While disposable instruments should be disposed of according to standard precautions, reusable instruments must be carefully inspected, cleaned, and sterilized for reuse. The first step to clean the instruments is to put on protective gear such as a gown, gloves, and eyewear. The instruments are carefully examined for any damage and then sanitized using a brush and disinfectant soap to remove all debris. Instruments that are delicate and cannot be scrubbed can be cleaned with ultrasonic sanitization. Solution is placed in an ultrasonic cleaning unit and sound waves are used to clean the instruments. After the instruments are cleaned, they then can be wrapped and sterilized.
To autoclave instruments, they must be wrapped in autoclave paper or packaged in special peel packs. Heat sensitive indicators are included in the packs to ensure sterile conditions were met. Hinged instruments must be open to allow the steam to penetrate all areas of the instrument. Sharp edges should be wrapped to prevent penetration through the wrapping.
The most common method of sterilization used in the office setting is the autoclave. These units are small and compact and easily used in the outpatient setting. Once materials are wrapped or packaged, they are placed in the autoclave per manufacturer’s recommendations. (Standard processing time is 250 degrees at 15 pounds of pressure for 15 to 20 minutes.) Processing and care of the autoclave should be done according to manufacturer’s directions to ensure correct operation. Once autoclaved, the items are considered sterile for 28 days, so each item must have the date and time of sterilization clearly visible on the outside of the pack. Indicators placed in the packs and autoclave tape will confirm parameters for sterilization have been met. Other methods of sterilization such as cold sterilization with chemical solutions or gas sterilization are available, but do not have the advantage of the autoclave. Cold sterilization is difficult to confirm and time consuming. Gas sterilization usually is done in a large health care setting, not in the outpatient setting.