Five simple rules for cleaning surgical instruments

In the sterilisation process for dental tools, each stage is of crucial importance and necessary for the following stage. The proper end result cannot be achieved unless all the procedures provided for are carried out.

Sterilisation is a composite process, in which the initial cleansing and decontamination stages are essential. To clarify, there are three essential concepts:

• Cleaning: this is what we do to remove dirt, dust and organic material from surfaces and objects. This is done wet (with water), with or without a detergent. Washing does not necessarily in itself have a microbicidal action, but a good wash drastically reduces microbial contamination.
• Disinfection: the purpose of these actions is to eliminate bacteria and microorganisms from the surface of instruments and equipment. This stage reduces the number of almost all microorganisms present, but it does not achieve the parameters established by the regulations.
• Sterilisation: these are the procedures designed to eliminate all microorganisms and spores. Once the instruments are packed and sealed, they can be made sterile again by placing them in an autoclave.

All these steps are important, and it is important to remember that they must be carried out in the right order.

Disinfecting the instruments without cleaning them first would not only be useless and costly; it would also be dangerous, because dirt can “protect and spread the microorganisms” to be eliminated, thus limiting the disinfectant action.

Whether the washing process is manual or mechanical, this stage:

•  helps remove from the surface the infective microorganisms and the organic material that contains them
•  prepares and improves the contact between the disinfecting/sterilising agent and the infective microorganisms left on the surface
•  guarantees the functionality and duration of the instruments

While it is true that “clean” is not synonymous with “aseptic”, it’s equally true that an instrument cannot be sterile unless it has been cleaned!

So here are the five simple rules for cleaning our instruments effectively.

To clean instruments properly, timely pre-treatment is necessary, to prevent dirt from drying on the surface.

To do this, and for all the other operations, it is imperative to use PPE (Personal Protective Equipment) at all times.

After use, the instruments (disassembled and kept wet) must be sprayed with a enzymatic spray and covered with a foam, spray or gel specifically designed for this purpose.

Plunging the instruments into a 0.5% chlorine solution, or using any other kind of disinfectant before cleaning is not recommended, for the following reasons

•  It may damage/corrode the instruments.
•  The disinfectant may be inactivated by the blood or bodily fluids, thus becoming a source of microbial contamination and causing a biofilm to form.
•  Transporting contaminated objects in a disinfectant solution may pose a risk to professionals.
•  It may contribute to the development of antimicrobial resistance to the disinfectants.
•  Despite their capacity to kill off pathogenic microorganisms, disinfectants tend to fix the protein dirt on the surface of the instruments, complicating the cleaning operations.

At the washing stage, it is important to use demineralised water (i.e. water with no residue of minerals such as calcium, iron and magnesium, which make it hard), because:

•  this means a much smaller amount of detergent can be used.
•  hard water can interfere with enzyme (catalytic) activity.
•  high levels of calcium/magnesium ions can block the active site of the enzymes.

When loading the thermodisinfector, a few simple rules should be followed to ensure it functions correctly and completely:

•  Make sure you have the appropriate loading accessories (baskets able to contain the various materials tidily and suitably).
•  Do not overload the baskets, arranging the instruments efficiently.
•  Make sure all the surfaces are exposed to the jet of water.
•  Open all the zips.
•  Remove any residue of foam, gel and disinfectant from the load (if provided for with a pre-wash phase).

When setting the phases in the disinfection process, they should include:

•  At least one pre-wash phase with cold water, lasting at least one minute. This removes any organic dirt not sticking to the instruments, as well as chemical residue, and moistens resistant dirt.
•  A detergent wash lasting at least six minutes. This phase should be extended if so required by the amount of dirt.
•  At least one preliminary rinse.

To guarantee best results, proper functioning and duration of the equipment used, daily and periodic maintenance should be carried out, following the suggestions of the manufacturer. In any case, you should always:

•  keep internal surfaces clean and free from limescale
•  clean the filters, the bottom of the chamber and the loading accessories daily
•  check the rotation of the arms and make sure the nozzles are not blocked
•  clean the detergent level indicator
•  schedule technical maintenance every three months (or as indicated by the manufacturer)

Ultrasonic Tanks

Professional ultrasonic tanks are indispensable instruments to remove even the most stubborn residues from dental instruments.

The Eurosonic® Pro System ultrasonic tanks guarantee maximum efficiency and extremely handy operation during daily tasks, which are made even easier and more user-friendly thanks to upgraded management and control systems and the redesigned range, now more compact and ergonomic.

Thermodisinfectors

The thermodisinfector is very important machine in the sterilization process, especially during the cleaning step: in a single cycle it pre-washes, washes, thermally disinfects and dries all instruments, so there is no need to clean by hand. Eurosafe 60 prevents staff from being exposed to the risks of handling contaminated instruments and it is environmentally friendly, thanks to the automatic dispenser that can be used to adjust the amount of detergent (Eurobright 360 and Euroclean 120).