1. Hand instrument sterilization

2.  Effective and efficient infection control in the dental
office is essential for the safety of patients and to ensure
that productivity does not suffer. Infection control
programs all include the cleaning and sterilization of
reusable dental instruments and devices. Care must be
taken by the dental healthcare professional to ensure
that all instruments are cleaned prior to sterilization, and
that this is carried out in a safe manner to avoid injury

3. Instrument Processing : Step by step!
 1 - Clean the dental instruments manually or through mechanical
means like a thermal washer disinfector or an ultrasonic bath.
Infection Control Services says that dental instruments cannot be
sterilized properly unless they are thoroughly cleaned beforehand.
 Cleaning can be accomplished by two automated approved
methods:

4.  Instrument washers- (which resemble a dishwasher but
are made to clean instruments; regular dishwashers are
not appropriate nor are they recommended)

5.  Ultrasonic cleaners
Always use a recommended ultrasonic solution. Also, establish a
schedule for testing the effectiveness of the ultrasonic. To do this,
simply dip several inches of a sheet of aluminum foil in the
ultrasonic and turn on for 20 seconds. If the unit is functioning
properly, the foil will be full of indentations and holes. If not, a
repair is needed.

6.  They may also be cleaned manually, but this presents
more risk of an occupational exposure.
 If you must clean instruments manually,
wear all PPE, use a scrub brush with a long handle,
and scrub just a few at a time while holding
deep in a sink. Rinse and inspect each instrument
before packaging. They should not have any
debris remaining.

8.  2 - Afterward cleaning through either
manual or mechanical means, the
dental instruments should be dried
with a disposable cloth.

9.  3 - Package the dried items into medical grade sterilization
wraps or sterilization cassettes to prepare them for sterilization.
They must be properly packaged before they are loaded into
the heat sterilization unit.

11.  4 - Sterilize the instruments using a heat, steam, or chemical
process. Heat is the usual method used in a dental setting. Use
sterilization equipment that is approved by the
Food and Drug Administration for
dental sterilization work and operate it
according to the manufacturer's
specific instructions.

12.  5 - Storage the sterilized instruments in their intact packaging.
According to the Centers for Disease Control, the packaging
must remain sealed and undamaged in order to retain sterile
nature of the instrument. If the packaging gets wet, tears or is
damaged in some way, the instrument should be sterilized
again through the same process.

13. Hand piece asepsis.
 sterilization between patients with
acceptable methods that ensure
internal as well as external sterility is
recommended.
 For proper sterilization of hand
piece, the manufacturer’s instructions
must be followed.
First, the hand piece should be flushed with
water by running it for 20 to 30
seconds, discharging the water into a
container.

14. Hand piece asepsis.
 If recommended by the
manufacturer, use ultrasonic cleaner to
remove any adherent
material, otherwise, it should be scrubbed
thoroughly with a detergent and hot
water.
 Package for sterilization in steam or
unsaturated chemical vapour following
the manufacturer’s directions. If
disinfecting a hand piece that cannot be
heat sterilized, spray or saturate with
disinfectant recommended by the
manufacturer.

15. Method of sterilization
 Steam pressure sterilization (autoclave).
 Chemical vapor pressure sterilization (Chemiclave).
 Dry heat sterilization (Dryclave).

16. Steam pressure sterilization (autoclave)
 Time required 15 min time at 2500F (1210C) and 15 lbs of
pressure (light load of instruments) Wrapped instruments – 7
min, 2730F (1340C) at 30 pounds of pressure. Preformed in a
steam auto clave.

17. Steam pressure sterilization (autoclave)
 Advantages - Most rapid and effective method for sterilizing
cloth surgical packs and towel packs
 Disadvantages – Items sensitive to elevated temperature
cannot be autoclaved. - Tends to rust carbon steel
instruments and burs. - Burs can be protected by submerging
in anticorrosive agent- 2% sodium nitrite

18. Chemical vapor sterilization (chemiclave)
 Performed in a chemiclave - Operate at 2700F (1310C) at 20
lbs for half an hour.
 Advantages: - Carbon steel
and burs are said to be sterilized
without rust.

19. Chemical vapor sterilization (chemiclave)
 Disadvantages:
 Items sensitive toelevated temperature
will be damaged.
 Towels and heavy cloth wrapping
may not be penetrated to provide
adequate sterilization.
 Only dry instruments should be
loaded

20. Dry heat sterilization
( Conventional dry heat oven )
 Heated at 320oF (1600C) for 30 min. Instruments should be
packaged in foil wrap or nylon bags.
 Wrapped instruments : 3350- 3450 F for 60-90 mins.
 Short cycle high temperature dry heat
Oven :- Sterilization time reduced :
6 min for unwrapped.
12 min for wrapped.
 Temperature – 370 – 3750F