Easi-Sterilise
Standard Operating Procedures
Introduction
&
Section 1
Cleaning Procedures
Housekeeping
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Fire exits
Bathrooms
Mobile phones
Tea and coffee
Respect
Topic
Time
8.30
0945
0945-1100
11001215
12151245
1245
1415
Easi-Sterilise Standard Operating Procedure
Topic:
Sign in, Meet and Greet
Morning Tea
SOP 1
SOP 2
Lunch
SOP 3
SOP 4
1415 - 1430
Afternoon Tea
1430- 1600
SOP 5 & Questions and Answers
Finish
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
QH Commitment
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
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
SOPs & WSAs
 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
Section 1
Cleaning Procedures
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.
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
1.2 Soiled Pickup Collection
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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
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
Don’ts
 Place heavy instruments on light instruments
 Lift above shoulder height
 Containers should not exceed 10 kgs
Containers for Transport from Surgery
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with a lid
easily cleaned
puncture and leak proof
kept in a clean, dry condition
not overloaded
 carefully packed
 sharps recognised
 facing same direction
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
Cleaning
 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
Cleaning
 Steam will not penetrate contamination left
on instruments
 If the item is not clean it won’t be sterilised
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
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
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
1.4 Chemical & Detergent Mixtures
 Enzymatic Cleaners
 Includes enzyme pre cleaners and enzymatic
detergents
1.4 Chemical & Detergent Mixtures
Drying Agents/Rinse Aids – Washer disinfectors
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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
1.4 Chemical & Detergent Mixtures
Acid Base Agents
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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
1.4 Chemical & Detergent Mixtures
Lubricants
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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
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.
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
1.5 Pre Cleaning
Rinsing removes excess blood and debris
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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
1.6 Hand Cleaning For Immersible Items
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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
1.6 Hand Cleaning For Immersible Items
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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
Double Sink 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
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,
1.6 Hand Cleaning For Immersible Items
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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
1.6 Hand Cleaning For Immersible Items
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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
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.
1.6 Hand Cleaning For Immersible Items
Cleaning brushes
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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.
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
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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
1.6 Hand Cleaning For Immersible Items
Drying – As per manufacturer’s instructions
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Drying cabinet
Disposable low-lint cloth for hose, battery and external
parts
Air pressure gun (for removal of excess moisture)
Disposable syringe
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
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
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
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
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)
 handpieces
Handpieces
 outside surfaces cleaned using
detergent wipe,
 rinsed by wiping
 dried
 slow speed motors
 outside surfaces cleaned using
detergent wipe,
 rinsed by wiping,
 dried
 lubricated (manually or automatic)
may need special adaptors
 Dried, wrapped & processed in a
wrapped cycle
Special adaptors may be needed
Special adaptors may be needed
Ideally, handpieces and
slow speed motors are
cleaned and lubricated
using mechanised
cleaning equipment
Special adaptors may be needed
1.8 Ultrasonic Cleaner
Purpose
Ultrasonic cleaning is a form of mechanical cleaning
that uses high frequency ultrasonic waves (cavitation)
that dislodges fine particles from the surfaces of
instruments.
Ultrasonic cleaning is an effective cleaning method for
instruments prior to the reprocessing
1.8 Ultrasonic Cleaner
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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.
1.8 Ultrasonic Cleaner
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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
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
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
1.8 Ultrasonic Cleaner
EMPTYING AND CLEANING THE MACHINE
 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)
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
1.9 Washer Disinfector Machines
Loading
 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
1.9 Washer Disinfector Machines
Loading
 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
1.9 Washer Disinfector Machines
REPORT IMMEDIATELY:
 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
1.10 Washer Disinfector Machines
Releasing the load and unloading the washer disinfector
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Authorising release of the load occurs on completion of
washer disinfector cycle and prior to opening the door.
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Check cycle parameters have been met and print out/log (or
equivalent) is signed
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Care opening the doors due to heat and moisture
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Inspect load not become dislodged or displaced
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Avoid injury and damaging the equipment/instruments
Washer disinfector printout
1.9 Washer Disinfector Machines
UNLOADING continued
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Check for cleanliness
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If machine does not dry - place into drying cabinet
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Industrial dry and oil free compressed air used to
remove excess moisture from lumen instruments.
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Only when dry, place instruments onto designated
work benches to await packing/wrapping
1.10 De-staining
Stains = corrosion, pitting or other damage
Staining can occur
Chemical incompatibility
Water quality
Interaction of alloys in instruments
Investigate cause
1.10 De-staining
Occupational Health & Safety
 PPE
 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
1.10 De-staining
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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
1.10 De-staining
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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
1.11 Drying Cabinet
Purpose
To dry the cleaned item prior to wrapping and
packaging and prevent damage that occurs to the
item if it is left wet.
 Loading
 Unloading
 OH & S considerations