| FAQ - Instrument Processing - 2015
I see that different manufacturers have different recommendations for how a sterilization pouch should be placed in an autoclave. Some recommend paper up (and plastic down) and others do the opposite. I was wondering if you could help with what is the CDC recommendation on this.
The 2003 CDC guidelines for infection control in dentistry states as follows:
Preparation and Packaging
In another section of the processing area, cleaned instruments and other dental supplies should be inspected, assembled into sets or trays, and wrapped, packaged, or placed into container systems for sterilization. Hinged instruments should be processed open and unlocked. An internal chemical indicator should be placed in every package. In addition, an external chemical indicator (e.g., chemical indicator tape) should be used when the internal indicator cannot be seen from outside the package. For unwrapped loads, at a minimum, an internal chemical indicator should be placed in the tray or cassette with items to be sterilized (254) (see Sterilization of Unwrapped Instruments). Dental practices should refer to the manufacturer’s instructions regarding use and correct placement of chemical indicators (see Sterilization Monitoring). Critical and semicritical instruments that will be stored should be wrapped or placed in containers (e.g., cassettes or organizing trays) designed to maintain sterility during storage (2,247,255–257).
Packaging materials (e.g., wraps or container systems) allow penetration of the sterilization agent and maintain sterility of the processed item after sterilization. Materials for maintaining sterility of instruments during transport and storage include wrapped perforated instrument cassettes, peel pouches of plastic or paper, and sterilization wraps (i.e., woven and nonwoven). Packaging materials should be designed for the type of sterilization process being used (256–259).
The sterilization section of the processing area should include the sterilizers and related supplies, with adequate space for loading, unloading, and cool down. The area can also include incubators for analyzing spore tests and enclosed storage for sterile items and disposable (single-use) items (260). Manufacturer and local building code specifications will determine placement and room ventilation requirements.
Sterilization Procedures. Heat-tolerant dental instruments usually are sterilized by 1) steam under pressure (autoclaving), 2) dry heat, or 3) unsaturated chemical vapor. All sterilization should be performed by using medical sterilization equipment cleared by FDA. The sterilization times, temperatures, and other operating parameters recommended by the manufacturer of the equipment used, as well as instructions for correct use of containers, wraps, and chemical or biological indicators, should always be followed (243,247).
Items to be sterilized should be arranged to permit free circulation of the sterilizing agent (e.g., steam, chemical vapor, or dry heat); manufacturer’s instructions for loading the sterilizer should be followed (248,260). Instrument packs should be allowed to dry inside the sterilizer chamber before removing and handling. Packs should not be touched until they are cool and dry because hot packs act as wicks, absorbing moisture, and hence, bacteria from hands (247). The ability of equipment to attain physical parameters required to achieve sterilization should be monitored by mechanical, chemical, and biological indicators. Sterilizers vary in their types of indicators and their ability to provide readings on the mechanical or physical parameters of the sterilization process (e.g., time, temperature, and pressure). Consult with the sterilizer manufacturer regarding selection and use of indicators. 1
Additionally, Practical Infection Control In Dentistry states as follows:
The manufacturer’s instructions for loading the sterilizer should be followed. Correct loading of the sterilizer chamber is essential. Items to be sterilized should be arranged to permit free circulation of the sterilizing agent (steam, chemical vapor, or dry heat). Overloading the sterilizer chamber can increase sterilizer warm-up times and may prevent thorough contact of the sterilizing agent with all items in the sterilizer. Accessories, such as racks or trays, are usually provided with the sterilizer, or can be purchased separately, to help users with proper loading procedures. Underloading the chamber may cause damage to the instruments from overheating. Generally, packages should be placed in the chamber on their edges so that the sterilizing agent can contact every surface of every of every article to be sterilized (Fig. 16-7). Instrument packs should be allowed to dry inside the sterilizer chamber before they are removed and handled. Packs should not be touched until they are cool and dry, because hot packs act as wicks, absorbing moisture and hence bacteria from hands and the environment. Also, wet packs can tear easily. 2
And, Infection Control and Management of Hazardous Materials for the Dental Team states as follows:
Do not stack packages, pouches, or cassettes flat in layers as shown in Figure 12-10; stacking impedes steam circulation and air removal in the chamber. One should load the sterilizer as instructed by the manufacturer and keep packs, pouches, or cassettes separated from each other so that steam has access to all package surfaces. Place items as shown on their edges as shown in Figure 12-11. Some sterilizers come with racks for packages that keep them separated and on their edge. 3
In summary, it is recommended that you follow the manufacturer’s instructions for use (IFU) for both the specific type of sterilization pouch and autoclave. Further questions should be directed to the manufacturer of the specific product.
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on September 21, 2015.
2) Molinari JA and Harte JA. Practical Infection Control In Dentistry – Third Edition. Wolters Kluwer / Lippincott / Williams & Wilkins. Page 228.
3) Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Pages 132-133.