Receiving, cleaning, and decontamination Instruments must be carefully transported from the dental hygiene operatory to the receiving section of the instrument processing area. Placing the instruments in an enclosed leakproof container or cassette helps to prevent injury during transportation. The first step in the sterilization process is cleaning to remove all debris as well as organic and inorganic contamination (CDC, 2020c). Ideally, instruments should be cleaned using automated equipment, which is safer and more efficient than manual instrument cleaning. Because of the increased risk with manual cleaning, it is important to help keep hands away from sharp instruments by wearing puncture resistant utility gloves, using a long-handled brush, and cleaning instruments under running water to prevent splashes. Most dental offices in the United States use ultrasonic devices for instrument cleaning. Ultrasonics work by producing sound waves that cause bubbles to implode, which loosens the debris on instruments. When using an ultrasonic device: Preparation and packaging The next section of the processing area is used for the preparation and packaging of cleaned but not yet sterilized instruments. The instruments should be clean, dry, and inspected prior to being assembled into cassettes or placed into sterilization bags. Properly packaging instruments helps to ensure that they maintain sterility during storage. All materials used for packaging of dental instruments are considered medical devices and must be cleared by the FDA and the manufacturer’s instructions for packaging must be followed. Instrument packages should be labeled to show which sterilizer was used, the cycle or load number, the date of sterilization, and expiration date if applicable. Sterilization The third section of the processing area is for sterilization. The most common method of sterilizing heat-tolerant dental instruments is steam under pressure in an autoclave. All sterilization procedures should be performed using only medical sterilization equipment cleared by the FDA. Each device has its own process for sterilization and monitoring, and the manufacturer’s instructions for sterilization times, temperatures, and other operating parameters should always be followed. During steam sterilization, instruments are exposed to direct steam at a required temperature and pressure for a specified time. Two types of steam sterilizers are the gravity displacement sterilizer and the high-speed prevacuum sterilizer. The majority of sterilizers used in dental practice are gravity displacement sterilizers; however, pre-vacuum sterilizers are becoming more widely used. In gravity displacement sterilizers, steam is admitted through steam lines, a steam generator, or self-generation of steam within the chamber. When loading the autoclave, always follow manufacturer’s instructions and do not overload the autoclave chamber. The sterilant must be able to circulate Storage Packages containing sterile instruments and supplies should be inspected prior to their use to confirm that no rips or tears are evident and to note that the packages are dry. Sterile instruments should be stored in closed or
DO:
DO NOT:
● Reach hand into ultrasonic. ● Overload.
● Use metal basket for inserting and removing instruments (This prevents dental personnel from having to reach into trays or containers holding sharp instruments that they cannot see.) ● Keep lid on during use. ● Use correct solutions. ● Change solutions daily (or more often). ● Follow manufacturer’s instructions. ● Submerge all instruments.
When using an instrument washer, always consult the manufacturer on proper use, loading, detergent recommendations, water quality, and instructions for use. High-level disinfectant such as glutaraldehyde should never be used as a precleaning or soaking solution or in the ultrasonic cleaner. Misuse of high-level disinfectants can lead to tissue toxicity reactions and equipment failures. This label will help in retrieving items in the event of any sterilization failure. Recommendations for packaging include the following: ● Instruments should be cleaned and dried prior to packaging. ● Except in rare cases, wrapping is required before sterilization.
● NEVER store instruments unwrapped. ● Follow manufacturer’s instructions. ● Open and unlock hinged instruments.
● Place an internal chemical indicator in each package. ● Place an external indicator (if internal indicator cannot be seen).
freely between instrument packs or cassettes to ensure instrument packs located in the center of the chamber are sterilized. Prior to unloading the autoclave, instrument packs should be allowed to dry and cool in the chamber. Hot or wet instrument packs act as wicks and absorb moisture and bacteria from bare hands. Thus, the barehanded handling of hot or wet instrument packs should be avoided. Liquid chemical germicides (cold sterilization) have been historically used in dentistry but are discouraged for several reasons: The sterilization process with liquid chemicals cannot be verified with biological indicators; these chemicals are generally highly toxic; and instruments sterilized in this fashion are unwrapped, yet instruments must be stored wrapped. As a result of these factors, the CDC recommends a heat-based method of sterilization (Rutala et al., 2019), and non-heat-tolerant instruments and devices should be replaced with newer heat-tolerant ones.
covered cabinets if possible, and they should not be stored under sinks or in locations where they could become wet. Wrapped sterilized instruments can be either “date-related” or “event-related.” In date-related practices, all packages
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