Infection Control Manual

Section VII: Sterilization and Disinfection of Instruments

1. Only properly sterilized or single-use instruments may be used in patient treatment.

2. All instruments must be submitted for sterilization promptly following use in patient care.

3. Prior to being sterilized, all instruments must be cleaned. Ultrasonic or mechanical cleaning should be used whenever feasible instead of cleaning by hand. Cleaning will be accomplished only in the Central Sterilization facility unless instruments are sterilized and repackaged on site for sterilization in individual sterilers.

4. Only instruments that have been cleaned of debris, disinfected, and dry may be submitted for sterilization in accordance with the procedures below:

1. For dry heat sterilization (used in DFP):

1. Put on heavy-duty utility gloves. Preferably, rinse, ultrasonically clean, and rinse instruments again. Otherwise, with heavy gloves, scrub debris from a few instruments at a time using hot water, disinfectant, and a scrub brush. Avoid squeezing sharp ends of double-ended instruments that can penetrate heavy gloves. Dry instruments thoroughly with paper towel.

2. Process no more than 22 clean and dry instruments in a heavy bag.

3. Date and sign a slow-color-change indicator strip and place with instruments.

4. Fold and seal bag with sterilization tape.

5. Submit instruments for sterilization at appropriate location.

6. Perforated metal alginate trays must be scrubbed free of debris, disinfected, and dried thoroughly.

7. No more than 12 clean and dry alginate trays should be placed in paper bag along with a dated and signed slow-color-change strip. The bag must be sealed with sterilization tape and then submitted for sterilization.

8. Do not overload sterilizer. Place bags a finger's width apart on the shelves.

2. For Steam Autoclaving Sterilization:

1. Follow the same procedure as for Dry-Heat Sterilization, for instruments that are sterilized within the clinical unit.

2. In some areas, but not in student operatories, instruments to be submitted to the Central Sterilization Unit, also must be scrubbed free of debris, disinfected, dried, and placed in the instrument tray.

3. In the student clinics, the tray should be returned to the paper bag in which it was received, for submission to be cleaned and re-sterilized. Individual instruments must be returned to the bubble pack in which they were received, for submission to be re-sterilized.

5. Instrument Cassettes: In Student Clinics, clinical cassettes of instruments will be handled as follows:

1. Carefully open the brown paper bag and remove instrument tray, making every effort NOT to tear the bag or damage the tape. Determine if any instruments are missing from the tray. If so, return the cassette to the dispensary for a new one.

2. Carefully write the social security number of the patient onto the brown paper bag.

3. At the completion of patient care, the cassette is placed back into the original brown paper bag. DO NOT SCRUB instruments in the operatory, but remove excess cement and gross accumulations of debris prior to insertion into the bag. PLEASE NOTE: Return instruments in a neat and orderly fashion to avoid bag puncture with contaminated sharps. Placement of the cassette into the bag is best achieved by turning the bag upside down (once the bottom of the bag has been freed of tape), inserting instruments, and tucking end of bag underneath. Extra bags are available at the dispensary as needed.

4. The cassette is then transported with gloved hands to the dispensary where the instruments are counted and checked in. PLEASE NOTE: Transportation of two cassettes simultaneously is permitted, but carrying books, book bags, purses, or other materials while carrying clinical cassettes is not permitted. FAILURE TO FOLLOW THESE RULES MAY RESULT IN LOSS OF CLINICAL PRIVILEGES.

6. Instrument Storage: After sterilization, instruments should be stored in their sealed packages until they are used in treatment. Whenever this is not possible, the instruments must be submitted for re-sterilization prior to use in patient care.

7. Supply Containers: Dental materials and supplies that are available on mobile carts and storage boxes in the clinical areas, which have been used/contaminated during patient treatment, must be sprayed wet with disinfectant and wiped dry with a paper towel after use.

8. Handpiece Sterilization: Sterilization of handpieces is required. The Central Sterilization Unit, which is responsible for all handpiece maintenance and sterilization, follows manufacturer's cleaning and sterilization directions. Before autoclaving a handpiece, clean internally with Midwest cleaner; clean in washer-decontaminator. Operate handpiece to remove solution; autoclave and re-lubricate. Handpieces are then placed in pre-sterilized peel-pockets and are distributed to dispensaries.

1. If the handpiece is stiff, fit a bur and rotate it with gloved fingers to start it. Operate the handpiece for 30 seconds or until it works freely. If the handpiece will not function properly, place a note on it with tape and return it to the sterilization center.

2. Slow speed motors are not sterilized, but are disinfected with alcohol and kept covered with a plastic sleeve during patient care.

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