Reusable instruments, supplies and equipment should be received, sorted, cleaned and decontaminated in one section of the processing area. Cleaning should precede all disinfection and sterilization processes. Both organic and inorganic material should be thoroughly removed because they may interfere with disinfection and sterilization process. Removal of debris may be achieved by scrubbing using surfactant, detergent and water or with the use of automated devices (eg, ultrasonic cleaner or washer disinfector); thorough rinsing of instruments must be done to remove residue. Faucets that minimize splashes are recommended. Instruments are considered contaminated until final disinfection.

In selecting the cleaning method, the efficacy of the method, compatibility of the items to be cleaned, and occupational health risk must be considered. Ultrasonic cleaners do not require pre-soaking and are extremely efficient cleaning devices. They also allow less handling of instruments and thereby minimize chances for exposure.

Instruments that cannot be manually cleaned immediately should be placed in a puncture resistant container and soaked with a detergent or disinfectant to make cleaning easier later. Do not use high level disinfectant as a holding solution. DHCP should use a puncture-resistant glove for manually washing the instruments.

RECOMMENDATIONS:

1. Minimize handling of loose contaminated instruments during transport to the instrument processing area. Use work-practice controls (eg, carry instruments in a covered container) to minimize exposure potential. Clean all visible blood and other contamination from dental instruments and devices before sterilization or disinfection procedures.
2. Use automated cleaning equipment (eg, ultrasonic cleaner or washer-disinfector) to remove debris to improve cleaning effectiveness and decrease worker exposure to blood.
3. Use work-practice controls that minimize contact with sharp instruments if manual cleaning is necessary (eg, long-handled brush).
4. Wear puncture- and chemical-resistant/heavyduty utility gloves for instrument cleaning and decontamination procedures.
5. Wear appropriate PPE (eg, mask, protective eyewear and gown) when splashing or spraying is anticipated during cleaning.