Dental Asia January/February 2024

CLINICAL FEATURE
after successful cleaning, disinfection, and
drying. A magnifying glass with light can be
used to facilitate the inspection process.
Damaged instruments or those with altered
surfaces should be identified and removed.
Some instruments require the use of specific
care products, and it is crucial to adhere
to the manufacturer’s recommendations.
For hinged instruments and other moving
parts, sterilisable and steam-permeable oil
should be applied in accordance with the
manufacturer’s specifications.
Step four: Packaging
Before sterilisation in an autoclave,
instruments must be appropriately wrapped.
This can be done by sealing them in
sterilisation pouches using a sealing device
or grouping them together in sterilisation
containers. This step should be performed
in a clean area of the decontamination room
using approved products. When wrapping
individual instruments in sterilising pouches,
the following points should be considered:
• Protective caps should be used on sharp
instruments to prevent damage to the
sterilisation packaging;
• Hinged instruments need to be slightly
opened to ensure proper sterilisation;
• Sterilisation pouches should not be filled
beyond 75% capacity and should not
exceed a maximum weight of 3kg per
package.
Step five: Steam sterilisation
The sterilisation process is systematically
carried out only after meticulous cleaning
and disinfection of instruments. Steam
sterilisation at 134°C is the preferred
standard procedure due to its low
dependence on influencing factors. It is
crucial to ensure that steam has access
to all the outer and inner surfaces of the
instruments. Instruments with complex
hollow bodies, such as dental handpieces,
should be sterilised in a class B autoclave.
Class B autoclaves enable the sterilisation of
both wrapped and unwrapped instruments,
no matter their type and complexity. The
fractionated vacuum reduces the air in the
sterilisation chamber through repeated
evacuation and steam injection. This process
permits the sterilisation not only of solid and
porous instruments, but also of complex
hollow body instruments with narrow lumen
such as surgical hand pieces.
During the sterilisation process, sealed
pouches should be placed on the tray with
the paper side facing downwards, multiple
pouches should not be stacked on top of
each other to ensure effective sterilisation
and a helix test body can be used for
controlling the sterilisation result of hollow
body instruments.
Step six: Documentation, approval, and
labelling
The instrument decontamination process is
completed by obtaining batch approval, which
must be performed and documented by
authorised personnel. This approval is based
on the process parameters determined during
decontamination, as well as the validation
and installation reports. The approval of the
steam steriliser involves documenting batchrelated
tests and checking the integrity and
dryness of the instruments and packaging.
To ensure legal certainty and reliable
traceability, it is essential to maintain a
complete documentation of instrument
decontamination logs and reports for a
minimum of five years. It is recommended
to store records for 30 years to mitigate
liability risks. Digital data carriers can be
utilised to facilitate long-term storage.
Additionally, the label or batch number
must be transferred to the patient record
after instrument use to ensure complete
traceability.
Step seven: Storage of instruments
Sterile instruments must be protected
from recontamination during transport
and storage. Therefore, the sterilised
instruments should be safely wrapped to
prevent recontamination. They should be
stored at room temperature in a clean and
dry location, shielded from dust. Careful
handling is necessary to avoid damage
and loss of sterility. It is recommended not
to store individually wrapped instruments
for more than six months. Seals around
instrument storage cupboards’ doors
offer additional protection against dust
and external influences, preserving the
sterilised instruments’ integrity.
CONCLUSION
Implementing a comprehensive hygiene
workflow for instrument reprocessing
is of utmost importance in maintaining
patient safety and preventing the spread
of infections in dental practices. Dr Teh’s
practice executes stringent procedures,
including: proper instrument preparation,
cleaning, disinfection, drying, inspection,
packaging, sterilisation, documentation,
and storage.
MELAG’s system solution, encompassing
autoclaves, washer-disinfectors, sealing
devices, and software solutions, supports
Dr Teh’s practice with a comprehensive
and coordinated approach to instrument
reprocessing. The advantages of a central
contact for instrument reprocessing
inquiries, cost optimisation through
synchronised device service, and a
process-optimised operating concept
underscore the effectiveness and value of
MELAG’s system solution. In employing
this solution, Dr Teh’s practice has
enhanced their instrument reprocessing
practices, ensuring better patient care,
optimal efficiency, and adherence to high
standards of hygiene and safety. DA
44 DENTAL ASIA JANUARY / FEBRUARY 2024