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File: Autoclave Pdf 91701 | Dental Sterilization
ental ssessment october 2010 dental sterilization solutions y avi cohen head of medical solutions objet geometries ltd abstract hemical sterilization this whitepaper describes the different sterilization adiation sterilization methods and ...

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            —ental ssessment
                                                        October 2010
           Dental Sterilization Solutions
           ƒy‹ Avi Cohen – Head of Medical Solutions, Objet Geometries Ltd
                                  Abstract                                      • …hemical sterilization
         This whitepaper describes the different sterilization                  • adiation sterilization
         methods  and  technologies  currently  available  in                    
         today’s  dental  equipment  sterilization  market  with               Common High Temperature Sterilization 
         observation  to  apid  rototype  models  ocus  is                  A. Steam Autoclave
         given  to  the  more  common  sterilization  methods                    team  autoclave  is  the  oldest  safest  and  most 
         used or available for dental equipment in hospitals                    cost  effective  method  of  sterilization  in  the  medical 
         and clinics  today  t  the  end  of  the  paper  there              equipment industry  The  steam  reaches  121Š1‘’°… 
         is  a  conclusion  and  table  which  summarizes  the                 †2”0Š•00°ˆ in the pressure chamber at 1”  ‰ The 
         common  sterilization  methods   i­  sterilization                    sterilization period is dependent on the temperature 
         methods€products  were  isolated  and  ranked                          and size of load and can range from 10Š–0 minutes
         based on their sterile efficacy and applicability to 
         medical  instruments  and  apid  prototype  models                   …onfigurable  cycles  allow  the  user  to  customize 
                                                                                the  sterilization  cycle  for  items  such  as  hard  items 
          terilization means the use of a physical or chemical                  wrapped items liquids in vented containers waste 
         procedure to destroy all microbial life including highly              and glassware
         resistant bacterial spores                                            The fastest steam sterilization used is flash sterilization 
         ƒacterial  spores  are  the  most  resistant  of  all  living          and  it  can  be  accomplished  using  either  gravityŠ
         organisms  because  their  capability  to  withstand                   displacement  or  preŠvacuum  cycles  ‰t  is  generally 
         destructive agents lthough the chemical or physical                  a  highŠspeed  steam  sterilization  of  an  unwrapped 
         process used to destroy all pathogenic microorganisms                  instrument or device for • to 10 minutes in 1•2°… 
         including spores is not absolute when all parameters                  saturated steam 
         of the sterilization process have been met instruments               This  type  of  sterilization  is  only  intended  for  use 
         supplies  and  equipment  are  thought  to  be  sterile               in  hospital  operating  rooms  for  urgently  needed 
                                                                                equipment
         n ob„ect should be sterilized depending on its intended 
         use …ritical ob„ects †those that enter sterile tissues or the         ‰n the steam autoclave process microorganisms are 
         vascular system or through which blood flows such as                  killed by heat and this is accelerated by the addition of 
         implanted medical devicesˆ require sterilization before                moisture  team by itself is not sufficient for sterilization 
                                                                                                                    atmospheric is needed 
         use                                                                   and pressure that is greater than
         ‰tems that touch mucous membranes or no intact skin                   to increase the temperature of steam for thermal destruction 
         like   endoscopes  respiratory  therapy  equipment                   of microbial life
         and  diaphragms  require  highŠlevel  disinfection                   Solutions:
         which  would  not  be  discussed  in  this  whitepaper                 team autoclave is used mostly for surgical instruments 
          terilization falls into the following three categories‹               This method is not well suited for heat sensitive materials 
         • Žigh temperature€pressure sterilization                              and instruments
         ™any surgical instruments are not designed to withstand           sterilization †safest fastest and least e­pensiveˆ and štO 
         prolonged heat and moisture of the steam sterilization            gas sterilization which leaves to­ic residuals ‰t is a low 
         process This leads to alternative sterilization categories‹      temperature nonŠto­ic but fairly e­pensive sterilization 
         chemical sterilization and radiation sterilization which         method ‰n this process hydrogen pero­ide is activated 
         allow heat and moisture sensitive materials to be sterilized     to create a reactive plasma or vapor
                                                                           The  terrad system is a Žydrogen ero­ide žas lasma 
         Common Chemical Sterilization                                      terilization system with an operating temperature range 
         A. Ethylene Oxie EtO as                                       of ‘”Š”0°… Operating cycle times range from ‘”ŠŸ0 
                                                                           minutes depending on size of system
         šthylene O­ide gas was introduced in the 1›”0’s and              This sterilization system uses a combination of hydrogen 
         it is an effective low temperature chemical sterilization        pero­ide and low temperature gas plasma to quickly 
         method ‰t also takes longer than steam sterilization            sterilize most medical instruments and materials without 
         typically 1–Š1’ hours for a complete cycle Temperatures         leaving any to­ic residues  terilization by this method 
         reached during sterilization are usually in the ”0Š–0°…           occurs in a low moisture environment
         range                                                            The Žydrogen ero­ide lasma rocess using  terrad‹
         šthylene o­ide †štOˆ is a chemical agent that kills               The process consists of two consecutive and equal 
         microorganisms including spores štO gas must have               sterilization phases
         direct contact with microorganisms on the items to be 
         sterilized —ue to štO being highly flammable and                 ¡acuum € replasma  tage‹
         e­plosive in air it must be used in an e­plosionŠproof           • ¢hen a low pressure is achieved in the vacuum stage 
         sterilizing chamber in a controlled environment                  low temperature air plasma is generated This helps in 
         ‰tems sterilized by this process must be packaged with            removing residual moisture from the chamber The system 
         wraps and be aerated The aeration time may be long               is then vented to atmospheric pressure at the end of this 
         and is needed to make sterilized items safe for handling          stage
         and patient use                                                   terilization  tage‹
                                                                           • ressure in chamber is reduced and an aqueous 
         ‰n general štO gas is a reliable and safe agent for              solution of hydrogen pero­ide is in„ected and vaporized 
         sterilization when handled properly                              into chamber
         Solutions:                                                        • The hydrogen pero­ide diffuses throughout the 
                                                                           chamber surrounds the items to be sterilized and starts 
         štO is used to sterilize items that are heat or moisture          the inactivation of the microorganisms
         sensitive —isadvantages of štO gas are that it can leave         • fter the pressure is reduced applying radio frequency 
         to­ic residues on sterilized items and it possesses several       †ˆ energy creates an electric field and thus forms low 
         physical and health hazards to personnel and patients that        temperature plasma
         merit special attention                                          • ree radicals are generated in the plasma by breaking 
          ince štO poses several health hazards there are                 apart the hydrogen pero­ide vapor Once the activated 
         currently two alternative technologies that are currently         components react with the organisms
         available‹  terrad a plasma phase hydrogen pero­ideŠ             and kill them they lose their high energy and reŠcombine 
         based sterilizing agent and  teris a per acetic acid based       to form o­ygen water vapor and nonto­ic byŠproducts
         technology
                                                                           • This is half of the total sterilization process The other 
                                                                           half of the cycle is completed by repeating the above 
         . Sterra   o­ Temperature Hyrogen €eroxie                    sterilization steps
         €lasma                                                            • t the completion of the second half cycle the source 
         œow temperature plasma sterilization was introduced to            of  energy is turned off vacuum is released and 
         fill the gap between autoclave‹ high temperature steam            chamber is returned back to atmospheric pressure by 
          introduction of filtered air                                               to­icity concerns 
           olutions‹                                                                   
          This system is best suited to sterilize heat sensitive medical              Solutions:
          equipment such as endoscopic equipment ¢ith two                            This solution is frequently used on surgical cameras 
          systems  terrad provides sterilization solutions for both                  †endoscopesˆ The item to be disinfected must be 
          smaller and larger  olutions                                               thoroughly cleaned and dried before immersion fter 
                                                                                      immersion the item must be rinsed thoroughly with sterile 
          C. Steris System ‚ Sterile €rocessing System                                water prior to use 
                                                                                       
          The  teris  ystem is another more common low                              ƒ.„. Common …aiation Sterilization
          temperature sterile processing system ‰t uses the  teris                   A. amma† eta Sterilization
          20  terilant …oncentrate that combines peracetic acid a                    ‰rradiation is an effective sterilization method but it 
          chemical biocidal agent and a proprietary antiŠcorrosion                   is limited to commercial use only The product to be 
          formulation to kill microorganisms at low temperature The                  sterilized is e­posed to radiation for 10 to 20 hours 
          process is achieved at a temperature of                                     depending on the strength of the source The highest 
          ”0Š”–°…                                                                    temperatures reached in gamma sterilization are usually 
          The  teris 20  terilant …oncentrate is mi­ed with sterile                   •0Š‘0°… žamma radiation is popular for sterilizing 
          water to create the solution that flows into the sterilization              before shipment and it can be done through the 
          chamber The sterilization time is 12 minutes                              packaging 
          This is followed by repetitive sterile water rinses to                       
          complete the process The entire process is completed in                    The principal sources of ionizing radiation are beta 
          less than •0 minutes for a standard cycle                                  particles and gamma rays
          eracetic acid by itself is an o­idant and disinfecting                   ƒeta particles free electrons are transmitted through a 
          agent for liquid immersion                                                 highŠvoltage electron beam from a linear accelerator 
                                                                                      These highŠenergy free electrons will penetrate into matter 
          ‰t maintains its effectiveness when high levels of organic                  before being stopped by collisions with other atoms This 
          debris are present ‰t is an acetic acid plus an e­tra                      means their usefulness in sterilizing an ob„ect is limited by 
          o­ygen atom that reacts with most cellular components to                    the density thickness of the ob„ect
          destroy cells                                                              and by the energy of the electrons These free electrons 
                                                                                      produce their effect by ionizing the atoms they hit 
          Solutions:                                                                  producing secondary electrons that kill microorganisms
          Only immersible instruments can be used with this method                   …obalt –0 is a radioactive isotope capable of breaking 
          and only a few instruments can be sterilized at one time                   down to produce gamma rays žamma rays are 
          £o packaging required                                                      electromagnetic waves that have the ability to penetrate 
                                                                                      a much greater distance than beta rays before losing 
          — …ide­ O  olution – lternative to žlutaraldehyde                       their energy from collision ƒecause they travel with 
          …ide­® O  olution is a Žigh œevel —isinfectant †Žœ—ˆ                      the speed of light they must pass through a thickness 
          for use in reprocessing heat sensitive medical devices                     measuring several feet before making sufficient collisions 
          …ide­ O  olution provides highŠlevel disinfection in 12                   to lose all of their energy 
          minutes at room temperature †20o…ˆ and is particularly 
          active against mycobacteria                                                olutions‹
          …‰—š¥ O  olution has the broad materials compatibility                    The radiation can change the properties of some 
          of glutaraldehyde requires no activation and has minimal                  materials like plastics and have adverse affects on glues 
          odor The …ide­ O                                                         or adhesives
           olution is replacing …ide­ and …ide­ lus due to their 
          s you can see each of the si­ common methods                        ƒ ¡Ž ™—  eries
          discussed above have their advantages and                             ¡Ž †¡aporized Žydrogen ero­ideˆ ™—  eries 
          disadvantages                                                         terilization  ystem for ™edical —evices is yet another 
                                                                                low temperature sterilization system ‰t is different from 
          • Other  terilization ™ethods                                        the  terrad system in that it only uses hydrogen pero­ide 
          ‰n this section the other less common sterilization methods         in vaporized form for sterilization while the  terrad 
          are described These methods are either e­isting being               system uses
          replaced by new sterilization or are still in development           vaporized hydrogen pero­ide to initiate the sterilization 
          •1 Other Žigh Temperature  terilization                             and then plasma  to complete the sterilization process
           —ry Žeat                                                           ‰n the ¡Ž process hydrogen pero­ide vapor is in„ected 
                                                                                into the chamber via a series of pulses to sterilize 
          This process is conducted at 1–0Š1Ÿ0°… for a minimum of               packaged medical and diagnostic devices The cycle 
          two hours —ue to its high temperatures its applicable use           time is 2 hours and the operating temperature ranges 
          is limited                                                           from •0Š‘0°…
          —ry heat in the form of hot air is used primarily to sterilize        £ote‹ This system is large capital equipment that uses 
          anhydrous oils petroleum products and bulk powders                  hydrogen pero­ide On the other hand
          that steam and ethylene o­ide gas cannot penetrate ‰n                 teris …orporation’s other product the  teris  ystem 1 is 
          the absence of moisture higher temperatures are required             a portable tabletop system that
          than when moisture is present because microorganisms                  uses peracetic acid as the sterilant and it is used to 
          are destroyed through a very slow process of heat                     sterilize equipment right before use
          absorption by conduction
          •2 Other …hemical  terilization                                     … …hlorine —io­ide
           žlutaraldehyde †…ide­ lus¦ and …ide­¦ˆ                            …hlorine —io­ide is a chemical liquid sterilization 
          • …ide­ lus  olution is a disinfectant that is used to               process The best operating temperature range for this 
          disinfect medical instruments                                        process is 2”Š•0°… while using low concentrations of 
                                                                                …lO2 The process requires – hours of contact time to 
          ‰t is a •‘§ alkaline glutaraldehyde solution which has              achieve sterilization The presence of organic matter 
          tuberculocidal and highlevel disinfection capabilities ‰t            reduces activity  processor converts a compound of 
          achieves highŠlevel disinfection in 20 minutes at                     dilute chlorine gas with sodium chlorite to form …lO2 
          2”°… and has up to a 2’Šday reuse life                               gas and this gas is then e­posed to the equipment in a 
          • …ide­ ctivated —ialdehyde  olution is used to disinfect            sterilizing chamber
          medical instruments and endoscopes This solution can                 — Ozone
          also be used in an automated reprocessor glutaraldehyde              Ozone sterilizes by o­idation a process that destroys 
          solution which has tuberculocidal and highŠlevel                     organic and inorganic matter ‰t penetrates membrane 
          disinfection capabilities ‰t achieves highŠlevel disinfection        of cells causing them to e­plode ‰n this process a 
          in ‘” minutes at 2”°… and has up to a 1‘Šday reuse life              generator is used to convert o­ygen to ozone as a 
          ƒoth have been used as a cold liquid highŠlevel                       – to 12 percent concentration of ozone continuously 
          disinfectant for heat sensitive equipment                            flows  through  the  chamber  Ozone  penetration  is 
          £ote‹ …ide­ †glutaraldehydeˆ products are being                       controlled by vacuum pressure or by adding humidity 
          withdrawn from the šuropean market due to concerns                    fter the process is complete o­ygen is allowed to 
          that it is to­ic and harmful to health care staff in hospitals       flow through the chamber to purge the ozone The 
          lso the ¨  market is requiring glutaraldehydeŠfree                cycle time may be up to –0 minutes depending on the 
          chemical solutions which led to the formulation of the               size of the chamber or load of items to be sterilized 
          …ide­ O solution                                                   —ue to ozone gas being corrosive and it being able to 
                                                                                damage moisture sensitive equipment or models there 
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...Ental ssessment october dental sterilization solutions y avi cohen head of medical objet geometries ltd abstract hemical this whitepaper describes the different adiation methods and technologies currently available in today s equipment market with common high temperature observation to apid rototype models ocus is a steam autoclave given more team oldest safest most used or for hospitals cost effective method clinics t end paper there industry reaches conclusion table which summarizes pressure chamber at i period dependent on methodsproducts were isolated ranked size load can range from minutes based their sterile efficacy applicability instruments prototype onfigurable cycles allow user customize cycle items such as hard terilization means use physical chemical wrapped liquids vented containers waste procedure destroy all microbial life including highly glassware resistant bacterial spores fastest flash acterial are living it be accomplished using either gravity organisms because capa...

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