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Easi-Sterilise Standard Operating Procedures. Introduction & Section 1 Cleaning Procedures. Housekeeping. Fire exits Bathrooms Mobile phones Tea and coffee Respect. Why are we here?. Patient and staff safety

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Easi-Sterilise Standard Operating Procedures

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Easi sterilise standard operating procedures l.jpg

Easi-Sterilise Standard Operating Procedures



Section 1

Cleaning Procedures

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  • Fire exits

  • Bathrooms

  • Mobile phones

  • Tea and coffee

  • Respect

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Why are we here?

  • Patient and staff safety

  • Directives from QH EMT for rapid implementation of education and training following incidents

  • Implementing a continuous quality improvement program

  • Targeting training needs not targeting individuals

  • Acknowledge an absence in effective communication when changes are made

  • To build on current level of knowledge in light of ever changing technology, standards, guidelines, advisories and legislation

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Is to:

Appropriately train and skill staff

Provide information and resources so that step-by-step quality processes are consistently followed

Assist in identifying gaps in knowledge and provide opportunities for improvement

QH Commitment

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Aim of this workshop

Provide participants with strategies to implement the SOPs and WSAs locally by improving and standardising knowledge on:

  • Pre-cleaning

  • Cleaning

  • Drying instruments

  • Packaging

  • Sterilising

  • Storage

  • Annual performance qualification/validation of the sterilisation process

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  • To assist Oral Health facilities operationalise QH policy and guidelines

  • A resource for staff

  • Update and supersede the OH Critical Instrument Tracking (2003)

  • A framework to assist staff identify competence and areas where education and improvement may be needed

  • A resource to identify opportunities for improvement within the department that will require further education and training

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Section 1

Cleaning Procedures

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1.1 Standard Precautions

Standard precautions are applied as a first-line approach to infection control. These form the basis for your decision-making and practice. Standard precautions are a set of guidelines based on the assumption that all blood and body fluids are potentially infectious.

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1.1 Standard Precautions

In the context of sterilising practice and ALL the Standard Operating Procedures, standard precautions include:

  • Hand Hygiene

  • Hand cream – approved by infection control – not in packing area

  • Personal Protective Equipment

    • Gloves

    • Face shields, hair protection, safety glasses and masks

    • Fluid resistant gowns/aprons

  • OHS Requirements

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    1.2 Soiled Pickup Collection

    • Standard Precautions - PPE

    • Contaminated items - dedicated collection trolley/cart

    • Keep instrument sets together

    • Follow the designated route with trolley (OHS)

      Collection containers are:

    • puncture-resistant

    • leak-proof and made of either plastic or metal

    • with a lid or liner that can be closed

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    1.2 Soiled Pickup Collection

    Cleaned items must be dried prior to transport

    Reusable instruments cassettes and single items placed into designated transport containers

    Secure single loose items


    Place heavy instruments on light instruments

    Lift above shoulder height

    Containers should not exceed 10 kgs

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    Containers for Transport from Surgery

    • with a lid

    • easily cleaned

    • puncture and leak proof

    • kept in a clean, dry condition

    • not overloaded

    • carefully packed

      • sharps recognised

      • facing same direction

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    1.3 Sorting Prior To Cleaning

    Instruments and items sorted by;

    • Type

    • Method of cleaning e.g. Manual , ultrasonic,

      Instruments and items are checked for;

    • Completeness

    • Defects

    • Sharps or blades that have not been removed

    • Heavily soiled items

    • Single use only items are not to be returned for reprocessing

      Report concerns to supervisor

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    • Cleaning removes organic and inorganic soil, blood, fats etc which contain pathogenic micro-organisms

    • Cleaning minimises contamination levels of bioburden (number of micro-organisms) prior to sterilisation

    • For sterilisation to occur the aim is to have a low number of micro-organisms present on instruments

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    Steam will not penetrate contamination left on instruments

    If the item is not clean it won’t be sterilised

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    1.4 Chemical & Detergent Mixtures

    • Breaking down and removal of

      • Blood, proteins and debris (organic soils)

      • Medicaments and chemicals (inorganic soils)

      • Breaks water tension – surfactant

      • Keeps the soils suspended in the water

    • Must be an “instrument” detergent. DO NOT use household type

    • Compatible with instruments and equipment

    • Material Safety Data Sheets (MSDS) – ChemAlert

    • Appropriate storage requirements

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    1.4 Chemical & Detergent Mixtures

    Manual cleaning agents

    • Mild alkaline instrument detergent - optimal pH: 8.0 -10.8

    • Low foaming properties

    • Non-corrosive

    • Non-toxic

    • Non-abrasive

    • Free rinsing

    • Bio-degradable

    • Preferably liquid

    • Use and rate of concentration: as per manufactures instructions

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    1.4 Chemical & Detergent Mixtures

    Mechanical cleaning agents

    • Mechanical washer manufacturer’s requirements

      e.g ultrasonic or washer/disinfector

    • May be stronger alkaline pH range: 8.0-11.5

    • Biodegradable

    • Nonabrasive

    • Low foaming

    • Free rinsing

    • Preferably liquid

    • Use and rate of concentration: as per manufactures instructions

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    1.4 Chemical & Detergent Mixtures

    • Enzymatic Cleaners

    • Includes enzyme pre cleaners and enzymatic detergents

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    1.4 Chemical & Detergent Mixtures

    Drying Agents/Rinse Aids – Washer disinfectors

    • Surfactants that “wet” the final rinse water

    • Automatically dosed into the final rinse water

    • Spreads evenly over a surface instead of beading

    • Beaded water leaves mineral salts

    • Not as effective on plastics

    • Load instruments and metals on the top racks with plastics on the bottom

    • Plastics on edge to allow drainage

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    1.4 Chemical & Detergent Mixtures

    Acid Base Agents

    • Only on stainless steel surfaces

    • Only intermittently descaling or destaining

    • Dissimilar instruments should not processed at the same time

    • Mix the agent as per manufacturers instructions

    • Only mix when required and discard at end of the day

    • OHS -Chemical manufactures instructions , including safety precautions, dilution and instrument compatibility

    • OHS - Rubber or nitrile gloves

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    1.4 Chemical & Detergent Mixtures


    • Water miscible – able to mix with water

    • Compatible with the sterilizing agent

    • As per manufacturers instructions

    • Instrument stiffness needs to be investigated

    • Lubrication used intermittently

    • Routine use = heavy contamination

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    1.5 Pre Cleaning

    • Pre cleaning (initial cleaning) allows for the removal of visible blood, body fluids and debris from items prior to cleaning (definitive cleaning). Pre cleaning shall be undertaken as soon as possible (e.g. during and post procedure chairside).

    • If blood, proteins and other debris are allowed to dry or remain in crevices and joints, the instruments become very difficult to clean and are prone to stiffness and accelerated corrosion.

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    1.5 Pre Cleaning

    • Pre cleaning can be performed by methods such as dry wiping, damp wiping or use of a commercially available single use only instrument sponge

    • Place the dry wipe, damp wipe or sponge on the bracket table and carefully wipe the instrument across the material

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    1.5 Pre Cleaning

    Rinsing removes excess blood and debris

    • Prevents blood and debris drying on items

    • As soon as possible - post procedure

    • Reduces bioburden - micro-organisms will multiply rapidly

    • Use warm water

      • hot water coagulates protein

      • cold water - congeals fats

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    1.6 Hand Cleaning For Immersible Items

    • Automated cleaning of instruments is the preferred practice, but not always feasible

    • Identify instruments that cannot be immersed under water for manual cleaning

    • Two dedicated sinks large, deep enough for practical use

    • Separate hand washing facility

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    1.6 Hand Cleaning For Immersible Items

    • Warm water – potable (drinkable)

    • Instrument brushes various sizes

    • Disposable low - lint cloth

    • Suitable instrument detergent Ph: 8

    • Pressure equipment

      • High pressure water

      • Air pressure

      • Disposable Syringe

    • Non abrasive pad

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    DoubleSink Operation

    • The first sink is to be always used for the initial rinse of instruments only and does not need to be cleaned between use.

    • The second sink is to be used for the cleaning and the final rinse of instruments and only needs to be cleaned between these two activities if the instrument cleaning water is discoloured or cloudy.

    • NB all sinks must be cleaned at the end of the day

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    Single Sink Operation

    • The sink is to be cleaned with a detergent impregnated wipe between the first rinse of the instruments and the filling of the sink for cleaning the instruments.

    • Following cleaning of the instruments and before the final rinse the sink only needs to be cleaned with a detergent impregnated wipe if the cleaning water is discoloured or cloudy.

    • NB all sinks must be cleaned at the end of the day,

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    1.6 Hand Cleaning For Immersible Items

    Standard Precautions

    Heavy duty gloves & PPE

    Initial Rinse - rinse instruments under warm running water

    Fill sink correct ratio of warm water and suitable detergent

    Identify instruments that require manual cleaning

    Disassemble and open items

    Inspect for damage or parts missing

    Immediately notify the supervisor and contact user area

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    1.6 Hand Cleaning For Immersible Items

    Limit the generation of aerosols

    Holding item low in the sink under the water line

    Apply adequate friction

    Visualise item under the water line

    Prevent against sharps injury and damage to the instrument

    Final rinse – Rinse thoroughly under hot running water

    Check that the item is clean LOOK and CHECK

    Use a magnifying glass if necessary

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    1.6 Hand Cleaning - Final Rinsing

    Final rinsing facilitates the drying of item

    • Use warm water

    • Mechanical washer disinfectors use hot water

    • Removes chemical residues

      • Tissue irritation

      • Instrument damage

    • If a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water.

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    1.6 Hand Cleaning For Immersible Items

    Cleaning brushes

    Check no broken bristles or requires replacing

    Kept free of visible debris during, after use and before reuse

    Single or limited use cleaning materials

    Single use, non-abrasive cleaning brushes are disposed of at the end of the day.

    Reusable cleaning brushes are to be thermally disinfected at the end of the day and stored dry.

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    Unsuitable Cleaning Agents or Equipment

    • steel wool or other harsh abrasives

    • cleaning powders

    • excessive temperatures

    • dangerous chemicals

    • corrosive chemicals

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    1.6 Hand Cleaning For Immersible Items

    Flush, Brush and Flush all lumen items

    Flush lumen with water

    Wet bristles of correct size instrument brush

    Pass instrument brush through the lumen and rinse debris off brush tip in an appropriate cleaning solution

    Withdraw brush

    Flush through with running hot water 

    Repeat until clean

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    1.6 Hand Cleaning For Immersible Items

    Drying – As per manufacturer’s instructions

    Drying cabinet

    Disposable low-lint cloth for hose, battery and external parts

    Air pressure gun (for removal of excess moisture)

    Disposable syringe

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    1.6 Hand Cleaning For Immersible Items

    Problems associated with incorrect drying

    • Items should NOT be air dried/ dripped dry

      Good conditions micro-organisms multiply in 20-30 minutes

    • Wet packaging result in unsterile item

    • Can cause rusting, corrosion, pitting to the item

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    1.7 Hand Cleaning For Non-immersible Items

    For those items that are unable to be submerged under water

    • Some items e.g surgical handpieces and attachments, may need hoses or caps attached to prevent water entering delicate parts

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    1.7 Hand Cleaning For Non-immersible Items

    • Initial rinse - Some items may be gently rinsed with warm water to remove gross soil as per manufacturer’s instructions.

    • Initial rinse - Some items may be rinsed using a low lint cloth immersed in water if the item cannot be placed under gently running water

    • Fill sink correct ratio of warm water and suitable detergent

    • Items are wiped using a clean cloth immersed in the clean, warm water with detergent added

    • The cloth is squeezed (wrung out) to prevent water entering the instrument, it is damp only, and not dripping wet

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    1.7 Hand Cleaning For Non-immersible Items

    The impregnated damp cloth is rubbed over the item

    May need to be repeated depending extent of soiling

    Handpieces that cannot be immersed in water follow the manufacturer’s instructions

    Non-immersible cannulated items - the manufacturer’s instructions must be adhered to in relation to flushing and brushing

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    1.7 Hand Cleaning For Non-immersible Items

    Following washing the detergent must be removed

    FINAL RINSE - Using a damp clean low lint cloth (that has not been in contact with detergent), wipe over the item to remove the detergent. Note if a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water

    These steps may need to be repeated to remove all traces of detergent (Dry as per instructions in SOP 1.6 immersible item)

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    outside surfaces cleaned using detergent wipe,

    rinsed by wiping


    slow speed motors

    outside surfaces cleaned using detergent wipe,

    rinsed by wiping,


    lubricated (manually or automatic) may need special adaptors

    Dried, wrapped & processed in a wrapped cycle

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    Special adaptors may be needed

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    Special adaptors may be needed

    • Ideally, handpieces and slow speed motors are cleaned and lubricated using mechanised cleaning equipment

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    Special adaptors may be needed

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    1.8 Ultrasonic Cleaner


    Ultrasonic cleaning is a form of mechanical cleaning that uses high frequency ultrasonic waves (cavitation) that dislodges fine particles from the surfaces of instruments.

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    Ultrasonic cleaning is an effective cleaning method for instruments prior to the reprocessing

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    1.8 Ultrasonic Cleaner

    • Minimises manual cleaning

    • Does not disinfect instruments

    • Remove debris using cavitation (sound waves)

    • Detergent as per manufacturer’s instructions

    • Requires degassing before use

    • Rinsing after use (if no further washer/disinfector processing)

    • OHS – do not immerse hands when operating

    • OHS – aerosols – use lid when operating

    • OHS – noise – use lid & hearing protection

    • OHS – dry hands – when handling electrical leads and turning on or off at power point.

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    1.8 Ultrasonic Cleaner

    Follow manufacturer’s instructions

    Newer models may have different requirements

    Fill the tank with water

    (may be cold or warm follow manufacturer’s instructions)

    Then add the specified amount of detergent

    Degas the water – close the lid for recommended time

    Lumen instruments undergo manual cleaning first (FBF)

    Initial Rinse – Rinse all items with warm water to remove gross soil before placing into designated baskets

    Disassemble and open items

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    1.8 Ultrasonic Cleaner

    Place instruments in basket as per manufacturer’s instructions. Do not overload basket as ultrasonic waves will be unable to penetrate the soil on the instruments

    Never place items on the floor as transducers will be damaged.

    Place delicate or small pieces of items into lock down baskets

    Fully submerge the items below the waterline.

    Close lid and operate for recommended time

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    1.8 Ultrasonic Cleaner

    For bench top ultrasonic cleaning, use clean gloved hands

    Final Rinse - Thoroughly rinse instruments with warm running water

    Lumened items to have excessive moisture removed by air pressure gun or disposable syringe

    Dry using a drying cabinet or with a disposable low lint cloth

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    1.8 Ultrasonic Cleaner


    Daily and if solution becomes murky or discoloured as cleaning cannot occur in dirty solution.

    Routine cleaning of the ultrasonic machine is required see

    (SOP 5.9 Routine Cleaning Reprocessing Equipment)

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    1.9 Washer Disinfector Machines

    • Batch and continuous type washer disinfectors clean and remove bio burden/micro-organisms (blood and debris)

    • Thermal (high level) disinfection using time at temperature – final rinse

    • Means the cleaning process is verifiable

    • Lumened items still require Flush brush Flush

    • Unlock and open items

    • Use appropriate washer baskets/inserts

    • Keep sets together

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    1.9 Washer Disinfector Machines


    Lumen instruments have been flushed, brushed and flushed

    Use specific washer insert that is required e.g. dental handpieces

    Disassembled, unlocked, opened (e.g. forceps, needle holders, scissors)

    Ensure parts of disassembled instruments are together

    Use disk or tags to identify instrument trays when using multiple baskets

    Small/light items placed in lidded basket with hold down catch

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    1.9 Washer Disinfector Machines


    If using barcode baskets select correct basket

    Load the baskets/racks ensuring they are not overcrowded or over opened

    Use a hold down screen

    Hollowware is loaded in a draining position

    Minimise lifting of racks

    Make sure equipment stays in the parameter of the rack.

    Select the appropriate cycle for the load

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    1.9 Washer Disinfector Machines


    Cycle parameters not meeting set requirements or variations to cycle parameters – failed cycles

    Items that appear dirty or stained are returned to the cleaning area for recleaning/destaining

    Excess water – check the following: the machine temperature, amount of rinse aid going into the machine or the way in which the machine was loaded

    Damaged instruments

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    1.10 Washer Disinfector Machines

    Releasing the load and unloading the washer disinfector

    Authorising release of the load occurs on completion of washer disinfector cycle and prior to opening the door.

    Check cycle parameters have been met and print out/log (or equivalent) is signed

    Care opening the doors due to heat and moisture

    Inspect load not become dislodged or displaced

    Avoid injury and damaging the equipment/instruments

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    Washer disinfector printout

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    1.9 Washer Disinfector Machines

    UNLOADING continued

    Check for cleanliness

    If machine does not dry - place into drying cabinet

    Industrial dry and oil free compressed air used to remove excess moisture from lumen instruments.

    Only when dry, place instruments onto designated work benches to await packing/wrapping

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    1.10 De-staining

    Stains = corrosion, pitting or other damage

    Staining can occur

    • Chemical incompatibility

    • Water quality

    • Interaction of alloys in instruments

      Investigate cause

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    1.10 De-staining

    Occupational Health & Safety


    Acid based de-staining chemicals are a strong acid and can cause burns to hands, eyes etc.

    Read and follow the manufacturer’s instructions and precautions.

    Refer to MSDS for first aid instructions

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    1.10 De-staining

    Only use intermittently NOT ROUTINELY

    Check de-staining solution is compatible

    Usually only stainless steel instruments.

    Standard precautions

    Wear protective clothing + heavy duty gloves

    Use a container with a good fitting lid

    Strictly follow manufacturer’s instructions on water temperature, chemical ratio and exposure time

    Dissimilar instruments not processed at the same time

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    1.10 De-staining

    Remove item using gloved hands

    After exposure item re-washed to remove chemical residue

    Only mix de-staining solution when required

    Change chemical daily or more often if solution discoloured.

    Remove gloves and wash hands.

    Identify and report any patterns of staining

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    1.11 Drying Cabinet


    To dry the cleaned item prior to wrapping and packaging and prevent damage that occurs to the item if it is left wet.



    OH & S considerations

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