Your dental practice is a well-oiled machine with efficient processes that keep things running smoothly. When it comes to sterilizing your dental instruments, the process in place must also protect your patients and staff from hazards associated with dirty or bio-contaminated instruments. In fact, the set-up or design of your sterilization center can greatly affect both efficiency and safety. In this month’s Practice Tips, we share helpful hints on how to streamline your sterilization center. The basic design of the sterilization center should support a smooth flow of:
dirty → pre-cleaning → pre-sterilization staging → sterilizer → sterile storage/op staging
- DIRTY INSTRUMENT STORAGE/QUARANTINE: The first area should be for dirty instruments directly from your operatories and should be located close to the entrance to your sterilization area, so contaminated items do not need to be carried far into the sterilization area. It is important that you have a space where you can store or quarantine dirty instruments until you are ready to clean them. In a storage area or drawer below, make sure there is protective outerwear available (heavy duty utility gloves [not exam gloves], safety glasses etc.,) for the user. There should also be separate waste containers for sharps, bio-waste (red bags), and regular trash. To save space and keep waste out of the way, consider through-counter waste chutes. Storage space or drawers should be made available to store extra bio-hazard bags, sharps containers, and similar items.
INSTRUMENT CLEANING/ HANDPIECE MAINTENANCE: The next area in your sterilization center involves the cleaning of instruments and handpieces. This should be adjacent to the “dirty” section to facilitate flow of instruments through the sterilization process. Make sure to allow adequate space for the use of devices that aid you in completing this phase of the process.
- INSTRUMENT PRESOAKING: Presoaking your instruments loosens debris, especially if you wash them by hand. You can presoak in a table-top instrument bath or some cabinet manufacturers even offer “presoak drawers,” which help to eliminate spills and are space saving.
- ULTRASONIC CLEANERS: These cost effective, automated cleaners offer effective cleaning of most instruments and cause the least amount of damage. They also have a short cleaning time, usually between 10 and 15 minutes. CDC guidelines recommend using “mechanical means” to pre-clean instruments to reduce the risk of injury.
- HANDPIECE FLUSH/LUBRICATING SYSTEMS: There are several convenient, automated or manual handpiece flush/lubrication systems on the market to assist you with consistent handpiece maintenance prior to sterilization. Using these systems can help increase the life of your handpiece turbines.
- LARGE SINK WITH SPRAYER: This is an imperative component if you hand wash instruments. Make sure the sink is large enough to accommodate different sized items (such as large instrument cassettes). Install a hands-free foot controlled faucet kit to reduce contaminating the area around your sink while cleaning and rinsing instruments. It is a good idea to include towel and soap dispensers for staff. Wall-hung units are available to save counter space.
- STERILIZATION STAGING AREA: This area deals with the preparation and packaging of instruments prior to sterilization. A drying area can be in this section or at the end of the cleaning area to allow instruments to dry before placing in sterilization pouches. Consider table-top, wall-hung dispensers, or drawer organizers to manage materials, such as pouches, sterilization indicators, tape, and pouch material. An impulse sealer, combined with pouch material, can afford great savings over pre-made pouches. If utilizing cassettes, the staging area is where you would make certain to load cassettes with your established instrument set-ups.
- STERILIZATION: After the staging area will be the key component(s): the sterilizer (or sterilizers). In the dental office, a "table-top" sterilizer is an essential component. Even if you are a small practice, consider a second sterilizer as a “best practice.” Redundancy in this area will not only increase efficiency, but can ensure you still have sterile instruments available if a sterilizer goes down. Make sure the sterilizer is positioned at a user-friendly height for ease of loading and operation. You might consider a cart system or cabinet to allow better access for maintenance and repair. If it is set on a counter top, make sure the area around the sterilizer is free from clutter or debris – there should always be adequate airflow around the sterilizer (typically 3” around the back and sides – check your owner’s manual for the specific requirements of your sterilizer). Print off and hang our handy “Sterilizer To Do List” in your sterilization area to keep your sterilizer running well, as this will reduce downtime and overhead.
- OPERATORY STORAGE/STAGING AREA: Depending on your office set-up, storage of your sterile instruments can be centralized or within your operatories. A cabinet with a rack system can protect instruments from contamination and keep them dry to minimize corrosion. Some manufacturers include the installation of a quiet, high efficiency fan in their cabinetry to keep instruments dry.
Design your Sterilization Center with “flow” in mind to ensure efficient and safe processing of instruments. Be sure to have dedicated areas specific to each phase of the cleaning and sterilization process to assist flow and maintain the safety of staff as well as patients.