September is Dental Infection Control Awareness Month (DICAM), and the Association for Dental Safety (ADS) is highlighting essential topics to ensure every dental visit is a safe visit. For the third week, we turn our attention to a cornerstone of infection prevention: Instrument Reprocessing.

Why Instrument Reprocessing Matters

Instrument reprocessing is the multi-step procedure that ensures all reusable dental instruments are properly cleaned, disinfected, and sterilized before use on another patient. Effective reprocessing breaks the chain of infection, protects patients and staff, and is a critical component of regulatory compliance. Inadequate reprocessing can lead to disease transmission and outbreaks in dental settings. [1]

Instrument Reprocessing Key Steps

• Cleaning: Instruments must be thoroughly cleaned - either manually or using automated equipment such as ultrasonic cleaners or washers-disinfectors - to remove all visible debris and organic material before sterilization. Debris can shield microorganisms from the sterilization process and compromise patient safety. If cleaning is not performed immediately, instruments should be soaked in a rigid container with detergent or enzymatic cleaner to prevent drying of patient material.
• Inspection and Packaging: After cleaning, each instrument should be carefully inspected for cleanliness and proper function. Damaged or still-soiled instruments should be re-cleaned or removed from service. Once dry, instruments should be packaged in wraps, pouches, or container systems that are compatible with the sterilization method being used. Hinged instruments should be processed open and unlocked, and disassembled if required by the manufacturer.
• Labeling: Each package of instruments must be clearly labeled to facilitate tracking and recall if necessary. The label should include:
  • The sterilizer used
  • The cycle or load number
  • The date of sterilization
  • (If applicable) The expiration date
  This information helps in retrieving processed items in the event of an instrument processing or sterilization failure.

• Sterilization: Use an appropriate sterilization method (such as steam autoclave, dry heat, or unsaturated chemical vapor) and always follow the manufacturer’s validated Instructions for Use (IFUs) for cycle parameters (time, temperature, pressure). Load sterilizers according to manufacturer instructions to ensure that steam or chemical vapor can circulate freely around all packages. Allow packs to dry completely before handling to prevent contamination.
• Storage: Store sterilized instruments in a clean, dry, and covered or closed cabinet. Before use, inspect each package for integrity—ensure the packaging is not wet, torn, or punctured. If a package is compromised, the instruments must be reprocessed (cleaned, packaged, and sterilized again) before use.
• Monitoring: Regular monitoring is essential to verify sterilization effectiveness:
  • Biological indicators (spore tests): Use at least weekly to directly assess sterilization by killing highly resistant microorganisms.
  • Chemical indicators: Use inside every package and check after each cycle for the appropriate color change.
  • Mechanical indicators: Record cycle parameters (time, temperature, pressure) for each load by checking sterilizer gauges, displays, or printouts.
  Maintain accurate records of all sterilization cycles, monitoring results, and equipment maintenance. Documentation ensures accountability and supports prompt action if a sterilization failure occurs. [1]
  

Check out CDC's sterilization area workflow video to see these steps in action!

Common Instrument Reprocessing Questions

Q: How often should I perform biological monitoring (spore testing)?
A: Spore testing should be conducted at least weekly to ensure the sterilizer is functioning properly. If a test fails, the sterilizer should not be used until the cause is identified and resolved. [2]

Q: What do I do if a sterilization cycle fails?
A: If a cycle fails, do not use the instruments. Investigate the cause, repeat the test, and only return the sterilizer to service once it passes. All affected instruments should be reprocessed.

Q: Can I store sterilized instruments in open drawers?
A: No. Sterilized instruments should remain in their packaging until use to prevent contamination.

Q: Is any documentation required for instrument reprocessing?
A: Maintain records of sterilization cycles, biological monitoring results, and staff training as part of your infection control program.

Q: Can I reuse diamonds burs?
A: According to CDC, devices like burs, endodontic files, and broaches can be hard to clean due to the nature of their construction. If you use any of these devices and they don’t include reprocessing instructions, they should be considered single-use.

Recommended Instrument Reprocessing Resources:

• Ask ADS
• CDC – Best Practices for Single-Use (Disposable) Devices
• CDC – Best Practices for Sterilization in Dental Settings
• CDC – Best Practices for Sterilization Monitoring in Dental Settings
• CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care
• CE Center – Instrument Processing Courses
• CE Center – Sterilization and Disinfection Courses
• DICAM Infection Prevention and Safety Resource Toolkit
• Infection Control and Management of Hazardous Materials for the Dental Team, 7th Edition
• Infection Control in Practice (ICIP), Volume 21, Issue 5
• Infection Control in Practice (ICIP), Volume 22, Issue 5

Get Involved!

DICAM is the perfect time to review instrument reprocessing protocols, educate your team, and share your commitment to patient safety. For more information, resources, and ways to participate, click here.

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