The sterilization process

Sterilization is a necessary operation to ensure the safety of patients treated in a practice. The  sterilization process consists of 10 steps:

1) COLLECTION: consists of a process of reducing the microbial load in order to avoid the risk of infection by operators. All instruments used must be transported, by operators wearing personal protective equipment, to the sterilization area.

2) DECONTAMINATION: this mandatory procedure involves the total immersion of the instruments in a disinfectant solution in order to remove pathogenic microorganisms present on the instrument.

3) WASHING OR THERMAL DISINFECTION?

3.A1) MANUAL OR ULTRASONIC WASHING: Manual washing consists of brushing the instruments with water and non-corrosive detergent in order to clean them. Mechanical washing involves the use of ultrasonic tanks that allow for the physical and chemical breakdown of bacterial contaminants. Mechanical washing is preferable to manual washing because it reduces the risk of accidents for operators. The ultrasonic treatment ensures more accurate cleaning of medical devices, especially those parts of the instruments that are difficult to clean with manual washing.

3.A2) RINSING: consists of washing the instruments with running water to remove any traces of detergent.

3.A3) DRYING: a procedure that can be performed with paper or cloth towels that do not release fibres. For some instruments, it is preferable to use an air pistol.

3.B) THERMAL DISINFECTION

The thermal disinfection allows pre-washing, washing, rinsing and drying to be carried out in a single cycle, removing the need for manual cleaning and guaranteeing fast, excellent results, and with fewer risks for operators. The thermal disinfection process takes place thanks to the combined action of detergents, temperature and time.

4) CONTROL AND MAINTENANCE: Medical devices must be checked to be sure of they are perfectly clean and undamaged. Instruments requiring maintenance should be lubricated with water-soluble products.

5) PACKAGING: after the check, the instruments are packaged. The packaging guarantees the sterility of the instrument until its next use.

6) STERILIZATION: the packaged instruments must be placed in an autoclave that will release steam up to a maximum temperature of 121° or 134°. This phase eliminates all living microbial forms, including spores and fungi.

7.A) TRACKABILITY: this process makes it possible to track the effectiveness of the machine and the results of the checks. It consists of clearly indicating the following information on the pouches: day of sterilization, autoclave used, type of cycle performed, progressive number, outcome, operators involved and expiry date established by the internal sterilization protocol.

7.B) TRACEABILITY: this phase is used to reconstruct the sterilization path carried out by the instrument. It consists of recording all the documents relating to the sterilization step in a dedicated register, so that it is always available to operators.

8) STORAGE: The purpose is to keep the sterilized instrument in optimal conditions for the time specified in the sterilization protocol.

9) PERIODIC CHECKS: this step regards some checks that should be carried out to ensure effective sterilization. The sterilization surface and the date on the sterilised packages must be checked daily. We recommend testing with the following frequency:

–  Every day: Vacuum Test

–  Every day: Steam penetration test for hollow (Helix Test) and/or porous load simulation test (Bowie & Dick Test)

–  At each cycle: Cycle parameter verification test

–  Every month: Sealing strip test (Euroseal Check Test)

10) EQUIPMENT MAINTENANCE: the equipment must be periodically serviced in accordance with the machinery book. Maintenance must be carried out by qualified personnel designated by the manufacturer.

Following the 10 steps for the correct sterilization process will guarantee the safety of staff and patients in the dental practice.