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RECOMMENDED STEPS IN
CLEANING, STERILIZATION & MAINTENANCE OF DENTAL
INSTRUMENTS
1.
HOLDING/PRESOAK
It is important NEVER to hold
instruments in a DRY container, which allows blood and debris to dry onto instrument
surfaces and makes cleaning more difficult. If rinsing and decontamination
processes are not
immediately available, pre-treat instruments or hold them in a neutral PH
holding/presoak enzymatic solution after patient use but before actual
cleaning. As soon as possible, rinse, disinfect and clean as follows:
2. RINSE
Immediately after use, remove organic
materials by rinsing instruments under warm (not hot) running water. Rinse
should remove
most blood fluids and tissue. Always wear safety protection gear.
3. DISINFECT
To protect medical personnel from
contamination during cleaning, immerse instruments completely in an EPA
approved disinfectant for approximately 10-20
minutes. Always closely follow manufacturers’ recommended disinfecting time
and solution
preparation instructions. Then rinse again.
CAUTION: Disinfected
instruments are NOT
STERILE.
Never expose stainless steel instruments to
bleach or other corrosive
chemicals to disinfect. Exposure to
bleach may result in instrument pitting.
4. CLEAN
All blood, dried body fluids and tissue
should be completely removed from the instruments prior to sterilization.
Several methods are available.
A. Soak: An enzymatic cleaner soak or a solution of water
and neutral pH detergent to remove organic material from instruments.
Use distilled water if possible.
Instruments should be fully submerged for at least
10 minutes. Be sure dissimilar
metal instruments are separated. Rinse
instruments under running water to remove cleaning solution. Change solution
frequently.
B. Ultrasonic Cleaning: Most instrument
manufacturers recommend ultrasonic cleaning as the most effective way to clean
surgical instruments, particularly those with hinges, box locks, and other moving
parts. All
instruments must be fully submerged in open position. Use distilled water if possible.
Make sure that "sharps" blades do not touch other instruments to prevent possible
surface scratching and also be sure dissimilar metal instruments are
separated.
Process instruments for full
recommended ultrasonic cleaning cycle. Change solution frequently, or as often as
the manufacturer recommends.
Rinse instruments with water to remove
the cleaning solution.
C. Automatic Washer Sterilizers: Follow
manufacturers’ recommendations but ensure instruments are lubricated after the
last rinse cycle and before the sterilization cycle.
CAUTION: Needle holders and forceps may crack
if sterilized in closed position.
D. Manual Cleaning: If ultrasonic cleaning is not
available, observe the following steps:
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Use stiff nylon
cleaning brush. Do not use steel wool or wire
brushes except specially recommended stainless steel wire
brushes.
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Use only neutral
pH detergents. If not rinsed off properly,
low pH (acidic) detergents break down the stainless protective
surface resulting in pitting and/or black staining. High pH
detergents (alkaline) can cause brown stains which can interfere with the
smooth operation of instruments.
-
Make sure
instrument surfaces are visibly clean and free from stains and tissue. This is
also a good time to inspect each instrument for proper function and
condition.
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Check scissors’
blades to ensure proper function. Blades should glide open and closed
smoothly. Cutting edge instruments should be sharp and free of
damage.
-
Check hemostats
and needle holders to ensure jaw tips close in first ratchet position and
entire jaw should close in third ratchet position. Check instruments for
loose hinges and verify that they lock and unlock easily. Also check
instruments for wear on jaw surfaces.
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After scrubbing,
rinse instruments thoroughly under running water. While rinsing, open and
close scissors, hemostats, needle holders and other hinged instruments to
make sure the hinge areas are rinsed out and no debris remain.
5. AFTER
CLEANING
Separate dissimilar metals prior
to sterilizing/autoclaving.
If instruments are to be stored, let them air-dry and store
them in a clean
and dry environment.
6.
AUTOCLAVING
A. Lubricate all hinged instruments which have
any "metal to metal" action, at the screw or box lock. A non-silicone,
water-soluble surgical lubricant is recommended. Do not use industrial oils or
lubricants.
B. Sterilize instruments either individually or in
sets.
Individual
Instruments: Disposable paper or plastic pouches are ideal. Make sure to use a
wide enough pouch for instruments with ratchet locks so instruments can be
sterilized in an open position. Instruments locked during autoclaving can
experience cracked hinges or other problems
because
of heat expansion. If wrapping
instruments, make sure the towel does not contain detergent residue, which
can stain instruments.
Instrument
Sets: Unlock all instruments and
sterilize in an open position. Place heavy instruments on the bottom of set (when
two layers are required). Do not overload the chamber because an air pocket may
form
that hinders steam
penetration.
CAUTION: With most portable tabletop
autoclaves, at the end of the autoclave cycle and before the drying cycle,
unlock the
door and open it no more than a crack, about 1/4". Then run the dry cycle for the
period recommended by the autoclave manufacturer. If the autoclave door is fully
opened before the drying cycle, cold room air will rush into the
chamber causing condensation on the
instruments that may result in water stains or cause wet packs. Make sure autoclave
filters and chambers are cleaned as recommended by the manufacturer.
Keep in mind the difference
between:
.Sterile - an absolute
term (no living organism survives)
.Disinfected - basically clean. Some organisms may
survive. Always use the proper sterilization/cleaning technique to render the
instrument in the required condition for use.
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