PRESTERILIZATION PROCESSING

You are still in the processing area of the CSR and have just finished cleaning your instruments using one of the three methods of cleaning discussed previously and letting them dry as shown in figure 10-5. Perform the following procedures in the sterilization process next.

Inspection and Sorting of Instruments

After drying, you must inspect items closely for wear, breakage, and cleanliness. Sort instruments according to sets or packs. This is the prestaging area where your instruments are sorted before wrapping and packaging.

Wrapping and Packaging

Wrapping and packaging is the last step just before the sterilization process. Many different types of sterilizers, packaging, and wrapping materials are used in the CSR.

Before terminal (final) sterilization, wrap or package all critical and semicritical items individually or in sets. Ensure you place consumable supplies (fig. 10-6) that are required by your command in each particular pack before wrapping such items as needles, cotton rolls and pellets, gauze, aluminum foil for dental light handles, internal indicators, and towels.

Dental instruments are usually placed in packs, on trays or cassettes, before placing them into the sterilizer. The most common wrapping materials and containers are paper, paper/plastic, nylon tubing, and cloth. Aluminum foil, closed metal trays, and perforated cassettes may also be used. The packaging or wrapping materials that you select depends on the compatibility of what type of sterilization method you are using. Table 10-1 shows various sterilization packaging materials and their suitability to withstand steam or dry heat sterilization. Always refer to the sterilizer manufacturer's instructions for suitability.

Paper materials are available in the form of bags or flat disposable wraps. Both types are sealed with adhesive indicator tape. The combination paper/ plastic peel packs (fig. 10-7) are available in varied sizes of preformed bags or rolls of varied widths that can be cut to the desired length. Either type can be sealed with the adhesive indicator tape or self-sealed.

Heat sealed plastic or nylon tubing should only be used as an overwrap after the pack has been sterilized. Heat sealed overwrapping will extend a 30 day shelf life to 180 days.

Figure 10-5.\Instruments drying in the processing area.

Figure 10-6.\Consumable supplies.

Table 10-1.\Sterilization Packaging Materials and Suitability for Steam or Dry Heat Sterilization

The practical use of some semicritical items may Wrapping loosely to allow steam to circulate preclude wrapping or packing. Basic guidance in freely throughout the pack. Arrange items so proper wrapping techniques includes the following:  Using trays or cassettes to reduce the possibility of puncturing the wrapping material and risk of injury during post-treatment handling.

^{that all surfaces receive direct exposure to the} sterilization agent.

Opening all hinged instruments during packaging to allow steam to penetrate these areas.

Figure 10-7.\Paper/plastic peel packs.

Using proper wrapping material for instrument sets. The use of muslin wraps are discouraged.

Cloth and nonwoven wraps are sealed with external indicator tape as illustrated in figure 10-8. The indicator tape will change color if exposed to the sterilization elements.

When wrapping instrument packs with indicator tape, always turn the tabs down on the tape. This provides a folded edge to aid in opening the package and removing the tape.

Launder muslin towels after each use and inspect for tears or pinholes.

Follow the manufacturer's time and temperature settings on sterilizers for the types of wrapping material used.

Using internal and external chemical indicators or multi-parameter integrators (measures temperature, steam and time).

Expiration Dates

After the packs, instruments, and ^{supplies are} wrapped or placed into containers and ^{sealed, they} must be labeled with the identification number of the sterilizer, the preparer's initials, and the dates of sterilization and expiration before they are placed in the sterilizer. To label, use an ink marker, preprinted indicator tape, or a marking device that won't run or fade when exposed to sterilization.

The shelf life or expiration date of sterilized items is the period during which an item is considered safe for use. Shelf life can be time-related or event-related. Your command ICO will determine what method your sterilization program will use.

TIME-RELATED.\Time-related shelf life is identified with an exact expiration date. After this date, the item is considered to be outdated and should not be used. Table 10-2 lists the different wrapping methods and their time-related shelf life in accordance with BUMEDINST 6600.10.

EVENT-RELATED SHELF LIFE.\The use of the event-related method presumes continued sterility until the package is damaged, wet, or torn. It is a well-recognized standard for items in good quality, self-sealed or hermetically (airtight) sealed, packaged in paper or plastic, or sequentially-wrapped and sealed

Table 10-2.\Time-Related Shelf Life of Sterilized Items

Figure 10-8.\Cloth and nonwoven wraps with external indicator tape.

in dust covers within a few hours after sterilization. If this method is used, the command policy must be clearly defined and consistently used throughout the DTF. When using the event-related method, all sterilizers must be biologically monitored at least weekly.