Using Instrument Washers
Keep patients safe with an improved sterilization process
Figure 1 | Dental instruments must be thoroughly cleaned before sterilization to ensure patient safety. Any debris or residue on instruments can prevent sterilization because the sterilizing agent must touch the surface of the instruments to achieve sterilization. Most dental offices use autoclaves for sterilization, which use steam as the sterilizing agent, but the steam cannot touch all surfaces if there is debris on the instruments.
In February of this year, the Centers for Disease Control and Prevention (CDC) investigated two patient deaths at the UCLA Medical Center and determined that the patients died of bacterial infections transmitted from improperly cleaned duodenoscopes. Though the duodenoscopes were sterilized, microbes in remaining debris transmitted infection to seven patients and two of them died.1
Traditionally, dental instruments are cleaned in an ultrasonic cleaning tank. When the ultrasonic cycle is complete, the assistant transfers the dripping instrument drain basket to the sink and rinses with running tap water. The dripping instruments are placed on a towel to air-dry prior to packaging in sterilization pouches or cassette wrap. There are a lot of variables with the ultrasonic system, including improper cleaning time for the size of the instrument load, improper mixing of cleaning solution, failure to test ultrasonic, and use of ineffective cleaning solution because the same solution was used all day. This process can now be replaced with efficient instrument washers.
Instrument washers automate instrument cleaning. At the end of the instrument washer cycle, which uses hot water, high water pressure, and fresh cleaning solution, instruments are thoroughly clean, dry, and ready to seal in sterile instrument pouches or wrapped cassettes.
I frequently observe dental teams placing wet instruments in pouches or wrapping wet cassettes, which compromises sterilization. The water drops can prevent steam from touching the instrument surface and the excess water in the sterilizer load contributes to wet instrument packages at the end of the sterilizer cycle. CDC Guidelines state that sterile instrument packages must remain in the sterilizer until dry.2 Wet packages can be contaminated if removed from the sterilizer prior to drying.
Instrument washers provide the most thorough cleaning method, prevent cleaning errors, and save valuable time.
- Instruments are dry at the end of automated washer cycle
- Eliminates the “shake and drip” ultrasonic cleaning process
- Washers utilize hot water, high water pressure, and cleaning solution to thoroughly clean instruments
About the author
Jackie Dorst, RDH, is a sterilization, infection prevention, and OSHA consultant for dental professionals. She is a member of the Organization for Safety, Asepsis and Prevention, the Association for Professionals in Infection Control and Epidemiology, and the National Speakers Association.
For more information, contact:
1. Guidelines for Infection Control in Dental Health-Care Settings, www.cdc.gov/oralhealth/infectioncontrol/guidelines. Updated December 19, 2003. Accessed August 24, 2015.
2. CDC Statement: Los Angeles County/UCLA investigation of CRE transmission and duodenoscopes. www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html. Updated February 20, 2015. Accessed August 24, 2015.