2.5 Principle IV: Make Instruments and Equipment Safe

Off-Site Sterilization

AutoclaveProper instrument transport is critical for off-site sterilization. OOH-funded school-based dental sealant programs should use securely fastened containers for transporting instruments so that instruments will not spill when jostled. Cleaning instruments before transport is not required, but it can reduce possible exposure risk during transport. Any state or local regulations pertaining to transport of biohazardous materials should be followed.

On-Site Sterilization

Adequate space for and design of the instrument-processing area is of primary importance for on-site sterilization. The sterilization area should have adequate ventilation and access to a sink and should be near the treatment area. It should have enough space to separate the dirty and clean zones and to allow for receiving, cleaning, packaging, sterilization/disinfection, and storing of processed instruments. Staff should avoid carrying or scrubbing contaminated instruments at times when the area is crowded with children.

All autoclave instruments must be heat sterilized in an autoclave. For those instruments that cannot withstand heat, a high-level disinfectant should be used according to the manufacturer’s directions. All disposable items should be put in the appropriate receptacle and not re-used.

Sterilization Monitoring

In Maryland, as per CDC recommendations, the autoclave should be monitored at least weekly by biologic testing (spore test) for proper functioning, and programs should document testing and keep a log with test results. Results should be verified by a spore-testing company. Testing should be done weekly, even if a program operates only 1 day per week.2 While programs may do biological spore testing themselves, very few in Maryland do so, electing instead to use independent sterilization-monitoring services.

If the autoclave has been idle for an extended period (e.g., during summer break), staff should perform a biologic spore test before program start-up to ascertain whether the autoclave is functioning correctly.

A sterilization log template is available for school-based sealant programs.