Instrument reprocessing is a vital activity in any dental practice and ensuring that every instrument which comes into contact with the patient in a clinical setting is both clean and decontaminated or sterilized (depending on how and where it’s being used) is of utmost importance and a key ingredient in your duty of care to each and every patient.
There are various methods of reprocessing dental instruments and the type of method used will depend on the type of instrument, its use and construction.
In this blog post, we will explore some of the most common methods of reprocessing dental instruments, so that you can choose the best option for your practice.
First, let’s start with a look at the instrument reprocessing cycle
Figure 1: A typical instrument reprocessing cycle in a dental surgery
The dental instrument reprocessing cycle includes the vital steps of cleaning and disinfection, inspection, packaging, sterilization, documentation and the approval of instruments before they are reused on the next patient. This should be a standardised process only carried out by trained staff every step of the way.
What are cleaning and sterilisation?
They’re pretty much the same thing, aren’t they?
Well, no. In fact, absolutely not.
Cleaning is the removal of dirt and debris, usually in the presence of a detergent. In a dental environment this could well include bodily fluids released as the result of dental treatments, like blood, tissue, tooth and bone fragments or pus.
Sterilization is a process, physical or chemical, which completely destroys micro-organisms – including even the most resistant bacteria and spores.
But sterilisation can only occur on a clean surface, so it is vital that the cleaning step takes place prior to sterilization (although, there are, of course, combination products available, which combine both steps).
So now we have that cleared up, let’s concentrate on how to make sure your instrument processing set up is both efficient and effective.
Where should Instrument Processing take place?
Effective infection control can only be achieved if there is clear, physical separation of dirty and clean areas for instrument reprocessing.
The room should be clearly demarcated with dirty and clean zones and have a simple flow of instruments from the time they are received back from a patient procedure, through the reprocessing area and equipment, to the time they are ready to be released as clean and ready for their next patient.
The ‘Dirty’ or ‘Red’ zone includes a delivery area, any precleaning equipment and the washer disinfector.
Instruments should then follow the pathway illustrated in Figure 1 above through inspection and packaging to the ‘Clean’ or ‘Green’ area post sterilization.
The unclean and clean areas in the reprocessing room can be visually represented very well using a coloured red & green signage on the wall or cabinetry.
The right equipment in the right place in any reprocessing room helps to optimize processes and increase the safety of patients and the practice team.
In addition, with equipment from just one manufacturer, the entire workflow can be made more efficient, saving a lot of time and money, as the equipment is all ideally matched to each other.
At Blueprint Dental we are proud to be the longest serving UK MELAG distributor and can offer safe and reliable instrument reprocessing solutions for dental surgeries. With a wide range innovative quality products, together with our excellent after sales service expertise and reputation, you’ll benefit from an ideally coordinated reprocessing workflow and a safe hygiene cycle in your practice.
So far we’ve concentrated on the instrument reprocessing cycle as a whole. Now let’s take a look at the individual steps in brief and some handy tips to getting the best out of your practice’s set up…
- Make sure dirty instruments are properly prepared for reprocessing
It might sound a bit daft, but getting the best cleaning results on your instruments starts as soon as they have been used. Blood and debris quickly begins to dry out on instruments’ surfaces and in lumens, so the quicker you can get them collected and delivered to the washer disinfector or a precleaning station the better. Precleaning may just involve immersion in a pre-cleaning solution or a short cycle in an ultrasonic cleaning bath and will serve to remove any gross debris prior to placement in the washer disinfector.
- Use a Washer Disinfector to ensure they are clean and have been thermally disinfected
Instruments should be processed in a washer disinfector as mechanical cleaning is particularly safe, time- and cost-efficient. A suitable cycle should be selected according to the type of instrument being reprocessed, but it is likely that the cycle will include exposing the instruments to a detergent, rinsing, thermal disinfection and quite possibly a drying phase to the cycle to conclude.
- It’s crucial to take a peek before packaging
After cleaning, disinfection and drying, a visual and functional inspection of the instruments must be carried out by competent personnel. Some instruments require the additional use of care products, primarily for lubrication, which should be done in line with the manufacturer’s instructions.
Any instruments which are not visually clean at this point in the process should be rejected and returned to the dirty zone to start the reprocessing cycle afresh.
- It’s a wrap
Before instruments are sterilized in a steam sterilizer, they must be suitably packaged – either as a set in a sterilization container or using sealing devices, individually wrapped in sterilization packaging.
These specialist containers or sealed packages will still enable steam at the correct temperature (eg 134oC) to come into direct contact with the internal and external surfaces of the instruments for the required amount of time for sterilization to occur, but will keep them sterile after the cycle and hence safe for use on the next patient.
5 The all-important Sterilization phase
Steam sterilizers are commonly used for this purpose in dental practices and are classified into classes B, S and N. Class B sterilizers are often referred to as vacuum or pre-vacuum units and offer the advantage of being able to sterilize instruments regardless of the type of packaging and complexity of the hollow body. S & N class units are more widely used for solid and less complex instruments.
6 Make sure you’re keeping your house in order
The active part of the instrument reprocessing cycle ends with approval which must be documented before the instruments can be put into storage or released for use on the next patient. A traceable and properly recorded document trail of the entire reprocessing workflow ensures legal security and safe traceability of the instruments back to the patient.
- Safe & Sterile storage ready for the next procedure
To prevent re-contamination prior to reuse, all packaged sterile instruments must be stored dust-protected, clean and dry at room temperature.
All instruments stored in this area should be clearly labelled to understand when they were reprocessed and the cycle repeated if the expiry date has been exceeded. This is especially true for kits used in specialist procedures or treatments performed infrequently, as using instruments which have been stored too long could compromise patients safety and elevate the risk of infection.