Sterilization: Cleaning

In dental health care settings, all instrument cleaning, disinfecting, and sterilizing should occur in a designated central processing area in order to more easily control quality and ensure safety. The instrument processing area should be physically divided into sections for 1) receiving, cleaning, and decontamination; 2) preparation and packaging; 3) sterilization; and 4) storage. This division is designed to contain contaminated items in an area designed specifically for cleaning, thus preventing contamination of the clean areas where packaging, sterilization, and storage of sterile items occurs. Reusable contaminated instruments and devices are received, sorted, and cleaned in the cleaning area. The packaging area is for inspecting, assembling, and packaging clean instruments in preparation for final processing. The sterilization and storage areas contain the sterilizers and related supplies, as well as incubators for analyzing spore tests, and can contain enclosed storage for sterile items and disposable (single-use) items. When it is not possible to have physical separation of these areas, clearly labeling each area (e.g., from contaminated to sterile) might be satisfactory if the personnel who process the instruments are trained in work practices to prevent contamination of clean areas.

Cleaning should precede all disinfection and sterilization processes. Cleaning involves the removal of debris (organic or inorganic) from an instrument or device. If visible debris is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process.

Selected References and Additional Resources

CDC. Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR, December 19, 2003:52(RR-17).

Harte JA, Molinari JA. Sterilization procedures and monitoring. In: Molinari JA, Harte JA, eds. Practical Infection Control in Dentistry, 3rd ed. Baltimore: Lippincott Williams & Wilkins, 2010;148–170.

Miller CH, Palenik CJ. Instrument processing. In: Miller CH, Palenik DJ, eds. Infection Control and Management of Hazardous Materials for the Dental Team,4th ed. St. Louis: Mosby: 2010;135–167.

Miller CH, Tan CM, Beiswanger MA, Gaines DJ, Setcos JC, Palenik CJ. Cleaning dental instruments: measuring the effectiveness of an instrument washer/disinfector. Am J Dent 2000;13:39–43.

US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final ruleexternal icon. Federal Register 2001;66:5317–5325. Updated from and including 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991;56:64003–64182.

US Department of Labor, Occupational Safety and Health Administration. Enforcement procedures for the occupational exposure to bloodborne pathogensexternal icon. Washington, DC: US Department of Labor, Occupational Safety and Health Administration, 2001; Directive Number. CPL 02-02-069.