INSTRUMENT
PROCESSING
Doc Dyann Pena
• A process intended to kill all microorganisms
• The highest level of microbial kill that can be achieved
Sterilization • The bacterial endospore is selected as the standard challenge
for sterilization because of its high resistance to killing by
heat and chemicals.
3 Types of
Sterilization
• Heat Sterilization
• Steam / dry heat / unsaturated chemical vapor
• Most common type in dental offices
• Operates at 121-190.6 deg Celsius
• Gas Sterilization
• Not commonly used due to high cost and long
exposure time required
• Liquid Chemical Sterilization
• Used on items damaged by heat sterilization
• Ex: Sterilants / High-level disinfectants
• Gluteraldehyde, special hydrogen peroxide, hydrogen
peroxide-peracetic acid
Disinfection
• A less-lethal process than sterilization
• Intended to kill disease-producing
microorganisms but not bacterial
endospores
• If the chemical is not sporicidal but can
kill other microorganisms, it is called a
disinfectant.
• Chemicals classified as disinfectants
cannot be expected to achieve
sterilization.
Categories of
Patient Care
Items
Universal
Sterilization
• Means that all reusable instruments and
handpieces are sterilized (rather than just
disinfected) between use on patients.
1. Holding (presoaking)
2. Precleaning
INSTRUMEN 3. Corrosion control, drying, lubrication
T 4. Packaging
PROCESSING 5. Sterilization or high level disinfection
6. Sterilization monitoring
7. Handling processed instruments
1. Holding
(Presoaking)
• Instruments are placed in a holding solution to prevent drying
of the saliva and blood and to facilitate the actual cleaning.
• Extended presoaking for more than a few hours is not
recommended because this may enhance corrosion
• The holding solution may be the same detergent as that to be
used for subsequent cleaning or may be water or an enzyme
solution
• Precleaning reduces the bioburden and gives the subsequent sterilization or
disinfection step the best chance to work.
2. Precleaning • Microbe-laden debris is referred to as bioburden.
• 2 Basic types of dental instrument cleaning system:
• ultrasonic cleaners
• instrument washers or washer-disinfectors
Precleaning
(Ultrasonic
Cleaning)
• Reduces direct handling of the
contaminated instruments and
the chances for cuts and
punctures.
• The ultrasonic energy produces
billions of tiny bubbles in the
cleaning solution that collapse
and create high turbulence at
the surface of the instruments.
This turbulence dislodges the
debris and suspends it in the
solution or dissolves it.
Precleaning
(Instrument
Washers)
• These washers automatically
provide cleaning and rinsing, and
some (called washer-disinfectors)
use hot water and achieve
disinfection of the instruments with
cleaning.
• Remove bioburden
• Reduce the direct handling of
instruments
• Can clean loose instruments in
baskets or instruments in cassettes.
Precleaning
(Manual Scrubbing of Instruments)
• Dangerous; even though the procedure is an
effective method of removing debris, if
performed properly.
• One should thoroughly brush all surfaces of
all instruments while the instruments are
either submerged in a cleaning solution.
• Use a long-handled brush
• If the mechanical cleaners are working
properly, hand scrubbing is unnecessary.
3. Corrosion Control,
Drying, and Lubrication
• Instruments or portions of instruments and
burs made of carbon steel will rust during
steam sterilization.
• Ex: burs, scalers, hoes, hatchets, the
cutting surfaces of orthodontic pliers,
and the grasping surfaces of forceps
• Use dry heat or unsaturated chemical vapor
sterilization on the items most susceptible
to rusting in steam.
• Instruments should be dried thoroughly
• Hinged instruments should be opened
before packaging.
4. Packaging
• Packaging involves
wrapping cleaned
instrument cassettes and
wrapping them or placing
them in sterilization
pouches, bags, trays, or
cassettes.
• Prevents instruments from
becoming contaminated
after sterilization during
storage or when being
distributed to chairside.
General Packaging
Procedures
• Use only packaging material or open
containers that have been designed for use in
sterilizers
• Cloth should not be used as a sterilization
wrap because it is not a barrier to microbes.
• Paper sterilization bags should not be used to
package heavy or sharp instruments.
• better used for gauze pads, cotton rolls
or pledgets, or paper products
Wrapping or Bagging
• Place functional sets of instruments on a
small, sterilizable tray and wrap the entire
tray with sterilization wrap.
• Seal the wrap with tape that will withstand
the heat process (e.g., autoclave tape).
Use of Instrument
Cassettes
• Reduces direct handling of contaminated instruments
and keeps the instruments together through the entire
process of cleaning, sterilization, and presentation to
the next patient.
• Wrap cassettes before processing them through a
sterilizer.
5. Sterilization
1. Steam Sterilization
2. Unsaturated Chemical Vapor Sterilization
3. Dry Heat Sterilization
Steam Sterilization
• Involves heating water to generate steam in a closed chamber, producing a
moist heat that rapidly kills microorganisms.
• The heat, not the pressure, inside a steam sterilizer is what actually kills
the microorganisms.
• A typical dental office steam sterilizer usually operates through four steps:
• heat-up cycle
• sterilizing cycle
• 121° C (250° F) for 30 minutes
• 121° C (250° F) for 15 minutes
• 134° C (273° F) for 10 minutes
• 134° C (273° F) for 3 minutes
• depressurization cycle
• drying cycle
• Do not stack packages, pouches, or cassettes flat in layers.
• Keep packs, pouches, or cassettes separated from each
other so that steam has access to all package surfaces.
• Drying packages inside the steam sterilizer is important to
maintain the sterility of the instruments.
Dry Heat Sterilization
• Heating air with transfer of heat energy from the air to the
instruments.
• Requires higher temperatures than steam or unsaturated chemical
vapor sterilization.
• 160° C to 190° C
• Main advantage: carbon steel items do not corrode as they do
during steam sterilization
