Instrument Processing
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Instrument Processing Procedures
1. Differentiate between sterilization and
disinfection; differentiate between critical,
sem-icritical, and noncritical patient care
items and describe differences in how such
items are processed; and define sterility
assurance.
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2. Do the following regarding instrument processing
procedures:
➢ List the steps involved in instrument processing and describe
the rationale for each step.
➢ Describe the three methods for instrument cleaning and the
techniques for performing this task safely.
➢ Determine which packaging materials are used for which
methods of sterilization.
3. Describe the physical conditions, advantages, and
precautions related to steam, dry heat, and
unsaturated chemical vapor sterilization.
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Introduction
Instrument processing is a collection of
procedures that prepares contaminated
instruments for reuse.
Processing must be performed carefully:
➢ To prevent disease agents from a previous
patient, from a member of the dental team, or from
the environment from being transferred to the next
patient
➢ To keep instrument damage to a minimum
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Seven Steps to Instrument
Processing
Holding (presoaking)
Pre-cleaning
Corrosion control, drying, lubrication
Packaging
Sterilization or high-level disinfection
Sterilization monitoring
Handling processed instruments
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Sterilization and Disinfection
Microbial killing methods:
➢ Sterilization: a process intended to kill all
microorganisms; the highest level of microbial
kill that can be achieved
➢ Disinfection: less lethal process than
sterilization; intended to kill disease-producing
microorganisms but not bacterial endospores
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Three Types of Sterilization
Heat sterilization—most common
Gas sterilization—not used often
Liquid chemical sterilization—used on items
damaged by heat sterilization
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Sterility Assurance for Patient
Protection
Universal sterilization: all reusable instruments
and handpieces are sterilized (rather than just
disinfected) between uses on patients.
➢ This provides the highest level of patient protection.
Sterility assurance: the correct performance of
the proper instrument processing steps and
monitoring of the sterilization step with
biological, mechanical, and chemical
indicators.
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Sterility Assurance for Patient
Protection, Cont’d
Four steps to sterility assurance:
➢ Select the proper procedure and confirm the correct way
to perform that procedure.
➢ Prepare a written step-by-step description of the correct
procedure to be used as a reference in training and to
document patient safety techniques used in the office.
➢ Incorporate the procedure into the office training program
to ensure that new employees learn the correct
procedure.
➢ Monitor the performance of the procedure to ensure its
routine use and, when possible, measure the results of
the procedure.
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Instrument Processing Procedures
Put on heavy utility gloves, protective
eyewear, mask, and protective clothing.
Remove gross debris from instruments by
wiping at chairside.
➢ Take great care to avoid sharps injuries.
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Instrument Processing Procedures,
Cont’d
Place loose, contaminated instruments in
ultrasonic cleaning basket or washer basket and
place basket in holding solution until ready to clean
thoroughly. If using cassettes, remove and dispose
of waste and rinse cassette/instruments with water.
Remove basket of instruments from holding
solution, rinse with minimum splashing, and place
in ultrasonic cleaner or washer, or place cassettes
in cleaning rack and place in ultrasonic cleaner or
washer.
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Categories of Patient Care Items
CDC categorizes patient care items as:
➢ Critical
➢ Semicritical
➢ Noncritical
The classification is based on the potential
risk of infection during use of the items.
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Instrument Processing Procedures,
Cont’d
Be sure ultrasonic cleaning unit or washer
has been filled to proper level with cleaning
solution.
Place cover on ultrasonic cleaner or close
washer door and operate for the time
recommended by the cleaning unit
manufacturer or cassette manufacturer.
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Instrument Processing Procedures,
Cont’d
Remove cleaning basket or cassette rack
from ultrasonic units and rinse under tap
water with a minimum of splashing. Rinse
cassettes individually and thoroughly.
Check instruments for broken tips and
cleanliness, and dry loose instruments with
a towel or let cassette drain. Replace or
reclean items as needed. Apply rust
inhibitor as needed for nonstainless items
to be processed in steam.
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Instrument Processing Procedures,
Cont’d
Place instruments into functional sets or
add desired items to cassettes, including
the appropriate biological and internal and
external chemical indicators.
➢ Use packaging material that is compatible with
the method of sterilization.
Sterilize following manufacturer’s
recommendations for loading, sterilizing
time, temperature, and drying.
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Instrument Processing Procedures,
Cont’d
Carefully remove items from the sterilizer
but wait until after the dry cycle with steam
sterilizers.
Observe external chemical indicators for
proper reaction; retrieve biological
indicators for analysis; observe internal
chemical indicators; and store or distribute
packages to chairside with minimal
handling.
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Instrument Processing Procedures,
Cont’d
Maintain sterility assurance records on date
and conditions of sterilization and results of
mechanical, biological, and chemical
indicators.
Sterilize reusable heat-labile items (e.g.,
some plastic items) in a liquid sterilant,
rinse, and package in clean packaging
material.
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Three Methods for Instrument Cleaning
Ultrasonic cleaning
Instrument washers
Manual scrubbing of instruments
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Ultrasonic Cleaning
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Ultrasonic Cleaning, Cont’d
Reduces direct handling of contaminated
instruments
Excellent cleaning mechanism; staff can do
other tasks while instruments are being
cleaned
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Instrument Washers
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Instrument Washers, Cont’d
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Manual Scrubbing of Instruments
A dangerous, but effective, method of
removing the debris
Use of a long-handled brush recommended
to keep hands far away from the sharp
instruments
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Packaging
Maintains sterility after instruments have
been processed in sterilizer
Involves wrapping cleaned instrument
cassettes and organizing cleaned loose
instruments in functional sets and placing
them in sterilization pouches or bags
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Unwrapped Instruments
Sterilizing unpackaged instruments using
short exposure times (flash sterilization) is
least satisfactory approach.
CDC recommends this not be used as a
routine sterilization procedure for patient
care items.
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Types of Sterilization
There are three common types of sterilizers
used in dental offices.
➢ Steam sterilization: involves heating water to
generate steam in a closed chamber, producing
a moist heat that rapidly kills microorganisms
➢ Unsaturated chemical vapor sterilization:
involves heating a special chemical solution in a
closed chamber, producing hot chemical vapors
that kill microorganisms
➢ Dry heat sterilization: involves heating air with
transfer of heat energy from the air to the
instruments
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Examples of Steam Sterilizers
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Example of Unsaturated Chemical
Vapor Sterilizer
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Sterilization Monitoring
There are three common types of
monitoring used in dental offices:
➢ Biological monitoring—uses live spores
➢ Chemical monitoring—uses chemicals
➢ Mechanical monitoring—observation of gauges
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Biological Monitoring
Evaluates the sterilization
procedure’s effectiveness
➢ Types of biological indicators (BIs)
(contain the bacterial endospores )
➢ Use of biological indicators
➢ Analysis of biological indicators
➢ Management of biological
monitoring
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Biological Monitoring, Cont’d
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Sterilization Failure
If the biological monitoring fails to kill
spores, this event requires immediate
action so as not to compromise patient
safety.
When a spore test is positive, it indicates a
sterilization failure.
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Chemical Monitoring
Involves the use of heat-sensitive
chemicals to assess physical conditions
during sterilization process
Two types of chemical indicators:
➢ Indicators that change color after a certain
temperature has been reached
➢ Integrated indicators that change color or form
slowly, responding to a combination of time and
temperature
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Examples of Chemical Indicators
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Examples of Chemical Indicators,
Cont’d
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Mechanical Monitoring
Involves observation of the gauges and
displays on the sterilizer and recording of
the sterilizing temperature, pressure, and
exposure time.
Although correct readings do not guarantee
sterilization, incorrect readings can give the
first indication that a problem likely has
occurred.
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Mechanical Monitoring, Cont’d
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Handling of Processed Instruments
The proper handling or processed items is
an important part of the sterility assurance
program for the office.
Know the importance of every step
involved:
➢ Drying and cooling of instruments
➢ Storage of instruments
➢ Distribution of instruments
➢ Opening of instrument packages
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Design of Instrument Processing Area
The instrument processing area should be
located centrally, if possible, for easy
access from all operatory, but it should be
away from traffic flow.
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Workflow Design
Recommended designs include a U-
shaped workflow pattern in a room with a
single door.
Key aspect in design of the processing
area is to separate the three main areas of
activity:
➢ Decontamination area
➢ Packaging area
➢ Sterilizing and storage area
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Instrument Sharpening
Difficult to manage from an infection control
point of view.
➢ Presents a risk for disease spread through
accidental punctures
The greatest safety is achieved by
cleaning, sterilizing, sharpening, and re-
sterilizing.
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Instrument Protection
Instrument processing can cause damage
to instruments.
Stainless steel instruments are the least
affected by corrosion, but many dentists
prefer carbon steel instruments because
they retain sharp edge longer.
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Headpiece Asepsis
Clean, package, and sterilize by heat
processing between patients:
➢ High-speed handpieces
➢ Reusable prophylaxis angles
➢ Nose cones
➢ Slow-speed handpiece motors
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Heat-labile Items
Although most reusable instruments can
withstand heat processing, a few plastic-
type items will be damaged by the heat:
➢ Some rubber dam frames
➢ Shade guides
➢ Rulers
➢ X-ray collimating devices
Liquid sterilants can be used in these
circumstances.
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Other Methods of Sterilization
Use of ethylene oxide gas
Vaporized hydrogen peroxide gas plasma
Bead “sterilizers”
Hot oil sterilizers
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Questions?
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