Medical and dental instrument processing is a critical aspect of employee and patient safety and requires a series of steps. There are four steps in instrument processing: cleaning, packaging, sterilization, and storage. This article will concentrate on cleaning and packaging. We will cover sterilization and storage next month.
Step 1: Cleaning Instruments
Before any instrument is disinfected or sterilized it is critical they are cleaned properly. This is the first step in instrument processing. Any contaminants that are present (dirt, blood, and other bodily fluids) must be removed prior to disinfection or sterilization. A contaminant being present acts as a barrier and prevents sterilization of the item. Contaminants should be removed as soon as possible to prevent drying of the material on the instruments.
There are two methods of cleaning instruments prior to disinfection/sterilization: manually and automated. Automated cleaning is the preferred method. Automated cleaning can be done either with an ultrasonic cleaner or washer-disinfectors. Household dishwashers are not recommended to be used. They can potentially harm the instruments and are not FDA approved to be used to clean instruments. Always follow manufacturers’ instructions for use on the equipment used for cleaning. Only utilize FDA approved devices.
Automated cleaning reduces the handling of sharp instruments and reduces employee exposure risk. Manual cleaning, or hand scrubbing, puts workers in close contact with contaminated sharps and contaminated splashes and spatter generated during the cleaning process. The instruments should be scrubbed by utilizing a long-handled brush. Be sure to utilize the appropriate personal protective equipment, such as eye protection, utility gloves, mask and gown. Once instruments are cleaned, they must be rinsed thoroughly and allowed to dry before packaging.
Step 2: Packaging Instruments
Once the instruments are cleaned, dried, and inspected to ensure all contaminants are removed, they will need to be packaged. Guidelines from Association of Medical Instrumentation (AAMI) and other organizations should be followed. These guidelines state that hinged instruments should be opened and items with removable parts are to be disassembled unless the device manufacturer suggests otherwise. Follow manufacturer’s instructions for preparing instruments such as concave surfaces placed downward and heavy items placed below light items to avoid damage. The wrapping must be done in a manner to prevent gaps and tenting.
There are different types of packaging material- plastic/peel pouches, paper bags, “blue” wraps for cassettes, and plastic tubing. Healthcare facilities can choose any of these options. When making a choice, the key is the packaging material must allow penetration of the sterilant, must be compatible with the type of sterilizer, and must be puncture resistant, durable, and have FDA clearance. The best practice is to always follow manufacturers’ instruction on any packaging material. Not following these is considered off-label use of the product and has a negative impact on the efficacy and safety of the product used during sterilization of instruments. Plastic/peel packaging and wrapping of cassettes are the most common packaging materials utilized.
Plastic/peel packs are easy to use, easy to open after sterilization, and are widely utilized. Appropriate pouch sizes should be available to prevent overloading the pouches and to allow the sterilant to penetrate them. These packs are for small light weight items. They should not be more than 75% full of instruments. When the pack is laid flat on the counter, the instruments will lay in a single layer inside the pack. The pack must be sealed correctly, on the perforation. There should be an inch of space (finger width) on each side of the pouch.
Blue wraps or paper wraps are commonly used to wrap medical/dental cassettes. Cassettes have many advantages, including:
Wrapping of the cassettes must be done in such a manner to avoid tenting and gapping. Double wrap is recommended, especially for surgical instruments. There is also a bonded double wrap available that can be used. There are two ways to wrap the cassette- gift style or envelope style. Either method is an acceptable way to wrap the cassette.
Healthcare facilities have many options available for cleaning and packaging instruments. You should choose the products that are suitable for your specific needs. There should be policies and procedures in place and checks and balances to ensure instruments are cleaned before packaging. Keep in mind, again, manufacturers’ instructions are to be followed along with guidelines from AAMI and Centers of Disease Control.
Total Medical Compliance
6124 Creft Circle
Indian Trail, NC 28079
Phone: (888) 862-6742
Fax: (866) 875-3809
©2023 Total Medical Compliance
Total Medical Compliance
6124 Creft Circle
Indian Trail, NC 28079
(888) 862-6742
Fax (866) 875-3809
©2022 Total Medical Compliance
