-practices.html

Dental Economics. (2011, October 1). Safe and Effective Instrument Cleaning. Retrieved from Dental Economics: www.dentaleconomics.com/science-tech/sterilization-and-infection-control/article/16394532/safe-and-effective-instrument-cleaning

Montagat, N. (2016, March 07). Classification of Instruments. Retrieved August 2, 2019, from The Future DENTIST: nicolasmontagnat.wordpress.com/2016/03/07/2-classification-of-instruments/

Riviere, J. E., & Monteiro-Riviere, N. A. (2014). Reference Module in Biomedical Sciences. Dental and Oral Biology, Biochemistry, 1(1), 1-8. doi:10.1016/B978-0-12-801238-3.01886-9

STERIS Life Sciences. (n.d.). 6 ISO Types of Chemical Indicators for Steam Sterilization: Cleaning Validation & Infection Prevention Solutions . Retrieved from STERIS Life Sciences: www.sterislifesciences.com/resources/documents/article-reprints/chemical-indicators-for-steam-sterilization