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Recently, the Ontario provincial government implemented a new dental sterilization protocol that aims on increasing the overall health and safety of Canadian patients. This new protocol ensures that all Ontario dental offices are equipped with up-to-date sterilization equipment in addition to having well trained employees who can ensure the proper sterilization of all instruments.

The Importance of Sterilization

The Ontario Ministry of Health has put extra emphasis on the importance of sterilization due to recent accounts of misconduct. In June 2017, multiple Ontario families were told to get checked by their family doctors for Hepatis B, C and HIV due to sterilization concerns. You can read the whole story here. 

In an attempt to avoid future catastrophes, the government has stepped in to increase safety procedures through creating a more in-depth protocol. 

Step 1 – Transport Instruments to Steri-Center


Contaminated instruments and handpieces should be transported to the processing area in a way that minimizes the risk of exposure to staff, patients and the environment. Once the contaminated instruments are finished being used, they should be transported from the room in a closed, leak-proof container, and the staff who is transporting the instruments should be wearing appropriate personal protective equipment (Source: Midmark).


Step 2 – Sort Instruments and Handpieces - Dispose of Waste Properly


Separate the reusable instruments from the disposable instruments and remove the handpieces for sterilization.


NOTE: Disposable instruments should be properly disposed of and not sterilized for reuse.


Sort the reusable instruments based on the type of sterilization that is going to be required and the materials the instruments are constructed of. If instruments cannot be cleaned immediately, pre-soaking or maintaining them in a moist environment may improve the cleaning process. Handpieces have a separate cleaning procedure prior to sterilization. Dispose of any excess waste in a biohazard waste receptacle (Source: Midmark).


Step 3 – Instruments: Soak and Ultrasonically Clean Instruments


To minimize the risk of personnel injury, instruments should be cleaned with a hands-free mechanical process such as an ultrasonic cleaner or instrument washer prior to sterilization. Ultrasonic cleaning is the preferred process since it is safer and more effective than manual cleaning and more efficient in penetrating inaccessible areas such as crevices and joints.


Visually inspect the instruments for residual debris, and damage and reclean or replace any instruments as appropriate. Hand scrubbing of instruments is not recommended because of the risk of “sticks” from sharp instruments.


Instruments are placed in an ultrasonic cleaning basket or cassette rack that assures positioning of the instruments at the proper distance from the bottom of the tank while keeping them completely immersed in ultrasonic solution.


While some microorganisms may be destroyed in the ultrasonic cleaner, this process should not be considered an appropriate substitute for disinfection or sterilization. Additionally, only those chemicals that are specifically labeled as ultrasonic solutions should be used. Detergents, disinfectants and various liquids not chemically prepared for such use should not be substituted (Source: Midmark).



Step 4 – Instruments: Rinse with Clean Water and Dry Instruments


After being ultrasonically cleaned, the instruments should be rinsed in clean water, and in certain situations, in distilled water. Then, dry the instruments before packaging by either allowing them to air dry, by patting them down or through the use of an instrument dryer (Source: Midmark).


Step 5 – Pouch or Wrap Instruments


To prevent instrument recontamination, it is important to package items since placement of unwrapped sterilized instruments in a contaminated drawer, tray or other receptacle undermines the purpose of infection control. All instruments to be sterilized should be packaged in pouches or wraps unless they will be used immediately after sterilization. Packaging must be sealed to maintain sterility and compatible with the type of sterilization used (Source: Midmark).


Step 6 – Sterilize and Dry Instruments


There are a variety of different sterilization methods including steam sterilization, dry-heat sterilization and chemical vapor sterilization. Critical patient care instruments (instruments that have direct contact with the bloodstream or tissues under the skin) must be sterilized prior to reuse to avoid possible transmission of infections.


Steam sterilization is the most commonly used and recommended method of sterilization. To achieve optimal sterilization conditions inside the chamber of steam sterilizers, it is necessary to remove the air trapped inside the chamber once the sterilizer door is closed.


A normal sterilization cycle includes four phases: a heating phase; an exposure phase; a venting phase; and a drying phase. The instruments should not be removed from the sterilizer until the full operating cycle is complete and the instruments and/or packaging is dry to prevent compromising packaging and re-contaminating the instruments (Source: Midmark).


Step 7 – Store in a Dry, Protected Area


Sterilized instruments should be stored in a clean, dry and protected place that has minimal airflow. Instruments should not be stored unpackaged as this will cause them to become contaminated from hands and airborne microorganisms when doors or drawers are opened.


Packaging should be placed on clean shelves or in clean drawers and instrument packages should be rotated on a “first in, first out” basis. To minimize the possibility of contamination, instruments should remain packaged until they are required for a procedure and the packaging should be inspected prior to use of the instruments to assure the packaging is intact. If the sterile packaging has been punctured or gotten wet, the instruments should be re-sterilized before using them on a patient (Source: Midmark).


For more information check out the whole report here.


Major Take Aways

In today’s world, infection prevention is more important than ever. It is so important to be following the proper protocol to ensure that your patients are safe and remain in the best hands possible. Not to mention, the Ontario government is conducting more random clinic visits to inspect the quality of your sterilization stations. In addition to passing inspections, remember, proper instrument sterilization is the protection of the patient and the employees from different harmful infectious diseases; and that is the most important thing.


For more information read this report written by the Royal College of Dental Surgeons of Ontario.  

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