Disinfection and Sterilization of
Dental Instruments
Learning Objective
• Classification Categories
• Disinfection
• Instrument Processing
• Decontamination
• Cleaning
• Packaging
• Sterilization
• Sterility Assurance
• Storing
Classification Categories
• Classification categories based on the risk of
transmitting infection (CDC):
Critical
instruments
Semi-critical
instruments
Non-critical
instruments
CDC: Centers for Disease Control
Critical instruments Semi-critical instruments Non-critical instruments
Penetrates soft tissues or Do not penetrate soft Do not penetrate soft
bone tissues or bone tissue or bone
Enter into or contact the Contact mucous Come into contact only
bloodstream or other membranes or non-intact with intact skin
normally sterile tissue skin
Should be sterilized after Should be sterilized after May be reprocessed
each use each use between patients
Sterilization is achieved by
steam under pressure High-level disinfection is Intermediate-level or low-
(autoclaving), dry heat, or appropriate level disinfection
heat/chemical vapor
Critical instruments Mirrors, reusable External components of x-
include forceps, scalpels, impression trays and ray heads, blood pressure
bone chisels, scalers and amalgam condensers cuffs and pulse oximeters
surgical burs
Levels of Chemical Disinfection
Level Level Definition and Description
Low Kills most vegetative bacteria except M.tuberculosis and some fungi,
and inactivates some viruses
Hospital disinfectant or sanitizers
Intermediate Kills vegetative microorganisms, including M.tuberculosis, all fungi,
and inactivates most viruses
Disinfectant of laboratory benches and as a part of detergent
germicide
High Kills vegetative microorganisms and inactivates viruses, but not
necessarily high numbers of bacterial spores
For medical devices (10-30 minutes), not on environmental surfaces
Can be use in “cold sterilization” (6-10 hours)
Organisms Resistance to
Germicidal Chemicals
Bacterial Spores
Mycobacteria
Nonlipid Virus
Fungi
Vegetative Bacteria
Lipid Virus
Activity Levels of
Selected Liquid Germicides
Procedure/ Product Aqueous Concentration Disinfection Activity Level
Glutaraldehyde Variable High to intermediate
Hydrogen peroxide 3-6% High to intermediate
Formaldehyde 1-8% High to low
Chlorine dioxide Variable High
Peracetic acid Variable High
Chlorine compound 1-10% household bleach Intermediate
Phenolic compounds 0.5-3% Intermediate to low
Alcohols 70% Intermediate
Instrument Processing
• All critical and semicritical dental instruments
that are heat stable should be sterilized after
each use by steam under pressure
(autoclaving), dry heat, or chemical vapor.
Decontamination Cleaning Inspection Packaging Sterilization Storing
Decontamination
Protect health care worker to perform following procedure
– Heavy-duty gloves should be worn
– Instruments should soak in disinfectant as soon as possible
after use to prevent drying of debris
Cleaning
Before sterilization or high-level disinfection, instruments should be
cleaned so that any debris is removed
– Use enzymatic and non-enzymatic solutions
– Heavy-duty gloves should be worn
– Instrument cassettes and mechanical cleaning (e.g.,
ultrasonic cleaners) may be used to reduce direct handling
of contaminated instruments
– Rinse with good quality water to avoid staining
More effective,
cleaner, safer
Inspection
• Each instrument should be inspected after
each cleaning for residual debris or damage
• Replace instrument as needed and never
sterilize dirty instruments
Packaging
Packaging rinsed and dried instruments before
sterilization protects them from contamination
after they are removed from the sterilizer and
during transport
For quality assurance, include a
chemical indicator inside and outside
to verify the sterilization parameters
were met
Packaging
Pouches Wrappers Perforated
• For small, • For dental Containers
lightweight trays • For dental
items surgery
intruments
Sterilization
Steam
Cycle : 121 C 30 minutes, 132 C 10
minutes, 135 C 4 minutes
Fast, inexpensive, efficient Allow packages
to dry in the
sterilizer before
Chemical Vapor
Cycle: 132 C, 20 minutes
they are
handled to
avoid
contamination
Dry Heat/ Rapid Heat
160 C for 1 to 2 hours
Sterility Assurance
Physical Indicators
Chemical Indicators
Biological Indicators
Physical Indicators
• Physical indicators:
– Time
– Temperature
– Pressure gauges
• Should be recorded every cycle
Chemical Indicators
• Should be on the outside and inside of all
packages to visibly show they have been
processed
Biological Indicators
• Highest level of sterility
assurance
• Contain bacterial spore Bacillus
stearothermophilusincubate
check
• Sterilizer should be spore tested
at least weekly, and every load
that contain an implant
Storing
• Sterile item should be
stored properly to
reduce contamination
• The self-life of sterile
packages is event
related and depends on
the quality of the
packaging material,
storage, and amount of
handling
