Infection Control and Sterilization in the Orthodontic Operatory
What this domain tests
Items here target the Spaulding classification, the instrument-processing cycle, sterilization monitoring, and the orthodontic-specific rules for pliers, handpieces, impressions, and waterlines.
Spaulding categories
- Critical: penetrates bone or soft tissue (extraction forceps, surgical burs, scalers that cut) - must be sterile.
- Semicritical: contacts intact mucosa without penetration (mouth mirrors, band seaters, impression trays, cheek retractors) - sterilize when heat-tolerant; high-level disinfection is the minimum for heat-sensitive items.
- Noncritical: intact skin only (light handles, chair, countertops) - low-level disinfectant.
PPE and hand hygiene
Gloves, mask, protective eyewear with side shields, and gown; remove PPE before leaving the operatory. Wash with soap and water when visibly soiled; otherwise an alcohol-based rub is acceptable. No artificial nails, no rings, short nails. Hepatitis B vaccination must be offered, and an exposure control plan with post-exposure evaluation must be in place.
Processing cycle
- Transport in a closed, labeled container.
- Don PPE, rinse, or hold in enzymatic detergent.
- Ultrasonic clean with lid closed.
- Dry, inspect, package with an internal chemical indicator, date and initial.
- Steam sterilize: 121–123 °C at 15 psi for 15–30 minutes, or a 132–135 °C prevacuum cycle of about 4 minutes, plus dry time.
- Cool and store packages closed; reject torn or wet packs.
Monitoring
Mechanical (gauge and printout each load), chemical (external indicator on every pack, internal indicator inside every pack), and biological (Geobacillus stearothermophilus for steam; Bacillus atrophaeus for dry heat and ethylene oxide) - weekly and every load containing implants.
Orthodontic specifics
Flush waterlines two minutes at the start of the day and 20–30 seconds between patients; use high-volume evacuation to control aerosol. Rinse and disinfect impressions with an intermediate-level disinfectant before pouring - alginate distorts if soaked. Debonded brackets and bands are single-patient items and are not reprocessed. Sharps containers are replaced at three-quarters full and needles are never recapped by hand. Blood spills: absorb, then 1:10 dilution of household bleach (0.5%) with adequate contact time.
Worked example
The weekly spore test comes back positive. Reasoning: the sterilizer failed, so every load since the last negative test is suspect. Quarantine those packs, do not use them, retest with a full load of controls, and review loading (overpacking, wrong cycle, dried debris) before returning the unit to service; document the recall.
Traps that cost marks
Calling an item sterile because it completed a cycle; treating glutaraldehyde as a sterilant when a 20-minute soak is high-level disinfection; assuming autoclave tape proves sterility; and forgetting hand hygiene after glove removal.