Ensure Successful Sterilization In Any Dental Office

QUESTION: I work as a temporary dental hygienist in many dental offices. In one practice, the dental assistants bag the dental instruments for sterilization but do not completely close the pouches (leaving their adhesive stickers intact). They then put the unsealed pouches in the autoclave and use the “unbagged” feature for faster sterilization. Is this an effective way to sterilize instruments? While the sterilization pouches are not closed, is the steam and sterilization time provided by
the unbagged cycle enough to achieve necessary infection control?

ANSWER: The answer to your question depends on several factors. If the  dental assistants are running the unsealed pouches on the unwrapped setting and then transporting them and using them immediately, this is acceptable as long as a chemical indicator is included inside the autoclave cassette to ensure sterile parameters are being met. Ideally, the bag/pouch has an indicator that changes color when the sterilization parameters are achieved. Pouches/bags are one-time use items, so if they are reusing the bags, they are not abiding by proper infection control protocol. The United States Centers for Disease Control and Prevention Guidelines state: “Unwrapped sterilization, also called ‘flash sterilization,’ should be used only under certain conditions:

• Thorough cleaning and drying of instruments precedes the unwrapped sterilization cycle
• Mechanical monitors are checked and chemical indicators usedfor each cycle
• Care is taken to avoid thermal injury to dental health carepersonnel or patients
• Items are transported aseptically to the point of use to maintainsterility

“Critical instruments that are sterilized unwrapped should be transferred immediately by using aseptic technique, from the sterilizer to the actual point of use. Critical and semicritical instruments should not be stored unwrapped.”¹

Critical items, which are used to penetrate soft tissue or bone, have the greatest risk of transmitting infection and should be sterilized by heat. These include dental instruments, curets and scalers, burs, and surgical instruments. Semicritical items, such as mouth mirrors, amalgam condensers, and X-ray film holders, touch mucous membranes or nonintact skin and pose a lower risk of transmission. Because the majority of semicritical items in dentistry are heat-tolerant, they also should be sterilized with heat.

There is no point in using the bag (sealed or unsealed) if flash sterilization is the goal. I would just load them unwrapped into the statim with a chemical indicator and make sure they are transported aseptically to the point of service for immediate use. If, however, the dental assistants are doing it this way and storing the pouches unsealed, then the contents are not sterile and they are not completing the process correctly. The pouch must be sealed, sterilized, checked that the indicator has turned color, and then stored for future use. Critical and semicritical items cannot be stored unwrapped.

References

1. Kohn WG, Harte JA, Malvitz DM, et al. Guidelines for infection control indental health care settings—2003. J Am Dent Assoc. 2004;135:33–47.

From Dimensions of Dental Hygiene. November 2015;13(11):74.