Instrument processing

• Cleaning: The removal of all visible dust, soil, and any

other foreign materials.

• Decontamination: The process of removing disease

producing microorganisms and rendering object safe
for handling.
• Disinfection: Destruction of pathogenic and other
kinds of microorganisms by physical or chemical
means.

• Disinfection is less lethal than sterilization, because it

destroys the majority of recognized pathogenic
microorganisms, but not necessarily all microbial
forms (e.g., bacterial spores).
• Sterilization: Use of a physical or chemical procedure
to destroy all microorganisms including substantial
numbers of resistant bacterial spores.

• Physical: Dry heat and steam sterilization (autoclaves).

• Chemical: Glutaraldehyde, hydrogen peroxide based

products, peracetic acid immersion.
 Instrument processing
• It is a collection of procedures that prepares
contaminated instruments for reuse.
 Instrument processing
1. Handling of contaminated instruments
2. Holding (presoaking): facilitates the cleaning process by
preventing debris from drying.
3. Cleaning: removes as much of bioburden as possible to
give the subsequent sterilization step the best chance to
work.
4. Corrosion control, drying, lubrication: reduce
damage to instruments and help ensure proper
functioning of the instruments.
5. Packaging: helps maintain sterility of instruments after
sterilization.
 Instrument processing
[Link]: kills all microbes remaining on the
instruments to ensure patients’ safety.

[Link] monitoring: measuring the use

and functioning of the sterilizer.
8. Handling processed instruments: Help maintain
the sterility of the instruments during storage.
 Instrument Processing Area
• Use a designated processing area to control quality and
ensure safety.

• Divide processing area into work areas

• Receiving, cleaning, and decontamination
• Preparation and packaging
• Sterilization
• Storage
For best practice, the clinical treatment area
should be clearly separate from the
decontamination facilities
 Instrument processing- linear
pattern

• Contaminated area: throw away disposables, place instruments in holding

solution or preclean with ultrasonic cleaner or other approved method, dry
instruments, dip in rust inhibitors if applicable.

• Packaging area: Place process integrators or biologic monitor (weekly), in

packaging fully wrap instruments, place process indicator tape on the outside
of the package, label, place in heat sterilizer.

• Sterilization and storage area: After sterilization is complete, store sterilized

instruments in their packaging, record results of spore tests.

Infection Control Unit

Instrument processing: U-shaped
pattern

Infection Control Unit

 Considerations for Designing an Instrument-
Processing Area:

Space requirements may depend on

• Workflow patterns
• Clean and sterile storage space requirements
• The need for separate areas for receiving, cleaning, and
decontamination preparation and packaging; sterilization;
and storage
• Types and amount of equipment and installation
requirements
• The workload and desired staffing
Floors, walls, ceilings, and countertops:

• Surfaces should be flush, smooth, nonporous, and

uncarpeted.

• Countertops should be chemical- and heat-

resistant, and be able to hold tabletop sterilizers and
other equipment.

• Materials should be able to withstand frequent

cleaning with chemical agents (e.g., environmental
surface disinfectants).
 This implies the use of a separate room or rooms for
the accommodation of clean (output) and dirty (input)
work.
 1-HANDLING AND TRANSPORTING CONTAMINATED
PATIENT-CARE ITEMS

Contaminated instruments should be handled as little as

possible and carefully to prevent exposure to sharp
instruments that can cause a percutaneous injury.
 Taking instruments to other
locations
Minimize exposure
potential.

Use carrying containers

to transport contaminated
instruments from the
operatory to instrument
processing area.
 Taking instruments to other
locations
• Containers for transport of instruments for
decontamination and of sterilized instruments should be
clearly marked as for each function and should not be
used interchangeably.

• Containers for transporting instruments for

decontamination should be kept visibly clean.

• A protocol for transportation that ensures the

segregation of contaminated product from
clean/sterilized instruments should be followed.
 1. Handling
➢ Wear puncture- and chemical-resistant
heavy duty utility gloves for instrument
cleaning & decontamination procedures
➢ Wear a mask, protective eyewear, and
long-sleeved protective clothing when
splashing/spraying is expected during
cleaning(PPE)
➢ Head/shoe covers may be required

Absolutely no open toed shoes in the

clinic
Handling and disposing sharps
BIOHAZARD
I
-
I
'"" DISPOSE OF
PROPERLY
 2. Holding (presoaking)
• If instruments can’t be cleaned soon after
use they should be placed in a holding
solution to prevent drying of the saliva and
blood to facilitate later cleaning.
• Extended presoaking time is not
recommended as it may enhance
corrosion.
• Place instruments in the ultrasonic or
washer baskets.
• Place the basket in water, detergent, or
enzyme solution.
• The solution is considered contaminated
and should be discarded at least once a
day.
3. Cleaning

• Pre-cleaning is an essential step before any sterilization

or disinfection procedure.

• Pre-cleaning is important to reduce the bioburden to

give the subsequent sterilization or disinfection step
the best chance to work.
3. Cleaning

Which is not clean can’t be sterilized

Improper cleaning: If visible debris, whether

inorganic or organic matter, is not removed, it will
interfere with microbial inactivation and can
compromise the disinfection or sterilization
process
 3. Cleaning
Removal of debris and contamination is achieved either
by:

➢Manual Scrubbing with a surfactant, detergent, and

water, or by

➢ An automated process (e.g., ultrasonic cleaner or

washer-disinfector) using chemical agents.
 3. Cleaning
1. Automated equipment:
➢ Ultrasonic cleaner

➢ Washer-disinfector

VS.
2. manual hand scrubbing
Manual cleaning
 Manual cleaning
• Clean, warm water which is fit for drinking is suitable for
cleaning instruments
Hot water is not used at this stage as it coagulates
protein which increases the difficulty of cleaning.
Cold water also solidifies lipids and should not be
used.
• Sinks must be deep enough, and taps provided with
anti- splash devices to prevent splashing.
• There should be three sinks: one for hand-washing, one
for washing contaminated instruments and one for
rinsing cleaned instruments
 Manual cleaning detergent
• A mildly alkaline, low foaming, free rinsing liquid
detergent should be used which is much more effective
than a neutral pH detergent in removing blood and fatty
substances.
• Common household detergents must not be used due to:
1. Difficulties in rinsing items free of detergent residue
which can interfere with the sterilizing/disinfecting
process.
2. Much foam prevents the operator from seeing
instruments under the water in the sink and thereby
greatly increases the risk of cuts and penetrating injuries
from sharp instruments.
 Manual cleaning brushes
• Cleaning brushes must be washed, rinsed and stored dry.
• A wire bur brush maintained in good condition is also
necessary for cleaning tungsten carbide and diamond
burs

• Abrasive cleaners such as steel wool and abrasive

cleaning powders should not be used as they:
1. Can damage instruments
2. Residues may be left.
 Manual cleaning
• Using work-practice controls (e.g., long-handled brush) to
keep the scrubbing hand away from sharp instruments is
recommended.

• Work-practice controls should include use of a strainer-

type basket to hold instruments and forceps to remove
the items.
 Manual cleaning
• Splashing: It should be minimized during cleaning and
rinsing.
• Keep instrument immersed while brushing.
• Wear PPE: goggles, heavy utility glove, mask and plastic
apron.
•After cleaning, instruments should
be rinsed with water to remove
chemical or detergent residue
Manual scrubbing of instruments
 Cleaning
Instruments, Burs and Files
Scrub with long
handled brush under Heavy duty gloves to
running water. protect from sharp
injury

Thoroughly brush all

surfaces of all
instruments

Put your hand

close to the
bottom of the sink
or scrub while
totallyputting hands in
Rinse after Use Two sinks a cleaning
scrubbing with solution to avoid
minimum splashing Should be deep spattering
 Ultrasonic cleaning
• The ultrasonic cleaner removes soil by a
process that uses electrical energy generate
sound waves.
•When the sound waves travel through the
liquid produces billions of tiny bubbles in
the cleaning solution that are formed and
burst continuously.

•This process is called cavitation and disrupts

the bonds that hold debris on the surface of
the instruments

• Some high-speed hand pieces can’t

withstand ultrasonic cleaning.
 Ultrasonic cleaning
• Ultrasonic cleaning units come in
different sizes.
• It can be free standing or built in.
• May be connected to water line and
may have automatic drain.
• One should use a cleaning solution
designed for use in ultrasonic cleaner.
• Instruments should be totally
submerged in the solution and cover
should be in place during operation.
 To test the performance of the ultrasonic
cleaner (foil test)

•Total immersion of about 12-inch length x6 inch

width of household aluminum foil into cleaning
solution for 20-60 seconds

•Bottom of the foil should be 1 inch above

bottom of the cleaner

•Starting the cleaning process without turn on the

heater
•After removal uniformly distributed indentations
(pebbling) are found

•If area greater than ½ inch square has no pebbling

this means the cleaner need servicing
To test the performance of the ultrasonic cleaner
(foil test)
 Instrument washer
• Three different sizes available:
1. Bench top model
2. Floor unit
3. Large production model
• They automatically provide cleaning
and rinsing.
• Washer disinfector uses hot
water and achieve disinfection of
instruments. It is the preferred.
• Be sure to use the detergent
recommended by the manufacturer.
 II/ .

'.

-·

·-:..
 3. Cleaning
• Advantages of the Automated methods:
1. They perform Excellent cleaning
2. They Save staff time
3. They Reduce direct handling of the contaminated
instruments and the chances for cuts and punctures
• For maximum decontamination, follow the
manufacturer’s instructions for operation of the
equipment, including :

• the operating time

• amount and type of cleaning solutions.
 4-Corrosion control, drying
• Instruments and burs made of carbon steel will rust
during steam sterilization.
• They can be sprayed by rust inhibitors (e.g. sodium
nitrite) .
• Other instruments should be dried carefully if they will be
packed in paper or paper-plastic wrap to avoid tearing of
wet paper during packaging.
 Hinged instruments
• Hinged instruments may need lubrication to
maintain proper functioning. Then excess
lubricant should be removed.
• Hinged instruments should be opened before
packing to facilitate access of the sterilizing agents
to the hinge.
 Dental handpiece
1. Remove all visible debris and flush handpiece water
and or airlines for 20-30 seconds.
2. Remove bur, clean and dry. (no ultrasonic)
3. Apply the handpiece cleaner and/or lubricant.
4. Attach to an air/water system and expel excess
lubricant.
5. Clean the fiberoptic with a damp cotton swab.
6. Package the handpiece and sterilize.
 5. Preparation & Packaging
➢ Packaging is important to maintain
sterility of the instruments after
processing and sterilization.

➢ Wrapping cleaned instrument

cassettes or organizing loose
instruments in functional sets and
wrapping them or placing them in
sterilization pouches, or bags.
➢ Add biological and/or chemical
indicator during the packaging.
 5. Preparation & Packaging
Packaging material should be
1. One should use packaging materials that withstand the
heat and have been designed for use in sterilizers.
2. These materials should allow penetration of the
sterilizing agents.
3. They should maintain sterility for at least 6 months.
4. You can use a see-through paper/plastic pouches that
have clear plastic film on one side and heavy sterilization
paper on the other side. These pouches have chemical
indicators printed directly on the paper side.
5-Provides an adequate barrier to microorganisms

6-Is puncture- and tear-resistant

7-Can be sealed easily and completely.

8-Is free of toxic elements and dyes.

9- If fabric, is low-linting.

10- Is cost-effective.
 5. Preparation & Packaging

• You should seal the wrap with tape that will withstand
the heat process (autoclavable tape.)
• The wraps should not be sealed with metal staples or
anything that puncture the material.
• Don’t use closed containers with solid tops and bottoms,
capped glass vials, or wrap with aluminum foil in steam
sterilization as the steam will not penetrate these
containers or materials.
Packaging & sealing
Packaging & sealing
 Packaging & sealing
Chemical indicator
Changes color after entering the autoclave
 Packaging/storage Rules
• Critical and semi-critical instruments that will be stored should be
packaged before sterilization.
• Each instrument or each set of instruments used at the same
time for the same patient should be wrapped in well-sealed
packages.
• Hinged instruments should be processed open and unlocked.
• Write the date of sterilization on each package.
• Shelf life may be considered to depend on events (way of
handling and storing the packages) rather on time, type of
packages used, and the infection control policy of the medical
facility.
• Shelf life is:
• √ In closed cabinets: 30 days
• √ In open cabinets: 14-21 days
 Packaging/storage Rules
• Packages containing sterile items should be inspected before
use to verify integrity and dryness.
• Re-clean, repack and re-sterilize any instrument package that
has been compromised.
• Store sterile items and dental supplies in covered or closed
cabinets, if possible.
• The newly sterilized packages should be arranged at the back of
the old ones, so the instruments can be used before reaching
the expiry date of sterilization.
• Dental supplies and instruments should not be stored under
sinks or any other location where they might become wet.
• Open the packages without touching the instruments so that
you will not contaminate them
 Packaging/storage Rules

Unwrapped sterilization should be used only under

certain conditions:
• Thorough cleaning and drying of instruments
should precede the unwrapped sterilization cycle.
• Mechanical monitors are checked, and chemical
indicators used for each cycle.
• Care is taken to avoid thermal injury to dental
workers or patients.
• The instruments should be used immediately and
transported aseptically to the point of use to
maintain sterility.