Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF

Patient-care items are
categorized as
critical,
semi critical,
noncritical,
depending on the
potential risk for
infection associated
with their intended
use.


Critical items used to
penetrate soft tissue or
bone have the greatest
risk of transmitting
infection and should
be sterilized by heat.
Surgical instruments,
periodontal scalers,
scalpel blades,
surgical dental burs



Dental Scalers
Surgical Forceps
Periosteal Elevator

Semicritical items
touch mucous
membranes or
nonintact skin and
have a lower risk of
transmission; because
the majority of
semicritical items in
dentistry are heattolerant, they also
should be sterilized by
using heat.


If a semicritical item is
heat-sensitive, it
should, at a minimum,
be processed with highlevel disinfection.
Dental mouth mirror,
amalgam condenser,
reusable dental
impression trays, dental
handpieces.

Although dental
handpieces are
considered a
semicritical item they
should always be heatsterilized between uses
and not high-level
disinfected.



Dental Mirror
Amalgam
Condenser
Reusable
Impression Trays


Noncritical items
contact intact skin and
can be disinfected.
Radiograph head/cone,
blood pressure cuff,
pulse oximeter



Radiograph Head
Blood Pressure Cuff
Pulse Oximeter


Handle carefully to
prevent exposure to
sharp instruments that
can cause a
percutaneous injury.
Place items in a
puncture proof
container, at the point
of use (operatory), and
transport to the
sterilization area.

Containers or dental
cassettes are ideal
ways to transport
contaminated items.

The central processing
area (or sterilization
area) should be divided
into sections.
1) receiving, cleaning,
and decontamination
2) preparation and
packaging
3) sterilization
4) storage

Contaminated items
should never be mixed
with sterilized items.


Contaminated items
should be received,
sorted, cleaned, and
decontaminated in one
section of the
processing area.
Cleaning should
precede all disinfection
and sterilization
processes manually or
mechanically.


To avoid injury from
sharp instruments,
wear punctureresistant, heavy-duty
utility gloves when
handling or manually
cleaning contaminated
instruments.
A mask, protective
eyewear and gown or
jacket should also be
worn.

Personal Protective
Equipment

Visible debris left on
instruments makes
sterilization and
disinfection ineffective.

Precleaned instruments

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.


Sterilizer indicators
should be used in every
package as well as an
external indicator with
each sterilization load.
(example indicator tape)
Types of indicators vary
with the type of
sterilizer.


Packaging materials
(example, wraps or
container systems)
allow penetration of
the sterilization agent
and maintain sterility
of the processed item
after sterilization.
Critical and semicritical
items that are stored
should be wrapped.



Self-sealing pouches
Sterilization wrap for
cassettes
Indicator tape

The sterilization
section of the
processing area should
include the sterilizers
and related supplies,
with adequate space for
loading, unloading, and
cool down without
cross contamination.

The sterilization times,
temperatures, loading
and other operating
parameters
recommended by the
manufacturer, as well
as instructions for
correct use of
containers, wraps, and
chemical or biological
indicators, should
always be followed.

When loading the
sterilizer, items to be
sterilized should be
arranged to permit free
circulation of the
sterilizing agent
(example: steam,
chemical vapor, or dry
heat). Manufacturer’s
instructions for loading
the sterilizer should
always be followed.

All pouched
instruments should
be placed in a rack
for proper
sterilization and
drying.


Clear side of one
pouch faces the
paper side of the
next pouch.
If rack not
available, place
pouches paper side
up to allow venting
of the water that
forms inside the
bag.

Do not pile pouches
on top of each
other or allow
packs or wrappings
to touch chamber
walls.

Packs require space
between them to
allow proper
sterilization.


Allow sterilized packs
and pouches to dry
inside the sterilizer.
Packs should not be
touched until they are
cool and dry because
hot packs act as wicks,
absorbing moisture,
and hence, bacteria
from hands.


Sterilizers should be
monitored by
mechanical, chemical,
or biological indicators
to ensure sterilization
is attained.
Consult with the
manufacturer’s
directions for proper
selection and use of
indicators.





Steam Sterilization
Dependable and
economical
Unsaturated ChemicalVapor Sterilization
Less corrosion than
steam sterilization
Hazardous waste
disposal requirements






Dry-Heat Sterilization
Prolonged process
High temperatures
required are not suitable
for certain patient-care
items and devices.
Sterilization of
Unwrapped Instruments
Sterilizing unwrapped
items for immediate use
“Flash sterilizing”



Other Sterilization
Methods
Heat-sensitive critical
and semicritical
instruments can be
sterilized by immersing
them in liquid chemical
germicides with certain
essential post
sterilization steps.
May require12 hours of
complete immersion.


The storage area should
contain enclosed
storage for sterile items
and disposable (singleuse) items.
If packaging is
compromised, the
instruments should be
recleaned, packaged in
new wrap, and sterilized
again.

Dental supplies and
instruments should not
be stored under sinks
or in other locations
where they might
become wet.

At the end of every
day, an inventory of
the supplies in the
dental operatory
should be done to
identify inventory
deficiencies and should
be replaced to be
prepared for the
following day.
Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF