I work as a temporary dental hygienist in many dental offices. In one office, the dental assistants bag the dental instruments for sterilization but do not close them completely (leaving their adhesive stickers intact).They then put them in the statim and use the “unbagged” sterilization feature for faster sterilization. My question is, is this an effective way to sterilize the instruments? While it is true that the sterilization pouches are not closed, would the steam and sterilization time be enough under an unbagged feature to perform the necessary infection control?
Many dental hygienists find themselves in these situations. The answer to your question depends on several factors. If the assistants are running the unsealed pouches on the “unwrapped setting” and they are going to transport them and use them IMMEDIATELY, then yes, this is ok as long as they are including a chemical indicator inside the cassette of the statim to ensure sterile parameters are being met. Ideally the bag/pouch (a one-time use item!) has the indicator on it and changes color when the sterilization paramenters are met. If they are “reusing” the bags, then this defeats the purpose, because pouches/bags are one-time use items. The United States Centers for Disease Control Guidelines state on page 23 “Unwrapped sterilization, also called “flash sterilization” should be used only under certain conditions: 1) thorough cleaning and drying of instruments precedes the unwrapped sterilization cycle; 2) mechanical monitors are checked and chemical indicators used for each cycle; 3) care is taken to avoid thermal injury to dental health care personnel or patients; and 4) items are transported aseptically to the point of use to maintain sterility. 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 semi-critical instruments should not be stored unwrapped.” 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, surgical instruments, etc. Semicritical items (mouth mirrors, amalgam condersers, X-ray film holders, etc) touch mucous membranes or nonintact skin and have a lower risk of transmission. Because the majority of semicritical items in dentistry are heat-tolerant, they also should be sterilized by using heat.
There is really no point in using the bag (sealed or unsealed) if they are truly doing “flash sterilization.” I would just load them “unwrapped” into the statim with a chemical indicator and make sure they are transported aseptically to the point of use for IMMEDIATE use. If, however, they are doing it this way and then 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 it can be stored for future use. Critical and semi-critical items cannot be stored unwrapped. Good luck to you!